29 responses to “Homebirth vs Hospital: Statistics To Die For”

1. 
   womantowomancbe

   June 4, 2008 at 7:20 am | Permalink

   Thanks for posting this! I’ve been on that blog which shall remain nameless a few times (that is, a few different threads — it obviously was more than just a few posts), and have come to the same conclusions that you have — especially about how the “good doctor” slices and dices the numbers like she advocates for the slicing and dicing of women’s bellies for birth. Ah, statistics — you can make of them what you will! Thanks for running these numbers, because it is so important to see the truth behind the statistics.

   As far as your comment about the difference in death rates by maternal race — yes, it is awful! The “good doctor” basically implied on one of her threads that it must be genetic, because she noted that women of African heritage, regardless of the country in which they give birth, fare worse than women of other races. Shocked me to see her say that, because it sounds so racist when you put it that way! But this was her way of “blaming the victim,” of course, which is what she must do when she doesn’t like the stats. However, I’ve looked up stats/stories from the UK, and it was noted by the researchers that a large percentage of black women in the UK are recent immigrants, and are therefore more likely to be poor and not speak English, so are less likely to seek prenatal care, and are more likely to have health problems, which put them and their babies at higher risk of death.

   I asked her at one point why she focused so much on home birth if she was really wanting to reduce neonatal mortality, because only about 1% of all US births are planned home births. So, even if her grossly exaggerated numbers were correct, CPM-attended home birth would generate an excess of 360 deaths per year (out of 4 million live births). I asked her why she didn’t focus on trying to get all women married, since the neonatal mortality rate for unmarried women is approximately twice that of married women. She, of course, ignored that.

   You mentioned something about different types of midwives. Here in the US, each state has its own rules governing the state. Certified nurse-midwives are legal in all states, but the majority of them practice only in hospitals (some states have them so regulated that it is nearly impossible for them to do otherwise — they must have doctor back-up, for instance, and most docs won’t back them up if they attend home births). About half the states allow non-nurse midwives to attend home births, and most of these states have “certified professional midwives” as legal, although some of the states do not have specific legislation on them (they are neither legal nor illegal, but “alegal”). Non-nurse midwives are also called “direct-entry midwives” since they went into midwifery without first going into nursing. Since not all DEMs have received formal training and education in midwifery, the standard of care can be quite different from one midwife to the next. Some midwives can be certified but have chosen not to become certified, while others undoubtedly would not qualify, yet still attend births (there are “bad apples” in every profession). For the purposes of these statistics, I’d say that “other midwife” includes anyone who practices as a midwife (regardless of actual training), whereas “other” birth attendant would include family members, doulas, ambulance drivers, firemen — whoever happened to be on hand to catch the baby.

   And even tho’ this comment is already too long, I’ll throw this zinger in for fun — the “good doctor” posted a similar link to the state of Wisconsin’s linked birth-death certificates, and with much fanfare produced that “other midwives” had a much higher rate of infant death than did certified nurse-midwives. She said she removed the CNM-attended home births because it had a “much higher” death rate than CNM-attended hospital births. (She compared the two groups of midwives because she said that would get women of similar risk categories, which actually ignores the fact that since CPMs weren’t legal in Wisconsin at the time, they may very well have taken some high-risk clients they should not have.) However, the truth behind the statistics is that CNMs attended very few births (like 300 over the course of a year or perhaps several years — it’s been many months since I’ve looked at the stats, so I’m going on memory), and there was only 1 death which skews the results when extrapolating that to deaths per thousand; ALSO, that death was the result of a congenital anomaly, so the baby likely would have died regardless of birth-place. Also, of the “other midwife”-attended home births, 7 of the 17 deaths were due to congenital anomalies. It is important to note that most of the Amish (a religious group that wears plain clothing, refuse electricity and automobiles, etc., and tend to intermarry within their religion, which sets up for some interesting potential genetic problems) would have a CPM attend them, which accounts for the high percentage of lethal birth defects.

   Sorry this comment is so long, but I’m so glad you wrote this post!!

   Kathy

2. 
   Lisa Barrett

   June 4, 2008 at 12:31 pm | Permalink

   Thanks Kathy for posting that fantastic comment. It just about qualifies as a post in it’s own right.

   You certainly clarified a few things and showed how complicated the Midwifery model is in the US.

   I did consider adding a facetious remark like ”Are neonatal deaths of women of African decent higher because they birth at home?”

   But I agree, the maternal race issue it’s not at all clear cut, there are a lot of interwoven variables at play there.

   So much energy goes into marginalizing homebirth under the pretence of reducing the tiny number of neonatal deaths. Yet if that energy was channelled into where the deaths were actually occurring it would save a lot more lives. Some people just like easy targets, which obviously rules out anything with a “race” angle.

   You see the same thing with the illegality of cannabis. The number of users is quite small but they are criminalised for the sake of their health. Yet tobacco is legally sold and kills a huge number of people each year. I suppose upsetting the tobacco companies and losing their tax dollars is simply unthinkable.

   There is a proverb (in the UK at least): Penny Wise – Pound Foolish.

3. 
   Kati

   June 4, 2008 at 4:38 pm | Permalink

   Hello!
   Just curious – if only vaginal deliveries are included then how can be taken into account planned homebirths that end up in transfer and (maybe) in caesarean?

4. 
   Lisa Barrett

   June 4, 2008 at 8:07 pm | Permalink

   Hi Kati,

   I was working on the principle that if a planned homebirth resulted in a transfer to hospital then the place of birth would no longer be “out of hospital” and would be incorporated into the hospital’s figures. Likewise, any planned hospital births that did not happen there, would not be included with their figures.

   I specifically removed the non-hospital caesareans as they seemed a peculiarity that few would advocate. As the “homebirth/out of hospital” figures are already low the dangerous practice of performing major surgery away from the hospital had the potential to unfairly impact their figures.

   There doesn’t seem to be any explicit way of identifying these “out of place” births, and even if there were it would be very contentious in agreeing who’d been responsible for client care. For example, in the case of a transfer to hospital, the hospital would immediately enforce their policies, but would try and shift the blame if the outcome was not good. Similarly if a planned hospital birth ended up badly at home or in the back of a taxi, I can’t imagine the hospital wanting it added to their figures.

   It’s a bit imperfect I know. No wonder statistics have such a bad rap.

5. 
   Susana

   June 6, 2008 at 7:28 pm | Permalink

   Hi Lisa,

   So glad for your post. I read “HER” post and immediately began searching for clarifications so that I can have/write my own response.

   Even though I have birthed at home 5 times, 4 UC, I couldn’t help but be a bit startled by the statistics as she hyped them. Even so, the idea of all women being encouraged (even pressured) to undergo elective cesarean at 39 weeks was far more startling.

   I immediately googled studies and found that cesareans at 39 weeks may lead predispose baby to adult asthma, possibly autism and other brain damage, suicide, and cause maternal hemorrhage (sp?) and hysterectomy.

   As I read different studies I also found out that in Taiwan, ceasareans increased after the country instituted Universal Health Care and they now have the highest rate of c-sections.

   I think this will be the case in America if the Democratic candidate wins (since UHC is his platform), especially with the results of this new study being
   touted.

   And thanks for mentioning that part of the UC statistics are from those who have unwanted, unplanned pregnancies. They might even be from unplanned UC births, which are different from UCer’s who study and prepare.

   Susana

6. 
   Lisa Barrett

   June 6, 2008 at 9:21 pm | Permalink

   Hi Susana,

   There isn’t really a lot of debate going on over there, everybody is just angry with one another. I think there’s more behind that crusade than there appears.

   The world export of the caesarian model is ironically like the export of McDonalds and the Western diet. Sure people have better nutrition but now they are suffering from obesity and chronic heart disease (amongst everything else). Still, the health industry can make even more money from treating those complains too.

   I am quite sure there is huge political pressure for many small countries to adopt our utopian health care model. Big business has to expand into new markets and our governments will help them. Can you imagine how much a modern hospital costs? They could spend it on water and sanitation but who’s going to make any money. Besides there are no recurring costs.

   I remember seeing a documentary a few years ago about how the British encouraged an African country to modernise it’s road network. They claimed the lack of infrastructure was preventing it from competing in world markets. So at enormous expense they built extensive 4 lane highways, service stations, even emergency telephones every few km. It would put much of Australia to shame! Eventually the money run out and the British left. Unfortunately, nobody is this African country had a car or could afford one. Even now the only thing that crosses those highways is tumble-weed and wilderbeast.

   I’m digressing off birth now, so I’d better not get started on IT in schools.

7. 
   Rachele Meredith

   June 7, 2008 at 6:11 pm | Permalink

   Hey Lisa,

   Yes, I read her original post over there about this data as well as the recent one maligning your post. What a strange and bizarre woman and what an interesting fiddling of statistics on her part. I wonder why she is so intent on maligning homebirth? And so insistent that no one other than MDs can understand statistics? How insulting and rude. Luckily I do understand statistics and am capable of critically reading research and have not yet come across anything that convinces me that birthing in hospital with an MD in attendance makes birth safer for a healthy woman experiencing a normal pregnancy. These statistics do have limited use. We have limited information about the planned place of birth or birth attendant, neonatal death rates include babies with congenital issues who would have died regardless of place of birth, there is no way of differentiating transfers, etc. We can assume that an out of hospital birth with a midwife in attendance is a planned homebirth, but that is still an assumption. Some of the hospital births would include transfers from a planned homebirth. Some women who birthed outside the hospital may have had a high risk profile; we are not comparing matched risk groups. Anecdotally, the women I come across who choose to birth at home tend to be less inclined to have scans or terminate pregnancies due to a congenital anomaly; this would skew neonatal death rates. These statistics are interesting, but they do have limitations. I come from a family of doctors and must admit that, in my experience; doctors tend to put on an arrogant superior attitude whenever challenged, stating that they are the only ones who really understand the issue at hand at that everyone else is not properly qualified. I wonder if they teach that in Medical School?

8. 
   Lisa Barrett

   June 8, 2008 at 1:32 am | Permalink

   Hi Rachele,

   Thank you for your comment. I wholeheartedly agree with you. When I was writing the post I was thinking much the same thing.

   As I’ve previously said there’s something very suspicious about her motivations. Particularly concerning her frequent assaults on DEM. Nobody spends such an inordinate amount of time savagely maligning something without an axe to grind. If instead she put all that time into campaigning for better DEM training to allay her concerns then her intentions may prove credible.

9. 
   amanda

   June 8, 2008 at 12:17 pm | Permalink

   I have been reading Homebirth Debate for quite some time, and I have seen Dr. Amy talk about ways to improve training for DEMs on many occasions. The issue seems to be that the DEM organizations do not want advanced medical training; their argument seems to be that they they do not want to be “medwives”. As a woman of childbearing age who did look into homebirth with a midwife while pregnant with my son I have to say that I do not understand that point of view. How could more training that enables more competent and capable handling of those rare, yet very real emergency situations be a bad thing? Why would anyone responsible for 2 lives willingly turn down additional training?

   What bothered me the most while reading some midwife blogs was the almost superstitious attitude toward training. The one that says “I am not going learn about how to handle it when things go wrong, because to do so would be inviting those things to happen.” The same attitude that causes people to not do the most basic checking to make sure things are still going okay, because of blind reliance on “intuition” to tell us if the mother or baby needs help. I have known people who needed help and intervention during birth, and they really had no idea.

   I suppose what I’m trying to say that is although Dr. Amy can sometimes phrase things in a way that hurts people’s feelings, I don’t see what she is doing as all bad. There are plenty of sites out there that will tell me that I don’t need a midwife at all…..that if anything happens to my baby it’s my fault because I didn’t trust birth enough and do what THEY told me to do. There has to be another side to the story and I’m glad she is presenting it. Personally, I don’t want to become complacent in regard to the health of mothers and babies. The discussion should remain open for the benefit of us all.

10. 
    Susana

    June 8, 2008 at 6:00 pm | Permalink

    Hi Amanda,

    I appreciate the comment that you have left. It is much more in line with the term “debate.”

    You are correct that we don’t want to be complacent. It is good to study and learn the risks involved with our choices. But we must remember that there are risks in all of life. It is risky to allow my children in a vehicle, but I do it.

    Death happens in life. Sometimes we have to take chances to get the most out of life. We may work to minimize risk, but in birth there is risk whether at home or in the hospital.

    As for the new study that the “good” Dr. is touting, it MAY show that cesareans at 39 weeks bring about more live babies,(Dr’s have been mistaken in thier recommendations before) but for me the trade off of possibly prematurely ending my ability to bear children, dying, or having my child deliteriously affected for life is something I would rather avoid. I see hospital birth, and cesarean birth especially, as more dangerous since I am low-risk, and as long as I remain so.

    If me or my baby are at risk either way (hospital vs. home) I’ll take homebirth. There is so much more opportunity for family bonding at homebirth, and it facilitates less painful birthing and a more spiritual experience, therefore I view it as superior.

    Yes, I have birthed at home and in the hospital and I found homebirth to be more spiritual. I could pray and reach out to God in a way that I couldn’t do in the hospital with nurses standing around watching me, poking and prodding.

    Anyway, those are my thoughts. I wouldn’t feel comfortable sharing them on the Homebirth Bash blog, I mean the Homebirth Debate blog.

    I am not saying you have to agree or that you should feel the way I do. I just want the freedom to have my own opinion, and make my choices for my body, my baby, my family.

    I believe that if the menacing Dr. had her way homebirth would be illegal. That is her goal. 100% cesarean birth is what she is striving for and so I could never support her or her blog. I will never, ever believe that ceareans recommended for every woman, or hospital birth for every woman could every be right and true.

    Susana

11. 
    amanda

    June 8, 2008 at 11:22 pm | Permalink

    Susana,

    Thank you for your kind response.

    I have to say, however that in the years I have spent reading Dr. Amy’s blog that she does NOT want to see homebirth made illegal. She has said several times that the choice of where to give birth is a woman’s choice to make. What she wants to do is challenge the information out there at says that “homebirth is as safe or safer than giving birth in a hospital”. She does so by using facts and figures.

    She says that the purpose of her blog is to make sure that every woman has information beyond “as safe or safer”. I have to say also, even as someone who loves the idea of giving birth at home, that the numbers do not seem to add up in favor of birth at home being “as safe or safer”.

    Don’t get me wrong, I think in most cases homebirth is relatively safe; certainly the good outcomes greatly outnumber the bad. What bothers me, though, is the demonization and attempts to silence anyone who wont fall in line with the party line of homebirth always being the safest thing to do. Kneelingwoman, a recently retired midwife http://closetotheroot.blogspot.com/ has written extensively about how the midwifery community has told her to “shut up” in so many words when she has broached discussions about birth safety. The same thing has happened to Navelgazing Midwife http://observantmidwife.blogspot.com/

    It is clear that there IS a discussion that needs to be had, and it worries me that some people don’t want that to happen. As an outside observer, it makes me wonder if the midwifery community is trying to hide something from birthing mothers to further their own goals.

12. 
    Rose

    June 9, 2008 at 1:44 pm | Permalink

    Amanda, i find it fascinating that you think us midwives would conspire to hide something, for our own goals/agendas??!! i can guarantee you 110% that i do this not for myself or my family, but for the women and their families, because i KNOW what they can have and deserve to have, by birthing their babies at home.

    This job demands my time 24/7, 365 days of the year, and i have to put myself and my family on hold to be with women, when they need me, and i stay with them for as long as need, days if required, all for barely enough money to cover my costs…….

    Now lets compare the work Obstetricians do….. Inductions and elective caesareans to work in with their schedule (if the poor woman dares to say how ‘tired’ of being pregnant she is!), or em. caesareans at about 6-7pm each night, or how about the episiotomy rates, for failure to wait. Now how much do they get paid??? about 3x what we earn!!!

    What about the quality of care?? Each antenatal visit with my clients goes for 1-2hours, OBS 10-20minutes?? How about labour and birth care?? I am with my clients for as long as they need me (happy to sleep on the couch)days at a time. OBS get called in at fully dilated, and even still cant wait so do an episiotomy, so total of 1 hour?

    So Amanda i find it very offensive that you believe the midwifery community is trying to hide something!!!!!
    I KNOW the Obstetric community is hiding everything!!!!
    Why do Private Hospitals not have to submit their perinatal outcome statistics?? how much more evidence of ‘hiding’ do you want?
    We’re private practitioners, maybe we should stop submiting our statistics?????

13. 
    amanda

    June 9, 2008 at 10:27 pm | Permalink

    Rose,

    You pretty much proved my point by responding to my polite attempt at discussion with a tirade.

    I’m not making this stuff up. I urge you to read through Navelgazing Midwife’s blog and Kneelingwoman’s blog. Two midwives with 60 years of experience between them, and they are the ones I got this information from. The midwifery community at large has attempted to silence 2 of its best and brightest for the unforgivable sin of pushing for better DEM training and licensing in the United States, which I brought up in response to Lisa Barrett’s comment about working to improve DEM training. I was pointing out that 2 of midwifery’s own have attempted to work toward that goal, and have been maligned by their own community for having done so.

    THAT is why I wonder if midwifery is hiding something. Why else would anyone want to silence 2 shining lights of their own industry? Kneelingwoman retired over it, for pete’s sake!

    I never suggested OB’s weren’t hiding anything, I didn’t even bring them up! Why did you? What does OBs hiding or not hiding things have to do with anything I said? It reminds me of when I babysit 2 little siblings. I ask one “Did you throw all that paper on the floor?”, to which he replies, “Sarah spilled her drink over there!”. He does this so he can divert my attention from the question I asked by telling me something that has nothing to do with what I wanted to know.

14. 
    pinky

    June 9, 2008 at 11:25 pm | Permalink

    Rose

    I am sorry you are offended. I sympathize. I have been offended regularly when patients think I am trying to hide something. When patients are thinking of sueing me and they have no case. It is upsetting when you spend all that time out of the goodness of your heart. I don’t think any of us do this for money. Most of the OB’s included. They could just do Gyn and make plenty of money. Most of them are getting out of obstetrics. INstead of looking at our differences, I think we need to look at what we agree on. We all want a healthy baby and Mother. Now, how to go about that is where we may differ. But if we work together our outcome will be better.

    I must admit. I love Doctor Amy. I just do. Cause she tells us things that are unpopular. And she will point you into the direction to read up on what she is talking about. I think that is a good thing. I have actually learned a lot more about stats from her. I did take stats in school. I wish I retained more of it.

15. 
    Rose

    June 10, 2008 at 1:09 pm | Permalink

    Amanda, I don’t think you are making this stuff up at all, I talked about OBs hiding things, because i cannot understand why Dr Amy feels she has to have a spicific blog, bagging DEM midwives (i have commented on her blog about this), when she could be using her time better to help improve the outcomes to women, by doing something about the DEM training, not just bad-mouthing it and generalising all DEM, world wide. I am a DEM in Australia, and our training is 2 years longer than the nurse/midwife training, so i do not at all feel inadequate to attend HB’s. It was not my training that taught me the HB skills, but working in a supported environment, with HB mums, where i learnt these skills.
    Maybe a mentor relationship with a CNM/exp DEM could prove helpful??
    I have only had a quick look into Navalgazing midwife’s blog, but i will read more.
    I enjoy debate, but i DO NOT like personal attacks, like being called a child, that’s just plain rude!

16. 
    Lisa Barrett

    June 11, 2008 at 6:34 pm | Permalink

    Amanda, There is nothing wrong with debate, it it is healthy and we can all learn from each other. I have never seen any debate on Dr Amy’s blog and know that any comment is always met with personal abuse and attack. I am not a DEM but trained for 4 1/2 years back in 1988 in the UK to become a midwife. The shining lights of your crusade The kneeling midwife and the navelgazing midwife only became that when they started to disagree with their community. I have read both the blogs and they are interesting and thought provoking but really have nothing to do with the type of midwifery that happens in other countries of the world where a midwife is the primary point of contact for a healthy pregnant woman.

    There is no doubt that intervention creates risk. Obs and midwives alike all over the world agree with this. All it seems except Dr Amy. I am looking forward to her talking at a conference so we can record and take into consideration her research. When she has done some.

17. 
    Anonymous

    December 16, 2008 at 6:09 am | Permalink

    Lisa,
    I am curious about the statistics. Did vaginal births in the hospital include vaginal births to women with no prenatal care, hx of drug use, hx of a diagnosis that would catagorize her as high risk (i.e gestational diabetes, diabetes, gestational hypertension, chronic hypertension, PROM, etc.), women who demand induction of labor, women who demand epidural anesthesia? Many women with these issues deliver at or after 37 weeks, and carry only single or twin gestation, but I would not consider them "normal" births.

    I envy those of you who can participate in home births…how amazing that must be. But reality is that most women will deliver in a hospital, regardless of the reason why, and some of us have chosen to attend to those patients. I am offended that I would be portrayed as the bad-guy by many of these blogs, when they don't even know me. My practice is important to me, and I have spent the last 23 years taking care of those women who don't qualify or don't want a home birth. I try to go above and beyond to give my parents the birthing experience they want.

    I don't deny that there is abuse from the medical arena. Manipulation and coersion is all over the place. I am saddened by the lack of education among women when it comes to their body and the birthing process. I hate that women come in demanding C/S's, inductions, epidurals, etc. But..regardless…I am here to care for these patients with the same passion you care for your well educated, healthy, low-risk moms & babies.

    Please let your readers know that there are health care providers out there who have a passion for the work they do, and desire to support them in whatever birth choice they have made.

    Thanks…JLS

18. 
    Lisa Barrett

    December 16, 2008 at 8:22 am | Permalink

    Dear JLS, I wonder who it is doesn’t qualify for a homebirth or basic respect in their birth? The stats in Australia has just revealed that only 2.5% of c/s were elective and non medical, leaving 97.5% for other reasons, I have yet to see proof of women all demanding this type of care.

    Feel free give us all the facts, figures and evidence as you see them, so we can read it for ourselves. Everything that is said here is backed up.

    I care for women of all risk.

19. 
    Anonymous

    December 30, 2008 at 12:16 pm | Permalink

    Lisa,
    Your comment “I wonder who it is doesn’t qualify for a homebirth or basic respect in their birth”…is, by your own stated RULES, rude and demeaning. I never said there was ANYONE who didn’t qualify for basic respect in their birth. Please don’t put words in my mouth. I believe you said you “do not believe EVERYONE should birth at home NO MATTER WHAT”…those are the women I am talking about. And again…some women don’t WANT to deliver at home. Who is to care for these women? Here, in Riverside CA, our midwives will not deliver anyone with fetal anomalies, severe IUGR, Insulin dependent Diabetes, Pregnancy Induced Hypertension, Lupus, certain Congenital Heart issues, Heroin abuse, Crystal Meth abuse, etc. at home. While you may feel comfortable managing these types of patients in a home birth…our midwives do not, and someone needs to be there to take care of these people. I should not be attacked for focusing my field of care on these patients.
    As for women who are coming in and demanding cesareans…this is real. In fact ACOG has released a formal opinion supporting “patient choice” C/S’s. Ann Fam Med. 2006 May; 4(3): 265–268, OB/GYN News, Sept 1, 2003 by Gwendolyn Hall, and CMAJ • March 2, 2004; 170 (5), all discuss this growing issue. It’s sad, we need to change this…but until then…someone needs to care for these women. Patients also come demanding induction of labor. We have had to limit our elective induction slots to 3 per day! And we don’t even want to do those! The NY Times published on this topic by LInda Villarosa on June 23rd 2002. She reports: A study last year by the National Institutes of Health found that the rate of labor induction more than doubled from 1990 to 1998, jumping to 19.4 percent of all births in 1998 from 9.5 percent of all births in 1990. ”In instances, we noted that more than 50 percent of inductions are elective,” said Dr. Jun Zhang of the National Institute of Child Health and Human Development in Bethesda, Md., who was the lead investigator on the study. This is what I see every day. Your readers can also read about this issue at http://www.aafp.org/afp/981115ap/vincent.html The CDC here in the us also reports the growing number of epidurals in their 2003 stats @ http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_02.pdf
    BUT…my whole reason for writing was not to throw numbers around, it was to ask for some respect for the work I do…just as I respect the work you do. There aren’t any STUDIES on that…sorry. JLS

20. 
    Lisa Barrett

    December 30, 2008 at 7:21 pm | Permalink

    Dear JLS, I was certainly not rude or demeaning in any way. Plus I have no idea who you are and you very clearly know all about me as I have been very open about it here.

    In instances over 50% of inductions were elective. This means nothing.
    “If you want me as your ob why don’t you get induced as I’m on holiday next week” is an elective induction. The jump in inductions hasn’t really affected outcomes for mother and baby except to increase the c/s rate x3. In South Australia as I have said 62% of first time mothers who opted for an induction had a section.
    I have no respect for practitioners who blame women for the poor maternity care provided. I myself would opt for an epidural if stuck in one room with no escape no food and water and nothing to do but listen to constant stream of negative.unnecessary and often untrue statements of progress and expectation
    I have the greatest respect for very few wonderful Ob that support women’s choice and provide fantastic and live saving help when it is required, leaving well alone and to the women and normal birth specialists on every other occasion.

    You cannot remand respect, it is earned.

21. 
    Anonymous

    January 2, 2009 at 6:56 am | Permalink

    Lisa,
    I’m not sure what else you need to know about me in order for you to offer your respect. I already shared with you that I have spent the last 23 years of my career working in a hospital invironment caring for women who did not want a home birth, or who are high-risk. I already shared with you that I am acutely aware of and disagree with the coersion and manipulation I see in the perinatal arena. I already shared with you that I respect the work you and others like you do. I already shared with you that all I ask is for you to let your readers know…that there are people in the hospital invironment who are passionate about the birthing process, about caring for them, and caring for their babies… should that be where they deliver, no matter the circumstances.
    I will assume your statement “I have the greatest respect for very few wonderful Ob that support women’s choice and provide fantastic and live saving help when it is required, leaving well alone and to the women and normal birth specialists on every other occasion.” refers to myself and all the others out there who have commited, with passion, to take care of the thousands that have and will deliver in the hospital invironment! Thanks. JLS

22. 
    Anonymous

    February 18, 2009 at 12:02 pm | Permalink

    I am a homebirth mama. After a kidnapping, rape and torture 10 years ago, I felt that I was reliving all that, being forced to undergo exams and tests in the hospital. I was chastised for not getting prenatal care — when my insurance co could not find a dr with an appointment for four months. CNM’s that I worked with while a little better, still maintained the medical model. One that included suggestions for epidural to “support me ” during labor since I was likely to “freak out”.

    When we got the midwives it was like coming home. They also were understanding of my native american heritage and birth ritual.

    I used a CPM/LM here in CA – that means they have had book training and hands on exams as well as an internship. Just like any other healthcare professional, it is the responsibility of the customer in US healthcare to look into the credentials and such of the caregiver.

    My son was almost 9 pounds born in water at home – in about 4 hours. In the hospital, we would have had to fight a c-section since they arbitrarily determined that I was too small to have an 8 pound baby. (fat chance – my mom was tiny -under 90 pounds and had a 10 pound breech before she had me) No drama.

    My second will be born at home with the same midwives in late summer. I get a lot of negative feedback, and I just don’t listen. One woman who had an elective section, I just told, you know what? you dont’ want me to comment on your choices. You are not welcome to comment on mine.

    Cheers all, and happy homebirthing!

23. 
    Anonymous

    February 19, 2009 at 3:18 pm | Permalink

    Hi Lisa,

    Thanks for your statistical analysis. I agree with almost all of the assumtions you made, and it was very informative.

    As an aside, it seems that you are against immunisation. Correct me if I’m wrong, but is this because you are going along with the anti immunisation hype, similar to anti-home birthers? Maybe you could apply your same rational processes to immunisation risks to separate the hype.

    To semi-quote you, there is an uproar whenever immunisations have a negative effect, but you never hear about the multitude of deaths/incapacitations of the unimmunised by these diseases.

    Thanks again for your work.

24. 
    Lisa Barrett

    February 19, 2009 at 5:48 pm | Permalink

    Dear Anonymous,

    I have never been one to go along with any hype, I have not mentioned immunisations on this blog as my personal view on this although backed up by research isn’t really related to birth.
    I wonder why you mention it?
    Thanks for reading.

25. 
    Anonymous

    February 20, 2009 at 9:55 am | Permalink

    “You retain control and are not obliged or encouraged to comply with hospital policy such as immunisation/injections that may have health implications further down the track.”

    You used it as a pro-homebirth benefit.

    I honestly don’t intend to offend, and only brought it up because it is an important issue that is touted as dangerous by the ignorant, exactly the same as homebirth is.

    Lyle

26. 
    Anonymous

    March 6, 2009 at 7:47 pm | Permalink

    Lisa,

    Couldn’t help but notice that, regrdless of practitioner, the maternal mortality was higher in the homebirths group than hospital group. (Eg CNM Homebirth 0.7%vs CNM hospital 0.49%).

    This is even taking into account you’re excluding complications during homebirth that resulted in transfer to hospital. (Thus possibly increasing the mortality stats for hospital?)

    Please explain how you can summarise from this that homebirths are just as safe as hospital births? I would say that they show you are better off having a midwife at hospital than at home! (From a life and death point of view that is!)

    RC

27. 
    Anonymous

    March 28, 2009 at 11:01 pm | Permalink

    I would also like an answer to the question Anonymous wrote on March 6.

    Your data is flawed because we don’t know the deaths in hospital were in fact transers from a homebirth that had gone wrong causing the death of a baby.

    Those results should not have been put in with the hospital results and should have been included in another table.

28. 
    lucy-in-the-sky

    February 19, 2010 at 7:04 pm | Permalink

    JLS:
    if you don't want to be doing elective inductions, indeed limiting to 3 per day, and that you say the ob's generally don't want to do it- then WHY? why are ob's, the learned experts, bowing to the demands of women, knowing that what they are asking for is wrong, dangerous and irresponsible?

    this is NOT caring for women's choice. but providing a service to ill-informed women for money. Would it not be best practice to educate women on the birth process and empower them to be happy for their body to dictate the babies birth date. Inductions are convenient for doctors too.
    This is just an indication of the McSociety we, the informed, must suffer.

29. 
    choice

    March 24, 2010 at 6:54 pm | Permalink

    I’m quite offended by the heading that infers that those who deliver in hospital ‘can’t be bothered’. Isn’t this about increasing choice rather than insulting those who CHOOSE to give birth in a hospital.
    Shouldn’t we be working towards uniting women not dividing.
    I’m also curious as to the comment “You retain control and are not obliged or encouraged to comply with hospital policy such as immunisation/injections that may have health implications further down the track.”

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