Thursday, August 28, 2014

Home Birth in the USA

There are some things you may not know about home birth in the USA. For example, if you were told that "home birth is as safe as hospital birth" then you need to know that is, in fact, not true... not in America... not even for low risk women. Here is some information regarding midwives, birth centers, home birth, studies, statistics, guidelines, and more, that you may find useful for learning more about home birth in our country. There is a lot to read here but it is important information in order for you to make a fully informed decision.

Let's start with an introduction for those who have never stopped by before. My name is Dani. I'm a birth doula and former home birth advocate. Here's my story:

One key issue with home birth here is the many different types of midwives we have in the USA: CNMs, CMs, CPMs, LMs, LDMs, lay midwives..... So many!! Each type has different standards for education and training (or no standards at all). Here is an easy-to-read series that touches on the three main types of midwives:

Most home births in the USA are attended by a Certified Professional Midwife (CPM) or Licensed Midwife (LM) (CPMs and LMs are very similar). It's important to know that CPMs and LMs would not be able to be licensed in any other first world country. The standards simply are not rigorous enough. They are only legal in 26 states, do NOT earn hospital privileges as a part of their training process nor do they have any higher level education requirements -- as opposed to American CNMs/CMs and midwives in countries like the Netherlands, Canada and the UK. Safer Midwifery for Michigan has an eye-opening post that explains how little it potentially takes to earn the title “Certified Professional Midwife”:

Here is a great series exploring what it takes to become a midwife in other countries: The Education of Midwives Around the World

Many home birth midwives do not carry malpractice insurance. Why is insurance important? Insurance protects you. It means that if something happens that causes death or injury, you are able to have recourse and accountability. It means that if your child suffers an injury during birth, you can have compensation to help pay for life long care that may be needed.

There is no transparency for home birth midwives. They do not have a publicly accessible board where any disciplinary measures would be listed. How do you know if your midwife has ever practiced negligently, resulting in the death or injury of a baby or mother? What is your midwife's real record? How can you verify it? How do you know for certain how many births she has attended? Far too many mothers have trusted their midwives, trusted the friendship they developed with their midwives, trusted their judgement and reputation, only to find out after a bad outcome that their midwife was less than forthcoming.

Is a freestanding birth center safer than a home birth? That depends. In many ways, a freestanding birth center birth is just a home birth in someone else's home. What equipment does your birth center offer that wouldn't be available at home? Is the distance to the hospital closer? What types of midwives are running the center and who will attend your birth? The 2013 Birth Center study shows that out-of-hospital birth can be a reasonably safe option. However, it's important to know that this study does NOT reflect all birth centers in the USA. It was a select group of birth centers, majority of which were run by CNMs. The birth centers met certain criteria and were CABC-accredited. Out of 248 freestanding birth centers in the USA, only 79 were included in the study. Read more about the Birth Center Study here:

Here are studies and statistics regarding home birth safety. It's important to look at studies done in the USA. Studies regarding home birth in other countries do not reflect home birth in America: different midwives, different health care systems. Outcomes will be better in countries where, for example, midwives have high standards for education and training and where the midwives have hospital privileges. These links are studies regarding home birth in America... and every single study shows a significant increase risk for babies born at home:

1. The 2014 MANA study, showing an increase risk of intrapartum and neonatal death of 3-5x for babies born to low risk women: Mortality rates from the new study by the Midwives Alliance of America 

2. Studies in the USA, current as of January 2014: Home birth studies 

3. 2013 studies (USA and internationally) and CDC data: 2013 Home birth studies and statistics 

Advocates of the home birth movement use infant mortality to try to scare women away from our hospitals / maternity care.

Infant mortality is not the correct mortality rate to use to gauge safety of obstetrics / maternity care. Infant mortality is live birth through the entire first year. It does not include stillborn babies. It includes any and all deaths like accidents, disease, SIDS, etc that may happen day 4, day 204 or day 364... death at any time, for any reason for the first full year of life. Perinatal mortality is a much more accurate measure for maternity care (even the World Health Organization acknowledges this). It includes prematurity, fetal mortality (death of baby in utero), intrapartum mortality (death of baby during labor and delivery) and neonatal mortality (death of baby during first 27 days of life).

So why don’t the leaders of the home birth movement discuss perinatal mortality? Because the United States does very well with perinatal mortality, tied with countries like France and Japan, and actually better than countries like the Netherlands and the UK.

When will they stop trying to scare women using the wrong mortality rate?

Home birth in our country is sadly built on a foundation of lies and misinformation. An example is the press release written by MANA for the new MANA study: it's lies, cherry-picked info and misinformation. I shared more about this in an interview with SteadyHealth (as well as thoughts on HBAC/VBAC). To touch on this issue of the MANA study, I tried to put things into perspective:

"A home birth mortality rate of 1.62/1000 [from the new MANA study] for babies born to low risk women might not mean much of anything without having something to compare it to. 1.62/1000 just sounds low. However, when you compare it to the 2013 Birth Center study, for example, which has a mortality rate of 0.87/1000 for babies born to comparable risk women, then it makes you wonder why is the MANA study mortality rate twice as high?

These numbers all seem low, though. But it’s important to remember how many babies are born every year in the USA, specifically how many are born in an out-of-hospital setting. According to the CDC Wonder Database, in 2012 there were 38,997 midwife-attended out-of-hospital births - some in birth centers, some at home. So just for the sake of illustrating a point here, let’s round up to 40,000 births and let’s pretend they are all low risk women. According to the MANA study mortality rate of 1.62/1000, approximately 65 babies would die out of 40,000. According to the Birth Center study mortality rate of 0.87/1000, approximately 35 babies would die. According to the hospital mortality rate of 0.38-0.58/1000, approximately 15-23 babies would die. That’s a huge difference in the number of babies born at home that would not survive either childbirth or the first month of life. Now those mortality rates don’t seem so small.

What is home birth in America doing so wrong that their mortality rates are so much worse than hospitals and (certain) CABC-accredited birth centers? 1.62/1000 is the mortality rate for babies born to low risk women. This is not acceptable. Instead of addressing this issue and figuring out ways to make home birth better, safer they instead are spending their time trying to pull the wool over everyone’s eyes. They want people to think that 1.62/1000 is good. But it isn’t."

Read more here: SteadyHealth Interview

Another big source of misinformation is the popular film “The Business of Being Born.” Here is my critique of the film, which hits on misleading information that is widely shared, not just in this movie:

What makes home birth a reasonably safe option? Here are some guidelines:
What equipment is available at home versus in a hospital?
Home vs Hospital: The Equipment
What questions should you ask your midwife?
Considering Out-of-Hospital Birth?

Have questions or more suggested reading material? Share in the comments below or here on Facebook:

Thursday, August 7, 2014

Ignore Doula Dani Because...

I hear/see a lot of reasons why home birth advocates try to convince people not read my blog. And it's not just me, it's anyone who brings up issues or concerns with home birth. We all pretty much hear the same things to deflect and/or discredit those of us who vocalize our concerns. If I take part in these conversations, I ask "what have I written that is not accurate?" But instead of answering that question (or addressing any of the issues I bring up), they either delete my comments or they avoid my questions or they try to attack me personally (in hopes of hurting my credibility). What are the typical excuses home birth advocates use? Let's discuss them.

1. She is a "minion of Dr. Amy."

I don't keep it a secret that I read The Skeptical OB's website. Am I her minion? No. Come on. I am not the minion of anyone. What is it about Dr. Amy? Do people think if they visit her website that free will flies out the window? It's just the most absurd thing. Do I agree with everything she writes and how she writes it? No. I highly doubt anyone reads any website or blog or what-have-you and agrees with everything the author says. But I think she brings up a lot of excellent points and I understand what her bottom line is regarding home birth: to help prevent more preventable loss.

Perhaps next time I am involved in a discussion about home birth -- which I often am -- instead of addressing someone's comment I will just say "you are just one of Ina May Gaskin's minions, there's no point in discussing home birth with you." But I wouldn't do that. Because it's a cop out.

Let's be clear: I have come to the place that I have and have developed my opinions and my own stance about home birth because of my own personal experiences and from reading and looking up information myself. I have references to everything on my blog so people can look up information themselves. If you don't want to believe me or what I have written, I completely understand! I am a stranger on the internet. I get it. So here's the good news: I provide all of the studies and resources so you can check for yourselves... and I think you should check for yourself. Have I made a mistake? Let me know. I am not here to make a point by deceiving anyone. I want you to have truthful, accurate information so you can make your own informed decision. My blog may not offer up anything you didn't already know. Or it may bring up some things you hadn't considered or weren't yet aware of. Regardless, I want to offer up truthful information and if I have made any errors in information I have presented, I want to and will fix it.

2. She has an agenda.

My agenda? To help women understand that there is another side to the home birth propaganda. To help women make informed decisions. Home birth forums/websites/pages/blogs consistently censor and delete information that does not support their point-of-view. They do not allow open conversation. They maintain echo chambers. So it's hard for women to see that there is another side to home birth because of all of the censorship. I started my blog to help share that "other side" coming from the perspective of someone who truly understands the value and appeal of home birth, someone who initially wanted home births for my own children. Just as I would hate for a woman to choose an elective cesarean section without true informed consent, I'd hate for a woman to choose home birth without true informed consent.

3. She wants hits on her blog.

Why? What would gaining "hits" do for me? I don't earn money from my blog. I purposely keep it ad-free just so readers can be 100% certain that gaining hits does not benefit me in any way. Quite a while ago, I removed the site traffic counter from my blog. I truly have no incentive at all to try to gain hits.

4. She wants everyone to draw the same conclusion that she did.

It is none of my business where you choose to give birth and with whom you choose as your care provider. It does not make a difference at all to me - no difference whatsoever. Your choices do not validate nor invalidate my choices. I am not campaigning to make home birth illegal.  I do not want home birth to be illegal. I simply want women to understand what they are choosing when they choose to have a home birth in our country.

5. She's biased, angry, and extremely anti-home birth.

I'm not against home birth. In fact, I think it is an important option for women. I understand the benefits of home birth. My issue is not with the option to have a home birth and it is certainly not with the women/families who choose home birth.

My issue is with how home birth is promoted with misinformation.

My issue is with NARM and their lack accountability and their low standards.

My issue is with the higher mortality rates at home births in our country and how these deaths are not dealt with, they are swept under the rug, nothing is being done to make improvements.

My issue is that the focus of MANA and those at the forefront of the home birth movement should be "what can we do to improve outcomes for home birth." But instead their focus is and has been "what can we do to fool women into believing these outcomes are good."

Yes, this stuff makes me angry: misinformation, misleading women, censorship, preventable loss.... to me these are good reasons to feel angry. I try to keep my tone as kind as possible. It was easier for me at first when discussing these issues... but over time, after being censored and called names and seeing how loss moms are treated (horribly) and having people dodge my questions over and over and over again, it takes its toll. It is hurtful, frustrating, angering.... and sometimes I have a hard time not writing out those frustrations. But I truly try to keep my tone and blog to reflect my true feelings: that home birth is an important option that I do not want to see go away but that our home birth system needs an overhaul so that it is a truly safe option. Is it bad to be angry at times? Is one supposed to walk through life without ever experiencing that emotion? Of course not. I deal with my anger in the same way that I teach my children to deal with anger and frustration: with my words.

So why else should you ignore me? Have I missed anything?

The truth is.... I'm not here to tell you not to choose home birth. I just want women to make informed decisions. I want women to understand what's going on with home birth in our country.... the full scoop.

Saturday, August 2, 2014

Enough is Enough

No. Home birth deaths aren't just happening because of a "few bad midwives." Too many preventable deaths are happening because the entire system is flawed. It's not just risky, unethical choices causing death and injury.... it's ignorance and incompetence as well. And a system that does nothing to protect women and babies.... but instead protects the midwives.

No. We aren't trying to "end home birth." We aren't trying to limit choices. We think women deserve the BEST choices. We want home birth to be an option.... when it's a reasonably safe option. This can happen.... if enough people start demanding it.

No. We aren't trolls. We are real people with legitimate concerns. We are a group far larger than those of us in this video... all walks of life, *including* midwives. All with a common desire to help women sort through the misinformation out there on which the home birth movement is built.

No. We don't think hospital birth is always perfect and doctors never make mistakes. Negligence deserves consequences no matter where it happens and at least in a hospital, a family can seek accountability if there is negligence. There is no accountability for home birth injuries and deaths. Majority of home birth midwives don't carry malpractice insurance.

Yes. We know babies die in hospitals, too. Hospitals see every type of pregnancy - low risk, high risk, extremely rare conditions and complications, all gestational ages, etc. But it is rare for a healthy, full term baby to die in a hospital. The numbers don't lie. EVERY study on home birth in the USA shows an increase risk of death to babies born at home. EVEN FOR LOW RISK WOMEN.

Yes. That's even what the new 2014 study from Midwives Alliance of North America shows. Don't stop at their ridiculous, dishonest press release. Read the study, compare numbers for yourself. It will be hard because they didn't provide any comparison rates for you to see for yourself.... don't think for a second that that was an accident. Total mortality rates from the MANA study are 2.06/1000 (all risk) and 1.62/1000 (low risk mothers only). These numbers are NOT GOOD ENOUGH. Compare it to the 2013 Birth Center study and you can see for yourself.

Enough with the strawman arguments. Enough with the mother blaming. Time to stop living in denial. Time to stop sweeping the loss under the rug.

Time to start demanding better care for women who want to give birth at home.

Please watch our 3 minute "Not Buried Twice" campaign video:

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