Thursday, April 5, 2007

Homebirth Saftey

Article taken from Compleat Mother

Each year in America, approximately 1% of the births occur in home settings. In Illinois in 1992, 1,218 families filed birth certificates that reflected a homebirth. Approximately one-third of the births occurred to Black families. Wisconsin had 591 recorded homebirths for the same year of which 22 were to Black families. 1 It is probable that many more Illinois homebirths actually took place but weren't recorded due to a discriminatory birth registration practice that places the responsibility for registering midwife-attended homebirths on the parents and requires a different mechanism than is used for any other occurring births.One measure of the safety of birth place is infant mortality, specifically, neonatal deaths within the first 28 days. According to the Center for Disease Control, there were 19,098 neonatal deaths for 1990 for babies born in a hospital. For those babies born at home, there were 260 newborn deaths. Infant mortality is figured as the number of deaths per 1,000 live births. The death rate for babies born in the hospital was 5.6 and for those born at home was 11.1, which would seem to indicate that a hospital is a better bet for a baby's survival. However, when the homebirth statistics are further broken down into who attended the birth, the picture changes dramatically. Direct Entry Midwives had the best outcomes with a death rate of 1.9 compared to CNM-attended births (2.9) or physicians -- D.O.'s (15.1) or M.D.'s (24.7). 2History Until 1900, homebirth was the place of birth for most every American. In fact, over 90% of those alive on earth today were born at home! Hospital or institutional birth is a relatively new occurance which began to gain in popularity during the 1920's due to physician promotion and the increased use of the automobile. As is the case today, it is a much more economic use of a physician's time to attend patients in a single place. There is also an economic incentive since a physician can attend to more than one patient at a time in the hospital and other, less important helpers can attend to the more mundane tasks of birthing. Part of this shift in birthplace must be attributed to the propaganda denouncing midwives which took place during this same time. With their economic and organized power, physician groups were able to legislatively increase hospital births by eliminating those who still attended homebirths -- by eliminating the midwife. From the 1930's through the 1960's state after state changed their laws to either restrict the practice of midwifery or wipe out the legal practice entirely. Yet no valid study then or to date has proven planned homebirth to be less safe than hospital birth. StudiesMany studies have been done in an attempt to prove that hospitals are the safest place to birth. Some of the earlier ones included all births which took place out of the hospital regardless of the gestational age or planned place of delivery. Those studies included miscarriages which took place at home as well as precipitous births and births that were unattended. To be valid, a study must compare equals and change only one item. Lewis Mehl did this when he matched 2,092 women and compared their birth outcomes. The result was that homebirth with a trained attendant was safer than a hospital birth. What does "safer" mean?Most families do not want to know the statistical odds of having a good outcome, they want to know more concretely exactly how a homebirth will be safer. Many studies address this by listing criteria and comparing the results. For example, Lewis Mehl's study listed the percentage of mothers with various complications:
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