3 posts tagged “midwives”

In short, low-risk home births had outcomes quite similar to low-risk hospital births, in terms of safety. The big difference is the rate of medical interventions: women giving birth in hospitals had much higher rates of episiotomy, forceps/vacuum delivery, and cesarean surgeries than women who planned home births.

So, midwives attending home births achieved the same safety rates as doctors and midwives attending hospital births, but without all the interventions.

Outcomes of planned home births with certified professional midwives: large prospective study in North America

Objective To evaluate the safety of home births in North America involving direct entry midwives, in jurisdictions where the practice is not well integrated into the healthcare system.

Setting All home births involving certified professional midwives across the United States (98% of cohort) and Canada, 2000.

Participants All 5418 women expecting to deliver in 2000 supported by midwives with a common certification and who planned to deliver at home when labour began.

Main outcome measures Intrapartum and neonatal mortality, perinatal transfer to hospital care, medical intervention during labour, breast feeding, and maternal satisfaction.

Results 655 (12.1%) women who intended to deliver at home when labour began were transferred to hospital. Medical intervention rates included epidural (4.7%), episiotomy (2.1%), forceps (1.0%), vacuum extraction (0.6%), and caesarean section (3.7%); these rates were substantially lower than for low risk US women having hospital births. The intrapartum and neonatal mortality among women considered at low risk at start of labour, excluding deaths concerning life threatening congenital anomalies, was 1.7 deaths per 1000 planned home births, similar to risks in other studies of low risk home and hospital births in North America. No mothers died. No discrepancies were found for perinatal outcomes independently validated.

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.

Ok, people. Prepare to be shocked. And awed. Great Britain's equivalent to the American College of Obstetricians and Gynecologists (ACOG), the Royal College of Obstetricians and Gynecologists (RCOG), issued a joint statement with the Royal College of Midwives explaining their position on home births.

Their position couldn't be any different from ACOG's.

Here's the full statement. The summary alone will blow your socks off.

Ahem. They issued a joint statement with midwives. See ACOG? Midwives are NOT the enemy.

RCOG and RCM then discuss not only the physical benefits to home birthing (due to lower levels of significant interventions like induction, augmentation, perineal trauma and surgical delivery), but acknowledge that the process of birth -- and its resulting emotional and psychological effects -- are quite important and should be considered when studying childbirth, whether in a hospital or at home.

They honestly state the risks and complications of birthing at home (all of which could also occur in a hospital). They conclude that transfer to a nearby hospital should be a backup plan, if serious complications with the mother or baby occur. They also recognize that some mothers choose to transfer for non-critical reasons, such as epidural anesthesia.

When discussing how to achieve best practices for childbirth, they state: "Both the RCM and the RCOG believe that to achieve best practice within home birth services it is necessary that organisations’ systems and structures are built to fully support this service. These will include developing a shared philosophy, fostering a service culture of reciprocal valuing of all birth environments. Comprehensive involvement by local multidisciplinary teams and users to underpin home birth practices within a clinical governance framework results in a quality service which demonstrates commitment to supporting women in their choices." (Emphasis added by me.)

They further flesh this out by placing birthing decisions into the hands of mothers and encourage care providers to give women unbiased information on the risks and benefits of home birth. They also encourage fathers to be involved in the decision-making and childbirth processes!

This next quote made me blink. Then I read it again to make sure I had read it correctly the first time: "It is acknowledged that there are no known risk assessment tools which have an effective predictive value concerning outcomes in the antenatal period and labour." Hallelujah! Finally, doctors who admit they have no way of predicting the future, especially the future of a woman's pregnancy and birth experience. When was the last time you heard ACOG admit it didn't know something?

RCOG and RCM conclude with recommendations about continuity of care, the importance of communication during the antenatal period, and the necessary service structures that should be in place to handle unexpected emergencies. They encourage employers and government entities to be supportive of home births and warn that discriminatory practices based on place of birth are harmful to both women's health and children's development.

Their conclusion? That while home births may not be suitable for every woman or preferred by most women, they are perfectly acceptable and safe for women at low risk of complications.

My only quibble with this? They don't explain what "low risk of complications" means. That simple phrase leaves an open door for unscrupulous care providers to provide biased information on the risks and benefits of both home and hospital births or to coerce a mother into a model of care she may not be comfortable with.

For shame, ACOG. For shame.

The American College of Obstetricians and Gynecologists' Statement on Home Births

I find their statement offensive in many ways. I'll briefly address two points, then let you read more from the links below. First, their opinion is just plain insulting to midwives. They imply that monitoring of the mother and baby do not occur at home births (not true), and then state that the only midwives who have any business delivering babies are CNMs. Direct-entry and other "lay" midwives are simply slapped in the face and called unqualified to attend births. All the CNMs I know don't believe this about their non-CNM counterparts.

Second, they insult women by implying that they are not capable to make an intelligent decision regarding the birth of their baby. ACOG says it respects a woman's right to make her own decision, but then tells women that deciding on a homebirth could kill her baby. Frankly, I'm more scared of giving birth in a hospital than I am at home. Hospitals with obstetric surgeons are fantastic for emegencies, but are by no means necessary for the majority of births. ACOG also insults women by stating that the rising C-section rate is due to the increase in old, fat women becoming pregnant. While maternal age, obesity and diabetes are important factors to consider, I argue that a greater cause for the rising rate of C-sections are doctors who continually insist on inducing, augmenting and interfering with a woman's labor process.

I could write an entire book replying to this, but so many eloquent women have already responded. I'll list a few below.

Mommy Blawg responds to several points, and ends her post with a challenge to ACOG.

True Birth analyzes ACOG's statements, then disproves many of them with ACOG's own papers, statistical facts and just plain common sense.

The True Face of Birth responds with what could be her own position paper. Good points here! She also provides an extensive list of other responses to ACOG's statement.

Pushed Birth pushes back and shames ACOG for playing dirty, and attempting to manipulate mothers while discrediting midwifery in general.

ICAN (International Cesarean Awareness Network) responds, encouraging women to make their own informed decision based on facts and evidence-based research.

While I agree with all these women's statements on home births, VBACs and natural childbirth, I do not necessarily agree with everything else posted on their blogs. You've been warned.