Thursday, May 3, 2012

Homebirth revisited

As part of my psychology course, we had to write a paper on the topic of our presentations for class. Since I presented on birth, this left me with a lot of good options. I was considering writing about VBAC but in the end, decided to focus on home birth safety.
I started researching and realized there were a lot of articles on the issue and got very involved contrasting and comparing different studies. Finally, I realized this was taking up too much of my time. The paper was only supposed to be 3 to 5 pages and I was getting carried away.
So I forced myself to focus only on two articles, including the infamous "Wax" study. After obsessing about my bibliography for way too long, I finally handed it in today. Now all I have left is my final and I will have successfully completed my first pre-requisite. 
The paper is too long to post but I will share some excerpts here. If you are interested, you can comment here or email me and I will send you the whole thing. Without further ado:

...The results showed that the rate of perinatal death per 1000 births was similarly low in all three groups.  It was .35 for planned home births, .57 for planned hospital births attended by a midwife, and .64 for planned hospital births attended by a doctor.
78.8% of the women who planned to give birth actually did, the other 21.2% were transferred to the hospital. The rate of interventions, including fetal monitoring, episiotomy and cesarean section, was significantly lower for the women who had planned to birth at home. Additionally, adverse maternal outcomes such as postpartum hemorrhage or third degree perineal tears were less common at home. The same goes for adverse outcomes for the newborn, such as birth trauma, required resuscitation at birth, meconium aspiration and others (Janssen et al., 2009, p. 379). The full charts comparing birth outcomes as well as level of intervention can be found on page 381 of the article....

In summary, Janssen et al.’s (2009) study showed that planned homebirth with a registered midwife is associated with “very low and comparable rates of perinatal death and reduced rates of obstetric interventions and adverse maternal outcomes compared with planned hospital birth attended by a midwife or physican” (p. 383)....
In conclusion, Wax et al. (2010) repeat that there is significantly less maternal and newborn intervention and morbidity in homebirths, especially if they are attended by highly trained and regulated midwives who are integrated into the healthcare system. Unfortunately, this is not always the case in the United States because midwifery is not regulated the same way in every state (p. 243.e7).
This rate of low intervention makes sense because women who chose homebirth do so in part to avoid the many interventions they may be subjected to in a hospital setting. Women who birth at home are considered to have low obstetric risk and so are more prone to having more favorable outcomes. Additionally, midwives have a different model of care than obstetricians, which has been shown to consistently lead to less medical interventions and improved perinatal outcomes (Wax et al., 2010, p. 243.e7)....
Giving birth is a very important milestone in the lives of all women. There are many physical, emotional and psychological aspects that need to be taken into account when choosing a care provider and a place of birth.  Most women feel that their needs will be best met in a hospital setting. Both articles state that there is an aspect of self-selection present in homebirth. Women who choose homebirth are looking for a different model of care and for a lower level of medical intervention that not all pregnant women are comfortable with.

While homebirth is not the right decision for all women and the United States will not be encouraging the midwifery model of care like other European countries, an analysis of the available data does indicate that planned homebirth with a highly trained and certified midwife is a safe and viable option for the women who chose it. 

1 comment:

  1. AWESOME POST. Is it ok if I link to it for our Sunday Surf on Mothers of Change? You did an excellent job. Could I post the whole paper on MC, if I credit you? It sounds awesome. =)