Posts Tagged ‘study’

July 11th, 2010

What the New Homebirth Study Doesn’t Tell You

Just something short and sweet today since there is so much hoopla over this new “Homebirth Study”.  Major problem I see with it?  It is not focused on planned home births with medical professionals which has been shown to be as safe as hospital births in other studies. In an attempt to spin Doctor, the group that published this study (in the heat of a public debate and legislature in New York City) did not focus on planned home births, but rather all home births.

Why is that a problem?
Because lumping in emergent situations or people who accidentally gave birth at home, or gave birth without a medical professional present in with people who researched, studied, and planned a birth at home with a medical professional is just foolish.

There should be two completely different studies.
One study focusing on the accidental home births, which no doubt would result in a three times higher risk of neo natal death.
And one study focusing on planned home births with medical professionals.
The problem is, the study on planned home births will not yield the alarming neo natal death results they want in the public eye. Which would not prove the hysterical point they are trying to make about home births being so “dangerous”.

A couple awesome posts proving why this study does not yield appropriate results?

Amy Romano, Midwife and awesome writer (who taught locally at the Yale School of Midwifery this last semester) wrote a blog called Meta-analysis : The Wrong Tool (wielded improperly)

Jennifer Block, Birth Advocate, Writer, and Author of Pushed wrote another awesome article about it too titled AJOG Home Birth Study Political?

The Big Push For Midwives made a press release also regarding this study.  All great reads.  Many other birth related organizations including CIMS (the coalition for Improving Maternity Care) also spoke out.
Just going to how how many true professionals in the field know the horrible inaccuracies being shared through this fly by night study.

(Other news articles on the planned home birth as safe as hospital birth)
USA Today
BMJ
The actual Study Text
Another Study

May 27th, 2010

Is Vaginal Birth after Multiple Cesareans an Option?

Many women think Vaginal Birth after Cesarean, better known as VBAC is only an option in women who have had one previous cesarean birth. Although the climate surrounding VBAC is not the best, a new published study has shown that VBAMC or Vaginal Birth after Multiple Cesarean’s is a safe option for women who do desire a trial of labor after more than one surgical birth.

Earlier in the year, MSNBC covered the study with an article they published online. The study suggests that :

Women who attempt vaginal childbirth after having several babies by cesarean section may not have a greater risk of complications than women who’ve had only one prior C-section.

Which is something most of the childbirth community has been working to prove for several years now. Personally I know several mothers who have had a VBA2C or even a HBA2C or more, which stands for Home Birth after 2 Cesareans. Amazingly, this study brought the infamous ACOG out of their cave to talk about the findings. ACOG says they do not suggest a VBAC or TOL (Trial of Labor) for a woman who has had 3 or more cesareans, but most of their providers still do not allow any options other than a scheduled cesarean after one previous cesarean section.

More information from the article, which talks about the study on VBAMC includes :

In the new study, however, researchers found that women with at least three prior C-sections showed no increased risk of uterine rupture during vaginal delivery.

In fact, none of the 89 women who opted to try vaginal childbirth had the complication, according to findings published in the British obstetrics journal BJOG.

While a study of 89 women is not a large scale study by any means, it is a huge step forward in research and more acceptance for VBAMC.

This information will help to show that women with 2, 3, or sometimes 4 previous cesarean sections can safely give birth vaginally if that it the path that they choose after having a previous cesarean birth.

Women today are not being given accurate information regarding the risks of elective repeat cesarean deliveries and the complications that can come, or increase with each subsequent cesarean birth, just a couple of the statistics include :

1st Cesarean
Risk of Hysterectomy : 0.65% (1 in 154)
Risk of Blood Transfusion : 4.05% (1 in 25)
Risk of Placenta Accreta : 0.24% (1 in 417)

2nd Cesarean
Risk of Hysterectomy : 0.42% (1 in 238)
Risk of Blood Transfusion : 1.53% (1 in 65)
Risk of Placenta Accreta : 0.31% (1 in 325)
Risk of Major Complications : 4.3% (1 in 23)
Risk of Dense Adhesion’s : 21.6% (1 in 5)

3rd Cesarean
Risk of Hysterectomy : 0.9% (1 in 111)
Risk of Blood Transfusion : 2.26% (1 in 44)
Risk of Placenta Accreta : 0.57% (1 in 165)
Risk of Major Complications : 7.5% (1 in 13)
Risk of Dense Adhesion’s : 32.2% (1 in 3)

4th Cesarean
Risk of Hysterectomy : 2.41% (1 in 41)
Risk of Blood Transfusion : 3.65% (1 in 27)
Risk of Placenta Accreta : 2.13% (1 in 47)
Risk of Major Complications : 12.5% (1 in
Risk of Dense Adhesion’s : 42.2% (2 in 5)

March 4th, 2010

New Home Birth Study Shows Increase for Out of Hospital Births…

Yesterday the Center for Disease Control (who collects National Medical statistics) release a report that detailed information on out of hospital births from 1990 to 2006.  I want to stress that the information ended in 2006, there is a good reason, but I will get back to that later in my post. What the information shows is a small, but noticeable increase in home birth, and births that take place in Free Standing Birth Centers. But surprisingly, this study also shows that the majority of women making these choices have already had at least one birth, in the hospital.

The number of midwife attended home births increase from 43% to 63% during this period of time. Which we already know that home birth, when attended by a trained medical professional is as safe as a birth in the hospital, if not safer because the lack of unnecessary intervention that takes place routinely in the hospital setting.

Unlike most people, I sat down last night, and actually read the study, news articles on it from ABC, and other various sources, and really analyzed it to write this post.

A couple interesting pieces of information that I pulled out of this study…..

• Out of 4,265,555 births for 2006, 24,970 births took place at home, and 10,781 took place in free standing birth centers.
• The majority of women choosing home birth were of white, non Hispanic descent, in the 25-29 age range.
• 33 of the births at home were to girls 15 years of age or younger.
• 6,582 of the births were second children.
• The state with the highest Home Birth rate was Oregon with 4,750 births.

Just to touch on a couple of these numbers, and pieces of information, what alarms me the most is the people choosing home birth. Mostly white, married, mid-aged women. When studies are showing more and more that the most at risk patients for unnecessary procedures, and some of the highest cesarean section rates are low income, unmarried, women of African American decent. Which is why I believe that in Health Care Reform we should be including more options for home birth insurance coverage, as well as alternative birthing coverage options for mothers who are low income on some form on medicaid.
It also shows that many of the women who are choosing home birth are very educated consumers. We need more child birth education options available to women, especially in the low income bracket. Programs that offer free classes paid by public health funds, WIC programs, etc.

33 of the home births, were to very young women, 15 years old or younger. There could be a lot of different explanations for this. But the one that stands out to me most is young women who hide their pregnancy until the baby finally comes and surprise!  It doesn’t seem that in today’s culture too many young women are signing up for any birth experience that doesn’t include someone with MD after their name and an epidural.

6,582 were their second baby. What this shows not only me, but one of the authors of the Study, Eugene Declercq, is that women are opting for their second birth out of the hospital because of what could have been a negative first birth experience, or just did not care for the hospital style maternity care system. Eugene was quoted in the ABC News story as saying “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,”
Which I completely agree with.
The numbers for other subsequent births include, third births at 4,500, fourth birth at 2,851, fifth birth at 1,808, sixth birth at 1,137, seventh birth at 827, and eight or more at 1,438.

Now that groups like ACOG and AMA are seeing these numbers, and this change, they are worrying because these births are taking money out of their own pockets. They have not been shy in recent years about their home birth policy, and how they feel about it even with a number of studies showing the safety.  With these new numbers, and developments, they have gone public saying that films such as The Business of Being Born and celebrity home births are having a great influence on the choices women are making for their births, but before opening their mouth, they should do their research.

Remember that little 2006 number I pointed out earlier in my post?  Well The Business of Being Born, the first mainstream film that showed home birth, as well as promotes it as a safe option was released in 2007.  Oooops!
So how are they going to explain this change, and how it happened before this mainstream film?  Maybe the fact that women were fed up with the maternity care system in hospitals long before Ricki Lake decided to work on a project on it?   It is nothing new that women do not like the one size fits all care the hospital maternity care system provides.
But that is a whole other post in itself.

A couple other things I wanted to talk about is where home birth is most popular, and rising.
The states with the highest home birth numbers are :

• Vermont
• Pennsylvania
• Wisconsin
• Utah
• Nevada
• Montana
• Idaho
• Washington
• Alaska
• Oregon

States with notable increases in home births :

• New Hampshire
• Maryland
• Virginia
• North Carolina
• Ohio
• Kentucky
• Alabama
• Kansas
• Wisconsin
• Minnesota
• California

I found the number of home births in my own state of Connecticut to be sad, but again, a whole other post in itself.
If you would like to read the full study yourself, the link for it is

http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_11.pdf