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natural birth

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14 years 5 months ago #2754 by DocMa
This is such an interesting topic! When I was preg with my first I had a lot of pressure from my in-laws to have a home birth because "they" (doctors) would rather cut me open and drug me than let me have a natural birth.
For myself, my bottom line, though, was that I can't think of a fate worse than being transferred to a hospital from home in hard labor--what a nightmare! So I have chosen OBs who support my wish to have a natural (drug-free) birth and have had no problem with this. My first was born just fine (wonderfully in fact) in a hospital and au naturale and I'm hoping for the same with #2 (halfway there!). BUT I have an OB providing my care in a top notch hospital just in case, so I feel as confident as I can which is the best way to go into labor.
Now, there are some women who do NOT feel confident in hospitals for whatever reasons and they may prefer to have babies at home (like my in-laws all did) and I think they ought to have this right as long as they are fully aware of the risks (just like informed consent in the hospital, right?). Everyone needs to make the choice that they believe makes them feel safest and most confident wherever that may be and with whatever aids, as long as they're aware of all the aspects of each decision. Just my :twocents: .

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14 years 5 months ago #2755 by white_feather
I would like to express my surprise that in a community of medical minded people, no one is offering an evidence-based, research-backed opinion.

There are a multitude of studies on homebirth and all but one demonstrate that homebirth is AT LEAST as safe as hospital birth for a low-risk mother. The one study that shows otherwise has been well refuted in the academic community.

Homebirth success rates are phenomenal. Midwives are trained to catch potential emergencies very early on and transfer if necessary. The most likely reason for transfer? Failure to progress. Homebirth midwives have impeccable outcomes, and it's NOT because of luck.

It's because they adhere to a birthing philosophy that is evidence based.

Homebirthing women don't give birth flat on their back thus rendering their pelvic outlet 30% smaller than it should be. They are not tied down with Continuous Fetal Monitoring, which impedes labor b/c mom isn't moving, and, as research demonstrates, is no more effective than intermittent fetal monitoring at identifying potential problems with the baby.

Homebirth midwives go to births armed with emergency equipment, but rarely use any of it.

Homebirth is a VERY valid way of giving birth for low risk women. It may not be every woman's choice, but to disparage such a choice with irrational emotion and fear, rather than an evidence based opinion and understanding of the issues and philosophy does a great disservice to women everywhere.

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14 years 5 months ago #2756 by DocMa
Is the "other" study that you refer to the ACOG one from late '02/early '03 from WA state? Has ACOG or AAFP published that homebirth is as safe? Everytime I do a journal search for the evidence I only see Midwifery Today or other midwife journals with this evidence. I'm not disputing you, I just would love to know which resources you refer to!!

As a quick side note, though, don't imply that a hospital birth necessitates continuous fetal monitoring and flat on your back delivery--it doesn't. My first daughter was born in a hospital with no pain meds and I walked until I was ready to push at which point I sat up on the edge of the bed and my husband got to be the one to catch her (with the OB right there if we needed her). Same is planned for #2 due in October. I have found both obstetricians to be very welcoming to my own birth preferences and the nurses to be awesome support!

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14 years 5 months ago #2757 by white_feather

Originally posted by mbp:
Is the "other" study that you refer to the ACOG one from late '02/early '03 from WA state?

Yes, the Pang study.

Has ACOG or AAFP published that homebirth is as safe?

I suppose if they did, they'd risk putting themselves out of work. Obstetrics is already in so much trouble. But other major medical organizations in the world do acknowledge midwifery and homebirth as safe, cost effective options.

Everytime I do a journal search for the evidence I only see Midwifery Today or other midwife journals with this evidence. I'm not disputing you, I just would love to know which resources you refer to!!

Good research is good research no matter who's doing it. Nursing and midwifery is held to the same high standards of peer reviewed research as is a researcher in any other field. However, there are studies published by doctors in medical journals. Here are some:

Here's a good review of research from the BMJ - bmj.bmjjournals.com/cgi/content/full/313/7068/1276

Outcomes of intended home births in nurse-midwifery practice: a prospective descriptive study. Murphy PA; Fullerton J (Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA. This email address is being protected from spambots. You need JavaScript enabled to view it.) Obstet Gynecol, 92(3):461-70, September 1998

Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in the Netherlands. T A Wiegers, M J N C Keirse, J van der Zee, and G A H Berghs
BMJ 23 November 1996; 313: 1309-1313.

Prospective regional study of planned home births. Davies J, Hey E, Reid W, Young G.
BMJ 1996;313:1302-1306 (23 November 1996)

Home versus hospital deliveries: follow up study of matched pairs for procedures and outcome. Ursula Ackermann-Liebrich, Thomas Voegeli, Kathrin Gunter-Witt, Isabelle Kunz, Maja Zullig, Christian Schindler, Margrit Maurer, and Zurich Study Team
BMJ 23 November 1996; 313: 1313-1318

Collaborative survey of perinatal loss in planned and unplanned home births. Northern Region Perinatal Mortality Survey Coordinating Group BMJ 23 November 1996; 313: 1306-1309.

Simulated home delivery in hospital: a randomised controlled trial. MacVicar J, Dobbie G, Owen-Johnstone L, Jagger C, Hopkins M, Kennedy J (Department of Obstetrics & Gynaecology, Leicester Royal Infirmary, UK. )
Br J Obstet Gynaecol 1993 Apr;100(4):316-23

The Safety of Home Birth: The Farm Study. A. Mark Durand, MD, MPH,
Published in Am J Public Health, 1992;82:450-452

Outcome of planned home births in an inner city practice. Ford C, Iliffe S, Franklin O (Department of Primary Health Care, Whittington Hospital, London.) BMJ 1991 Dec 14;303(6816):1517-9

As a quick side note, though, don't imply that a hospital birth necessitates continuous fetal monitoring and flat on your back delivery--it doesn't.

You're right. There are some great OB's and great hospitals out there. However, we're kidding ourselves if we think most women in the US deliver in any other position besides supine. Many women don't have the ability to choose better hospitals or better obstetricians for a variety of reasons - not the least of which are insurance and accessibility.

But mostly my interest is ensuring that people understand the safety and validity of homebirth as an option (and a bit about the philosophy thereof), since the safety of hospital birth is usually a given.

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14 years 5 months ago #2758 by Dental-Mom
mbp, same here! I had my midwife, a doula and my husband as the best coachs ever. My hospital wants moms to avoid epidurals too....

I didn't seat at all until it was time to push and the baby came out quick....

I'd love to have my babies at home of course, but that was not a choice with 2 high risk pregnancies.

My second had the cord arounbd his neck...so they took him away for 2 hrs.

I had a tear on the top rather than at the bottom...I lost a lot of blood.

That was couple of emergencies we had, and I'd hate to go through it at home. A baby with little oxygen is something to think about....

Sure, other countries support home birth, but I'd love to see how many women had to be rush to the hospital and how many babies had emergencies. US keep good track of numbers--maybe that's why they like to cover their backs so much.

I think that technology has evolved so much, why can we instead change how we have our babies in a hospital? Like letting the mom walk, stand...and support her choice of no drugs?

Denta mom.

Dental Mom<br />Determination: You don't know what you can do until you try.<br />Applying this summer<br />Dental school 2010!

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14 years 5 months ago #2759 by DocMa
White Feather--Thank you so much! I can't wait to dig in and read some of those articles. I would be very disappointed to think that OBs and Fam docs would ignore good data--their insurance probably prevents most of them from providing services at home and I suppose many wouldn't want to (because so many do choose to focus on high risk cases). But either way, like you said good data is good data so that leaves some definite concern.... I've thought a lot about going the midwife route instead of med school and I can't think that there can't be some nice balance. So much to think about!

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