OB-GYN-L Messages for October, 2000: home birth safety

home birth safety

From: Alana A. Millman

midwife2be@lvcm.com

Sun Oct 22 19:41:07 2000

http://www.changesurfer.com/Hlth/homebirth.html

from PubMed Meta-analysis of the safety of home birth. http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query_old?uid=9271961&form=6&d b=m&Dopt=b also if you go to this page and click on related articles you will find 122 about birth safety.

This is an article titled "Is Homebirth for You?: 6 Myths About Childbirth Exposed" http://www.gentlebirth.org/format/myths.html Here is a portion of the article with references:

Studies Indicate That Homebirths Are Safe Myth #1 — Hospital births are statistically safer than homebirths. Safety in childbirth is measured by how many mothers and babies die and how many survive childbirth in less than perfect health. Studies done comparing hospital and out-of-hospital births indicate fewer deaths, injuries and infections for homebirths supervised by a trained attendant than for hospital births. No such studies indicate that hospitals have better outcomes than homebirths. While maternal death rates have vastly improved since the turn of the century, factors like proper nutrition and cleanliness have played a big part in the change. Overall neonatal death rates have also improved since the 30s, but homebirths appeared to be safer even then. In 1939, Baylor Hospital Charity Service in Dallas, Texas, published a study that revealed a perinatal mortality rate of 26.6 per 1,000 live births in homes compared to a hospital birth mortality rate of 50.4 per 1,000.[1] Since the 1970s, research done in northern California, Arizona, England and Tennessee all point to the relative safety of homebirth.[2] The only matched population study, comparing 1,046 homebirths with 1,046 hospital births, was published in 1977 by Dr. Lewis Mehl, a family physician and medical statistician.[3] While neonatal and perinatal death rates were statistically the same in Mehl's report, morbidity was higher in the hospital group: 3.7 times as many babies born in the hospital required resuscitation. Infection rates of newborns were four times higher in the hospital, and the incidence of respiratory distress among newborns was 17 times higher in the hospital than in the home. A six-year study done by the Texas Department of Health for the years 1983-1989 revealed that the infant mortality rate for non-nurse midwives attending homebirths was 1.9 per 1,000 compared with the doctors' rate of 5.7 per 1,000.[4] Certified nurse midwives' mortality rate was 1 per 1,000 and "other" attendants accounted for 10.2 deaths per 1,000 live births.[5] A study of 3,257 out-of-hospital births attended by Arizona licensed midwives between 1978-85 shows a perinatal mortality rate of 2.2 per 1,000 and a neonatal mortality rate of 1.1 per 1,000 live births. In testimony before the U.S. Commission to Prevent Infant Mortality, Marsden Wagner MD, European Director of the World Health Organization, suggested the need in the U.S. for a "strong independent midwifery profession as a counterbalance to the obstetrical profession in preventing excessive interventions in the normal birth process."[6] Wagner states that in Europe midwives far outnumber physicians: "In no European country do obstetricians provide the primary health care for most women with normal pregnancy and birth." He states that the U.S. has the highest obstetrical intervention rates as well as a serious problem with malpractice suits and concludes that a strong, independent midwifery service in the U.S. would be a most important counterbalance to the present situation. 1)The Five Standards of Safe Childbearing, 1981, Stewart, p. 241. 2) Ibid, p. 115-116, 127, 243-246. 3) Ibid, p. 247-253. 4)Texas Lay Midwifery Program, Six Year Report, 1983-1989, Bernstein & Bryant, Appendix VIIIf, Texas Department of Health, 1100 West 49th St., Austin, TX 78756-3199. 5) Labor Pains: Modern Midwives and Homebirth, Sullivan & Weitz, 1988. 6) Mothering, Jan/Feb, 1990

Here is a clip of California Law http://www.leginfo.ca.gov/pub/bill/sen/sb_1451-1500/sb_1479_bill_20000905_ch aptered.html BILL NUMBER: SB 1479 INTRODUCED BY Senator Figueroa (Coauthors: Senators Haynes and Vasconcellos) (Coauthors: Assembly Members Bock and Mazzoni) FEBRUARY 10, 2000 An act to repeal and add Section 2508 of the Business and Professions Code and to amend Section 102415 of the Health and Safety Code, relating to midwifery.

SEC. 4. The Legislature finds and declares that: (a) Childbirth is a normal process of the human body and not a disease. (b) Every woman has a right to choose her birth setting from the full range of safe options available in her community. (c) The midwifery model of care emphasizes a commitment to informed choice, continuity of individualized care, and sensitivity to the emotional and spiritual aspects of childbearing, and includes monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle; providing the mother with individualized education, counseling, prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support; minimizing technological interventions; and identifying and referring women who require obstetrical attention. (d) Numerous studies have associated professional midwifery care with safety, good outcomes, and cost-effectiveness in the United States and in other countries. California studies suggest that low-risk women who choose a natural childbirth approach in an out-of-hospital setting will experience as low a perinatal mortality as low-risk women who choose a hospital birth under management of an obstetrician, including unfavorable results for transfer from the home to the hospital. (e) The midwifery model of care is an important option within comprehensive health care for women and their families and should be a choice made available to all women who are appropriate for and interested in home birth.

I could go on but I think that will provide plenty to discuss for anyone who is interested.

Alana Millman Apprentice Midwife ;-)

"The way you activate the seeds of your creation is by making choices about the results you want to create. When you make a choice, you mobilize vast human energies and resources which otherwise go untapped. All too often people fail to focus their choices upon results and therefore their choices are ineffective. If you limit yourself to only what seems possible or reasonable, you disconnect yourself from what you truly want, and all that is left is a compromise." Robert Fritz

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