I’ve felt somewhat disheartened over the past few days. It seems that most people to whom I mention the concept of a home birth without an attending physician are nothing short of horrified!!
I’ve had one person throw the ‘fact’ at me that “50% of babies have the umbililcal cord around their neck”. I corrected him that at one time or another during pregnancy, MOST babies will have the cord around their neck … but that when labour actually commences, only 35% remain there.
A study on 3,000 randomly selected newborns performed by RHOADES D. A. ; LATZA U. ; MUELLER B. A. ad the Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, Washington found that that when labour is induced, the chances of a nuchal cord (cord around the neck) is TWICE as great.
Anyways, this man went on to say that his baby suffered brain damage because of a the cord being aorund the neck. I would have NEVER guessed that this baby, now an adult, had ever suffered from even slight damage, as he is a high achiever and a very able communicator.
The labour process ended up dislodging one of the mothers’ kidneys, she had an episiotomy, and I’m guessing that she was induced (whether through drugs or AROM (artificial rupture of membranes, where the embryonic sac is burst, speeding up the birthing process, often carrying the cord with the mass exodus of water, and causing a rush of strong contractions)). Either way, the cord would have have either become TIGHTLY wrapped around the neck or squeezed in order to have caused lack of oxygen.
Most nuchal cord deliveries proceed without complication.
I did a Google search for “dangers of home birth”, and found an account of a homebirth gone wrong. It was an interesting read about a baby born face first, rathern than ‘top-of-the-head first’.
The only differences I could pinpoint between this woman’s attempted home birth, and that at a hospital were that she had a midwife, and that it was planned on taking place at home.
The lady’s membranes were artificially ruptured, she took medication (albeit homeopathic) to ‘encourage’ (induce) labour, and when the timeline started to exceed that regularly imposed by hospitals, and they started to noticed traces of meconium, they transferred to hospital.
Nurses openly exclaimed their outrage that delivery of a face-first baby was attempted at home … but they did not perform an emergency C-Section … the proceeded with vaginal birth.
In the end, it came to surface that the baby had experienced a stroke to the left hemisphere of her brain.
The hospital did NOT blame this on the length of time taken for the birth, nor did they state that the birth had been traumatic enough to have caused a stroke.
I don’t know that time of stroke was ever pinned down (I don’t know if it could be) … but in the end, the mother stated that her daughter, then nearly three, was in preschool and was average or above-average in all areas, and had not shown any major physical or mental disablities from her stroke.
In support of my decision to birth at home, I have always reasoned that many of the rare and unpredictable risks associated with pregnancy and birth cannot be changed by any location or even by any provider. Midwives and doctors alike can only respond to events as they happen.
There are NO doubts that the environment at home is far superior to that at a hospital. We will have a professional midwife present, and will be less than 10 minutes away from the hospital should a transfer be required.
Quote: “The conditions and attitudes of medical caregivers TOWARD midwives and the woman who chose homebirth and transports PLAYS A HUGE PART in the CO-CREATED problem and the lack of partnership between midwives and doctors. WOMEN and BABIES are the ones harmed by the fervent control of birth by medical profession and disregard for midwifery care. I have heard many, many times by obstetric residents the sentiment, “That’s your choice to have homebirth, but expect us to clean up your mess.” The “messes” of homebirth are never greater than the ones in the hospital.”
Quote: “The World Health Organization has been telling the USA to return to a midwife based maternity care system since 1980.”
An old quote says “The baby is unlikely to get into trouble in labor as long as the membranes are intact”. While the membranes are intact, the baby is cushioned, and pressure is equally applied.
Sentiments I found regarding vaginal exams and the practice of artifically rupturing the membranes: “If they wanted you to get to it, they’d have put it in a much easier place to find”.
A study with data taken from the Cochrane Pregnancy and Childbirth Group’s Trials Register (January 2008), Cochrane Effective Practice and Organisation of Care Group’s Trials Register (January 2008), Current Contents (1994 to January 2008), CINAHL (1982 to August 2006), Web of Science, BIOSIS Previews, ISI Proceedings, (1990 to 2008), and the WHO Reproductive Health Library, No. 9. was undertaken to compare midwife-led births and OB-led births.
Selection criteria
All published and unpublished trials in which pregnant women are randomly allocated to midwife-led or other models of care during pregnancy, and where care is provided during the ante- and intrapartum period in the midwife-led model.
Main results
We included 11trials (12,276 women). Women who had midwife-led models of care were less likely to experience antenatal hospitalisation, risk ratio (RR) 0.90, 95% confidence interval (CI) 0.81 to 0.99), the use of regional analgesia (RR 0.81, 95% CI 0.73 to 0.91), episiotomy (RR 0.82, 95% CI 0.77 to 0.88), and instrumental delivery (RR 0.86, 95% CI 0.78 to 0.96) and were more likely to experience no intrapartum analgesia/anaesthesia (RR 1.16, 95% CI 1.05 to 1.29), spontaneous vaginal birth (RR 1.04, 95% CI 1.02 to 1.06), to feel in control during labour and childbirth (RR 1.74, 95% CI 1.32 to 2.30), attendance at birth by a known midwife (RR 7.84, 95% CI 4.15 to 14.81) and initiate breastfeeding (RR 1.35, 95% CI 1.03 to 1.76). In addition, women who were randomised to receive midwife-led care were less likely to experience fetal loss before 24 weeks’ gestation (RR 0.79, 95% CI 0.65 to 0.97), and their babies were more likely to have a shorter length of hospital stay (mean difference -2.00, 95% CI -2.15 to -1.85). There were no statistically significant differences between groups for overall fetal loss/neonatal death (RR 0.83, 95% CI 0.70 to 1.00), or fetal loss/neonatal death of at least 24 weeks (RR 1.01, 95% CI 0.67 to 1.53).
Hatem M, Sandall J, Devane D, Soltani H, Gates S. Midwife-led versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD004667. DOI: 10.1002/14651858.CD004667.pub2.