Including these women among hospital births would bias the results
of planned hospital births negatively and home births positively.
Using this tool we compared the outcomes of planned home births with
those of planned hospital births for primiparous and multiparous women after controlling for the confounding effects of social, medical, and obstetric background.
Conclusions: The outcome of planned home births is at least as good as
that of planned hospital births in women at low risk receiving midwifery care in the Netherlands.
METHODS: We compared the outcomes of 862 planned home births attended by midwives with
those of planned hospital births attended by either midwives (n = 571) or physicians (n = 743).
We compared the outcomes of 862 planned home births attended by midwives with
those of planned hospital births attended by either midwives (n = 571) or physicians (n = 743).
RESULTS: The rate of perinatal death per 1000 births was 0.35 (95 % confidence interval [CI] 0.00 - 1.03) in the group of planned home births; the rate in the group
of planned hospital births was 0.57 (95 % CI 0.00 - 1.43) among women attended by a midwife and 0.64 (95 % CI 0.00 - 1.56) among those attended by a physician.
The rate of perinatal death per 1000 births was 0.35 (95 % confidence interval [CI] 0.00 - 1.03) in the group of planned home births; the rate in the group
of planned hospital births was 0.57 (95 % CI 0.00 - 1.43) among women attended by a midwife and 0.64 (95 % CI 0.00 - 1.56) among those attended by a physician.
Results: The rate of perinatal death per 1000 births was 0.35 (95 % confidence interval [CI] 0.00 — 1.03) in the group of planned home births; the rate in the group
of planned hospital births was 0.57 (95 % CI 0.00 — 1.43) among women attended by a midwife and 0.64 (95 % CI 0.00 — 1.56) among those attended by a physician.
We had 2 comparison groups
of planned hospital births.
We compared them with the outcomes
of all planned hospital births that met the criteria for home birth and were attended by the same cohort of midwives.
We compared the outcomes of planned home births attended by midwives with
those of planned hospital births attended by midwives or physicians.
«Kenneth C Johnson and Betty - Anne Daviss's Outcomes of planned home births with certified professional midwives: large prospective study in North America, BMJ 2005; 330:1416 (18 June), found that the outcomes of planned homebirths for low risk mothers were the same as the outcomes
of planned hospital births for low risk mothers, with a significantly lower incident of interventions in the homebirth group.»
In yet another example of a strikingly robust finding, planned homebirth in NZ had more than triple the neonatal death rate
of planned hospital birth.
Her quantitative research includes co-authoring a Cochrane meta - analysis
of planned hospital birth versus planned home birth (2012).
Benefits and harms
of planned hospital birth compared with planned home birth for low ‐ risk pregnant women.
It could be argued that unplanned home births are similar to planned home births which were transferred to hospital during labour (because birth did not take place in the intended location), and that not getting to hospital in time is a risk
of planning a hospital birth, and for this reason we have run the analysis both with and without unplanned home births (see «results» section).
When that data is pooled with the data from Ontario (also 4 yr midwifery degree, hospital priv for RMs and smooth transfer) perinatal mortality with planned homebirth was 2 - 3x that
of planned hospital birth.
In much the same way as the location
of a planned hospital birth is subject to the availability of beds, we can not guarantee that a birth room will be available.
Benefits and harms
of planned hospital birth compared with planned home birth for low - risk pregnant women
Our research has shown that, for women with low risk pregnancies in the Netherlands, choosing to give birth at home is a safe choice with an outcome that is at least as good as
that of planned hospital birth.
Not exact matches
With that said, I will say, having worked labor and delivery at a county
hospital, you honestly don't have time to read the
birth plans of all the patients you are taking care
of.
And so I learned that the
hospital is not an evil place (though choose your
hospital wisely if youâ $ ™ re
planning to
birth there), that I am stronger than I thought (I sort
of want to cross-stitch â $ œ12 hours on pit with not pain medsâ $ into a pillow), and that even though it can sometimes appear as though they are, medical professionals are NOT the enemy (butâ $ ¦ do your research!
By now you may have gathered that instead
of choosing to have an OB - attended
hospital birth this time around, we are
planning to have a midwife - attended homebirth.
Practice Guidelines for California Licensed Midwives Best Practice Guidelines: Transfer from
Planned Home
Birth to
Hospital Citizens for Midwifery Home
Birth Facts Canadian Medical Association Journal: Outcomes
of Planned Home
Birth Solace for Mothers: Informed Consent Questions to Consider when Interviewing a Doctor or Midwife
«Maternal and newborn outcomes in
planned home
birth vs
planned hospital births: a metaanalysis» by Joseph R. Wax, MD; F. Lee Lucas, PhD; Maryanne Lamont, MLS; Michael G. Pinette, MD; Angelina Cartin; and Jacquelyn Blackstone, DO, appeared in the American Journal
of Obstetrics & Gynecology, Volume 203, Issue 3 (September 2010) published by Elsevier.
Last Summer, ACOG «leaked» data from a study to be published in the American Journal
of Obstetrics and Gynecology stating that
planned home
births carried a 2 - 3 fold increase in neonatal death compared with
hospital births.
In addition to getting to know each other over the course
of the mom's pregnancy — learning about her hopes, fears, and wants for her
birth experience — home birthing moms also have
birth plans to clarify things like which post-
birth procedures the family does and doesn't want (like vitamin K shot, eye ointment, etc.), and preferred
hospitals and care providers to call in case
of transfer.
She also has a great understanding
of women who
planned to
birth at home and were transferred to the
hospital, as well as attachment parenting issues.
One more thought Penny... wouldn't it be ideal if a mother
planning the
birth of a breech baby could opt for
hospital TOL with her midwife?
Even though most
of our clients do not need to go to the
hospital, we recommend all
of our clients have a transport
birth plan.
Supports women experiencing symptoms
of depression or anxiety after a traumatic
birth experience, including early and late miscarriages, still
birth, newborn illness, NICU,
hospital transfer during
planned homebirth, inadequate pain relief, unplanned medical intervention,
birth plan not being honored, c - section, infant resuscitation, placental abruption, or general anesthesia during
birth.
Although tragic, cord prolapse and AFE occur rarely at homebirth, 1/5000 and 1/500, 000 respectively, when balanced with the dozens
of acute emergency conditions endangering the health
of mother and baby that occur at
planned hospital birth caused by intervening in the
birth process, the scales tip easily in favor
of planned attended homebirth for low risk women.
Rates
of acute emergencies for low risk
births at
planned attended homebirth vs
planned hospital birth:
Simply: If
hospital birth were useful, the data would support it, but all homebirth studies (1 - 20), show better outcomes
of low risk women at
planned attended homebirth.
Outcomes
of planned home
births versus
planned hospital births after regulation
of midwifery in British Columbia.
Another lengthy scan with very little discussion between the technician and us, again our worrying about our being steamrolled into a management
plan without through evaluation
of the risks and benefits, or being essentially pushed into a
hospital birth because it would be best for the baby but also mean that I would not have the option
of birthing vaginally was all a little more than my tear ducts could bear.
I've experienced a
planned hospital birth, a
planned homebirth that ended with an induced
hospital birth (and a month - early preemie) because
of pre-eclampsia, and two homebirths.
Planned attended homebirth outshines
hospital birth for low risk women in every category
of acute emergency.
As your best guarantee
of having a normal vaginal
birth once you're in the
hospital, we suggest that you
plan in advance to have helpers — mate, doula, and perhaps a monitrice (your personal ob nurse)-- with you.
I appreciate that the AAP states that pediatricians should share with each woman
planning a homebirth that some families require transfer to the
hospital due to complications and this should be viewed «not as a failure
of the home
birth but rather as a success
of the system» (AAP, 2013, p 1017, para 3).
Authors Wax, Lucas, Lamont, Pinette, Cartin & Blackstone sought to systematically review the medical literature on the maternal and newborn safety
of planned home verses
planned hospital birth, a level IV rating on the Hierarchy
of Evidence.
Perinatal mortality rates for
hospital births of low risk women are similar to outcomes
of planned homebirth in general, but the maternal morbidity at
planned hospital births is much higher.
Specifically, they should be informed that although the absolute risk may be low,
planned home
birth is associated with a twofold to threefold increased risk
of neonatal death when compared with
planned hospital birth» (ACOG, 2011).
Homebirth and midwifery advocates point with pride to a recent study that showed that homebirth with a midwife in the Netherlands is as safe as
hospital birth with a midwife (Perinatal mortality and morbidity in a nationwide cohort
of 529 688 low - risk
planned home and
hospital births).
while being coerced to push even though I wanted to breath the babies down, I didn't get to see them at all for 15 hours after they were born because the
hospital staff didn't get their act together, not because it was medically necessary, etc., so much so that the head
of OB (my office doc) later admitted they had me on suicide watch because what happened was so different than my
birth plan... I wasn't stuck on exact details, especially because twins throw a loop in all
of it, but it was nothing like I had hoped for, at all.
The coroner has concluded Midwives should not attend HBs alone, the emergency services should be notified and given prior warning when a HB occurs, and «that the distance
of a home
birth from the local maternity
hospital should be factored in whenever home deliveries are
planned.»
This is because the vast majority
of stillbirths delivered in the
hospital are known to be antepartum and not intrapartum.29, 30, 31 On the other hand, in out -
of -
hospital settings, most antepartum deaths in
planned home
births would be transferred to the
hospital.
«While most pregnant women who choose to have
planned home
births are at lower risk
of complications due to careful screening,
planned home
births are associated with double to triple the risk
of infant death than are
planned hospital births.
We might also find a number
of babies who had lethal congenital anomalies, who would not have survived no matter where they were born or who attended the
birth; there may be important differences between home and
hospital populations with regard to whether these anomalies were detected prenatally and whether parents changed their
birth plans because
of it.
I had a client who was
planning a home
birth but it turned course leading to a transfer to the
hospital and a cesarean
birth, two opposite ends
of the birthing spectrum.