Thursday, December 01, 2011

Just the facts: The Home Birth/Hospital Birth Conundrum Part 2

In Part 1, we took a  look at the Home Birth Summit from October of 2011. 

But a question still begs to be answered: If there was consensus amongst organizations, why is there still a conundrum?  Conflicting stories based on equally conflicting studies published in journals continue to flood the news.

“A new study (published in the BMJ) in England shows little difference in complications among the babies of women with low-risk pregnancies who delivered in hospitals versus those who gave birth with midwives at home or in birthing centers.”


“A study published in the BMJ, which was conducted by researchers from Oxford University has revealed that first time expecting mothers who opt to have home deliveries are at greater risk than those who opt for obstetric or midwifery unit.”

Ironically, they are talking about the same study in the same journal.  Why the difference? 

It leads us to the five basic reasons for the conundrum:

Media Influence
Media spin has a damning effect on childbirth, here in the US and world wide.  Documented in her video  Laboring Under an Illusion, Vicki Elson exposes the drama-seeking Hollywoodism and stretching of the truth in our every day viewing.  Seeing this, and not being exposed to the truth, leads to accustomization ~ where we begin to believe what we see because we are accustomed to seeing it!

Education Gap in Professional Training
A second reason for the conundrum is Statement 9 in the Home Birth Summit Consensus document:  “We recognize and affirm the value of physiologic birth for women, babies, families and society and the value of appropriate interventions based on the best available evidence to achieve optimal outcomes for mothers and babies”.  In reality, this is not done in our major universities, medical schools and nursing schools.  If it was embraced and taught, then all of the things that certified childbirth educators teach their classes or the information discussed by doulas would not be new information to nurses, physicians, and yes, even some midwives.

Fear of the Unknown
Childbirth is not a foreign event for women.  However, since we are such a mobile society, we are not routinely exposed to family and friends having babies.  Hence we have lost the ability to tap into the inner wisdom.  Dr. Amali Lokugamage  discusses finding the inner wisdom in her book The Heart in the Womb.  She states that “fear of childbirth really does prevent women from discovering their inner wisdom.”  Women with this fear (fear of the unknown, fear of pain, fear of disaster, etc) look to others to “solve” their problem.  To the rescue is modern medicine, and the discouragement of childbirth education classes or doula services.  It is viewed that with information and an informed support person, labors will be more difficult for the medical staff.  It boils down to whose birth is it anyway?

Incongruent ways of reading research
As demonstrated by the Summer of 2010’s Wax home birth meta-analysis , definitions make or break a study and the efficacy of the information in the study.  For example,  as Amy Romano pointed out the definition of neonatal death was different.  In the Wax study of 9,811 homebirths, neonatal death was defined as death of a live-born infant between 0 and 28 days.  In the Ank de Jonge study of 321,307 homebirths, the definition was the death of a live-born infant between 0 and 7 days.  The latter is also the definition used by the World Health Organization.  Wax also had no requirement for home birth eligibility.  The Dutch study defined who was eligible based on national guidelines – to ensure that homebirths are healthy and at very low risk for complications.

Professional Obstacles
I really didn’t know how else to phrase this contributor to the conundrum but there are professionals who are, either informed or uninformed, against homebirth.  Period.  No discussion.   Heidi Anne Deurr, MPH said in her recent article for titled “Home Birth Consensus Summit: Much Ado About Nothing?”:

While the intentions and words involved in the statement might be well-meaning, the merit of the summit and its consensus statements is questionable.  For one thing, ACOG has come out against home births.

Legal liability certainly has a hand in this last contributor to the conundrum.   As pointed out in Statement 7 of the Home Birth Summit Consensus, the legal system needs repair and there needs to be adequate access to homebirth and birth center births within an integrated health care system.

In reviewing the above five conundrum contributors, the bottom line, in my humble opinion, is consistency in research and education about the research.  We must talk the same language with the same numerical values and the same definitions.  If studies and research varies so greatly, no congruent statement can be made about any issue.  Second, practitioners of all kinds should be educated about this research and work together for healthy mothers and babies.  To do otherwise, is to ignore “First Do No Harm.”

1 comment:

Anonymous said...

Thanks for posting. I totally agree.