Baby killers?

Every so often I like to plug "home birth" into a google news search and see what's out there. This morning I found something that has consumed my thoughts all day: "New study indicates hospital delivery safer for babies than home birth." What?! I hadn't heard anything about this study, so I checked it out.

Here's an excerpt describing the study's findings:

"The risk of neonatal death (dying during or shortly after birth) with a hospital delivery for a baby at term (between 37 and 42 weeks) was approximately 0.06%. The risk with a home delivery with a certified nurse midwife was almost double at 0.1% and with a non-certified midwife at home that number jumped to 0.18%. Low Apgar scores, a reflection of oxygen levels at birth, were also more common with home deliveries than in the hospital"(source).

Those are some disturbing numbers. Especially considering that they conflict with the growing body of evidence already published in peer-reviewed journals about the safety of home birth for low-risk women. Obviously I wanted to know more. So I poked around the internet off and on all day trying to find an original source for this study. All I could find were a few articles reporting about it. For example...

"Safety of midwife-attended home births questioned," from Canada.com
"Analysis Finds Risks With Midwife-Attended Home Births," from redOrbit.com

There were several other similar links. They all seem to be regurgitating the same words, but none of them directs me to more information. (It appears that this study has not yet been published in a peer-reviewed journal.) I want to know details!

Based on their findings, the researchers concluded that "the safest setting for the delivery of babies is in a hospital attended by a certified nurse midwife"(source). While the media grasped onto the home birth headline, they could just as easily have written: "New Study Shows Nurse-Midwives Safer Birth-attendants than Doctors." Except, while the press release willingly shared the neonatal death rates of the midwife-attended births, the only information we get about the doctor-attended neonatal death rate is: "Malloy hypothesized that in-hospital deliveries attended by certified nurse midwives had lower mortality risks in his study than in-hospital physician deliveries because the physicians were delivering babies at higher risk"(source). Wait a second... only a few paragraphs earlier, we're told that they limited the analysis to "low risk" births, which they define as full-term vaginal deliveries. If the only births included were "low risk," how could "high risk" babies explain why doctors were less safe?

Other questions I have about this study...

Were babies born with conditions or defects incompatible with life included?
Where did they find the records for these births?
What was the death rate for the babies delivered by doctors?
What about the birth center rate?
When was the "recent 5-year time period" they pulled data from?

I also have a hard time with their limiting the study to full-term vaginal deliveries. It seems sort of ridiculous to imagine including cesareans in such a comparison, but think about it... One of the reasons mothers choose home birth midwives is to avoid unnecessary interventions--for example, unnecessary cesareans. How many women began labor as "low risk," but ended up having their babies surgically removed because their labors were derailed by the bright lighting, immobility, strangers, or drug side effects? What about neonatal deaths preceded by cesareans that were brought about through iatrogenic complications? Excluding those neonatal deaths by removing cesareans from the study analysis removes one of the largest strikes against hospital birth in the minds of home birth proponents--the "cascade of interventions" leading to cesareans and increased risks for both mother and baby.

Clearly it's difficult to compare home birth and hospital birth. They're two completely different species. And there's no perfect way to structure a study's cohort to make home and hospital birth comparable.

But here's what we do know... at present, the published body of peer-reviewed research indicates that home birth is just as safe for low-risk women as hospital birth. We also know that home birth would be even safer than it is if hospitals and doctors would collaborate more fully with midwives in creating a better system for handling those rare emergency transfers (as we see in many European countries). Home birth would also be safer if practicing midwifery weren't illegal in some areas of the U.S.

Couldn't we focus on making all births safer instead of bickering about who's better? Couldn't we collaborate with each other in working to provide women and babies with the absolute best care possible? Couldn't we incorporate practices that facilitate healthy births in all settings? When will we demand that our care be evidence-based?

As for me, I knew giving birth to my son at home was the right choice for us regardless of the research. God trumps research... even studies of 12 million births.

If you have any more details about this recent home birth study, please let me know.

New Feature: Quote of the Day

Hey friends,

Just a heads-up that I've decided to add a new feature to my sidebar. Sometimes I read an article or a study, and I want to let people know about it, but I don't have the time or energy to write a whole blogpost. In those instances, I'll be featuring an excerpt in my "Quote of the Day" with a link to the original source. So, if you're subscribed through a reader, be sure to visit my actual blog on occasion to check out what I'm sharing!

Today's comes from a post by Henci Goer. Gosh I love that woman!

Hugs!
Busca

"Elective" Cesarean

My heart has been aching the last couple of days for my blogfriend, Sarah. She recently shared the intimate details leading up to, during, and following her daughter's birth. It is a heart-breaking story. After educating herself, working hard to find the right provider, and hoping and praying, Sarah ultimately ended up losing her dream of a VBAC with an "elective" cesarean. I put elective in quotation marks because, like so many other women reaching for VBAC, the odds were stacked against her. And Sarah's heartbreak only intensified when her daughter suffered life-threatening complications as a result of her cesarean. Though her story is painful, I encourage you to read it. The truth needs to be shared so that the future of birth can be brighter. Thank you for being willing and courageous enough to put it out there, Sarah.

It was sadly fitting that I read a news report about the risks of repeat cesareans the same day I read Sarah's birth story. US News and World Report explains:

"Babies delivered by elective, repeat cesarean section delivery are nearly twice as likely to be admitted to the neonatal intensive care unit (NICU) than those born vaginally after the mother has previously had a c-section, a new study finds.

"These c-section babies are also more likely to have breathing problems requiring supplemental oxygen, the researchers say" (source).

Sarah's story is a sad testament to these facts. I ache for her and all women like her.

It makes me wonder... why did I get to have such good experiences? It's not fair, really. I didn't do anything to deserve smooth births. Sarah couldn't have prevented her first cesarean--twins in transverse position. Why was she dealt such difficult circumstances and I such uncomplicated ones? I suppose none of us avoids difficulty in this life. We'll all encounter struggles in some aspect of our lives. But today I'm feeling especially grateful for my wonderful births... because I realize today, more than ever, what a blessing they were. Oh how grateful I am!

Sucker

I will never look at a baby with a pacifier the same way. For the first time, I have a binkie baby. Cue the gasps of horror. :-O

I remember when my first baby was tiny. She showed disdain for artificial nipples, so breastfeeding and lots of holding were all she needed to stay happy. It was around this time that I first subscribed to Mothering Magazine. I needed it dearly at that point in my life because it gave me confidence in the parenting style I had chosen. I remember reading an article about pacifiers and their harmful effects and thinking to myself... I'll never give my children pacifiers! Nobody else should either! My baby clearly didn't need a pacifier, so obviously nobody else's baby did either! Ha ha!

Then there was Bubby boy. Sometimes breastfeeding and holding are all he needs to be content. But sometimes they're not. Sometimes it's clear that he wants desperately to suck, but he doesn't want to eat. Up until the last few days I have given him my finger in those moments. But sometimes you need your fingers (like when you're driving and your baby is [screaming] behind you). So, for the past couple of days, I have been trying to help my little guy get the hang of the pacifier.

Many evenings he gets quite fussy. I always offer the breast first, but he often gets even more agitated as the milk starts gushing into his mouth. So we try bouncing on the birth ball and finger-sucking and changing positions and the baby swing and whatnot. Eventually he will fall asleep. Tonight I wrapped him up in a blanket and bounced him on the birth ball with the binkie in his mouth. Within minutes, he was out. For the first time in my mothering career, my baby fell asleep with a binkie.I have so many mixed emotions about it. It feels sort of like a victory... I feel like the pacifier will help keep my baby (and me) calm and happy. I think it will make car drives less heart-breaking as well. But I also feel sort of sad and conflicted. Am I damaging my child? Will I regret this later when I have to take it away? And I feel sad that I can't meet all of my baby's needs naturally... that it is taking something plastic and artificial to soothe him. I wish I was enough.

But the biggest and best lesson I learned as a brand new mom was to listen to my heart and do what it told me. It told me to bring my baby girl to bed with me, to pick her up when she cried, and to feed her whenever she was hungry (even if I had just fed her 10 minutes before). Well, I must say that my heart has been telling me "Just give him the binkie!" for weeks. And I've been fighting it. But I think my heart is right again.

We can add this to the ever-growing list of things I never thought I'd do. How many times will I eat my words before I die?

P.S. He spit out the binkie and started crying a few minutes after we took the above photo. I tried to put it back in his mouth, but he didn't want it. Instead, he wanted to nurse. :-) I'll definitely be savoring those times when I am enough.

UPDATE: He actually never really became a pacifier baby at all. It was useful for a few days, but he never really took to it. Ever since then he's been all about the real deal. I'm relieved.

Reincarnated

My birth supplies have been reincarnated. :-)

Soothing fussiness...And providing relief from the triple digits...Oh, and... remember when I dreamed Bubby would have my husband's lips? Well he totally does! Yay!Oh, and Happy Mother's Day!

Pushed and preoccupied

I finally finished Pushed today. I've read a lot of books about childbirth, but this is most definitely one of the best I've ever read. The funny thing is that when I initially heard about the book in '07 and saw it sitting on display with the other new books at my library, I was turned off by it. Being the birth junkie I am, you'd think I would have eaten it up. For whatever reason, I couldn't bring myself to read it. But then my cousin-in-law read it and raved about it. And another friend. And a fellow doula-in-training. And I said to the universe... alright, already! I'll read it!

Thank you, universe. Thank you, thank you, thank you. Or, rather, THANK YOU, Jennifer Block. Too bad we can't mandate that everyone on the planet read the book. ;-)

I can't tell you how many times I read a sentence, statistic, or statement from a doctor or midwife and wanted to write a blogpost about what I'd learned. I think I was stunned, thrilled, appalled, and/or enchanted by something on every single page. I can't wait to read it again. Definitely buying my own copy for future reference and lending purposes!

Alright, enough gushing...

There's no question I loved reading this book, but it certainly wasn't an easy read. There were many times I felt sad enough that I wondered if I could keep reading it. The book also raised some important questions for me... questions I hadn't ever really considered before. And they are tough questions. I don't have time to address all of them here, but I do want to touch upon one or two.

Jennifer Block spent a chapter discussing doulas and childbirth educators. I've dreamed for several years about becoming a doula. I've been trained, I've read the books, and I've felt certain I wanted to pursue this path. Until now. Yup... thanks to Jennifer Block, now I'm just not so sure it's for me. Reading the experiences of the doulas she interviewed, I had to ask myself... can I really do this?! Here's an excerpt that hit me hard:

"Many doulas are emotionally devastated by the treatment they're privy to. 'If you care about birth, doing hospital births is very hard on your psyche,' says Barbara Stratton. 'It's hard to watch what they do to women.' And yet part of the doula's mandate is to make the woman regard her experience as a positive one. The doula ultimately can't throw herself in front of the scalpel, but she can figuritively throw herself in front of the woman's psyche. . . .

"As doulas 'reframe' the birth experience for their clients, they are also shielding the hospital and its care providers from criticism and complaint. . . .

"'The unanswered, fundamental question is whether [doulas] are making birth better for women, or just making women feel better about their births,' write sociologists Bari Meltzer Norman and Barbara Katz Rothman. They raise a fair critique of the doula as an enabler. By supplementing the handholding and informed consent conversations that nurses and doctors should be doing, and by buffering the level of intervention, they are perpetuating the very system that they are in the business of changing. . . .

"'This is is the hidden story of what goes on in birth. We've got folks talking about it as medical rape. Doulas are witnessing these things, and it's eating them up inside'" (p. 160-161).

This section caused me some serious self-reflection. Am I capable of throwing myself in front of the psyches of my clients? Could I really stay positive in the face of abuse? Can I allow myself to be an enabler of this horribly broken system? Can my own psyche handle the emotionally challenging task of witnessing "medical rape" on a regular basis? I really just don't know if I could do it... Maybe I'm better suited to prenatal education? I just don't know if I can handle working in the trenches.

But then I think of the enormous impact doulas have. I think of the women who desperately need a supportive presence as they give birth. Can I leave these women alone?

So many questions... and I'm still not really sure what the answers are.

Ask Busca: Turning a breech baby?

Tiffany asked:

I am 36 weeks and currently my baby is breech. The doc said if he doesn't move by next week I need to either schedule an external reposition of the baby or a c-section. This is my first and I was going to try to have a natural vaginal delivery but it might not be possible now. I was wondering if you had done any research or pro and cons of repositioning the baby. Thanks!

Busca's babble:

Great to "meet" you, Tiffany! I hadn't actually done much research into handling breech babies, but I'm always thrilled to learn something new. First of all, I think it's worth your while to try anything and everything (within reason) to try to encourage your baby to turn. While not all turning methods have high success rates, most of them are not harmful.

1) External Version
Based on what I've read, external version is safe for most women. There are some risks, but they are reported to be very minimal. These include: premature labor, premature rupture of the membranes, bleeding, and fetal distress leading to an emergency cesarean delivery (source). The procedure is also apparently quite uncomfortable (one woman described it as the worst pain she's felt besides childbirth). You could approach it as a warm-up for childbirth. :-) Practice your pain-coping techniques, work on relaxing all your muscles, and visualize your baby turning. External versions are successful about 60% of the time.

2) The Webster Breech Technique
You may also want to consider visiting a chiropractor skilled in the Webster Breech Technique. This technique is designed to release stress in your pelvis and relax the uterus and surrounding ligaments, making it easier for your baby to turn. This technique has been reported to have a very high success rate--82% according to one study. Excellent odds! And it'd probably ease some of the late-pregnancy discomforts too. :-)

3) At-home techniques
I think it's also worth trying at-home techniques. These include the breech tilt position, using music (at the lower abdomen) and/or ice (at the top of the uterus) to coax baby to turn, etc. The website Spinning Babies is a great resource. I also found another site that listed 17 ways to turn a breech baby.

I hope some of this was helpful. Good luck! Let me know how things turn out. ;-)

One month?!

And he's already losing that newborn baby look! Ah! Slow down, Bubs! I've been wanting to get some nice photos of him as a newborn so I won't forget what his tiny fingers and toes looked like, his skinny little legs... and, well, the rest of him too! After the girls were born, my sister (and her fancy camera) took some sweet photos of them when they were tiny and new. Since I no longer live near her, I was on my own this time... minus the fancy camera. But I made do (it was really fun!) and fiddled with the pics in iPhoto, and I'm really happy with how they turned out. Of course it helps having such a gorgeous subject to work with... ;-)So, um, it's probably bad news that I can't ever imagine feeling "done" having babies. And the more of them I have, the more of them I want... :-/ uh oh.