Sunday, February 26, 2012

Understanding Risk

Whose Risk are We Talking About?

"We must never underestimate the power fear of litigation holds over obstetricians. In my experience, as a motivational force it over shadows their desire to lower the maternal mortality rate." 
~ Dr. M. Wagner

The "Risks" of Home Birth: Why haven't we heard about this? 

"We now have good, solid scientific evidence that makes clear that planned home birth attended by a midwife is a perfectly safe option for the 80 to 90 percent of women who have had normal pregnancies...This study is by far the largest scientifically valid study of planned home birth ever conducted...In summary this prospective, highly reliable study, which followed the course of more than 7,000 pregnant women planning home births attended by CPMs (Certified Professional Midwives), collected data on more than 5,000 who intended home birth at the initiation of labor. Among these women, the obstetric intervention rates were far below the rates reported in low-risk hospital births. The combined intrapartum/neonatal death rate (babies dying during labor, birth or shortly following birth) was as low or lower than rates reported for low-risk hospital births. And the maternal mortality rate was zero." ~ Dr. Marsden Wagner Born in the USA

When I looked up this study I found that 12.1% of the women ended up needing to be transported to the hospital but many of the transported women still didn't need a cesarean. Of the total low-risk home birth women in the study only 3.7% needed a c-section. How does that compare with our hospitals? Visit my Hospital Statistics post to find out.

If this study was published in the Boston Medical Journal in 2005 (six years ago!) why don't more people know about it? Why isn't the whole medical community talking about it, trying to understand what this means about how hospital-based birth is conducted? Why aren't they trying to understand the lessons that can be learned from home birth and how to incorporate those lessons into their practices? To read more about this study visit the Boston Medical journal web site. 

Which Local Hospital is the Safest?

Why would the same OBs who delivered babies at Sierra Vista for years, before they had a Neonatal Intensive Care Unit, now being telling women that French Hospital is unsafe because they don't have a NICU? They never told women in the past they needed to go out of town to a hospital with a NICU to safely deliver their babies. Just saying??? Did you know both hospitals have special baby respiratory therapists at births as a safety precaution? Did you know the same pediatricians and neonatalogists will go to either hospital if a baby arrives in need of their services? 

Hospital Versus Home Birth: Accepting the fact of risk

"If the obstetric tribe says that out-of-hospital birth is not "safe", the implication, of course, is that a hospital birth is safe, which is not true. Newborn babies die in hospitals every day, sometimes because someone made a mistake. When the obstetrics establishment implies that this doesn't happen, the family naturally feels deceived when it does happen." More from Marsden Wagner's 'Born in the USA'.

One of the hallmarks of a good out-of-hospital midwife is that she explains that there are risks to birth and is clear that the parents need to be willing to accept those risks. The reality is with life comes the risk of death no matter where you are or who you are. 

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