The Sept 15 issue of Canadian Medical Assoc Journal has a new study on the safety of homebirth in comparison to hospital birth.

The full study with stats is attached here or can be read at this link:

The study's conclusion says:

"Our study showed that planned home birth attended by a regis-
tered midwife was associated with very low and comparable
rates of perinatal death and reduced rates of obstetric interven-
tions and adverse maternal outcomes compared with planned
hospital birth attended by a midwife or physician. Our popula-
tion rate of less than 1 perinatal death per 1000 births may
serve as a benchmark to other jurisdictions as they evaluate
their home-birth programs. "

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In Canada, if you have had 1 cesarean, you are considered low-risk, and will be offered a homebirth. VBAC stands for vaginal birth after cesarean. This is radically different than the hoops women are having to jump through in other countries to have a VBAC at home or in the hospital system.

I'm from TX too S&A! I'm glad to hear that quality care is making a comeback in our state.

I'm out of the country now, but the maternity services in Australia closely mirror the US, and the c/s rate is over 30% here also.

My last baby was born at home after 4 hours of active labor, after 1 previous c/s, and we're fine. The labor was so much easier than recovery from surgery. There was one point, about 10 minutes before she was born, that I thought about an epidural, but otherwise the pain was nothing compared to trying to get out of bed the first time after a c-section; it came in bursts that peaked and then stopped so there was a breather between contractions. I had planned on, and paid for, a midwife to attend, but the labor went too fast and she arrived in time for the placenta. I wouldn't change anything, but that's only because things turned out OK.
Oh I see. Yes, here a woman that would like a VBAC is welcome to that choice. Why is this so difficult there? What studies or "facts" are they looking at to come to the conclusion they have? It's not fair at all. Do people feel this will change in time? What is being done to help this along? So many questions.
The biggie is fear of uterine rupture. The fear is driven by the fact that uterine stimulants have been used in the past to hurry along women who have had cesareans and who were laboring for a vaginal birth. Some of those families sued for deaths and disabilities caused by ruptures and were rightly compensated. Now the obstetrics groups are afraid of VBAC instead of being afraid of uterine stimulants, so hospital VBAC is thoroughly discouraged to the point of arresting some women who refuse cesareans and forcing them to have surgery. This is of course only one aspect of this issue.

Families and some practitioners are thankfully coming together to try and reorient maternity services to provide best practice care. There's lots of momentum currently. Besides this community, which includes the Business of Being Born producers, and the authors of My Best Birth, there are other Google-worthy sites:

The Unnecesarean
Woman to Woman Childbirth Education
Marsden Wagner
Henci Goer
Sarah Buckly
Ilithyia Inspired
Lookinglass Alice
Childbirth Connection
Joyous Birth
The Maternity Coalition
Gloria Lemay
Nursing Birth
Homebirth Australia
Midwife Mutiny
Diary of a Sydney Midwife

We all are working toward change in our own ways, even if it is just by researching birth, and yes it will change, but just when remains to be seen.
Might I also add to your list? :)

The MAMA Campaign: This stands for Midwives and Mothers in Action and is advocating for CPMs as a HIgh-value option for quality cost effective maternity care

The Birth Survey: A project of CIMS (Coalition to Improve Maternity Services), intended to move towards transparency in maternity care, providing a "consumer reports for birth." Specific feedback from moms on their birth experience, birthplace and provider will be gathered through the survey and results made available for all to view online in order to make the best choices for their care provider and place of birth.

The Coalition for Improving Maternity Services (CIMS): a coalition of individuals and national organizations with concern for the care and well-being of mothers, babies, and families. Our mission is to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs. This evidence-based mother-, baby-, and family-friendly model focuses on prevention and wellness as the alternatives to high-cost screening, diagnosis, and treatment programs.
Science and Sensibility is great too for evidence based research on birth.
Thanks for the info. I will add this to my Fav's :) Also thanks for the posting and info from the study author. There was no reply to this link so I am posting my appreciation here.
Thank you for all the information. Yes, I have heard of this fear with VBAC's and granted it's something to consider but like you said the considerations should be following the direction of the use of stimulants all together. It would seem to be the wiser starting point. No matter what the fears it should still be a choice; I mean there are fears that woman have of many other things as well, even in a low risk pregnancy. There are even fears in a home birth and even others who would fear a hospital birth. There are fears for every option period, but in the end the choice should be in the hands of the woman who is birthing. This burns me, really burns me. These laws are so disrespectful to woman. To make a woman drive or move to another area just so she has a choice to birth as she would like to, or arrest a woman..???! Good lord. I'm glad to see there are so many smart woman out there that are reading up on birth and their options, it will make a difference. I also hope that there will be a day soon where these laws change. I'm going to ask around here and see if there is anything that myself or other woman could be doing here to help make that change. Thank you again.
As Susan said the fear of UR and the use of drugs to induce/augment labor in VBAC women caused the risks to be overstated. The ACOG (American College of OB & Gyn) decided that since the risk of UR and litigation was a problem that they would place strong restrictions on their practice guidelines in VBAC. The OB's do not have to follow these guidelines but leave themselves open to litigation by not following them. Basically, these recommended practices dictate the "standard of care."

The latest recommendation for VBAc is that all women who are attempting VBAC should only be allowed to do it in a hosp that has "the ability to perform an immediate c/s" this means that throughout a woman's entire labor & delivery an anesthesiologist and an OB be immed. avaiable and on site anytime a woman is atttempting a VBAC. In most cases, the anesthesiologist and OB are on call but not on site. Making them stay on-site means that they cannot see other patients in the meantime. This means less money for them. They are stuck at the hospital waiting on 1 woman to give birth. This also menas the hospital has to provide more anesthiologists b/c they work on-site not on-call. This costs the hosptial more money too. This is the biggest reason why a lot of OB's and hosp have decided to ban VBAC stating that they cannot meet the recommendations of the ACOG concerning VBAC and being able to perform an imm c/s. To make matters worse, malpractice ins companies have started to deny coverage for OB's that perform VBAC in many areas of America. It is easier and more profitable for OB's and hosp to ban VBAC and require all women w/previous c/s have another.
Here's the problem I see with ACOG and other doctors. I don't believe they are out for the least not the majority of them. Malpractice insurance is very high and I think most of them are doing this because the want to. But they truly, truly believe that most HB moms don't care about the safety of their babies and feel like any conssesions to them would be condoning the idea that it's ok to not be safe as long as you like the experience. As I'm sure most of you know, that's not the case, but that's how most physicians I talk to feel like.

More than anything there is a cultural problem here in the US. Whereas in other countries, HB and midwifery are very much a part of the system and have been for a while, that's not so here. Midwifery in general has been seen as suspicious. Even many CNM's who birth in hospitals are viewed that way. I doubt many physicians have gotten past the scolding phase to really talk to women who have given birth at home. I think it is unfair, though, to believe that physicians have this view point just for money. It's more of an ingrained believe system that needs to be upturned.
I also wonder how much of ACOG's motivation stems from the belief that OB's are the "experts" in labor and birth, that entrusting your care to a MW, much less having a HB, is just plain reckless--and that if everything goes smoothly then it was simply because the mom/baby got lucky. How many OB's are willing to admit that their field of medicine uses the LEAST amount of evidence-based care? That's a fact. How many OB's have watched a fully natural labor and delivery (they usually only attend the delivery of babies, not mom's entire labor), much less seen hundreds of them as do most midwives? I'm guessing none. OB's are trained surgeons. They are trained in testing, interventions, medications and cesarean delivery. They are not trained (and most seem to have little interest) in normal, physiological labor and birth with no interventions. They do what they went to school to learn to do. The use of unnecessary medical interventions on low-risk moms as standard procedure causes further interventions to be required and often leading to instrumental or surgical deliveries. What I find very frustrating is when you see this domino effect of interventions resulting in baby being born via cesarean, is the claim that the doc "saved" the baby by doing a cesarean. He/she very well may have. However, the chain of events resulting in what led up to the cesarean's necessity are never discussed.

I'm glad we have OB's. Women need them for their reproductive health. However, pregnancy is not a medical condition. There are times when medical situations do arise where an OB's expertise is needed, but over 85% of low-risk women could give birth without interventions if they were given the chance (and wanted to, of course). Sadly, in the hospital most women aren't given the chance and they are rarely encouraged to go natural, should that be their choice.
Well written, and very true.
What does everyone think about the comment that was posted on the CMAJ article?

I don't know enough about 20-week vs. 28-week stillbirths to know if the commenter was making a valid point or not.

I do understand that, regardless of how the study's author's analyzed infant mortality, that the incidences of obstetric interventions and adverse maternal outcomes was lower with HB.



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