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 ...do 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.):

via
via


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."



***Once Blogger gets to 200 comments on a post, you must click "load more" under the comment box at the bottom to see all of the comments. You need to click it again for every additional 50 comments.***

332 comments:

  1. This is so true. After my experience with Aubrey`s birth I would never do a home birth. If we would have done hers in a center or at home she would not have made it. Thanks for sharing!

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  2. I've never felt like I could really say much on this subject because I have never given birth, but I totally agree with you on all of this! Shaun and I have always said if we ever were to get pregnant there is no way we would not do all we could to deliver at the hospital. We were in the room when our daughter was born, and if she had not been born at a hospital with nurses who knew what they were doing, she would have died. If she had eaten before the nurses realized that there was a hernia in her stomach, she would've died. It was scary enough at a hospital, I cannot imagine having been anywhere else in that dire situation. My son also would have faced some serious repercussions if he'd not been born at a hospital. I wish this was all more common knowledge for everyone

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    1. Trained midwives are also able to recognize conditions like these. In fact, the research cited in this article is falsely skewed by including unplanned, unattended home births as well as those attended by a trained midwife. I commented as such, but apparently the blogger is only allowing comments that agree with her to post.

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    2. Actually, these statistics do not included unplanned, unattended home births. If you read each study cited, you'll see that these numbers reference only planned, midwife attended home births. I have not deleted any comments at all.

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    3. Furthermore, even if a midwife had immediately recognized there was a problem at home, this problem could not have been dealt with at home - only at a hospital.

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    4. Which is why all qualified midwives have a transfer plan in place. If you aren't filtering out comments, where is the one I posted? This is based on skewed statistics that included unattended, unplanned home births with those planned and attended by a skilled midwife. It also ignores the women and babies who suffer serious side effects of unnecessary medical interventions. Many physicians choose home birth for themselves, so clearly it is a valid, safe option. http://avivaromm.com/choosing-home-birth Please research articles more throughly before posting things that are potentially harmful to your readers. Try sites like: http://www.improvingbirth.org and http://evidencebasedbirth.com. By the way, I am NOT a home birth advocate, I gave birth to all 3 of my children in a hospital. I am an advocate for women having choices and rights in childbirth, not having them taken away or scared by articles like you posted.

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    5. Unless you are ready to compare the actual danger of giving birth in a hospital, like unneeded interventions that result in serious complications for mother and child up to and including death, then you are only looking at one side of the equation. Birth is much riskier in the US than it should be and for every home birth horror story there are just as many if not more hospital horror stories (see http://www.improvingbirth.org/2014/08/vid/ or http://www.improvingbirth.org/2014/07/trauma/ or many others) It's just that home birth horror stories are rarely subject to gag orders or shaming that tends to happen when something awful occurs at a hospital birth. Women should be empowered to make decisions about their own birth, not scared by things like what you wrote. Very, very irresponsible to use your platform to misinform and scare women.

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    6. I don't know where your comment is; I can only guess that it didn't load correctly. I checked the "spam" filter in my blog comments, and it's not in there either.

      And no, as I said before, these statistics do NOT include unplanned, unattended home births. They only include planned, midwife attended home births. Read each one if you'd like to check.

      Each of the three websites you posted, however, are not evidenced based, despite the names. Aviva Romm advocates for home births, but she won't attend them. Why? Could it be because she knows they're dangerous and a liability to her? She also writes lots of things that have no scientific backing - for example, she claims that the World Health Organization says that c-section rates should never go above 7%. The WHO has never made any statement even close to that. She's also written incorrectly about what causes Chorioamnionitis. And to see examples of Improvingbirth's bias, you can see an example of them trying (and failing) to discredit inductions here: http://goo.gl/7YwJWH.

      And I remember when I found evidencebasedbirth, too - I was tricked by the name into thinking it showed, you know, evidence. Nope. Here's Rebecca Dekker (the author of evidencebasedbirth) advocating FOR waterbirth, right after American Academy of Pediatrics’ Committee on Fetus and Newborn and the American College of Obstetricians and Gynecologists strongly recommended AGAINST it, based on the evidence they found: "Some of the reported concerns include higher risk of maternal and neonatal infections, particularly with ruptured membranes; difficulties in neonatal thermoregulation; umbilical cord avulsion and umbilical cord rupture while the newborn infant is lifted or maneuvered through and from the underwater pool at delivery, which leads to serious hemorrhage and shock; respiratory distress and hyponatremia that results from tub-water aspiration (drowning or near drowning); and seizures and perinatal asphyxia."

      So thanks, but I think I'll err on the side of the experts.

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    7. Really, Jannelle? You read a well-researched blog post that cites evidence-based research papers, and the best you can muster for a rebuttal is Aviva Romm and Improving Birth? You are the one who is woefully uninformed here.

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    8. Yes, instead of discussing actual studies, she cites to websites. You must refute actual NUMBERS, Jannelle. You can't just cite to other web pages. And if you argue that this article did that, you'll find that there are citations to real studies on those pages. Aviva Romm just makes stuff up. She doesn't actually run studies. It's the studies that matter. And even MANA admits the numbers for home birth are terrible. How do you refute MANA's own findngs?

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    9. Janelle, "Which is why all qualified midwives have a transfer plan in place." Yes, that's true and it probably saves lives sometimes. But it doesn't always, tragically transfer can be too late, did you take the time to read the stories linked by the names in point #10? I think it is important to do so.

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    10. “I am an advocate for women having choices and rights in childbirth, not having them taken away or scared by articles like you posted.”

      Jannelle, how does a presentation of the facts take away a woman's rights in childbirth? And why would any intelligent woman be “scared” by the facts? It seems that you have a very low opinion of women if you think they can be scared into anything. Do women not have the sense to discern fact from propaganda? A woman does have choices in childbirth—she can give birth anywhere and with anyone she prefers. However, not everyone has the right to call herself a qualified birth attendant and fortunately, the law in several states reflects that.

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    11. Amazing, isn't it, that people who deny being homebirth advocates post a comment and at not seeing it immediately, start howling, "You're censoring comments!", instead of thinking that there might be a technical problem of some kind. Makes one wonder what kind of NCB echo chambers they typically dwell in.

      Projecting much, Janelle?

      And by the way, most of those studies actually RAISE hospital death rate artificially because when a midwife transfers and a baby dies, that death goes into hospital stats, Even so, homebirth midwives manage to score death rate at least 3 times higher than comparable risk hospital birth.

      Darkly impressive.

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  3. This article I full of inaccurate statistics which immediately makes this an unreliable source. When making a comparison of " the good and the bad" you should present both sides of what your comparing. This is a very bias article which doesn't stand well when trying to " inform". Seems like a women who has had some bad personal experiences rather than a factual collaboration of information.

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    1. Which statistics do you think are inaccurate? Please provide specific examples.

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    2. This is an opinion piece. You don't need a counterargument in an opinion piece.

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    3. "Trust birth."
      "Our bodies were made to give birth."
      "Interventions are bad because they interfere with the natural process and most are unnecessary."

      Maternal mortality rate of natural childbirth without any interventions ( WHO estimate): 1000 - 1500 dead women per 100 000 live births.

      Maternal mortality rate with all the evil unnecessary interventions included (USA 2013):
      18.5 dead women per 100 000 live birth.

      Which of these births would you trust with your life and the life of your unborn child?


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  4. More inaccurate sources then I have time to write about. I'm not your editor, just a person who is well educated and writes research papers all day... So from a educated readers perspective this article became unreliable in the first few paragraphs.

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    1. Translation: You cannot back up your assertion that the post has inaccurate statistics.

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    2. Well, I happen to be an academic librarian and I find the cited evidence to be quite compelling. If you are such an "educated reader," perhaps you would care to enlighten us with your own peer-reviewed references to prove your point?

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    3. And how do you argue with MANA's own statistics? Even MANA admits that HB is much riskier than hospital birth. How can that be ignored? MANA is the almighty great organization of your amazing midwives, Kelsea. Refute the MANA stats, please. Feel free to ignore the other studies. Let's just focus on the MANA numbers.

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    4. Oh, and also, you're saying, Kelsea, that a citation to the CDC Wonder Database is an inaccurate source? And MANA as well? And studies from Cornell, a major university? And the state of Oregon's own numbers? How are these inaccurate sources?

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    5. Do share which sources are inaccurate, Kelsea. I won't hold my breath for your response.

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    6. Kelsea, while you're checking your statistics you might also do some studying on why these statements are grammatically incorrect before you hand in your next research paper: “a educated readers perspective,” “then” “what your comparing,” “a very bias article” and “seems like a women.” When you make mistakes like these, your credibility as an “educated person” slips.

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    7. Kelsea, I deleted your last comment because of cussing, as I already warned another commenter that I will not tolerate foul language here. If you'd like to post your comment again without swearing, I will not delete it.

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  5. Kelsea, some of the sources are another blog. Maybe you don't like that as it may not be proper for a research paper. But if you go to those blogs, you will see that the source materials from peer reviewed scientific journals are linked, and thus available to anyone who would like to read the pertinent data.

    Unfortunately, no one has ever successfully refuted Dr. Amy on the facts she presents, or Doula Dani, or Sara Snyder. You are just one more in the long line of people who dispute, then slink away with excuses.

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  6. Love you, jocey! I trust you did your research and I know you personally and you would never mislead anyone or try to scare someone out of a personal choice without reason to back it up. You did an awesome job.

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    1. Wow...how about do your OWN thinking and tour OWN research? Because this person is obviously no expert, and I've given birth at home to a super healthy and advanced child with the help of a midwife. Don't be a sheep! This information is propaganda, untrue and inaccurate, nothing more than a misguided, sad opinion. :(

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    2. The funny thing about statistics is, they are NOT opinion. They're cold, hard numbers. I challenge you to show me a flaw in the research I cited.

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    3. Richard Graham.... is the fact that your child is "super healthy and advanced" relevant to the discussion of whether said child was born at home? Is my child an idiot because she was born in the hospital?

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    4. Yeah seriously, my youngest son born via C-section is totally bright healthy and advanced (walking by 10 months, can you believe!). My middle son who was born at home with the help of two midwives is dead.

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    5. Dhanya, I thought I recognized your name and that you might be Shridam's mom. I am so sorry for your loss. Congratilations on your new healthy and advanced son, though! It always makes me happy when I see a loss mom having a new little one. Not that it can be a replacement but still, it's a jpy.

      Amazed

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    6. Thank you Amazed, it certainly helps heal our broken hearts, the new joy is wonderfully healing, we are very blessed. We will miss Shridam forever but are so blessed with our living children.

      We really were "sheep" beforehand, we honestly thought the worse homebirth outcome we could have would be transferring for a C. How wrong we were. Ignorance is bliss, as they say.

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  7. For those who cannot grasp how horrible our home birth system is here in the USA, perhaps you should look at outcomes for planned, midwife attended home births in the USA compared to planned, midwife attended home births. References are included.

    The intrapartum mortality rate comparison is beyond worrisome:

    Home births in the USA: 1.3/1000
    Home births in the Netherlands: 0.3/1000

    https://www.facebook.com/douladanielle/posts/701873499881382

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    1. Compared to planned, midwife attended home births in the Netherlands. I forgot to finish my sentence ^^ :)

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  8. I notice none of the homebirth advocates have commented on the lack of equipment at home, the delay of having to travel to the hospital if there is an emergency, or the lack of personnel to look after both baby and mother if necessary. Some of the problems, such as inadequately trained "midwives" can be solved, and maybe it could be arranged to have another specialist at the birth to focus on the baby's care, but the problems of lack of equipment and the greater time needed to get help in an emergency are inevitable in home births.

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  9. My home birth had a CNM, a MW in training, a doula, and my husband. There were plenty of people to care for myself and my son. The stupidity here is astounding.

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    1. So true! This is so sad. Women need to have confidence that their bodies will do what is needed during birth. You don't NEED intervention.

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    2. You are right that many women don't need intervention. But many women DO. Having confidence in your body has nothing to do with whether birth will go smoothly or not. See point #8 in the post above.

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    3. What amazes me is that you can be provided with studies that show how dangerous HB is and STILL be in favor of it. Did you not just read how long it can take to transfer in an emergency? What about all the women who have lost babies at HB due to cord prolapse or placental abruption? Were their bodies "doing what they were supposed to do"? Were those babies supposed to die? If they would have lived had their mothers been at the hospital, how can you claim that interventions are unncessary? You're lucky you've never lost a baby. I haven't either. But a lot of people have, and they are devastated by the loss. A lot of these women were low risk. Some of them had had home births before. There's no way to know if you'll have a complication ahead of time. But seriously, go ahead and tell people that our bodies know how to birth babies. I'm sure that's a huge consolation to the women whose bodies decided to break on them.

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    4. Those stories are rare. Hospitals have babies die, too. Birth is not a medical emergency to be feared; it is a normal, physiological process. Less than 5% of women need intervention in birth.

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    5. Wildflower, I'm beginning to question whether you even read the post. Did you read this? "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."

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    6. Or this?: "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."

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    7. Tell you what Wildflower, how about YOU lose your baby in homebirth then tell us you didn't NEED intervention.

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    8. I love when men weigh in on giving birth. Nothing like hearing about how we need to "have confidence in our bodies", and we "don't need interventions", when he'll absolutely never know what it's like to give birth. Some of us WANT interventions. Some of us desperately NEEDED interventions that never came for us.

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    9. I choose to remain anonymous because I don't want to hurt a friend of mine....

      Locally, homebirth is common. I had both of my babies at home, several of my friends had all or most of their babies at home. It's not weird. The midwives here are equipped and have backup systems in place and relationships with doctors and hospitals (yep, I'm in the USA). Yes, I'm fine with doppler monitoring during labor instead of continuous EFM. That's also the FIRST study I've seen where it actually causes a massive decrease in problems instead of remaining neutral and don't forget the whole increasing unnecessary c-sections. Our local hospitals have over a 33% c-section rate for the LOW RISK category.

      I have only one friend that lost their baby full term. She planned a hospital birth. To this day I still hear from her how horrible the whole experience was on top of actually losing her baby. I never see these stories posted and now I understand why. No one blames her OR her decision to birth in a hospital (even though her doctor acted negligently and BLAMED HER for her baby's death). Not only that but it's flat out disrespectful to exploit someone's story (something most anti-hb people don't get). No one would dare take my friend's name, publish it, with her child's name, and the exact flow of events that lead to her child's death and push it out there and say, "SEE!? IT'S NOT SAFE!!" It's a disgusting thing to do...but anti-hb people do it anyway.

      I've been in a hospital when someone's baby was stolen.

      I've been by a woman's bedside when they told her that her baby "might be over 8 lbs" and probably too big to fit and that's why her labor was taking so long (4 cm to 7.5 cm from midnight to 7 AM). The baby was not in distress and the doctor said, "You have to say, 'I want a c-section'. It's not technically an emergency so you have to tell me you want it so I can do it," WHILE the woman was in the middle of a transition contraction. She stood there at the foot of the bed and said it several times.

      I have personal sought help while I was hemorrhaging during a miscarriage by calling my OB's office while I soaked 4 postpartum pads in the span of 3 hours. I had a history with the OB office and had ONLY been seeing the OB at that point. The OB on the phone told me there's nothing he could do to help me and to stay home and bleed. I saw my regular OB the next morning and he was LIVID. I ended up needing treatment for massive blood loss and was admitted to the hospital.

      Another friend of mine went into labor at 28 weeks. It was her 5th child. She called her doctor and her doctor told her, "Oh, you could come in, but we'll probably just send you home so I wouldn't bother." She didn't go in....even though SHE HAS A HISTORY OF PRETERM LABOR and is put on bedrest for EVERY pregnancy. She LISTENED TO HER DOCTOR. She gave birth the next morning. Her baby almost didn't survive and still suffers from her doctor being negligent.

      So yeah...I can think of numerous reasons why I'll keep planning homebirths. This is the tip of the iceberg. But my friend who lost the baby just switched OBs and doesn't talk about it. The girl with the unnecessary c-section just gave up and said her labor stalled (!?!). My friend with the preterm baby still sees the OB and doesn't think it's his fault for telling her to not bother coming in despite her bad history. But these stories never get published. Afterall, they made the right decision, right?

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    10. Point being, I guess....I'm super glad the hospitals have all that equipment to fix all their screw ups. Oh...except the baby that died. Can't fix that.

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    11. I am sorry your friends suffered such horrid negligence. No one is trying to say that hospitals or doctors are infallible. I myself have seen people suffer from hospital and docotr negligence. I hope your friends filed complaints about their treatment. The medical establishment is built to force further training and even restrict physicians who have proven themselves unsafe. However the homebirth system in the US has NOTHING in place for events like this. The hospital system is not perfect. No one says it is. But the possibility for justice and compensation is available. That is the key.

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    12. The homebirth system DOES have something in place. My friend's baby died from undiagnosed IUGR. When she lost weight her doctor accused her of being anorexic during her pregnancy. When she measured behind, they blamed her. After the birth they assured her there was nothing wrong that they could see except her 4 lb dead baby. They offered an autopsy. Idiots. They "later" found that the baby had a two vessel cord instead of three. Something that could have easily been identified and dealt with earlier on. My midwife does not have a fear of doctors and referring me out when something could even POTENTIALLY be wrong. SHE is the one who told ME when I started going post term that the RESPONSIBLE thing for me to do as a parent was to see an OB. She supported me when I scheduled my hospital induction (which ended up being unnecessary). She listens to me but also encourages me to make the right decisions. Doctors around here stink. My friend's baby didn't need to die and had it happened to me, my midwife would have referred me out for an ultrasound right away without batting an eye.

      I had another friend who almost lost a baby because their idiot doctor decided it was fine to break her water at 37/38 weeks (for three out of four pregnancies) because she was 3.5 cm and that was "close enough". Well, her lungs weren't developed so she was life flighted downtown to the children's hospital and spent time in the top NICU in the area. That was the third baby and third time she did it. The fourth time? She gave her a steroid shot at 37 weeks....then broke her water to induce her.

      With so many doctors putting babies at risk and letting them die in my area, why on earth would I EVER choose to birth there when I have better options....?

      Delete
  10. She's also regulated. She carries IV fluids, oxygen, pitocin, and a host of other equipment. The hospital is ten minutes away in case of a RARE complication, and yes, they are rare. Here come some actual facts.

    The author didn't write this from an unbiased, neutral standpoint. She didn't report all angles. Many facts are blatantly wrong.

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    1. "The hospital is ten minutes away" - please see point #4 in the above post. "She carries a host of other equipment" - Does she carry an operating room? Electronic fetal monitoring? A blood bank? A neonatal resuscitation team?

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    2. An ambulance has blood. It takes time to prep an OR; true emergency sections are not done in an instant. In the case of transfer, yes, the hospital can have the OR prepped by the time you get there.

      And yes, she can resuscitate a baby. My son did need some minimal resuscitation.

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    3. EFM is also notoriously inaccurate and has no proven benefit. I'll find the UNBIASED link for that.

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    4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595164/

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    5. Actually, no, ambulances do not carry blood. Not sure where you heard that.

      True emergency c-sections, when you're already at the hospital, can be done in three minutes flat. And no, you cannot go straight into a c-section the moment you arrive at hospital by ambulance. The hospital themselves still have to evaluate you to make sure that's the needed course of action, and that takes at least a few minutes.

      "Notoriously inaccurate" - among who? Home birth advocates?

      And sure, here's the unbiased link to the research that shows EFM cuts neonatal death rate in half and decreases neonatal seizures: http://download.journals.elsevierhealth.com/pdfs/journals/0002-9378/PIIS0002937811004807.pdf

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    6. Ambulances almost never carry blood. The only unit they could carry is O negative which is rare. EMTs aren't trained to transfuse blood.

      Only in the case of a true trauma, where someone's life was at stake would a surgery be rushed without taking the time to evaluate the patient and do the necessary testing. The woman in labor would need to be literally dying in the ER before she'd be rushed straight into the OR. If she was stable, then all necessary precautions would be taken first.

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    7. The study you reference was published in 2003 and was published in "The Journal for Perinatal Education," which, according to Lamaze International, is the "leading peer-reviewed journal specifically for childbirth educators." Translation: Has significant bias toward unmedicated vaginal birth, and on top of that is outdated.

      The study I just linked to was published in 2011, and was released in a "Report of Major Impact" by the American Journal of Obstetrics and Gynecology. Translation: Has significant bias towards live babies, and is up to date.

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    8. "The Journal of Perinatal Education" is "The Official Journal of Lamaze® International," published by Springer Publishing.

      While the journal is listed on PubMed (an index of peer reviewed journal articles hosted by the NIH), it is NOT published by the NIH. The NIH is primarily a research organization, which employs scientists and issues grants, not a publisher.

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    9. Wildflower, our EMT ambulance workers did not have blood, I didn't get that until we were at the hospital. They (the EMTs) were amazing highly trained and YES they were miraculously able to resuscitate my baby boy but after 40 minutes of oxygen starvation and at LEAST 20 mins without a pulse.. he was damaged beyond repair (yes he died, but I guess that doesn't count because shoulder dystocia is RARE with 11 pound babies... oh wait, no it's not).

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    10. I know you guys, you Wildflower, and others, think that the homebirth deaths listed in #10 don't count, or somehow don't matter because babies die in hospitals too. Babies do die in both settings, my IRL baby loss friend loss her child due to damage sustained during a hospital birth. She was able to hold her provider accountable, read board finding, get compensated for loss and bills all of that. Whether my providers did wrong or their best none of that was available to me, My midwives made me soup, told me they'd been playing around with their birth baby doll and model pelvis to see what went wrong and that they'd never seen such a, "Wackadoo sticky shoulder." Anyways transfer CAN be too late if an unforeseeable emergency happens is it better to have 2 or 3 people doing their best or say the best qualified on a staff of 20? Anyways I think you, "Wildflower", should read each of the stories in #10 before you discount people's loss as insignifigant and insult people who have a genuine concern for safety in birth choices.

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    11. Dhanya, I am so very sorry for the loss of your son. It never ceases to amaze me that home birth advocates are routinely so very cruel to those who paid the greatest price for a home birth gone wrong: a dead child. Emergencies happen, even during the most textbook labor and deliveries. I should know - I had one of those emergencies. Had I not been in a hospital, I would not be here to write this. I would have bled to death during transport. No matter how good the midwife, a cervical laceration will not stop bleeding until it is clamped and sutured. This cannot be done at home, and the volume of blood lost even with prompt hospital treatment still nearly resulted in a transfusion. I am tired of these smug assertions about "trusting birth" and "doing your research." In the developing world, child birth continues to exact a huge toll upon women and their children. They are dying for lack of intervention that we can take for granted here.

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    12. I agree with you Moto_librarian. If the technology and education is available to reduce risk, why in the world wouldnt you use it?

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  11. http://mana.org/index.php?q=blog/home-birth-safety-outcomes

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    1. Yes, those are the MANA statistics referenced in point #1 that showed a 5.5X greater death rate for babies at home birth. They also showed that 15% of home birth mothers had excessive postpartum bleeding, and breech babies died 28X more often at home than at the hospital. http://goo.gl/UlXbuV

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    2. s. Babies born to low-risk mothers had no higher risk of death in labor or the first few weeks of life than those in comparable studies of similarly low-risk pregnancies.

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    3. Read MANA's data, not their media comments.

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    4. MANA's data shows 3 times the level of perinatal mortality compared to low-risk women. They also have a high interpartum death rate. Do you not realize how vanishingly rare it is for a term infant to perish once a woman has been admitted to labor and delivery in a hospital? That MANA's rates are so hideous should shock you.

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  12. http://www.cdc.gov/nchs/data/databriefs/db84.htm

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    1. This simply says that the number of home births is increasing. Yes, they are. And...?

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    2. That's not all it says.

      "Home births have a lower risk profile than hospital births, with fewer births to teenagers or unmarried women, and with fewer preterm, low birthweight, and multiple births

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    3. Yes, lower RISK PROFILE. That means that the women who choose to give birth at home have less risks than the combined group of women that give birth at the hospital. Which makes it even MORE shocking that home birth has at least 3X the death rate than hospital birth - home birth is dealing with people with less risks, and it still kills more babies!

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    4. LOL.
      That was funny, but do try reading with comprehension next time.

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  13. American mortality rates are HIGH for mothers and infants, precisely because hospitals constantly push unnecessary interventions and convince women their babies will die otherwise (rarely the case). An American woman is 8x more likely to die in childbirth than a woman in CHINA or SAUDI ARABIA. Our health and maternal care systems are awful, not great, as you propose.

    http://thinkprogress.org/health/2014/05/06/3434509/us-maternal-mortality/

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    1. See above for misuse of infant mortality. You need to consider perinatal mortality.

      As far as maternal mortality goes, the real issue in our country is health of pregnant women. Maternal death is very rare (what's why it's measured per 100,000). And it's even more rare for healthy, low risk women.

      Our number one pregnancy-related killer for women in the USA is cardiovascular disease.

      Some important information to read/consider:

      "In the U.S., deaths from hemorrhage, sepsis (infection) and abortion (the medical definition of which includes ectopic pregnancy, miscarriage and induced abortion) are on the decline, according to the report. But deaths from medical complications that were either exacerbated by pregnancy or started during pregnancy -- things like congenital heart disease, diabetes, obesity and kidney problems, are on the rise." (http://www.huffingtonpost.com/2014/05/19/us-maternal-mortality-rate_n_5340648.html )

      And here's more food for thought on maternal mortality:
      http://everymothercounts.org/chronic-disease-and-maternal-health-in-america/

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    2. In the United States, the maternal mortality rate is 28/100,000 live births (So, 0.00028%). In China, the maternal mortality rate is 32/100,000 live births (0.00032%). In Saudi Arabia, the maternal mortality rate is 16/100,000 live births (0.00016%). So, the maternal mortality rate in the US is less than twice that of Saudi Arabia, and lower than China. http://goo.gl/ncJ2Gb Those numbers are from the World Bank, 2013. This CIA data from 2010 shows that, in 2010, the United States had a maternal mortality rate of 21/100,000, better than both China and Saudi Arabia that year. http://goo.gl/zmMWDF

      Maternal mortality IS on the rise in the United States, but do you know the most likely factors why? Increasing age and obesity of pregnant women. As the maternal age and obesity of pregnant women in the US increase, so do complications such as cardiovascular diseases. So, while traditional killers of pregnancy (hemorrhage, pre-eclampsia, blood clots) are killing less and less mothers, more complicated health problems are taking their place due to an older and less healthy population giving birth.

      And regarding perinatal mortality (not infant mortality, which covers the whole first year of life is the wrong statistic to use for safety of newborns during and after labor) - see #6 in the post above. The US has one of the best perinatal mortality rates in the world.

      Delete
  14. Before I became pregnant with my daughter, I actually considered doing an out-of-hospital birth. When I got a positive pregnancy test, I just had this strong feeling that my baby needed to be born in the hospital. It's a good thing, because I developed a rare liver disorder that could have killed my daughter if I didn't delivery her early. And yes, I know for a fact that there are midwives who will allow women with what I had to birth at home, and that is simply unacceptable.


    I was induced at 37 weeks and my daughter was born healthy and never needed NICU time or even breathing help. Of course, there are those who say that my induction was unnecessary because neither of us experienced complications, but the fact we induced early is WHY we didn't have complications. Chances are, I'm going to have this disorder in future pregnancies (it runs in my family, it turns out), so I will never NOT deliver in the hospital.

    I currently live in a state where midwifery licensure is optional--why is it my hairdresser has to have a license to cut my hair but a midwife doesn't need a license to deliver a baby?! That makes no sense to me.

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  15. This is only one persons opinion. The problem is that it is fear mongering. It doesn't provide people with info on how home births make complications less likely due to less interventions. The bias in this blog makes it appear as if the author wants women to only have one choice. I'm not sure why but maybe it's fear or jealousy?
    What about exploring how to best support women in providing their birth of choice? One sided articles like this are laced heavily with guilt and shame, which is proven in the title of "never, ever, ever.". Therefore, I'll disregard it and look otherwise.

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    Replies
    1. "Fear, and jealousy!" For sure. Also, just plain ignorance...

      Delete
    2. How is it fear mongering when the studies back up the claims? You can't provide studies that show HB is safe. No one is saying you can't have a HB... just be aware that it's more dangerous than a hospital birth. I love how pro-HB people show up and call these types of articles "fear mongering" without any support for their position.

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    3. Oh, and Richard Graham... fear? Maybe. Fear that something will go wrong (and it DOES, quite frequently in fact... or are you ignoring the babies who died because of things like placental abruption... or how about Gavin Michael, who would be alive if his mother had been told to get to a hospital ASAP instead of being strung along by her midwife).

      But jealousy? No. Just like you don't want a hospital birth, a lot of women don't want a home birth, me included. In fact, I didn't even want to have a vaginal birth. It's hilarious that you get all mad over someone saying hospital birth is safer and superior and then you post something that shows that you think that everyone should in fact have a home birth.

      Also, what do you guys not understand about "OPINION PIECE". It's a blog, not a newspaper.

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    4. "Complications less likely due to less interventions." Please see point #8 in the post above, where I predicted what you were going to say.

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    5. You're an idiot. Before I had my home birth, I researched everything to a T. I read studies, unbiased ones, and compared outcomes for mothers and babies across the world. Interventions DO cause problems and death. OB's are surgeons who went to school because they wanted to cut people for a living, and get paid more for surgical births. Hence they see pathology where there is none, quite often. Midwives are the experts in birth. They observe it start to finish, they don't just walk in to catch or when there is a problem. They won't have you labor on your back, which decreases the pelvic opening by 30% and causes a more difficult labor. Midwife means "with woman". Midwives have had natural births, by and large. They have had far more training in normal, uninterrupted birth than an OB. OB's rarely see births that aren't interfered with - AROM, Pit, Cervical exams, EFM, epidural, etc. To blindly trust the medical establishment as better is foolish. Most home birthed have more than one child and have experienced birth trauma at the hands of OB's and hospitals. Insurance and liability dictate birth, not best practices.

      And yes, humanity thrived before hospitals. Of course there are rare complications and occasional deaths. But most women would fare better at home. Women who birth at home are not foolish nor putting themselves in danger. I'm done arguing with someone who doesn't know anything about it, since you seek not to understand, but to spew a bunch of bullshit that will scare other mothers away from a perfectly safe, peaceful and lovely birth option. I will have my babies at home. No drugs to cross the placenta, no nurses to push formula, no worries about someone cutting an episiotomy without my consent. High risk, by all means, go and get the advanced care you need from an OB. But home birth is not unsafe for every woman.

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    6. Looks like you've gone right to the lowest level of Graham's Hierarchy of Disagreement: http://commons.wikimedia.org/wiki/File:Graham%27s_Hierarchy_of_Disagreement.svg. Also, almost everything you said is on "Homebirth Bingo": http://goo.gl/8jKcPx and "Twelve things you shouldn't say unless you want to appear very foolish": http://goo.gl/ok4X3l. I'll let those posts refute you, rather than copy them here.

      Please refrain from using swear words in your future comments. If you use foul language again in a comment again, I will delete that comment.

      Delete
    7. Epidurals don't cross the placenta--they don't even enter the bloodstream. If they do, then the anesthesiologist placed it incorrectly. IV pain meds DO cross the placenta.

      I gave birth in the hospital, and had none of that. Yes, I did have pitocin and an epidural, but I HAD to be induced because I had cholestasis and the epidural is what saved me from needing a c-section. I had no episiotomy, no formula pushed on me, none of that. My daughter was placed on my chest as soon as she was born, and even when she was away from me (weighing and evaluations), their priority was to bring her back to me as quickly as possible.

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    8. Nadine, do you understand that the author is presenting why SHE would not have a homebirth? Did it ever occur to you that your friendly neighborhood home birth midwife may just be a little more interested in her livelihood than in you making a TRULY INFORMED decision?

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    9. OMG... Wildflower12... seriously? OB's went to medical school because they want to cut people????? Where in the world would you come up with something like that?

      And yes, humanity survived before hospital birth. That doesn't mean that women and babies didn't die... it just means that you had to have a lot more children to ensure that some lived past infancy.

      Do you understand how absolutely insulting it is to women who have lost babies at homebirth to say what you said? OF COURSE we will survive as a species if we suddenly decided everyone should birth at home. But we'll start losing a lot more babies, and moms, if we do that.

      How can you ignore all the women who've had emergencies arise during their homebirths who tried to transfer but ended up with a dead baby? How do you justify that as being okay? Please give us statistics that show that babies are dying preventable deaths at hospitals in the same numbers as at HB. You won't be able to. Because it doesn't happen.

      Are we saying it NEVER happens? No. The difference is that it's much rarer and when the hospital and doctor screws up, there is accountability through board hearings and insurance.

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    10. Oh, it's really just so sad that more of you supposedly "strong" mamas aren't capable of birthing naturally in a hospital. I had a natural birth with my first child in a hospital. It really wasn't that difficult. I arrived at the hospital dilated to 9 cm., after laboring at home since SROM early that morning. I pushed in lots of different positions, had a nice soda to drink between contractions, and the aid of my husband, a L&D nurse, and a CNM. No one offered me any drugs or tried to change my mind.

      Now I should note that my second child was a planned epidural birth. I found nothing empowering about writhing in pain, and the life-threatening complications that I experienced after my first birth were terrifying. But I constantly here that women birth at home for two contradictory reasons: 1. They are "strong" and "trust their bodies." 2. Hospitals coerce women into interventions that they don't need. Sounds to me like a lot of NCBers don't really trust themselves to not cave in and accept pain medication when labor kicks in. So are you guys warriors or are you babies? Answer that one for me, Wildflower.

      Delete
    11. Am OB

      Get paid the same regardless of birth method.

      Do more (uneducated) vaginal births than Caesars.

      Certainly would not classify myself as a surgeon.

      Went to medical school to help people and because I love learning - not to cut people

      Have cut one episiotomy so far in my whole career.


      Think you need an attitude adjustment Wildflower. But go on.. Keep hating me and mine if it makes you feel better. I'll brandish a scalpel if it will help?

      Delete
  16. Can I just throw out there that she didn't claim this was an unbiased comparative post? She said 10 reasons why "I'd " never ever have a home birth. She didn't say "unbiased comparisons as to why a hospital birth is better than a home birth".

    Can I just say that I love this article. I have a birth defect that causes my uterus to not fully form. It's called unicornuate uterus (which is rare) but it's not all THAT rare to have an undiscovered/ unknown dangerous condition that would make child birth a dangerous thing. It's actually quite common to have unpredictable dangerous emergencies to occur. A home birth has always sounded appealing to me. Especially when watching the beautiful perfect birth moments where everything goes right. But just because there are impressionable perfect stories about home birth- does not mean they are all that common.

    Not all women with my condition know about it before they have a child. But almost all of them had to have emergency csections and there is a high percentage of them that have had still births and preterm labor. It's not just about being monitored during labor by a doctor rather than a midwife.. It's about the whole pregnancy and getting the prenatal care you need and the forewarning to know they you are running out of room(half uterus)... That your cervix is shortening and you need it sewn up.. That you need to be in trendelenburg to keep that baby from being born at 22 weeks. It is not uncommon to suffer a uterine rupture, a placental abrupt ion or a lack of blood flow. I know for a fact that my baby(who I am finally pregnant with after years if trying) will not survive if I attempt a home birth.if I didn't know this about my body- and tried to attempt a home birth with my condition.. My baby would die. How would I know to deliver in the hospital if I am seeing a midwife the whole time, without proper monitoring, and in labor about to have a uterine abrupt ion but she is telling me "it's okay, your body was designed for child birth."... My body was NOT designed for child birth. My uterus would completely betray me and my baby if I tried to do it outside of a hospital. That's not biased, i have educated myself and have learned abou t my body and my situation. Everyone should educate themselves. I will be delivering at a hospital near the children's hospital- because I plan on not holding my baby at birth.. I plan on spending weeks or months in the nicu. If people realized all the risks they could avoid by just being cautious and delivering in a hospital- they would stop complaining about what position they labored in and if they were drugged or not. A healthy baby is the goal. It's my goal- that might be impossible to attain. Be grateful that your bodies "were built for this" but also prepare for the imperfections and unexpected things your body might throw at you. It's NOT all in your control. If it was, I would have four Other children right now and my baby wouldn't have a 50% mortality rate.

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  17. Hi, Jocelyn, thanks for sharing your opinions! I personally wouldn't choose an at-home birth for many of the reasons you stated above, but because I genuinely am curious (and not because I want to start any sort of debate): do any of the studies you cited distinguish between CNMs and CPMs? If not, do you know of any that do? Seems to me, given the vast differences in qualification for each, that any study including both groups would yield misleading information for both groups (i.e. that it would artificially help CPMs stats and harm CNMs'). Thanks, and I think you're handling all of this exceptionally well!

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    1. Some of them do; this one distinguishes between CNMs, MDs, and DEMs (CNMs and the like): http://goo.gl/UgNkIG and this one does as well: http://goo.gl/iJKDW3. This one also compares hospital CNM birth, home CNM birth, and home "other midwife" birth: http://goo.gl/06igKm. In all of those data sets, the CPM death rate was higher than the CNM one, which, just like you said, would help CPM states and hurt CNM ones when they're combined.

      Delete
  18. This article has made me so sad. So many distorted facts, so much misinformation. Nearly every one of your points I could return with a valid, peer reviewed study and health department guideline(from several countries I might add) which states the exact opposite. But I will just say one thing, I am in Australia, and although in your post you say that America is one of the safest in which to give birth, I would like to say, that globally, yes it is fairly safe. But you need to remember that globally, there are many third world countries in which the death rates are catastrophic. If you were to compare first world countries however, America has one of the worst, countries such as the UK and Australia, Sweden, the Netherlands (I could go on) try their best to NOT copy America, because of their appalling practices and death rates. America has the highest medical intervention rate and also the highest death rate in the settled world. Please, please do a bit more reading about this topic, don't just accept all of the propaganda that the big money hospitals spoon feed you.

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    Replies
    1. Name one specific "distorted fact" or one specific piece of "misinformation."

      "I could return valid, peer reviewed studies...several countries." But that's exactly the point. You cannot use home birth data from other countries to prove home birth safety in the United States. The US has one of the worst home birth systems in the developed world. As Doula Dani pointed out above, the intrapartum mortality rate at home births in the USA is 1.3/1000. At home births in the Netherlands it is 0.3/1000. You CANNOT use other countries' data to prove anything about US home birth. Show me a peer-reviewed study from the US, using US data, that can rebut any one of my points.

      Secondly, read point #6 in the post above - "the United States has one of the lowest perinatal mortality rates in the world, lower than Denmark, the UK and the Netherlands," according to the World Health Organization. It does NOT have the highest death rate in the settled world - again, read point #6 in the post above. It has one of the best.

      It doesn't seem as though you actually read this post, or any of the many excellent comments already posted.

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    2. I just wanted to add, I am neither pro home birth or pro hospital birth, I believe in a woman's personal choice. However, an article like this has the danger of providing false information to women who are still trying to form their own opinion on the issue. I believe in informed choice, this only promotes fear and promotes the belief that women's bodies are broken. Question the OB, make sure that you know EVERY option available to you in a hospital setting, not just the one which is most conveinient to medical staff. It is YOUR body and baby, you don't have to consent to anything without all of the facts.

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    3. It's incredibly ironic that you are for informed consent, and against this article. There is no false information in this article. This provides facts, not fear. I said specifically in the article that having a normal, human body doesn't make you "broken" - that's the language and ideas perpetuated by the home birth movement. Having a normal human body makes you human.

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    4. No, Linfea, please don't stop here. Return Jocelyn's points with the valid, peer reviewed studies from several countries that you have. And make sure they say what you think they say. Don't just read the abstracts.

      And after returning Jocelyn''s points (or trying to since to date, there isn't a single study proving that midwife-led birth, in any first world country is safer than comparable risk OB-led birth, even in the Netherlands), would you please return her points about homebirth in the USA that she is writing about?

      Amazed

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    5. Birth does not change because you are in a different country. Women's bodies do not reach America and change to only be able to safely birth in a hospital, on a bed, with medical interventions. So then the data from the international sources stands. Just as the the WHO statistics you used stand. Also, if we are only going on American data, look into the safe motherhood quilt project and tell me that the hospital system is great. "our national goal for a maternal death ratio to be no higher than 3.3 deaths per 100,000 live births by 2010. Unfortunately, we are far from achieving that goal—in fact, we are moving in the wrong direction. Currently, according to the World Health Organization and several United Nations agencies, the United States ranks behind no fewer than 40 other nations in preventing maternal deaths .......In 2005, the last year for which we have figures, the maternal death ratio was 15.1 deaths per 100,000 births. " There is a quote from an American peer reviewed journal article, from the "journal of perinatal education". The NICE guidelines, which are an international (so yes, it does apply to America) health directive which may differ from many of the standard practices used in hospitals in most countries, not just ours. The death rate in neither place of birth is acceptable, but false statistics and data is not helping any one.

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    6. The UK has recently released an article from their government stating that more birth should move from the hospital. Not, complex cases, they need specialist care, but a normal woman with an uncomplicated pregnancy is recommended to look into home birth or birth centre birth with her own midwife. New Zealand has one of the best maternity systems in the world, very few women ever see the inside of a hospital. Australia's Rebirthing report stated that less intervention and community lead care was the best way to improve our perinatal outcomes. Although I accept that that is your opinion, of you are using statistics, and they are not correct, then it is not just your opinion.

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    7. So the competence of provider doesn't matter, eh, Linfea? That might be true for the huge percent of births that go so smoothly that the provider is only needed to catch the baby. But there is this pecky other percent where competent help matters. I, for one, am very happy my mother didn't try to give birth in Africa, with the result of both of us dying under a tree for the lack of blessed vacuum.

      The only birth that doesn't change because you are in a different country is unassisted birth. Is that what you advocate?

      As to the motherhood quilt project, I somehow can't shake off the idiocies the woman behind it sprouts continuously, like comparing a cervix to a sphincter. I can't shake off her self-pubished statistics that she never let anyone check. And I especially can't shake off the fact that she chose to give birth to her premature baby on her own and watched him die instead of seeking medical help for him.

      And since we won't see eye to eye regarding Ina May's credubility as expert, why don't you show the reliable studies that you claim show midwives are equal or even superior to obstetricians?

      Amazed

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    8. Sigh.

      The studies, Linfea, the studies. Don't state moneysaving efforts of governments or headlines that you've seen. Actual studies. You claim you can refute the majority of Jocelyn's claims. Do it, then. But the only way is to show studied. Hint: de Jonge beating her chest that midwife-led births have equal mortality in the Netherlands, be it home or hospital is not a ringing endorsment.

      Amazed

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    9. NICE guidelines 2014 also state that Electronic Fetal Monitoring is contraindicated in low risk, healthy women. CTGs were brought in in1978 as a way to prevent cerebral paulsy, studies have since shown that it does not infact lower the instance of this tragedy and it also means that women are stuck on the bed, which increases her pain and the likelihood of needing medical intervention.

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    10. AJOC claims, though, that EFM leads to significantly lower mortality. In low-risk pregnancies, it led to better APGAR score; in high-risk pregnancies, it reduced neonatal seizures, as stated here.

      http://download.journals.elsevierhealth.com/pdfs/journals/0002-9378/PIIS0002937811004807.pdf

      Anyway, you still haven't refuted a single one of Jocelyn's points which were, IIRC, that hospital birth was safer than homebirth for every level of risk. I fail to see what EFM has to do with it, other than support her points, of course, since better mortality rates are a wonderful things, better APGARs are a good thing, and EFM isn't available at home.

      Amazed

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    11. I have just checked the WHO's data on maternal mortality ration and they are as follows...
      USA- 28/100 000
      NZ - 8/100 000 (mostly midwifery lead care)
      Australia - 6/100 000 (midwifery and ob
      UK- 8/100 000 (midwifery and ob)
      Netherlands- 6/100 000
      Sweden 4/100 000.
      The lack of regulation for the home birth midwives is something that needs to be addressed however, and change won't be achieved this way.

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    12. Actually, Linfea, I would say that women's bodies do change in America. We're fatter, older, and use more assisted reproductive technology than any other country in the world. That automatically makes up higher risk.

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    13. Oh, and I forgot. We're more racially diverse and have the absolute worst public health initiatives in the developed world, with no healthcare or social safety net. So, the data from other countries does NOT hold true here.

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    14. So fight for change. Use all that anger and frustration to promote change and positive practices in America. Promote good health policies for the older, sicker, fatter, racially diverse, etc. women. I can't change policy over there, but if enough women who want change work together then you can. Keyboard warriors on a blog won't change anything. Nothing anybody reads on here is going to change their lives, or even opinion. If you think that the maternity scheme in America is flawless, then great, if not, work for change. There is obviously a lot of anger out there about place of birth, so use that to get change happening. Demand better care options, professionals, regulations. Australia is also racially diverse, fat, sick, older, etc. yet our policies are changing and our mortality rate is getting better. Change won't happen unless the consumer asks for it.

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    15. Amazed, I read your study you posted a link to. The study went on to say that the use of EMF leads to higher incidence of operative birth and intervention, that it does not improve the cerebral paulsy outcomes or neonatal mortality outcomes and concludes that effort should be made to lower the incidence of intervention. EFM is an intervention. So I'm please I read that article, it just supports my above statement.

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    16. But the consumer cannot ask for it if they don't know there is a problem. And the majority of women who homebirth truly don't know, as Dhanya, a homebirth loss mom, said in her comments.

      Such blogs are important because they raise awareness. All your suggestions would be wonderful if we had honest people to meet us on the other end. But Americah homebirth midwives and their leading authorities aren't it.

      Linfea, do me a favour. Google Gavin Michael, Christy Collins, Jan Tritten, and crowdsourcing. Then, you might get a better idea what kind of ethical and capable providers American homebirth midwives are.

      Amazed

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    17. No, Linfea, it says that while increasing operative deliveries, EFM decreases "early neonatal mortality-and therefore infant mortality -and also decreasing neonatal morbidity." It does not improve cerebral paulsy outcomes but it most certainly improved neonatal outcomes.

      Sure, it says, "attempts should be made to minimize unnecessary interventions". What makes you think that an intervention decreasing neonatal mortality is unnecessary?

      Now, I am all against using forceps and vacuum for fun. But EFM is something different.

      Intervention is not an outcome, as MANA is trying to convince women. A c-section is not an outcome. A live and healthy baby is. Or sometimes, not a live one.

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    18. Sorry, that was me - Amazed.

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    19. "EFM and STAN do not improve long-term outcomes, like cerebral palsy or neonatal mortality" I guess I imagined that. The maternal death ratio is much higher in the US as is the rate of intervention. EFM is classed as an intervention. Would you class an out come as a maternal morbidity because she was put on a bed and could not move for hours due to EFM, which then lead to a blood clot at six weeks post partum. It was not picked up because she had none of the indicating factors? Interventions are not outcomes, but interventions can lead to poor out comes. I have no idea what MANA are pushing for, but after a brief peruse of their standards and qualifications, they seem to be in line with the NICE guidelines, the WHO guidelines for maternity care, the UKs maternity standard, Australia's rebirthing report, New Zealand's core principals, the royal college of midwives and Australia's college of midwives. I'm not quite sure what MANA are being accused of in this instance. America isn't so different that what is recommend and encouraged in the rest of the world is contraindicated there.

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    20. Yes, you imagined it. The actual quotation is "In
      addition, in the future to avoid being beset by criticism that EFM and STAN do
      not improve long-term outcomes, like cerebral palsy or neonatal mortality,
      RCTs, at a scale unknown to us thus far, must be undertaken.

      It doesn't mean that they do not improve neonatal outcomes. It just means that more RCT are needed to confirm the results and avoid any possibility of future accusations that that they improve them. Granted, they don't seem to improve cerebral palsy. But they do improve neonatal mortality.

      You haven't seem to have read Jocelyn's posts regarding maternal mortality in the USA. American women are more high risk in general.

      As to MANA, you can choose to drink their koolaid or ask yourself why those people insist that homebirth is perfectly safe for low-risk mothers - and then refuse to define what low-risk is. No, to them breech, post-dates. gestational diabetes, twins, VBACs are just "variations of normal". Their guidelines are not obligatory. As a high-ranked MANA member said, midwives can choose where to follow them. MANA made no effort to improve their politics regarding breech birth even when their own breech birth data revealed a terrifying death rate of 5 in 22. Their members are not obliged to share their outcomes. A preventable death. Aquila Paparella's, was penalized by thyeir board by fining the midwife with 500 dollars. Is this really the way maternity care is in the institutions you pointed out?

      Aquila's death is in point 10 of Jocelyn's post. The audio records of the midwife "peer-reviewing" her death is in the net, posted by her mother, Liz. Give the links a try, instead of arguing about EFM in regards to homebirth. I believe Liz's records will give you a better idea of what Jocelyn is against.

      Amazed

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    21. Linfea, I'm copying and pasting this from another comment of mine above, since you must not have seen it:

      "In the United States, the maternal mortality rate is 28/100,000 live births (So, 0.00028%)...Maternal mortality IS on the rise in the United States, but do you know the most likely factors why? Increasing age and obesity of pregnant women. As the maternal age and obesity of pregnant women in the US increase, so do complications such as cardiovascular diseases. So, while traditional killers of pregnancy (hemorrhage, pre-eclampsia, blood clots) are killing less and less mothers, more complicated health problems are taking their place due to an older and less healthy population giving birth."

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    22. I was only using EFM as one of many examples, it was you who ran with that one. The point I made about it was that the reason it was introduced has been proven, as stated in the article you provided, that it doesn't improve the cerebral paulsy outcomes. End point- countries where there is a very strong midwifery presence and drive for minimal intervention have better out comes. The maternal death ratio is as much as 4.6 times higher in the US as in countries where practices are different. I feel, and I have provided information which disprove some if the "facts" that were stated in this article. Such as 3,4,7,8,9 and especially, especially 6. Number 6 alone is enough to discredit everything else that this article is stating as it is so inaccurate. Every death is a terrible avoidable tragedy and the focus should be on improving the services offered, not making women who are choosing not to use the equally flawed hospital system to birth their babies. Other countries have high maternal age, obesity, cardiovascular health, diabetes, smoking, they are increasing everywhere, yet our rates are still better than the US's were 15 years ago. Something is seriously wrong with the health system over there and things like this won't change that, it only wastes time, energy and spreads hate.

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    23. Countries you are citing as examples of excellent midwifery approach to birth re outcomes are all countries in which CPMs and all other birth junkie lay midwives would not be allowed to practice for lack of education, training, standards of practice and oversight. How about USA homebirth advocates start right there, follow the "evidence-based" practice and insist on firm regulation of midwifery and full licensure?

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    24. Correction: the death for breech birth was 5 in 222, not 22. Now, that would have been beyond imagining.

      Amazed

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    25. And homebirth and hospital system AREN'T equally flawed. Maternal mortality is measured in 100 000, it's just so small. Neonatal mortality is measured in 1000 - and in the USA, homebirth fares at least 3 times worse than comparable risk hospital birth.

      And your assertion that countris employing midwives have better outcomes is just flat out wrong. Both Netherlands and the UK have WORSE outcomes than the USA, with its problems in having access to health care. And the reasoning is simple: since neonatal mortality is measured in 1000, the USA mortality of 7/1000 and 28/100 000 mothers means maternal mortality of 0.28/1000 and perinatal mortality of 7/1000. Netherlands mortality is 8/1000 for babies and 0.06/100 for mothers. That means that for each low-risk birth, a baby dies in the Netherlands that wouldn't have died in the USA. The reverse cannot be said about a mother because maternal mortality is just so small compared to perinatal mortality.

      You still haven't googled the sordid story of Gavin Michael's birth, have you? I can say you haven't because no one who has seen the terrifying lack of knowledge of midwives who teach other midwives, the death that followed in the wake of this incompetence, and the scrambling to erase this baby and this conversation from existence can say that homebirth and hospital birth are equally flwed. Unless they are the most rabid of homebirth advocates which you claim you aren't.

      It was nice chatting with you but I really don't think we have too much to say to each other before you read what Jocelyn is talking about. Since you haven't posted links to the studies showing equal or better safety with midwives, I take it that you have looked at them and realized that they don't support your assertion. Just read something about the way MANA practices, not what their members write to advertise themselves, and we might just have a meaningful discussion.

      Amazed

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    26. Damned system, I cannot edit... I meant 0.06/1000, of course.

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    27. For 1000 low-risk births, a baby dies in the Netherlands that wouldn't have died in the USA.

      Coffee withdrawal SO doesn't agree with me.

      Amazed

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  19. Wow. Your article is highly inaccurate and disgusting. I would encourage you to do a little more unbiased research. You are a fear mongering anger inciting individual.

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    1. What specific statistical information do you think is inaccurate?

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    2. I just want to point out, Anonymous, speaking of "anger inciting individuals," that you are the one calling names.

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  20. Yeah, home birth is so dangerous that it's a preferred method in Europe, even for the royal families. Did you know the U.S. has the highest in-hospital-birth mortality rate than other developed countries? I'm pro-hospital myself, but why make an article to shame mothers who give birth at home? Why make it a right vs. wrong topic? I hate articles like these. It serves no purpose other than showing arrogance, hence, "Why I would never". If you don't like home births, don't have one. The women who choose to, prepare for the worst and spend their entire pregnancy, some before conception, planning and researching. These women know your statistics and a LOT more than you haven't listed, and have plans in place. This is just another mom's attempt at I'm-better-than-you-because. Maybe ask women why they chose home birth. I agree with them not wanting such a beautiful thing happening in a place of sickness and death. They want immediate contact with the baby, including the father. They want a delayed cord clamping, which science confirms beneficial. They all want something for their baby that the hospital won't take the time to address. As I said, the hospital will be the way for me, but that doesn't suit everyone. I have respect for women who give birth at home, and you need to spend time with one choosing to do so. They have mentally changed my mind about home birth, but I couldn't physically bring myself to do it. I don't know what made you think that women doing a home birth don't know these statistics. It's silly to make a shaming article over such a thing. Next, you can target formula feeding mother. It's another shaming topic that disrespectful people use when they forget that everyone is entitled to choices that fit their life styles.

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    1. You took the words right out of my mouth. Amen!!!! When will women stop competing with one another and start helping and empowering one another.

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    2. It doesn't have the highest "in hospital birth mortality rate" among developed countries. See #6 in the post above.

      What in this article shames mothers? Where did I make a single judgmental statement against them? This articles shames incompetent health care providers, sure. It shames people who tell women that home birth is "as safe or safer than hospital birth." It shames people who don't have adequate medical training for the things they attempt to do.

      The hospital isn't a "place of sickness and death." The hospital does provide immediate contact with the baby, as many (including myself) can attest to. Hospitals do do delayed cord clamping upon request.

      And, lol about shaming formula feeding mothers. If you look at my past blog posts, you'll find one a couple months ago called "I love formula feeding."

      This article isn't about competition. It isn't about shaming. It in no way or form makes judgement statements about peoples choices. What it IS about is informed consent, and making sure people have ALL of the information before they make a choice.

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    3. lol at hospital isnt a place of sickness and death...what hospitals have you been in? I am pretty sure sick people go to the hospital, thus a place of sickness, and i am pretty sure it's a place where a fair number of SICK people die. Infact the gown you birth in could quite possibly be the gown someone died in.

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    4. In the USA, where babies are concerned, home is the place they die during labour or shortly after at a rate at least times greater than comparable risk hospital birth.

      Amazed

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    5. And so is hospital, where doctors may accidentally decaptitate an infants head during a c-section. Or have adverse reactions to sometimes unnecessary interferance. Babies die in hospital too.....

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    6. Please link to any report in which a baby's head was decapitated during a c-section.

      From the post: "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."

      And "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. "

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    7. Not low-risk babies, though. Not at such high rate, anyway,

      Since you all love the decapitated baby story, would you mind telling me how this high risk abdominal dystocia baby would have fared better at home? Because, you know, more intervention was needed. A c-section. Because, you know, the case you all love so much was actually an ill-advised vaginal birth on the doctor's part. And it was forceps, not a c-section. By the way, mom wanted a c-section but the doctor didn't agree.

      Now, do tell about all those adverse reactions to unnecessary intervention. Start with proving that interventions were unnecessary in the first place. So, a stat c-section done after a uterine rupture after a failed V-bac doesn't count.

      Amazed

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    8. Anonymous @ 9:17 - Are you referring to the case in which a couple was coerced into a vaginal delivery against their will, the doctors decapitated the baby during the attempted vaginal delivery, and then tried to hide it with a c-section? Yes, that was and is extremely horrific. But it was not caused by a c-section - it was caused by a vaginal delivery.

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    9. Omg. Some of the idiocy........so hospitals have seperate EVERYTHING for L&D wards. Even their air circulation systems are completely seperate. The gowns provided for women in L&D and postpartum wards have openings for breastfeeding. Gowns for an oncology ward dont have those I am pretty sure. And british royals havent done homebirths for decades. They have lost too many beloved princesses and royal babies to childbirth complications. Even mental floss magazine has written about the devestation the entire nation felt after princess Charlotte died when the doctor refused to use forceps in the birth of her stillborn son. (At home)(even in their beautiful palace)

      Not amazed, but I wish I could refute you numbnuts like amazed can

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  21. "the women who choose to,... These women know your statistics and a LOT more than you haven't listed, and have plans in place. This is just another mom's attempt at I'm-better-than-you-because. Maybe ask women why they chose home birth. "

    The thing is most home birth moms do NOT know of these statistics, we never did, they weren't covered in Bradley class, our midwives didn't know or mention them, they aren't on homebirth pages. I think that's why Jocelyn and others try so hard to get them out there, so mothers can BE truly informed, not just feel it.

    We chose home birth to avoid a repeat cesarean and to have immediate skin to skin. Skin to skin is SO important to me and there's much research showing it's benefits. Our unexpected shoulder dystocia caused my son to be born lifeless, resuscitation was eventually performed. After we got to the hospital he had to have his entire body cooled to try to minimize his brain damage (it didn't work). It was over 72 hours after his birth until I got to hold him, so as for why I chose a home birth, skin to skin, it wasn't really worth it.

    Of course hospitals need to be more homey, more considerate, but that fact doesn't make homebirth any safer, it just makes it more attractive.

    "I don't know what made you think that women doing a home birth don't know these statistics."

    They don't Brandy, they really don't :(

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  22. http://www.cdc.gov/nchs/data/databriefs/db84.htm

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    1. See the responses to Wildflower 12's comment at 1:39 p.m.

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  23. Hospital births carry many risks too. The exception here is they often get swept under the carpet with doctors using medical jargon to hide the fact that they make mistakes in hospital too. This is coming from someone whose own body and child were affected badly by malpractice and wrong decisions by the doctor.So while I appreciated the sentiment of backlashing against homebirth due to personal experiences and statistics framed in a certain way and interpreted in a certain way, it should be duly noted that Hospital birth too carry grave risks. BIRTH carries grave risks. Does someone have to be right or wrong? Or can we agree there is safe homebirth, and dangerous homebirth. There can be safe hospital birth, and dangerous interventional hospital birth? Birth is dangerous regardless of location.

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    1. I don't think anyone is saying hospital births are risk free or that malpractice doesn't take place in hospitals. But if you look at the numbers, homebirth in the U.S. is much riskier than hospital birth, plus if your homebirth goes wrong you have very few legal options available to you since homebirth midwives don't carry malpractice insurance. And most women who choose homebirth don't understand they are taking on an increased risk to their baby.

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    2. In that case I feel very sorry for US women. We do not have this issue in New Zealand. Our midwives are ALL university qualified. Even homebirth midwives in NZ are hospital experienced too ( can't get qualified in NZ without it). So I think the question is, why do people put so much time into condemning homebirth itself, when the issue is they way it is performed in the US. Perhaps if half that energy was put into bettering homebirth midwives and homebirth practice in the us, then US women would be empowered by having TWO options where to birth. Discouraging people away only means homebirth practices get worse because they are not practiced. If they are practiced and improved and empowered it can be a very good thing.

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    3. The homebirth midwives themselves have fought every attempt to better regulate the profession and establish universal practice guidelines. For example, it was only a few years ago that a high school diploma was made a requirement for obtaining the Certified Professional Midwife (CPM) certification and there are many lay midwives who never bother getting a CPM. Here is an article comparing the training of U.S. CPMs with midwives in other countries: http://safermidwiferyformichigan.blogspot.com/2013/04/the-education-of-midwives-around-world.html

      BTW, none of the above applies to U.S. Certified Nurse Midwives (CNM), who are university trained and mostly practice in hospitals. The CPM credential deliberately obscures the difference and fools women into thinking CPMs are highly educated when they aren't.

      Guesteleh

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  24. Decided to got through all the research and studies, and citations....Stopped when I discovered DR Amy Tuteur. A doctor reknown for stealing woman's birth stories and condemning grieving mothers days after their infant had died. Any research from this misogynist should be heeded with great caution. I personally know one of the women she did this to.

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    1. The research isn't Amy's, though. Have you looked at the studies themselves? Just because Amy posts them doesn't invalidate the research. And I'm someone who shares your repugnance at her publishing the birth stories. As awful as Amy can be sometimes, she's one of a handful of people who are calling attention to the appalling lack of education and accountability among homebirth midwives.

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    2. You personally know someone who lost their child at a home birth? Did she file a complaint against the midwife?

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  25. Here's one factor you forgot to consider. A midwife has a one low fee. Her ultimate goal is successful birth at home and clients' happiness. She would stay at your side whether it's 3 hours or 3 days without sleep. For a mere low fee. IN CONTRAST:
    (1) An OB doctor has a quote of C-sections s/he has to meet to make it profitable.
    (2) If OB has zero C-sections in a month and mostly vaginal birth, that OB will likely lose her or his job pretty soon.
    (3) OB has ZERO obligation to stay by your side AS LONG AS IT TAKES, unlike midwives.
    (4) OB has to go home or play golf after his shift is over, so if you are close to his shift ending and still not doing it, OB will likely recommend pitocin to induce, which WILL GUARANTEE to lower baby's heart rate, which will create an emergency situation that qualifies OB to do C-section "to save" the baby.
    (5) OB with highest rate of C-sections will more likely to get promoted or bonused or got a raise.
    (6) OB's comfort is of utmost importance. Why do you think you lay on your back for hours? That's against gravity. That's abnormal. The only reason that position is invented is to make it comfortable for OB to observe and do their job. Regardless whether it's bad for mothers' back or slow down labor. Midwives would put mothers' comfort as ultimate goal. Gravity helps, so mothers often stand up, kneel, or in praying position, while midwives squat, bend over, and do whatever it takes for the mother and baby. OB will NEVER do these things. It's beneath them
    (7) Midwives, at most, depending on which state, experience, etc. charge $2,000-3,000 per birth. OBGYNS make average $600 on vaginal birth and $4-7,000 per C-section, and OB only has to be there for 1 hour. They can rake in 10 C-sections a day if they want to and they would.

    >> What's my qualification to say these things? My own mom is OBGYN and I have one uncle and two other cousins who are OBGYNs. Trust me, we talked about this. Your article made me wonder if you received some "endorsements" from a certain group. Or maybe not. Regardless, the article didn't hold.

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    1. Hey, if your rels could show us where to find those numbers I'd appreciate it.
      Heck, I'm sure some OBs would like to know where they can put in a day's work and walk out $20,000 richer. With that rate of pay, you'd think there would be a surplus of OB-Gyns.

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    2. Here's something you failed to consider:
      not all obgyns are douche bags like you mom, uncle, cousins, whoever, who is only out for their comfort and convenience.
      And midwives wanna get paid too... I've read and seen wayyyyyyyyy too many instances where midwives are all friendy friendy fakey fakey trying to get paid, lying to their clients so they can keep them as clients --they got bills to pay too ya know. Oh but insurance for accountability, at least they dont gotta pay that right? ....

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    3. Three days without sleep... and that's the person who's in charge for me and my baby?

      Terribly unprofessional. That's patient endangerment.

      Amazed

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    4. You are such an idiot that I doubt that there's much point to me replying to you, Audrey, but I'll bite. PROVE that OBs have a quota of c-sections per month, and that they face losing their jobs for failing to meet it. Because from where I'm sitting, all that I hear about is pressure to REDUCE the c-section rate. Everything that you said above is pure fantasy. Do you not understand that the reasons c-sections cost more is because multiple healthcare providers are involved (anesthesiologist, nurses, usually two OBs), and each one of them needs to be paid?

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  26. Number 7. is backwards. Midwifes give personalized care and OB's give cookie cutter one size fits all care. Just ask any pregnant mama who visits her OB and ask how long the appointment was? 15 minutes? Hah! Midwifes spend about an hour or two per appointment. Also, a lot of your facts are wrong. You should give references to the garbage you are spewing. I am an aspiring Midwife who will be "certified" when I am done with my education. I will be better trained than a CNM when it comes to natural physiological birth.

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    1. "Number 7 is backwards...midwives spend an hour or two per appointment." Doing what? "You should give references." I did. After every single number. "A lot of your facts are wrong." Which ones? Name them specifically. "I will be better trained than a CNM when it comes to natural physiological birth." No, you won't.

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    2. Most of my appointments with my midwives averaged 15 minutes. They took longer when I had specific questions, particularly during my first pregnancy. Frankly, I don't want my midwife trying to be my friend. She needs to maintain a professional distance, and 1-2 hour prenatal visits are totally unnecessary. I value my time, and I would expect my providers to as well.

      And if you think you're going to be "better trained" than a CNM, you are woefully ignorant and arrogant.

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  27. This is so amusing. WHYYYYY can't any of this prohome birthers able to share real studies --- that say what they think they say, not just misinterpreted/lack of understanding studies like wildflower posted--- when they comment? Besides, I didn't gather from this post that the author is anti home birth, I gathered that she feels that before someone chooses homebirth, we need to have better educated, accountable, insured midwives across the board. ... Are you people really against that?!

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  28. I have had two safe and gentle home births and am planning another home birth in a few weeks. My midwife is a Certified Nurse Midwife. She has assisted in hundreds of births and has never lost a baby. She is amazing. Sleeping over while I labored for three days with my first and called her too soon. She has always put my comfort ahead of her own and has advocated for me when I was feeling uncomfortable about the people I chose to have at my birth. I only had my husband at my first and then with my second, my mother and best friend but if I wanted 20 people there, I could have. I was in my home comfortable in a pool full of warm water which helped with pain and softened tissue which helped me to not rip.

    I personally would not choose a hospital birth unless there was an issue I knew about prior to labor. My midwife gets all my blood work and sonogram info and if there was ever an issue she would be right by my side in a hospital.

    That being said, I would NEVER make a woman feel bad about her choice to birth at a hospital. Every woman has the right to choose where they birth. Every woman should birth where they are most comfortable as that is the environment in which it is best to birth. If you are panicking the whole time because you wanted to be somewhere else, labor will suck even more.

    It is not anyone's place to make any woman feel bad about their choice of where to birth. It is no one else's concern but the woman having the baby and her family.

    I can appreciate your concern with home birth but the way you have written your post is as if to say that woman who choose to have home births and choosing to kill their babies. Woman who have babies at hospital do not care about their children any more than home birth mothers do. We are all trying to do what we believe is best for our children. At the end of the day we all have to live with our choices, not anyone else.

    And my midwife appts are usually and hour to an hour and a half. We discuss how I'm feeling, any concerns, common things during "this month". Then we talk as friends for a few minutes about family life and whatever else we share with each other. After that she checks my blood pressure, listens for the baby's heartbeat and let's me know the beats per minute, feels around my belly to check baby's position and measures my uterus to check growth. Oh and when I first get there I pee on a little stick thing that checks for protein in my urine.

    But yes to me it sounds like this blog was written to be completely against home birth because as she says at the bottom of the blog "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."

    That to me sounds like a stab against home birthers and an assumption that we don't care about our children.

    Any woman, no matter what birth choice should educate herself on her birthing options. Would you choose a doctor or has a high c-section rate in healthy mothers? Or a doctor that other woman have warned you against?

    I certainly would have never chosen my midwife had other woman told me that she was horrible and not to go to her. Or that she has lost a lot of babies. That to me says that she isn't doing her job properly and isn't caring for these woman and their children as she should. Every woman has the right to choose her own birth as I said before. No one has the right to shame anyone else.

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    1. You use words like "comfort", as though comfort were important compared to your baby's safety. Women considering home birth SHOULD reconsider. If something unexpected happened during labor, you will be more likely by several factors to lose your baby, or your baby could suffer a brain injury. I would rather be in the coldest. most uncomfortable delivery room or even have the most unnecessary c-section with the rudest ObGyn ever than accept those risks for my baby. These are not theoretical dangers slightly more probable to happen- they are REAL dangers and they are several times more likely to happen. I doubt you will ever look honestly at what a foolish risk home birth is, but maybe someone reading this will take my harsh words to heart. Have your baby in a hospital: so it for all the women in history who never had the chance, and who lost their children because of it.

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    2. "That to me sounds like a stab against home birthers and an assumption that we don't care about our children." I'm sorry that it came across to you that way; I don't think it's intended to mean that (and I certainly don't mean that). I know that women who choose home birth love their children just as much as those who choose hospital birth. To me, what that statement is saying is - "It could happen to you. Complications are not impossible." and just to know that and take that into consideration. When risks are spoken of in much of home birth discussion, they are dismissed as being "rare." Well, someone is going to be that rare woman. And to me, that statement is simply staying, "Don't dismiss the risks." It's not a judgement statement.

      I'm glad that your first two births were safe and hope that your third is as well. Some of the things you mention - like your midwife attending you for three straight days - are the reasons I would want to choose the hospital. I want a change of staff, so that they're well rested. I also want teams of people that could be at my bedside at a moment's notice. And "she has assisted in hundreds of births." I want an OB that's assisted in thousands, so that's she's seen the rare complications that might come up. And I would choose the hospital even if there were no issues prior to labor, because many issues come up during labor that could not have been predicted before.

      I think that there should be stronger regulation of midwives, so that even if a mother doesn't have a chance to be educated or to ask around about different home birth midwives, she would be safe with whoever she chose (as safe as you can be at home).

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  29. Jocelyn,
    I have 4 children. I have had 1 hospital birth, 1 birth center birth, and 2 home births. While I agree with many of the things you have said, even ACOG has admitted that it is very difficult to provide rock solid studies on this subject. Many aspects just haven't been studied enough or have inadequate statistics. That said, I look at it all a different way. I am a Mormon as well. Like anything else I do with my family, prayer was a very important part of childbirth preparation for me. Obviously, home birth is not for everyone. Apparently for at least 1 in 1000, it's a horrible idea. However, for a certain few, it may be the best option. My first baby was born in the hospital. It was a good experience and it didn't create a bias toward hospitals for me or anything. When I was pregnant with my 2nd, I used a birth center run by CNM's and physicians just outside the hospital complex with direct transport available. My labor with #2 was 45 minutes and I almost didn't make it. With #3 I was in the temple one day and had the distinct, unmistakable impression that I needed to prepare to have my baby at home. As I prayed, I was given the assurance that there would be no issues and that a home birth was the right thing for me. It was. My labor was just over an hour and delivered by an experienced CNM that also delivers at hospitals (CNM's sometimes DO deliver at home! It's very common in Amish areas.) Same thing with #4. I prayed, got a blessing, and felt at peace with my decision. Now, that doesn't mean I think it's for everyone, but you must admit, if it wasn't for some, mankind would not have survived. So what do you think about that as a Mormon? I understand what you are trying to do and say, but its sometimes about so much more than statistics. I do believe you can have a baby safely at home if that's what you want. Thousands do it every day. Heck, Christ was born in a stable. The decision for me is based in prayer. I absolutely believe that though the Lord gives us an option, he can give us reassurance about our decisions. Also, I have a hard time believing the Lord lets the decision of infant mortality completely up to where it happens. If the child is meant to be, I believe he either would let us know (if we ask) what to do, or intervene. Just my 2 cents.....

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    1. You took a risk and you got lucky. That is, your baby got lucky, despite your foolish decision.You disrespect the dangers our fore mothers faced with every pregnancy and delivery by airily waving it all away like it was nothing. God doesn't guarantee a safe delivery to any woman, no matter how special she thinks she is. We are lucky, however to live in a peaceful country with top notch medical care for mothers and infants. It is the height of ungratefulness to act like that is not important.

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    2. I too am LDS, and your last sentence sort of bothers me. "If the child is meant to be, I believe he either would let us know (if we ask) what to do, or intervene." While I definitely believe in personal revelation and that our Father in Heaven does perform miracles, I also believe that we have agency (hello - it's a MAJOR part of the plan). And with that agency, comes consequences. Heavenly Father isn't a puppet master in our lives. I actually struggled with the same idea: why would Heavenly Father let a baby die if that baby was meant to live? Why are more babies dying (proportionately) at homebirth than hospital birth? Is Heavenly Father really purposefully sending babies "who aren't meant to live" to families that choose homebirth? I honestly don't have a clear answer to those questions. The only thing that keeps coming to me is that we have our agency, and that agency comes with consequences, both good and bad.

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    3. If you believe in personal revelation, than how is what I did wrong? You don't think the Lord can guide us in any situation? I didn't say hb is right for everyone, I said it was right for me. It was not luck. Plus, with my fast labors, it's a heck of a lot safer than on the side of the freeway. I dont know all of what goes into whether or not a child dies or not, but I dont think where it happens is the end of the story. I think the Lord does give us the choice and can guide us to know whether it is a wise one or not.

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    4. Pretty sure I never said that what you did was wrong. You (along with everyone else) are entitled to make whatever decision you'd like regarding childbirth. My hope is just that they are truly informed decisions. Your decision isn't truly informed if you believe that a homebirth is as safe or safer than hospital birth. I personally could never choose homebirth knowing that, because I couldn't live with the consequence if something bad happened at home that could have been prevented or treated in a hospital. I understand though, that even though the risk is higher at home, it's still a relatively small risk. MOST people who have babies at home will have things go well, but it is still a riskier decision. However, if someone knows that, and is willing to accept that higher risk for the benefits of homebirth, that is absolutely their decision. And having had a fast labor myself (that resulted in an unplanned, unassisted homebirth that luckily went perfectly), I can recognize that there are some comfort benefits to being at home. And having fast labors does definitely make things trickier as far as getting to the hospital on time (obviously). I respect the process you went through in your decision making, even though I wouldn't have made the same decision.

      In your original comment you said, "Now, that doesn't mean I think it's for everyone, but you must admit, if it wasn't for some, mankind would not have survived." The biggest problem is, that we can't truly know that it'll be right for us until it's said and done (as with EVERYTHING in life). We can have feelings and impressions, but sometimes the impressions and guidance we receive ends up looking completely different in retrospect.

      And I definitely do believe that the Lord CAN guide us in any situation, but that doesn't mean that our impressions or feelings can't be wrong, we are imperfect afterall. Just because Heavenly Father gives us a choice doesn't mean that He's going to ensure that everything goes perfectly, that's just not how things work. If you think it does, then how can you explain anything bad that's ever happened to someone who was making "the right choice?" There's a book called "Ironmom" by Mette Ivie Harrison who planned a homebirth with her sixth child. She went two weeks overdue and received a priesthood blessing from her husband that her daughter would be fine. She was stillborn. Like I said earlier, sometimes the guidance and impressions we receive end up looking different in light of how things actually transpire.

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    5. Well, you are saying I was "uninformed" which is a nice way of saying wrong, lol. Look, life is all trading risk and benefit. Only an individual can make the best decision on how that balance works for them. I see no reason why I would have had that impression and the subsequent reassurance if it was not the right thing for me. So, in my case, it was not "uninformed." Again, not everything is about statistics. Statistics are constantly changing and have flip flopped over the years on several issues. I'm not saying they are wrong, but there is more to it than that. I don't know what I would choose if I had a 5th, but I don't see why I can't ask the Lord to help me with the decision yet again. As you said, you never know until later. Could it not also be true that had I gone to the hospital instead, there could have been something the Lord was trying to warn me about? Could it have resulted in a dangerous infection? I don't know, but I know what I have done was the best decision for me. I'd also like to point out that hospital birth is crazy expensive. $10,000 with no complication! Maybe more women would be able to have a hospital birth if it wasn't so dang expensive!

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    6. Hi Anonymous @10:27;

      Thank you for your comment. Just to address your first point - ACOG's statement from 2011 (and reaffirmed last year) says that: "Although the Committee on Obstetric Practice believes that hospitals and birthing centers are the safest setting for birth, it respects the right of a woman to make a medically informed decision about delivery. Women inquiring about planned home birth should be informed of its risks and benefits based on recent evidence. Specifically, they should be informed that although the absolute risk may be low, planned home birth is associated with a twofold to threefold increased risk of neonatal death when compared with planned hospital birth." ACOG does say in that same statement that research is still limited in this area, but if you look at all the studies I listed in #1, you'll see that a lot of them just came out this year and last year. A lot of new research is coming out on home birth, and it's all showing the same thing - increased death rate.

      To discuss the rest of your comment, and the ones below it: You bring up a really interesting point. I don't think there's a right or wrong when it comes to choosing homebirth. I think it's definitely wrong for home birth advocates to perpetuate misinformation like birth at home is "safe or safer than the hospital." That just isn't true. Sure, many births will be perfectly safe at home. But many births won't be - and for the births that have unexpected complications, the hospital is hands down safer than being at home. Once women know that, and have the real, unbiased, not sugar-coated information in front of them, it's totally up to them to make their choice.

      I agree with Anonymous @12:07 that I personally could never choose homebirth knowing the risks, because I could not live with myself if something went wrong and my child was hurt. But that doesn't mean that people who do choose home birth are bad or wrong in any way. If they are are making an informed choice (which many of them, unfortunately, are not - that's what I'm trying to change), they just have a different view of acceptable risk than I do. There's no right or wrong to that.

      Regarding personal revelation - I honestly don't know, when it comes to home birth. It's personal for a reason. Heavenly Father has given us our agency to make choices. And, as you said, he can guide us to know if we're making a wise decision or not. But that doesn't always mean that our impressions mean what they think they mean. Just like Anonymous @12:07 said, "Just because Heavenly Father gives us a choice doesn't mean He's going to ensure that everything goes perfectly."

      I had to make an important decision once in my life, and I was praying about it constantly. I felt the spirit confirm that the choice I was making was a good choice to make. But as soon as I made that choice and actually committed to it - that feeling disappeared, and I realized that I actually should have made the opposite choice. But this was the only way Heavenly Father could have gotten me to see that I actually needed to choose the second option. I never would have been sure about choosing the second option if I hadn't chosen the first option first and realized it was a mistake. Which makes me think of this story - https://www.lds.org/new-era/2005/07/wrong-roads-and-revelation?lang=eng.

      Anyway, sorry, this is getting kind of rambly. I guess what I'm trying to say is that homebirth is a personal decision. We all have our agency. And we can all be guided by Heavenly Father.

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    7. Original Anonymous, you said: “I do believe you can have a baby safely at home if that's what you want.” You are confusing faith with magical thinking. Simply wanting or believing has no effect whatsoever on the physical processes involved in childbirth. Obviously I can't challenge your claim to personal inspiration, but I have a hard time understanding why the Lord would want you to dismiss the resources He has made available to you while so many of His children are dying for lack of medical care in childbirth. The Church has spent a considerable amount of time and money in providing neonatal resuscitation to medical professionals in underdeveloped nations to try and improve mortality rates. (Do a search on neonatal resuscitation on lds.org.) At least you used a CNM for your home birth, but some LDS women don't, thereby putting their risk at about the same level as women in those underdeveloped nations.

      “I think the Lord does give us the choice and can guide us to know whether it is a wise one or not.” Yes, He does, but some choices should be no-brainers. The Church encourages its members to get the best medical care possible: “Latter-day Saints believe in applying the best available scientific knowledge and techniques” (Dallin H. Oaks, “Healing the Sick,” Ensign, May 2010). “Much knowledge has been gained since the gospel was restored to the world in 1830. As the Spirit of the Lord has been poured out upon the earth, many new discoveries have been made to help us maintain good health. Many resources have been provided to help us cure or prevent disease. The Lord expects us to use the resources available to us” (YW Manual 3, Lesson 39). Current RS curriculum states that it is “our responsibility to provide each new spirit child of our Heavenly Father with a healthy body.” The hospital is statistically the best place to do that.

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    8. Aargh. That should say, "in providing neonatal resuscitation TRAINING to medical professionals."

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    9. I stated things incorrectly in my earlier post, when I said "your decision isn't truly informed," I didn't mean your decision personally, I obviously don't know what information other than prompting went into your decision to homebirth. That should have said, "Anyone who makes the decision to homebirth isn't truly informed if they believe homebirth is as safe or safer than hospital birth." That's my biggest issue, most people who choose homebirth are making that decision without all the facts. While someone still has to personally weigh the pros and cons for themselves, it's hard to do that if they don't really know what they are! Not that I think hospital birth is perfect either. If I could choose an ideal situation for myself, it sounds similar to your second birth. Unfortunately, a birth center like that doesn't exist where I live.

      Life IS all about trading risk and benefit, but it's also easy to say that something was the right decision for you when everything went the way you wanted it to. It's when things don't go the way we want them to that it's hard to feel like the decision was right.

      Hospital birth can be expensive, but I wonder how much of an issue that is for the majority who choose homebirth. Midwives aren't exactly cheap either, most don't take insurance, and they often collect the whole fee even if you end up transferring to the hospital. I personally know a couple people who have paid significantly more out of pocket for homebirth than they would have for hospital birth (since they already pay for health insurance that would have only required a much smaller copay than the fee their midwives charged).

      We could go back and forth on this all night, so I'm just going to bow out, because I'm exhausted! Lol! It's so hard having discussions like this in an online forum because tone and such must be inferred, but I truly never meant to insult in any of my comments, and hope you don't feel I was personally attacking you or your decisions. Good night!

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    10. I didn't have an unassisted homebirth. I used an experienced cnm with physician oversight. I had all the same tests as any other woman. How is that not using medical care? Should I have used a high risk ob since that is the "best available?" I assume you are not saying we should use all medicine available simply because it's there. No, we use our discretion. The Church has never said anything about birth practices. Providing it for people who need it is not the same as endorsing it for everyone. I think it's funny how you are all finding different ways of saying my decision was wrong. As far as magical thinking, I meant that if you ask the Lord because it's something you want, I dont see a reason why he can't give you that blessing. We ask for blessings of safety all the time. It d oesn't mean that it will be the right answer just because you asked. It means that I dont see why the Lord wouldn't want you to be a part of the decision making. I think you get what I'm trying to say but dint want to come close to agreeing that someone can have a hb and have it be the right thing, lol.

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    11. Oh and as far as fees go, I know it's a big deal to the Amish communities. They don't use insurance so the majority do home births because of the cost.

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    12. What about me? I am a Believer in Jesus Christ and love the Lord with all my heart. I wanted to have a homebirth and trusted it would go well, thought I was informed and it'd be a blessed occassion. I had it... I had a homebirth with my 1st child and it ended horribly. He was a severe shoulder dystocia, born completely flat. He survived, but suffers a life long birth injury that affects everyday of his life. Am I thankful, by some miracle, that my son survived? Yes! Do I think he would have been born healthy (via c-section) in a hospital and wouldn't have had to go through his life with his challenges? Yes! Do I regret my decision even though I trusted and prayed it would go well? Yes! Do I make the best out of his situation and choose joy? Yes.

      I made a BAD choice. The consequence could have been MUCH worse than it was. I do wonder why I didn't pay the ultimate price (the death of my son instead of his birth injury) for it, while some other women do. I feel like God intervened in my son's life (because even with oxygen, a midwife can't do proper rescussitation), but chose not to intervene in his lifelong injury.

      God gives us free will to make good decisions and bad ones... He doesn't promise us all our decisions will be free from consequence. In His word, He says we are to make decisions with a "sound mind"... sound mind points to hospital births as the safest way to give birth. Timothy 1:7. Most homebirthers I know, give birth at home because they are scared of hospitals, of the unknown staff, of what interventions COULD happen, etc underneath all the "trust birth" stuff. I learned the hard way and even though I was scared of what a hospital birth would bring with my subsequent babies, I followed that verse's advice and had the rest of them in the safest place to be. And big shocker... the rest of my babies have been born healthy and free of pain/injury.

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    13. *Sigh....I'm not saying just because you want it and have faith you will get what you want! I'm saying, the Lord WANTS us to ask for things that we want and if it's not contrary to his plan for us, he wants to give it to us. Why would birth be different? If we were talking about something else, would you think it was right to ignore a prompting from the Lord? Why on earth would I ignore what the Lord told me and wave statistics in his face? The Lords reason is not always the same as mans reason. I don't know anything about your situation. All I've said from the beginning is that in my situation, it was 100% the right thing.

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    14. OP Anonymous, as I said in my comment I do feel that some LDS women disregard the resources the Lord provides but I apologize for directing those quotes at you. Using a CNM is definitely taking advantage of medical care, but no matter who the provider is, having a home birth means taking unnecessary risks. The Church actually has said something about birth practices. “Have Regular Medical Examinations. A woman should visit a doctor or a health clinic as soon as she suspects that she is pregnant. The doctor or the nurse will usually have her return for a checkup at regularly specified times during the pregnancy. Health workers, such as doctors and nurses, are trained to recognize problems that may arise during pregnancy. Therefore, it is wise to have regular checkups” (https://www.lds.org/manual/the-latter-day-saint-woman-basic-manual-for-women-part-b/homemaking/lesson-22-maternal-and-infant-care?lang=eng). That may be irrelevant to our discussion, since you followed that counsel, but it becomes significant for the LDS women who subscribe to the “trust your body” theory. Obviously each woman can choose for herself, and choosing home birth is not contrary to any commandment. The Church will likely never make a statement about where a woman should give birth since so many women worldwide don't have a choice.

      It's those women who do have a choice that I don't understand. At a time when most births took place at home, general Relief Society president Clarissa S. Williams “was concerned about the high mortality rate of mothers and infants. . . . In 1924, with support and encouragement from general and local priesthood leaders and Sister Williams, the Cottonwood Stake Relief Society established a maternity hospital. This hospital later became part of a network of Church hospitals” (http://www.lds.org/relief-society/daughters-in-my-kingdom/manual/charity-never-faileth?lang=eng). Decades later President Kimball said, “Much headway has been made, and mortality tables are encouraging; more infants survive, more mothers go through childbirth successfully . . . We are grateful to all those hardworking scientists who have contributed to this great accomplishment” (“President Kimball Speaks Out on Administration to the Sick,” New Era, Oct. 1981).

      Home birth is usually safe. But hospital birth is safer and I believe women who have access to it should choose the safest option. There have been many statements from modern prophets that advances in medicine come from the Lord. I know that the Lord can and does answer the prayers of women for safety no matter where they give birth. I just don't think it makes sense to ask for His protection when we haven't already done all we can do by using the resources He has provided.

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  30. I don't think this post was intended to shame anyone else. The author is stating her opinion and studies that back up her opinion. One of the biggest problems with homebirth in the US (aside from the fact that all our midwives aren't university trained), is that women who choose homebirth often think that it is as safe (or safer) than hospital birth. Even MANA's own statistics prove this to be false. Obviously everyone is free to choose what works best for them and for their families, but it needs to be a truly informed choice. If you know that choosing homebirth raises the risk of your baby dying, but after considering everything you still choose homebirth (whatever your reasons), I don't personally agree with that decision, but it's yours to make. The problem is that most women who choose homebirth truly believe that it's the safest choice. (I have family members that have had homebirths and I've heard the SAME thing from them that I've read in many of the comments above: "birth is as safe as life gets," "trust birth," "our bodies aren't broken," etc.)

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    1. Shoot - that was supposed to be in response to Victoria Mckay above.

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  31. When I gave birth to my daughter in 2010, I had to be given Nubain, an epidural, and an anti-anxiety drug because pain gives me anxiety, which leads to my asthma acting up. Am thinking about having another baby, and when I asked on a Midwife site if there were alternative pain meds, one of them said; "You need to take classes and realize it is a natural process." Totally ignoring my medical history!!

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  32. Replies
    1. What an excellent and well-reasoned response that successfully refutes the points made in the post!

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  33. I didn't get a chance to read all the comments. Has anyone brought up the Canadian study? It seems to really conclude that the type of attendant is the issue here. Not home birth in general. Since you seem to be so set on statistics, what do you think of this study?
    http://www.cmaj.ca/content/181/6-7/377.full.pdf

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    1. Hi Shem! Thanks for commenting.

      I think the study you posted is interesting. One of the things that sticks out to me first is that the researchers chose a very unusual measure of mortality. Instead of choosing neonatal mortality or perinatal mortality, as is usually standard in these types of studies, they chose to include deaths from 20 weeks of gestation through 7 days of life. This is odd, since babies who pass away from 20 weeks to 28 weeks gestation are considered stillborn and not usually included in safety rates. These deaths would have been attributed to the hospital groups, making them look poorer in comparison.

      Apart from that, the study does show that homebirth in Canada is as safe as hospital birth in Canada. But that's the key - in Canada. The US home birth system is incredibly different. In Canada, there are strict risking-out criteria before woman are considered for home birth. In addition, there are high transfer rates to the hospital during labor. Both of these things keep woman and their babies safer and lower the homebirth mortality rate. In the US, it's not like that. Midwives can (and do) accept anyone as their clients, even if they are very high risk. There are low transfer rates (midwives are even proud of their low transfer rates - seemingly without realizing that the high transfer rates in other countries are a sign of safe, competent care). Both of these things contribute to the US's abysmal mortality rates at home birth.

      I agree that the type of provider makes a difference. As you can see from some of the studies I posted above that break down provider as well as location - http://goo.gl/UgNkIG, http://goo.gl/iJKDW3, http://goo.gl/06igKm - providers DO make a difference. In each of those studies, CNMs had better numbers than CPMs and other lay midwives. That's why I'm in favor of stronger regulation of home birth midwives - it's clear from the numbers that with better education of the midwife, outcomes are better for home birth moms and babies.

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    2. The point is, there are ways of having a middle ground. We could become like Canada. Home birth is never going to go away. There are too many women who need it or want it for various reasons. Science just cannot replace every element. Just like if science was able to produce a healthier, more nutritious infant formula that statistically was better for babies. There would still be breastfeeders since the health part is not the end of it. Consider all the other risks we take in favor of our perceived benefits. People will always want to own pools or take their kids to the beach despite drowning as a leading cause of child death. We choose driving over walking even though it is safer and healthier. Despite some studies showing it can be deadly, women will still want to sleep with their babies as they have throughout time because there are benefits as well. Studies show that the vast majority of women have slept with their baby at least once. This is just one more of those. So drawing a definite line in the sand and declaring that it is wrong, wrong, wrong, doesn't always help. Why not say that we can do better.

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    3. Where did I say it was "wrong, wrong, wrong?" I said that home birth in the USA, as it currently stands, is something I would never choose. I agree with you that there is a middle ground, and the the US should strive to reach it. The US is not currently at that middle ground. It is way, way below it. And it needs to improve. I agree with all of your points, so I'm not sure what we're arguing about.

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    4. I meant to add....
      So before you judge women for making a "risky" decision, consider the many times you have taken a possibly tragic risk. Cant think of any? Perhaps you don't know all the risk statistics of everything you do. If you did, would it change your mind? Maybe, maybe not since that is probably not all that goes into your decision. What you eat, how you drive, countless decisions about your children typically have some risk. Statistically, if you kept your child rear facing till age 5, or heck, if all passengers faced backward in the car it would save many lives! What? You don't want to face backward even though it could save you in a crash? How selfish! I'm kidding of course, but really we all do it some way or another. : )

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    5. I think you've misunderstood the point of my whole post. I am not judging women for choosing home birth. Find one sentence in my post that judges them for making that decision. Who I AM judging are the people who tell them misinformation like home birth in the US is "as safe or safer than the hospital." I am judging the unqualified midwives who lose babies and continue to practice as though they did nothing wrong.

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  34. Successful home births are not luck. And I knew/know that my choice is safer for me and my children than having hospital births. I would have had a c-section with my first because I was in labor for three days which would have lead to two more after this baby. Why would I choose that?

    Now, if something were wrong with my baby and I HAD to have a c-section then absolutely I would not say no just because it wasn't part of my plan. My baby comes before me. But a peaceful and gentle home birth followed by nursing and skin to skin contact, lots of love and snuggles at our home, is safer to me than a hospital full of people with infections and diseases. No thanks. And that is my personal choice and my personal opinion. I do not look down on my friends who have bad hospital births and they respect my choice to birth at home. As a community of women, we need to support each other. Not try to prove everyone wrong all the time. Would you regret having a baby in a hospital if heaven forbid you lost it? Would you blame the doctors and the hospital?

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    1. I *knew* having a homebirth would be safer for me and my baby too... but I was wrong. After a severe shoulder dystocia, a baby born completely flat and suffering a lifelong birth injury that entails surgeries, therapies, and a lifetime of limited movement (and not to forget me who would be safer at home too... bleeding too much, tearing up and all they way to my anus, and breaking my tailbone which still gives me pain), I realized that a c-section in the hospital can be the safest thing. That "knowing" doesn't mean the facts are in my corner just because I "believe" what I want to believe.

      The funny thing is, my baby's heartbeat was lost in utero, but there was not enough time for an ambulance to get to me, transfer me, have doctors assess me, and operate on me before baby was born so he could have been born healthy and whole. So we had to get him out at home. So it always makes me sigh a big sigh, when I hear homebirthers say they'd do a c-section if need be, because time is of the essence and there is not enough time many times (as a fellow homebirther I know learned the most tragic way and some other homebirth friends I know learned at the expense of their babys' brains). A c-section and a healthy baby because of it is not usually an option for homebirthing women. To think so, is just willful ignorance.

      I'm thankful you were lucky to have had "peaceful and gentle homebirths followed by....". That was not my experience and, unfortunately, it's not the experience of MANY other homebirthers (3x more than hospital birthers). All the ones I know (including myself) have went on to birth our babies in the safest place... a hospital "full of people with infections and diseases"... and have had healthy babies because of this wonderful place.

      And I LOVE my homebirthing friends (I have many), but I do not support their decision. It is not my job as a member of a community of women to encourage bad decisions and act like they are okay. I know some friends have and other ones might have children who pay the price for their decision (as my son did). I don't support that risky decision. I love them and pray for them and their babies with great fervor though.

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    2. I'm extremely sorry for how your home birth went. No mother should ever have to go through that and I completely understand how that experience changed your mind. It would change mine too. And to firmly believe and trust in something and then be let down by it would be a hard lesson to learn.

      I do not think that we should encourage choices that we don't believe in. I would never tell a friend to plan a c-section. I would simply say "I am here for you if you need anything."

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    3. The weird thing is... my birth experience did NOT change my mind about homebirth!!! I was so entrenched in my beliefs. It took many years of me reading, having my notions challenged by actual science and data (trust me, that sucked and was so humbling!), working through a lot of things, etc. for me to change my stance on homebirth. It was definitely NOT my birth that brought me around though.

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    4. I did forget to add to my above paragraph... though it took other things for me to change my stance on homebirth; my homebirth DID help me see, firsthand, how horrific a bad homebirth can be though, the lack of accountability midwives have in the U.S., and the backlash speaking out about one's traumatic homebirth can cause. And it also humbled me greatly.

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    5. " Successful home births are not luck."

      Yes they are because statistically a baby has the same chance of surviving a "successful home birth" with a lay midwife (CPM) as surviving being born in the parking lot with taxi driver in attendance or being born in the street with random passers by helping out.

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  35. I think one of the biggest problems here is that there are many factors to look at, and it's hard, if not impossible, to know in advance which ones will apply to you. For example, you blasted people for using infant mortality statistics. Perinatal mortality is an important and probably more indicative measure, but considering some of the long term effects of C-sections, such as asthma, coupled with the fact that the C-section rate in the US is twice as high as the WHO says it should be, the infant mortality rate is not completely irrelevant. Just one example of the different variables at play.

    I have had two hospital births and three homebirths, all planned that way. All went well, so I can't speak too much to emergency situations. So what I do want to comment on is number 7 and number 8. My personal experience is that midwives give much more personalized care than OBs, prenatally, perenatally, and definitely post-natally. Every one of your bullet points in number 7 is completely inaccurate for my case. My midwife took an extensive medical history, had labs done, etc. She believes in home birth, but she would be the first one to tell me if my case was beyond her scope. That's part of why I chose her. My OB didn't even attend my first birth, even though it was an induction that he pressured me into. Most of the time no one was in the room except my husband and doula. With my second birth, I was pressured to induce in order to get 2 rounds of antibiotics for Group B strep, (allergic to penicillin, so I had to take something else that required 2 doses). But my OB got impatient and upped the pitocin and broke my water after the first round.

    Does the fact that people sometimes choke while eating mean that we should only eat in a hospital under supervision? That argument is specious.

    Also, while the differential in the death rates is a serious issue, we need to look past the fear mongering "three times higher!!!" and remember that even in the evil homebirth group, we are talking about a rate of less than .002%. And that hospitals could take simple steps (like informed consent) to make hospital birth a better option. Many people like me do not feel safe going into a hospital because we do not feel like we are respected as human beings there. Until things like court ordered C-sections are off the table, I will not feel safe in a hospital. I consider hospitals complicit in the rise of homebirths for this reason. The hospital experience was certainly a factor in my own decision.

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    1. I apologize, I think that should be .2%. My knowledge of percentages is getting rusty.

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    2. And, hospitals can do much more mundane things to make hospital birth a better option. Eating in labor is a big one. The only reason I was ever given for the ban on food was the fear of aspirating it under general. But considering that most C-sections aren't done under general, and most births are not C-sections, this seems like overkill. I for one go downhill fast when I don't eat, and going through the work of labor without food is a serious concern to me.

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    3. I don't have time to run through all the numbers, but I did it once before and even though the percentages seem small, they aren't when you blow them up. The CDC Wonder database basically was .35/1000 births and MANA was 5 times that at around 1.7 to 2.0/1000 (these are deaths per 1000, not congenital issues). So when you blow those numbers up to 10000, you get 3.5 deaths versus 17 to 20. That's a HUGE difference. I don't think the people who have lost babies to home birth will be satisfied with a statement of "but the percentages are still super low". It does matter... it matters to them.

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    4. And eating isn't really the right analogy... seat belts are a better analogy. Even if you can take 100 trips without wearing your seatbelt, does that mean you SHOULD? The idea is that risk can be minimized... wear seat belts, have babies near an OR, etc.

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  36. I just want to compliment Jocelyn on the fantastic job she has done on this blog post and in responding to the frenzied opinions of home birth advocates. Well done. No one can teach the unwilling; however, you have done a great job at sticking to the facts. Thank you!

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  37. I love the crap about unfeeling OBs. My MALE OB is amazing. He has had plenty of time for this first time mom-to-be and has insisted I call his personal cell if I have a freak out over something. There are three other OBs in the practice and they have made sure I have gotten to know all four in case one of them has to deliver instead. I feel safe knowing that my OB truly does care about me (he remembered our wedding anniversary last month and got us a card when he had only told him the date once <3 ) and will much prefer delivering in a hospital with the highest rated NICU in case something does go wrong with either of us.

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  38. I won't say that every home birth is safe or that every midwife is qualified. I know there have been some truly terrible experiences and deaths. I would like to point out some differences, though, from my own experience with home birth.

    I went with a reputable, certified group of midwives. They had a policy of being VERY selective in who they would take for a home birth. Medical history was absolutely considered. Risky, complicated situations were referred right to a doctor from the beginning. As many midwives would surely agree, sending a potential client away is far better than losing a mother or her baby at home due to foreseeable complications. Besides, at least around here, midwives book up extremely quickly. They're not hurting so baldy for business that they would shrug off lives to try to make more money. They do have hearts.

    At the labor itself, my vitals and the baby's heartbeat were checked regularly. They checked before, during, and after contractions to make sure the baby was coping well. The idea was to keep a close eye on things so that transferring to a hospital could be done BEFORE an emergency where 5 minutes is too long. Way before.

    Every midwife present (all three of them) was certified to be able to resuscitate a newborn. My baby stopped breathing at the last minute and went limp. They had the oxygen right there and went to work. He's an active, normal toddler now.

    I didn't look much into national statistics when I was researching my options. Like it's been said, anyone can call themselves a midwife and start practicing. I looked instead at the statistics for the specific care providers I was considering. In over thirty years, the group I went with had one infant death and no maternal deaths. The infant death was due to an inoperable condition.

    I think it's very important to be careful and ask a lot of questions, and home birth is definitely not always the best choice. I just hate to see all home birth put under one big umbrella of chaos. It isn't all like that.

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  39. I only got through 3 of the blog post links about those who've lost their babies in home births before I was feeling physically sick. Those moms would give anything for a re-do. How much heartbreak could have been avoided - not to mention the life of a child saved. 1,000,000 times not worth the risk. (P.S. Joc - sorry that there are such mean little internet snot-headed trolls out there. I'm glad our parents taught us better and glad you're not phased by their lack of tact. You're awesome, my dear.)

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  40. Excellent post backed up actual studies.

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  41. The right to choose shouldn't stop at deciding to or not to have a baby. Rather than rally against home births altogether, why not work to make them better by making them as safe as possible? Why not advocate so that hospitals do better by patient care when patients have concerns about what happened to them?

    Did you know that most women who have home births do so as a reaction to poor hospital experiences?

    http://www.npr.org/blogs/health/2012/01/26/145880448/home-births-grow-more-popular-in-u-s

    I had a hospital birth and a homebirth. I've breastfed abd formula fed.

    I'm not a homebirth advocate despite having had a home birth just like I'm not an abortion advocate despite being pro-choice. I favor options and choices with regulations and oversights. Homebirth, like abortion, isn't going away. The practical thing isn't to rage against this fact with other facts. The practical, logical way to priced is to use those facts to make it better. Women's lives matter. Babies lives matter. We owe it to women and to babies to improve our homebirth standards so it's not so dangerous. Will it ever be as safe as a hospital? Maybe not. But when we can do better, we should do better.

    People get to choose the risks they take. This will never change. We can only hope to make those risks less risky.

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