friday follow-up

regarding the perils of hombirth

so the today show did a recent scare segment re homebirth (originally titled 'the perils of midwifery' but later changed to 'the perils of homebirth' and naturally the birthing blogosphere has been abuzz

http://blackhillsportal.com/npps/story.cfm?id=3430
http://www.rhrealitycheck.org/blog/2009/09/11/nbc-today-shows-homebirth-scare-segment
http://mybestbirth.ning.com/forum/topics/the-perils-of-journalism-ricki

of course the topic of home birth has been a contentious one for quite some time as these earlier links attest.

http://www.babble.com/CS/blogs/strollerderby/archive/2009/04/18/home-birth-a-right-or-a-must.aspx
http://www.timesonline.co.uk/tol/comment/columnists/melanie_reid/article6101189.ece


some of the debate focuses on the rights to even have a homebirth, some on the safety of homebirth



the australian healthcare system has been duking it out over homebirth for a while . heres some of the latest from over there http://www.thepunch.com.au/articles/homebirth-wars-confusing-a-right-with-whats-right/



despite the evidence regarding the safety of homebirth http://www.bmj.com/cgi/content/full/330/7505/1416 the american college of obstetrics and gynocology has been on a campaign to remove the choice of homebirth... they put out a press release in february 2008 in which they re-iterated their stance http://www.acog.org/from_home/publications/press_releases/nr02-06-08-2.cfm and now they are using the media to skew public perception as to the dangers of homebirth and the competancies of midwives.

heres the thing though....

i think most women do take their own health factors into consideration when preparing for a home birth. most wome will change their plans when the situation requires it. there may be some disagreement as to what requires a change of plans: breech baby? twins? higher order multiples? postdates? what about vbac? but in other situations theres just not as much grey area and most women and midwives recognize that and respond appropriately.

according to this study http://www.jmwh.com/article/S1526-9523(08)00338-3/abstract a perception of GREATER safety was one of the major factors involved in planning a home birth.

The percentage of women choosing to birth at home has remained fairly steady for the past 2 decades http://www.uptodate.com/patients/content/topic.do?topicKey=~l0l0wKntyU7Dhn1

"From 1989 to 2003 the rate of home births in the United States declined from 0.69 to 0.57 percent of births, or by an average of 0.01 percent annually. The 2006 figures represent a very slight increase in both absolute numbers and rate, reaching 0.59 percent of all births [5]. This rate is comparable to that in other industrialized countries with two exceptions: England has experienced a slight rise in its home birth rate from 1.0 percent in 1989 to 2.7 percent in 2006 [6], while the Netherlands has maintained rates of home birth of approximately 30 percent [7]."

acog recently released a statement http://www.acog.org/from_home/publications/press_releases/nr09-11-09.cfm that basically says obs are practicing in a manner that is highly concious of the risks of litigation.

here are the results from the listening to mothers II survey http://www.childbirthconnection.org/pdf.asp?PDFDownload=LTMII_report this shows women are suffering as a result. rather than focus on the less than %1 of births that occur at home why not focus on improving the care women recieve during the %99 of births that occur at hospitals or birthcenters?

homebirth is already 100% LEGAL in every state in the us. the legality of attendance by a midwife is fast becoming just as legal.

In addition to the Lamaze 6 Care Practices that support Normal Birth http://www.lamaze.org/ChildbirthProfessionals/ResourcesforProfessionals/CarePracticePapers/tabid/90/Default.aspx

the coalition for improving maternity services has already created the mother friendly initiative in order to give hospitals and providers some concrete goals to focus on in improving their maternity care http://www.motherfriendly.org/mfci.php these steps are a good focus point for anybody involved in birth reform.

this is a good year for legal birth reform: we have a new president, congress is involved in overall healthcare reform. and the numbers are on our side 80% of women experience childbirth. within that majority of women i would guess theres enough support to protect by law the normal, healthy birth care practices that the evidence supports and women want

Lamaze Healthy Birth Practices

The six Lamaze Healthy Birth Practices below are supported by
research studies that examine the benefits and risks of maternity care
practices. Therefore, they represent "evidence-based care," which is the gold
standard for maternity care worldwide. Evidence-based care means "using the best
research about the effects of specific procedures, drugs, tests, and treatments,
to help guide decision-making." Please note: The English versions
were revised in 2009.

Let Labor Begin on Its Own

Walk, Move Around, and Change Positions Throughout Labor

Bring a Loved One, Friend, or Doula for Continuous Support

Avoid Interventions That Are Not Medically Necessary

Avoid Giving Birth on the Back and Follow the Body’s Urges to Push

Keep Mother and Baby Together – It’s Best for Mother, Baby, and
Breastfeeding

Ten Steps of the Mother-Friendly Childbirth InitiativeFor
Mother-Friendly Hospitals, Birth Centers,* and Home Birth Services
To receive
CIMS designation as “mother-friendly,” a hospital, birth center, or home birth
service must carry out the above philosophical principles by fulfilling the Ten
Steps of Mother-Friendly Care.


A mother-friendly hospital, birth center, or home birth service:


Offers all birthing mothers:

Unrestricted access to the birth companions of her choice, including
fathers, partners, children, family members, and friends;

Unrestricted access to continuous emotional and physical support from a
skilled woman—for example, a doula,* or labor-support professional;

Access to professional midwifery care.


Provides accurate descriptive and statistical information to the public
about its practices and procedures for birth care, including measures of
interventions and outcomes.


Provides culturally competent care—that is, care that is sensitive and
responsive to the specific beliefs, values, and customs of the mother’s
ethnicity and religion.


Provides the birthing woman with the freedom to walk, move about, and
assume the positions of her choice during labor and birth (unless restriction is
specifically required to correct a complication), and discourages the use of the
lithotomy (flat on back with legs elevated) position.


Has clearly defined policies and procedures for:

collaborating and consulting throughout the perinatal period with other
maternity services, including

communicating with the original caregiver when transfer from one birth site
to another is necessary;

linking the mother and baby to appropriate community resources, including
prenatal and post-discharge follow-up and breastfeeding support.


Does not routinely employ practices and procedures that are unsupported by
scientific evidence, including but not limited to the following:
shaving;
enemas;
IVs (intravenous drip);
withholding nourishment or water;
early rupture of membranes*;
electronic fetal monitoring; other
interventions are limited as follows:


Has an induction* rate of 10% or less;†


Has an episiotomy* rate of 20% or less, with a goal of 5% or less;


Has a total cesarean rate of 10% or less in community hospitals, and 15% or
less in tertiary care (high-risk) hospitals;


Has a VBAC (vaginal birth after cesarean) rate of 60% or more with a goal
of 75% or more.


Educates staff in non-drug methods of pain relief, and does not promote the
use of analgesic or anesthetic drugs not specifically required to correct a
complication.


Encourages all mothers and families, including those with sick or premature
newborns or infants with congenital problems, to touch, hold, breastfeed, and
care for their babies to the extent compatible with their conditions.


Discourages non-religious circumcision of the newborn.


Strives to achieve the WHO-UNICEF “Ten Steps of the Baby-Friendly Hospital
Initiative” to promote successful breastfeeding:

Have a written breastfeeding policy that is routinely communicated to
all
health care staff;

Train all health care staff in skills necessary to
implement this policy;

Inform all pregnant women about the benefits and
management of
breastfeeding;

Help mothers initiate breastfeeding
within a half-hour of birth;

Show mothers how to breastfeed and how to
maintain lactation even if they
should be separated from their infants;

Give newborn infants no food or drink other than breast milk unless
medically indicated;

Practice rooming in: allow mothers and infants
to remain together 24 hours
a day;

Encourage breastfeeding on
demand;

Give no artificial teat or pacifiers (also called dummies or
soothers) to
breastfeeding infants;

Foster the establishment of
breastfeeding support groups and refer mothers
to them on discharge from
hospitals or clinics

† This criterion is presently under review.