To home birth or not to home birth? Looking for stats on infant complications.

bunnie712

I had a pain med free labor and delivery with DD in a hospital two years ago.  I'm rethinking that now that I would have to change practices to keep delivery at that hospital.  Chaning hospitals is out of the question since I did a lot of laboring on my knees in the tub and the other hospital in town does not offer rooms with tubs.  This is what started me thinking about a home birth.

I'm looking for any input you guys may have on choosing a care giver and any questions or concerns I should have for them.  I'm far enough along in my pregnancy that it's starting to be a time crunch for me to get a prenatal appointment set up.

My biggest concern is the health of the new baby.  I have read statistics online and it appears that generally there is increased chance of complication, but it's a doubling/trippling of a tiny number and is still a tiny number.  The infant complication numbers I've seen do not specify a CPM from a CNM.  I'm planning to go with a CNM if I do a home birth - how does that change the statistics?  Does anyone have any resources they can point me to?

Thanks in advance for any help.  I feel like I'm making a bigger deal out of this than it needs to be, but I'm an engineer and as such prefer to make decisions based on numbers.  Although with the effort I'm going through, my luck will be that I'll have a breeched baby that won't turn.

ETA: I had group b strep with DD, but didn't mind being hooked up to the iv every 4 hours.

annabelle.27

This study was done in BC, and for it the Ministry of Health tracked every single homebirth that occurred in the province over the span of a few years when they made the decision to cover midwifery under public health care, and compared the outcomes to a matched group of low risk women who chose to give birth in hospital with a physician, in an effort to determine if the new services were proven to be safe. Midwife attended births actually had better outcomes than physician attended births and fewer complications across virtually all measures, and as already stated, all births were low risk and met the requirements for homebirth so there were no high risk hospital births to skew the results. BC doesn't have cpms or cnms though; all midwives have a four year degree in midwifery.

https://www.cmaj.ca/content/early/2009/08/31/cmaj.081869.full.pdfhtml

ncbelle

I biggest thing I would ask about as far as complications...when does your midwife decide it's time to transfer and what's the arrangement - does she have privileges at a hospital, a partner doctor? I would absolutely not go with a HB midwife who is "under the table" - if things do require transfer is she going to wait to the last minute, call for help when needed?

Good HB midwives (and there are certainly plenty!) should be very clear about their policies on transfers (either for mama or baby after birth), how they handle common emergencies (say shoulder dystocia), how they determine when transfers are needed and how those will happen. 

bunnie712

Thanks ladies! I also appreciate hearing the difference on cpm vs cnm.

The cnm we were planning to go with delivered 3 babies for one of my coworkers and 1 baby for another. Both families were very happy with their decision.

It's hard to beat the convenience and cost we have a high deductible health insurance plan of a home birth. Especially with DD around, it will be nice to plan a home delivery so we don't need to rush her out of the house to a baby sitter. Plus we can all stay the night together the first night instead of the baby and I being stuck at the hospital.

bunnie712

ncbelle:

I biggest thing I would ask about as far as complications...when does your midwife decide it's time to transfer and what's the arrangement does she have privileges at a hospital, a partner doctor? I would absolutely not go with a HB midwife who is "under the table" if things do require transfer is she going to wait to the last minute, call for help when needed?Good HB midwives and there are certainly plenty! should be very clear about their policies on transfers either for mama or baby after birth, how they handle common emergencies say shoulder dystocia, how they determine when transfers are needed and how those will happen.nbsp;

Thanks. I'll add this to my list of questions. Recessitaion equipment was something else I wanted to ask about. We have an ambulance dispatch close by, but it's about 15 minutes to the hospital from here.

StefandTodd

secondaryPULSE:

annabelle.27:

This study was done in BC, and for it the Ministry of Health tracked every single homebirth that occurred in the province over the span of a few years when they made the decision to cover midwifery under public health care, and compared the outcomes to a matched group of low risk women who chose to give birth in hospital with a physician, in an effort to determine if the new services were proven to be safe. Midwife attended births actually had better outcomes than physician attended births and fewer complications across virtually all measures, and as already stated, all births were low risk and met the requirements for homebirth so there were no high risk hospital births to skew the results. BC doesn't have cpms or cnms though; all midwives have a four year degree in midwifery. https://www.cmaj.ca/content/early/2009/08/31/cmaj.081869.full.pdfhtml

I think you intended to link this article, but the link didn't work for me, so I'm going to jump in...

https://www.cmaj.ca/content/early/2009/08/31/cmaj.081869.full.pdfhtml

I actually know the midwife who managed this study. This is the largest study of planned home births out there.

I wouldn't automatically discount CPM's. There are pro's and con's to both CNM's and CPM's, and it's not as cut and dry as one might think. The liscensure process to become a CPM is rigorous, and requires lots of hands on. Many CNM programs focus more on book knowledge rather than actual "doing." 

I became an RN in the hopes of becoming a CNM, but after further research, have decided to pursue the CPM path (in the future, when my children aren't so young) because of the autonomy I would be afforded (among other things....). Unfortunately, CNM's are required to have a backup physician, and often times the CNM's are subject to the same protocols as the physician. Their hands are often tied when it comes to what they can and cannot do. It's becoming increasingly more difficult to find a CNM that attends home births just because physicians won't back them because they are afraid to be sued. It's all very political.

I hope this makes sense. I'm not saying that CNM's are more or less qualified, I'm just trying to illustrate that the differences between CNM's and CPM's and encourage you to do your own research and draw your own conclusions.

Not necessarily.  My CNM does not.

StefandTodd

I'm also an engineer, had baby #1 in a hospital, no complication.  We had baby #2 at home and I would do it again a million times over.  It was an amazing experience.

If you run the numbers presented in the recent study that shows home birth results in a doubled infant mortality rate when compared with hospital birth, I think you go from like 99.85% to 99.70% chance complications or something like that (at least the one someone on my local board linked me to once when speaking out against home birth).  Meaning, the numbers ARE so teeny tiny to begin with that even a doubling of it brings your chances of something going wrong from almost impossible to almost impossible.  It's like buying 2 lottery tickets instead of 1.  You double your chances of winning.  From one in a billion to two in a billion.  Personally, as an engineer, the raw numbers actually helped me to see that there was absolutely nothing to worry about having a baby at home.  It was a fantastic experience, and if you can find a MW you feel comfortable with, and feel comfortable yourself with the idea of home birth, it's really, IMO, worth the extra money out of pocket completely (our insurance also won't cover the cost, and so it was very expensive for us compared to what a hospital birth would've cost).

GL with your decision and in your search for the right person ! 

OldGlory

ncbelle:

I biggest thing I would ask about as far as complications...when does your midwife decide it's time to transfer and what's the arrangement - does she have privileges at a hospital, a partner doctor? I would absolutely not go with a HB midwife who is "under the table" - if things do require transfer is she going to wait to the last minute, call for help when needed?

Good HB midwives (and there are certainly plenty!) should be very clear about their policies on transfers (either for mama or baby after birth), how they handle common emergencies (say shoulder dystocia), how they determine when transfers are needed and how those will happen. 

I agree with this. My HB MWs were clear on what they would do and what they wouldn't do and what their transfer policy was for them as well as what their back-up OB prefers.  My MWs also gave me their transfer rates for each of them individually. One is a CPM and the other is a CNM. Many times both will even attend a birth if they are available.

Mrs E in Oregon

Most stats lump all out of hospital births together as "home birth" or some variation of them like all home births planned and unplanned. That isn't wrong, but it doesn't reflect that there are women who stay home because they didn't know they were pregnant, teens that don't tell anyone, high risk fast deliveries, and they are higher of higher risk pregnancies anyway. But when you look at planned home births with medical professionals your risks go way down.

 This is on my midwive's website: https://vivantemidwifery.com/sitebuildercontent/sitebuilderfiles/CPM2000StudyAbstract.pdf

Conclusions: Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.

Mrs E in Oregon

I forgot to add that my midwives gave me this to reduce risk of having GBS in the end. It's called Fem Dophalis and when given enough time, it will crowd out GBS if present and can make it so you don't have to have an IV. Even if you do, most won't make you leave it in at home, once you have the meds they can take it out and administer again in 4 hrs if you haven't delivered yet. Freeing you up to move and get in a birthing pool if desired.

https://www.vitaminshoppe.com/store/en/browse/sku_detail.jsp?id=JF-1021&sourceType=sc&source=fg&adGroup=40-60&keyword=JF-1021&cm_mmc=Google+Shopping-_-Product+Listing+Ads-_-40-60-_-JF-1021&gclid=CNjN45iKjLUCFUjZQgodSwMADA

bunnie712

Thank you so much everyone!  I put in a call to a midwife that came recommended to me.  I've got a name of another one and plan to meet with them too after hearing metion of the importance of clicking with a particular care giver.