Article about Risks of Home Births in the US

[goddess25]

In Canada the risks for home birth are very low, the stats are fantastic. I am planning a home birth and have all my supplies. There is a fantastic book by Sheila Stubbs about home birth can't remember the name and so many articles now pro home birth.

I am afraid I totally disregard that article as being out of date with current world wide statistics.

Obviously there are situations that are going to arise in every situation.

 

[goddess25]

Just incase any of you are interested, my midwives have been to my home. They are pretty prepared for what can arise. 2 midwives come to your house, 1 to look after the baby and one to look after the mother post partum. They have put medication in my fridge incase of PPH, which obviously is a very short term measure until I get to the hospital. Obviously its a bit daunting but everyone prepares.

North America and I include Canada (where I live) in that are years behind the rest of the world in terms of obstetric care. For the most part giving birth is a natural occurence with no complications that does not require any intervention from medics at all. It is slowly changing though in positive way in Canada, not sure how these changes are happening in the US, I guess it varies state to state.

 

[J.D.]

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'.

That's not how research works. Any research published in a respectable journal is peer-reviewed, which means practitioners with potentially dissenting opinions have reviewed the work and have not found significant fault with process or intent either by design or by error in the study.

You'd be surprised how many crackpots there actually are out there trying to get utter bull published in respectable journals (see the everything-causes-autism-crowd and the anti-gay loonies), and how many well-intentioned people do studies and fail the peer-review process all the time because of serious weaknesses in a study that has taken years and cost thousands/millions.

One study (certainly one localised in a country I've never lived in) can only inform me partially about the risks of home birth (also saying there are risks involved in home birth does not negate risks of hospital birth -- there are risks in both). It can't actually tell me whether, in my case, a home birth would make sense. I know in this country that 1. There are no independent midwives working in my region and 2. I am high risk, and as such, even if such midwives existed, their insurance wouldn't cover me, and they would face disciplinary action by the state (who provides their indemnity) for attending me.

But seriously, we have to stop biting each other's heads off for presenting research that, clearly, people on this board find threatening. I personally think home birth sounds wonderful. I dislike noise and chaos, hospital food makes me want to barf, my own hospital has a 40% section rate and I really do not want pitocin even though with GD I am likely to be told to be induced. But shrugging off research, instead of engaging it (presenting other reputable studies, pointing out its limitations -- every study has them, etc) just shows ignorance and an unwillingness to question something you have bought into hook, line and sinker. That's just as bad as the hospital people who push everyone into having a section.

Personally, I want an evidence-based birth, and that means actually looking at all the evidence, whether it suits my personal opinion/choices or not.

I'm sorry if I've offended anyone reasonable here, but I'm not sorry if I've offended the people who attacked the OP for posting a freaking link to a study, because there was absolutely no call for all that hostility.

 

[Foxy37]

I think I've missed the bit were the op was attacked, I joined this convo early and I thought it was a well argumented discussion. We're we all came to the same thinking that it only suits some. A poster did get short when I said about women being brave choosing home births but as I had explained I ment no offence by it. Because I've had complications I would not be brave enough to bite the bullet and go for it xx

 

[Buttercup2]

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

Thank you so much for posting this article! It was really interesting to read.

For anyone who couldn't read it, this is what I got from it:

100,000 women in the Netherlands were followed for their homebirth vs hospital birth. There were about half and half home vs hospital. No data was taken about baby, this paper was specifically about complications in the mother. The complications they looked at were
1) admission to ICU
2) eclampsia (dangerously high blood pressure)
3) large volume blood transfusion
4) postpartum hemorrhage
5) manual removal of placenta
They found that for first time moms, there was no different between home and hospital births. For experienced moms, there was a 2x decrease in risk of these complications for home birth.

Of all Western countries, Netherlands has the highest rate of planned home birth so it's basically the home birth "best case scenario" (according to the paper's authors).

 

[Buttercup2]

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

I don't think people would be upset, I think hospital birth is not black and white either. There are pros and cons for home, birth center, and hospital births.

 

[Creative]

As another person who has taken part from the beginning, I don't think anyone was attacked or got at, we've handled the discussion sharing information and recognising that for each person the situation is individual. Some birth choices involve homebirth some do not. Each person is an individual and makes choices based on their own personality, situation, expectations etc. No one is slating anyone for having a different perspective / choice.

 

[sheldonsmommy]

I definitely found a few posts to be hostile and defensive, but the resulting discussion has been informative, so thanks ladies!

There are so many factors to consider with the process of birth (demographics, socio-economic status, physical properties, family history, attitude, influence of society and family, etc, etc) that it is impossible to control all the variables in a study, thus will never be scientifically black and white: it is not possible. The fact that I can hop onto any search engine and find 100 articles for and against the same topic make it even more difficult to inform oneself.

 

[Pearls18]

Hmm a country without socialised healthcare has produced an article which has concluded hospital birth is safer.....wonder why this could be.....I would want to know more about where the research has come from, who has funded it before using it to inform my own decision (obviously it has no importance to me in the UK, but if I was in the US)

 

[Quest55]

consider the source!!! ALWAYS ALWAYS ALWAYS consider where the info is coming from. It may be extremely biased and come from misconstrued information.

 

[Buttercup2]

Hmm a country without socialised healthcare has produced an article which has concluded hospital birth is safer.....wonder why this could be.....I would want to know more about where the research has come from, who has funded it before using it to inform my own decision (obviously it has no importance to me in the UK, but if I was in the US)

That information is included in the paper, actually. Were you able to access the article?

I posted this article because I feel that its enormous sample size helps reduce the influence of bias/opinion. So, compared to many other research papers out there, this one is very likely to be bias-free.

The article from the Netherlands had only 100,000 women in their study. This is probably good for Netherlands because it is a small country (population of 16 million), but is barely big enough to be published in the US (population 315 million). The reason small sample sizes can't get published is because it possible for bias to still come into play (not that anyone should automatically assume the midwives that wrote that paper were biased towards homebirth, although it would be easy to jump to that conclusion). The article from the states looked through the records of 13,000,000 women. This enormous sample size is part of how the paper's authors attempt to erase bias. It would be nearly impossible to look at that many records and then pick and choose only ones that "fit your bias".

Could someone not also say that a country with socialized healthcare would push people toward home birth because home birth is cheaper for the government? That kind of snap judgement can swing both ways, and it's equally unproductive either way.

 

[Pearls18]

Hmm a country without socialised healthcare has produced an article which has concluded hospital birth is safer.....wonder why this could be.....I would want to know more about where the research has come from, who has funded it before using it to inform my own decision (obviously it has no importance to me in the UK, but if I was in the US)

That information is included in the paper, actually. Were you able to access the article?

I posted this article because I feel that its enormous sample size helps reduce the influence of bias/opinion. So, compared to many other research papers out there, this one is very likely to be bias-free.

The article from the Netherlands had only 100,000 women in their study. This is probably good for Netherlands because it is a small country (population of 16 million), but is barely big enough to be published in the US (population 315 million). The reason small sample sizes can't get published is because it possible for bias to still come into play (not that anyone should automatically assume the midwives that wrote that paper were biased towards homebirth, although it would be easy to jump to that conclusion). The article from the states looked through the records of 13,000,000 women. This enormous sample size is part of how the paper's authors attempt to erase bias. It would be nearly impossible to look at that many records and then pick and choose only ones that "fit your bias".

Could someone not also say that a country with socialized healthcare would push people toward home birth because home birth is cheaper for the government? That kind of snap judgement can swing both ways, and it's equally unproductive either way.

Did I say I believe everything the British NHS publishes? No I didn't, a snap judgement is healthy because it means I am not going to be gullible enough to just read something at face value, it means I am aware of the agenda that can be behind research, I choose to be skeptical until proven otherwise and that was my reaction to the discussion on the article. I didn't read it because it has no use to me a) being British b) having done enough of my own research to know home birth is statistically safer for me to have my baby at home. I couldn't help but have a giggle to myself about the findings of the research and the country of origin, doesn't mean the research is futile of course it's just funny to me that such a coincidence can occur (especially considering the nature of maternity care in the US), I only hoped my comment would make people think about the source of the research, not that I was directly saying the research was of little use, as I say I have no interest in reading it and didn't make it sound like I had at all.

 

[Buttercup2]

In Canada the risks for home birth are very low, the stats are fantastic.

Can you post a link for this? I'm always interested to read more about it.

I am afraid I totally disregard that article as being out of date with current world wide statistics.

Well, it was an article specifically about the US. A couple of the authors were from England and Germany, but all the records came from the US. I have to disagree that it's out of date, though, because the records that were used in the study came from 2007 to 2010.

 

[special_kala]

Hmm a country without socialised healthcare has produced an article which has concluded hospital birth is safer.....wonder why this could be.....I would want to know more about where the research has come from, who has funded it before using it to inform my own decision (obviously it has no importance to me in the UK, but if I was in the US)

That information is included in the paper, actually. Were you able to access the article?

I posted this article because I feel that its enormous sample size helps reduce the influence of bias/opinion. So, compared to many other research papers out there, this one is very likely to be bias-free.

The article from the Netherlands had only 100,000 women in their study. This is probably good for Netherlands because it is a small country (population of 16 million), but is barely big enough to be published in the US (population 315 million). The reason small sample sizes can't get published is because it possible for bias to still come into play (not that anyone should automatically assume the midwives that wrote that paper were biased towards homebirth, although it would be easy to jump to that conclusion). The article from the states looked through the records of 13,000,000 women. This enormous sample size is part of how the paper's authors attempt to erase bias. It would be nearly impossible to look at that many records and then pick and choose only ones that "fit your bias".

Could someone not also say that a country with socialized healthcare would push people toward home birth because home birth is cheaper for the government? That kind of snap judgement can swing both ways, and it's equally unproductive either way.

That statment is completely true imo which is why i trust our healthcare system the way i do. Things are done for medical need not just to make money. Health is not a business here

 

[Buttercup2]

...a snap judgement is healthy because it means I am not going to be gullible enough to just read something at face value, it means I am aware of the agenda that can be behind research, I choose to be skeptical until proven otherwise and that was my reaction to the discussion on the article. I didn't read it because it has no use to me a) being British b) having done enough of my own research to know home birth is statistically safer for me to have my baby at home.

Healthy skepticism is good. Making a judgement without reading the paper isn't. But I can totally understand why the paper/this discussion doesn't really apply to you for the reasons you stated.

I only hoped my comment would make people think about the source of the research, not that I was directly saying the research was of little use.

And my comment was that, for people who read your comment, the information is available in the paper. Wondering about the source of the research isn't a reason to automatically dismiss the paper (although a person may have other legitimate reasons to dismiss the paper after reading it).

 

[Pearls18]

...a snap judgement is healthy because it means I am not going to be gullible enough to just read something at face value, it means I am aware of the agenda that can be behind research, I choose to be skeptical until proven otherwise and that was my reaction to the discussion on the article. I didn't read it because it has no use to me a) being British b) having done enough of my own research to know home birth is statistically safer for me to have my baby at home.

Healthy skepticism is good. Making a judgement without reading the paper isn't. But I can totally understand why the paper/this discussion doesn't really apply to you for the reasons you stated.

I only hoped my comment would make people think about the source of the research, not that I was directly saying the research was of little use.

And my comment was that, for people who read your comment, the information is available in the paper. Wondering about the source of the research isn't a reason to automatically dismiss the paper (although a person may have other legitimate reasons to dismiss the paper after reading it).

But my background knowledge of research on home birth (as an amateur of course) and my understanding of American maternity care -from afar- has very much enabled me to make a snap judgement, human nature, this is a parenting forum after all not a scientific peer review of the paper, an opinion is just as justified as a scientific interpretation in this forum. As a generalisation from someone who hasn't looked at the paper I find it difficult to believe how unsafe home birth can be in country that so heavy-handedly interferes in the birthing process, having said that knowledge is power and given what seems to be a complete (perhaps deliberate) misunderstanding of labour from the general American health care attitude I have witnessed (of course not necessarily representative) perhaps it isn't surprising that American statistics don't correlate with those of other western cultures, however reliable the research.

 

[Buttercup2]

That statment is completely true imo which is why i trust our healthcare system the way i do. Things are done for medical need not just to make money. Health is not a business here

I don't have any personal experience with European healthcare. Are the midwives volunteers (many of our firefighters here are volunteers), or aren't they paid by the government? Don't the midwives make money by having women use their services?

 

[special_kala]

That statment is completely true imo which is why i trust our healthcare system the way i do. Things are done for medical need not just to make money. Health is not a business here

I don't have any personal experience with European healthcare. Are the midwives volunteers (many of our firefighters here are volunteers), or aren't they paid by the government? Don't the midwives make money by having women use their services?

They are healthcare professionals.

They work in hospitals ant the community. We do not routinly deal with doctors during pregnancy or birth.

 

[Buttercup2]

...perhaps it isn't surprising that American statistics don't correlate with those of other western cultures, however reliable the research.

I think this is 100% true! The US doesn't really support home birth well at all, which is, I think, why this paper found that home births in the US are not as safe as hospital (in the case of the specific, rare complications that were evaluated). But even with this research, there are still many good reasons for some women to choose home birth. Everybody has said that their choices are well-researched, and I'm really interested to read the research that other people are finding that helped them decide on a non-hospital birth.

I did hope this thread would be a discussion of a scientific paper and not just a sharing of opinions, tho. I'm really interested to hear where people got the information that caused them to form their opinions. That doesn't make your opinion not valid, so I'm sorry if I made you feel your opinion was un-valued.

 

[Buttercup2]

They are healthcare professionals.

They work in hospitals ant the community. We do not routinly deal with doctors during pregnancy or birth.

But I guess what I don't understand is who pays their salary (because it sounds like they're not volunteers)? Here in the states, Drs, nurses, and midwives are paid by the hospital or clinic where they work. Do you pay your midwife directly?