Wednesday, January 18, 2012

Home Birth, A Safe Option?

Two articles have recently come to my attention (see, you think that I'm all on the ball and a researcher type, but REALLY, I just have great friends who send me this stuff =D) regarding the safety of home birth.

The first I read is from England, and it compared midwife-attended home births, midwife-attended center births, midwife-attended hospital births & doctor-attended hospital births.  The findings were fascinating:  for first-time births, midwife-attended center births are safest overall; fewer C-sections & other interventions risky to the mom, as well as low infant mortality & morbidity.  Midwife-attended hospital births were next, followed by doctor-attended hospital births. Home births were marginally less safe (we're talking under 1% difference).  For all later births, there was no difference in harm to the baby.  However, as far as "normal" birth is concerned (meaning one without interventions like forceps, and episiotomies), home birth is the clear winner.  Here's how the percentages stack up for normal births:  90% home birth, 83% freestanding midwife unit, 76% hospital midwife unit, and 60% hospital obstetric unit.
This Oxford University research raises fundamental questions about maternity care in the UK. Nine out of 10 babies are born in medically-led obstetric units. There has been a trend to centralise this into fewer and larger centres to guarantee consultant cover. Many of the decisions have taken place without definitive evidence about the safety for babies and the experience for mothers. This study provides that.

It reveals an unexplained difference in the rate of normal birth between units run by midwives and those run by doctors. The disparity on emergency Caesarean sections is particularly striking. It suggests a different culture in the way midwives and doctors see birth, with doctors concerned about risks and midwives focused on normality.
The second article is on a similar study in Canada, though from 2000-2004 (published in 2009).  It compared midwife-attended home births, midwife-attended hospital births and doctor-attended hospital births, and revealed "the mortality rate per 1,000 births was 0.35 in the home birth group, 0.57 in hospital births attended by midwives, and 0.64 among those attended by physicians."  This article continues:
Women who gave birth at home were less likely to need interventions or to have problems such as vaginal tearing or hemorrhaging. These babies were also less likely to need oxygen therapy or resuscitation, the study found.

The authors acknowledge that "self-selection" could have skewed the study results, in that women who prefer home deliveries tend to be healthier and otherwise more fit to have a home birth.
Good stuff to think about!

Just as a note, it's enlightening to read the same UK study reported with a different "spin."  While it's clear from the actual study that the risk to the babies was all under 1% (4.5 per 1000 to 9.3 per 1000), this study spins the data to say: "First-time mothers who opt for a home birth are almost three times more likely to have a baby who dies or suffers brain damage"!  Sounds much more scary when it's put that way, doesn't it!?  This just highlights why it's important to look at actual data, not just the way a newspaper reports them! (Here's a link to the actual medical journal article from the UK study, and a link to the Canadian study.)


Amanda said...

I've had one hospital birth with nurses and doctors and one home birth with midwives and I have to say that I FELT much safer birthing at home. Although I'm sure the hospital staff were well intentioned, the number of strangers, the sights, the smells, the sounds and the unfamiliarity of it all did not allow me to relax and work well with my body resulting in a very long labour and a variety of unwanted interventions. I felt distracted, exposed, and on edge.
In contrast, my home birth was peaceful, I felt comfortable in my surroundings and only had people I knew and trusted there. My midwives were so supportive and knew the tricks to help me work with my body and get through the tough contractions. Afterwards I was able to peacefully rest and bond with my new baby. I felt safe and secure in my own "nest". What I'm trying to say is that the mothers mental state affects her body during labour and the bonding that happens afterwards.
Now that I have experienced the difference it makes I would go the home birth route again. Baby and I were both better for it.

As a side note, it really is funny how they spin the numbers! You know what they say: There are 2 kinds of lies - LIES and statistics! lol

Eowyn's Heir said...

Thanks for stopping by, Amanda! I haven't had a home birth, but am hoping to have a water birth in a free-standing center (so getting the home-birth "feel") with this baby. Maybe with #3 (if the Lord gives us that many), we will move all the way home... it would be so nice to not have to go anywhere!

Anonymous said...

How big of a factor do you think liability concerns are w/ regard to doctors being more likely to resort to c-sections, etc? OBGYN malpractice insurance is some of the highest. A lot of MDs are switching to just GYN because of this.


Eowyn's Heir said...

litigation a factor? Oh, goodness, YES!!! HUGE!! One of my dad's closest friend is a doctor, and got out of the practicing aspect & into the behind-the-scenes computer aspects because of this... he used to talk about how malpractice insurance is The driving factor in the cost of mainstream health care. However, the view doctors have of birth is typically that it's a disease with symptoms needing treatment (pregnancy is classified as a disability, etc), so they are expecting to have problems and want to head them off, lest their patients come to harm (and they get sued). That plays in big time to how they "manage" birth and treat their patients.