Mother Talkers

Homebirth debate

by NJmom

Fri Dec 21, 2007 at 08:09:42 AM PDT

Amy Tuteur takes on the homebirth advocacy groups on her website, Homebirth Debate.  Tuteur, a trained OB, is unabashedly against homebirth and cites many statistics to prove that homebirth is more dangerous than a hospital birth.  Tuteur really digs down into the statistics to prove her points. She then spends tons of time rebutting the comments and arguing with the pro-homebirth crowd.

Anyway, Tuteur has an interesting slide show on her blog, called the Risk Quiz.  Tuteur believes that the homebirth advocacy side puts out erroneous information on the safety of homebirth.

Here is a sample of questions:

  1.  True or False?  Studies show that homebirth is as safe as hospital birth for most women.
  1.  Arrange the following events in order of risk of death from highest risk to lowest risk:  Trial of labor, epidural, vaginal breech, c-section
  1.  In the last 100 years, modern obstetrics has reduced materal mortality by how much?  Choices:  0.5%, 5%, 50%, 90%, 99%
  1.  True or False? Birth is inherently safe.
  1.  True or False?  If birth weren't safe, we would not have survived as a species.

See the answers below the fold...

  • ::
  1.  True or False?  Studies show that homebirth is as safe as hospital birth for most women.  

Answer: FALSE

  1.  Arrange the following events in order of risk of death from highest risk to lowest risk:  Trial of labor, epidural, vaginal breech, c-section

Answer: Breech, trial of labor, C-section, epidural

  1.  In the last 100 years, modern obstetrics has reduced materal mortality by how much?  0.5%, 5%, 50%, 90%, 99%  

Answer: 99%

  1.  True or false? Birth is inherently safe.

Answer: False

  1.  If birth weren't safe, we would not have survived as a species.

Answer: False

Tuteur also monitors what she calls "potential tragedies" on various homebirth boards, such as the unassisted childbirth (UC) board on Mothering.com.  Here is a post from Tuteur from Dec 13:

Another potential tragedy is shaping up on the UC board on MDC. A woman with uncertain dates has had ruptured membranes for more than 48 hours, 2 vaginal exams and irregular contractions. She is posting for advice. She didn't ask me, but I'm going to offer some facts about prolonged ruptured membranes. They are not specific to her case, but they are factors that she should consider and that she probably doesn't know. Certainly no one on MDC is going to tell her because they don't know either. And of course, no one dares to mention that within the last few weeks an MDC member lost her baby to overwhelming infection after prolonged ruptured membranes.

I have to agree with Tuteur on this point.  I've only skimmed boards like this, but it sometimes does seem that the goal of unassisted childbirth can often take priority in the debate.  And the fact that women try to undergo childbirth alone and then ask anonymous people on internet forums for medical advice sounds pretty darn dangerous.

No matter where you stand on the homebirth "debate," Amy Tuteur's website is an interesting read if you are interested in this topic, although it sometimes feels like you are watching a trainwreck, and sometimes a very dangerous one.

Tags: homebirth (all tags)

Permalink | 47 comments

  • fascinating site (0 / 0)

    thanks NJMom for the post. I had both of my babies in a hospital and ended up having C-sections both times after trying for vaginal births. My first son weighed 10.5 pounds and the second weighed 9.11 pounds. I'm small, my pelvic bones made it so that the baby would have had to dip down and then up to make his way out and both times, it just didn't happen. I pushed and nada.

    The second time, my son wasn't breathing when they pulled him out and they had to give him oxygen and other things I couldn't see from my vantage point. He spent three days in the NICU, progressively getting better and now everyone is fine. I wanted a low-impact birth and instead I got lots of medical care that I firmly believe we all needed to make it through the process alive and well.

    So that's my perspective. If it hadn't been for modern medicine I honestly don't think I would have survived the birth of my first son.

    I've read before about the unassisted childbirth movement and I think it's nuts. Sorry if there are MTers who disagree, but to try to go at it without even a midwife present seems way too risky. Homebirth with a midwife present and the option of getting to a hospital quickly seems more reasonable. Do you think Dr. Amy is against both?

    by Stacey on Fri Dec 21, 2007 at 10:02:49 AM PDT

    • asdf (0 / 0)

      I would have to double check this, but I believe Dr. Amy is all for "natural birthing wings", actually attached to hospitals, staffed with nurse midwives supervised by docs, where low-risk women could labor and deliver as they choose (no drugs, etc) but that would be right down the hall from an OR and an OB if needed.

      She's against homebirth is any way shape or form from what I remember, whether assisted or unassisted.  

      by NJmom on Fri Dec 21, 2007 at 10:24:18 AM PDT

      [ Parent ]

      • IMO (0 / 0)

        I would have to double check this, but I believe Dr. Amy is all for "natural birthing wings", actually attached to hospitals, staffed with nurse midwives supervised by docs, where low-risk women could labor and deliver as they choose (no drugs, etc) but that would be right down the hall from an OR and an OB if needed.

        this seems like the best option.

        by Stacey on Fri Dec 21, 2007 at 02:32:51 PM PDT

        [ Parent ]

        • That's pretty much what I did (0 / 0)

          and it was great. I had all the benefits of natural childbirth with the backup of medical assistance if necessary. My daughter had a bit of a challenge getting through the birth canal (she was corkscrewed and her shoulder got stuck), and if we'd been completely unassisted, that might have been it for both of us. Luckily my midwife got her out, and the baby stayed in my room for the next 24 hours straight, even though she'd swallowed some meconium and they had to suction her. They even weighed and bathed her in my room, and she was never out of my sight.

          I wouldn't change a thing if we were planning to have another one (which we aren't).

          I must say after checking out the Dr. Amy site and all the back-and-forth on her blog that I am very glad I am past all that controversy over how to have a baby! It's anxiety-producing enough as it is, without having so many other people weigh in on it.

          by trueblue illinois on Fri Dec 21, 2007 at 03:11:48 PM PDT

          [ Parent ]

    • Option of getting to a hospital (0 / 0)

      If a person lives 5 minutes from the hospital, and an ambulance is called, that can turn into a 30 minute ordeal to arrive in the hands of expert emergency care (an operating room, NICU, etc).      Meanwhile, transfer to OR can take place in a matter of heartbeats when you area already in the labor and delivery wing of a hospital.

      The tricky part is, there is NO WAY to predict when a scenario will arise in which every second counts, and especially not in the home where sophisticated diagnostics are not done. So, women in hospitals are typically subject to the maximum amount of interventions. Hospitals would rather err on the side of living babies than happy mothers.

      I'm all for backing off on interventions for low risk women. There really should be more friendly environments within the hospital to give birth in. But, births will always be safest when they take place within moments of an operating room.

      I've lurked on Homebirth Debate for a several months. Amy is against misinformation far more than any particular birth practice. That said, all of her information leads to the conclusion that nowhere is as safe as the hospital.

      Mother wannabe, ETA Spring 09 if biology allows.

      by faedrake on Fri Dec 21, 2007 at 10:55:15 AM PDT

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      • Yeah... and I just don't buy that.. (0 / 0)

        ...all of her information leads to the conclusion that nowhere is as safe as the hospital.

        I think to make a blanket statement like that is just not responsible.  I think there are bad situations at hospitals and probably some not so great situations regarding homebirths as well.  

        I've known many many women who have either tried for a homebirth and ended up at the hospital or, had successful homebirths.  Even the ones who ended up at the hospital were thankful they had their midwife present as their advocate... which sadly, is lacking in a lot of OB practices.  

        I've also heard absolute horror stories from women who felt they had lost complete control of their birth due to their OB in the hospital.  Interventions are wonderful things when needed.  But not everyone needs or wants them.  I think if a woman wants a homebirth... she should have one.  Same goes for a hospital birth.

        "If it's not Scottish, it's crap!" ~Mike Meyers

        by 1plain1peanut on Fri Dec 21, 2007 at 11:01:36 AM PDT

        [ Parent ]

        • That's what I don't get though (0 / 0)

          I've known many many women who have either tried for a homebirth and ended up at the hospital or, had successful homebirths.

          How do you square "and ended up at the hospital" with a belief that homebirths are as safe as being in the hospital? If homebirth is as safe, why would these mothers decide to go to the hospital at some point in their labors? I don't get it.

          by RachelD on Fri Dec 21, 2007 at 12:45:57 PM PDT

          [ Parent ]

          • There are some deliveries that should (0 / 0)

            not be done at home...and often, this becomes clear during labor.  No one is arguing that delivering a breech baby or delivering a mother with sky-rocketing blood pressure at home is as "safe" as it is in a hospital...however, these complications usually leave a woman plenty of time to be transported to a hospital.  Good birth attendants will have arrangements with nearby hospitals to handle such transports.  

            by tjb22 on Fri Dec 21, 2007 at 01:04:42 PM PDT

            [ Parent ]

          • It's because (0 / 0)

            things weren't progressing along they way the were expected to.  Maybe the mom's labor stalled, or something like that.  And, a transfer is usually with the prodding of the midwife.  Some ended up with c-sections, some delivered vaginally.  But from what I gather, even though things didn't go the way the mothers planned, they had their midwife as an advocate with them at the hospital, which they very much appreciated.

            "If it's not Scottish, it's crap!" ~Mike Meyers

            by 1plain1peanut on Fri Dec 21, 2007 at 01:05:47 PM PDT

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            • That's the thing though (0 / 0)

              A blanket statement of "homebirths are just as safe as hospital births" is just not true. The caveat "for some women" is very difficult to assess for any one woman.

              by RachelD on Fri Dec 21, 2007 at 02:54:51 PM PDT

              [ Parent ]

              • The caveat is "for women with low risk pregnancy" (0 / 0)

                Homebirths have been found to be as safe or safer than hospital births for women with LOW RISK pregnancies.  But a pregnancy can change from a low risk status to a high risk status at any time, and then the person either transfers to a hospital situation or assumes a higher relative risk.

                by Ecomama on Sat Dec 22, 2007 at 08:02:56 PM PDT

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  • I agree with Amy (0 / 0)

    From her website:

    Birth, like any aspect of caring for a child, is not a piece of performance art; it is just one aspect of a deep and abiding responsibility to put the well being of your child above all else.

    A good birth, in my opinion, is one where the baby and I are alive at the end with no permanent injuries. As much as I loathe hospitals (and regard them as cesspools of infection) there is no chance in hell I would not go to one for the birth of my child.

    I've never been one to get all hyped about specific vision of how a specific day should go. I was loosy-goosey about my wedding, let's just do the deed and have some wine, and also about my son's birth, just get him out however you see fit. Not that I think medical professionals are flawless and godlike, but they do know a lot more than I do about birthin' babies.

    There are some things in life over which I am highly controlling. Christmas decorating is one. There are other things where I am content to relinquish control and leave it to the professionals. This includes car repairs and labor and delivery.

    I don't understand why some people would put their need for the perfect day ahead of their child's life, health and safety. I think, like this blog suggests, many people are simply uninformed.

    by minnmom on Fri Dec 21, 2007 at 11:00:03 AM PDT

    • This is pretty much (0 / 0)

      what I think, too, but then I talk to a bunch of women I know who are homebirth advocates and survivors (I joke that they've had "macho" births, and I admit I'm a bit jealous because their home births sound very very nice). These people know the risks and make very good arguments for homebirthing.

      However, I'm still not gonna do it. All arguments that homebirthing will go right seem to be statistical arguments, and I've been on the wrong end of a statistical unlikelihood (1/500 chance of a stillbirth for my particular doctor, but I had one) one too many times. Even the risk for Down's Syndrome, a mere 1/100 chance, seems so likely to me now.  

       

      by tarantula on Mon Dec 24, 2007 at 06:12:31 AM PDT

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  • Doesn't the Netherlands do safe homebirths? (0 / 0)

    I think there is a place for low-intervention births and our crazy high c-section rate doesn't do anything to improve infant mortality or maternal mortality rates.  That said, I had a c-section with my first and was perfectly happy with the reasons behind it.

    At one point there was research that suggested continuous fetal monitoring during labor led to more interventions (forceps, vacuum extraction, c-sections) and no improvement on outcome.  Not sure if this continues to be the case.

    I think homebirth is fine as long as one is being honest about the risks involved.  It's not "natural" for women to survive labor in great numbers, we've made it that way through medical interventions including, but not limited to, controlling hemorrhage & infection.

    I think hospitals should do more to make anti-hospital folks feel comfortable in a birth setting.  I'm a nurse by training so I feel great in a hospital setting -- much more comfortable than at home.  I like the machines, I like the proximity to the OR and I don't ever feel like I'm not communicating well with the nurses & doctors.  But, for someone without my background, the hospital can be a scary place.  We should do better than that - for the sake of moms and babies.

    by Anu on Fri Dec 21, 2007 at 12:37:16 PM PDT

    • Infant mortality (0 / 0)

      As I read her blog entry, infant mortality really doesn't have a lot to do with homebirths v. hospitals-- perinatal mortality is the thing to look at, and the U.S. is among the lowest in the world, according to recent WHO stats. So perhaps all those interventions aren't necessary, but they appear to help more babies live, in general.

      The thing is, it's really hard to square individual experience with probability.

      by minnmom on Fri Dec 21, 2007 at 12:53:55 PM PDT

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      • Repeat c-sections aren't great (0 / 0)

        From what I understand, two is one thing but three is a completely different story.  So while the babies may fare well, the moms may not.  As someone who had a c-section with my first pregnancy I certainly appreciate my own health being put above that of a baby I bear.  Of course I want both, but I won't do babies any favors if I end up dead ;-)

        I'd love to see the figures for maternal outcome with 3 plus c-sections...

        by Anu on Fri Dec 21, 2007 at 02:20:28 PM PDT

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    • I agree about making hospitals (0 / 0)

      more "user friendly".  It can be done if one searches out those that do have more laid back policies as well as making plans and talking to nursing staff before hand.  

      by tjb22 on Fri Dec 21, 2007 at 12:58:05 PM PDT

      [ Parent ]

  • For certain groups of women, (0 / 0)

    homebirth is as safe.  Not as safe for ALL women in general.  I've known lay midwives who did homebirths as well as nurse midwives.  Never would they consider doing some of the riskier births at home...in fact, some of them transport or refer up to half of their expecting clients to hospitals.  I myself saw such a midwife with my sixth son...and in my 7th month, was practically "fired" as there were just too many unknowns and possible risks.  She was absolutely right...I was disappointed at the time, and the birth, totally natural in the hospital, was without complication, but in her place, I would not have delivered me at home, either...I just wasn't a good candidate at that point.

    I did have my last one at home...rather unintentionally.  It went very well, and quite frankly, if I had been in a hospital, I'm not sure the labor would have come off as well.  Ofcourse, I never went to a hospital to labor...always held out until I knew I was near delivery.  Can't imagine doing 20 hours in a hospital having to fight off interventions that I didn't want.

    by tjb22 on Fri Dec 21, 2007 at 12:55:42 PM PDT

    • fighting off interventions (0 / 0)

      I was in the hospital for 15 hours before DS finally made an appearance, and there was this flurry of effort by the staff to "do something!" A wire here, some oxygen there, not sure it made a bit of difference in the end. Or maybe it did. Who really knows?

      by minnmom on Fri Dec 21, 2007 at 01:06:02 PM PDT

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      • Honestly, there's much (0 / 0)

        in the practice of medicine that has to do with making a patient feel cared for.  Its  human nature.  I think if one needs to feel as if someone is "doing something" to help them, then some of these milder interventions are probably helpful in the long run.  However, if one is having to "fight them off" because they're unwanted, then I think they might be harmful.  Depends on the person and how they deal with pain or discomfort.  Personally, I'm always the type who wants to be left alone when I'm sick or hurting.  Put me in a dark room by myself and leave me alone.  Stay out of my way.  Others, however, feel better with the opposite approach, I suppose.

        by tjb22 on Fri Dec 21, 2007 at 01:12:44 PM PDT

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  • Believe it or not ..... (0 / 0)

    Childbirth in hospitals HAS improved ... at least since 1984, when I had my last child.  At that time, I asked if I could deliver my child sitting up.  I was told NO.  (That method is much easier for mothers, but harder for the doctors.)  LOL  That is a minor topic, but indicative.

    When talking to my MIL about my husband's birth, she mentioned she was "sure" her regular OB didn't deliver the child, even though his name appeared on the birth certificate.  I asked her, "Well, weren't you THERE?  What do you mean "you are sure?"  I guess at that time, too many (most?) mothers were highly drugged during birth, so much that they really didn't know who was in the room.

    In 1984, at least in Sacramento, Birthing Rooms at hospitals were quite new.  I wonder if they ever took off.  Probably not, since that means one room, entirely for one woman, labor until you leave the hospital -- no moving.  Harder for the doctors, I guess, since they had to go to the patient, rather than the other way around.  Are they still around?  For all I know, that is the norm now.  But I doubt it.  But you had to promise to leave the hospital in 24 hours, which was highly unusual then, but the norm now.

    I hated the hospital for labor.  It was noisy, etc.  Not conducive to a calm birth.  (My middle child was my best hospital experience -- we went right from the car to the delivery room -- no labor room necessary.)

    by Shell on Fri Dec 21, 2007 at 02:26:44 PM PDT

    • Birthing rooms in Sacramento (0 / 0)

      Well, I can attest that they have them at UCD Med Center, where my kids were both born.  If they have them there, you can bet they have them at Sutter and Mercy.  I think Kaiser has them too, I have a friend who had a natural birth at Kaiser South Sac.

      Katherine

      by pat of butter in a sea of grits on Fri Dec 21, 2007 at 05:06:23 PM PDT

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    • I'm in upstate NY (0 / 0)

      Birthing rooms are the trend around here.  Two of our hospitals have birth centers that use this model.  They are very well-equipped with whirlpool tubs in the rooms.  I had my second child in one that was newly built in the two years between my children.  This wasn't a birthing room where you could stay after the child but I did stay there overnight for labor and delivery in the same room.  Then we were transferred to the maternity unit for an additional day.

      My OB just transferred his practice to the other hospital and it is basically the same set-up.  So far, I've had mostly natural births-no pain meds or interventions were pushed other than pitocin as both of my babies were late and large and I wasn't going into labor on my own.   The nurses were very willing to work with me and let me labor how I wanted to labor and I had certified nurse midwives deliver both of my babies-so far 9lbs10oz and 12 lbs 3.6oz.  

      by music teacher on Fri Dec 21, 2007 at 09:53:13 PM PDT

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  • Fraut with peril (0 / 0)

    True or false? Birth is inherently safe.
    Answer: False

    The first time DH delivered a baby, he came home in shock, muttering, "I just don't see how we all made it. That's a terriibly designed process."

    Obvs. he chose another specialty. ;)

    by sangfroid on Fri Dec 21, 2007 at 02:45:40 PM PDT

    • ha! (0 / 0)

      great story about your husband.

      by Stacey on Fri Dec 21, 2007 at 03:20:44 PM PDT

      [ Parent ]

    • had a med student observing (0 / 0)

      my labor with Jess. The poor guy was absolutely green about the gills; they gave me an episiotomy and had to use the suction machine to pull Jess out. I really don't think he opted for an OB specialisation!

      Really, that bit about the med student was the only funny thing about the episiotomy...

      by Rachel on Fri Dec 21, 2007 at 03:58:15 PM PDT

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      • Me too! (0 / 0)

        Mine was an EMT trainee. I tried to joke with him and he looked like he was going to vomit the WHOLE TIME.

        by lilianna28 on Fri Dec 21, 2007 at 09:02:04 PM PDT

        [ Parent ]

        • mine couldn't look me (0 / 0)

          in the eyes post-delivery. It was really funny. He mentioned as how his next rotation was in geriatrics and that he was looking forward to it ... now.

          I probably should've been offended, but after having given up on modesty the minute my ankles hit the stirrups and a multitude of midwives and nurses started examining me, I just thought it was funny.

          (BTW, I give big shout-outs to DH because he watched the whole things and told me afterwards he found me the most beautiful, sexiest woman in the world!)

          by Rachel on Sat Dec 22, 2007 at 12:53:36 AM PDT

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    • It really IS! (0 / 0)

      Its a horribly designed process!!!  I pondered that quite a bit last time.  I join your DH in amazement that we made it as a species.

      by tessajp on Fri Dec 21, 2007 at 04:10:41 PM PDT

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    • My husband and I (0 / 0)

      keep marveling at this, too. The whole pregnancy birth thing just seems so unlikely. It's just amazing that it works.

      by tarantula on Mon Dec 24, 2007 at 06:04:28 AM PDT

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  • Read more and she seems obnoxious (0 / 0)

    I read more of her posts and while I often agree with her, I find her tone abhorent.  I pity any patient of hers.... Her other sites aren't so strident, but this one sure is.

    by Anu on Fri Dec 21, 2007 at 04:56:06 PM PDT

    • amazing isn't it (0 / 0)

      Just how strident people can get about this stuff? Everyone is so convinced of their own rightness. Homebirthers can be just as strident and crazy on their own sites. I can forgive her for providing an alternate opinion...but I don't particularly want to read it all!

      by aussieyank on Fri Dec 21, 2007 at 05:09:21 PM PDT

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  • I dunno... (0 / 0)

    I've got loads of friends that are really into the homebirthing thing. I fell in with a natural parenting group when I was pregnant the first time. Now there are lots of things that I don't agree with these people about (home birth, vaccination, unschooling, to name a few), but I feel like they're smart enough to make their own decisions. I sure as hell wouldn't want them interfering in my birth or my kids. And while I get odd looks on occasion, we all just respect each other's beliefs. A bit like religion. And it's fantastic to be able to go to a birthday party and know that the junk food and sugar will be minimal, if there at all. And to know that no one will be harsh at all with my children if I'm not there. So I value the friendships, and respect their decisions.

    One friend had an accidental unassisted home birth. The baby just came too fast for the midwife (although she was there for the early part of labour). They were thrilled to bits. My first reaction was "Thank god nothing went wrong!! Holy crap!!". And my next reaction was jealousy. How amazing to have brought a child into this world with just you and your partner there (and toddler asleep upstairs). What an incredibly empowering , beautiful thing. Not something I would advocate or do myself...but how amazing. And so different from both of my births.

    by aussieyank on Fri Dec 21, 2007 at 05:07:54 PM PDT

    • A friend of ours (0 / 0)

      also had an accidental homebirth, and the veterinarian's receptionist was called. She'd assisted in so many animals births (puppies, horses, cows, etc.) that she was the only one with enough experience that anyone could think of to call.

      The receptionist arrived just in time to help the friend and her mom decide to cut the cord.

      by tarantula on Mon Dec 24, 2007 at 06:02:53 AM PDT

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  • Planned and attended homebirths are just as safe (0 / 0)

    ...as hospital births. See this study in the peer-reviewed British Medical Journal.  http://www.bmj.com/...
    Low-risk homebirths have similar outcomes to low-risk hospital births for fetal and maternal mortality, and better rates for morbidity.
    This study is one of many that get this result.  The studies showing the safety of homebirth outnumber the ones showing danger 6 to 1.
    High risk women are not allowed to birth at home by professional midwives.  If hospital intervention is needed, usually it is anticipated hours before the actual delivery--allowing for a safe transfer.(12%)  As for instances like baby needing O2-homebirth midwives have it.  I had two great home births. In my first, my uterus did not contract after the birth as well as it should, and I was bleeding too much. My midwife gave me a shot of pitocin. I was fine. It is not like these birth professionals are practicing with a pot of hot water and a towel and that is all. They are highly trained.

    As for this Amy Tuteur.  I guess the potential threat of low-cost homebirths to her profession would not have anything to do with her problems with it. When homebirths started to increase in the 1980s the OB-GYN profession hit back hard--using unfounded scare tactics. Tuteur discounts the BMJ study because a midwife was involved with it.  Wouldn't that make all studies done by OB-GYNs invalid?  I'll trust the validity of a study that has been peer-reviewed in a major medical journal over her biased view.  The "risk quiz" just makes me laugh/scream.  She will tell us what is TRUE!  For example #3--The biggest decrease to maternal mortality in the last 100 years is due to ANTIBIOTICS.

    On a side note--I saw the "Business of Being Born" (the Ricky Lake documentary). I highly recommend it.  In regard to the previous discussion about whether Ricky would have been so hot to show these births if they needed hospital transfer--It turns out her producer is shown in the movie as she tries for a homebirth. She gets transferred to the hospital after being convinced she needs it by her midwife.  It turns out her baby had Intrauterine growth restriction which went undiagnosed by her OB-GYN  whom she saw concurrently with the midwife.  She needed an emergency C-section and got it.

    Barbara

    by wornoutstroller on Fri Dec 21, 2007 at 05:38:58 PM PDT

    • Tuter's quiz is ridiculously biased (0 / 0)

      Which is more dangerous: trial of labor or cesarian?  The real answer is: it depends on the patient.

      If you have a morbidly obese woman with uncontrolled gestational diabedes and a big baby (11 lbs), then a cesarian probably truly is safer than a trial of labor.  I worked with a patient in this condition when I was a nursing student.  She had a planned C/S, and it was the best safest course of action for her and her baby.

      For a healthy woman with a normal pregnancy, in good shape, healthy diet, etc, then a cesarian is much more dangerous than a trial of labor.  Cesarians are major abdominal surgery with very serious risks (infection, adhesions, injury to the baby during the surgery, increased risk of uterine rupture or a badly placed placenta in future pregancies, etc).  Sometimes for certian women the risks of a vaginal birth outweigh the risks of the C/S, but not for every woman.

      You can't just take the total number of deaths resulting from trial of labors and the total number of deaths resulting from cesarians, and say that the one resulting in the fewest deaths is safer for every woman.  That statistic is meaningless to individual women.

      People who chose homebirth are a self-selected group.  In general they are people who are very health-concious and who are willing to work towards having a healthy pregnancy and birth (diet, exercise, in-depth  prenatal care and prenatal education).  There are some crazy people who will attempt a homebirth no matter what, even if it is clealy not safe for them, but these people are in a tiny minority.

      by Joanne on Sat Dec 22, 2007 at 05:15:14 AM PDT

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      • just noticed another thing about the quiz (0 / 0)

        I can't find where she gives any references for the answers that she gives to the quiz questions.  It's not clear when she is talking about mortalities if she means maternal, baby, or both.  It's also not clear if she is using data from the US or if it is world-wide.  

        There are many places in the world where pregnant women don't have access to hospitals or cesarians even if they truly need them.  If the data she is using is world-wide, then it would make a trial of labor look more dangerous in comparison to a cesarian than it actually is for a woman in the US who does have acess to hospital care.  

        by Joanne on Sat Dec 22, 2007 at 05:30:05 AM PDT

        [ Parent ]

      • taking issue (0 / 0)

        People who chose homebirth are a self-selected group.  In general they are people who are very health-concious and who are willing to work towards having a healthy pregnancy and birth (diet, exercise, in-depth  prenatal care and prenatal education).  There are some crazy people who will attempt a homebirth no matter what, even if it is clealy not safe for them, but these people are in a tiny minority.

        i would venture to guess that every woman on this site considers themselves to be someone who is "health-conscious and willing to work towards having a healthy pregnancy and birth" with all the things you mentioned above. i don't think that people who choose to have a hospital birth are any less inclined to treat their pregnancies or their births this way. i think it's more of an attitude towards childbirth and medicine that leads some women to want to stay home for the birth versus wanting to be in a hospital setting.

        part of the risk of having a home birth is that you don't know ahead of time whether or not you'll end up needing hospital care. many women end up having beautiful birth experiences at home, but many also end up in a car on the way to the hospital when labor is full-on and someone has decided the home isn't the best place to be. you never hear about women getting rushed back home from the hospital in the middle of labor because everything is going along smoothly.

        by Stacey on Sat Dec 22, 2007 at 10:26:36 AM PDT

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        • Of course you never hear that ... (0 / 0)

          the hospital women are often tethered with monitors. I'm sure many would want to bolt, but are scared silly by the "risks".

          by wornoutstroller on Sat Dec 22, 2007 at 11:00:19 AM PDT

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          • i was "tethered" (0 / 0)

            and i barely noticed it. i was in the tub, out of the tub walking around the room, sitting on the edge of the bed, whatever i wanted to be doing. and somewhere in the corner of my mind, was the knowledge that the baby was doing fine in the process. i'm not saying that everyone should do things the way i did it. i do take issue with the idea that having a birth in a hospital is necessarily a terrible experience.

            i was lucky because my midwife practice delivers at a very good hospital. we also had a doula with us and the nurses were lovely to me. when it came time to decide that i needed a c-section, i felt like i'd been honored throughout the process. hospital births are not necessarily anti-woman.

            by Stacey on Sat Dec 22, 2007 at 12:09:17 PM PDT

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            • That was my experience too (0 / 0)

              I had good hospital births.  Even with the monitoring, I had plenty of freedom.  It was telemetric and waterproof so I was in the tub, on the ball, in the shower-wherever I wanted to go pretty much.  I was also able to deliver on all fours and encouraged to find what position was the most comfortable with both of my children.  The nurses were helpful and honored my wishes to labor with as little intervention as possible and without an epidural or any other pain medications.

              From what I've gathered here and elsewhere, the good hospital experiences may be the exception to the rule.  It's too bad because so far I've been very fortunate and it would be nice if the hospitals were all like mine.

              by music teacher on Sat Dec 22, 2007 at 04:44:28 PM PDT

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