Monday, September 29, 2014

10 reasons I'd never ever ever have a home birth

Home birth in the United States is dangerous. If your baby is born at home, they have at least 3 times the risk of dying than they do if they were born at a hospital, and somewhere around seventeen times the risk of permanent brain damage. US home birth midwives are unregulated, and the vast majority are so uneducated, inexperienced, and unskilled that they would not qualify to practice in any other developed country.

So, here are the top ten reasons that I'd never ever ever have a home birth.

1. Appalling rates of Death at home births

Study after study after study has shown that home birth in the United States has at least 3 times the neonatal death rate that hospital birth has. That means that at least three times as many babies die in labor or at birth at home than at the hospital.

To be very clear: these studies are all on planned, midwife-attended home births.

  • This study, published February 2014 and with a huge sample size of 10,453,778 births in the US, found that home birth has 4 times the death rate of hospital birth: Term neonatal deaths resulting from home births: an increasing trend
  • These statistics, gathered by the state of Oregon in 2012 and released in 2013, found home birth had a death rate of term babies 8 times higher than hospital birth: Intrapartum Fetal and Neonatal Deaths Associated with Planned Out-of-Hospital Births in Oregon (2012). Eight times! Judith Rooks, past president of the American College of Nurse-Midwives and the CNM in charge of collecting the data, said: "Many women have been told that out of hospital births are as safe or safer than births in hospitals…But out-of-hospital births are not as safe as births in hospitals in Oregon, where many of them are attended by birth attendants who have not completed an educational curriculum designed to provide all the knowledge, skills and judgment needed by midwives who practice in any setting."
  • These CDC statistics from data collected in 2008, released in 2013, show that "the neonatal mortality rate for planned homebirth attended by a non-nurse midwifes (CPM, LM) is 3.5 times higher than comparable risk hospital birth attended by a CNM (certified nurse midwife).": CDC Wonder Database Homebirth Statistics.
  • And this data, collected by the Midwives Alliance of North America themselves, found that babies born at home died 5.5 times more often than babies born at hospitals: MANA Home Birth Data 2004-2009. And if you looked at various subgroups - such as breech babies - the numbers were truly shocking. MANA reported, "Of 222 babies presenting in breech position, 5 died either during labor or the neonatal period." That's a rate of almost 22.5 deaths per 1000 babies born. Breech babies born in the hospital have a rate of 0.8/1000. So breech babies born at home died at a rate 28 times higher than those born in the hospital. That's HUGE.

Four times the death rate, three and a half times the death rate, eight times the death rate, five and a half times the death rate - one thing that all these studies have in common is that they clearly show giving birth at home significantly increases the chance that your baby will die during birth.

Homebirth advocates like to say that "babies die in hospitals too," but the difference is that babies don't die preventable deaths at hospitals. At a homebirth, at least two out of every three babies that die die for causes that would not have killed them in a hospital.

2. Appalling rates of Brain Damage at home births

One study that came out this year, Home birth and risk of neonatal hypoxic ischemic encephalopathy, found that babies born at home birth have 17 times the amount of brain injuries that babies born at hospitals do. Seventeen times! These brain injuries are caused by lack of oxygen to the baby during labor and delivery. It's really not surprising that dramatically higher rates of brain injuries occur at home births, since the lack of electronic fetal monitoring equipment at home makes it almost impossible to tell if a baby is being deprived of oxygen during labor.

In the hospital, the nurses and doctors are continually monitoring your baby during labor and will act if your baby is in distress (meaning, if she's not getting enough oxygen). If needed, the doctor can give you a c-section, and that can save your baby's brain function. Thus, the rates of brain damage are much, much lower at the hospital.  At home, midwives have only a doppler to listen to your baby's heartbeat, and that can't tell them the same information that electronic fetal monitoring can. So, your midwife misses the warning signs, and doesn't act. And even if she does realize the baby's not getting enough oxygen, what can your midwife do? At the hospital, doctors can perform an emergency c-section in minutes and save the baby's life and/or brain function. At home, midwives can...send you to the hospital. Or do nothing. And every minute the baby is deprived of oxygen, the brain damage worsens.

Correspondingly, another study published in 2012, Selected perinatal outcomes associated with planned home births in the United States, found that three times as many babies at home births have seizures than babies born in the hospital.

Going right along both with the increased rates of brain damage at home birth and increased numbers of seizures at home births, researchers have found that having a baby at home instead of the hospital increases the risk of that baby having a five-minute Apgar score of 0 by over ten times.

Apgar scores are assigned to babies at 1 minute and 5 minutes after birth to assess how the baby is doing. They measure complexion (from blue or gray to pink), pulse, reflex (response to stimulation), activity, and respiratory effort (how well the baby is breathing). A score of 10 is perfect; a score of 0 means that there are no signs of life. And babies born at home have over ten times the risk of showing no signs of life five minutes after they are born compared to babies delivered by OBs in the hospital. Ten times the risk that your baby will have no signs of life after five whole minutes! Many of those babies are eventually resuscitated, but what kind of brain damage will there after going so long without any oxygen?

3. Lack of equipment at home

Both of these points - higher rates of death at home birth and higher rates of brain damage at home birth - bring me to my next point: your home does not have the same equipment a hospital does. And no matter how big the bag your midwife brings with her is, she will still not have the same equipment a hospital has.

 ***Thank you to everyone who contributed to this section.***

Resources the hospital has that your midwife does not:
    Electronic fetal monitoring gives much more information explains what EFM can tell you that a doppler can't. In a nutshell, by just listening to the baby's heart rate with a doppler you will miss patterns in the heart rate like decreased variability, absence of accelerations, and subtle late decelerations - all signs of a baby deprived of oxygen and in distress. An EFM tracing will show these things, the nurses and doctors will see and act on it, and your baby's life and brain function will stay intact. At home...nope. You cannot measure variability with a doppler and it's almost impossible to determine if there are no accelerations or if there are late decelerations. So, at home, you cannot tell if your baby is being deprived of oxygen during labor.

    By the time your baby's heart rate shows bradycardia - a sustained abnormally low heart rate (something your midwife can detect) - it's almost certainly too late. So a baby can have a heart rate in the normal range the entire period of labor, and still drop mostly dead (and almost certainly brain damaged) into the midwife's hands. That wouldn't happen in a hospital, because their distress would have been picked up on the monitors and interventions would have been performed to save them. Home birth advocates often complain about "unnecessary interventions" in the hospital, seemingly without realizing that these same interventions save lives and brain function. When you decrease interventions, you increase brain damage. When you decrease interventions, you increase deaths.

    Electronic fetal monitoring halves early neonatal mortality explains about a study published in 2011, "Electronic fetal heart rate monitoring and its relationship to neonatal and infant mortality in the United State," published by the American Journal of Obstetrics and Gynecology in a "Report of Major Impact," that shows that electronic fetal monitoring cuts early neonatal death (from birth to 7 days) rates in half. I'll repeat that with less words - Electronic Fetal Monitoring cuts early neonatal death in half. EFM allows nurses and doctors to immediately see that a baby is in distress, and act in time to save them from death and brain damage. At home you do not have that.
  • An operating room. This goes along with the EFM mentioned above. If it's discovered during labor that your baby is being deprived of oxygen, a c-section could save their life and their brain function. In the hospital, an emergency c-section can be performed in minutes. At home, you have to get to the hospital before a c-section can be performed. And as I explain below, from moment of the decision at home "This is an emergency, let's go to the hospital," to an emergency c-section at hospital, it will be at least over thirty minutes. And every minute matters during an emergency.
  • A resuscitation team that can do the specialized work required for a newborn. If your baby is born with breathing issues, or not breathing at all, hospitals have a resuscitation team who are well-practiced in advanced resuscitation skills and who immediately begin to work on your baby with equipment for suctioning, ventilation, oxygenation, intubation, central line IV access, administration of emergency drugs, monitoring, and lab value assessments.  Home birth midwives often say that they are trained in NRP (Neonatal Resuscitation Program), and they indeed might have taken a class, but they cannot perform true NRP at home because they do not have the equipment, medications, or training necessary to do so. This article goes more into that: A neonatal resuscitation class does NOT mean that a midwife is actually qualified to resuscitate a baby. Additionally, hospitals have a team of professionals with the appropriate equipment to deal with a maternal resuscitation. What happens at home if the baby and mother need emergency attention at the same time?
  • More staff. At a home birth, there are at most two midwives, and more usually one, dealing with the needs of two people. At a hospital, the staff is able to greatly outnumber you if it looks like it might be necessary. In the event of an emergency like a tight nuchal cord, shoulder dystocia or other  problem, there will be many hands to immediately help. If your labor is prolonged, a change of shift means the staff will be adequately rested. At home births, there is no change of staff for your midwife, and there are no extra teams of people to help when needed.
  • More practice. Homebirth midwives are considered "experienced" if they've attended more than a hundred births. OB residents get that much experience in their first few months. When the Labor & Delivery unit is quiet, the staff run drills on coping with things like shoulder dystocia.
  • Supplies. Hospitals have the stuff they need to take care of you. They bought it in bulk. When appropriate, they have it wrapped up in sterile packaging. You are not responsible for making sure the hospital has enough chux pads, or suturing kits, or units of O-. There's a department of administrators that makes sure the hospital has the necessary supplies, and that they stored them correctly. 
  • IV drugs to stop a postpartum hemorrhage before it really gets off the ground. According to MANA's own data, 15% of home birth mothers suffered excessive blood loss. Some midwives carry pitocin that they can inject, but in cases of severe postpartum hemorrhage that is not enough to stop the bleeding. IV drugs are needed, and those can only be administered by a CNM or at the hospital. CPMs and other lay midwives will not have those drugs.
  • A Blood Bank. In addition to strong medications that a midwife cannot legally have or administer, the hospital has a blood bank on site. If the worst happens and you hemorrhage uncontrollably, the hospital has blood products that can save your life should other measures to control hemorrhaging fail. If you lose too much blood, and if it's not replaced soon enough, you go into irreversible hypovolemic shock and die. The blood bank can supply red cells, plasma, clotting factors and platelets ... whatever is needed. And they can supply it quickly. If your baby needs transfusions, the blood bank will use blood from O-NEG donors that has been rigorously screened.
  • Oversight, accountability and witnesses. If something goes wrong at a homebirth, it is incredibly easy for a midwife to get away with something they did wrong. Reporting them to NARM (if they are a CPM) does basically nothing, and they can continue to practice without disclosing their history of injuries or deaths to their future clients. At the hospital, nurses, doctors, and CNMs have people watching over them every single day. They are accountable for their actions. They have insurance. If they make a mistake, their insurance will pay for your medical bills. Almost no home birth midwives are insured. If they make a mistake and you have huge medical bills because of it (or life-long medical bills to pay in the case of a brain-damaged child), there is no safety net for you to fall back on.

Homebirth advocates like to say that complications are rare, and you likely won't need any of this stuff at your birth. So let me remind you - the death rate at home birth is at least 3 times higher than the death rate at the hospital. The rate of brain damage is 17 times higher. A lot of women and their babies did need all this stuff at home - and it wasn't there.

 4. "Five minutes" from a hospital is too far from a hospital

The talk above of oxygen deprivation brings me to my next point - distance from the hospital.  People planning home births often say something like, "We live just five minutes from the hospital in case anything goes wrong!"

I want to ask you something - how long can you hold your breath? Can you hold it for five minutes? Try holding it for the next five minutes. Because every minute from the time something goes wrong until you are at the hospital, in the operating room ready for an emergency c-section, your baby will be holding their breath. Do you think they can live through that? Do you think they can live through that without brain damage?

"Five minutes from the hospital" is not really five minutes from the hospital. Sure, on a normal day, once you are in your car you might be able to drive from your house to the hospital in five minutes. But this is not a normal day. You are in labor, in severe pain, and there is an emergency occurring. It could take five minutes - or more - just to get from whatever room you are in to the car. Then it could take another five minutes to drive to the hospital, if the traffic happens to be good and you don't hit any red lights. And even if you drive up to and park in front of the ER, it will probably take another couple minutes to make it out of the car, inside the ER, and explain the situation. They have to evaluate you themselves, and make the decision to do an emergency c-section. Then they have to prep your for surgery. All of that takes at least another twenty minutes. At this point, it's been at least forty minutes from the moment of decision to go to the hospital until you're going into surgery. Can you hold your breath for that long? Can your baby? Is that "five minutes away?"

And if you think this would all be significantly sped up if you call for an ambulance at the moment of decision - think again. First, the ambulance has to get to you. If you're lucky, it will be at your house in five minutes or less. They load you up - another five minutes. Drive to the hospital - another five minutes. Unloading you, hooking you up to monitors, getting the story and your history, checking the baby, prepping you for surgery - another twenty minutes. At the very best, from moment of decision to incision to save your baby is 35 minutes.

So remember, "living five minutes from the hospital" really means "living over thirty-five minutes away from an emergency c-section." And every minute counts when your baby is deprived of oxygen.

*Edited to add* - this is a good piece about the same point: When Minutes Matter in Nursing

5. Home birth midwives are shockingly undereducated and unregulated.

In trying to understand why home birth is so dangerous, it's important to understand the "qualifications" of home birth midwives.

There are several different types of midwives in the United States and if you're not familiar with all of them their titles can sound similar and confusing. CNM, CPM, CM, DEM, LM...what's the difference? As Danielle Repp explains in her series "American Midwives": 

"There are two midwifery certifying bodies in the USA: American Midwifery Certification Board (AMCB) and North American Registry of Midwives (NARM). The AMCB is considered the Gold Standard for midwifery certification and is the certifying body for Certified Nurse Midwives (CNMs) and Certified Midwives (CMs); NARM is the certifying body for Certified Professional Midwives (CPMs). Licensed Midwives (LMs) also fall under NARM as it is the NARM entrance exam they take. Specific requirements for LMs may vary by state in order to take the exam."

"So in short, midwives in the USA basically fall into one of these three categories:
1. AMCB certified
2. NARM certified
3. Uncertified"

She continues:
"1. Certified Nurse Midwife (CNM)"

"Certified Nurse Midwives (CNMs) are some of the most highly skilled and educated midwives in the world. The Certified Nurse Midwife is one of the only types of midwives in the world that requires a nursing degree. The CNM also holds a master’s degree as the minimum level of educational requirement (some have doctoral degrees). CNMs must complete their education through an ACME-accredited midwifery program (ACME = Accreditation Commission for Midwifery Education). Once completed, they can apply to take the AMCB certification exam."

"Certified Nurse Midwives are licensed and have prescriptive authority in all 50 states (and other territories of the USA). The educational and clinical skills training of the CNM not only includes pregnancy and birth care but also primary care for women throughout life, reproduction, infertility, newborn care, andent of sexually transmitted diseases."

"2. Certified Midwife (CM)"

"The Certified Midwife (CM) credential has existed since 1994. The CM is the direct-entry version of the CNM. While CMs do not need to have a nursing degree, they must take all of the nursing school pre-requisites (such as anatomy, physiology, microbiology, etc) and must receive a bachelor’s degree and master’s degree. The CM’s educational and clinical skills training is similar to the CNMs, as it again not only includes pregnancy and birth care but also primary care for women throughout life, reproduction, infertility, newborn care, and management of sexually transmitted diseases."

"3. Certified Professional Midwife (CPM)"

"The Certified Professional Midwife credential ... was developed as a direct-entry route to become an out-of-hospital midwife. CPMs are not authorized to work in a hospital setting."

"Certified Professional Midwives do not have any degree requirements. The only educational requirement is to have a high school diploma, which was not a requirement until September 1, 2012."

"The Portfolio Evaluation Process (PEP) is a popular route to become a CPM. It is an apprenticeship where the student midwife follows and learns from a preceptor midwife. After attending 40 births (and the prenatal exams leading up to it), the student midwife can qualify to take the NARM exam. Anyone with a desire to become a midwife can seek out a preceptor. Half of CPMs have earned their credential through the PEP route."

"Another route to become a CPM is to graduate from a Midwifery Education Accreditation Council (MEAC) school. There are nine MEAC schools in the USA, some of which award certifications, some diplomas and some degrees."

"CPMs not have prescriptive authority in any states (in certain states, CPMs are able to obtain certain medications, such as Pitocin, Cytotec, antibiotics, etc but CPMs cannot write prescriptions). CPMs also would not qualify to practice midwifery in other developed countries due to the lack of formal education requirements; the CPM requirements also do not meet the International Confederation of Midwives (ICM) standards."

The above was all from Danielle Repp's series American Midwives, part 1, part 2, and part 3; emphasis mine.

I want to repeat - Certified Professional Midwives - the kind of midwives that attend the majority of the home births in the United States - do not have any educational requirements other than a high school degree. And if they became a CPM before 2012, they don't even need that. They don't need to take basic college biology. They don't need to take anatomy, or physiology, or microbiology, or immunology. Heck, as a stinkin' zoologist I have more formal education on the human body than many CPMs.

And do you know what's even worse? In some states, midwives do not have to have any qualifications at all to practice. None. The state where I spent my college years - Utah - has voluntary licensure, which means that if a midwife simply decides that she'd rather not be licensed by the state, she has no educational requirements, no limits on her scope of practice, and no accountability for her actions. This satirical website points out the weaknesses in such a system.

Here are a couple charts that explain the difference between the midwives who work at doctors offices and in hospitals (CNMs) and the majority of home birth midwives (CPMs, LMs, lay midwives, etc.):


Even in countries idealized by home birth advocates, where home birth is integrated into the medical system and homebirth midwives have far more education and standards than they do in the US, it is still more dangerous to have a homebirth with a midwife than a hospital birth with an OB. In fact, in the Netherlands it's more dangerous to be a low-risk woman giving birth with a midwife than a high-risk woman giving birth with an OB. This study from the Netherlands found that "Delivery related perinatal death was significantly higher among low risk pregnancies in midwife supervised primary care than among high risk pregnancies in obstetrician supervised secondary care." More babies died from low-risk pregnancies under the care of midwives than from high-risk pregnancies under the care of OBs!

And this holds true both in the hospital and out! In this last study from the Netherlands, both hospital births and home births with midwives had higher neonatal death rates than hospital births with OBs.

Now, if you think you'll be safe at home birth if you choose a CNM instead of a CPM, think again. Researchers in 2009 found that home birth with a CNM had twice as many babies die than hospital birth with a CNM. Even if your midwife is a CNM instead of a CPM, you still won't be able to tell at home if your baby is being deprived of oxygen, you won't have an operating room if it becomes urgently needed, and you won't have a neonatal resuscitation team with all of the equipment that might be needed to save your baby.

More excellent articles that explain the disparity between US home birth midwives and US hospital midwives and the home birth midwives in other countries can be found here:

The hypothetical situations you can imagine when you think about home birth midwives' lack of education and regulation - like, "If my labor suddenly goes from low-risk to high-risk at home, will my midwife know what to do? Will she have the skills and training to save my baby?" - clearly actually happen at home, as we can see from the numbers. With home birth midwives, three times as many babies die. With home birth midwives, seventeen times as many babies have brain injuries. These are the numbers that result from the faulty regulation and pitiful education requirements required of US home birth midwives.

6. The United States has one of the lowest perinatal mortality rates in the world (which tells you they have some of the best obstetric care and practices in the world)

Home birth advocates love to say that OBs are incompetent and the US medical system is weak, because "the US infant mortality rate is one of the worst in the world's developed countries."

The problem with this claim? Infant mortality is the wrong statistic to use. "Infant mortality" records the deaths of all babies who die in the first whole year of life. It is a measure of pediatric care, not obstetric care.

"According to the World Health Organization, the best measure of obstetric care is perinatal mortality, usually defined as deaths from 28 weeks of pregnancy (stillbirths) through 28 days of life. And according to the World Health Organization, the United States has one of the lowest perinatal mortality rates in the world, lower than Denmark, the UK and the Netherlands." You can see those numbers here: World Health Organization, Neonatal and Perinatal Mortality or read another article about it here: Infant vs. Perinatal Mortality.

Now, in the pro-homebirth movie "The Business of Being Born," they repeat multiple times that the US has a poor infant mortality rate (a caption even references it as the "newborn death rate," but they are talking about infant mortality rate, and the two are not the same thing!), while implying this means hospitals are dangerous and doctors don't know what they're doing.  But infant mortality is the wrong statistic to measure obstetric safety! Which tells us one of two things: Either the people who made this movie about obstetric safety don't understand how obstetric safety is measured, or else they are deliberately trying to mislead their audience. If you've watched "The Business of Being Born" and have any questions about the statistics it talks about in that movie, a doula at the blog What Ifs and Fears Are Welcome breaks down the movie in a great post, The Business of Being Misled. She also talks about it in her personal story, What Drew Me to Home Birth and What Turned Me Away. Another great post of hers is 5 Reasons We Decided Against Home Birth.

The US has some of the best obstetric care and practices in the world, and it's proven by the US's low perinatal mortality rate.

7. OBs give personalized care; home birth midwives give "one size fits all care."

In deciding to give birth at a hospital or at home, women will often hear things from home birth advocates like "homebirth midwives give so much more personalized care than OBs! They really know who you are and tailor their care to you!" This is, in fact, the opposite of the truth. OBs give personalized care; midwives give "one size fits all" care.

OBs will take everything about your health into account when recommending a course of action - your age, weight, pre-exisiting conditions, medical history, previous complications, previous shoulder dystocias or c-sections or postpartum hemorrhages, if you have gestational diabetes or group B strep, if the baby is breech or very large or very small or twins - everything. They take everything into account and help you have a safe pregnancy and delivery. They make different recommendations to each person based on that person's medical history and current health.

Midwives, on the other hand? Sure, a home birth midwife will chat with you and know all of your childrens' names and what your husband does for a living, but what about your medical care? Is her version of "personalizing your healthcare" to your risk factors telling you to ignore them? Will she base her recommendations on all of your medical history and current risk factors, or will she tell you that you, regardless of your risk factors, can manage a home birth? That you can have an unmedicated vaginal delivery? Of course she'll tell you that. Because if she tells you anything otherwise, she will lose you as a client. When all you've got is a hammer, everything looks like a nail. Home birth midwives have one tool - unmedicated vaginal delivery. Hospital midwives and OBs, on the other hand, have a full toolbox with which they can handle any situation and recommend the best course of action for each woman.

Home birth midwives will tell you platitudes like "Your body is made for this." "Trust birth." "Women have been doing this for thousands of years." If they tell you that because of your blood pressure, or because your baby is breech, or because you had a previous cesarean, or because you are now past 40 weeks pregnant, or because it's your first baby, or because your pelvis is a different shape, or because you are group B step positive, that your baby's risk of death or injury is substantially higher in a home birth, they know they will lose you as a client. So, they don't tell you that. Another author sums it up better than I could about the lack of individualized care that comes from homebirth midwives:

"Personal characteristics are irrelevant. Advanced maternal age, maternal obesity, pre-existing maternal disease? It doesn’t matter because the counseling and treatment plan are always the same: you can and should have an unmedicated vaginal birth at home.

Medical history is irrelevant. Had a previous shoulder dystocia, C-section, postpartum hemorrhage? Who cares? You can and should have an unmedicated vaginal birth at home.

Complications are irrelevant. Baby is breech, have gestational diabetes, colonized by group B strep? Who cares? You can and should have an unmedicated vaginal birth at home.

Labor complications are irrelevant. Dysfunctional labor, prolonged rupture of membranes, pushing for 4 hours? Who cares? You should still stay home because you can and should have an unmedicated vaginal birth at home."

8. Our bodies are not perfect

Home birth advocates often say things like, "Your body is made for this," "Women have been doing this for thousands of years," and "Trust birth."

Our bodies were made for eating. Does that mean no one chokes? It doesn't really matter what our bodies are "made to do" - things can still go wrong, and people can be seriously injured or die. Human bodies are not perfect, and we cannot always predict what they are going to do.

And there is no shame in having an imperfect body. There is no shame in having complications in labor. We all have imperfect bodies. It's not something we can control. You didn't "fail," you aren't "broken" - you are human.

Just because birth is "natural," just because birth is "normal," does not mean that birth is safe.

Hemlock is natural. Does that make it safe?

Food allergies are normal. Does that make them safe?

"Normal" is a measure of frequency and "natural" means that you can find it in nature. Neither are a measure of safety. Birth can be safe, and it can also be dangerous. Birth does inherently carry risk. There is no reason that you should trust it. Yes, women have been doing this for thousands of years, and countless women and babies have died in birth in that time. Emergency situations can suddenly arise in completely healthy, "low-risk" women and babies during labor. If those situations are not dealt with properly, either because lack of education or technology, lives can be and are lost.

Home birth advocates like to claim that because women at home are moving and walking around, that complications are rare, and that the hospital itself makes birth dangerous. So I will remind you again -  there is a clear, three times higher rate of death of babies born at home. Complications are not rare, and they cannot be dealt with adequately at home.

9. Freestanding Birth Centers are Dangerous, Too

An important end note about birth centers:  When I was pregnant with my first and reading "What to Expect When You're Expecting" about hospitals, birth centers, and home births, I thought that a birth center was a kind of nice middle ground between hospitals and home births. I thought it was some kind of detached labor and delivery ward, like what you'd have at a hospital, just not attached to a hospital.

It is not.

First of all, and this is very important to understand, there are two kinds of birth centers. The first type is the kind that I originally thought they all were: they are attached to hospitals, and are staffed with licensed, nurse midwives. As this post explains, "If at any time during your pregnancy or labor complications arise, your care would shift to that of an obstetrician at the same birth center or hospital." Medical technology is available, everyone has insurance, and there are regulations and oversight.

The other type of birth center is a freestanding birth center, which is not directly overseen by a hospital. Choosing to give birth at a freestanding birth center is, in the words of Sara, whose son Magnus died at a birth center, choosing "a home birth in someone else's 'home.'" Freestanding birth centers are not some kind of detached labor and delivery wing. They do not have doctors. They do not have the equipment you would have at a hospital. They have the same midwives, with the same lack of education and regulation, that deliver babies at home births. Babies born at freestanding birth centers are more than three times more likely to have a 5-minute Apgar score of 0 (no signs of life) than those born at a hospital. Babies born at freestanding birth centers are almost twice as likely to have seizures than those born at the hospital. Babies born at freestanding birth centers are twice as likely to die than those at the hospital.

The excellent website "Safer Midwifery for Michigan" has a good post about birth centers called What We're Seeking: Defining "Birth Center". In it, they explain: "Freestanding birth centers do not have emergency medical equipment beyond oxygen.  They cannot intubate or give medications that would be used in a resuscitation circumstance. They do not use Electronic Fetal Heart Monitoring, instead using intermittent Doppler assessments.  Midwives working at a freestanding birth center may or may not be licensed as individual, may or may not carry insurance, and may or may not be trained in NRP (Neonatal Resuscitation Program). There is no requirement for any midwife at a birth center to have a license. The bottom line is that in the event of an emergency, they are under equipped for life saving measures."

And finally, the 10th reason I would never have a home birth:

10. I know their names.

I've read Aquila's story. And Mary Beth's. And Wren's. And Sam's. And Thomas's. And Zen's. And Grant's. And Angela's. And Sheppard's. And Magnus's. And Shridam's.  And Silas's. And Vylette's. And Brody's. And Sarai's. And Maranda's. And Zinn's. And  Charlsie's. And Gavin Michael's. And every one of these babies.

Gavin's mother said this on her Facebook page, In Light of Gavin Michael:

"Last year, today was my due date. I wish I had Gavin on this date or around it so I wouldn't have to go through what I have. He would be here and I'd spend my time raising him instead of sharing my story to help educate people.

Honestly, I didn't know anything compared to what I do now. I didn't know the risks and dangers of home birth. I didn't know people pretended to be more educated than they actually are. I didn't know there is no system set up for accountability. I didn't know babies were becoming injured or dying from home birth.

There are so many things I really did not know. I only was told the positive stuff but never the other side of things. I didn't know that when home birth goes bad, it goes insanely bad in ways that I couldn't imagine.

I've gone through many what ifs and thought about what I could have changed to have my son here alive today. The only way would have been if I had an OB. They would have explained risks to me truthfully. They wouldn't let me go so far over due. They would have been paying attention to the fluid levels.

So I could have picked any OB out there and my son would be alive. I wouldn't have cared if their bedside manner wasn't very good or if they didn't spend that much time with me for appointments. Being nice doesn't mean a baby is going to be ok.

I picked a home birth with a CPM because I believed it was safe and the midwife would know if something was wrong to protect us. To take care of us. To be there for everything.

I was wrong."

As the author of the blog in the last link in the list above says,

"These are 40 deaths that I wrote about in the past 2 years. And only the American homebirth deaths. And only the deaths that I heard about.

Homebirth represents approximately 1% of US births. When you look at term births of normal sized babies to white women, homebirth represents approximately 1.4% births. So if you are planning to tell me that “babies die in the hospital, too,” ask yourself if you’ve heard of nearly 3000 deaths of term babies in the hospital in the past 2 years.

Homebirth kills babies (and mothers) and the only people who appear to be unaware of that fact are homebirth advocates.

Thinking about homebirth? Maybe you should think about these babies (and their mothers), and think again."

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Friday, September 26, 2014

Captain's Log, Week 231

How do these weeks go by so fast? I swear I just wrote our last Captain's Log.

What Ellie said this week

Last week Ellie wasn't going to sleep one night, so Jason was telling her some stories about her and Zelda that he was making up as he went along. There were a lot of funny moments, but my favorite is this one. Jason was finishing telling Ellie a story about how she and Zelda made a cake.
Jason: "They waited for a few minutes, and the cake was done. So they took it out."
Ellie: "And they ate it all."
Jason: "And they ate all the cake in their mouths, arrr, and it was so yummy and delicious. The end."
Ellie: "Read another story!"
Jason: "So, one day it was very nice. It was a beautiful day. So then they went to the zoo. And they saw the monkeys."
Ellie: "And they ATE the monkeys!"

Ellie got a hold of my deodorant and touched the stick to each of her arms. Then she said, "Mom, I'm all armpitted up."

Ellie was looking at a new photobook we got this week, and one page she started laughing and pointing and said, "Look at this guy! It's Daddy."

Me: "Ellie, would you like some noodles?"
Ellie: "Yes, because I'm upset."
Me: "We eat noodles because we're hungry. Would you like some noodles because you're hungry?"
Ellie: "Yes. Because I'm upset."

Ellie: "Mom, Zelda's a lucky boy."

Ellie, pushing her hand into the carpet: "Mom, I'm making a paw print."

She was playing in the bath yesterday and randomly said, "Mom, two more minutes. Then we can go to Christmas!!!"

Ellie ate a bite of oatmeal and said, "It comes down to my tummy. That's where my grown ups live, in here."

What we did this week

Well, last Saturday we went to a "Fall Festival" they held in a nearby town. They had a couple streets of booths set up, which we walked around (my favorites were the "Garden Club" booth and the antique farm equipment booth), but we spent most of our time at the bounce houses. We paid $5 to get Ellie a wristband that allowed her unlimited access to all the bounce houses, and she had a blast.

On Sunday we went to stake conference. (For those not of our faith, that's a big meeting with multiple congregations in the same area.) It was down in Fayetteville, so we got to drive the roads down there and see the countryside. It was really pretty! We passed this ginormous Goodyear factory, too. Biggest factory I've ever seen. Really really big. Seriously. Stake Conference was good. We sat in the primary room, where they had a TV set up so we could see the speakers who were in the main chapel. We were right next to the nursery, and we kept going in there and getting puzzles and books to keep Ellie occupied. It worked out really well.

Other things we've done this week:

Found a tiny little frog in our backyard:

Got matching Halloween pajamas from Nana, and ran around the deck in them:

(I love Zelda's expression in these next two. She stood there smiling like that at me for like thirty seconds.)

Fed bread to the animals:

When I first walked in the room, I did a double take. I thought Ellie was making an animal sandwich. But then she told me, "All of the animals are eating bread."

Played in the bathroom mirror:

Found potatoes and carried them all around the house:

Sat on the high chair:

Shoved all of the animals into the playdough:

Climbed up on chairs:

And on the desk:

Took naps on the family room floor:

Ate ice cream:

Wore diaper covers on our head:

And smiled a lot:

Ellie also painted her own fingernails and toenails for the first time:

And we played on the deck after it finished raining yesterday:

Zelda was blowing bubbles with her mouth.
Ellie was drinking the rainwater off the deck with this straw. I know...really hygienic.
Here she was saying "Ah ah ah" like a monkey. She does that now, if we tell her to say "Ooh ooh ooh ah ah ah!" She also says "Quack!" That was a surprise. We were talking to Ellie the other night and said "quack quack!" and Zelda immediately repeated "Quack quack!"

Also, this happened this morning:

Ellie had a plate of toast with peanut butter on it. Zelda came over and grabbed the plate, flipping it over and launching all of the peanut butter toast into her face. She still smells like peanut butter, haha. :)

Other things from this week: I finished and ordered a couple Shutterfly books, during their 50% sale. I'm really excited about these ones. One of them is all the pictures from my senior year of high school and Jason's freshman year of BYU. I'll share more of it when they get here. I also finished "Five Kingdoms: Sky Raiders" by Brandon Mull (I liked it!) and "The Heart of a Samurai" by Margi Preus. I just started "Peter and the Starcatchers" by Dave Barry and Ridley Pearson. Also, my goal for 10,000 steps a day is coming along great; I've still made it every day! Jason's school week was good, he had three tests (I think - I'm beginning to lose track) and was studying a lot and I'm excited that it's finally the weekend so that we'll be able to spend more time with him.

And that was our week!

Saturday, September 20, 2014

Captain's Log, Week 230

Wow, I just realized that I've been doing our weekly Captain's Log for over a year now. The first "Weekly Roundup" (the precursor to the Captain's Log) was September 6 of last year. Sorry this week's is a day late; we had a busy day yesterday!

What Ellie said this week

I was in the hall, and Ellie was on the couch. Suddenly she called to me,  "Mama, I need a towel for the pee."
Me: "Ellie, did you go pee on the couch?"
Ellie: "No, I need a towel for the pee."
Me: "Elllllie, you shouldn't go pee on the couch. That makes me sad."
Ellie, gently: "Mom, are you getting frustrated?"
So I cleaned up the wet spot and went about my business and forgot about it. Like ten minutes later, all of the sudden Ellie yelled,  "I know what I can do!"
Me: "You do?" (having no idea what she was talking about)
Ellie: "Yes, to make you happy. Play this game!" And she brought the ipad over, with some random app she plays with open.
Then, a minute later (as we were playing with the app), she said: "Mom, are you happy? I'm happy too. And Zelda...has sharp teeth."

Ellie: "Daddy's running, maybe."
Me: "He's at school."
Ellie: "Oh, is Daddy running for school?"

Ellie has a Buzz Lightyear doll. You might remember him from this post. He has a couple buttons on his chest; a couple that make him talk, and one that makes his wings pop out. Well, this week Ellie was really into pretending that she had buttons that made her have wings, and that made her fly. On Sunday before church she said, "I need to press my red button to make me fly. Mommy, press your red button to make you fly! Now press your green button to make you go!" Then she ran around yelling, "I'm flying!" And after that, "Ah, I need to press my red button when I'm dizzy."

I was cleaning up the kitchen and Ellie came in.
Ellie: "What are you pretending to be?"
Me: "I'm pretending to be a cleaner girl."
Ellie: "I want to be a helper girl!"

Me: "Ellie, do you want some popcorn?"
Ellie: "No. Popcorn is poison."

Talking about an app on the ipad. Ellie: "That one's locked, honey mama."

Ellie was trying to show me her graham cracker while I was talking to Jason. Ellie: "Mommy, don't talk! Talks are dangerous." That went along with the day before when I was standing up and she wanted me to sit down next to her and she said, "Mommy, don't stand up! Standing is dangerous."

Ellie, sighing: "It's a long day for me."

Jason and Ellie were checking the weather on his phone, and then she took his phone and said, "I  need to check your brains for a minute." Then she said, looking at the phone, "They're getting littler." And Jason and I were like, "Oh no, that's not good! Quick, Ellie, fix it." And then she kind of touched his shirt pocket and said, "Ope, they're big again!"

We were playing with blocks one day and Ellie was getting a little frustrated. Then she told me, "I'm confrusting, mama."

Ellie was playing with her little plastic dinosaurs. She started looking around, and asked me, "Mom, where's the trains?" She wanted to play with dinosaurs and trains at the same time. She wanted to play Dinosaur Train.

Ellie was taking video with Jason's phone this week, and he told her, "Ellie, say 'I'm cute!' and 'Zelda's cute!'" She did, but then she started walking around and giggling and saying things to the phone like, "The wall is cute! The wall is cute!" over and over. 

What we did this week

Well, we got to play with puppies. Here are pictures of that joyous event:

Ellie's face in these next two cracks me up:

They're our neighbors', and they're really sweet.

We also went exploring in the woods. This is in our backyard. For real.:

Zelda's really liked putting stuff around her shoulder this week. Toys (like the one below), the dress-up shawl, washcloths, basically whatever will stay there. And she'll put them there and just walk around and play with them around her shoulders.

Ellie and I were watercoloring one time this week, and she wanted to write "Daddy." She had me write the letters, but she told me which letters to write. "It starts with a D...and then a E...and then another D! That spells Daddy!" hahahaha :)


And here are just all the other pictures from this week! It was a pretty standard week - church on Sunday, Jason had school and studied all week, and the girls and I did a bunch of random stuff. That's our life!

Zelda's first ponytail!
Zelda figured out this week how to pull this spider along while she's walking. She was so delighted that she was giggling as she did it.
Both girls love this turtle inner tube. Zelda just goes and sits in it all the time.

We actually went to the park twice on Thursday. We went for a playdate in the morning, and then again in the afternoon because we picked Jason up from school and he needed to go to this retirement home for an assignment from school, and we played there while he was at the retirement home: (yay run-on sentence!)

Zelda started crawling up this thing, and actually made it all the way up!

Other stuff from this week: We went to the library last Saturday. (Yay!) We got lots of books for the girls, which Ellie has just been wanting to read over and over again all week. I finished reading Harry Potter and the Deathly Hallows, and have been reading other bits of Harry Potter trivia on JK Rowling's site "Pottermore." I've also started "Five Kingdoms - Sky Raiders" by Brandon Mull. I've also been working on a photo book on Shutterfly to take advantage of their 50% off sale that goes through next Wednesday. Jason's had lots of school and lots of studying. Ellie's been energetic and funny and frustrating and cute and very Ellie. Zelda's been adorable and just keeps getting bigger and older.

Finally, here are two adorable videos from this week. Zelda playing in the bathtub, and Ellie making "formula pizza" for Zelda.

And that was our week!