Article about Risks of Home Births in the US

[Creative]

Not a dangerous one, but I was a nurse. I have seen so many women giving birth lying on their backs, strapped to machines etc. I had two hospital births and then finally a home birth (and this one will also be a homebirth)
FOR ME I lost all power and choice in both hospital births.
I hate to be told to do this and do that
lets moniter you
lets time you
Boss, boss, boss
I want to listen to my body, do what my body tells me and have the power to make decisions. My homebirth was the most amazing and empowering situation. I could have my children there and call all the shots. My midwives were totally supportive and not once did they "instruct me".

 

[txbiscuit]

Homebirth is illegal in some states????

Home births attended by CNMs and doctors are legal in all 50 states, but (from what I understand) not all those states have CNMs or doctors willing to attend home births, so some women "illegally" give birth at home attended by non-CNM midwives. (I've seen this cited as a reason that unassisted/unplanned home births may be over reported.)

wow how scarey for the women , i wonder why why they are not willing ?? do you think its due to liability ? xx

I think so. I don't think most liability insurance allows them to attend home births.

 

[Foxy37]

Not a dangerous one, but I was a nurse. I have seen so many women giving birth lying on their backs, strapped to machines etc. I had two hospital births and then finally a home birth (and this one will also be a homebirth)
FOR ME I lost all power and choice in both hospital births.
I hate to be told to do this and do that
lets moniter you
lets time you
Boss, boss, boss
I want to listen to my body, do what my body tells me and have the power to make decisions. My homebirth was the most amazing and empowering situation. I could have my children there and call all the shots. My midwives were totally supportive and not once did they "instruct me".

I presume your hospital doesnt have a birthing unit ?
I have decided not to go for this also lol (im a worrier and would rather be on a bed on monitors etc lol)
I can understand your choice XX.

 

[PreggyEggy]

Not a dangerous one, but I was a nurse. I have seen so many women giving birth lying on their backs, strapped to machines etc. I had two hospital births and then finally a home birth (and this one will also be a homebirth)
FOR ME I lost all power and choice in both hospital births.
I hate to be told to do this and do that
lets moniter you
lets time you
Boss, boss, boss
I want to listen to my body, do what my body tells me and have the power to make decisions. My homebirth was the most amazing and empowering situation. I could have my children there and call all the shots. My midwives were totally supportive and not once did they "instruct me".

I presume your hospital doesnt have a birthing unit ?
I have decided not to go for this also lol (im a worrier and would rather be on a bed on monitors etc lol)
I can understand your choice XX.

The problem with birth centres (or midwife led units here in the UK) for me at least is that you're just steps away from the consultant led unit. If you deviate from the norm for whatever reason (sometimes really small reasons), you'll be sent to deliver with the doctors instead. It's much harder to argue because it's policy, and they are entitled to stick to that policy.

For example, my first labour stalled at 5cm. It was most likely caused by fear and stress, or perhaps the baby wasn't quite in the right position. In a midwife led unit, you'd be sent to consultant led for your labour to be sped up. At home, you can relax, calm down (though you've be far more likely to be calm in the first place), try and reposition baby. You've still got the option of transferring if you still don't move on from that place, but you're a lot less likely to hear "well, you've failed to progress, let's get you on a drip!"

 

[Buttercup2]

It's an interesting paper, but I don't (personally, based on my limited understanding of this type of study) think it's conclusive. There were significantly fewer mothers in the home birthing and birth center groups. They were also quite a bit older and more likely to be 1-2 weeks past their due date, which could correlate with more negative outcomes. The authors seemed to draw conclusions about CNM and physician-attended home births, but I did not see the data for those births separated out (although I may have missed it). Several of the authors work at teaching hospitals with high-risk populations and equally high (35-38%) c-section rates, which may have colored their views on the safety/naturalness of birth in general. Also, according to ACOG, up to 25% of U.S. home births are unplanned. The authors said they attempted to exclude unplanned home births, but that leaves room for subconscious or conscious bias to affect the data. I'd like to know whether they compared data from states where home birth is illegal with states where it is legal, and if so, if there were differences in birth outcomes. I did find it interesting that hospital births attended by midwives had the best outcomes. (I wonder how births attended by both midwives and doctors are recorded on birth certificates?)

It's worth noting that there are other possible negative birth outcomes beyond the (very serious) ones studied here...

I don't think I'm ready (or ever would be ready) to say one type of birth is always better than another for all women. I'm glad research is being done with the goal of improving birth outcomes for women, but I don't think the "either you care about your baby or your own 'experience'" tenor of some studies does much to improve the level of discourse.

Thank you so much for this thoughtful reply!

I think there weren't any physician-attended homebirths in this study, but I'll double check. One thing I didn't like about the study, though, is that it didn't/couldn't separate "lay midwives" (with no training) from "midwives with actual degrees" (CNMs). But it did note that CNMs in hospitals did just as well as physicians, as you said, suggesting it's the being-at-home part that causes the difference.

I absolutely agree that there are limits to this study--9/10 women in their study chose hospital birth, which is probably unavoidable since that's most likely a representation of the population in the US. Also, any homebirths that were referred to the hospital (the paper said 45% of the homebirths were referred to the hospital!) ended up counting as hospital births. Both of those things could skew the data, although they skew it in different directions.

I think the age difference between the two groups is also unavoidable, because an 18 year old mother is less likely to feel free to choose whatever birth she wants. Older mothers are just more likely to choose a home birth. You're right that it could be part of the issue. But does that then suggest that older mothers should be especially cautious about homebirth?

I completely agree that choosing an APGAR score of 0 (which means no signs of life in the baby) does make the data more dramatic. I don't think this is a limitation of the study, though, because when you are studying 13 million data points (as they were) you have to put some limits on it or you'll be drowned in information. I think the authors are trying to avoid shades of gray, so by choosing the absolute worst outcome, they're more likely to actually see data that is statistically significant.

I'm not sure I agree about possible bias. I think the 13 million data points helps erase any bias that the authors may have had. Plus, I think only 3 of the authors were actually MDs, the rest were PhDs and so would not have any interaction with actual patients regularly. But I'll have to think about that more.

One other thing to note, there is a 10x greater risk of APGAR score of 0, but i think the risk went from something like .001% (so 1 in 100,000) in a hospital to .01% (so 1 in 10,000) at home. Which is really tiny risk, but still a 10x increase.

 

[MandaAnda]

If you'd like a counter article... This is from the BMJ (British Medical Journal) and based on a two year study in The Netherlands, I believe including all birthing women in those two years there, where (home) birth is normal.
https://www.bmj.com/highwire/filestream/649778/field_highwire_article_pdf/0/bmj.f3263

 

[TMonster]

I think there are many clear cut high risk situations. I am extremely high risk and it isnt due to GD, weight, age, baby position or anything else but my lo has a severe congenital heart defect which goes undiagnosed in 80% of cases. The particular variant she has would mean that if she isn't given a particular drug very shortly after birth she would die. The rate of this condition is higher in the UK than the US. I know 2 women from this forum who had babies born with this condition. Neither of them were diagnosed in utero. The first, who had the same variant as my Zoe had a hospital birth, her son went blue within minutes and couldn't breathe and if he wasn't in a hospital he would have died. The second had a home birth and fortunately did not have the same variant but a much milder version. It wasn't diagnosed until her daughter was 5 months old and she was suffering with complications as well as tet spells which prevented oxygen from reaching her brain without the mother knowing. When she went to the doctors office at 5 months they told her that her daughter needed emergency surgery or she could die. IF her daughter would have had the variant that Zoe has, she would have almost certainly died. In many cases, even with Zoe's variant the baby can come out and look totally normal and be fine without noticing any breathing issues or problems because the ductus is open but once it closes the baby can't breathe at all and nothing you can do will help it because the pulmonary valve is defective.

Obviously this is a rare situation but the fact that it is undiagnosed in 80% of cases and even during my 31 week scan where the tech knew the condition was there and couldn't see it was pretty darn scary since it was a total fluke and the fact that I just had an extra anatomy scan that was considered unnecessary detect it.

Yes, its rare and unlikely but from my perspective I would rather be safe than sorry and while it may not be as empowering and I don't get to call all the shots at the hospital, the fact that if something did go horribly wrong, my lo could have access to anything they might need as would I, makes me feel much better.

Even if I had nothing wrong with my pregnancy I would still choose a hospital birth because I feel that is the right decision for someone like me but I respect everyones right/ability to do their own research and pick what is best for them.

The UK also has far more midwives and their midwives deal with far more pregnancies and home births than the ones here will ever see regardless of being a CNM or not unless they work in a hospital setting as well. We have areas in the US that are an hour or more to the nearest hospital and sometimes 4+ hours to a hospital with a decent NICU should one be needed. It isn't always a clear cut decision what someone should do.

I know another tet mom in the US who wasn't diagnosed in utero and chose to deliver in a small hospital. Her son had the same variant but was born blue and since it was a small hospital they didn't know what was going on but giving him oxygen wasn't working so they had to transfer him to a larger hospital over 2 hours away while the mother was still recovering and at that point once they realized what was going on told her that her son only had a 50% chance of survival and she couldn't see him or be with him.

There are plenty of real situations that do require hospital births and while I agree the majority wont, from my perspective I would rather not take that chance. Having an empowering birth experience is less important to me than the health and safety of my child and yes, there are all sorts of risks of contracting infections and dealing with unwanted/unnecessary medical interventions that are invasive in a hospital setting its the only way someone like me would feel safe. Perhaps that is because my pregnancy has been filled with complications or because I am in the US but that is just where I am coming from.

I support everyone's right to choose the best option for their birth/family.

 

[_jellybean_]

Interesting study. I wouldn't have thought that people would be upset that you posted this. I find it very informative. Thanks for posting.

 

[Foxy37]

I think its a great post and good to see every ones views xx

 

[MikaylasMummy]

Hi ladies , i love a good debate and as we are all hormonal im sure here is the best place for us to all speak out complete opinion .
I am not against home births as i think every one should have the choice however , My first born i hemorrhaged very bad and had i been home i would have died and that is the bottom line , for first born i think it can be risky as we never know how its going to go as there's nothing to compare it by, also we don't know how we will feel as we have never been through labour before .
Also i can never understand why when a women has been told there high risk and a home birth is not recommended why they would fight it and put them and baby at risk .
If for that split second something goes wrong on delivery or during then its going to take longer to deal with and possibly could be life or death .
I do believe that women who have had a successful birth previous then home birth i can understand xx

This is exactly my position on home births.i hamerraged with my first (lost 2 litres) before a WHOLE TEAM of not one,but THREE midwives,THREE doctors and an anesthetist managed to stop the bleeding.by the time an ambulance arrived and took me to hospital I'd be a goner,or at least extremely ill.i had no idea what was in store for me so how do home birthing ladies know??i have met lots of women who have hamerraged so I'm sure it's not rare

 

[PreggyEggy]

I think the difference here is that for me, birth is not a medical emergency and is a normal part of life, where as for some of you ladies that have had complications, bad experiences and sick babies, it is. That's absolutely and totally understandable, our different experiences in life have led us to believe different things about birth. Neither of us are wrong, we make the decision that is best for us.

I would also like to point out that just because I want to have a good experience bringing my son into the world, it does not mean I value that experience over a healthy baby. I have looked at the risks and statistics and have decided for myself that I can have both, but that does not mean that I would not transfer to hospital if I needed too, and there are very few situations, when you are having a normal pregnancy, that would result in anything that would happen that a transfer wouldn't sort out.

As for PPH, I would just like to point out that despite your experiences Mikayla'sMummy, haemorrhages are definitely (thankfully for all of us!) a rare event. It's also interesting to not that most of the treatment of a PPH is the same at home as it would be in a hospital setting, although obviously in hospital they can do more. Should it occur to me while I was at home, my midwife would inject me with a chemical to make my uterus contract, while also performing a massage on my stomach to do the same thing, which is what they would do in hospital.

It's also interesting to note that while the majority of PPHs happen within the first 24 hours (not just minutes after birth), they can happen for a few weeks after the birth. You're not completely risk free from a PPH just because you birthed in hospital.

If you are interested in learning more about PPH in a homebirth setting, you can here (it's a UK website though):
https://www.homebirth.org.uk/pph.htm

 

[Proserpina]

Wow, OP. I'm sorry to see that you got such hostile and volatile reactions all because you posted an article and asked for opinions on it. Participants on this forum often remind me of something G. K. Chesterton said: "People generally quarrel because they cannot argue." That said, the more measured and respectful discussion between you and txbiscuit has been a delight to read.

Re: illegal homebirths, take the state of Illinois. The CPM qualification (Certified Professional Midwife) is not legally recognized here, so the only people who can attend home births are doctors and CNMs (Certified Nurse Midwives)---but they typically won't because of how high it makes their malpractice insurance premiums. There are no freestanding birthing centers in the state, either, though one was recently announced as planned. I live in the northern Chicagoland area. There is only one CNM in the area who will attend homebirths, and I'm told she's incredibly busy. There used to be a family doc or OB-GYN (not sure which) in Libertyville that would do it, but he either retired or stopped doing it in the past few years.

So Illinois is exactly the kind of state where a woman might have an "illegal" homebirth assisted by a CPM who is certified in another state or something, and she might then report that homebirth as "unassisted" so as not to get the CPM in trouble.

 

[PreggyEggy]

I don't think there has been quarrelling here. I feel that mostly, everyone has discussed the topic with respect. I've seen posts that are much more "hostile and volatile" then this one on this forum!

I think what most people found offensive was the implication that a home birthing mother is not smart, which was an unfortunate side effect of the way the OP worded her original post. (edit to say: I'm not saying that that is what the OP meant at all! ) I certainly don't object to the material posted!

 

[Foxy37]

I think its been a really good discussion and yes it could have got nasty but we all discussed it with the fact that we all have different views,opinions and situations .
And we all agreed that its an individual and personal choice .

xxx

 

[Cccbb61013]

I personally thought the OP was unreaonably attacked. I didn't read the article (not doing a home birth, but if I was, I would have read it before going on the offense), but from the original post I could tell she was trying to be helpful & offer an informative article for people to read. Not to mention she complimented the intelligence of the women on here & she gets jumped all over? Sometimes ths particular forum can b downright nasty. In any event, I see where she was trying to go with it (a thought provoking article = an interesting debate) & there were some worthwhile responses, it's too bad the whole thread wasnt like that.

 

[mo0nangel]

Buttercup you should read Ina May Gaskin's book a guide to childbirth. Honestly I would read this article with a huge grain of salt coming from the AJOG, not because you can't trust them but because they have a lot to lose from people deciding to do a homebirth, or go to a birthing center.

I have read this book.

The AJOG is just a journal (it's not an organization or anything), it doesn't actually have any financial stake in births at all. That would be like saying BabyAndBump or the New York Times has some kind of stake in whether or not people make certain choices about where to have their babies.

AJOG is actually one of my favorites because they are so balanced in the kinds of articles they accept. All the articles are "good science" and they're peer-reviewed and everything, so they're pretty trustworthy. Right now on the front page of the AJOG website they have an abstract for an article talking about the risks of early induction.

That's true the journal doesn't profit but the research and articles published have an effect on public opinion(is definitely not comparable to bnb or nytime, to have your research published there are a lot of requirements that need to be met)

 

[teacup22]

I know that in the UK the risk of death is lower with a homebirth, the risk of infection lower, csection, instrumental delivery etc.

Homebirths in many respects are far safe then a hospital birth.

This.

I'm a smart, well-informed lady. I've done my research and I chose homebirth.

Thanks anyway.

This.
Also you can find research to undermine most things, which unfortunately only show the OPINION of the person who conducted the 'research'.

 

[Buttercup2]

This.
Also you can find research to undermine most things, which unfortunately only show the OPINION of the person who conducted the 'research'.

Although this is true for posts on the internet, real scientific journals shouldn't have this. Removing bias/opinion is the point of the scientific method and the peer-review process (at least, that's how it is here in the states). The reason you can find science on both sides of the homebirth issue is because it's not a black-and-white, someone-is-right-someone-is-wrong kind of issue.

 

[teacup22]

This.
Also you can find research to undermine most things, which unfortunately only show the OPINION of the person who conducted the 'research'.

Although this is true for posts on the internet, real scientific journals shouldn't have this. Removing bias/opinion is the point of the scientific method and the peer-review process (at least, that's how it is here in the states). The reason you can find science on both sides of the homebirth issue is because it's not a black-and-white, someone-is-right-someone-is-wrong kind of issue.

Is anything black and white? You could say exactly the same about hospital birth (probably more so) but I expect you'd upset a lot of people

 

[Foxy37]

Everyone and every situation is different.
I'm glad we are all different xx