Talk:Home birth

Bastian Study

I have removed the following paragraph:

"Conversely, there are some studies that demonstrate a higher perinatal mortality rate with assisted home births (e.g. Perinatal death associated with planned home birth in Australia: population based study. BMJ. 317(7155):384-8, 1998 Aug 8.) Despite these, It is generally accepted that properly assisted home birth carries no greater risks than hospital birth for low-risk pregnancies.

The reason I have done so is that the Bastian study is highly contentious in Australia, not only for the conclusions drawn but also the methodology. In short, the study showed that for normal healthy women, the outcomes at home were as good, if not better than in hospital. But for women with complications, home birth was less safe. The reason for this lower safety aspect was that in transferring from home to hospital, the transfer was 'stuffed up' and the woman did not receive adequate hospital treatment.

Prof Sally Tracy has done quite a bit of work on the Bastian et al study and one of her letters regarding the study can be found on the BMJ site here: BMJ 1999;318:605 ( 27 February) http://bmj.bmjjournals.com/cgi/content/full/318/7183/605/b?hits=10&FIRSTINDEX=0&AUTHOR1=bastian&SEARCHID=1117021210508_6194&gca=bmj%3B318%2F7183%2F605%2Fb&

I've got umpteen references at work that shows that HB is as safe, if not safer than hospital births. I'll put up references to them tomorrow.

But, I don't think we want to have reference arguments in the article text. Here is a good place for reference arguments. --Maustrauser 11:57, 25 May 2005 (UTC)[reply]

Systematic review of safety

I've removed the several references to homebirth being as safe or safer than hospital birth as this is opinion (and was anyway contradicted further down in the article). This belief is not based upon any available evidence. All the references quoted below refer to published work that is deeply flawed and subject to much bias. Unfortunately, It is technically almost impossible to randomise women to proper trials of birth location in order to minimise bias. Quite rightly, women want to choose for themselves where to give birth, not take part in a trial.

The best evidence thus far for birth safety when doctors aren't supervising is quoted in the article. Cochrane reviews are non-biased, quite rigorously performed and have great influence. This Cochrane review gathers several trials comparing birth centres with a homely environment run exclusively by midwives, with hospital care. They are properly conducted randomised trials. Several effects were noted, not least of which was an increase in perinatal mortality of about 80% in the birth centres. This is an important fact, probably the most important in this debate, and should be discussed in the article.

Women are served by having access to evidence from both sides of the debate. Perinatal mortality is low overall in low-risk women, wherever the birth takes place. Obscuring the relative risks however, is not acceptable, and I hope these changes help understanding. —The preceding unsigned comment was added by 87.113.31.143 (talk) 18:31, 28 April 2007 (UTC).[reply]

References on homebirth safety

These references conclude that home birth is as safe if not safer than hospital birth.

Patricia Janssen, Shoo Lee, Elizabeth Ryan, Duncan Etches et al, Outcomes of planned homebirths versus planned hospital births after regulation of midwifery in British Colombia Canadian Medical Association Journal, FEB. 5, 2002; 166 (3)315-324.

Chamberlain G, Wraight A, Crowley P. Birth at home: a report of the national survey of home births in the UK by the National Birthday Trust. Pract Midwife1999;2:35-39.

Janssen P, Holt V, Myers S. Licensed midwife-attended, out-of-hospital births in Washington State: Are they safe? Birth 1994;21:141-8.

Wiegers T, Keirse M, van der Zee J, Berghs G. Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in the Netherlands. BMJ1996;313:1309-13.

Ackermann-Liebrich U, Voegeli T, Günter-Witt K, Kunz I, Züllig M, Schindler C, et al. Home vs. hospital deliveries: follow up study of matched pairs for procedures and outcome. BMJ1996;131:1313-8.

Gulbransen G, Hilton J, McKay L, Cox A. Home birth in New Zealand 1973–93: incidence and mortality. N Z Med J1997:110;87-9.

Patricia A. Janssen, Shoo K. Lee, Elizabeth R. Ryan, R and Lee Saxell, An Evaluation of Process and Protocols for Planned Home Birth Attended by Regulated Midwives in British Columbia, J Midwifery Womens Health 2003;48: 138–146

Sorry for not getting them up earlier as promised. --Maustrauser 13:23, 31 May 2005 (UTC)[reply]

Golden staph and other hospital infections

I've removed the statements on infections being more prevalent in women in hospital. There is no evidence for this statement. Your house may be clean. As a practising professional who has given care in people's houses, I'd have to say that you are lucky. There may be increased transmission of bugs between patients. If so, let me know the reference for good evidence comparing homebirth vs. hospital birth and infection.

Nandesuka has removed the reference to women at home being less susceptible to hospital based infection, such as Golden Staph. Whilst I agree that the sentence was not written particularly well, it is a truism that if you aren't in a hospital then you are not likely to get hospital based illnesses. Why not point this out?

Frankly, I know how clean my house is. I control who my guests are. I don't have an airconditioning system potentially spreading airborne diseases all over the place. Of course, a normally kept, hygienic home is cleaner than a hospital full of sick people. --Maustrauser 12:02, 25 May 2005 (UTC)[reply]

There are any number of facts we can choose to include in an article like this. For example, one might observe that a home birth is safer than a hospital birth because if you give birth at home, you run no risk of being run over by a truck on the way to the hospital. Likewise, a hospital birth is safer because if lightning strikes the building you are delivering in, the larger hospital will provide less chance of the lightning coming in the window and striking you in the face, killing you. Implicit in including such facts is the trust on the part of the reader that we included them because they were relevant. Particularly with regards to medical issues, common sense is often a less useful guide than research. If women are dropping like flies from Golden Staph (or even if there's a statistically significant elevated risk of such), then surely there should be a study supporting that claim (and let's be clear: there is absolutely no shortage of studies on the safety of home birth.)

I'm willing to let this percolate in Talk for a few days, but I call bullshit on the Golden Staph claim unless you can show not just that it's "common sense" that women are at greater risk of catching it at the hospital, but that they actually do. Nandesuka 12:37, 25 May 2005 (UTC)[reply]

Some nice points about the lightning and the truck! I wonder how many women are injured in the 'race to the hospital for the birth?' "Sorry Officer, I was speeding because my wife is having contractions... Shame about the carnage Ihave left!" Hmm. With regard to Golden Staph etc, the Association for Improvements in Maternity Services Journal has an interesting article regarding hospital based infections. See: http://www.aims.org.uk/Journal/Vol12No3/infection.htm --Maustrauser 12:54, 25 May 2005 (UTC)[reply]

I don't know about Golden Staph in particular, but I think it's safe to say that women truly are more at risk of developing an infection in the hospital than they are at home. I think it's ridiculous to compare it to something like getting run over on the way to the hospital or getting struck by lighting. Those things could happen, but they're not really related to birth or the birth environment, except by going out on a limb. Exposing yourself and your newborn baby to a whole host of pathogens in a hospital birth setting is directly related to birth. The article that Maustrauser pointed out notes that there are studies that are showing that there is a risk of infection in the hospital. That risk is much less at home. Hospitals are where sick people go and thus where sickness is breeding. You cannot brush off that particular benefit of home birth by saying that it's "going out on a limb" like one would say about quoting the risk of being hit by lighting. Skrimpy 04:56, 28 December 2005 (UTC)[reply]

Lewis Mehl study and Texas Department of Health study

I just found the Dr. Lewis Mehl study in the PubMed database. Searching for "mehl l" finds the study and a followup. The author has published a number of other interesting articles as well; the Tasered mother one is kind of famous I think.

where: Women Health. 1980 Summer;5(2):17-29
title: Evaluation of outcomes of non-nurse midwives: matched comparisons with physicians.
authors: Mehl LE, Ramiel JR, Leininger B, Hoff B, Kronenthal K, Peterson GH
PMID: 7210691 [PubMed - indexed for MEDLINE]

Hopefully this link to the abstract isn't going to expire. Notice that the midwives came out slightly ahead even after the worst 50% of the doctors were eliminated from the comparison. (more fetal distress and placental problems with the doctors)

That's pretty damning I think.

A 1983-1989 study by the Texas Department of Health shows births attended by doctors having 3x the death rate of births attended by non-nurse midwives. The name of this study is:

Berstein & Bryant
Texas Lay Midwifery Program, Six Year Report, 1983-1989
Appendix VIIIf
Austin, TX
Texas Department of Health.

Maybe somebody knows where to find the text?

AlbertCahalan 03:44, 27 May 2005 (UTC)[reply]

laws on homebirth in U. S.

I removed the sentence which said that "Certified Nurse-Midwives may attend homebirths in all 50 States, if their back-up physician will allow it." I can't speak to other states, but I know that in Nebraska it's illegal for a CNM to attend a homebirth regardless of physician approval. I suspect this may be the case elsewhere as well, but as I said I can't say for certain. spoko 5:47, 11 June 2006

I removed the sentence which said that first-time mothers are especially likely to want assistance at a home birth. In the U.S., practically everyone wants assistance. The number of unassisted home births is vanishingly small, first-time mother or not.

I also changed the passage that said that midwife-assisted home-birth is illegal in the listed states. It is not. Our son was born at home in Illinois with two midwives assisting -- nothing illegal about it. Midwives who assist at births must be nurse-practitioners, which makes finding one hard, but not impossible. I suspect the other states listed have wiggle-room as well -- and that the states listed as "legal" have some restrictions. I would strongly suggest taking down that map. It's deceptive, and providing deceptive information about such a subject is kind of indefensible . Providing a link to a site that gives an in-depth discussion of conditions in all 50 states would be a much better option. NoahB 14:34, 2 August 2005 (UTC)[reply]

Nurse-practitioners are often not considered to be true midwives. They generally only operate in a hospital setting while under the supervision of a physician. In other words, they are nurses. If you had a situation where the nurse practitioner was answering only to the parents, you had something rather unusual. AlbertCahalan 04:07, 14 August 2005 (UTC)[reply]

In any case, a link to in-depth discussion of all 50 states is provided at the bottom of the page. Your state is listed as "Prohibited by Statute, Judicial Interpretation, or Stricture of Practice". AlbertCahalan 04:07, 14 August 2005 (UTC)[reply]

There are nurse practitioners who are also midwives who do homebirths and are not associated with a hospital. It's not that common, but it happens. There are a handful in Chicago. There are also doctors who assist in homebirths (not midwives, at all.) The point is that it is possible to have a legal assisted home birth in Illinois (or at least in Chicago.) You just have to know what you're doing. I suspect that's the case in most cases where it's "illegal" -- and I also suspect that in many states where it's "legal", you still need certain qualifications if you're going to present yourself as a midwife. The situation is complicated, which is why the map does more harm than good, from my POV. NoahB 00:20, 17 August 2005 (UTC)[reply]

New York State

I'm fairly sure homebirth is actually legal in NY, since I've had three (2000, 2002, 2004), attended by a midwife and paid for by Medicaid, so I imagine if it were illegal someone would have said something! It would probably be a good idea to check the accuracy of the rest of the map, too.

Homebirth Debate

This is the only site on the web that analyzes the homebirth studies from a scientific point of view. It is not pro-homebirth, because the reality is that there is not a single study that demonstrates that homebirth is as safe as hospital birth. There are studies that claim to demonstrate homebirth safety, but a statistical analysis shows that they do not.

I find it interesting that it was removed because it "attacks" homebirth. Don't people deserve the opportunity to read both points of view, and make a decision for themselves? One of the most notable things about homebirth advocacy is the absolute unwillingness to respond to scientific and medical criticism of homebirth. Professional homebirth advocates do not present their claims to meetings of scientific or medical peers, and never put themselves in a position to take or answer questions posed by scientific or medical peers.

Women (and men) do not need to be protected from opposing points of view. Homebirth advocacy should be able withstand scientific and medical critique, and not have to hide from it by deleting any references that are not favorable.

Amy Tuteur, MD January 23,2007 —The preceding unsigned comment was added by 66.31.153.193 (talk) 14:34, 23 January 2007 (UTC).[reply]

Firstly, post at the bottom of the page, not at the top. Secondly, please sign your posts. Thirdly, posting links to your own websites is considered 'poor form' and demonstrates your lack of desire to be neutral in your contributions to the encyclopaedia. It breaches Wikipedia Guidelines WP:COI and [[WP{:Links]]. Fourthly, your website exists to disparage homebirth and not as you claim to scientifically analyze the safety of homebirth. I removed the link to it because it did not have the balance that you profess in your link description. It reads more like a blog than an attempt to provide envidenced-based science. Where studies support homebith you claim the studies were badly designed. Where studies do not support homebirth you claim that they are well designed. Your bias is obvious. Your site attacks professions, such as midwifery, as a whole. Please feel free to add references to scientific research to this article that are peer-reviewed and verifiable. Maustrauser 21:53, 23 January 2007 (UTC)[reply]

Couple of suggestions

1. The first sentence as it stands is nonsense. Taken logically from this, a birth in an ambulance, in a car, on a plane, in a workplace, a school, a shopping centre or anywhere else other than a hospital or 'birthing centre' is a home birth.

2. The statement In countries where midwives are the main carers for pregnant women, home birth is more prevalent is contentious. In the UK, midwives are the main carers but home birth is NOT more prevalent. Perhaps the writer was looking from a US position, where I believe physicians are the main carers.

3. Legal situation in the United States section: either the first or the last sentence should go - they say the same. Emeraude 18:30, 1 February 2007 (UTC)[reply]

Citation Discussion

I am checking citations. I loath to remove something that is on here, but if it is unsupported then I will. Need help on this one: "Matthews et al., Infant Mortality Statistics from the 2000 Period Linked Birth/Infant Death Data SetNational Vital Statistics Report, Volume 50, Number 12, August 2002. Shows that the hospital neonatal death rate for 2000 was 0.9/1000..." I have read the report and cannot find the "hospital neonatal death rate for 2000 was 0.9/1000" anywhere in the report. In fact, the report states, "Other variables that are available in the linked file data set (1), but are not discussed in this report include: …place of delivery…" Whomever added this reference, please provide the page on which it appears. Thanks. Kreisman 00:48, 18 February 2007 (UTC)[reply]

I've now read the paper too and I cannot find the rates as claimed. I think the document was added by User:Amy Tuteur, MD who runs an anti-homebirth website [1]. I had some discussions with this user on my talk page. See: [2] Maustrauser 02:05, 18 February 2007 (UTC)[reply]

You need to perform the calculations yourself. Infant Mortality Statistics from the 2000 Period Linked Birth/Infant Death Data SetNational Vital Statistics Report does not separate the statistics by risk level. The appropriate comparison group for the Johnson and Daviss study would be white women at term with singleton pregnancies. Looking at the raw data we find:

2,824,196 births to white women at term (37+ weeks), see Table 2 and 2,602 deaths of white babies weighing more that 2500 gm see Table 6 for a death rate of 0.9/1000. Amy Tuteur, MD 01:31, 19 February 2007 (UTC)[reply]