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@Arden: agreed!!! In my research Europe has a track record for amazing natural and home births and over all healthier babies. I'm totally jealous. It's an eyebrow raiser for them that in the US 90% of moms give birth in hospitals (I just threw that number out there, I have no idea what the percentage is so correct me but it sure seems like that many!)
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@runsyellowlites: the vbac factor is definitely something I have not thought about. It is great to read the perspective of someone who had both experiences, home birth and hospital!
I definitely think the whole attention factor is big... While I delivered at a huge hospital that has every kind of doctor in the building 24/7, all the OBs have several laboring patients all at once. I believe midwives only have one or two at a time? That being said, my hospital is known for their postpartum nurses so there was someone to check on me all the time.
just a quick thought about the whole "stalled labor" thing. I'm thinking it definitely makes sense, but a friend of mine labored at home for 48 hours (she went to the hospital and she was 3 cm, and pretty much forced them to let her go home instead of getting admitted and put on pitocin) and never got past 6 cm. She finally agreed to an epidural since she hadn't slept in 2 days, fell asleep, and 15 minutes later was being shaken awake because she was fully dilated! I think her body was fighting the pain so hard and she wasn't relaxing enough to let her cervix dilate.
Every body is different
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http://usatoday30.usatoday.com/news/health/2009-09-03-midwife-home-birth_N.htm?csp=N009
Ok, so that article also clearly states: “The authors acknowledge that "self-selection" could have skewed the study results, in that women who prefer home deliveries tend to be healthier and otherwise more fit to have a home birth.”
Hospitals have to deal with the gamut of maternal and fetal issues; from mothers who are in great health and have had excellent prenatal care, to mothers who are high on crack while delivering and have had no prenatal care. Places like “The Farm” carefully screen and select women to accept as “patients” (not sure of the correct term they would use). They don’t deal with risky women or risky pregnancies. Unless studies are comparing strictly kind-for-kind; they are really not particularly valid.
Also, Europe’s better rates of infant and maternal mortality might have something to do with the fact that every woman has access to prenatal care, regardless of health insurance status.
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@mrs. wagon: The vbac aspect was just recently brought up by a friend of mine and TBH I had NEVER thought about it like that. It really made me think about how ready a hospital really is!
And I do totally agree that every woman is different when birthing. I had an INCREDIBLY looooooooooong labor both times! 17 hrs at home with DS to only be 2 cm when admitted and even longer with DD: 5 nights of "false labor" contracting from 1 a.m. to 7 a.m and then 37 hours to get to FOUR cm! ARGH! The only reason I was able to make it (IMO) is because I had gotten alot of tips from other natural moms previous "mistakes" so I rested, ate, and didn't push my labor or get discouraged when I had been contracting for 30 hours to only dilate 1 cm. We (the moms on this natural board) actually made a recent thread about "Mistakes Made" to try and help other moms AND ourselves to be as successful as we can be. With DS though, I went alot like your friend only I didn't get a vaginal birth but then "need" a cesarean. Boo!
Oh well, every birth and every mom is different and we adjust and learn where we can, right?! =)
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@runsyellowlites: omg, GOD BLESS YOU for going through those two deliveries!!! Goodness gracious. 37 hours and only 4 cm!!!! I would have ripped someone's head off!! You are superwoman.
@yoursilverlining: excellent point.
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@yoursilverlining: Oooh I totally agree about the access to healthcare making a HUGE difference is perinatal outcome! BUT, not so sure about the healthier & more fit homebirth moms OR the screening at the farm. I gained like 65lb and hadn't worked out since before I had DS some EIGHT years ago. lol Many of the moms I know in my area that have homebirthed are along the same lines as I was. Also, the farm accepts vbac, breech, and multiples births, things that in most cases are automatic cesareans in a hospital setting.... ultimately making hospitals more selective in who is allowed to have/attempt a vaginal birth IMO.
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I think that there are a lot of women who are passionate about advocating natural and/or home births because they wish they'd had the knowledge sooner. I agree that sometimes it can come across as "judgmental" to those that are choosing hospital/medicated births, but I really believe that the intention is usually to help educate more women about their options. I've talked to a lot of friends with kids that said they never even considered a home birth -- didn't know it was even an option in this day and time. That makes me so sad, and makes me want to do everything I can to make sure that the people I love have all the facts before they choose their birthing path.
On a personal level, I agree with a couple of the other posters on here that, as an advocate for the natural birthing process, I feel incredibly judged for my opinions. "Why would you want to go through all that pain when you don't have to??" I feel like there's judgment on BOTH sides, but it's the medicated birth advocates that pitch a fit about it, most often.
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@mrs. wagon: I slept as much as I could early on which made such a huge difference!.. My first birth I walked my butt off to try and bring on more contractions, it totally came back to bite me. =/
My birthstory is posted on the boards if you want a suspenseful read! =)
http://boards.hellobee.com/topic/my-completely-unmedicated-hbac-turned-hospital-birth-almost-cesarean -
@allison: "I've talked to a lot of friends with kids that said they never even considered a home birth -- didn't know it was even an option in this day and time."
THIS!
With my first I SHOULD have switched to a midwife and had a homebirth but had NO clue it was an option. My friend, who did receive this knowledge before she delivered switched & had a successful unmedicated birth... I on the other hand ended up with a very unnecessary cesarean. Would I have still needed intervention? Maybe, but being able to exercise my right to choose my birth would've helped tons with me feeling taken advantage of & bullied into something I didn't want.
Those feelings are what I'm passionate about no mom EVER having to feel so being well informed is important to me!
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@Arden, I read the study a year or so ago. I don't remember where I came across it, but it said that birth mortality rates are 2-3 times higher than hospital rates and babies were more likely to die during labor, which is unheard of in the hospital (b/c they go to c-section immediately)....it mentioned how not all states require their midwives to provide information on the births, so the information that is given is often skewed. And something about how they don't often carry liability insurance in some states. It was so long ago, only those few things stuck out to me.
This article mentioned a few of the things, in addition to the varying licensing that midwives can have: http://www.ama-assn.org/amednews/2012/02/13/prsa0213.htm but it wasn't the same study I read last year. I'll see if I can find it, but my internet is pretty spotty today.
I realize babies die in hospitals, too, but I do believe that if they died in a hospital, there was probably nothing to save them, unless you had a really crappy doctor. Then you have a malpractice suit on your hands.
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@runsyellowlites: omg how did I miss this?? I love a good birth story... especially suspenseful ones... going to read it NOW!!!
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@runsyellowlites: Yes; women are screened at the Farm.
As confirmed in this article given by Ina May Gaskin:“Of course, comparing the Farm to hospitals is of limited value. Many hospitals deliver at least as many babies in a year as the Farm midwives have delivered in three decades. Women who give birth at the Farm are self-selected, and midwives screen them further, eliminating, for instance, women with complicated medical histories. Hospitals would undoubtedly have better outcomes if all pregnant women arrived in excellent health.”
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@allison: I wonder who these medicated birth advocates are? I chose to have an epidural, but it's certainly not something I talk at length about (well, certainly not IRL anyway). In fact, I don't think I've come across anyone who is stridently pro-epidural. I have come across people who wish to have their choice respected, provided it is a choice that is not harming mother or baby.
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@yoursilverlining: Sorry for not being clear.... I do understand they screen, as any midwife out of hospital or birth center would BUT how the pregnancy presents itself like in cases of breech, vbac, & multiples they are still open to allow these types of vaginal births whereas many hospitals do not. THAT is what I meant.
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@meredithNYC: acquaintances of mine (and FB friends of friends) have said things like "get the epidural as soon as they'll let you!" in a joking sort of way. Like, of course you're going to get the drugs, yak yak yak! What idiot wouldn't? It's really offensive to me because I have done so much research throughout my pregnancy to make the decisions that I have made. To see the use of drugs during pregnancy/labor reduced to a joke is really unfortunate. And also, like I said before, it just makes me sad. I'm really glad to know that there are people that are respectful of the natural birthing process, even though they choose other methods for themselves.
I do realize that this thread is supposed to be about home births, not just unmedicated ones. I'm sorry if I've gone slightly off-topic!
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@blackbird: Sounds like you're referring to the Wax study.
http://www.scienceandsensibility.org/?tag=wax-et-al-study-on-homebirth-vs-hospital-birth -
@runsyellowlites: Ah, I see what you mean!
They do allow VBAC and breech babies; but only if they have already qualified those pregnancies are healthy, or whatever criteria is used in the screening process. So, in that way; it's a little similar to a hospital - not everyone who wants a VBAC would be accepted to have one there.It’s also noted in that article that Ina May (who I know is praised a lot!) actually has no formal medical training, and neither do many of her midwives. So while some/many/most(?) midwives definitely have formal medical training; there are obviously ones who do not and who still practice and hold themselves out to be experts. Women just need to know that they need to research the credentials of non-OB/MD/licensed doctors, and not assume they actually have medical training.
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In my state, you don't even need a degree to be a certified professional midwife! Just a high school diploma and a training program/apprenticeship.
Now, I do know we have CNMs, who have nursing degrees and post graduate training, but they don't do home births here. I equate them to the nurse practitioners I see all the time.
Wax study doesn't quite sound familiar, but it looks like that's some of the info I had heard.
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@Minnie_Girl: @blackbird: My understanding is that the Wax study was invalidated. Let me see if I can find the study in which I read that.....
Found it, but don't think I can link, because I'm only able to access full text because I'm on a university network. It's a meta-analysis. Johnson, Kenneth C. International Data Demonstrate Home Birth Safety. American Journal of Obstetrics and Gynecology. (April 2011), 204 (4), pg. e16-e17
"The metaanalysis by Wax et al 1 resulted in misleading results and conclusions about the safety of home birth.
The authors appropriately found no difference in perinatal mortality rates between planned home and planned hospital births when they included all of the selected studies, which included the very large, high-quality Dutch study that represented >90% of the available data. 2
However, when they summarized the risk for neonatal death separately, they chose to look only at combined early (0-6 days) and late (7-28 days) neonatal deaths. Because the Dutch study reported only on early neonatal deaths, Wax et al excluded it, thus ignoring neonatal mortality rates for 90% of the available home birth data. If early neonatal deaths had been examined separately, the Dutch study would have been included, and the conclusion would have been that the risk of early neonatal death in home births was no different than that for low-risk hospital births.
Across perinatal/neonatal studies in high resource countries, 65% to 80% of neonatal deaths consistently occur in the first 7 days. 3 There is no reason to expect that the rate of late neonatal mortality in the Dutch study would carry any difference in safety than the early neonatal mortality rates, had it been reported by or requested from the Dutch researchers.
Furthermore, when the high-quality Dutch study 2 is excluded from the neonatal analysis, the American study by Pang et al 4 consequently becomes the largest study that contributed to the neonatal risk estimate. Based on birth certificate records, this study does not meet the quality criteria of more sophisticated approaches of home birth research that, since the 1980s, have required home/hospital birth comparisons to be able to stratify explicitly for whether the home births in the studies were planned and had a midwife or physician in attendance, 5 as the Dutch study does.
Leaving out the study by Pang et al 4 or including the Dutch study 2 would have meant that the authors could not have jumped to the conclusion that less medical intervention or home births create higher neonatal risk. Rather, the more accurate conclusion of the metaanalysis would read, “planned home birth produces the same intrapartum and neonatal outcomes as planned hospital birth with far less intervention.” The international media may not have picked it up so enthusiastically, but the public would not have been misled either."
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ah ok. Well it was definitely impactful b/c that's all I've remembered from it over the past year! I did a little more searching and came across this article: http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Obstetric_Practice/Planned_Home_Birth which DOES site the Wax study but also a slew of others. It seems that there lacks a good, consistent study. They're all kind of skewed one way or another. The article specifically states there is a lack of reliable data.
Hopefully the women who choose to go about this route really do their investigative work and don't just go with it based on the one movie they saw =P. Which i see peeves a lot of other people, too, ha!
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@runsyellowlites: where is that "mistakes made" thread? i'd love to read up about past experiences! thanks for being so open and helpful!
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@birdofafeather: It's on a natural birth group that I pretty much called "home" while I was pregnant. Going unmedicatd was the least of the backlash I got having an hbac so it was really nice to be in a group of like-minded ladies!
Here's the link for the thread:
http://babybump.alt12.com/community/groups/139-natural-birth/posts/2388958-making-mistakesMy favorite part for myself was being able to see how I learned from my first experience to my next & how next time will be even smoother! =)
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@blackbird: I hope that here in the future we get more reliable information regarding homebirth!
I didn't have alot of options when choosing my midwife as I was either a homebirth with her (the only MW in the area at the time) or an automatic erc.
What I was happy to find out though was her amazing STATS, which I think are important regardless of the kind of provider you choose. She's a CPM with 20 years experience, 800+ births, never had to use CPR on a momma or baby but has used O2 on one baby (had down syndrome & just needed a little help), only seen ONE 4th degree tear, which she has since learned how to properly suture (she had an obgyn she worked with do it), 1 mom that had CPD & truly couldn't push her baby out, has a very small transfer rate, and "never risks her mommas or babies". Figured there weren't many entire practices that could compare so she was a good fit! lol
Definitely knowing how to interview a provider is important for all of us, especially in cases where we want something not considered the "norm". =)
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Yes well it certainly isn't my intent to spread unreliable info. It just goes to show that it's definitely out there. Home births aren't very uncommon in the US.
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@blackbird: They account for less than 1% of the births in the USA, so I would call that uncommon.
In other countries (especially in Europe) home birth account for anywhere from 20% - 75% of births, which I would call common. -
@Arden: Interesting!
I actually found this though saying that the rates are rising incredibly fast though
Births taking place outside of the traditional hospital setting increased 29 percent between 2004 and 2009, from 0.56 percent of all births to 0.72 percent — almost 30,000 births — according to a new report from the U.S. Centers for Disease Control and Prevention.
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Derp I meant aren't common. I knew they were <1%
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For those questioning the safety of home birth, I just ran across this study from the Netherlands which found no difference in either maternal or infant death rates between hospital or home births, among 530,000 births. Very interesting study.
I'd especially like to point out that this study was conducted among low-risk women only - high risk pregnancies were excluded from the study on BOTH sides, so you can be sure that this is an accurate finding and not skewed from "self-selection", as some have mentioned earlier in this thread.
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@blackbird: I don't want to be annoying by ressurecting an old thread just to argue, but I seem to have missed a sentence in your previous comment, and I really feel the need to address your statement below.
"...babies were more likely to die during labor, which is unheard of in the hospital (b/c they go to c-section immediately)".
That is completely inaccurate, wildly so. Babies die every day in hospital settings - and particularly in the USA, where infant mortality rates are some of the highest in the industrialized world.
There were 2,437,163 infant deaths in America in 2009, the vast majority of which were in a hospital setting (since that's where 99% of American women give birth).Other countries where home birthing is more common and where the c-section rates are much lower have much better outcomes. http://www.huffingtonpost.com/howard-steven-friedman/infant-mortality-rate-united-states_b_1620664.html
Clearly, hospital birth does not equal a risk free birth, and c-sections certainly don't. Babies will die, and do die, every day- regardless of whether those births take place at home or at the hospital.
And in reply to your other comment regarding women choosing home birth as a result of watching one movie? I agree. I hope they do more research than just watching a movie.
But keep in mind that you based your entire opinion about the safety of home birth on one study you read years ago and can no longer remember the name of, when there are many more studies that prove just the opposite.It goes both ways - one article, one movie, one study - it's not enough to base an opinion on. Serious issues like this call for real research, and using a "fact" that isn't backed up is walking down a dangerous road towards spreading misinformation.
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