Thursday, October 25, 2007

Homebirth stats needed for old friend

Ok, someone got my goat. I wasn't going to let them, but they did. They asked me for proof that homebirth is "actually safer" than hospital birth, etc, and I just am not in the mood to really get all into this right now. I guess they wanted some of those good studies with the stats and numbers.....I am so past that part of my personal life's education, if that makes any sense, and my heart just wouldnt be into the sleuthing when I get so little time online anymore, anyhow.

But, admittedly, it would be cool to have some sidebar stuff, and yep, to send to my old accquaintance who laid the challenge before me, though I do not understand just why they did...

So, dear readers, if you've got links, can you please leave me some? I wouldnt mind brushing up on this stuff myself. Thank you in advance :)



Lynette said...
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Lynette said...

Big British Medical Journal study from 2005, basically concludes that homebirth with DEMs is as safe as hospital birth, and that homebirth has fewer interventions

Jill said...

Such studies are bound to be fallible, because:

A) Most successful homebirths are not "on the books," there is no one standing around with clipboards to record such things in the home.

B) Most homebirths that ARE recorded are hospital transfers, and of course these are the "failed" ones, so that skews the study once again.

I know as well as anyone that homebirth is best, but I'll be interested to see if someone comes up with hard numbers. I could throw a thousand websites at you, but my memory fails me right now as to whether or not any of them have actual statistics and data supporting this fact.

Summer said...

Gah, my mind isn't alert enough to remember exactly. But i believe ther wa a 1996 study featuring birth at The Farm in Tennesee. I'd also look to other countri where homebirth is more the norm, such as Holland.

Rixa said...

The back of "Ina May's Guide to Childbirth" has the Farm's statistics published in detail.

This site has a complation of various studies and literature about home birth safety:

Also, if your friend wants a more thorough statistical analysis and explanation of why out-of-hospital births are safer, refer her to Marjorie Tew's book "Safer Childbirth?: A Critical History of Maternity Care." I'm re-reading it right now.

There's also Mehl & Mehl's matched study:
"Summary of Results of Matched Population Study Comparing Hospital Birth with Home Birth." Summary of epidemiologically controlled comparison of home and hospital birth. Original study, by Mehl LE et al.
A summary of the findings, which matched 1146 home births with 1146 hospital births (matched for things such as age, parity, etc):
* In the hospital, 3.7 times as many babies required resuscitation.
* Infection rates of newborns were 4 times higher in the hospital.
* There was 2.5 times as many cases of meconium aspiration pneumonia in the hospital group.
* There were 6 cases of neonatal lungwater syndrome in the hospital and none at home.
* There were 30 birth injuries (mostly due to forceps) in the hospital group, and none at home.
* The incidence of respiratory distress among newborns was 17 times greater in the hospital than in the home.
* While neonatal and perinatal death rates were statistically the same for both groups, Apgar scores (a measure of physical well being of the newborn) were significantly worse in the hospital.

Judit said...
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Judit said...

Yeah! Rixa said it all, she is her usual thorough self :-)

Imagine the reverse situation though: defendants of hospital birth ready to cite by heart studies showing hospital birth safety. There's plenty of THOSE PEOPLE, how come you've never met one with facts at their fingertips? Because it would be the same studies. Hospital birth would have to be compared to *something* to prove its merits, right?

The burden of proof fell on home birth. It's not fair or logical, it's just the way it is though.

I just read the book Pushed, where Jennifer Block discusses how the medical establishment considers randomized, controlled trials (RCTs)the best kind of scientific evidence. That is, if such evidence is possible to come by! RCTs happen to be best suited to examine the efficacy of very narrow and specific issues, such as a particular procedure or drug applied to a specific diagnosis.

Of course, laboring is not a diagnosis, being in one's home is not a treatment, and having (or not) a midwife present is not a procedure. Neither can you randomize by tossing a coin to assign mothers to at-home or in-hospital groups.

This does not mean that without RCTs we cannot be reasonably reassured by the vast amount of existing data that home birth confers similar safety while using fewer interventions. (Which strongly suggests that the intervention rate at hospitals is unwarranted.)

The absence of RCTs has been misrepresented by the obstetric establishment in order to dismiss what we do know. This is a move they use year after year to manipulate public opinion against home birth. The way I see it though, if home birth is not proven safe, then neither is hospital birth proven SAFER.

Kelley said...

Hear, hear, Judit. I love your point. NO one could possibly convince me that having a baby in a hospital is any safer than at home. Bull-larky. No way.

Rixa said...

And really, what do we mean when we talk about safety? Perinatal/neonatal mortality? Morbidity? Emotional trauma? How breastfeeding is affected? Mother-baby bonding or separation?

If we think of safety as meaning "nothing bad will happen," then we are up for serious disappointment. In home or at hospital, "bad" things happen and often nothing could have changed the outcomes. Sometimes--and the evidence indicates that this is often the case with hospital management of childbirth--the "treatment" caused the bad outcome.

So, what is safety?
- statistical probability that the benefits of a certain course of action outweigh the possible risks. (This gets complicated by the fact that certain risks aren't acknowledged by our culture, while others are greatly overstated. Same goes with benefits. I mean, if a mother were truly concerned with safety, surely she wouldn't accept any procedure that has no physiological benefits and many known risks to both her and her baby? Epidurals, narcotics, and electronic fetal monitoring all fall squarely into that category.

- perception that a certain set of choices will guarantee/prevent a bad outcome (which is the main selling point of obstetrics, even though it can't deliver on that promise)

Rixa said...

I should add: those last two items weren't a definitive list, but just versions of what we mean when we say the word "safety."

Housefairy said...

Thank you guys SO much for these great links so far!

I didn't delete anything, but keep 'em coming. I'll get all this to my friend...thanks again and love to you all :)

Joy said...

I honestly think "safety" means to these people, that if you have your baby in the hospital, it will come out blue and they will revive it.

If you have your baby at home it will come out blue and you "won't know what to do".

These people have NO understanding of the cycle with Rixa so beutifully explained in her own blog of the fact that all these maternal/fetal "rescues" are DIRECT results of the the very interventions that are put onto laboring owmen in hospitals, and those interventions are not used in homebirths.

So, all the bad stuff that can come with the pitocin augmentation, with continuous electronic monitoring, with IVs and cathetewrs and their physical and psychological immobilization, the skull implant monitors, the epidural anesthesias, the narcotic anesthesias, the slicing of vaginas and forced pushing, the vaginal exams, the bright lights, the strange environment, the interruptions, the irreverent vibes, the cesarean sectioning....NONE of that happens at homeburth and so NONE of the resultant "emergencies" that can come from those interventions happen at home, really.

So, if only people could/would think of the people who truly birthed in autonomous unhindered non directed spontaneity vaginally in a hospital, and then asked them selves what "emergent" event occured during a birth like that that a midwife or educated person couldn't handle, then that would be a conversation. But just BEING in the hospital, first f all they never let you just BE, and secnd of all, it isnt safe whatsoever, BELEIVE ME. It is RISKY as hell, too risky for anyone who knows anything about the real deal.

Doesnt mean there wont be a few lucky ones who fall through the cracks--a few moms who birth in the hospital and suffer few violations. But thats not a strong enough stat for me.

Judit said...

The dictionary definition of safety is 'the quality of averting or not causing injury, danger, or loss'. When speaking of safety in childbirth at a hospital, the definition would sound something like 'danger or injury caused in a controlled setting whereby loss of life is successfully averted'. Now, is there an appropriate word for that in the English language? Help me out, I'm a non-native speaker >insert irony<

Rixa said...

But Judit, loss of life is not always successfully averted--so I would change it to:
"danger or injury caused in a controlled setting in the hopes of averting loss of life"

Judit said...

You're right: not always. But at the current mortality rate, considering how much danger they invite and how much injury they inflict, they DO do a pretty good mop-up job most of the time! I'm being sarcastic again, but obviously this *is* how they get away with it all.

Rixa said...

Gotcha, Judit. Agreed.