New Study: Home Birth as Safe as Hospital Birth

Ahem!
Is anyone in the medical community paying attention?
This wasn't exactly a "small" study.
Will ACOG revise their radical stand opposing homebirth?
I'm just wonderin'. . .

Look at these rates:
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%

It looks like people were just ever so slightly more likely to be "safer" at home. Hmm....
And as a side benefit, more happy and comfortable in their own beds and bathrooms and living rooms. Oh, and it cost less.

No matter where you have your baby, there is no guarantee that it will all turn out well or that you will like the outcome or that whatever happened couldn't have possibly been prevented in the opposite setting. BUT, to say that home is more risky than the hospital for healthy women...
Show me!!


NEW YORK (Reuters Health) Jul 28 -
In terms of perinatal morbidity and mortality, a planned home birth is as safe as a planned hospital birth, provided that a well-trained midwife is available, a good transportation and referral system is in place, and the mother has a low risk of developing any complications, new research shows.

"Low-risk women should be encouraged to plan their birth at the place of their preference, provided the maternity care system is well equipped to underpin women's choice," Dr. A. de Jonge, from TNO Quality of Life, Leiden, the Netherlands, and co-researchers emphasize in the August issue of BJOG: An International Journal of Obstetrics and Gynaecology.

Data regarding the safety of home births in low-risk women are lacking, due in part to the fact that studies with very large sample sizes are needed to assess relatively rare adverse outcomes. Moreover, randomized trials comparing home and hospital births have not been done because women usually want to choose their place of birth, the authors explain.

The present study, an analysis of 529,688 low-risk planned births, was conducted in the Netherlands, the only country in the west with a large enough data set. The group included 321,307 women who wanted to give birth at home, 163,261 who planned to give birth in the hospital, and 45,120 with an unknown intended place of birth.

All of the outcomes studied occurred with comparable frequency in the planned home and hospital birth groups. These included intrapartum death (0.03% vs. 0.04%), intrapartum and neonatal death within 24 hours of birth (0.05% vs. 0.05%), intrapartum and neonatal death within 7 days (0.06% vs. 0.07%), and neonatal admission to an intensive care unit (0.17% vs. 0.20%).

"As far as we know, this is the largest study into the safety of home births," the authors note. The findings, they conclude, indicate that with proper services in place, home births are just as safe as hospital births for low-risk women.

BJOG 2009;116:1177-1184.

New York City Midwifery Care - 1931-1961

The Maternity Center Association, New York City ~ 1931-1961

From 1931 the Lobenstine Midwifery Clinic of New York City, in affiliation with the Maternity Center Association (MCA), offered home birth services to help meet the needs of the most economically deprived and needy families of the upper Manhattan tenements. Between 1931 and 1961, 5,766 mothers registered with the clinic, of which 87% gave birth at home, attended by midwives. Their maternal mortalities were less than one third the national rates of the time. Their average neonatal death rates were only 16 per 1,000, while that of New York City as a whole ranged from 28.9 in 1931 to 18.4 in 1961. These results by the MCA midwives are even more remarkable in light of the fact that poor nutrition was prevalent among their clients. 36.4% of them suffered from secondary anemia, 6.3% tested positively for syphilis and 6% were in their tenth pregnancy. The MCA discontinued its home birth services years ago, but retains its legacy of superior outcomes.

~ From Law, M., Report on the Maternity Center Association Clink, NY, 1931-1951, American Journal of Obstetrics and Gynecology, 69:178-184, 195S.

~ Faison, J., The Maternity Center Association Clinic, NY, 1952-1958, American Journal of Obstetrics and Gynecology, 81:395-402, 1961.

These data and additional studies which I will be posting and crediting to Dr. David Stewart's work have been excerpted from his book, The Five Standards for Safe Childbearing, by Dr. David Stewart, Ph.D. Dr. Stewart is a medical statistician with special education in obstetrics and is one of the leading world authorities in the area of midwifery and home birth statistics. He has been an invited lecturer at meetings of the American College of Obstetrics and Gynecologists (ACOG) and the National Perinatal Association (NPA) and numerous other childbirth-related functions throughout North America. He has served on committees of the American Public Health Association (APHA) and the American College of Nurse Midwives (ACNM). Dr. Stewart is the author or co-author of more than 200 publications, including 13 books. He serves as the Executive Director and co-founder of the International Association of Parents and Professionals for Safe Alternatives in Childbirth - NAPSAC International.

For more information, or to purchase The Five Standards for Safe Childbearing, contact:

NAPSAC International

Rt. 4, Box 646

Marble Hill, MO 63764

Phone/Fax: (573) 238-2010 or

(800) 758 - 8629

Protecting Your Pelvic Floor

Researchers grouped seventy women according to whether they exercised regularly, did postpartum exercises only, or never exercised, and measured the strength of their pelvic floors one year after childbirth.
Regular exercisers fared the best, postpartum exercisers fell in between, and non-exercisers had the weakest pelvic floors. Exercise regimens included fitness classes, walking, jogging, running, dancing, swimming, and yoga.

Gordon H and Logue M;Perineal muscle function after childbirth.
Lancet 1985; 2:123-125



Researchers evaluated perineal and pelvic floor outcomes in 460 first-time mothers according to how much they exercised. Women engaging in weight-bearing exercise more than three time weekly were equally likely to have an episiotomy, but only 16 percent experienced anal injury, compared with more than one-quarter of those exercising less often.

Klein MC, et al.; Determinants of vaginal-perineal and pelvic floor functioning in childbirth. American Journal of Obstetrics & Gynecology 1997; 176(2):403-410

Research on the Stillbirth-Cesarean connection

From the Lancet 2003; 362: 1779-84:

Stillbirth linked to cesarean section

Investigating the relationship between previous cesarean delivery and subsequent stillbirth.

Cesarean section can increase the risk of stillbirth in subsequent pregnancies, claim researchers, in findings that add to the growing debate over the acceptability of elective cesareans.

Professor Gordon Smith (University of Cambridge, UK) and colleagues studied data on 120,633 births in Scotland between 1992 and 1998. They found that the proportion of stillbirths was greater in women who had previously delivered by cesarean section (2.4 per 10,000 women) than among women who had only delivered vaginally (1.4 per 10,000 women).

The increased risk of stillbirths with unknown causes began at around week 34 of the pregnancy in women who had undergone a cesarean for a previous birth, regardless of the reason for the procedure.

The association is "biologically plausible," the team comments, reasoning that previous cesarean delivery may influence uterine blood flow and mechanisms of placentation in future pregnancies.

An OB's opinion on C-section

From www.obgyn.net

There are many benefits of vaginal delivery, for both mother and baby. During a vaginal delivery the amniotic fluid is squeezed from the baby's lungs, making it easier for him or her to breathe. This does not happen as much during c-section.

Furthermore, it is a misconception that c-section is always safer for babies than vaginal delivery. Scalpel injuries and trauma to babies during c-section, although rare, can certainly occur. In most cases vaginal deliveries are safer for mothers than c-sections, with some medical studies indicating that the chance of death for a mother is 7 times higher when delivered by c-section versus vaginally.

Contrary to popular belief, a c-section is a major operation, not unlike a hysterectomy in it's complexity and potential complications! These complications may include infection, hemorrhage, scar tissue formation (which may produce lifelong abdominal or pelvic pain), anesthesia complications, opening of the skin incision leading to a very large scar, damage to the bladder or intestines, and the formation of blood clots within blood vessels or the lungs.

These complications are usually much more common with c-sections than vaginal deliveries, although as with all medical issues the patient's individual situation will dictate which complications are more, or less, likely.

An unfortunate side effect of our legal system is that many women are led to believe by malpractice lawyers that a c-section will prevent any and all problems for their baby. This is simply untrue and is a very unsophisticated way of looking at this major operation and pregnancy in general.

D. Ashley Hill, M.D.
Associate Director Department of Obstetrics and Gynecology
Florida Hospital Family Practice Residency Orlando, Florida