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Homebirth controversy


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  #1  
March 26th, 2013, 01:48 PM
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Anyone who is interested in a discussion of whether or not homebirth is safe, please post here.

This is a continuation of the homebirth discussion that began on the "au natural" thread.

beckiethedoula wrote:
Quote:
Please make sure you have truly "done your research" before stating misinformation as fact.

Please direct me to which of my statements contains misinformation, so that I may research it more carefully.

Last edited by LadyMorgan; March 26th, 2013 at 01:53 PM.
  #2  
March 26th, 2013, 01:52 PM
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You misquoted me. I didn't say that.
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  #3  
March 26th, 2013, 01:53 PM
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apologies to Babybear4; I've corrected the attribution.

Last edited by LadyMorgan; March 26th, 2013 at 01:54 PM. Reason: misspelling
  #4  
March 26th, 2013, 01:55 PM
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For me, personally, I would just be interested in some links to both sides of information on HB.
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  #5  
March 26th, 2013, 02:04 PM
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Quote:
....as it's extremely difficult to obtain accurate numbers and statistics regarding successful home births because in several states the practice of attending a planned home birth as a midwife is illegal and as it's incredibly contradictory with the extensive research that I have done over the last few years....
Here is the link to the Oregon study that I referred to. In Oregon, planned homebirth with a direct-entry midwife is not illegal, and the state specifically collected information about birth outcomes and planned-site-of-birth in order to properly address the question of out-of-hospital safety.

https://olis.leg.state.or.us/liz/201...gDocument/8585
  #6  
March 26th, 2013, 02:05 PM
Keakie's Avatar Learning to walk in faith
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I'd have to do some digging as I stopped most of the research I had been doing once we realized we'd be moving to a place where I would have access to a midwife-operated birth center (which, for the record, I have chosen as opposed to a home birth primarily because this is my first baby - the vast majority of home birth to hospital transfers are first time mothers who panic, and I'm admittedly a slight hypochondria - and so a birth center was a happy medium for me). That said, Shelley, I would happy to send you whatever links I still have laying around. Were you looking for any specific type of information?

ETA: LM - you realize that most statistics from the CDC or AMA are going to be deliberately slanted against home births, right? That these groups have a vested financial interest in keeping birth in the hospital? That the information you've provided is very limited and no extrapolations on the circumstances have been given for any of these situations, and that non-fatal but life-threatening or otherwise significant complications as a result of unnecessary interventions were not included? In addition, one year in one state is a fraction of a sample for home births overall in the developed world.

You also realize that there are plenty of doctors who get all of the right education and training who are still terrible care providers because they treat their patients like cattle, ignore their wishes, make medical decisions based on what's more convenient for their schedules even if it's not ideal for the mother or the baby? I'm sure you would agree with me that it would be unfair to claim that because there are doctors like this who exist, ALL doctors must be like that or ALL hospital births must be traumatic. Midwifery and home birth is no different.

Do you realize that the US is the only western country that does not universally support and encourage home birth? That in Canada, the UK, Australia, the Netherlands, etc. home birth is considered a viable birthing option and is encouraged for low-risk mothers by official medical organizations?

Do you also realize that the nightmarish circumstances that can be fatal during birth (cord prolapse, placental abruption, nuchal cord) are no less of a risk at a hospital than they are at home?
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Last edited by Keakie; March 26th, 2013 at 03:09 PM.
  #7  
March 26th, 2013, 02:06 PM
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Here is a link to a blog by a doula who was initially a proponent of homebirth, and changed her mind, writing about the reasons why she changed her mind:

* What Ifs & Fears are Welcome: A Birth Doula's Take on Home Birth

I would be interested in your links too, keakie.
  #8  
March 26th, 2013, 02:14 PM
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Kayla, nothing in specific. I am considering a home birth because it would eliminate our issue with finding child are during labor and delivery and because the hospital is so close that I can see it from the end of the street.

I think I would be most interested in just hearing about what is and isn't done durin a home birth. As silly as it sounds, one of the things I look forward to most is seeing my contractions on the monitor and I am assuming that is something midwives don't do or have at a home birth.

I am also really worried about an unintentional home birth since my last labor was only 5.5 hours and I don't tend to have any warning that labor is coming on, so I don't have that early labor phase to get myself ready to go. So, it would probably be a good idea to have some knowledge of how that would work, even if I do decide against an intentional home birth.
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  #9  
March 26th, 2013, 02:21 PM
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I'm never sure why this is such a controversial topic.

I suppose home birth should be done just like anything else regarding pregnancy. Err on the side of caution, research the **** out of it and trust your instincts.

I know TONS of women that have done home births and every single one of them says it was the most beautiful, empowering experience of their lives. Would I personally ever do it? No. But I bet if I ever get around to really researching epidurals, I would consider it.

Anyway, I think it's great that so many women these days are giving traditional hospital births the finger and saying "Hey! My body, my baby, my way!" I say, do birth however you WANT... Because if its what someone else wants, you'll just be miserable about it forever.

My ex husbsnd's mom gave birth to all 9 of her children in her own bed with her husband as a "midwife". Baby number 4 was breech and Baby number 6 weighed 11 POUNDS. But everything was all good and she always said that the harder ones were more satisfying.

Again, home birth is not for me. But I don't think it's fair to say its not safe. There are risks with all births, you know? Do what's best for YOU.
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  #10  
March 26th, 2013, 02:31 PM
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I linked it in the other thread, but Giving Birth Naturally has a lot of information about normal labor progression and common misconceptions about the birthing process that, IMO, is relevant to the process of evaluating risks and options. Birth Without Fear is also a great resource for stories and articles regarding home birth.

I would also encourage you to watch "Pregnant in America" and "The Business of Being Born". A lot of fantastic information in those, too. I'm not sure if they're still up, but I originally watched both on Netflix and it's my understanding you could find at least TBoBB online free.

Because it's an easy one to remember, http://www.homebirth.org.uk/ is another great source of information. It's primarily about birthing in the UK as the title would suggest, but most of the information is relevant to midwifery and home birth in other western countries as well.
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  #11  
March 26th, 2013, 02:40 PM
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I had a homebirth with my DS and it was amazing I researched the crap out of it before hand to make sure that what I was doing was 'safe'. In BC, where I live- we chose to either have a midwife or a doctor when we get pregnant and homebrith is completely funded if we chose that. Our system is amazing and midwives are also allowed to deliver in the hospitals. We have a great transfer system which is imperative if a safe homebirth is to happen. Our midwives work directly with the hospitals, so if a client needs to be transfered the midwives are on the phone with the hospitals while we are on the way letting them know what needs to happen when we get there.

I think a lot of people that don't educate themselves about homebirth assume that being in the hospital has no risks itself. This is just one basic major risk, but if you have a hospital birth it increases your chances of a c-section (depending on where you live) to normally at LEAST around 30%. If you have a c-section- it DOUBLES your chance of mortality. I could go on on and on about the risks of delivering in a hospital but thats one major one.

I dont know about the states, but here in BC 2 of the major hospitals closest to me, dont have anethesiologists at the hospital overnight. Meaning if I needed an emergency c-section in the middle of the night, one would need to be paged and it could take 15 mins for them to get there. Which is about how long the drive is from my house to the hospital (less if by ambulance). So just because you are in a hospital doesnt mean you are going to get those emergency services within minutes. Just some food for thought.

Here is a great study that was done in BC with our registered midwives and our system that we have that incorporates home births and hospital births. It shows that PLANNED home births with a registered midwife (and a low risk pregnancy) are just as safe as hospital birth.

Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician


I could talk about this all day if anyone wants more information!
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  #12  
March 26th, 2013, 02:53 PM
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This:

Quote:
However, there is a certification out there for mid-wives that have only a high-school education, and I was alarmed when I learned about that. I did want to bring people's attention to the difference between those two certifications.

There is NO CERTIFICATION in North America for midwifery that only requires a high school education for certification. If you think this is true, please link me to the organization that is handing out these "certifications" willy-nilly so I can report them to MANA and the AMA.

If you are speaking about CPM's or Lay Midwives, you are so incredibly wrong to infer that they "have only a high-school education".
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  #13  
March 26th, 2013, 02:58 PM
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*another thing to note- Again I can only speak for my province- but to become a midwife you need at least a 4 year midwifery degree here. You spend your whole 4 years learning about pregnancy, birth and newborn care. You must attend at least 60 births before you can be registered.

My brother just became a doctor and went to school in the States. He spent 12 weeks total learning about pregnancy and birth and spent 6 weeks on a hospital rotation in the OB/GYN ward. He came out of med school not having delivered one baby.

I dont understand when people feel safer using a doctor than someone who SPECIALIZES in pregnancy/birth/babies. (unless of course its an OB/GYN). Again Im speaking for the system we have here.
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  #14  
March 26th, 2013, 03:00 PM
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My purpose in responding to your original post was not to go out of my way to validate home birth to someone who obviously has a giant bias against it. I don't have the time or the inclination to fight with the internet.

It was to make it clear that other women's birth choices are not for you to judge, criticize, or make assumptions about. Especially here, where we come for kindness, support, and commiseration. Not judgement.

If a woman wants your opinion about her birth choice, she'll ask.
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  #15  
March 26th, 2013, 03:20 PM
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beckiethedoula wrote:

Quote:
There is NO CERTIFICATION in North America for midwifery that only requires a high school education for certification. If you think this is true, please link me to the organization that is handing out these "certifications" willy-nilly so I can report them to MANA and the AMA.
Please refer to the link below. This organization grants a "Certified Professional Midwife" certificate, and their requirement for formal education is limited to "All applicants will be required to submit evidence of a high school diploma or equivalent."

They also have a mentoring requirement for attendance at a certain number of births, so they do not fit the criteria you specify of "only requires a high school education for certification"....however, their requirements are consistent with my statement that "there is a certification out there for mid-wives that have only a high-school education".

http://narm.org/req-updates/
  #16  
March 26th, 2013, 03:20 PM
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beckiethedoula wrote:

Quote:
There is NO CERTIFICATION in North America for midwifery that only requires a high school education for certification. If you think this is true, please link me to the organization that is handing out these "certifications" willy-nilly so I can report them to MANA and the AMA.
Please refer to the link below. This organization grants a "Certified Professional Midwife" certificate, and their requirement for formal education is limited to "All applicants will be required to submit evidence of a high school diploma or equivalent."

They also have a mentoring requirement for attendance at a certain number of births, so they do not fit the criteria you specify of "only requires a high school education for certification"....however, their requirements are consistent with my statement that "there is a certification out there for mid-wives that have only a high-school education".

Updates to CPM Eligibility Requirements | NARM
  #17  
March 26th, 2013, 03:50 PM
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Just going to throw in my 2 cents lol

Women have been having babies since the beginning of time (at least this is what I believe as a christian lol), our bodies were created to to nurture and birth babies. Women have given birth in extremely dirty, un-sterile environments and there were many deaths and complications for the mother. Technology has advanced and the maternal mortality rate has decreased dramatically, as well as many birth defects (ie: spina bifida thanks to folic acid awareness, etc) and infant mortality rates. You can achieve a sterile, safe environment in your own home too. And you still get prenatals to take, etc. The technology applied in hospitals can be used in the home as well (with the exception of an OR obviously).

When in a hospital environment doctors *typically - in my own personal experience* do not put a lot of stock into mother's intuition and things may still be overlooked. I had a partial placental abruption and my doctor argued and argued that the pain I was feeling with my 4th child was "false labor". When I started bleeding profusely later that evening and sped into the ER I was dialated to 7 cm. He apologized to me the next day and admitted he should have listened when I said the pain was not normal. I have a feeling that a CNM would have taken me more seriously because they know how well a woman knows her own body. I am not at all opposed to homebirths - I think they are beautiful and natural, and completely normal - this is how most of humanity came into existence after all

BUT, that being said, I have certain conditions with my own medical history that would make me a high risk pregnancy so a homebirth (IMO) isn't a safe option for me. If I were a low risk pregnancy I may actually consider this - it certainly is more intimate care than what I have received from doctors. And it would be nice to be more in control of my environment (like not having pitocin "to speed things up" with all my labors because they are taking too long and they need the labor room for another patient - grrrrr). Anyway, I digress. My point is that both a hospital or a homebirth are vaild options and neither is more or less dangerous. CNM's are much better about listening to their patients (again in my experience) so even with a traditional OB/GYN there can be unforeseen complications because a doctor is too arrogant to listen to the pateint.

I really am kinda at a loss as to why this is even a debate...if it were truly dangerous then homebirths would be illegal accross the US. Obviously there is value in them, and I think it is awesome when a woman has that as an option GL ladies!
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  #18  
March 26th, 2013, 03:58 PM
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I'm not sure I'm understanding the point you're trying to make. The website you linked to states that there is an attendance requirement for this certification, and you acknowledged this in your own post.

By that definition, the certification you're referencing absolutely does not require "only a high school education". It requires a high school diploma in addition to graduated birth attendance under the supervision and guidance of a qualified preceptor* and on a specific time schedule. They also require a knowledge and skills assessment and at least one written exam for this certification.

In none of your posts did you state that there are organizations that give out certifications for "only a high school diploma as far as formal education goes (plus apprenticeship-style experience, assessments and exams)". You stated that they gave out certifications for "only a high school diploma". I believe that your statement is false, and deliberately misleading.

That sounds like a reasonable starting place to me. It will still come down to the mother to speak with the midwife, ask her about her experience, training, certifications, ask her about her birth and emergency transfer policies, ask her about any previous losses of babies and/or mothers, ask her for references including midwives who may have trained them, doulas who have worked alongside them or previous mothers who've birthed with them (and the midwife's ability to answer those questions and provide that information to the satisfaction of the mother) before she would be considered as a care provider.

Many women who birth with CNMs and OBs ask the same questions. It's important for ANY mother to determine whose hands she's comfortable placing her pregnancy and birth experience. Verifying accreditation, certifications, experience and policies is not unique to CPMs.

What do you call someone who passes their medical exams and certification assessments with flying colors? A doctor.
What do you call someone who scrapes by those same medical exams and certification assessments by the skin of their teeth? A doctor.

*The guidelines for a qualified preceptor as recognized by NARM are as follows:
Quote:
A preceptor for a NARM PEP applicant must be credentialed as a Certified Professional Midwife (CPM), Certified Nurse Midwife (CNM), or Licensed Midwife who has an additional three years of experience or 50 births, including ten (10) continuity of care births beyond the primary birth experience requirements for CPM certification. The exception route for preceptors who do not meet these requirements closed December 31st 2011. No new preceptor exception applications are being accepted at this time.
I'm not here to change your mind, and really only shared some of my favorite links because someone else expressed an interest in learning more from both sides. I am a huge proponent of ALL mothers having the right to make birthing choices that they feel most comfortable with. It does not ruin my day if someone makes a choice that differs from my own. However, I do take issue with blatant misinformation and have stuck around to address some of that misinformation a little more specifically.

At this point, though, I'm finding this thread stressful and have several things to take care of this evening, so I'm going to leave the information I've shared and step out.
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Last edited by Keakie; March 26th, 2013 at 04:05 PM.
  #19  
March 26th, 2013, 04:54 PM
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kimberlyw- thanks for your balanced perspective. I tend to agree with you that CNMs will listen to the mother more than the doctor. My first delivery was with a CNM, and she was great! Unfortunately, the hospital stopped allowing nurse-midwives to do deliveries there. I wish we had a system in the USA that was more like Canada has, where nurse-midwives do many of the deliveries. At my second delivery, I really had to fight to have as close to a natural birth as you can have with pitocin, and they didn't believe me when I said I had to push. I expect a similar fight for my next delivery.

Please have a look at the link I posted from the Oregon study- they found that the rate of neonatal death was much higher in planned out-of-hospital births than in planned hospital births. So your statement that "neither is more or less dangerous" isn't quite correct...recent results are proving otherwise. When I first started looking into this a few months ago (because I wanted a homebirth), I also thought they were equally safe, but I have learned otherwise.
  #20  
March 26th, 2013, 05:01 PM
Keakie's Avatar Learning to walk in faith
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Quote:
Originally Posted by LadyMorgan View Post
Please have a look at the link I posted from the Oregon study- they found that the rate of neonatal death was much higher in planned out-of-hospital births than in planned hospital births. So your statement that "neither is more or less dangerous" isn't quite correct...recent results are proving otherwise. When I first started looking into this a few months ago (because I wanted a homebirth), I also thought they were equally safe, but I have learned otherwise.
The study that Steph shared, which is from a significantly less biased source than the CDC, contradicts the study that you linked.
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