Latest scientific evidence about at-home births

thaisac1 · January 2016

First of all, I am NOT posting this to point fingers at anyone, or to judge anyone's preferences. I am simply posting as I feel my A16 ladies should be fully informed about the latest scientific evidence about birthing choices.

Click on this link to read an abstract for the most recent article on this topic: https://www.nejm.org/doi/full/10.1056/NEJMsa1501738#abstract

Of note, the New England Journal of Medicine is the most respected and highest impact journal in Medicine. Only about 1% of Science is accepted there, and understood to be he best medical science. They are very strict with what they publish.

To summarize: in an epidemiological study, authors compared outcomes from planned at-home births to planned in-hospital births. Although rates of vaginal delivery were higher with home births, rates of perinatal mortality (read: baby's death around the time of delivery) were higher among those who had a planned at-home birth.
The odds ratio for perinatal mortality for home births was 2.43. Translating: babies born from planned at-home deliveries were 143% more likely to die around the time of birth than babies born from planned hospital deliveries.

As we all approach our due dates, I though you may want to know and reflect upon the latest data on the field.

AmadorRose · January 2016

The thought of the mess alone is enough to send me to the hospital. Also, my mother would murder me shortly after I pushed the baby out.

Shouldn't you be enjoying your vacation?

thaisac1 · January 2016

AmadorRose said:
The thought of the mess alone is enough to send me to the hospital. Also, my mother would murder me shortly after I pushed the baby out.

Shouldn't you be enjoying your vacation?

I am, but.... What can I say, I have no excuse for my nerdiness.

elasticheart13 · January 2016

There's no way I would ever have the guts to give birth at home. I'd be terrified of something going wrong, and as @AmadorRose mentioned, the mess alone is a big enough incentive for me to do it at a hospital

spicedice · January 2016

From what I've heard, a home birth is a lot more relaxing for the mom, since she is in a place that she is already comfortable with and she's only surrounded by people she knows and trusts.

Personally, I couldn't do a home birth. Pre-eclampsia with my first has made me beyond paranoid about labor complications.

K&Elizabeth · January 2016

I think the general idea of a home birth sounds nice, but figuring out the actual logistics of it makes my skin crawl with anxiety. Like, who cleans everything up, where does the placenta go, and then everyone just leaves and we're home alone with the baby?? Even as a STM, I'm looking forward to the nurses help that first day/night.

Ready4theParty · January 2016

My Dr actually suggested I go the midwife and home birth option since my last labor and delivery were textbook, minus being induced.

The mess is my biggest concern for not having a home birth and if there happened to be complications I would want to be as close to a hospital as possible not the now 20 miles away. Kudos to those who do home births...I just know it's not for me.

cmjenkies · January 2016

As hard as I try to be open minded, if there is anything I feel judgey about in the world of 'mommy wars'.. it's home birthing. I find it to be misguided and a bit irresponsible. Women always say "we were born to do this, it's in our DNA, this is what our ancestors did" so on and so forth. You know what else our ancestors did? Died in childbirth, and lost children, regularly. With advances in modern medicine, infant and maternal mortality rates are so incredibly low. Even if you are anti-intervention, the what ifs of labor and delivery are too much to gamble with. There are ways to have your ideal birth in the approriate environment. There is no legitimate argument against the safety of having a legitimate medical backup support plan (preferably on-site). Contrary to semi-popular belief, childbirth is a *medical event* for a reason, not a time for women to be self righteous and holier than thou know it alls. We may know our bodies, but when it comes to possible birth complications or post birth complications, there are many people who are more qualified to direct those situations and save our lives. I can't save myself from a uterine hemorrhage. I didn't have one the first time, but who knows what could possibly come. It's just not worth it. Never say never.

*This may be a UO. Steps off soapbox.*

Edited to add: I don't intend to say that mothers who choose this route are idiots or are all "self righteous holier than thou know it alls." This just describes a particular couple of people in my mind and some of the tones of boards I've read in the past from members of this camp. I just truly do not understand the rationale behind such a decision in today's world.

blonde151188 · January 2016

I considered it this time around. This is my 4th, my other labors were fast and complication free, but there's always the what if's and the small percentage that something could go wrong. I just read an article last night of a home birth gone wrong and the mom and baby are lucky to both be alive and well. It was a textbook pregnancy, but the rarity of the baby's presentation and his size made for a very difficult delivery and they both had to be rushed to the hospital. It was nothing they knew ahead of time and yet it still happened. That paired with the fact that I would miss out on my 2 days of nurses being there for me sold me on just sticking with the hospital.

ivyvines6 · January 2016

I'm still sad I'm not able to have a home birth, but whatever is best for the little leach... I mean baby...

thaisac1 · January 2016

cmjenkies said:
As hard as I try to be open minded, if there is anything I feel judgey about in the world of 'mommy wars'.. it's home birthing. I find it to be misguided and a bit irresponsible. Women always say "we were born to do this, it's in our DNA, this is what our ancestors did" so on and so forth. You know what else our ancestors did? Died in childbirth, and lost children, regularly. With advances in modern medicine, infant and maternal mortality rates are so incredibly low. Even if you are anti-intervention, the what ifs of labor and delivery are too much to gamble with. There are ways to have your ideal birth in the approriate environment. There is no legitimate argument against the safety of having a legitimate medical backup support plan (preferably on-site). Contrary to semi-popular belief, childbirth is a *medical event* for a reason, not a time for women to be self righteous and holier than thou know it alls. We may know our bodies, but when it comes to possible birth complications or post birth complications, there are many people who are more qualified to direct those situations and save our lives. I can't save myself from a uterine hemorrhage. I didn't have one the first time, but who knows what could possibly come. It's just not worth it. Never say never.

*This may be a UO. Steps off soapbox.*

Edited to add: I don't intend to say that mothers who choose this route are idiots or are all "self righteous holier than thou know it alls." This just describes a particular couple of people in my mind and some of the tones of boards I've read in the past from members of this camp. I just truly do not understand the rationale behind such a decision in today's world.

I try not to speak too much about it, as it is not my position to pass judgement on anybody. But as a healthcare professional, I have been much more exposed to the situations when labor goes wrong than the average pregnant woman, and for this reason the possibility of a home birth has never, ever been in my deck of cards. People are correct that our bodies were made for this, but you are also correct in pointing out that maternal and perinatal mortality were way, way higher back in the old days when Medicine was less advanced. There is nothing I want more in this whole world than bringing a healthy baby into the world in late March/early April. For that reason, my mind cannot cope with the very small possibility of a medically unassisted labor complication - I want all the monitoring, supervision and assistance modern Medicine can offer.
My OB shares the exact same thoughts, as do nearly every OB I know. I think the recent study above may help shed light into this important issue, and help inform pregnant women so that whatever it is the decision she makes, it will be a well informed one.

rebelone · January 2016

I have had way too many instances to have ever consider an out of hospital birth, and I have never actually never considered having an out of hospital birth and didn't realize it was a thing until about 5 years ago. I thought it was always the thing that you have your baby at a birthing center or hospital so this is relatively new to me. However, here's the thing about the study: The test sample was taken out of a single year in Oregon. Given that small bit of information, it's hard to measure the rest of the country on the sample alone. However, I can kind of see the risks in general given that out of hospital births are limited in resources. I just wish the sample was much larger than the state of Oregon and more than a year.

thaisac1 · January 2016

rebelone said:

I have had way too many instances to have ever consider an out of hospital birth, and I have never actually never considered having an out of hospital birth and didn't realize it was a thing until about 5 years ago. I thought it was always the thing that you have your baby at a birthing center or hospital so this is relatively new to me. However, here's the thing about the study: The test sample was taken out of a single year in Oregon. Given that small bit of information, it's hard to measure the rest of the country on the sample alone. However, I can kind of see the risks in general given that out of hospital births are limited in resources. I just wish the sample was much larger than the state of Oregon and more than a year.

True, although that does not de-validate the study or the Methods. Many epidemiological studies are from confined regions, and thought to represent a population. I'll give an example: the entire world uses a risk score to estimate future cardiovascular risk that was based on an epidemiological study done in a small city in Massachusetts (Framingham). Tiny city, robust results, worldwide widespread use since the 1970s.

rebelone · January 2016

thaisac1 said:

rebelone said:

I have had way too many instances to have ever consider an out of hospital birth, and I have never actually never considered having an out of hospital birth and didn't realize it was a thing until about 5 years ago. I thought it was always the thing that you have your baby at a birthing center or hospital so this is relatively new to me. However, here's the thing about the study: The test sample was taken out of a single year in Oregon. Given that small bit of information, it's hard to measure the rest of the country on the sample alone. However, I can kind of see the risks in general given that out of hospital births are limited in resources. I just wish the sample was much larger than the state of Oregon and more than a year.

True, although that does not de-validate the study or the Methods. Many epidemiological studies are from confined regions, and thought to represent a population. I'll give an example: the entire world uses a risk score to estimate future cardiovascular risk that was based on an epidemiological study done in a small city in Massachusetts (Framingham). Tiny city, robust results, worldwide widespread use since the 1970s.

Which is also true and I agree on all of this.

mrstrax · January 2016

rebelone said:

thaisac1 said:

rebelone said:

I have had way too many instances to have ever consider an out of hospital birth, and I have never actually never considered having an out of hospital birth and didn't realize it was a thing until about 5 years ago. I thought it was always the thing that you have your baby at a birthing center or hospital so this is relatively new to me. However, here's the thing about the study: The test sample was taken out of a single year in Oregon. Given that small bit of information, it's hard to measure the rest of the country on the sample alone. However, I can kind of see the risks in general given that out of hospital births are limited in resources. I just wish the sample was much larger than the state of Oregon and more than a year.

True, although that does not de-validate the study or the Methods. Many epidemiological studies are from confined regions, and thought to represent a population. I'll give an example: the entire world uses a risk score to estimate future cardiovascular risk that was based on an epidemiological study done in a small city in Massachusetts (Framingham). Tiny city, robust results, worldwide widespread use since the 1970s.

Which is also true and I agree on all of this.

That Framingham study is such an interesting read, especially for how old it is. My degree is Kinesiology, which is typically used as a undergrad for either med/PA, PT or AT, so we did a lot of exercise prescription. My favorite professor does his research on stress and hypertension/CVD in state troopers so we heard about Farmingham a lot

AnnikaD20 · January 2016

cmjenkies said:

As hard as I try to be open minded, if there is anything I feel judgey about in the world of 'mommy wars'.. it's home birthing. I find it to be misguided and a bit irresponsible. Women always say "we were born to do this, it's in our DNA, this is what our ancestors did" so on and so forth. You know what else our ancestors did? Died in childbirth, and lost children, regularly. With advances in modern medicine, infant and maternal mortality rates are so incredibly low. Even if you are anti-intervention, the what ifs of labor and delivery are too much to gamble with. There are ways to have your ideal birth in the approriate environment. There is no legitimate argument against the safety of having a legitimate medical backup support plan (preferably on-site). Contrary to semi-popular belief, childbirth is a *medical event* for a reason, not a time for women to be self righteous and holier than thou know it alls. We may know our bodies, but when it comes to possible birth complications or post birth complications, there are many people who are more qualified to direct those situations and save our lives. I can't save myself from a uterine hemorrhage. I didn't have one the first time, but who knows what could possibly come. It's just not worth it. Never say never. *This may be a UO. Steps off soapbox.* Edited to add: I don't intend to say that mothers who choose this route are idiots or are all "self righteous holier than thou know it alls." This just describes a particular couple of people in my mind and some of the tones of boards I've read in the past from members of this camp. I just truly do not understand the rationale behind such a decision in today's world.

Thank God for modern medicine. Thank God I wasn't at home 20min from care with my first birth.

I hemorrhaged. My birth was medically uneventful, and my post partum bleeding was within the normal range, and then surprise! 8 hours after my son was born, blood everywhere. If I had a home birth, I'm sure all my labor support people would have gone home by then. But I was in a hospital room, and I pushed the call button, and I had a team of five doctors and nurses in my room within minutes. They got the bleeding to stop, I got a transfusion, and I lived to tell the tale.

As far as which environment I can relax more in, it's the one with trained medical staff across the hall.

spicedice · January 2016

The study was done in Oregon?! How did I miss this! I know a lot of moms who are opting for a home birth, and I LIVE IN OREGON. Those numbers terrify me:

thaisac1 · January 2016

fbanke42 said:
The study was done in Oregon?! How did I miss this! I know a lot of moms who are opting for a home birth, and I LIVE IN OREGON. Those numbers terrify me:

This is very very recent data @fbanke42 . It literally just got published.

RoseShadow873 · January 2016

It is interesting but I'm not quite sure how much this should worry people since it sounds like the deaths are still very rare in both cases with small numbers like 1.8 deaths out of 1000 for hospital and 3.9 out of 1000 for non-hospital and they said they didn't have statistical significance. The percentages make it sound like a huge difference. But I never had any interest in home birth anyway.

thaisac1 · January 2016

RoseShadow873 said:
It is interesting but I'm not quite sure how much this should worry people since it sounds like the deaths are still very rare in both cases with small numbers like 1.8 deaths out of 1000 for hospital and 3.9 out of 1000 for non-hospital and they said they didn't have statistical significance. The percentages make it sound like a huge difference. But I never had any interest in home birth anyway.

Absolutely correct that mortality rates were low in both arms (thank God!!!!). Although these are the kind of numbers we deal with populational studies and clinical trials nowadays. You should see some of the contemporary cardiovascular clinical trials comparing drug x to y; the absolute difference in outcome is usually less than 1%, but given the huge sample sizes it reaches statistical significance so everyone goes hooray about it (and of course the relative risk reduction rather than the absolute risk reduction gets quoted everywhere).

Back to this study, reading the abstract again I was confused as to why the adjusted odds ratio was statistically significant (95% confidence interval did not cross 1.0), but the adjusted risk difference wasn't (95% CI crossed 1.0). I will have to read the full paper, which I can't do right now as I'm on vacation without access to my university library. I will read it in full upon my return.

helleebellee · January 2016

I considered home birth with my 5th, but I live in a small community and the only midwife for 3 hours in any direction is bat shit crazy. I ended up with fifth disease, so it was probably better I stayed with my OB. Now, since being diagnosed with a blood clotting disorder and needing daily lovenox injections, I wouldn't even consider a home birth. Plus, I'm kind of in love with epidurals...

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