Saturday, December 17, 2011

Homebirth- Part 1

Before writing about homebirth, I want to stress that I am not trying to convince anyone to have a homebirth or that homebirth is the only/optimal way. I strongly believe every woman needs to educate herself and make the choices that work for her and her family. My aim is just  to show that homebirth is a viable and safe option for most low-risk women.
When discussing homebirth and its safety, I am referring to planned homebirths attended by certified and licensed midwives, whether they be CNM (certified nurse midwives) or CPM (direct-entry midwives). I do not mean accidental homebirth, where the woman did not make it to the hospital in time, or unassisted childbirth, which is a whole topic onto itself .
A certified nurse midwife has undergone rigorous training and can provide pretty much the same care as doctors- she can monitor the baby's heart rate, give IVs of fluid or antibiotics if necessary, repair any tears, administer pitocin to help postpartum bleeding, do newborn assessment as well as neonatal resuscitation. What a midwife cannot do is administer an epidural or perform a C-section.
Study after study has shown that homebirth is as safe, if not safer than birth in hospitals. The neonatal and maternal mortality rates at home are the same to those in hospitals. If you would like to see a study that backs this claim up, click here. Another study done in the Netherlands can be found here. You can find links to other studies in this post.  Intervention rates of home births, as you can imagine are much lower- To quote one above mentioned study
Individual rates of medical intervention for home births were consistently less than half those in hospital, whether compared with a relatively low risk group (singleton, vertex, 37 weeks or more gestation) that will have a small percentage of higher risk births or the general population having hospital births (table 3). Compared with the relatively low risk hospital group, intended home births were associated with lower rates of electronic fetal monitoring (9.6% versus 84.3%), episiotomy (2.1% versus 33.0%), caesarean section (3.7% versus 19.0%), and vacuum extraction (0.6% versus 5.5%). The caesarean rate for intended home births was 8.3% among primiparous women and 1.6% among multiparous women."
Additionally, here is a study that finds the midwifery model of care to be superior to the other models, in terms of outcomes for mothers and babies.
In case you are wondering what the Midwifery model of care is, here is an excerpt from the website of the Midwives Alliance of North America:

Midwives Model of Care™
The Midwives Model of Care™ is based on the fact that pregnancy and birth are normal life events. The Midwives Model of Care includes:
  • monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle
  • providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
  • minimizing technological interventions and;
  • identifying and referring women who require obstetrical attention
The application of this model has been proven to reduce to incidence of birth injury, trauma, and cesarean section.
The Midwives Model of Care definition above is Copyright © 1996-2001, Midwifery Task Force, All Rights Reserved.

I don't want to bore everyone here with statistics, and there is no need to reinvent the wheel. There are many excellent websites that have great information about homebirths, you just have to find them. Here are just a few:

Choices in Childbirth
NY Homebirth Midwives
Bring Birth Home
Why Homebirth- an article in midwifery today

Coming up in Part 2- "What if something goes wrong/Thoughts about Risk" and "How exactly does this work?"

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