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Old 02-04-2014, 07:47 AM   #1
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Homebirth increases adverse outcomes and death

I haven't seen this talked about here, so I wanted to put this collection of studies together so women can see them and make an informed choice.

Low risk, full term neonatal death rates in hospitals are typically accepted as between .4 and .6 (per thousand, it's usually per thousand), for all races and demographics. For all risk births in a hospital, across all races ages and demographics, it is usually .8. Intrapartum deaths, when the baby is alive when labor starts but dies during labor, are so small the numbers can't be calculated. The reason is, Peds and Neos and resuscitate just about anything.

The vast majority, over 90+% of homebirths are a choice that white educated women make, and are supposed to be low risk. When you tease out those demographics, hospital birth death rates are about .38.

Every study has its limitations, that's why it is important to look at the body of work and draw conclusions.
~~~~~~
First, the MANA (midwives alliance of north america) stats that were released a few days ago.

http://onlinelibrary.wiley.com/doi/1...mwh.12172/full

Quote:
Excluding lethal anomalies, the intrapartum, early neonatal, and late neonatal mortality rates were 1.30, 0.41, and 0.35 per 1000, respectively.
That's what they say, but in the full text they detail out their numbers, so the rates are actually 2.06 for all their homebirths, 1.61 when you take out the high risk women.

The breech birth rate was even higher, 5 our of 222 babies died. That's a rate of 20, when in the hospital they are .8.

Also, MANA took out the deaths from congenital anomolies, whereas they are included in the hospital rates.

~~~~~~~
Then Cornell published a study this week saying much the same thing.

http://www.ajog.org/article/S0002-93...155-1/fulltext

Quote:
NNM for those delivered at home by others and by midwives, and those delivered in a freestanding birthing center was significantly higher than those delivered by midwives in the hospital: hospital midwives: 3.1/10,000 (RR:1); home others: 18.2/10,000 (RR: 5.87; 95%CI: 4.21-8.19), home midwives: 13.2/10,000; (RR: 4.32 95%CI: 3.29-5.68), freestanding birthing center: 6.3/10,000;(RR: 2.03; 95%CI: 1.28-3.24). The excess NNM for home births by midwives was 10.2/10,000 births (95% CI 6.9-13.2), and 15.0/10,000 births (95% CI 9.4-20.6) for home births by “others”.
~~~~~~~
Judith Rook's testimony to the state of Oregon. She is a home birth CNM and CDC trained epidemiologist.
https://olis.leg.state.or.us/liz/201...gDocument/8585

Quote:
The total mortality rate associated with those births [planned OOH births with direct-entry midwives as the planned birth attendants] – excluding the one involving congenital abnormalities – is 4.8 per 1000.
The congenital defects were also taken out of this group, but they are always included in hospital stats.
~~~~~~

A study from Arizona showing higher death rates at home:
http://www.azdhs.gov/als/midwife/doc...ure-review.pdf

Quote:
Nine studies were included in the meta-analysis of child health outcome of births attended by midwives in homes or in hospitals. We analyzed 8 outcomes of child health (neonatal deaths, prenatal deaths, Apgar

Pooled results indicated that homebirths attended by midwives were associated with increased risks for neonatal deaths [pooled OR (95%CI): 3.11 (2.49, 3.89)]. There were no significant differences in outcome of home or hospital births attended by midwives for the other child health measures.
~~~~~~~~

This one from the AJOG is interesting because it is studying APGAR scores and birth place.

http://www.ajog.org/article/S0002-93...641-8/abstract

Quote:
Home births (relative risk [RR], 10.55) and births in free-standing birth centers (RR, 3.56) attended by midwives had a significantly higher risk of a 5-minute Apgar score of 0 (P < .0001) than hospital births attended by physicians or midwives. Home births (RR, 3.80) and births in freestanding birth centers attended by midwives (RR, 1.88) had a significantly higher risk of neonatal seizures or serious neurologic dysfunction (P < .0001) than hospital births attended by physicians or midwives.
Quote:
The increased risk of 5-minute Apgar score of 0 and seizures or serious neurologic dysfunction of out-of-hospital births should be disclosed by obstetric practitioners to women who express an interest in out-of-hospital birth. Physicians should address patients' motivations for out-of-hospital delivery by continuously improving safe and compassionate care of pregnant, fetal, and neonatal patients in the hospital setting.
~~~~~~~

This one is about neonatal HIE (basically baby brains being deprived of oxygen, which causes brain injuries) and homebirth from the AJOG again.

http://www.ajog.org/article/S0002-93...604-9/fulltext

Infants born at home are more than 16 times likely to need cooling therapy.

Quote:
From 2007-2011, 69 neonates underwent cooling for suspected HIE at our institution. These cases were compared to 276 normal controls. There were 5 home births (1.4%) and 340 hospital births (98.6%). Women who delivered at home had 16.9 times the odds of neonatal HIE compared to women who delivered in a hospital (p=<0.01). The odds remained significant after controlling for maternal age, ethnicity, education level, primary payer and pre-pregnancy weight (aOR 18.7, 95% CI 2.02-172.47). After controlling for mode of delivery the odds of HIE increased for home birth compared to hospital birth (aOR 32.9, 95% CI 3.52-307.45).

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Old 02-04-2014, 08:02 AM   #2
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Re: Homebirth increases adverse outcomes and death

Thank you for this
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Old 02-04-2014, 08:10 AM   #3
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Wow great info. Thank you!
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Old 02-04-2014, 05:10 PM   #4
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Re: Homebirth increases adverse outcomes and death

My question is, do these numbers include all types of home births? Planned and unplanned? Lay midwifes, trained midwives and Uc/UP? I only asks because other countries, with higher home birth stats sf not show high numbers like these, so it makes me wonder, what are the numbers including?
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Old 02-05-2014, 07:44 AM   #5
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Re: Homebirth increases adverse outcomes and death

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Originally Posted by Fairycat View Post
My question is, do these numbers include all types of home births? Planned and unplanned? Lay midwifes, trained midwives and Uc/UP? I only asks because other countries, with higher home birth stats sf not show high numbers like these, so it makes me wonder, what are the numbers including?
I'd have to go through each individual study again, but I'm 100% positive that the Oregon and the MANA data were planned homebirths. And they had the worst numbers. Unplanned homebirths are really pretty unusual, though.

I believe that the Oregon ran the numbers with all types of midwives and births separately. I'd have to go through the studies again, but they are right there, look through the full text and see if they pull out type of midwife.

There aren't a lot of studies overseas comparing homebirth to hospital birth. There's an old one done in the Netherlands, but I believe that the last few years their death rates have been going up as well, and they are trying to put in more regulations. There is also the recent UK birthplace study, that didn't have horrible numbers for very low risk women, but it has been widely criticized as just a way for the health admin to save money.

In addition, you really cannot compare other countries to home birth here in the US. For one thing, they have more training and regulations, and we don't. Pretty much anyone with any education and training level can call themselves a midwife here, whereas in places like Canada and the UK they have educational standards that are pretty rigorous. In addition, they have very strict standards for risking out women. Only the very lowest risk women will be attended by a licensed home birth midwife in most other countries. And lastly, you can't extrapolate data from other countries because of our varied demographics, size of our country (so distance to a medical facility), and lack of universal healthcare.

I think, too, the safety of homebirth has been grossly exaggerated the last decade or so to promote an agenda. Even now MANA is trying to obfuscate the actual data and say there is no increased risk of adverse outcomes. Because of this, I think this data has come as a shock to many people who have been told that home birth is as safe, or safer, than hospital birth.

The next step, really, is what can we do to make homebirth safer, if anything? And unfortunately from the major midwives organizations, all you hear are crickets chirping.
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Old 02-05-2014, 08:10 AM   #6
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Re: Homebirth increases adverse outcomes and death

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Originally Posted by Minniebees View Post
I'd have to go through each individual study again, but I'm 100% positive that the Oregon and the MANA data were planned homebirths. And they had the worst numbers. Unplanned homebirths are really pretty unusual, though.

I believe that the Oregon ran the numbers with all types of midwives and births separately. I'd have to go through the studies again, but they are right there, look through the full text and see if they pull out type of midwife.

There aren't a lot of studies overseas comparing homebirth to hospital birth. There's an old one done in the Netherlands, but I believe that the last few years their death rates have been going up as well, and they are trying to put in more regulations. There is also the recent UK birthplace study, that didn't have horrible numbers for very low risk women, but it has been widely criticized as just a way for the health admin to save money.

In addition, you really cannot compare other countries to home birth here in the US. For one thing, they have more training and regulations, and we don't. Pretty much anyone with any education and training level can call themselves a midwife here, whereas in places like Canada and the UK they have educational standards that are pretty rigorous. In addition, they have very strict standards for risking out women. Only the very lowest risk women will be attended by a licensed home birth midwife in most other countries. And lastly, you can't extrapolate data from other countries because of our varied demographics, size of our country (so distance to a medical facility), and lack of universal healthcare.

I think, too, the safety of homebirth has been grossly exaggerated the last decade or so to promote an agenda. Even now MANA is trying to obfuscate the actual data and say there is no increased risk of adverse outcomes. Because of this, I think this data has come as a shock to many people who have been told that home birth is as safe, or safer, than hospital birth.

The next step, really, is what can we do to make homebirth safer, if anything? And unfortunately from the major midwives organizations, all you hear are crickets chirping.
I just wanted to say that some states have rather rigorous qualifications for a mother to have a home birth and to become a midwife that may attend homebirths. My first two were born in the hospital and third was born at home in Arkansas. I had to submit to every single test required by my local health department (Pulaski county) and I was not allowed to decline any of them. My first two I was able to decline quite a few prenatal tests (such as the stds testing, the pap smear bc I had had one done a few months prior,the longer gestational diabetes test, and an ultra sound). And I was able to decline them even though I was giving birth in the hospital. I have very low risk pregnancies and even with that track record the health dept said I had to have all those tests in order to birth at home. Maybe not all states have the same requirements as AR but I felt very safe in my decision to homebirth and the nurse practitioner felt the same way once all the tests came back showing I was indeed low risk. You also have to be with in so many miles of a hospital with a labor and delivery unit and must have ambulance services in your area and a back up plan in case of transfer. My midwife also was very strict (compassionate but still strict) with her guidelines for keeping me and my baby healthy enough to safely birth at home. She monitored what I ate, how much sleep I was getting, the amount I exercised each day...the list goes on. So I actually put MORE effort into my decision to birth at home than I did my decision to birth in a hospital and I was monitored more closely and taken better care of during my 3rd pregnancy than my other two.

And for what it's worth I believe those restrictions and guidelines to homebirth are very important and are glad they were in place in the state I lived in. It helped to assure me that I was making the best possible choice for my family and I was going to have the best birth possible for us as well.
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Old 02-05-2014, 08:37 AM   #7
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Re: Homebirth increases adverse outcomes and death

eh, I will still take my chances and birth at home. safer in MY opinion
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Old 02-05-2014, 08:54 AM   #8
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I trust in my midwife & her training and will absolutely be having my baby at home,for the second time.
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Old 02-05-2014, 09:10 AM   #9
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Re: Homebirth increases adverse outcomes and death

Quote:
Originally Posted by Minniebees View Post
I'd have to go through each individual study again, but I'm 100% positive that the Oregon and the MANA data were planned homebirths. And they had the worst numbers. Unplanned homebirths are really pretty unusual, though.

I believe that the Oregon ran the numbers with all types of midwives and births separately. I'd have to go through the studies again, but they are right there, look through the full text and see if they pull out type of midwife.

There aren't a lot of studies overseas comparing homebirth to hospital birth. There's an old one done in the Netherlands, but I believe that the last few years their death rates have been going up as well, and they are trying to put in more regulations. There is also the recent UK birthplace study, that didn't have horrible numbers for very low risk women, but it has been widely criticized as just a way for the health admin to save money.

In addition, you really cannot compare other countries to home birth here in the US. For one thing, they have more training and regulations, and we don't. Pretty much anyone with any education and training level can call themselves a midwife here, whereas in places like Canada and the UK they have educational standards that are pretty rigorous. In addition, they have very strict standards for risking out women. Only the very lowest risk women will be attended by a licensed home birth midwife in most other countries. And lastly, you can't extrapolate data from other countries because of our varied demographics, size of our country (so distance to a medical facility), and lack of universal healthcare.

I think, too, the safety of homebirth has been grossly exaggerated the last decade or so to promote an agenda. Even now MANA is trying to obfuscate the actual data and say there is no increased risk of adverse outcomes. Because of this, I think this data has come as a shock to many people who have been told that home birth is as safe, or safer, than hospital birth.

The next step, really, is what can we do to make homebirth safer, if anything? And unfortunately from the major midwives organizations, all you hear are crickets chirping.
This was actually what I was curious about, in the break downs in just the US firstly. The issue is if you count lay midwives, and inexperienced people, then I would assume it would skew the rates. In some places, I know training and supplies required by midwives are much more regulated. I was wondering if the numbers shown would be effected based on training and regulations. I might have to go and read all of it more thoroughly, but I was just curious how these things were accounted for in the numbers.
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Old 02-05-2014, 09:14 AM   #10
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Re: Homebirth increases adverse outcomes and death

Great post!
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