Latest homebirth/birth center study of 80k Oregon women shows higher infant mortality

This is an article about an analysis of births in Oregon, where homebirthing (and to a lesser extent use of birth centers) is extremely popular at rates above the national average, and where the women are mostly of more “slim” BMI and other conventional health markers.  The takeaway is that infant mortality is rare homebirthing or birthing at a center, but occurs at a greater relative frequency than in hospitals.  There was also a higher risk of neonatal seizures, needs for infant ventilators and blood transfusion need for mothers in out of hospital births. Minor complications like tears were lower, however.

This analysis excluded all the actual high-risk to OBs women (breech, twins, etc.), and that’s a big flaw, because women with “weird” (breech) or genuinely high-risk conditions are a big chunk of the homebirthing pool (not the birth center pool, since they are excluded from nearly all American birth centers) and that is one of the reasons there is so much antipathy towards homebirthing (even though those women doing so is itself a response to obstetric mismanagement with hospital birthing).

The basic takeaway is that if you’re a low risk, healthy woman, homebirthing or using a birth center is not unreasonable and probably will be easier overall in terms of recovery, but yes, your baby is more likely to die if you birth away from high-tech emergency equipment.  By excluding the high-risk women who choose to homebirth, though, the discussion of how to improve obstetric management for those women remains left off the table.

 

Advertisements

27 thoughts on “Latest homebirth/birth center study of 80k Oregon women shows higher infant mortality”

  1. You can add homebirth VBACs to the list of common homebirth high risk groups.

    There’s also the issue of brain injuries to the baby.

    I’m not going to link it (I don’t want to make an example of some perfectly nice people), but there was recently a homebirth disaster story in a large blogging family you know. The story had the usual helicopter flight, cooling cap, mom separated from baby, mom left the worse for wear, etc. So, lots of drama.

    Like

  2. I’m planning homebirth, mostly due to the fact my mother’s family has done it accidentally for generations anyway (due dates are almost always off and we are rurally based, so I think we’ve never had a hospital birth) and I get seriously bad white-coat so I’d be constantly anxious and/or angry.

    But one thing I’m confused about is how many homebirthers COMPLETELY eschew medical help. Regular check ups, making sure the baby is in the right position, checking for heart or lung malformations and having medical staff on hand aren’t exactly ridiculously invasive procedures. Neither is it unreasonable to get to a hospital if the birth is very early, the baby is in a dangerous position, the baby has malformations or the mother needs surgical assistance. There seems to be a pretty solid divide between “by the books” (constant scans, every pill, hospital from when waters break, painkillers administered, c-section and induction accepted when suggested) and “hippie” (no scans, no meds, try to birth with one extra person and no more, no accounting for medical issues, no follow-up doctor visit for mother or baby). In short, how and where a woman gives birth seems to be a cultural thing, rather than a balanced judgement on an individual basis.

    Like

    1. “But one thing I’m confused about is how many homebirthers COMPLETELY eschew medical help.”

      I think that has to be blamed on homebirth midwife culture and their financial incentive structure. If the expectant mother does the scans and something turns up and transfers care to an OB, the midwife has lost a patient. Hence, there’s a huge incentive for the midwife to steer the patient away from any scan or test that would reveal the need for TLC (group B strep, ultrasound, gestational diabetes, etc).

      Have you thought about interviewing a couple of OBs that your friends like and doing some hospital tours? You might be pleasantly surprised.

      Liked by 1 person

      1. That sounds awful, but I believe you. Midwives aren’t saints just by virtue of delivering babies. Though that makes it all the more shocking, that someone with solid medical education could be the instigator of it all.

        Most of my friends are distant and/or over fifty, a bit older and childless by choice or my age and only just getting engaged and married, so not much luck finding an OB through them.

        The NHS varies from awesome to dreadful. So far they’ve treated me quite well, though I’m glad not to see much of them. I have two doctors who know about my mood swings and various fears about hospitals, so I will discuss everything with them once I’m 12 weeks in and holding. One of them is more alternative-friendly, so she may be helpful in finding a middle-ground, if there is one. I am hoping a home birth is possible, though. If it’s not I’ll have to suck it up and be a grownup and live with beeping sounds, doctors, bright lights, seeing scalpels and needles, MRSA, crowds, etc. But I’d really rather not.

        Like

        1. Things are different outside the USA with midwiving in a modern country. As far as I know, the UK doesn’t have a class of barely-trained midwives with in some cases no real medical background at all, which is what AmyP is referring to. They are called lay midwives, and their certification requirements vary across the nation, but are usually quite lax. Midwives associated with hospitals who have years of medical training are what everyone else does outside the USA for the most part, but in the USA, they’re a separate class of midwife, sometimes dismissively called “medwives” for their hospital affiliations.

          It’s worse than what she says, it’s not about money (those midwives often work for about 2k total per birth, or even less), it’s about the status and authority gained from the women by creating a situation where they’re totally dependent on the midwife for the whole birth.

          Liked by 1 person

          1. That’s pretty bad. For all the awesome things American medicine does, its underbelly is pretty disturbing.

            Most midwives here are associated with hospitals and many will have a GP assisting home births as well, if they can persuade the mother. But, again, many homebirthers here would rather pay for a doula or have no doctors present with the midwife. Even when you can get a doctor-assisted home birth for free on the National Health, some people just don’t think modern medicine is good enough.

            Like

      2. How in the world can this situation create status and authority, when the situation can become medically challenging? I understand mothers don’t want to constantly be tested, poked, and prodded if they are healthy and are of younger child-bearing age, but if you have any kind of risks it’s just gambling to me.

        Like

        1. The women who choose that kind of midwife feel like they’re participating in “traditional folk birthin’s”. Or they are desperate to avoid a c-section and convinced that “trusting birth” by not doing anything will guarantee no complications or surgical birth.

          Like

      3. Or they are desperate to avoid a c-section

        That part baffles me. To my understanding, even young women in very good health can end up with C-sections. No one can predict where and how the umbilical cord moves.

        I wonder if this is a response to the “over-medicalization” of births? Do people trust obstetrics? That leads me to a question– compared to how midwifery worked in the past– and how women gave birth for hundreds of years with the practice– did obstetrics improve the quality of the birthing process, along with decreasing infant mortality? Or do people view modern methods as part of the problem?

        Like

    2. The modern birthing centers (at least here in the states) are pretty nice and not like the rest of the hospital. Yes, you have the gear and whatnot, but it’s in the corner, and the birthing room is pretty cushy. The interventionist attitude is why so many women idealize home birth. That and peer pressure.

      Also, hospital stays (I had two c/s, so I stayed a while) SUCK and I was very eager to get home to be treated properly and get some rest. Opposite of the olden days. (You are moved from the cushy birth room to a hospital room after baby comes).

      Liked by 1 person

  3. superslaviswife,

    I see that TPC has said what I wanted to say–I was speaking on the assumption that you are in the US, where homebirth midwives are often outlaws without a relationship to the official medical system.

    There’s a tricky issue with titles in the US. Real hospital midwives are CNMs, are highly educated and highly experienced nurse midwives. Homebirth midwives are usually CPMs, minimally educated and experienced. They do apprenticeships and consider themselves good to go after 40 births. They don’t do much volume (a busy homebirth midwife does one a month), so they often don’t recognize unusual complications–they’re often basically hobbyists. They also usually don’t carry malpractice insurance, which in the case of a homebirth disaster story in the US, can have devastating results for a family left with a brain-damaged child. The word “midwife” is used to describe both, which is often confusing to the expectant US mother.

    I’ve looked at a US birth center staff list where there wasn’t a single CNM or nurse in the building, which was very concerning.

    Under the NHS, you are in much better hands, whichever way you go.

    Like

  4. Maea said:

    “I wonder if this is a response to the “over-medicalization” of births? Do people trust obstetrics? That leads me to a question– compared to how midwifery worked in the past– and how women gave birth for hundreds of years with the practice– did obstetrics improve the quality of the birthing process, along with decreasing infant mortality? Or do people view modern methods as part of the problem?”

    At the time of the switch-over from homebirth to hospital birth, women were often deeply appreciative of the improvements. See, for example, how the mothers felt about hospital birth in early 20th century memoirs like Cheaper by the Dozen and The Egg and I–a hospital birth was regarded as virtually a vacation for the new mother. And you can see why–old time hospital stays were very long, and for a woman with a large family (Cheaper by the Dozen) or heavy home chores (The Egg and I) being able to stay in bed and just rest up was a glorious not-to-be-missed opportunity. That’s one of the practical problems with home birth in the US–unless there are very unusual conditions at home, there’s going to be a lot of pressure to immediately start cooking and cleaning–no matter how inadvisable that is. And that goes double if you have the wrong kind of grandma “help.”

    I think a big piece of the problem is unrealistic expectations. Women have gone from thinking as childbirth as a harrowing, possibly fatal-to-everybody experience to having virtually unmeetable expectations. Here’s a really extreme example:

    http://www.treehugger.com/culture/woman-plans-dolphin-assisted-birth-hawaii.html

    A little more realism is in order.

    Hospital birth is full of annoyances and inconvenience, but maybe it would be more tolerable if more women didn’t go into childbirth expecting some sort of spa experience?

    Like

    1. I can’t go trawl the databases right now, but this is a list of the places where homebirthing is most popular.
      “In 2012, out-of-hospital births comprised 3%–6% of births in Alaska, Idaho, Montana, Oregon, Pennsylvania, and Washington, and between 2% and 3% of births in Delaware, Indiana, Utah, Vermont, and Wisconsin. Rhode Island (0.33%), Mississippi (0.38%), and Alabama (0.39%) had the lowest percentages of out-of-hospital births.”

      Like

      1. So are these the clusters?

        –Pacific NW/some Mountain states
        –Mormon country (overlaps with some mountain states)
        –Amish country
        –Other hippie lands (Wisconsin/Vermont)

        Not sure how Delaware got in, though. Amish?

        California is strangely absent.

        Like

  5. yeah but Oregon data can’t be anything but data from Oregon. There are lot of reasons homebirthing might be more dangerous here. Nothing else works, why would midwifery work?

    Like

    1. Yeah, Oregon midwives are well known in crunchy circles as the ones who will take ANY PREGNANT CLIENT. Six c-sections? NO PROB JUST TRUST BIRTH. Got triplets? NO PROB. History of premature delivery? NO PROB.

      It’s the Oregon way.

      Like

Comments are closed.