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    Questions? Ask Henci!


    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

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    Archived User
    Henci,

    What does the body of research on homebirth have to say about it? safe or not safe? I'm aware of the homebirth article printed in the BMJ about a year ago and of The Farm's birth statistics. By: Anonymous
    Archived User
    Hi,
    I am not Henci, but being a 'homebirther' (expecting #4 any day now) and being from the Netherlands, I have looked into this.
    One site I can refer you to, and I would love to have Henci's feedback on this is http://www.gentlebirth.org/ronnie/homesafe.html
    I am coming from a background where homebirth is normal, so I have not done much researching and comparing myself, but overal the conclusion seems to be that homebirth with an experienced attendant is as safe as hospital birth. My 'own' conclusion added to that is that the risk of interventions is 1/3 greater in hospitals than at home, and that the risk of infections is quite high in hospitals as well.
    maria. By: maria
    Archived User
    There is, in fact, a large body of research on home birth going back over 25 years, including a systematic review, in addition to the two studies you mention. Studies with sound methodology uniformly conclude that planned home birth with a qualified birth attendant produces equally good, and often better, outcomes than are found in similar women planning hospital birth. The exception is an extremely flawed study, Pang 2002, which I have deconstructed in the "Flawed Studies" section of this website.

    -- Henci

    P.S. Coming Attractions: Within the next 6 months, the Coalition for Improving Maternity Services will be publishing a systematic review of the research underpinning the Ten Steps of the Mother-Friendly Childbirth Initiative. It will provide an abundance of research, including the research into the safety and effectiveness of home birth. By: Henci Goer
    Archived User
    What do you think about this Henci?
    This is quoted from an OB
    "I'll try to find some good statistics for you, but I think that looking at homebirth midwives themselves will give you a good idea of what is going on.

    Take the BMJ study for example. There were 7228 midwife patients included in the study. Of these, only 5418 were cleared for homebirth by the time labor began. So 1810 women (fully 25%!) were transferred by the midwives themselves before labor began.

    Then 655 women were transferred by their midwives after labor began. So, out of the original group, the midwives transferred 2465 women, fully 34% of their own patients, to the hospital, because they felt that the situation had become too complicated for them to handle.

    That gives you a good idea of what we are dealing with. In the lowest of the low risk populations, 34% of women developed problems that were too serious for homebirth midwives to handle.

    That's a pretty astounding figure when you think about it. That means over a third of all women who were considered low risk at the start of pregnancy developed a significant complication of pregnancy or childbirth. Even I'm surprised by how high the proportion is! "
    -----------------------

    And if it's not too much of a hassle, could you name the studies that show homebirth is safe? By: Anonymous
    Archived User
    Let's look in more detail at what actually happened to the 7286 women who registered for home births in the Johnson 2005 study:

    Johnson KC, Daviss BA. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ 2005;330(7505):1416.

    -- 103 women made an initial visit and never returned

    -- 436 (6%) had social reasons (chose hospital birth, moved, changed midwife, cost, other) for not having a home birth

    -- 469 were referred for medical reasons (6.5%), including pregnancy complications (205), miscarried (171), preterm labor (58), antepartum fetal death at 20 wks or more (19), twins (16)

    -- Of the women continuing care with the midwife, 667 (11%) intended care in a birth center at labor onset, and 163 (2.5%) intended a hospital birth.

    -- Of the 5418 women still planning a home birth at labor onset, 655 (12%) were transferred to hospital during labor or afterwards. Almost all (83%) of these transfers were before the birth, and in half of these cases, the reason was poor progress, desire for pain relief, or exhaustion. The cesarean rate among these 5418 women was less than 4%, so the vast majority of the transfers in labor resulted in vaginal births.

    So you see, when you look at the details, a very different picture emerges: Less than 7% of the original population were transferred out of midwifery care in pregnancy, of which only half had pregnancy complications of some kind, and nearly 90% of women intending home birth at the onset of labor gave birth and recovered at home.

    As for a bibliography of home birth studies, I append a list. In addition to these, there is the infamous Pang 2002 study, concluding that home birth was dangerous. I have deconstructed that study elsewhere on this site.

    Ackermann-Liebrich U et al. Home versus hospital deliveries: follow up study of matched pairs for procedures and outcome. BMJ 1996;313(7068):1276-7.

    Bastian H, Keirse MJ, and Lancaster PA. Perinatal death associated with planned home birth in Australia: population based study. BMJ 1998;317(7155):348-8.

    Duran AM. The safety of home birth: the Farm study. Am J Public Health 1992;82(3):450-453.

    Gulbransen G, Hilton J, McKay L, et al. Home birth in New Zealand 1973-93: incidence and mortality. N Z Med J 1997;110(1040):87-9.

    Janssen PA, Lee SK, Ryan EM, et al. Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia. CMAJ 2002;166(3):315-23.

    Johnson KC, Daviss BA. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ 2005;330(7505):1416.

    Olsen O. Meta-analysis of the safety of home birth. Birth 1997;24(1):4-13.

    Weigers TA et al. Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in The Netherlands. BMJ 1996;313(7068):1309-13.

    Woodcock HC et al. A matched cohort study of planned home and hospital births in Western Australia 1981-1987. Midwifery 1994;10(3):125-35.

    -- Henci By: Henci Goer
    Archived User
    thank you!! By: Anonymous

    All Times America/New_York

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