Hello all,

What do you say to people when you line up all the research that defends the safety of homebirth, and the person you're talking to says: "well, I heard that if a woman chooses to give birth at home, and then needs to be transferred to the hospital, and the baby dies at the hospital, the death counts as a hospital death....so who KNOWS if homebirth is REALLY safe?!?"

Please help me. I don't believe that these perspectives doubting home birth are trully evidenced-based, but I find myself not knowing how to proceed. Does anybody know how these stats are handled? Can anyone cite specific research/studies to help me out? I'm doing graduate studies, so I don't mind looking up a specific article is someone just tells me what it's called, when it was published....I don't mind reading through long articles. I just want to know how to answer this question. Just please throw me some leads. Somebody...anybody...lol...???

Tags: birth, death, home, infant, midwifery, mortality

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Hi Marci,

I would start with the Dutch study that was published earlier this year. It was the largest study ever on planned homebirth.

http://www.washingtonmidwives.org/netherlands-study.shtml?7da7e360

Good luck with your studies.

Tracy
The fact of the matter is, we need more research, but I think the Dutch study is about the best we've got so far. There are numerous risk factors at a hospital also...infection rate is higher, instrument use is higher, the high use of unnneccesary pitocin which can cause fetal distress and uterine rupture. There are more. I would point out some of these things. In all reality what you are doing is making a choice between risk factors and that's hard to research. Who's to say that the risk of getting an infection at the hospital is worse than the risk of a baby needing to be transfered. Or that the risk of uterine rupture with pitocin is worse than a hemorrhage at home. It's hard to compare those things.
For me, on a much smaller scale, I asked my midwife how many, if any, babies or mothers she had lost. I understand that you can't apply this to any kind of statement about what is safer on the grand scale, but it make me feel good. :)
Thanks so much to everyone who replied! This is such a hard topic to explain to others, especially when there's so much skepticism that a homebirth can be safe. I also wish I knew who records a baby's death if a transfer occurs, but hopefully as more research comes out, we'll be able to have more answers:)
Deaths are recorded by the hospital on death cerificates and reported to the state. Each state has different laws regarding the details that must be reported. Most states do not require the hos to report where the birth was planned on the death certificate. This is one reason why it is so hard to get accurate, retrospective studies on planned HB. The current studies that are evidence based and reliable are done in "real time" and planned rather than done retrospectively after the fact (which is how most medical studies are done) this is one reason why it has been so hard to get reliable studies on HB accomplished in the US. When states begin to require hos to include planned place of delivery on the DC then this area of research can be more prolific. As of now, most reliable studies are done w/MWs and follow women from beginning of PG through delivery and beyond.
Awesome explanation - thank you so much!!!:)
I highly recommend Henci Goer's The Thnking Woman's Guide to a Better Birth. She cites numerous studies indicating that homebirth is at least as safe as, if not safer than, hospital birth.
take a look at this study (just out today) from Canadian Medical Assoc Journal showing safety of homebirth and lower risk of perinatal death. http://www.cmaj.ca/
Thanks so much for this study - this is awesome:) Hot off the press, too!!!
thanks so much for sharing your thoughts, and providing some insight into how the "recording" of these things works:)
Reliable evidence based studies are based on the planned place of delivery. Planned assissted HB and planned Hos births are seperated and compared. Transports to the hos (either during or after delivery) are considered as a "complication" of HB and listed as such in the planned HB category/stats. Deaths/complications that do occur are based on the planned place of delivery and categorized as such, regardless of where they actually occur. When stats are tallied the complications/deaths in planned HB that required transfer to the hos are listed as complications of planned Hb not just thrown into the hos category. Studies that are not based on planned place of delivery are not scientific, evidence based studies and should be disregarded as unreliable (these are the studies that find HB unsafe compared to Hos birth).

In additon to the studies already mentioned the following links have many, many studies on HB from all over the world. As a Grad student you have access to research databases right? I found a lot of studies that I could not get full text to but I have access to reaserch databases through my univ so I was able to access them that way. If you find a study that you need a subscription to view full text go to your reasearch database and seach for the article in medline--I found most there.

Happy researching :)

http://www.collegeofmidwives.org/Citations%20or%20text%2002/BMJ_HmB...

http://www.midwife.org/siteFiles/education/Home_Birth_10_08.pdf

http://www.gentlebirth.org/archives/homsafty.html#References

http://www.homebirth.org.uk/

http://www3.interscience.wiley.com/cgi-bin/mrwhome/106568753/HOME (this is part of the Cochrane Collboration and you will have to use your research database to get the articles, not available to public w/out paid subscription.)
Thanks so much for this detailed response - this cleared up a lot of questions that I didn't know how to answer when asked. These studies are amazing, and I'm sure I'll be able to get these through the research databases. The links are great:)

Thank you:)!!!!

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