Talk:Home birth

Legality of Midwives in US

This paragraph does not make sense:

"In 37 states it is legal to acquire the services of a midwife. Many midwives continue to attend mothers in states where it is illegal, while efforts are underway to change the law."

Practicing as a certified nurse midwife is legal in all states. Is this statement meant to refer to legality of direct-entry midwifery? If so, it should be clarified. Also, I think the statement that it "is legal to acquire the services of a midwife" is misleading, as it implies that in some states, it is illegal to hire a midwife. To the best of my knowledge (and please correct me if someone knows otherwise) it is not illegal to hire any type of midwife anywhere in the United States, rather, direct-entry midwives can be prosecuted for practicing in some states.Jane Snow (talk) 22:50, 6 July 2009 (UTC)

What is low risk pregnancy?

The page makes a couple of references to "low risk" when considering the safety of home birth. What is "low risk"? A quick googling only found one definition - from a 1997 paper by Rosenblatt et al ["Interspecialty differences in the obstetric care of low-risk women.", Am J Public Health, March 1997]. This mentioned "a major medical condition, a previous obstetrical complication, a serious risk factor in the current pregnancy, no obstetrical care in the first trimester, or were under 18 or over 34 years old." as all meaning "not low risk". According to this definition, 53% of the pregnancies in that study were "not low risk". So, what's the general definition of "low risk", and what proportion of pregnancies meet that criterion? Pvanheus (talk) 10:40, 5 December 2009 (UTC)

Research on Safety

The description of the NICE report seems unclear to me in this article. I tried to look over the report and see where some of this wording was coming from. Maybe I'm missing something, but I can't find where the report mentions that planning birth in a consultant-led unit decreases satisfaction. The section begins with the report's introduction to a set of points they think women deciding between settings should be informed about, so I think this section should be completely revised to describe an overview of these points. I think this would be clearer and more accurate. I'm going to go ahead and try to do that if no one objects. --Aronoel (talk) 16:49, 7 May 2010 (UTC)

Go for it, sounds great! -- btphelps ^{(talk) (contribs)} 19:32, 7 May 2010 (UTC)

I could not find the quote you added that was supposed to be from the NICE study. While the edit summary said, "Revised and expanded section about NICE report," it dramatically altered the tenor of the prior quote from home-birth neutral to home-birth negative. The new quote was:

"The uncertain evidence suggests intrapartum-related perinatal mortality (IPPM) for booked home births, regardless of their eventual place of birth, is the same as, or higher than for birth booked in obstetric units. If IPPM is higher, this is likely to be in the group of women in whom intrapartum complications develop and who require transfer into the obstetric unit."

When unanticipated obstetric complications arise, either in the mother or baby, during labour at home, the outcome of serious complications is likely to be less favourable than when the same complications arise in an obstetric unit.

I searched the NICE study for three different phrases in the above quote without success. Perhaps there is another source? So I reverted the change and added a ref for the existing quote from the study. The second graf is un-sourced and appears to be original research. -- btphelps ^{(talk) (contribs)} 03:08, 11 May 2010 (UTC)

If you follow this link, [1] which I included in my reference when I made the changes, and go to page 23, you will see the section of the NICE report called "Recommendations on planning place of birth" and a sub-section called "Home Birth." This is the part of the report that I quoted and summarized in my changes, and you will see that they are not original research or my own point of view.

The current part of this article describing NICE is lifted directly from this page: [2] This is a possible copyright violation and as far as I can tell, the source used isn't published and is less recent than the one I used. For these reasons and the reasons I mentioned originally I hope you restore my changes. --Aronoel (talk) 15:45, 11 May 2010 (UTC)

The information you say is lifted that could be a possible copyright vio is actually a copy of this Wikipedia article. Note the word "Wikipedia" upper right on the article.

Sorry, I didn't catch your other reference. Please re-add it but I suggest leaving the existing info as both pieces of info seem to have validity. I read page 8 of the document you provided and from what I could gather -- I am by no means an expert in this field -- some intrapartum-related perinatal mortality (IPPM) rates were higher in the UK but lower in Australia. It states, "It should be noted that the calculated IPPM rates are sensitive to transfer rates, which themselves are particularly uncertain." The quote you provided also cites "uncertain evidence." Seems to me that all of the information cannot be validated with a high degree of certainty.

On page 23, along with the quote you cite, it reports, "Planning birth outside an obstetric unit seems to be associated with an increase in spontaneous vaginal births, an increase in women with an intact perineum and improved maternal satisfaction." I don't have time to absorb all of it, but it seems like the report equivocates on all its recommendations. Women who value a vaginal birth and and "intact perineum" (i.e., a non-induced labor) would find value in some of the recommendations, while women who are concerned about possible negative outcomes due to complications would find value in other recommendations. Some kind of balanced summary of what appear to me to be inconclusive recommendations would be appropriate IMO. -- btphelps ^{(talk) (contribs)} 17:27, 11 May 2010 (UTC)

I edited that section somewhat and tried to clarify the equivocal nature of the information. You could certainly improve it. Maybe you could also fix the lede? It's much too short. -- btphelps ^{(talk) (contribs)} 17:35, 11 May 2010 (UTC)

Sorry, on second look it was clearly not a copyright violation.

I agree that the NICE report does not seem to have very certain recommendations, and it mentions many times that the evidence is too poor to have a high degree of certainty about any of the conclusions. I think the point of the recommendations was to evaluate the what little and contradictory evidence there is and create a set of information, but with caveats.

Also, I really question the validity of the "Final Draft of Guideline on Intrapartum Care" source. This is not a situation with two separate articles or reports, it's really the same report, and one version seems to be an earlier unpublished draft. If they decided to change their recommendations in the published version, I think there must be a reason why.

I agree that the points about intact perineum and vaginal labor should be included, because it's valuable information for some people. In my version I did include these points, even though I'm not sure that they technically fall under the "safety" category.

I'll work on the things you suggested, but in the meantime, do you think that it would be good if we completely restructured the section on safety so that instead of using block quotes and summarizing a bunch of different studies of dubious quality, we try to outline some basic facts and viewpoints that we find in multiple sources? --Aronoel (talk) 19:16, 11 May 2010 (UTC)

That sounds fine, please go for it. I'm on deadline with some other writing projects and won't be much help, I'm afraid. -- btphelps ^{(talk) (contribs)} 05:26, 12 May 2010 (UTC)

What about this: Caroline Lovell, 36, once advocated for midwife funding and legal protection in Australia; but in January, Lovell died of a heart attack just one day after giving birth at home to her second daughter, Zahra, the Australian newspaper Herald Sun reported? http://abcnews.go.com/blogs/health/2012/02/02/death-after-home-birth-raises-questions/ Dr. Jux 17:31, 14 February 2012 (UTC) — Preceding unsigned comment added by Juxtaposit (talk • contribs)

Apgar Scoring

Regarding the safety for the baby, it would not be helpful to use the apgar score as the measure of safety. Apgar was invented to describe what state the child was in at the time of the delivery, and has been shown not to correlate well with long-term outcomes (unless the score is very low at 10 minutes of age). [3]

Professional resistance

Aronoel, good addition to the lede about the American Medical Association and College of ObGYn's opposition. However, the lede is supposed to summarize the body. Can you add some content to the body describing their opposition? (Like the AMA's "Resolution 205 on Home Deliveries," passed in 2008.) Here are some possible links:

• Ricki Lake's home-birth film upsets AMA
• Thoughts on the AMA Homebirth “Ban,” Ricki Lake, and Midwifery
• American Medical Association passes resolution to outlaw homebirth
• Missouri court says midwives can continue to practice
• American Medical Association House of Delegates (A-08) p. 15.

AMA Resolution 205 in full:

Resolution 205 (1) that our American Medical Association support the recent American College of Obstetricians and Gynecologists (ACOG) statement that “the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers”; and (2) that our AMA develop model legislation in support of the concept that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the AAP and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.”

Note that self-published sources like blogs are not generally acceptable as third-party sources, although this generally applies to individually-published content. Exceptions may include professional organizations. Use your discretion.

I think the basic thrust of the arguments that the AMA and College of ObGyns have is against midwives and not home birth per se, because the midwives are competing for a piece of their business. They don't say that, but their critics do. So presenting both the medical association's and the professional midwives association's point of view should be helpful.

-- btphelps ^{(talk) (contribs)} 22:57, 13 May 2010 (UTC)

Thanks, I want to add the professional midwives association's response, but I'm having trouble finding a press release or a published article where they explain their criticism. Do you know of one or a good place to look? -Aronoel (talk) 16:44, 14 May 2010 (UTC)

Home Birth Opinions

    Based on the research on home birth would some of you still recommend home birth after knowing the benefits and the risks of it to other women who wants to have home birth?  — Preceding unsigned comment added by 68.63.209.120 (talk) 23:35, 2 February 2012 (UTC)