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Jul202012

Radical Doula’s RHReality Check Article

Miriam Perez, whom I adore, wrote a piece July 17, 2012 entitled “Is it Safe? Asking the Wrong Question in the Home Birth Debate” wherein her contention isn’t that home birth is the issue, but that babies die in the hospital and that is where our focus should be. It’s surprising that Miriam would use the fetal death rate when, in fact, it’s the perinatal death rate that should be being looked at. The fetal death rate measures deaths starting at 20 weeks of gestation and ends at birth, with a stillbirth, whereas the perinatal death rate begins at 20 weeks and ends one to four weeks (depending on source) postpartum. Looking at this, you can see why, without batting an eye, why hospital births have many more deaths than at home; they include deaths before 37 weeks, which is when a midwife would typically begin attending the births. Let’s look at births in the hospital of normal, full-term babies and compare those to home births and see, use the ratio keeping them even and see who has the lower death rate. It’s unlikely anyone will be able to do this, but this would be the way to measure whose perinatal death rate is larger.

Miriam talks about the cesarean crisis and I agree the rate of cesarean sections is far too high, but she quotes the World Health Organization’s recommended rate of 15%, but neglects to mention WHO dropped that statement in June 2010, that statement saying there was no exact number that dictates what the percentage of cesareans should be.

Where we agree is that hospital standards need examining and revising, birth in the hospital should be civil and respectful (which, by the way, I see happening more and more as the years go by) and that those that make mistakes need to be held accountable. She mentions that deaths and accidents are hidden from view in the hospital, but that isn’t my experience. Families readily sue OBs and nurses, whereas that possibility isn’t available to those birthing at home. The most a mourning home birth family can do is go to the press and express themselves there. I believe that’s why it seems we hear more about home birth deaths than hospital ones.

Looking at the way hospitals operate is important, but for those of us who are immersed in the natural, home birth communities, it is those births that deserve our attention right now. Let’s get the non-nurse midwives more education and skills training as well as reign in the risks they/we take and lower our own perinatal death and complication rates. Then we can more evenly review what happens in the hospital and perhaps get that required-for-safety collaboration with the medical system.

I, for one, want it all.

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Reader Comments (6)

I agree. I was hoping she was going to make the point that asking whether homebirths are safe is missing the point that families are going to choose it. And instead why aren't we working to make it safer, via collaboration between care givers and national standards for homebirth midwives.

Missed opportunity, IMO.

July 20, 2012 | Unregistered CommenterVanessa

I want it all, too.

Perfect. I love it.

July 20, 2012 | Unregistered CommenterEx-apprentice

Ms. Perez is just showing the type of ignorance that gives non-CNM midwifery a bad name. She uses the wrong criterion, fetal vs. perinatal death, and she ignores the fact that hospitals tend all kinds of women who could never, for various medical and social reasons, deliver at home no matter how "safe" home birth were to become. She also uses an outdated and rather absurd WHO figure which was never more than an opinion, anyway, and treats it as if it were Gospel. And lastly, she ignores all the very recent evidence from several states that proves conclusively that home birth, for low risk mothers, is much more dangerous than giving birth in hospital.

Some babies will never survive being born, no matter how good the technology. Some mothers won't, either. In fact, quite a lot of people die in hospitals -- should we stop admitting patients with terminal illnesses because they'll die in hospital? Of course not.

Home birth will never be as safe as hospital birth. Even if every home birth was attended by an OB, every woman wanting a home birth was rigorously vetted to screen out any form of high risk, transfer was truly quick and easy. Perfectly normal, low risk women can suddenly, almost in the blink of an eye, become high risk; babies can suddenly develop severe fetal distress for no apparent reason, traffic jams or bad weather can delay transfer times, and the clock is ticking. The list of scenarios which can be successfully dealt with in hospital but cannot in a home is almost endless.

Your point, NGM, about improving the hospital experience is a good one. A great deal can be done, and should be done, there. But the sad reality is that hospitals have little incentive to do anything which will cost them money, like increasing the number of staff, for an obstetrical service, a chronic money loser, because not all the beds are filled all the time, and a lot of situations, like prematurity and the NICU, fall between the chairs of insurance companies, leaving the hospital in the lurch.

Lastly, can we puleeeze get away from the C/S rate? It could be halved tomorrow. How big an increase in perinatal death are you [speaking generally, not personally] willing to accept. The "unnecessarean" is only diagnosed in retrospect, as every doctor knows. And he knows that if he delays, and there is a bad outcome, he will be sued, big time, so he can't afford to do so.

July 20, 2012 | Unregistered CommenterAntigonos CNM

Excellent article Barb

July 20, 2012 | Unregistered Commenterpinkyrn

Not all unnecessary c-sections are diagnosed in retrospect. The moms' group member whose OB talked her into an elective c-section for her first child's birth because baby was "so big"? Defend that medically. Another acquaintance was induced because she was past 40 weeks with her first (and I don't mean days or weeks past), the induction failed, and she was sectioned, and she scheduled an ERC with her second because, obviously, her body "doesn't dilate anyway." Until there are doctors whose standards of practice do not include convincing women their bodies are broken, there will be legitimate pushback against the c-section rate. There are lots of good, sound reasons for c-sections. There are also some really dumb ones.

July 22, 2012 | Unregistered CommenterAmelia

"she ignores all the very recent evidence from several states that proves conclusively that home birth, for low risk mothers, is much more dangerous than giving birth in hospital"

For the sake of transparency on both sides of the argument, would you please share what evidence you are referring to?

July 23, 2012 | Unregistered CommenterSW

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