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August 04, 2007

Protect home-birth option

It is distressing to see that some obstetricians and public officials refuse to acknowledge the medical literature on the topic of home birth. Planned home birth with a skilled midwife in attendance has been shown many times to be a safe and reasonable option for low-risk women. (See, for example, the study published in the British Medical Journal, June 18, 2005: “Outcomes of planned home births with certified professional midwives: large prospective study in North America”).

National certification is currently available to midwives, as is licensure in many states. With the high rates of unnecessary Caesarean sections in most hospitals across the country — and the well-documented problems associated with surgical deliveries — it is more important than ever to preserve safe choices in childbearing that have the potential to reduce unnecessary interventions and their attendant risks.

Both home births and hospital births carry specific risks, and women who seek to reduce the likelihood of unnecessary medical interventions should be able to choose the home birth (or free-standing birth center) option.

As our obstetrician consultants for our forthcoming book on pregnancy and birth would agree, it is simply a myth that having a baby in the hospital will guarantee a better outcome for mother and/or baby.

Judy Norsigian
Executive director, Our Bodies Ourselves
Boston

Comments

BrokenRecord

Thank you, Ms. Norsigian, for your insightful perspective and that of the obstetrician consultants for your new book. There is no doubt that your long-standing credibility in the women's health field will help to bring homebirth into the public consciousness as a safe and empowering option for low-risk U.S. women.

It's not surprising that one of your first comments is from a rabidly anti-homebirth ex-obstetrician, splendidly underlining your point. Complete with conspiracy theory! Anyone familiar with Ms. Tuteur's antics will recognize the exact same comments posted on every article and blog across the web wherever homebirth is discussed. She has a lot of energy to try to eliminate homebirth as a choice for women, but unfortunately, not enough energy to make sure that her math is correct or accusations based in fact.

Before this article is completely hijacked by Ms. Tuteur's crusade, I want to thank you again for your support of homebirth midwifery in Missouri and across the country. We eagerly await your new book on pregnancy and birth!

AmyTuteurMD

"It is distressing to see that some obstetricians and public officials refuse to acknowledge the medical literature on the topic of home birth."

The medical literature shows that planned homebirth is NOT as safe as hospital birth. Planned homebirth with a skilled midwife in attendance has been shown to have an increased rate of preventable neonatal death compared to hospital birth for comparable risk women. This excess risk is in the range of 1-2/1000 ABOVE the neonatal death rate in the hospital.

"(See, for example, the study published in the British Medical Journal, June 18, 2005: “Outcomes of planned home births with certified professional midwives: large prospective study in North America”)."

While the Johnson and Daviss study CLAIMS to show that homebirth is as safe as hospital birth, it ACTUALLY shows that homebirth has a neonatal death rate more than 3 times higher than hospital birth. In 2000, the neonatal death rate for low risk women at term in the hospital was 0.7/1000, substantially less than the homebirth neonatal death rate. Look at the paper. Where is the neonatal death rate for low risk women in the hospital in 2000? The authors left it out and compared homebirth in 2000 to hospital birth in out of date papers extending back to 1969.

Moreover, it is important for people to know that both Johnson and Daviss are long time public advocates of homebirth. Daviss is a homebirth midwife, and Johnson is the former director of research for the Midwives' Alliance of North America, the study was comissioned by a homebirth advocacy group and was funded by a homebirth advocacy group.

The amount of data on homebirth is sparse, and most of the studies are poorly done and biased. Even so, the existing scientific evidence shows that homebirth has an excess rate of preventable neonatal death. There is not enough evidence to draw any conclusions regarding maternal mortality. There is, however, a repository of statistical information that dwarfs all the existing scientific information, even when it is added all together.

The data for the BMJ study of homebirth in 2000 was collected by MANA (Midwives' Alliance of North America). After the study ended, they continued collecting statistics for all registered midwives from 2001-2006 and up through the present. This database probably contains somewhere in the range of 30,000 deliveries, perhaps more. We know that the data is available because MANA is offering it to pre-approved individuals who sign confidentiality agreements preventing them from sharing the data with anyone else.

What does that data show? The issue of licensing of DEMs is being discussed in several states. If the MANA data demonstrated the safety of homebirth, one would expect that they would release it publically themselves. The fact that they refuse to release it except to pre-approved individuals, and the fact that they require a legal document preventing disclosure suggests that the data will be very harmful to MANA's interests.

MANA does not seem to realize that it has an ethical obligation beyond serving its members and their professional and economic interests. It has an ethical obligation to patients. If MANA is in possession of a large database that demonstrates that homebirth is not safe, and I believe they are, it is unethical for them to withhold that information and to take legal steps to insure that the public does not learn that information.

MANA should release the information immediately, both in print and on the web. Any state agencies contemplating DEM licensure should insist on a release of the information as a prerequisite for even considering the licensure issue.

There is simply no ethical justification for withholding the safety information in the MANA database.

irishguy

At the dawn of the 20th Century, childbirth was the leading killer of women in the United States. That number thankfully has been reduced, but still, one woman in the United States dies every DAY in childbirth.

The leading cause is severe bleeding. That is followed by infection. Together, they make up nearly 40 percent of all childbirth deaths.

There is no such thing as a "low-risk" woman.

 
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