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July 08, 2008

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I was wondering if you would have the same midwife -- you had so much good to say about her last time.

Sorry that your OB is such a pain. But like you said, you already have a pretty good history with homebirths and a good backup plan in place. Therefore, he should let you be.

Hey! I threw up today, too! But before breakfast, when I was brushing my teeth. At 24wks 1 day. But that was pretty uncommon. I would like to see a midwife, too, but with my history I cannot imagine a midwife ever taking me as a client. I'll just have to manage the best I can with my doctor.

I'm looking forward to reading about how everything goes with this little one!

The most recent data with a CNM, which you have, does demonstrate that CNMs are good at recognizing risks to both mother and child and are as safe or safer than hospital births. As long as you don't have any risks, go for it.

I do wonder what you think of other statisticians who agree that the 2005 BMJ study used the wrong comparison group for the hospital births. Say what you will about Dr. Tuteur, but she's right on that study.

If I am ever graced with another pregnancy, I am going to try so hard to have a home birth. I had a terrific water birth in the hospital last time, and the only thing that would have made that better was to crawl directly into my bed afterwards and stay there, snuggling my new little one.

Hi, Sarabeth, I was wondering what you would think about this post, since you must hear from your husband about the births at home gone wrong. I actually don't agree with Amy's critique of the Johnson & Daviss study, and I've been trying to decide if I can write a quick summary of why, or if the attempt will suck me back into the vortex that is homebirth debating. :-)

In a nutshell: Amy insists on lumping together intrapartum and neonatal deaths at homebirths and comparing them to neonatal deaths alone in hospitals. She insists on including the high-risk homebirths in her calculations as well. While it's useful to quantify the outcomes of high-risk homebirths, it's also important to acknowledge that high-risk homebirth is a high-risk undertaking, and that those outcomes diverge sharply from outcomes for low-risk women.

She also doesn't have the information she needs to make a statistically valid comparison between the J&D cohort and the larger population -- i.e., variations in legality of CPM practice (I would bet good money that transfers have worse outcomes when CPMs have to worry about prosecution), variations in transfer times (important since 10% of the J&D cohort was Amish and lived in rural areas -- a planned hospital birth isn't going to have a great outcome either if your cord prolapses at the onset of labor and you're 45 minutes from the hospital), and variations in risk of lethal anomalies (again, a real issue in the Amish community). Ideally, J&D would have followed a cohort of 5418 low-risk women planning hospital births in the year 2000, of whom 10% were Amish. There are some funding challenges to figure out there, though.

I could go on (and on) but I will rein myself in. For now. :-)

CJ, we talk about all births gone wrong--not just homebirth ones. Where we are currently, there aren't many homebirths. When we lived in Washington, the story was quite different.

So much of home v. hospital birth is due to philosophy, which is not something I am going to debate as people can become rabid--never good for a debate.

AS for the J&D study, it is not done well and shouldn't be held as the gold standard in stating that home birth is safe for infants. I'm referring to the recent data (I've lost my link) regarding how well CNMs perform over MDs (expected as MDs take the most high risk patients) over CPMs. Personally, I have a problem with CPMs who don't have the level of training I would expect.

A home birth was never an option for me, nor would I choose one. If you can and want to, lovely for you and others.

Hi, Sarabeth. Agreed, there are some flaws in the J&D study. Further agreed, there are some scary CPMs out there. I hope my previous comment back to you didn't sound adversarial -- not intended that way at all.

Also, let me know if you find that link, please. Are you talking about the 2003-04 CDC death rates that Amy's been quoting around the internet? If it's not that but a recently published study, I haven't seen it and would very much like to.

CJ, you didn't sound adversarial.

I am talking about the CDC death rates, but I had heard of it from a maternal/fetal medicine specialist when we were at dinner together. He worried that some would see the raw data thinking that OBs weren't good at what they did based on the MD v.CNM numbers. He also talked about another paper, but I don't know the author or date. I'll ask Phill.

I don't know if this helps you at all. I hemorrhaged after my first two births, lost a lot of blood. For my third birth, they gave me a medicine (in suppository form) after the birth, preventatively. (After the doctor told me they wouldn't do it preventatively -- they did). Anyway, it worked. And I can dig up the name of the drug that was used if you're interested.

Best,
Kris

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