Thursday, August 06, 2009

Home birth news and articles

The blog has been quieter than usual--not from a lack of things to write about, but from an overwhelming number of ideas spinning around in my mind. So it's time to condense. In this post, I'm including links and some brief excerpts from several articles and posts and news about home birth.

Judith Lothian's guest post at Science & Sensibility: “Being Safe”: Making the Decision to Have a Planned Home Birth discusses, among other things, her recent research on women's experiences of home birth in the US. She will present her findings at the 2009 Lamaze Conference in Orlando:
Many of the findings of the research surprised me. Women made their decision to have a planned home birth before becoming pregnant, early in the pregnancy, or sometimes as late as 30 weeks into the pregnancy. I was surprised that all of the women described themselves as “mainstream”. They all wanted a natural birth. All the women came to believe that “intervention intensive” maternity care increased risk for them and their babies. They valued the personal relationship with their midwife and believed that this relationship increased safety. They believed they could manage the work of labor more easily and more safely in their own homes. They all expressed confidence that a hospital and skilled physician care were available if needed. ‘Being Safe’ emerged as the theme that captured the essence of women’s decision to plan a home birth. In stark contrast to the current thinking, that birth is safer in hospitals under the care of an obstetrician, these women believe that giving birth at home is safer for them and their babies.

In a powerful way, the findings suggest that we need to look closely at the meaning of safety for women, and whether women and their babies are indeed safe in the current system.
Her findings are remarkably similar to the ones I and my coauthors found in our article Staying Home to Give Birth: Why Women in the United States Choose Home Birth. From the article's abstract:
The most common reasons given for wanting to birth at home were: 1) safety (n = 38); 2) avoidance of unnecessary medical interventions common in hospital births (n = 38); 3) previous negative hospital experience (n = 37); 4) more control (n = 35); and 5) comfortable, familiar environment (n = 30). Another dominant theme was women's trust in the birth process (n = 25). Women equated medical intervention with reduced safety and trusted their bodies' inherent ability to give birth without interference.
Jennifer Block wrote a fascinating and sometimes quite funny article about The Birth Wars: Who's Really Winning the Homebirth Debate? She argues that beyond the vitriolic insults that each side often hurls at each other (home birth is putting your baby at risk and is a selfish choice the mother makes just for "the experience" coming from one side and doctors and hospitals are evil places that injure mothers and babies just to make money coming from the other). She includes more about Melissa Cheyney's research and an example of birth telephone that Cheyney investigated that turned out to be totally fabricated. Cheyney commented:
What we found is that the animosity is so high between midwives and obstetricians that all kinds of rumors spread that are unsubstantiated. A woman and her midwife would transport for something relatively benign, and three or fourOBs away, the story was that the baby came in half-dead. You know that game Telephone? That's the folklore, that's what becomes the institutional memory.
Jennifer Block dedicated several paragraphs to explaining the Dr. Amy phenomenon. Sorry all you conspiracy theorists out there--Dr. Amy is in fact a real person, not an online avatar paid for by theACOG. Block explains Dr. Amy's mission and talks about her face-to-face meeting with her:
"The most important piece of information that every woman should know about homebirth is that all the existing scientific evidence to date shows that it has an increased risk of preventable neonatal death," she wrote on "Even the studies that claim to show thathomebirth is as safe as hospital birth, actually show the opposite." This is a typical Tuteur declarative. She has read the data and done her own calculations, and she believes a different number than the one that was peer-reviewed. This is usually challenged by several readers or activists, some of whom have been summoned like a volunteer fire department to respond. A "debate" then ensues, in whichTuteur charges that the study's authors are, simply, wrong. Then there's the name-calling. The researchers, which she often names, are "biased," pulling a "bait-and-switch," and women are falling for it. "I have written repeatedly about the fact that whilehomebirth advocates claim to be educated . . . they are easily duped because they lack the most basic knowledge about science, statistics and childbirth itself," she writes.

Then there's the name-calling. So omnipresent has Dr. Amy been on the boards that she began to take on a mythical status among the home birth community. Some activists believed she wasn't real, that her picture and bio were fake, that she was a mere avatar for some sort of undergroundACOG propaganda machine (rumors live on all sides).

But "Dr. Amy" is real. I sat with her, face to face, for nearly three hours at a Starbucks off Route 1 south of Boston a couple years ago. She is not a researcher, not an epidemiologist, and probably not onanyone's payroll; she is an obstetrician-gynecologist who left private practice more than a decade ago because, she told me, she'd had it withHMOs and wanted to spend more time with her four kids (she let her license lapse in 2003, according to the Massachusetts Board of Medicine). And for some reason, which I never quite got to the bottom of, she believes in every cell that Home Birth Kills Babies (that's in fact the title of her most recent post on her new site, The Skeptical OB), and no amount of research evidence will convince her otherwise.
And then there's the problem with the research. Because randomize controlled trials do not, and will not ever, exist for home birth vs. hospital birth, those opposed to home birth will continue to insist that the practice is not safe, despite the many observational studies that indicate it is likely a reasonable choice with many benefits for both mothers and babies:
...if the only research that will satisfy those with authority and power is research that is unfeasible, the controversy will never be resolved. There could be 20 more large, observational studies that come to the same conclusion as those that already exist, but they still wouldn't be randomized controlled trials. The home birth advocates would continue to say "The research proves it's safe!" and the American medical establishment would continue to say "The research isn't good enough!"
Jennifer Block also wrote another article Where's the Birth Plan? for RH Reality Check, arguing that incorporating midwifery care into the proposed national health care scheme would have both financial and health benefits.
Compared to healthy women who get standard obstetric care and deliver on high-tech labor and delivery wards, women with low-risk pregnancies who get care with a midwife and deliver in birth centers or even in their own homes, benefit from a five-fold decrease in the chance of a cesarean delivery, more success with breastfeeding, and less likelihood that their baby will be born too early or end up in intensive care. And all of this for a fraction of the cost of the statusquo.

A new economic analysis forecasts savings of $9.1 billion per year if 10 percent of women planned to deliver out of hospital with midwives. (Right now, just one percent do). If America is serious about reform, midwifery advocates are saying, "Hey, how about us?"
Childbirth has been compared to various other life experiences and situations, from running a marathon to having sex to going to the bathroom. In Restaurant Wars and Birth Wars, Sheridan of Enjoybirth analogizes birth choices, and the ACOG's opposition to home birth specifically, to the choice between eating out or cooking at home. I suspect her post is a response to Jennifer Block's article The Birth Wars. An excerpt:
Imagine the year is 2035. People rarely cook at home anymore for a few different reasons. They have gotten too busy and because of subsidies from the food industry eating at a restaurant is less expensive. They actually pay more out of pocket to eat at home. Many people look back and remember, “People actually prepared meals AT HOME! It is amazing that they were willing to go through all that time and energy and that so many survived.”

There are of course a few “natural” people who still eat at home. There is a renewed interest in examining this practice, when a celebrity makes a movie called The Business of Eating Out, examining the risks of doing so and reminding parents about the option of eating at home.
This next one isn't exactly news, but a Medline/Reuters recap of the recent Dutch home birth study. From Home Births Can Be as Safe as Hospital Births in Low-Risk Women:
Intrapartum death:
Home: 0.03% vs. Hospital: 0.04%
Intrapartum and neonatal death within 24 hours of birth:
Home: 0.05% vs. Hospital: 0.05%
Intrapartum and neonatal death within 7 days:
Home: 0.06% vs. Hospital: 0.07%
Neonatal admission to an intensive care unit:
Home: 0.17% vs. Hospital: 0.20%

Jill of Keyboard Revolutionary argues that we shouldn't have to say no when giving birth:
We have to write out a detailed birth plan, make our doctors read it, and then cross our fingers that they will actually listen to our wishes. We have to bring a "support person" or five to the hospital who are also well-versed in our birth plan to help us fight off the marauding staff....I often hear this in response to women who relate their tales of hospital birth trauma. "You can always say no. You should have said no." YOU SHOULDN'T HAVE TO. If you are in the "care" of someone that you need to threaten with lawsuits in order to make them listen, you need to take a step back and do some serious reevaluating.
Briefly noted:
Read about Cindy Crawford, Christy Turlington And Other Celebrity Homebirths
Sazz argues that outlawing home birth will hurt hospital birthers too and features a comment about losing normal birth skills

State & local home birth news: reports about Home delivery: Families opt to have children at home
Fort Wayne Journal Gazette: For some, life begins at home
News OK: Giving birth at home remains popular with many Oklahoma mothers
WCCO: Home Births On The Rise, But Are They Safe?
Colorado's 9News: Woman gives birth in her home - alone

From the UK
For the BBC, Cathy Warwick of the Royal College of Midwives recommends: 'Don't tell women how to give birth'
Also by Cathy Warwick for the Tribune: Seismic shift needed on homebirths
London Financial Times: Baby Talk


  1. When I first read the (very clever) Restaurant Wars post a few days ago, I kept thinking about how the allegory would work for future procreation. My first thought was “Remember when babies were made by having sex at home in a non-sterile environment? Gross!”


    “Can you believe that people used to attach emotional significance to the act of conceiving a baby? Fools! Selfish! Don’t they know that this is best left to professionals who can put them in the right positions and monitor the event and give drugs to speed up conception? Because all that matters is that a baby was conceived.”

    (Of course, there are women who benefit everyday from fertility treatments, which has nothing to do with this allegory)

  2. From the Fort Wayne story "For some life begins at home", Laura Gilbert was my backup midwife. Nice article. I like seeing more reporting on homebirths as done by "normal" people, not just "freaky hippies". Someday homebirth will be normalized in our society.

  3. I actually had an interesting response to my Restaurant Wars post.

    "As someone who cooks as an art and a love, I think that this makes quite a compelling case AGAINST homebirth. So strong, in fact, that I am reconsidering my position. Think about this: if no one cooks at home, then it is highly unlikely that people would have reasonably equipped kitchens (refrigeration, stoves) or know the safe cooking skills. As a cook, I would be horrified if people undertook to cook at home under these circumstances and would, indeed, consider the parents reckless and negligent. And this scenario is not farfetched, btw. During the Industrial Revolution, most middle or lower class people did not have kitchens and ate in pubs or assembled their meals from various specialists precisely because it was cheaper and safer. This analogy hit home for me, and my faith in homebirth has been shaken dramatically."

    I had to think a bit, but then came up with this response.

    "If I lived in that future and I wanted to cook at home. I would find someone who cooks as an art and a love. (maybe you!) I ask you to come and help me cook at home!

    That is exactly what a midwife is. Someone who helps others birth as an art and love. They are specially trained, have the proper tools, etc. Moms ask them to come and help them birth at home!"

  4. I've said it before -- it's not the risks of homebirth but the silly state of affairs (in PA at least) that make homebirth not an option for me. I wouldn't want to put a midwife in a vulnerable position due to the risks in ANY birth -- hospital, birth center, or home -- but due to the laws in PA it could be risky to the midwife to transfer a patient. Especially with a vbac, it is just not for me.

    So for me... I chose a hospital birth with a great midwife. As recently as last Tuesday (yay me!!!).

    I don't think it's anything to do with trusting birth or not, but rather trusting DAs who want to have a big flashy case in the headlines.

  5. Thanks for so much info, Rixa! You rock.

  6. Late to the party here as usual.

    I continue to be saddened by the number of people that are 'afraid' of homebirth. I gave birth to my 10 pound 4 oz baby at home. Midwife almost missed it -- a precipitous labour.

    The main comments I get are "you are lucky nothing happened", or "You ended up with a section right" (no, 45 minute labor,woulda been shorter but I was waiting for the tub to fill up) or the ubiquitous, "How many stitches?" (none)

    I know --from several L&D nurses that it is HIGHLY unlikely that I would have been "allowed" to give birth vaginally in a local hospital. Of course, I like to respond with, "and um, they would have had time??? " I likely wouldn't have MADE it to the hospital, and it is only 15 minutes away!

    Few trust birth. And fewer trust women. For my part, I don't trust doctors or hospitals to EVER have my best interests at heart at this point. What is best for me is always going to be coloured by their financial interests. While my own choices may have a financial bias in there somewhere, at least its mine.


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