Sad story

Buzzy Bee wibbled

We're in a slightly better position here because there is a duty
of care placed upon the NHS, so if they fail to send someone out
to a woman saying "I'm in labour, I'm having it at home, even
though its breech" they are opening themselves up to be sued if
they do not and something goes wrong. Many Trusts would
unfortunately still fail to send someone out.

Even this is undone by the acts of some women though. I read a story
recently (warning: unpleasant)...











A woman in the Bristol area was charged earlier this year with
either murder or manslaughter, I forget which. She refused OB/MW
care early on, despite previous pregnancies' complications, and when
she took herself into hospital for a late scan because she thought
the baby was breech, and it was, she still refused any MW care. It
was put to her that completely unassisted breech birth was not going
to be easy and that an experienced MW would be happy to attend her
homebirth to help. She still refused. When she went into labour 2
MWs attended but by law were not allowed to assist her (one wonders
why she let them in at all). They watched the baby emerge and get
stuck, half in, half out. She would not let them help to get the
baby out and they could have been sued if they had even touched her
- they weren't willing to risk it. After *hours* rather than minutes
she was too exhausted to continue and agreed that they could help
her. The baby was dead.

The way the story I read was written didn't put a bad spin on
homebirths, or MW services, but on the mother herself, who made a
bad judgement in the writer's (and the court's) opinion. I can't
quite see why she had the scan at all if she was so anti-hospitals
or medical professionals, and of course there was no information on
whether she'd attempted to turn the baby herself so we can't know.
And of course, being written about in a particular magazine, the
story has probably put a fear of homebirths into its uninformed
readers. Sigh.

I didn't want a homebirth, and couldn't have one for T because of
*my* medical situation, nothing obstetric. My reasons for not
wanting one, had I been in perfect health, are largely domestic
though. We have very thin walls, not much space, and I certainly
couldn't have concentrated on labour thinking about whether the
bathroom was clean, fixating on the parts of the walls that need
painting, worrying about the postman ringing the doorbell, next door
wanting their football back out of our garden, the telephone going
as people try to find out what is happening, and all the other
domestic issues that definitely frustrated me when I was
recuperating and trying to nurse a newborn! We'd have had to hire
professional cleaners just to get the house in any fit state to
admit a MW let alone birth a baby. ;-)

Jac

What bothers me is that OF COURSE home births (and midwife assisted births)
are going to come out looking safer. If someone is high risk because of a
prior pregnancy, or has signs during the pregnancy that there are possible
complications, or, probably, has genetic indicators in mother or siblings
that this might not be a good idea, they're probably going to go with a
medical center. And, if medical centers get a vast majority of the
complicated pregnancies, they're going to, based on statistics alone, have a
higher rate of fetal and maternal death than home births.

The Maternal/Fetal death rate after the first trimester has been FALLING
since hospital assisted birth and interventions became available. If home
birth was safer overall, this wouldn't have happened.

Similarly, if you look at maternal/fetal death rates, a low risk OB is going
to look better than the most qualified perinatologist on the planet-because
a perinatologist only takes those women as patients who have, or are at very
high risk for, complications which are life threatening. Doesn't mean that
the low risk OB is safer than the perinatologist-only that the low risk OB
sees only patients who are at much lower risk of problems.

If you want to have a home birth, and it's your cup of tea, go for it. But
that doesn't mean that it's safer for all women. Just look at statistics
from when it was the option for all women.

Donna wrote:
"Larry McMahan" wrote in message
...


:
: Larrry, Larry... do you have any respectable cites for any of what you

write

: above?

You betch'ch, Donna. I would not make claims like that without!




Snip


Perinatal loss in planned and unplanned home birth. The Northern Region's
Perinatal Mortality Survey Coordinating Group. BMJ 1996;313:1306-9.


Unable to find the article.


Home versus hospital deliveries: a prospective study on matched pairs.
Ackermann-Liebrich U, Voegli T, Guenther-Witt K, Kunz I, Zullig M,

Schindler C,

et al. BMJ 1996;313:1313-8.


Unable to find the article.


Outcome of planned home and planned hospital births in low risk

pregnancies

in the Netherlands. Wiegers T A, Keirse M J N C, van der Zee J, Berghs G

A H.

BMJ 1996;313:1309-13.


Unable to find the article.

These three can be found he

http://bmj.bmjjournals.com/content/vol313/issue7068/

Mary

Iuil wrote:
"Donna" wrote

www.homebirth.org.uk and www.aims.org.uk both have plenty cites for
the sort of things Larry has talked about.

Megan.

Those are homebirth advocacy websites.


AIMS is a midwifery advocacy site, not just homebirth. And they base their
reports on published articles in peer reviewed journals. For example, the
first link I posted last night cites a reference from the Lancet, the
British equivalent of the NEJM. They also cite the British Medical Journal
and British Journal of Midwifery elsewhere on the website, among others.
Both of thoses publications would be considered eminently reputable. Or do
you only want American cites?

Jean



One problem I have with some data presented in midwifery sites and
documents is that it is sometimes taken out of context to the point
where the meaning is changed. Now, please don't ask for an example,
because I never bothered to save any. ;-) I'm just going by memory, so
either trust me or not. Anyway, I have definitely seen some
pseudoscience going on with midwifery. I have also seen some
pseudoscience going on with the medical establishment. It pains me to
see the two sides get pitted against one another. Neither is wholly
better than the other; they both have their pros and cons, and there are
situations in which one type of care is better than another (both ways).
I really wish that the fight would just stop. :-) I wish that they
would focus more on telling women which type of care *might* be better
for which type of situation, so that women can make a more informed
choice without the hoopla getting in the way. (and of course I can say
the same about almost every other aspect of child rearing, since it
seems like *everything* has some emotional charge involved)

Marie" wrote in message
I would do it again (except that I won't be having more babies).
Marie the unwise

I'm sorry if my opinion offends you. Having an unassisted birth is a risk
that *I* would not be willing to take. That goes for not having any prenatal
care either. If you were comfortable taking the risk of not having any care
and giving birth unassisted, then that is the risk you were willing to take.
I do wonder though how you would have felt if something would have happened
and it could have been prevented, but since your outcome was a good one, we
will never know. I do know that I wouldn't have wanted to go through labor
and have to worry about if the baby was doing okay. I'm not advocating lots
of interventions, but certainly a licensed midwife can assess the situation
and take precautions. Not having a trained person there would totally
distract me from giving birth.
--
Sue (mom to three girls)

"Mary W." wrote in message
k.net...

These three can be found he

http://bmj.bmjjournals.com/content/vol313/issue7068/


Thank you, Mary. I wonder why they didn't come up on PubMed? Probably my
search technique, I imagine. Anyway, I read the abstracts, and all three
support that carefully selected low risk home births can be as safe as
hospital births. While these three abstracts are relevant, current, and
supportive of the safety of homebirths (which is not the case with the vast
majority of the list of references provided above) they still doesn't
support the statements made by the OP that homebirths are "always as safe as
hospital births and sometimes safer", and so far nothing even remotely
relates to his assertion that "for a multipara with no contraindications, a
hospital birth at 40 is as risky or riskier than a homebirth.". (And
the last assertion, even if someone *could* come up with a respected cite
for it, it's irrelevant. So what if statistically a 40 year old has a
higher risk of poor outcome than a homebirth? How is that at all relevant
to homebirths being safer than hospital births? Is the implication that 40
year olds shouldn't have children? Or that 40 year olds shouldn't have
homebirths? I mean, what is the inference to be drawn there, even if it
could be cited? I'm confused.

For the record, I'm not against homebirth (except for me grin), assuming
that women are fully informed of the risks and benefits to themselves and to
their babies. Nor, for that matter, am I against elective C-sections,
assuming that women are fully informed of the risks and benefits to
themselves and their babies. What I am against is misinformation and spin
instead of accurate, unbiased research.

Anyway. Off for the weekend. Again, thanks for the link!

Donna

"Iuil" wrote in message
...



"Donna" wrote

www.homebirth.org.uk and www.aims.org.uk both have plenty cites for
the sort of things Larry has talked about.

Megan.

Those are homebirth advocacy websites.

AIMS is a midwifery advocacy site, not just homebirth. And they base
their
reports on published articles in peer reviewed journals.

I just went and poked around AIMS again. It's an advocacy site, not an
unbiased resource. It's wonderful for what it is, but it's strongly biased
in favor of midwifery/homebirths, etc. With a cursory review, I didn't
see any kind of acknowledgement that the choice to have a homebirth *does*
carry with it some increased risks, nor did I find any kind of references to
data that doesn't support homebirth. Which is perfectly normal for this
type of website, by the way. I wouldn't go to *my* industry's websites
(ACP/DIA) and see a lot of unbiased reporting on how pharmaceutical pricing
is regulated. Not a criticism of AIMS - just an explanation as to why I
don't consider it unbiased.

For example, the
first link I posted last night cites a reference from the Lancet, the
British equivalent of the NEJM.

I didn't see your post, unfortunately. I have been skimming the newsgroup
over the last week or so, and haven't kept current. What was the link?

They also cite the British Medical Journal
and British Journal of Midwifery elsewhere on the website, among others.
Both of thoses publications would be considered eminently reputable. Or
do
you only want American cites?

No, I'm not particularly biased towards American data at all. I don't know
anything about the BMJ, although the Lancet is certainly, as you put it so
perfectly, "eminently respectable". I stayed away from midwifery
journals for the reasons that another poster outlined in the post above -
that sometimes the data in midwifery journals gets spun enough that the
actual science is lost.

Again, please don't interpret my posts as anti-midwifery/homebirth/whatever.
I'm very much in favor of women being fully educated in their options, and
being able to select the best situation for themselves and their births. I
just get a bit ... irritated sometimes that so much misinformation gets
spread. It's always better, imho, to have information, pro *and* con, about
an issue, so one may make an informed choice.

Donna

"Vicky Bilaniuk" wrote in message
...

It pains me to
see the two sides get pitted against one another. Neither is wholly
better than the other; they both have their pros and cons, and there are
situations in which one type of care is better than another (both ways).
I really wish that the fight would just stop. :-) I wish that they
would focus more on telling women which type of care *might* be better
for which type of situation, so that women can make a more informed
choice without the hoopla getting in the way.


Exactly, Vicky.

My point, but much more succinctly stated than I have thus far managed to
do.

Donna

I certainly understand how you feel. On the other
hand, what are you advocating here?

What I got from that was trust your instincts.

Tori

--
Bonnie 3/20/02
Xavier due 10/17/04

"Donna" wrote

I just went and poked around AIMS again. It's an advocacy site, not an
unbiased resource. It's wonderful for what it is, but it's strongly
biased
in favor of midwifery/homebirths, etc. With a cursory review, I didn't
see any kind of acknowledgement that the choice to have a homebirth *does*
carry with it some increased risks, nor did I find any kind of references
to
data that doesn't support homebirth. Which is perfectly normal for this
type of website, by the way. I wouldn't go to *my* industry's websites
(ACP/DIA) and see a lot of unbiased reporting on how pharmaceutical
pricing
is regulated. Not a criticism of AIMS - just an explanation as to why
I
don't consider it unbiased.


Midwifery is the standard of care in the UK and elsewhere for pregnancy.
AIMS is an advocacy group for improvements in midwifery practises, both in
homebirth and in hospital settings. The two can go hand in hand. However,
had you looked at the AIMS reference pages you would have found the same
journals I did.



Again, please don't interpret my posts as
anti-midwifery/homebirth/whatever.
I'm very much in favor of women being fully educated in their options, and
being able to select the best situation for themselves and their births.
I
just get a bit ... irritated sometimes that so much misinformation gets
spread. It's always better, imho, to have information, pro *and* con,
about
an issue, so one may make an informed choice.


That's only become clear to me today. I think we're actually very much at
the same point, just looking in different directions due our personal
previous experiences.

Jean