What's so unfortunate is that natural birth *can* happen in hospitals, although it is far rarer in the US than elsewhere. My daughter was born in a New Zealand hospital. I had my midwife and husband in attendance, and nobody else until the back-up midwife arrived for the actual delivery. The room had a window with natural light, but no harsh lights were turned on. I wasn't strapped to any monitors, I wore my own clothes, I wasn't forced not to eat or drink, and I didn't have any pain medications. I stayed active and upright and walked, swayed, squatted, sat on a swiss ball... etc. I had a birthing pool which I laboured in, although I eventually gave birth on the bed. Not flat on my back with my feet in stirrups but with one end of the bed raised up so I could kneel and hang over it, which was how I felt most comfortable. The expectation is that the majority of women will have a normal physiological birth without intervention, rather than taking a pathological view of birth.
Hospital birth is not necessarily an endless cascade of intervention, and it's really sad that so many people (not meaning you, momma2threegirls, but some of the people on this thread) think that this is the only way that birth can be.
I was alerted to this thread and am getting on late as computer time for me is difficult in my house these days with summer vacation. ;) I stopped reading after the first page of threads since like I said, my time is limited. ;)
I am a huge believer in statistics, and have no doubt that this is accurate. However, as a mother who has given birth 3 times inside her own home, I chose to do so in good conscience and if I were need to choose a birth place again, it would be at home. (DH got a vasectomy at the end of June, so very unlikely)
Where I live, there are a lot of MW's. I have my pick because of the population of Amish and Mennonite families being one of the countries highest and both of them choose to give birth at home. (I live in central PA) I have realized in my almost 7 years now of being "into" (researching etc) homebirth that there are good MW's and there are not so good MW's. There are women who are healthy and have healthy babies and those who really can and do need the assistance of an OB. I have no doubt that things just *happen* that cannot be prevented in either setting. Being involved in the stillbirth community (more on that later) I see time and time again babies who were born still and there was absolutely no indication even with all the monitors in the hospital during labor that something was going wrong.
I am not a person who screams "Babies can die in hospitals too", because while they can, I also know that babies can die at home and sometimes, not always but sometimes, these deaths could possibly have been prevented had they been in the hospital. It's not that I know a lot of babies born still at home or anything (I know of 2, over the past 7 years and one of these babies was born to a first time obese mother that I would have probably not taken on a client had I been that mw) but when a baby dies during a HB (or mother) there tends to be a lot of finger pointing at how perhaps the hospital could have saved the one who died and rightfully so, yes, maybe sometimes they could have but, not always. When a baby dies in a hospital setting (or a mother) is the hospital to blame? Who is to blame? And while its not about "blame" it should always be about giving the mother and baby the best support they need to have a happy and healthy pregnancy. MW's need to "know their stuff" and also be willing to drop clients at the sake of being "poo poo'd" by the natural birthing community (which sadly, happens near me...a MW will drop a client and she will find a new MW, or, go on to an OB and be told how high risk her and baby are and the natural birth community poo poo's that which come on...mama has GD with twins, um, yeah, of course she shouldn't be giving birth at home!) and they also need to know their limits of what they can and cannot take on in a months time. Lack of sleep can lead to poor decision making, I have close friends who work in the HB field who are wonderfully educated and skilled but get "burned out" from time to time. (And I am certain this happens to OB's too or hospital MW's...my sister is a float pool nurse for peds/womens health and she was this way until she went part time)
2 of my 3 homebirths had babies who needed help after delivery. Linus got stuck coming out and needed O2. Wolfgang's heart rate started to go really low and he also needed O2 when he was born. Both cases (and truly, for me to have 2 out of 3 HB's end this way is rare at least from those I talk to who have actually given birth in their home to more than 1 baby) ended fine and the reason I chose the MW's I did was because of their skill with not only seeing "red flags" (which there were none btw) but that they "knew their stuff" involving shoulder dystocia, o2 use and pit use after birth for bleeding if needed (and being able to carry it, and use it, which I didn't need) , why they transfer and how they transfer and a whole host of reasons. I feel I got the best locally each time in this case, and, there are *lots* of MW's to choose from who have no formal training but "lots of births" under their belts (to which I was uncomfortable which hiring one like this...I wanted the "lots of births" *and* the "formal training", choosy HB consumers here in this house ;) ) . I am very uncomfortable with unassisted birth, women who choose HB when they are no where near a hospital (I was 10 minutes away for the first 2 and 5 for the last one) , HB's of high risk moms and babies and no prenatal/mama screening during pregnancy. (I chose to get blood tests, US's, etc each time...but know many who choose not to and midwives who *do not recommend it*)
In the end, while I have no doubt that the research done was through and is accurate (to whatever degree of accuracy it can be), I also know that for where I live, and for, my own family birthing at home 3 times was the best choice for myself, my baby and the entire family and I will continue to advocate HB in the way that I do (cannot stand behind a woman with GD HBing twins without prenatal care of course) and encourage anybody who is wanting to learn more about HB to find a trusted MW in their area and talk to their former clients. That's all I have to say on this topic. :)
Just realized I didn't finish up my part on stillbirths...my son, Felix, was born still at 21 weeks after an induction because he was seen to have died in the womb. Not of anything relating to the fact that we had been seeing a MW with hopes of another HB (he had a very tight knot in the cord which cut everything off to him...very rare, I know, but it still happened) and I chose induction in the hospital for him with all the unknowns.
Also want to add that I never doubted the care I was getting with any of my MW's one bit, I felt I was in the best hands for those births and if I had to back and change it, I would not have done so. I chose HB before all the Ricki Lake stuff happened, and, chose it because I knew many who had given birth, safely, at home with skilled MW's and felt it was the right choice for myself and my family.
This is really sobering Blade.
I am so curious about how many cases of oxygen-deprivation are attributable to discrepancies in skill-level/training/risky practices of the home-birth and freestanding birth-center MWs. What percentage might have been prevented with proper fetal monitoring, with regard for the timing of labor, with a good resuscitation team - things like this that a conservative home-birth nurse-midwife would presumably be more careful about? And what percentage resulted from things that were less MW-related and more just unpredictable disasters that couldn't be resolved outside of a hospital: shoulder-dystocia, sudden cord-compression without access to c-section, placental abruption, etc?
As someone extremely interested in home-birth, I am prepared to go hunting for the smartest, most skillful nurse-midwife around, knowing that not all midwives are created equal. As you know, there are CNMs who practice in both settings, and ones chances of having a safer birth increase dramatically with a CNM. Depending on how things go for me, I think I'm prepared to accept the small amount of absolute risk involved in not having a surgeon immediately on-hand (I do live two blocks from a hospital.) Some risks are inevitable with home-birth, but one hopes that other risks can be minimized when midwives follow safer protocols and when good transfer plans are in place. What do you think?
Either way, these numbers are terrible terrible terrible and your post makes me think harder about my desire to give birth at home and how to avoid a bad outcome. Was there any additional data about the circumstances of these births? Seems to me that settings, "home vs freestanding birth-center vs hospital" aren't necessarily in direct relationship to the type of practitioner (OB/CNM/CPM/DEM) in attendance, and they've erroneously categorized the midwives as just "homebirth MW" and "hospital MW." So maybe the variables are imperfect?
Anyway thanks Blade. Very interesting. Makes me want to take statistics!