Home Births

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Home Births

Home Birth Study Finds No Increased Risk For Mom Or Baby, Experts Still Divided

Tanya Smith-Johnson has given birth to four healthy babies: two in a hospital and one in a birth center attached to a hospital. Her fourth was born at home, with the help of a midwife. Though the experiences were similar in many ways, Smith-Johnson -- who enrolled in medical school, but stopped after one year -- said she'd had to justify the home birth to friends and family in a way that wasn't necessary with the others.

"Because I had been in med school, people were almost horrified that I would make that choice, thinking that it was a bit reckless," she said. "They had all these questions ... 'What does [the midwife] do? Do they have medicine?' ... I had to explain so much."

"I always trusted that home birth can be as safe as hospital birth," Smith-Johnson said. "But the numbers weren't there for the world, so to speak."

A new study tracking the safety of home birth in the United States has taken a major step in that direction, its authors believe, finding that outcomes among women who had planned, midwife-led home births were "excellent," and that the women experienced relatively low rates of intervention.

The study, published in the Journal of Midwifery & Women's Health on Thursday, looked at the home birth outcomes for roughly 17,000 women as recorded in the Midwives Alliance of North America data collection system between 2004 and 2009.

"There's a large body of research that shows that home birth is safe in other high-resource countries ... but there's been some ongoing question about whether those data can actually transfer to the United States," Melissa Cheyney, an associate professor of Medical Anthropology at Oregon State University, told The Huffington Post. "Is home birth safe in the United States, when there isn't a system of integrated care between home birth, birth centers and hospitals? This study is important because it's a first step in the right direction."

Roughly 94 percent of the women in the study had a vaginal birth, and less than 5 percent required oxytocin augmentation (which is used to make contractions stronger and closer together), or an epidural.

Eleven percent of the women who intended to give birth at home were transferred to a hospital. The primary reason for transferral was failure to progress, followed by desire for pain relief, fetal distress and maternal exhaustion. Approximately 1,100 women in the study were attempting a vaginal birth after cesarean section, and of that group, 87 percent were able to deliver vaginally.

Newborn outcomes were also largely positive, the researchers say. One and a half percent of the newborns had a low Apgar score, which is a measure of a baby's health in the first minutes after birth, and 2.5 percent were admitted to the intensive care unit in a hospital at some point during the six weeks after birth. Six weeks after delivery, more than 97 percent of newborns were at least partially breastfed.

Complications were more common among high-risk women -- for example, those whose babies were breech, those who had multiples or those who had certain conditions, such as preeclampsia.

Dr. Jeff Chapa, director of maternal fetal medicine at the Cleveland Clinic -- who did not work on the study, but had reviewed it -- argued that many high-risk women should not attempt a home birth at all. "Those are patients that, in no uncertain terms, should be delivered in a hospital," he said.

Currently, only 1 percent of all births in the U.S. occur in homes or birth centers, although home birth is on the rise. Recent estimates suggest that the proportion of home births increased by 41 percent between 2004 and 2010, with 10 percent of that increase happening in the last year of that period.

Still, home birth has many critics. An opinion piece published last week in the Journal of Medical Ethics called for further investigation into the risk of avoidable, longterm disability associated with home birth, and likened it to driving without a seatbelt.

"Most children will be unharmed," the authors wrote, according to NBC. "Some trips are very safe. And wearing a seat belt will not remove all risk of injury or death ... But on balance it is much safer with a seat belt."

Chapa cautioned against drawing any conclusions from the new study, as it relies on observational data, and noted that the American College of Obstetricians and Gynecologists believes hospitals and birth centers are the safest settings for birth.

Though he said low-risk women who want a home birth "can feel good in that they're probably going to be OK," he said he was not particularly swayed by the study. "The bottom line in all of this is you can't predict who is going to have an issue or a complication," Chapa added.

But mothers like Smith-Johnson, who have had safe, happy home births, say the experience is unlike anything else. Though she had what she described as uneventful, natural births with all of her children, her home birth stood out.

"It was so beautiful to have my baby, and be right up in the bed after. It was just me and my baby, and he was on my chest," said Smith-Johnson, who is now training to be a midwife herself. "It was tender, and I was being told how powerful I was."

"What I see [in the U.S.] is two very staunchly opposed groups who have dug in their heels," Cheyney said of the home birth debate. "One group will argue home birth is safe enough and it should be a woman's right to choose, and the other side will argue that because it's so dangerous, it's simply unethical for physicians to participate in their care. What I would say is that who is hurt in that is women."

Debate Questions - Are they safe? Should they be legal? Would you be willing/want to have a home birth?

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Of course assisted home births are safe. If there is a complication that necessitates medical care, the midwife can arrange that.

Of course they should be legal. It absolutely blows my mind that it might not be in some places. I hope none of those places are in the US "land of the free."

No, home birth isn't for everyone. Neither are the increased risks associated with hospital births and intervention snowballing. It surprises me that insurance companies don't push for homebirths because of the decreased costs.

I had one hospital birth and one homebirth. The homebirth was much better for a variety of reasons, but mostly because there were no unnecessary interventions.

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Yes, they are safe for low risk moms & babies who have prepared for a home birth and are attended by a trained midwife. Yes, they should be legal everywhere *and* covered in full by insurance. And yes, I planned both of my children to be born at home. Sadly, both of my children required very medically necessary c-sections to get them here, but the care & support I got from my midwives after birth, coming every other day to check on me & baby, was far superior to what I got from the hospital, both times. The post-partum care alone for a c-section mom was almost worth the money!

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Not a choice I would make but I think they should be legal.

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I agree with Jessica. I have no problem with it being legal, but when it came time to give birth I wanted to be in the best hospital possible with as many doctors near by as possible. No mid wife would come anywhere near accepting me anyway though.

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Yes, they should be legal, no I wouldn't want it for myself. This is just another chapter of the mommy wars, though, so people can argue about who is BETTER at giving birth, being pregnant, raising children, etc.

Things can go wrong in the hospital too, things can go wrong anywhere.

My great-grandmother was a midwife and I have great respect for that profession. We still have her notebook where she cataloged all the births! I think it was harder for Jewish patients to get decent care back then -- my great-grandmother later went on to co-found Mount Sinai Hospital in Toronto -- so this was a much-needed option.

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"freddieflounder101" wrote:

Yes, they should be legal, no I wouldn't want it for myself. This is just another chapter of the mommy wars, though, so people can argue about who is BETTER at giving birth, being pregnant, raising children, etc.

Things can go wrong in the hospital too, things can go wrong anywhere.

My great-grandmother was a midwife and I have great respect for that profession. We still have her notebook where she cataloged all the births! I think it was harder for Jewish patients to get decent care back then -- my great-grandmother later went on to co-found Mount Sinai Hospital in Toronto -- so this was a much-needed option.

Great story!

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"freddieflounder101" wrote:

My great-grandmother was a midwife and I have great respect for that profession. We still have her notebook where she cataloged all the births! I think it was harder for Jewish patients to get decent care back then -- my great-grandmother later went on to co-found Mount Sinai Hospital in Toronto -- so this was a much-needed option.

What an amazing thing!

But depending on the age of your great-grandparents, midwifery probably wasn't an option so much as the only way. Hospital births and obstetricians (aka surgeons) are a very new invention.

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Laurie - cool story about your great-grandmother.

I would have loved to have a midwife, I actually have a couple of friends who are midwives. I am high risk though and so not able to have a midwife.

My nephew's wife had 3 home births and one at the hospital (he had stopped growing at 32 weeks). I loved hearing about her experiences and the care her midwives gave is superior to what I got from an OB. Her midwife went with her for the induction and acted as a doula during the birth.

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That is such a cool story Laurie!

I had a mid wife but was in the hospital both times. I LOVED having a mid wife. I felt very "pro mom" vs. a medical situation and when dd2's birth turned into a natural birth unexpectedly....my midwife was an awesome coach. I had a lot of problems following both deliveries that were unforeseen (at least the first time) and I'm convinced I wouldn't have made it to the nearest hospital if I was at home.

Plus, I had promised my grandmother before she died that I would deliver in the hospital because a distant cousin of mine almost died after having complications at home.

But, you're right bad things happen at hospitals too. The one I delivered at is being reviewed now for losing 2 patients in 30 days. Sad stuff.

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"Jessica80" wrote:

That is such a cool story Laurie!

I had a mid wife but was in the hospital both times. I LOVED having a mid wife. I felt very "pro mom" vs. a medical situation and when dd2's birth turned into a natural birth unexpectedly....my midwife was an awesome coach. I had a lot of problems following both deliveries that were unforeseen (at least the first time) and I'm convinced I wouldn't have made it to the nearest hospital if I was at home.

Plus, I had promised my grandmother before she died that I would deliver in the hospital because a distant cousin of mine almost died after having complications at home.

But, you're right bad things happen at hospitals too. The one I delivered at is being reviewed now for losing 2 patients in 30 days. Sad stuff.

If for some reason I was at home when I had Alyssa I do not think I would have made it either. (I was hospitalised for a week beforehand for pre pre-eclampsia before they induced her at 34 weeks) Such a blessing that we live in a time that if you have medical problems that you have the option of hospitals. 100 years ago I would not have lived through any of my pregnancies.

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Testing

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"AlyssaEimers" wrote:

If for some reason I was at home when I had Alyssa I do not think I would have made it either. (I was hospitalised for a week beforehand for pre pre-eclampsia before they induced her at 34 weeks) Such a blessing that we live in a time that if you have medical problems that you have the option of hospitals. 100 years ago I would not have lived through any of my pregnancies.

But you wouldn't have delivered at home even if you had planned a homebirth in this case. Midwives check for pre-e the same as doctors do, and bring their charges to the hospital if necessary. They do a great job at weeding out unnecessary c-sections but do get emergency surgeons involved when necessary.

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I have a good friend that had her first baby at home and LOVED it. When she was about to deliver her second at home she had a bad feeling about it, and decided to deliver at the birth center attached to the hospital with her mid wife. If she has delivered at home she most likely would have died. She ended up having a really race complication with the placenta and almost bled out. She loves to help moms now listen to their gut

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"mom3girls" wrote:

I have a good friend that had her first baby at home and LOVED it. When she was about to deliver her second at home she had a bad feeling about it, and decided to deliver at the birth center attached to the hospital with her mid wife. If she has delivered at home she most likely would have died. She ended up having a really race complication with the placenta and almost bled out. She loves to help moms now listen to their gut

What kind of "rare complication" was that? The one placental complication I can think of that would cause excessive bleeding is a retained placenta. Retained placenta is fairly common, and when managed correctly it's not a life-threatening situation. Midwives carry methergine and pitocin to help control bleeding, they often have other natural things to try (like chewing a piece of the placenta, which most times will stop bleeding quickly) and they are trained on how to manually remove a retained placenta. If those things don't work, or if the midwife isn't comfortable with it for some reason, they'll transfer you to a hospital for medical management. My midwife with Weston told me up front that she wouldn't attempt removal of a retained placenta because I was a VBAC, and I was fine with that.

Another major cause of post-partum hemorrhage is that most hospitals still practice "active management" of the delivery of the placenta by pressing on the mother's belly and pulling on the cord, which causes the placenta to tear off, rather than dislodge on its own. It's sometimes called a hemorrhage, but more often, and incorrectly, referred to as a retained placenta although it's actually an open wound on the uterus. That can also cause excessive bleeding but is not something you would see in a home birth because midwives just don't do that.

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[QUOTE=Spacers] they often have other natural things to try (like chewing a piece of the placenta, which most times will stop bleeding quickly)/QUOTE]

Am I reading this wrong? (Please say yes) If not, that is beyond disgusting.

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My issue was a retained placenta that I couldn't deliver. Despite high dosages of pitocin following that I would not contract and would not stop bleeding. These issues do come up.

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No, you read it right, and it does work! Some women dry out their placenta & put it into capsules to help with bleeding & hormonal balance after birth, but it works best, and fastest, just chewing a chunk of it. My step-sister suffered a hemorrhage with her first baby and the doctor tried everything, she was still bleeding. He went to tell someone to get an operating room ready, and her nurse cut off a chunk & told her to pop it in her mouth, and her bleeding had stopped by the time the doctor got back in. Of course the doctor said it was the medications finally working, but it's a well-known midwifery technique.

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"Spacers" wrote:

No, you read it right, and it does work! Some women dry out their placenta & put it into capsules to help with bleeding & hormonal balance after birth, but it works best, and fastest, just chewing a chunk of it. My step-sister suffered a hemorrhage with her first baby and the doctor tried everything, she was still bleeding. He went to tell someone to get an operating room ready, and her nurse cut off a chunk & told her to pop it in her mouth, and her bleeding had stopped by the time the doctor got back in. Of course the doctor said it was the medications finally working, but it's a well-known midwifery technique.

No offence but :puke:

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"AlyssaEimers" wrote:

No offence but :puke:

I must agree.

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"Spacers" wrote:

No, you read it right, and it does work! Some women dry out their placenta & put it into capsules to help with bleeding & hormonal balance after birth, but it works best, and fastest, just chewing a chunk of it. My step-sister suffered a hemorrhage with her first baby and the doctor tried everything, she was still bleeding. He went to tell someone to get an operating room ready, and her nurse cut off a chunk & told her to pop it in her mouth, and her bleeding had stopped by the time the doctor got back in. Of course the doctor said it was the medications finally working, but it's a well-known midwifery technique.

I cant remember what it was? I will have to ask her. She was a huge home birth advocate (still is) but she is happy she listened to her gut. She is even working towards becoming a midwife

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I agree that it's gross...and I think the case for it is not a solid one.

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Had to call her, it was Placenta accreta. It went undetected because she didnt have any ultrasounds. They were able to save her uterus, but just barely. She went onto have 2 more kids at home (I thought the other 2 were at the hospital) but she did have ultrasounds to make sure the placenta was okay

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Oh yeah, placenta accreta is a bad thing and if she didn't have a history of uterine surgery, there wouldn't be a reason to look for it. I'm a big fan of home birth, obviously, because I do believe it's safer for most moms & babies than being in a hospital, but I'm also a big fan of trusting your gut, and your baby. I truly believe Tiven saved her own life because she's the one who told me to go to the hospital.

And if I were on the verge of losing my uterus to excessive bleeding, I don't care what they gave me to chew on, if it would help! Every other mammal in the world eats its placenta; humans are the only ones that stopped. There is a biological reason for it, and that's because it helps the mother stop bleeding quickly (which is important when there are predators looking to eat you for dinner!) and gives her a boost of vital nutrients (which is also important especially if it's been a long, tiring labor and/or a predator is looking to eat you.) Most of us aren't in danger of being hunted down by wolves or bears after giving birth, but we can still reap the benefits of an age-old practice.

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"Spacers" wrote:

What kind of "rare complication" was that? The one placental complication I can think of that would cause excessive bleeding is a retained placenta. Retained placenta is fairly common, and when managed correctly it's not a life-threatening situation. Midwives carry methergine and pitocin to help control bleeding, they often have other natural things to try (like chewing a piece of the placenta, which most times will stop bleeding quickly) and they are trained on how to manually remove a retained placenta. If those things don't work, or if the midwife isn't comfortable with it for some reason, they'll transfer you to a hospital for medical management. My midwife with Weston told me up front that she wouldn't attempt removal of a retained placenta because I was a VBAC, and I was fine with that.

Another major cause of post-partum hemorrhage is that most hospitals still practice "active management" of the delivery of the placenta by pressing on the mother's belly and pulling on the cord, which causes the placenta to tear off, rather than dislodge on its own. It's sometimes called a hemorrhage, but more often, and incorrectly, referred to as a retained placenta although it's actually an open wound on the uterus. That can also cause excessive bleeding but is not something you would see in a home birth because midwives just don't do that.

They really do this? I have never had this done to me, and my last delivery they were getting pretty panicky for me to deliver the placenta so they could sew me up. I go hard and fast when the baby is ready and have been told that any worse (ie. another delivery) and I will end up in the OR to be 'repaired', so it was a real worry that I was bleeding too much and they never pulled or pushed. I finally did tell the nurses they could give me pit when I overheard the worried whispers (I had a birth plan saying I didnt want it). But I have delivered in 2 different hospitals and never had this done. Maybe they dont do it as much any more? Sounds painful.

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Not all individuals in all species of mammals eat their placenta...and saying we are the only ones who stopped does not a solid case make. The ability for it to stop bleeding is not scientifically well documented...if it was highly proven, you could find a lot more evidence of it in scientific research and not just on home birth and natural birth advocacy sites. We have all sorts of nutrition readily available to us that may not be as readily available to animals in the wild. I'm not saying there is no possibility of it being beneficial in some manner...I'm saying a solid case for it has not been made. Certainly not enough to convince me anyone actually needs to do it. Not saying people can't if they want to of course.

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OK, yes I suppose I should have clarified that... the land-dwelling mammals, all of them except for humans and the occasional camel, are known to eat their placentas. There is a lot of evidence that eating a piece of placenta stops post-partum bleeding quickly; there is absolutely none that eating a chuck of steak or chicken or tofu does the same.

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"Spacers" wrote:

OK, yes I suppose I should have clarified that... the land-dwelling mammals, all of them except for humans and the occasional camel, are known to eat their placentas. There is a lot of evidence that eating a piece of placenta stops post-partum bleeding quickly; there is absolutely none that eating a chuck of steak or chicken or tofu does the same.

Word. I seriously can not even wrap my mind around the idea. What percentage of people do this?

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"Spacers" wrote:

OK, yes I suppose I should have clarified that... the land-dwelling mammals, all of them except for humans and the occasional camel, are known to eat their placentas. There is a lot of evidence that eating a piece of placenta challengepost-partum bleeding quickly; there is absolutely none that eating a chuck of steak or chicken or tofu does the same.

It's not the fact that you left out the word land dwelling that doesn't make a solid case. It's the pure lack of good scientific research. Weren't we just taking about the importance of scientific research in another thread? Why is it no longer important here. I challenge you on this reliable scientific proof that chewing on placenta stops bleeding. And the question wasn't "does eating your placenta have more nutrition than a steak" I said there is not a solid case that women should do it..as in "a significant advantage to eating ones placenta vs. Not eating it exists for humans"

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"KimPossible" wrote:

Science & Sensibility ? Placentophagy: A Pop-Culture Phenomenon or an Evidence Based Practice?

Sums it up for me

While both gross, there has got to be a difference between sending your placenta away to be washed, processed, and put into pill form, then to reach down after labor and grab a piece and start chewing on it. In my mind that would be like chewing on your used period pad.

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"ftmom" wrote:

They really do this? I have never had this done to me, and my last delivery they were getting pretty panicky for me to deliver the placenta so they could sew me up. I go hard and fast when the baby is ready and have been told that any worse (ie. another delivery) and I will end up in the OR to be 'repaired', so it was a real worry that I was bleeding too much and they never pulled or pushed. I finally did tell the nurses they could give me pit when I overheard the worried whispers (I had a birth plan saying I didnt want it). But I have delivered in 2 different hospitals and never had this done. Maybe they dont do it as much any more? Sounds painful.

I have never had anyone pull on my placenta either. I had one that was not wanting to come out, but the nurses put the baby back on the breast (I had taken him off to let Dh hold him) and it came right out. I have never even had pit?