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Natural Birth
Homebirth has triple the neonatal death rate
I know this post is gonna blow up like dynamite. But I've been lurking on this board for quite some time and I never see any posts that realistically look at the dangers of HB.
I am all for med-free births, but I don't agree with taking risks without first knowing all the facts. I know many (if not most) of you will just attack me and find ways to pick apart the data to make yourselves feel better. And that's fine. But for those that may be lurking and on the fence about whether to choose HB, I hope I've just given them another perspective to consider.
I go to this blog a lot, and yes the blogger is an OB. So you're going to say, how can we trust this woman, she's a doctor and wants our money. But, she talks about the recent ACOG guidelines on HB and also why they came to these conclusions. I think if you really want to educate yourselves on the safety of your choices you should read this post:
https://skepticalob.blogspot.com/2011/01/new-acog-opinion-on-planned-homebirth.html
FTR, I'm not interested in getting in a pisssing match with any of you. I am not going to argue and defend myself, so don't think I got ran off. I am posting this link to offer education. That's all.
This discussion has been closed.
Re: Homebirth has triple the neonatal death rate
Make a pregnancy ticker
i'll tell you what i find interesting. i bet OBs will jump all over this yet when the new guidelines about vbacs came out from ACOG over the summer, they all said ACOG who?
the fact is, all birth has risk. are you willing to accept a marginal increase in the already miniscule risk of neonatal death over the GIGANTIC increase in risk to both mother and baby by birthing at a hospital and accepting all the standard procedures? there is a happy medium somewhere. for some people, it's making sure there homebirth risk is a low as possible. for others, it's birthign at the hospital and declining those standard procedures and interventions (which, having birthed twice now, i find more difficult and challenging than labor itself).
while i see that this opinion doesn't include unplanned homebirths, all of the studies i've read in the past included those births that happened at home that were not planned and not attended by a medical professional. i even read one such study that included MISCARRIAGES in it's determination that homebirth increased the risk of death to the baby. i'd like to see the ACTUAL numbers of increased risk. i mean, are we talking an increase of .005 to .015? i recall during my vbac research that i learned the increased rate of uterine rupture in a vbac was insignificant and comprable to the risk for a first time mother, so what's the big deal?
the only thing of merit i see in this opinion is that moms need educated and experienced care providers, no matter where they choose to birth.
i was at a hospital last night, in the ER. a very well respected hospital in my area. there was SOMEONE else's blood in the sink. the nurse who drew my blood removed her gloves to wipe up blood that had spilled out of the hole in my arm, which she stuck before she was ready. the machinery was filthy and the floor was disgusting. chance of me getting an infection that could kill me or my baby? much bigger than the chance at home.
as long as my pregnancies remain low-risk, i'll take my chances at home.
Thank you for such a nice comment. I posted this specifically for people like you, so that hopefully you can find information from many different sources to make your final decision!
Best of luck!
Lindsey -
The SOB is a huge joke. She and I have gone rounds and she is only into petty name calling, cyclical arguments, and regurgitating what she reads without being able to disprove anything that anyone comes against her with. (sorry, harsh but true). I refuse even to click on her links because it just gives her a higher count.
I wrote a response to these fallacies in a paper. Read below for the information:
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A Better Look at the Safety of Home-birth
Informed Consent for Educating Options in Birth Setting
The July 1st online edition of the American Journal of Obstetrics & Gynecology includes a new meta-analysis comparing home birth and hospital birth outcomes1. ?Maternal and newborn outcomes in planned home birth vs planned hospital births: a meta-analysis,? by Joseph R., Wax, MD, and colleagues, concludes that ?less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate? (Am J Obstet Gynecol 2010; 203).
This meta-analysis on home-birth has blown through the United States like wildfire. And why? Because it supposedly proves that home-birth is extremely risky; in fact, they state that home birth is three times as risky as hospital birth. But, does it really?
A Meta-analysis is a type of statistical analysis that brings together the findings from a number of independent studies in order to make conclusions about the combined results. It is useful when the studies included are credible and a clear and consistent methodology is presented.
Dr. Nicholas Fogelson dubs this particular meta-analysis as, ?a flawed study published in a ?second-tier journal??. There are many reasons why he makes this bold statement. A few of the reasons include:
? It includes information on any out of hospital birth: birth on the side of the road, spontaneous and too-quick birth, unassisted birth, birth from women who abandon their babies, premature births (before 34 weeks), and women in high-risk situations to begin with. Unfortunately medical records in many of these studies only notes two types of birth: in hospital or out of hospital (which includes all of the above).
? It includes information from the Pang Study2 ? a study that is also inherently flawed with the above information.
? It includes small case studies (one of which had a total of 10 women in the study ? which can greatly skew the data).
? It includes old studies that include old practices that did not have the technology that we have today (such as limited or no use of fetal monitoring or ultrasound and thus, many higher-risk women were being accepted as home birth clients without knowing that they were high-risk for lack of appropriate equipment)
? It doesn?t discuss any exclusions, such as perinatal or intrapartum deaths, planned vs. unplanned home birth, demographics (health, age, income, parity, etc..), cause of death, multiples pregnancy, breech, or post-term babies.
In fact, it was so flawed that there were obstetricians and certified nurse midwives, as well as health and safety advocacy organizations that all defended planned home-birth with a skilled attendant, and shamed the meta-analysis published by the AJOG.
The American College of Nurse-Midwives3 state,
?The safety of home birth has been the focus of significant research in recent decades. It is important to note that the authors? conclusion differs significantly from findings of many recent high-quality studies on home birth outcomes which found no significant differences in perinatal outcomes between planned home and planned hospital births??. ?In this publication, we are puzzled by the authors? inclusion of older studies and studies that have been discredited because they did not sufficiently distinguish between planned and unplanned home births?a critical factor in predicting outcomes. Also troubling is that several recent credible studies of home birth were excluded for no apparent reason.?
More backlash from this publication includes a press release from The Big Push for Midwives4,
?Many of the studies from which the author?s conclusions are drawn are poor quality, out-of-date, and based on discredited methodology. Garbage in, garbage out.? said Michael C. Klein, MD, a University of British Columbia emeritus professor and senior scientist at The Child and Family Research Institute. ?The conclusion that this study somehow confirms an increased risk for home birth is pure fiction. In fact, the study is so deeply flawed that the only real conclusion to draw is that the motive behind its publication has more to do with politics than with science.?
He goes6 on to say,
?We?re dealing with a politically motivated study?
In fact, a grass-roots organization5 which seeks to make maternity services as safe as possible released a statement immediately afterward that included,
"In our analysis of multiple studies from countries worldwide," stated CIMS Chair Michelle Kendell, MBA, AAHCC, "CIMS found that the authors of the study included confounding data, such as outdated and low-quality studies, low-risk and high-risk mothers, babies born preterm, babies unintentionally born at home, births attended by unqualified providers, and data from birth certificates that researchers have found to be notoriously inaccurate."
Out of the largest studies included in this meta-analysis, only three of them clearly distinguish between planned and unplanned home birth. These three recent studies are in direct opposition to the meta-analysis published by the AJOG. These three studies all found that planned home birth with a skilled attendant is as safe, if not safer, than a planned hospital birth for a healthy and low-risk woman. In fact, one of these studies meets the gold standard for quality in home birth research and found that babies born at home were just as safe born at home.
In conclusion, other countries have recently done rigorous studies7 with specific including and excluding factors for planned home birth versus planned hospital birth8 with a skilled and qualified attendant and found that there was no increase in newborn death or illness among healthy, low-risk women10. There is good reason to be wary of the AJOG meta-analysis.
Nicole Deelah
Childbirth educator, birth doula,
and midwife apprentice
www.sagemama.net
07/18/2010
Additional Reading:
https://womantowomancbe.wordpress.com/2010/07/14/a-flawed-study-published-in-a-second-tier-journal/
https://www.birthactivist.com/2010/07/sorry-guys-homebirth-is-still-saf/
https://www.themidwifenextdoor.com/?p=930
https://www.scienceandsensibility.org/?p=1349
https://jenniferblock.com/wordpress/?p=122
Resources:
1 https://www.ajog.org/article/S0002-9378(10)00671-X/abstract
2 https://www.collegeofmidwives.org/news01/ACOG Hm Brth Study Aug 02.htm
3 https://www.midwife.org/documents/ACNMstatementonAJOG2010.pdf
4 https://www.thebigpushformidwives.org/_ccLib/downloads/7-7-2010_PushNews_RELEASE_OB-GYN_Journal_Fast_Tracks_Publicity_on_Deeply_Flawed_Study.pdf
5 https://archive.constantcontact.com/fs078/1102083584231/archive/1103553258617.html
6 https://www.theglobeandmail.com/life/health/us-analysis-on-home-birth-risks-seen-as-deeply-flawed/article1624918/
7 https://www.ncbi.nlm.nih.gov/pubmed/19624439
8 https://www.cmaj.ca/cgi/content/full/166/3/315
9 https://www.bjog.org/details/news/182410/New_figures_from_the_Netherlands_on_the_safety_of_home_births_.html
10 https://www.bmj.com/content/330/7505/1416.full
Do you have any studies to support this statement?
Sage Beginnings - YOU ROCK!
it makes me so sad to see stuff like this come out and scare moms into accepting less than ideal situations for their births.
Have you read the study that statistic came from? The statistic was complied with no distinction between planned and unplanned homebirths or assisted and unassisted homebirths. So it's basically lumping all out-of-hospital/birth center births in one large category, whether it's the mom who didn't know she was pregnant until she gave birth on her bathroom floor, or the mom who received regular prenatal care with a qualified midwife and had an assisted homebirth. When you control for those factors, which was done in the SAME STUDY, it shows that planned, assisted home births are as safe as hospital births. Blogs are great, but I prefer to get my facts straight from the source.
google is your friend. they are everywhere.
i don't think it's a secret that moms and babies are at greater risk for unnecessary interventions including surgical birth and all the risks that come with that when they choose to birth at a hospital.
I had to go to the ER a couple years ago for stitches..They put me in a room that was disgusting and there was blood all over the sink! I was absolutely disgusted!! I'm with you on this... To each there own.. And for me that is in the comfort of my home!!
Agreed! Definitely seems be scare tactics to me!
What is frustrating is that people believe those who choose homebirths do so willy-nilly, with no research or education. I had my son in a country (much like the US, not a developing nation) where they encourage homebirths. I am sure there are some women who choose it without much education on the topic, but all of the women I know who chose a HB did so after hours of research, educating themselves, and discussion with their spouse.
This is so typical of what ACOG would publish. It's funny how now studies are cited. If you truly want to educate yourself you should look at STUDIES done - not just on the ACOG's opinion.
If you want actual numbers & statistics for educational purposes opposed to OB's worried about their bottom line. Here ya go...
This one is from Canada https://www.cmaj.ca/cgi/content/full/181/6-7/377
"Results: The rate of perinatal death per 1000 births was 0.35(95% confidence interval [CI] 0.00?1.03) in the groupof planned home births; the rate in the group of planned hospitalbirths was 0.57 (95% CI 0.00?1.43) among women attendedby a midwife and 0.64 (95% CI 0.00?1.56) among those attendedby a physician. "
Here is another https://www.ncbi.nlm.nih.gov/pubmed/8942692
"CONCLUSIONS: The perinatal hazard associated with planned home birth in the few women who exercised this option was low and mostly unavoidable."
I have a friend who delivered far too early(in a hospital), and her baby died. She is in a grief counseling group with another woman whose baby died during a home birth. That woman seems to have an extra layer of suffering because she feels guilty that the medical help available was insufficient. In this particular case, it was (though my friend does not know the details).
These are the stories that scare me. I am too removed from the situation to get sufficient information, though I believe everything I am being told by the friend.
I don't trust ob's or midwives exclusively, and I go back and forth in terms of what I will do when and if I ever actually get pregnant.
http://oi62.tinypic.com/2w73hq9.jpg
I'm sorry but I call BS on this. Why would you come onto the NB and say you are trying to "offer us an education" and inform us about the horrible risks of our choices? I think you came here to stir things up and start a debate. You have your mind made up that people who chose home birth are in the wrong and now you want to "educate" us?
FYI most of the educated ladies on this board are familiar with the existing studies on home birth and are well aware of the Wax study and also well aware of who Amy Tuteur is and what her writings say. The Wax study came out months ago and has been discussed ad nauseum on here and on natural birth blogs and sites, so I think it's kind of funny that you came on here telling us what its conclusions are as though that is some revelation to us.
This. I used a brand new hospital that was "state of the art" and always appeared clean. During my first appointment with LO, the vaginal ultrasound device had blood dripped down the bottom of it. When I asked for it to be cleaned before they put it into my vagina, the nurse told me that it would be fine because that part wouldn't be entering my body and she was putting a condom over the top anyway. Hospitals are not always as safe and clean as one may think.
Also, Dr. Tuteur says this:
The only places where homebirth might potentially be as safe as hospital birth is The Netherlands and Canada, both of which have strict eligibility criteria, dedicated transport systems and highly trained midwives. Of these three criteria, American homebirth lacks ALL of them.
But the thing is, HB advocates have been trying to create that in the US for decades--and they've been blocked every step of the way by ACOG and obstetricians. Every time a bill comes up about legalizing and regulating home birth midwives in state legislatures, ACOG and the AMA and a bunch of OBs are right there testifying to legislators about how horrible it would be to pass that bill. So home birth midwives remain unregulated in those states--but it doesn't stop them from practicing. That means so strict criteria and no oversight. There is no integrated transport system between home births and hospitals in the US because hospitals and OBs don't support home birth at all and won't agree to anything like that and because all ACOG ever says is how dangerous HB is.
If anyone is making HB in the US dangerous according to what the link you provided states, its ACOG, hospitals and OBs who refuse to work with home birth providers or recognize home birth as a legitimate choice that isn't going anywhere.
TY, me too. It makes me sad that ppl don't actually take the time to read the why behind ACOGs statements and then really do a critical analysis of their 'sources'. Sheeple (SOB) bug me. lol.
YES!!!!
Oh, here we go again.
OP, what do you want us to say? You've shown us something we've never seen before?
I think most of us researched before making our decision and are comfortable with our choice. I appreciate your concern, but to say that this post was not to start a debate is silly. If you have been lurking here for a while, you are well aware of where most of the posters stand and know that they have researched this topic extensively.
Uh, yeah. I read SOB's blog once in a while and then do a headdesk and remind myself not to do it again. OP piped up with this as if there are no OBs or doctors who think differently, and that's just not true. I'm a big fan of Marsden Wagner, who is a perinatologist and perinatal epidemiologist that is also a proponent of HB.
I don't think the OP was looking for a well researched debate but was baiting the board for these kinds of comments. Too easy...
PS, here's links with different organizations' and people's views on the Wax paper.
https://www.nacpm.org/documents/070610-NACPM-Press-Release-Wax-etal.pdf
https://jenniferblock.com/wordpress/?p=122
https://www.thedailybeast.com/blogs-and-stories/2010-10-02/home-births-under-fire-amid-outcry-over-wax-paper/
https://www.mamasonbedrest.com/2010/07/cims-responds-to-the-publication-of-study-on-the-safety-of-homebirth/
https://www.thebigpushformidwives.org/index.cfm/fuseaction/home.showpage/pageID/67/index.htm
Thank you OP for posting to begin with. If there was credible evidence that homebirth was dangerous, I would certainly want to hear it so that I could consider it in my decision to HB, as should anyone else. I think whatever decision someone makes should be informed so that they know it is the best decision for them. You aren't stirring things up because of the information, but because most of us here have BTDT with the Wax analysis and it can really get us going to see the misinformation going around again. But I don't blame someone for feeling that this was something that should be shared. I hope you look into the issue deeper so that you know the problems with it before you pass it around in the future.
My OB is supportive of HB. And the local HBers are supportive of him.
There doesn't HAVE to be contention between the two groups. We all want the same thing. Healthy, happy, moms and babies. So instead of continuing this pissing contest lets work together to support the same cause.
This! I completely agree. Not to say that other moms aren't educated. But by comparison natural birthing mommies are always so educated about their choices.
This is the kind of thing that alienates people from natural birthers and makes them think they are all stuck up snobs. Just FYI.
I was really sad to see the OP put so much merit into the study.... I hate seeing all the misinformation that goes around! THANKYOU for posting this study, I hope it will spark more research on her part, and others who take this study at its word.
You should always look at AJOG sources, they tend to contradict themselves and have openly stated that homebirths are just as safe and have significantly less unnecessary interventions than hospital births in previous statements, making them safer for low risk pregnancies.
Agreed.
Plus, I was 100x more educated about my c-section than I was about my natural birth.
I know that I personally have become a lot more educated about my choice to have a home birth vs when I assumed I would have a hospital birth mainly because I knew that I would have to defend my decision to everyone I knew. This does not, however, mean that all home birthers do extensive research.
This.
I'm a little disappointed she never came back.
I'm thinking she just stumbled across the blog post, skimmed it, and felt like it was her duty to inform all of the uneducated homebirthers about how dangerous their decision is. It was probably the first thing she as ever read on the subject and to her it was really informative.
That's a pretty generous assessment. I think she came to stir up sh!t.
Yep. She says she reads Amy Tuteur's blog a lot so I can't imagine it's the first time she's ever read anything on home birth. Amy Tuteur blogs about it a lot, not to mention how she comments on like every blog post ever written about home birth.
Ya, I thought that she would have a little more to say when so many people came back with other facts and studies. At the very least back up her opinion. Everyone is entitled to their own preferences, but have the knowledge to back it up! I agree, I think she just wanted to cause some drama.