The Safety of Home Birth – New Study of 530,000 Women

A recent study in the Netherlands, a country known for it’s fantastic maternal and infant outcomes, has proven that home birth is safe.  It is the largest study of it’s kind and found that low-risk women planning to give birth at home had as good outcomes as low-risk women birthing in the hospital.

Check it out!

Home births ‘as safe as hospital’

Newborn baby

There have been few comprehensive studies into home births

The largest study of its kind has found that for low-risk women, giving birth at home is as safe as doing so in hospital with a midwife.

Research from the Netherlands – which has a high rate of home births – found no difference in death rates of either mothers or babies in 530,000 births.

Home births have long been debated amid concerns about their safety.

UK obstetricians welcomed the study – published in the journal BJOG – but said it may not apply universally.

The number of mothers giving birth at home in the UK has been rising since it dipped to a low in 1988. Of all births in England and Wales in 2006, 2.7% took place at home, the most recent figures from the Office for National Statistics showed.

The research was carried out in the Netherlands after figures showed the country had one of the highest rates in Europe of babies dying during or just after birth.

FROM THE TODAY PROGRAMME

It was suggested that home births could be a factor, as Dutch women are able and encouraged to choose this option. One third do so.

But a comparison of “low-risk” women who planned to give birth at home with those who planned to give birth in hospital with a midwife found no difference in death or serious illness among either baby or mother.

“We found that for low-risk mothers at the start of their labour it is just as safe to deliver at home with a midwife as it is in hospital with a midwife,” said Professor Simone Buitendijk of the TNO Institute for Applied Scientific Research.

“These results should strengthen policies that encourage low-risk women at the onset of labour to choose their own place of birth.”

Hospital transfer

Low-risk women in the study were those who had no known complications – such as a baby in breech or one with a congenital abnormality, or a previous caesarean section.

Nearly a third of women who planned and started their labours at home ended up being transferred as complications arose – including for instance an abnormal fetal heart rate, or if the mother required more effective pain relief in the form of an epidural.

The NHS is simply not set up to meet the potential demand for home births
Louise Silverton
Royal College of Midwives

But even when she needed to be transferred to the care of a doctor in a hospital, the risk to her or her baby was no higher than if she had started out her labour under the care of a midwife in hospital.

The researchers noted the importance of both highly-trained midwives who knew when to refer a home birth to hospital as well as rapid transportation.

While stressing the study was the most comprehensive yet into the safety of home births, they also acknowledged some caveats.

The group who chose to give birth in hospital rather than at home were more likely to be first-time mothers or of an ethnic minority background – the risk of complications is higher in both these groups.

The study did not compare the relative safety of home births against low-risk women who opted for doctor rather than midwife-led care. This is to be the subject of a future investigation.

Home option

But Professor Buitendijk said the study did have relevance for other countries like the UK with a highly developed health infrastructure and well-trained midwives.

Women need to be counselled on the unexpected emergencies which can arise during labour and can only be managed in a maternity hospital
RCOG

In the UK, the government has pledged to give all women the option of a home birth by the end of this year. At present just 2.7% of births in England and Wales take place at home, but there are considerable regional variations.

Louise Silverton, deputy general secretary of the Royal College of Midwives, said, the study was “a major step forward in showing that home is as safe as hospital, for low risk women giving birth when support services are in place.

“However, to begin providing more home births there has to be a seismic shift in the way maternity services are organised. The NHS is simply not set up to meet the potential demand for home births, because we are still in a culture where the vast majority of births are in hospital.

“There also has to be a major increase in the number of midwives because they are the people who will be in the homes delivering the babies.”

Mary Newburn, of the National Childbirth Trust, said: “This makes a significant contribution to the growing body of reassuring evidence that suggests offering women a choice of place of birth is entirely appropriate.”

The Royal College of Obstetricians and Gynaecologists (RCOG) said it supported home births “in cases of low-risk pregnancies provided the appropriate infrastructures and resources are present to support such a system.

But it added: “Women need to be counselled on the unexpected emergencies – such as cord prolapse, fetal heart rate abnormalities, undiagnosed breech, prolonged labour and postpartum haemorrhage – which can arise during labour and can only be managed in a maternity hospital.

“Such emergencies would always require the transfer of women by ambulance to the hospital as extra medical support is only present in hospital settings and would not be available to them when they deliver at home.”

The Department of Health said that giving more mothers-to-be the opportunity to choose to give birth at home was one of its priority targets for 2009/10.

A spokesman said: “All Strategic Health Authorities (SHAs) have set out plans for implementing Maternity Matters to provide high-quality, safe maternity care for women and their babies.”

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Mar 14 – Movie Screening: “What Babies Want”

Join New Body Balance for a screening of the film “What Babies Want” starring Noah Wyle!

Saturday, March 14
4:00pm – 6:00pm
$5 per person
REGISTER

Tickets must be purchased in advance as space is limited.  No children please but nursing babies are always welcome.

“This innovative film is about the profoundly important and sacred opportunity we have in bringing children into the world.  Surprising and sometimes shocking it challenges our beliefs about what infants are thinking and doing.  It includes ground-breaking information on early development as well as appearances by the real experts: babies and their families.”

Narrated by: Noah Wyle

Featuring interviews by:
Joseph Chilton Pearce
Sobonfu Some
David Chamberlain
Mary Jackson
Jay Gordon
Barbara Findeisen
Marti Glenn
Ray Castellino
Wendy Anne McCarty

Funds raised from this event will help build our “non-profit support group fund” and will help make future events like this possible.

Great Midwifery Article in the LA Times

Here’s a wonderful pro-midwifery article in the LA Times!

I also have the text here:

Midwives deliver

America needs better birth care, and midwives can deliver it.

By Jennifer Block
December 24, 2008
» Discuss Article (23 Comments)

Some healthcare trivia: In the United States, what is the No. 1 reason people are admitted to the hospital? Not diabetes, not heart attack, not stroke. The answer is something that isn’t even a disease: childbirth.

Not only is childbirth the most common reason for a hospital stay — more than 4 million American women give birth each year — it costs the country far more than any other health condition. Six of the 15 most frequent hospital procedures billed to private insurers and Medicaid are maternity-related. The nation’s maternity bill totaled $86 billion in 2006, nearly half of which was picked up by taxpayers.

But cost hasn’t translated into quality. We spend more than double per capita on childbirth than other industrialized countries, yet our rates of pre-term birth, newborn death and maternal death rank us dismally in comparison. Last month, the March of Dimes gave the country a “D” on its prematurity report card; California got a “C,” but 18 other states and the District of Columbia, where 15.9% of babies are born too early, failed entirely.

The U.S. ranks 41st among industrialized nations in maternal mortality. And there are unconscionable racial disparities: African American mothers are three times more likely to die in childbirth than white mothers.

In short, we are overspending and under-serving women and families. If the United States is serious about health reform, we need to begin, well, at the beginning.

The problem is not access to care; it is the care itself. As a new joint report by the Milbank Memorial Fund, the Reforming States Group and Childbirth Connection makes clear, American maternity wards are not following evidence-based best practices. They are inducing and speeding up far too many labors and reaching too quickly for the scalpel: Nearly one-third of births are now by caesarean section, more than twice what the World Health Organization has documented is a safe rate. In fact, the report found that the most common billable maternity procedures — continuous electronic fetal monitoring, for instance — have no clear benefit when used routinely.

The most cost-effective, health-promoting maternity care for normal, healthy women is midwife led and out of hospital. Hospitals charge from $7,000 to $16,000, depending on the type and complexity of the birth. The average birth-center fee is only $1,600 because high-tech medical intervention is rarely applied and stays are shorter. This model of care is not just cheaper; decades of medical research show that it’s better. Mother and baby are more likely to have a normal, vaginal birth; less likely to experience trauma, such as a bad vaginal tear or a surgical delivery; and more likely to breast feed. In other words, less is actually more.

The Obama administration could save the country billions by overhauling the American way of birth.

Consider Washington, where a state review of licensed midwives (just 100 in practice) found that they saved the state an estimated $2.7 million over two years. One reason for the savings is that midwives prevent costly caesarean surgeries: 11.9% of midwifery patients in Wash- ington ended up with C-sections, compared with 24% of low-risk women in traditional obstetric care.

Currently, just 1% of women nationwide get midwife-led care outside a hospital setting. Imagine the savings if that number jumped to 10% or even 30%. Imagine if hospitals started promoting best practices: giving women one-on-one, continuous support, promoting movement and water immersion for pain relief, and reducing the use of labor stimulants and labor induction. The C-section rate would plummet, as would related infections, hemorrhages, neonatal intensive care admissions and deaths. And the country could save some serious cash. The joint Milbank report conservatively estimates savings of $2.5 billion a year if the caesarean rate were brought down to 15%.

To be frank, the U.S. maternity care system needs to be turned upside down. Midwives should be caring for the majority of pregnant women, and physicians should continue to handle high-risk cases, complications and emergencies. This is the division of labor, so to speak, that you find in the countries that spend less but get more.

In those countries, a persistent public health concern is a midwife shortage. In the U.S., we don’t have similar regard for midwives or their model of care. Hospitals frequently shut down nurse-midwifery practices because they don’t bring in enough revenue. And although certified nurse midwives are eligible providers under federal Medicaid law and mandated for reimbursement, certified professional midwives — who are trained in out-of-hospital birth care — are not. In several state legislatures, they are fighting simply to be licensed, legal healthcare providers. (Californians are lucky — certified professional midwives are licensed, and Medi-Cal covers out-of-hospital birth.)

Barack Obama could be, among so many other firsts, the first birth-friendly president. How about a Midwife Corps to recruit and train the thousands of new midwives we’ll need? How about federal funding to create hundreds of new birth centers? How about an ad campaign to educate women about optimal birth?

America needs better birth care, and midwives can deliver it.

Jennifer Block is the author of “Pushed: The Painful Truth About Childbirth and Modern Maternity Care.”

MY FIRST BIRTH!!!

Look at the beautiful mama!

Look at the beautiful mama!

MERRY CHRISTMAS TO ME!!!  I just came back from my first birth this Christmas Eve, and it was the most perfect first birth ever!

Mama had a few hours of early labor, then things really got crankin’ around 1 pm.  She got down to the hospital at 3:30 pm and baby was born at 4:22!  We all arrived at the hospital at the same time, mom was checked and at 8 cm, then she got in the tub for only about 20 minutes.  It was just a few contractions in the tub when she started feeling tons of pressure and the urge to push, so we got out and she got on all fours on the bed.  The midwife had to step out to attend another birth so a resident that mama hadn’t met before came it.  She was wonderful!!  Basically she said, “You feel good in that position?  Ok, I can work with that!”  Two or three pushes and beautiful baby was born.

Mama did so terrific dealing with contractions.  She was joking in between and looked really relaxed.  When a contraction would hit she would just go limp, groan a bit, let it wash over her, and be totally in the moment.  I was so proud of her!  She did it naturally, just like she wanted (and she doubted to the end, but everyone else had faith!  she is so strong!).

It’s so funny, she said she couldn’t have done it without us (Lauren Williams and I) and I’m like, “Really??  Because you give birth like a rockstar!”  I know a doula doesn’t have to *do* something all the time, but I was only there under an hour before baby was born and I didn’t do too much.  Mom just totally rocked!

Mostly I feel privileged and honored to be a part of this day with them.

Merry Christmas All!

Amy

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Lyric’s Birth Story

Here is the story of my second daughter’s birth.  I like to say that Haven made me a mother, which was about as earth shattering as you could get, but Lyric’s birth made me a doula and aspiring midwife.

Following a miscarriage in September of 07, my previous OB told me it was my fault because I was still breast-feeding.  I had already decided I wanted a water birth with the second and wanted to switch providers but this really sealed the deal.  I went looking for an affordable and more sympathetic (and less myth-based) approach.
Meeting the midwives at the Mountain Midwifery Birth Center I realized everything the midwifery model of care could offer.  They actually seemed like the LIKED their jobs and talking to moms about their pregnancy and whatever else was going on in their lives, unlike my OB.
My last pregnancy was good, but Lyric’s pregnancy was even better.  I felt fantastic, even right up until I went into labor.  Towards the end she was measuring a little small, so Cassie sent me for an ultrasound.  I was freaked out and the midwives were so great and supportive and listened to my fears (everything showed up fine).
I went into the office Wednesday, June 18 for my last prenatal appointment.  Tracy did my forty-week check and found me to be 2 cm and 70% effaced.  I was feeling totally overwhelmed and emotional and when I broke down and started bawling in the waiting room, Heather said, “I think you’ll have your baby really soon.”

Sure enough, that Wed I went into early labor, waking all throughout the night with contractions.  They got much more regular at 9 am, from 2-5 minutes apart for three hours.  At 12:30 we decided to head down to the Birthing Center since we live a bit far.  We dropped off our stuff and headed to a nearby park to walk around outside.  I think this turned out to be not the best idea since I couldn’t really get inside myself and settle into the Birth Center.
We returned at 4:30 where they checked me and found I was 2 cm, 70% effaced…exactly the same as yesterday!  I was so frustrated!  I didn’t mind a longer, slower, labor as long as it seemed to be doing something!  Cassie and Tracy were awesome at talking me through my frustration, Tracy saying her last birth took three days to get there!  Tiffany also helped me regain control by saying my baby might just need a little extra time to get used to the idea of being on the outside.  They almost sent me home to a bath and glass of wine, but I really didn’t want to spend an hour in the car (contractions in the car are awful!) and I wasn’t sure when to come back since contractions were pretty close together anyway.  They decided to give me two hours to see how I would progress.

I calmed myself down, refused to look at the clock, and went inside myself.  After two hours Cassie checked me and I was at 4 cm so they decided to let me stay!  I spent some time on the toilet where my water broke, a high tear that didn’t continually leak fluid.  Two of my good friends came, including my friend who was a doula and was amazing at helping me with my breathing and rubbing my back!  Contractions started getting really strong, along with bloody show and more of the mucous plug was lost.

I spent my time going through transition in the tub, which was great and made the contractions much more round.  I was always a little worried I wouldn’t have a break if I did it naturally since I had had an epidural with Haven and it really helped my long labor by giving me a rest.  Magically my body seemed to know this and contractions slowed down to 7-8 minutes after I had gone through transition.  I even started to fall asleep in the water between contractions!  My body was naturally preparing me to push.

I was checked and found to be sort of stuck at 9.5 cm with a little “lip” of cervix left.  After sixteen hours at the Birthing Center, I really wanted to be done, so Tracy said I could try and push past it if I wanted to.  I tried but it was hard, like pushing into a hammock where the baby kept bouncing back.  Cassie ended up helping break the bag of water around her head which felt AMAZING, like her head was suddenly half as big.  Then she helped hold the lip of cervix back while I pushed.
At first I couldn’t tell what was a productive push and what wasn’t and I was losing all my energy out my voice.  Tracy gave me a great pep talk to help me learn the right way, then I became much more productive.  Twenty minutes of pushing and she was out!  My daughter Haven watched as I brought her out of the water and then she and Kyle joined me in the birth tub.  As soon as she came out of the water Haven said, “It’s a baby sister!”  Even to this day she likes to tell the story.  She says “Uterus squeeeeze the baby out and the baby came out Mommy’s yoni in the water and nurse and get all dry dry.  That was hard work for Mommy, Mommy did a good job, good job Mommy!”  Haven was totally thrilled with her new baby sister and held her even before Daddy!  We got out of the bed and spent time cuddling as a family on the bed.
After a long time, Kyle and the nurses did all the weighing and checking while I took a luxurious, relaxing herbal bath.  It felt wonderful!  We stayed for a while, then packed up to go home…at 4 am!  It was nice to be in our own bed after such a long night.  The nurses and midwives needed a break too because with the full moon and Summer Solstice brought six new babies…IN 24 HOURS!
The recovery went really really well, much better than after Haven’s birth.  I think I was able to be aware of what my body was doing so much more without the epidural and not rush my body into a place it wasn’t ready to go.  As a result I had only one tiny tear that felt fine after a day or so.
Haven’s birth was good, but Lyric’s birth was phenomenal.  I never thought I could be so nurtured and supported in the process.  The midwives and nurses were all fabulous and Kyle and I both enjoyed the intimate atmosphere.  We loved having Haven there to watch the birth.  I can think of no greater responsibility than teaching our children (especially our daughters) that birth is a normal, natural part of life and nothing to be feared.  It was all I could have hoped for and more.

birth-145Lyric Hana Brynn
Lyric:  because she loves being sung to
Hana:  meaning “flower” in Korean, her placenta is buried under a flowering linden tree
Brynn:  meaning “little drop of water” for my little water birth baby

June 20, 2008
12:23 am
7 lb 3 oz
20 in

View Haven’s Birth

In the tub

In the tub

birth-010

She's born!

She's born!

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Proud Daddy

Proud Daddy

7 lb, 3 oz

7 lb, 3 oz

So happy

So happy

Our family with my good doula friend Rebekkah

Our family with my good doula friend Rebekkah

VIDEO – Baby born in the Caul

Here is an amazing video of a baby born “in the caul.”  Basically this means that the bag of waters never breaks and the baby emerges in a sac of water.  It’s amazing!

Most of the world has traditionally thought this phenomenon to be a good omen.  Some of the lore includes:

  • The baby will be destined for greatness
  • The child will never drown
  • The child will be psychic
  • The child will be able to travel and never tire
  • A sailor or ship that posses the caul will never drown or sink
  • Protection against infertility and evil forces
  • Intelligence
  • If twins are born in caul that means they are marked by an angel and their souls are shielded

Choosing a Birth Attendant

Most people see pregnancy as a time to prepare for the baby.  I see early pregnancy as a time to figure out what you want before you even go to your first appointment.  A lot of women don’t even think about the actual birth until a few months or weeks before the baby is born!  It can be difficult to make a change that late in the game.  You should choose the provider who has the same philosophy as you instead of hoping to change them by the end of the pregnancy.

Tips for choosing a birth attendant

  • Think about your core birthing philosophy.  Do you feel that birth is a natural physiological process?  If so, a midwife is your best bet.  Do you have physical issues that dictate that there could be a potential problem?  Do you see birth as dangerous with lots of opportunities for things to go wrong?  Then an OB might be your preferred provider.
  • Visit The Birth Survey, a consumer reporting site dedicated to birth.  Go to rate your OB, midwife, and place of birth.  As of now the site is just up and running and they should have formulated the results by Fall of 08
  • Get recomendations from people who share your birthing point of view, visit online forums (like mothering.com) and ask questions.
  • Interview your potential care provider.  Remember, they are working for you, not the other way around.  Related posts:  Interviewing your OB, Interviewing your Midwife, and Interviewing your Place of Birth
  • Create a birth plan well before your second or third trimester.  Going to your provider interview with a birth plan or at least an idea of what you want can help you ask the right questions.  Just make sure to not be negative or badger the doctor!
  • How much one-on-one, hands-on support do you want during pregnancy? Midwives generally treat the whole woman:  mentally, physically, socially, psychologically, spiritually.  Prenatal appointments generally last about an hour and they are usually there for the majority of labor and birth.  OBs on the other hand are primarily surgical specialists who have a prenatal appointment time of about five minutes and generally just come in at the end to catch the baby.
  • How much involvement do you want in your pregnancy and birth? Many times in midwifery practices the mom gets to do her own urine dip and weigh herself at her appointments.  The midwife tries to explain things to her and tries to get her to interact during her visits.  An OB visit is more in-and-out with the nurses doing everything behind the scenes.
  • Where do you want to give birth? Some women just go to an OB because they think they’re supposed to and then realize late in pregnancy that they want a home birth!  Where you give birth automatically dictates who will be there.  For example in Colorado at this time, OBs work in the hospital, only Certified Nurse Midwives (CNM) can work at a birth center, and Certified Professional Midwives (CPM) and CNMs can do home births.  Most CNMs (90-95%) work with doctors in the hospital.
  • Do you want to have a waterbirth? Some hospitals allow it, some do not.  If you have to give birth in a hospital and want to fight a policy that does not allow waterbirth, having a provider who supports it can go a long way.  Yes, it is possible to change hospital policy!  In Gentle Birth Choices Barbara Harper talks about how to do this.
  • Choose someone you’re comfortable with. If you’re not comfortable with your provider there is no way you can let your body open up and relax enough to have a baby.
  • If a provider or place (like home or birthing center) is out of your insurance network, talk to your insurance provider.  Also, often times a home birth or birthing center is cheaper even though you have to pay in full.  For example, in Colorado a typical, no-intervention birth in a hospital usually costs around $12,000-13,000.  In an insurance plan where you pay 10% of hospital and doctor’s costs you’re looking at a few thousand dollars.  A home birth or birth center birth usually costs around that if you’re paying in full.
  • Do you feel more comfortable with a male or female doctor?  Remember that just because a doctor is female doesn’t mean she believes in the same birthing philosophy as you do.