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| Posted By |
n/a on 6/29/2008 4:07:53 PM |
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RE: two questions |
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This conversation baffles me. Neither the WHO or the NICE has recommended against planned home births.
The World Health Organization citation provided above discusses improving antenatal care. It does not discuss home births at all. It does refer to a Cochrane database article about home-like institutional birth settings (such as in-hospital birthing rooms or birth centers attached to hospitals). The Cochrane database article that actually discusses home births concludes that there is no evidence that hospital birth is safer than planned home birth. Here are the links to the Cochrane database articles.
Cochrane database: Home birth compared to hospital birth
http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000352/frame.html
Cochrane database: Home-like versus conventional institutional settings for birth
http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000012/frame.html
Here is some links to the NICE (National Institute for Health and Clinical Excellence)
Full clinical guidelines:
http://www.nice.org.uk/nicemedia/pdf/CG55FullGuideline.pdf
guidelines for patients:
http://www.nice.org.uk/nicemedia/pdf/CG55FullGuideline.pdf
NICE does not say that home births are dangerous. It does caution awareness that “if something goes seriously wrong during your labour (which is rare) it could be worse for you or your baby than if you were already in hospital with access to specialised care.” On the flip side if a labor and birth are normal, being in a hospital carries increased risk of interventions and subsequent complications of the interventions. So a mother planning a home birth is still stuck with the original dilemma, predicting whether she is going to have an uneventful birth (likely) or a complicated one (rare but possible).
In addition to the immediate causes of neonatal and maternal morbidity and mortality, delayed causes of death and injury to mother and infant such as suicide, substance abuse, or homicide are often not discussed. As a facilitator of a postpartum group, I believe that these problems can be traced in part to the mother’s birth experience and how that experience affects her perception of her mothering capabilities. In effect, the future life and death of each infant may depend on the empowerment of the infant’s mother through her birth experience.
As a physician myself, I am offended by Amy Tuteur’s paternalistic attitude. Flaunting the M.D. to bully readers into trusting to your words demonstrates desperation and a certain mean-heartedness that sullies the title for other physicians. Since most obstetricians lack any training in home births and have most likely never even seen a in home birth, the title of MD carries very little substance. It makes much more sense to discuss the risks and benefits of home birth with a birth attendant who has seen the ins and outs of such a practice.
Today's patients, like any other consumer, demand transparency in their care and respect for their autonomy. We wish to make our own decisions about the type of care we receive including birth attendant and place of birth. ACOG also supports this approach, at least in theory if not in practice. See their excellent statement on the ethics of maternal care.
http://www.acog.org/from_home/publications/ethics/co321.pdf
http://www.acog.org/from_home/publications/ethics/co390.pdf
Physicians may argue that patients cannot possibly learn all there is to know without becoming a physician themselves. On the other hand, I know very little about how to rebuild a car engine, but I can go to Consumer Reports or the NHTSA and make a choice based on reliability or gas mileage. We should have auditing organizations independent of care providers and payors, similar to the FEC. In this election year, we should all look carefully at how our government can protect consumer choice and consumer responsibility for their health and the health of their families. I recommend the book by Regina Herzlinger (coincidentally also from Harvard =) titled “Who Killed Health Care?”
Tienchin
HBAC mother and retired MD, FACS |
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