CDC Study Says Home Births on the Rise in U.S.

Found on the abc News/Health website
Written By JOSEPH BROWNSTEIN
Published March 3, 2010

After having her first child in a hospital, Lorra Jacobs decided it was an experience she did not care to repeat.

She had two more children, and she chose to have both of them at home.

"When I had my first child in the hospital, I was young and I didn't know of any alternatives. It wasn't a real positive experience," said Jacobs, who now works as the office manager at Mat-Su Midwifery in Wasilla, Alaska. "It was a stark, very impersonal feeling, treating me like I was sick and not pregnant."

Jacobs explained she believed she had more control over many aspects of the birth when it took place at home, including whether she got to be with the baby after delivery and having the siblings there at the birth.

"Doing a home birth, I felt like I had a say," said Jacobs. "This is not the hospital's baby. This is my baby."

New numbers released today by the Centers for Disease Control and Prevention indicate that a very small but slightly growing number of women are making the same choice that Jacobs did. While less than 1 percent of all births in the United States take place outside the hospital, the number of those births taking place at home has increased by 3.5 percent between 2003-04 and 2005-06, according to the new report. The stats say there were 46,371 home births in 2003-04, and 49,438 home births in 2005-06.

"They're still not that common, but we did see some increase," said Marian MacDorman, a statistician at the CDC's Nation Center for Health Statistics and one of the study's authors.
The new numbers came after a period in which births outside the hospital, which can include births at a birthing center or in a doctor's office, as well as home births, had been decreasing since 1990.

Some of the breakdowns behind the new numbers suggest that the most recent trend might be a negative reaction to a hospital birth experience, since the majority of mothers choosing a home birth have had children before.

"The fact that it's primarily women who had kids before and had birth in hospitals before, certainly suggests it's a reaction to their prior birth," said Eugene Declercq, a professor of community health sciences at the Boston University School of Public Health, and a author of the study. "It certainly suggests it's an experience they don't want to repeat."

Finance Not A Likely Driving Force

Home births may cost only a quarter or a third of what a hospital birth costs -- $7,737 for a vaginal delivery, $10,958 for a C-section, according to a 2004 March of Dimes study -- but finances do not appear to be a prime reason for choosing home births.

The CDC's numbers appear to suggest that finances are not a driving force, since mothers who are older and better educated seem to choose home birth most often.

"I suspect that economic issues are not the main issues," Eileen Ehudin Beard, a nurse and senior practice adviser for the American College of Nurse-Midwives. "I suspect consumers are becoming more informed … and seeing home births are a safe alternative for healthy women with a qualified provider."

She said a likely cause of any increase is a desire to avoid the interventions hospitals perform, ranging from cesarean sections and epidurals to controlling when the mother is with the newborn.

"I think a lot of consumers are really scared by the high cesarean rate, and they're becoming aware that Caesarian is a major surgical procedure," said Beard.

She stressed that home birth is only a safe option for healthy mothers who are not expected to have complications.

A Dearth of Evidence About Safety of Home Births

Home birth remains a contentious issue.

The American College of Obstetricians and Gynecologists has long opposed home births, citing a lack of data regarding their safety.

"Studies comparing the safety and outcome of U.S. births in the hospital with those occurring in other settings are limited and have not been scientifically rigorous," according to the organization's 2007 statement.

It goes on to say that, "Until the results of such studies are convincing, ACOG strongly opposes home births. Although ACOG acknowledges a woman's right to make informed decisions regarding her delivery, ACOG does not support programs or individuals that advocate for or who provide home births."

While the risk of neonatal death is low overall, it may be higher at home births and that is a problem, said Dr. William Barth, Jr., chair of ACOG's committee on obstetrics practice and chief of the division of maternal-fetal medicine at Massachusetts General Hospital

"It's one of those situations where overall the risk is low, but it is increased two to three-fold," he said. "Even though it's a rare outcome, it is a catastrophic outcome. It's preventable in that it is less likely in the hospital."

Explaining his stance, Barth cites a study presented by researchers from Maine Medical Center at the Society for Maternal-Fetal Medicine meeting in Chicago in early February. The study, a meta analysis of research from around the country comparing home births to hospital births, appeared to show a twofold increase in the rare event of neonatal death at a home births.

Declercq said one problem with relying on this study is the results may have been skewed because the researchers relied on the location the birth was planned for rather than where it actually took place.

While the gold standard of clinical research is the double-blind, placebo-controlled, randomized clinical trial, it is impossible to blind a mother to whether she is giving birth at home or in a hospital, and most mothers are unwilling to be randomized to a home birth or hospital birth.
Studies of home versus hospital birth are typically the less reliable cohort study, where women who chose one option or the other but have otherwise similar characteristics are compared.

Barth said that an attempt to run a randomized controlled trial of home versus hospital births had to be canceled because only 11 mothers signed up.

Home birth advocates have cited several studies supporting the safety of home births among low-risk women. However, those studies have taken place in the Netherlands and Canada.
Barth said its unrealistic to apply the findings to the United States.

"Those are highly regulated, highly integrated systems. Their system is prearranged -- it's very different from the systems available in the United States," he said.

Agreeing with that notion, Declercq argued that it is the lack of such a setup that keeps safer
home births from being a bigger option in the United States.

"In the United States, people who want to have a home birth have to fight the system," he said, explaining that there is a lack of support for a midwife who decides a patient is too high-risk for a home birth and should be transferred to a hospital.

"I think if you actually move to a system like that, it would be fine in the United States, because the evidence from other countries suggests that it is as well," said Declercq.

Looking at the numbers, he said, adopting such a system probably wouldn't lead to widespread home births in the United States. It would not climb to 30 percent like the Netherlands, but would be closer to the rise to 3 percent seen in the United Kingdom.

But for now, he said, it is likely to remain a highly charged issue, with some advocates of home birth irrationally opposing the choice of a hospital while opponents cite risks of home birth while ignoring complications that can happen at a hospital.

"The mothers who are having these home births are not crazy, unaware people," said Declercq. "They plan carefully, they think about this all the time. They think they're better off not having the interventions that they feel will happen unnecessarily at hospitals."

Is Water Birthing Safe?

Found on the Fox News.com website
Originally published Wednesday, February 03, 2010

Supermodel Gisele Bundchen made news recently by giving birth to her son Benjamin in an unusual way: at home in her own bathtub (Unusual way? When did water birth become unusual?). It wasn't an accident or surprise delivery; instead she did it as part of a growing trend called "water birthing," considered by some women and midwives to be a healthier, more natural alternative to traditional hospital births.

Mothers who choose water birth go through labor and delivery immersed in warm water (not always. Many Moms choose to get in and out of the tub), believing that pain will be less severe and the experience more enjoyable and relaxing. Some studies have shown that mothers who choose a water birth request fewer painkillers than women who don't, and fewer drugs translate into the perception of a safer and more natural birth (definitely more natural).

If it's good enough for a celebrity supermodel, water birthing advocates suggest, then it's good enough for most women. But is it good for the baby?

The research isn't clear.

In a 2002 study published in the journal Pediatrics titled "Water birth: A near-drowning experience," researcher Sarah Nguyen questioned the safety of water births and described instances of infants inhaling water and feces following underwater deliveries. In a follow-up commentary, other researchers concluded, "At this point, we are convinced there is no evidence to support any benefit of underwater birth for the neonate, and plenty of evidence to suggest harm [including] the potential for drowning, hyponatremic seizure activity, infection, and pneumonia."

The American College of Obstetricians and Gynecologists does not recommend water births, suggesting instead that children born in hospitals are safer — if for no other reason than professional medical help is immediately available in case of complications (does a water birth have to be at home? There are several hospitals in my area that have birth tubs in the room. If hospitals are incorporating them in their birthing suites how dangerous is it? You know hospitals would NEVER offer anything they think is dangerous). Unless your bathtub happens to be located near a neonatal unit, emergency medical help may not be available during the baby's first minutes of life.

Of course, there is some risk to both the child and the mother during any birth, whether it occurs in a bathtub or a hospital. All births are natural, yet some births are safer than others.

Found on the Natural Child.org website

"Why doesn't the baby drown?"

To me this was the obvious concern; after all, anybody who doesn't consciously hold his or her breath underwater is in fear of drowning. The answer is so logical and so simple. A baby doesn't drown during a water birth because the baby is already in water in the womb. It takes air for breath and when a baby comes from water into water without the introduction of air, the lungs remain collapsed and no water can enter. Once the baby is brought to the surface and its face hits the air, breath is drawn and life on earth begins. Knowing these facts, it is clear that water birth is a safe way for a baby to be born.

Resources found on the Waterbirth International Website

1. Waterbirth Recommendations - RCOG and RCM Joint Waterbirth Recommendations -
2. Guidelines for safe Water use
3. Safety Recommendations for Pool Use

You will also fund several articles and Reviews on the Water Birth International website. Click Here to visit them.

No need for pregnant women to fast during labor

Found on the Reuters website
Written by Megan Brooks
Originally published on January 20, 2010

NEW YORK (Reuters Health) - There is no reason why pregnant women at low risk for complications during delivery should be denied fluids and food during labor, a new Cochrane research review concludes.

Health

"Women should be free to eat and drink in labor, or not, as they wish," the authors of the review wrote in the Cochrane Library, a publication of the Cochrane Collaboration, an international organization that evaluates medical research.

Dr. Jennifer Milosavljevic, a specialist in obstetrics and gynecology at Henry Ford Health System, Detroit, who was not involved in the Cochrane Review, agrees that pregnant women should be allowed to eat and/or drink during labor.

"In my experience," she told Reuters Health in an email, "most pregnant patients at Henry Ford are placed on a clear liquid diet during labor which includes water, apple juice, cranberry juice, broth, and jello. If a patient is brought in for a prolonged induction of labor, she will typically be permitted to eat a regular diet and order anything off the menu in between different induction modalities."

Milosavlievic has "not seen any adverse outcomes by allowing women the option of liquids and/or a regular diet in labor."

Standard hospital policy for many decades has been to allow only tiny sips of water or ice chips for pregnant women in labor if they were thirsty. Why? It was feared, and some studies in the 1940s showed, that if a woman needed to undergo general anesthesia for a cesarean delivery, she might inhale regurgitated liquids or food particles that could lead to pneumonia and other lung damage.

But anesthesia practices have changed and improved since the 1940s, with more use of regional anesthesia and safer general anesthesia.

And recently, attitudes on food and drink during labor have begun to relax. Last September, the American College of Obstetricians and Gynecologists (ACOG) released a "Committee Opinion" advising doctors that women with a normal, uncomplicated labor may drink modest amounts of clear liquids such as water, fruit juice without pulp, carbonated beverages, clear tea, black coffee, and sports drinks. They fell short of saying food was okay, however, advising that women should avoid fluids with solid particles, such as soup.

"As for the continued restriction on food, the reality is that eating is the last thing most women are going to want to do since nausea and vomiting during labor is quite common," Dr. William H. Barth, Jr., chair of ACOGs Committee on Obstetric Practice, noted in a written statement at the time.

But based on the evidence, Mandisa Singata of the East London Hospital Complex in East London, South Africa, an author on the new Cochrane Review, says "women should be able to make their own decisions about whether they want to eat or drink during labor, or not."
Singata and colleagues systematically reviewed five studies involving more than 3100 pregnant that looked at the evidence for restricting food and drink in women who were considered unlikely to need anesthesia. One study looked at complete restriction versus giving women the freedom to eat and drink at will; two studies looked at water only versus giving women specific fluids and foods and two studies looked at water only versus giving women carbohydrate drinks.
The evidence showed no benefits or harms of restricting foods and fluids during labor in women at low risk of needing anesthesia.

Singata and colleagues acknowledge that many women may not feel like eating or drinking during labor. However, research has shown that some women find the food and drink restriction unpleasant. Poor nutritional balance may be also associated with longer and more painful labors. Drinking clear liquids in limited quantities has been found to bring comfort to women in labor and does not increase labor complications.

The researchers emphasize that they did not find any studies that assessed the risks of eating and drinking for women with a higher risk of needing anesthesia and so further research is need before specific recommendations can be made for this group.

SOURCE: Cochrane Library, 2010.