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Old 02-02-2012, 04:42 PM
 
Location: Georgia, USA
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Quote:
Originally Posted by Dorthy View Post
The mother who died in the "homebirth tragedy" in Suzy's link also died after the birth of her child, a day later and at the hospital. Her baby was also okay.
Caroline Lovell was "critically ill" when the ambulance arrived to take her to the hospital. Whatever killed her started at home. She actually died in the hospital or was pronounced dead when she got there. We will have to see what her autopsy shows.

Quote:
Homebirth is NOT more risky for a low risk woman under the care of a trained midwife then a hospital birth. Homebirth does not put the baby at an increased risk of death. ACOG based their findings on a flawed data and they know it. There are plenty of studies that show the rates of maternal and neonatal mortality to be the same for home and hospital birth for low risk women under the care. Homebirth is only more risky when it is unplanned and/or unassisted or the mother is NOT low risk or the midwife is NOT trained.
You keep missing the point. A single death of a mom or injured or dead baby that could have been prevented by delivering in a facility equipped to deal with obstetrical emergencies is unacceptable.
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Old 02-02-2012, 06:38 PM
 
Location: Manhattan, Ks
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Quote:
But the difference between home birth and hospital birth lies in having quick access to care should an unforeseen complication emerge.
“The question would be: Had she been in the hospital, would there have been ample time to resuscitate and save her life?” said Imler.
From the story you linked. I believe this is suzy_q2010's point.
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Old 02-02-2012, 07:05 PM
 
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Quote:
Originally Posted by kansas sky View Post
From the story you linked. I believe this is suzy_q2010's point.
I deleted my post because this conversation is going in circles. I'm not going to change anyone's mind and vice versa. But since you quoted something from the link, I'll re-post it. http://abcnews.go.com/blogs/health/2...ses-questions/

Caroline Lovell died from a heart attack in the hospital one day after giving birth at home.

Under Suzy's (and other posters) logic we should not be seeing any deaths for low risk women and babies who give birth in hospitals due to all of the interventions available but the fact of the matter is we are seeing deaths in the hospital and at the same rate as we see them for homebirths. We don't know if those women and babies who died in homebirths would have been saved if they had birthed in a hospital and we don't know if those women who gave birth in the hospital would have died if they had given birth at home.

Women and babies sometimes die in childbirth. It's an unfortunate fact of life. They die at home and they die in the hospital. It happens at the same rate at home as it does in the hospital so to say that birthing in a hospital is safer is just not true.

You all think I'm missing your point and I think that you are missing my point. I'm not going to debate this further.
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Old 02-02-2012, 07:21 PM
 
Location: Georgia, USA
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Quote:
Originally Posted by kansas sky View Post
From the story you linked. I believe this is suzy_q2010's point.
Exactly. Thank you.
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Old 02-02-2012, 07:41 PM
 
Location: Georgia, USA
10,463 posts, read 10,280,068 times
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Quote:
Originally Posted by Dorthy View Post
I deleted my post because this conversation is going in circles. I'm not going to change anyone's mind and vice versa. But since you quoted something from the link, I'll re-post it. http://abcnews.go.com/blogs/health/2...ses-questions/

Caroline Lovell died from a heart attack in the hospital one day after giving birth at home.

Under Suzy's (and other posters) logic we should not be seeing any deaths for low risk women and babies who give birth in hospitals due to all of the interventions available but the fact of the matter is we are seeing deaths in the hospital and at the same rate as we see them for homebirths. We don't know if those women and babies who died in homebirths would have been saved if they had birthed in a hospital and we don't know if those women who gave birth in the hospital would have died if they had given birth at home.

Women and babies sometimes die in childbirth. It's an unfortunate fact of life. They die at home and they die in the hospital. It happens at the same rate at home as it does in the hospital so to say that birthing in a hospital is safer is just not true.

You all think I'm missing your point and I think that you are missing my point. I'm not going to debate this further.
We do not yet know what caused Lovell's death. The autopsy is pending.

She was in cardiac arrest when the EMTs arrived. The issue is whether she could have been saved if she had arrested in the hospital rather than at home. We will have a better idea after the autopsy is done.

Another issue is whether the midwife was prepared to deal with a maternal cardiac arrest. I understand that Lovell's midwife (or midwives) were not nurse midwives. She advocated for midwives with a lower level of training than was allowed by the Australian system to be allowed to practice. In the hospital, an arrest brings together a team of trained people and a cart full of medications and a defibrillator.

I submit that if home birth is truly "safe", then there should be better statistics for home birth, not "just as a good" as in a hospital. There should be no preventable maternal or infant deaths at all.

If the risk is the same for home birth and hospital birth, then the midwives who do home births must be delivering some higher risk patients at home. Certainly any midwife who would deliver twins, and I have heard of it, at home is doing so.

And a completely "normal" labor can become high risk in a matter of minutes. If a midwife waffles over having to send "her" patient to the hospital, the delay can be costly.

Then midwives who do transfer patients cannot understand why the hospital staff and obstetrician get huffy about having a high risk patient that they do not know dumped in their laps.
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Old 02-02-2012, 08:31 PM
 
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Quote:
Originally Posted by suzy_q2010 View Post
I submit that if home birth is truly "safe", then there should be better statistics for home birth, not "just as a good" as in a hospital. There should be no preventable maternal or infant deaths at all.

If the risk is the same for home birth and hospital birth, then the midwives who do home births must be delivering some higher risk patients at home. Certainly any midwife who would deliver twins, and I have heard of it, at home is doing so.

And a completely "normal" labor can become high risk in a matter of minutes. If a midwife waffles over having to send "her" patient to the hospital, the delay can be costly.
This study compares low risk women birthing at home with a midwife to low risk women birthing in a hospital with a midwife to low risk women birthing in a hospital with an OBGYN. Safety favors homebirth first, midwife in a hospital second and OBGYN last. Homebirth is safer then hospital birth among low risk women. With all of the life saving equipment available in hospitals we should not see any deaths from low risk women under your logic. But we do! And at a higher rate!!!

Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician

Quote:
We included all planned home births attended by registered midwives from Jan. 1, 2000, to Dec. 31, 2004, in British Columbia, Canada (n = 2889), and all planned hospital births meeting the eligibility requirements for home birth that were attended by the same cohort of midwives (n = 4752). We also included a matched sample of physician-attended planned hospital births (n = 5331).
All patients were considered low risk.

Quote:
The rate of perinatal death per 1000 births was 0.35 (95% confidence interval [CI] 0.00–1.03) in the group of planned home births; the rate in the group of planned hospital births was 0.57 (95% CI 0.00–1.43) among women attended by a midwife and 0.64 (95% CI 0.00–1.56) among those attended by a physician. Women in the planned home-birth group were significantly less likely than those who planned a midwife-attended hospital birth to have obstetric interventions (e.g., electronic fetal monitoring, relative risk [RR] 0.32, 95% CI 0.29–0.36; assisted vaginal delivery, RR 0.41, 95% 0.33–0.52) or adverse maternal outcomes (e.g., third- or fourth-degree perineal tear, RR 0.41, 95% CI 0.28–0.59; postpartum hemorrhage, RR 0.62, 95% CI 0.49–0.77). The findings were similar in the comparison with physician-assisted hospital births. Newborns in the home-birth group were less likely than those in the midwife-attended hospital-birth group to require resuscitation at birth (RR 0.23, 95% CI 0.14–0.37) or oxygen therapy beyond 24 hours (RR 0.37, 95% CI 0.24–0.59). The findings were similar in the comparison with newborns in the physician-assisted hospital births; in addition, newborns in the home-birth group were less likely to have meconium aspiration (RR 0.45, 95% CI 0.21–0.93) and more likely to be admitted to hospital or readmitted if born in hospital (RR 1.39, 95% CI 1.09–1.85).
Quote:
Then midwives who do transfer patients cannot understand why the hospital staff and obstetrician get huffy about having a high risk patient that they do not know dumped in their laps.
Hospitals are for emergencies. Why would OB's get huffy about doing their job?
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Old 02-02-2012, 11:10 PM
 
Location: Georgia, USA
10,463 posts, read 10,280,068 times
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Quote:
Originally Posted by Dorthy View Post
This study compares low risk women birthing at home with a midwife to low risk women birthing in a hospital with a midwife to low risk women birthing in a hospital with an OBGYN. Safety favors homebirth first, midwife in a hospital second and OBGYN last. Homebirth is safer then hospital birth among low risk women. With all of the life saving equipment available in hospitals we should not see any deaths from low risk women under your logic. But we do! And at a higher rate!!!

Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician

All patients were considered low risk.
This study was done under an "intention to treat" format. Unfortunately, it does not tell me how many of the women who intended to deliver at home actually did so. That would be useful to know.

For example, there were two prolapsed cords in the group who intended to deliver at home. Did those happen at home or were the patients already in the hospital? I would be really impressed if it was possible to transport a patient to a hospital who had a prolapsed cord at home and not get a dead or damaged baby. There were no perinatal deaths in the actual home deliveries, so perhaps those women were already in the hospital.

This study does indicate that these Canadian women were apparently appropriately transferred to a hospital if that became necessary.

What the study cannot get around is that there will be the possibility of obstetrical emergencies that will have a poorer outcome if they happen outside the hospital. The number will likely be small, but there is no way to triage out those women ahead of time.

I still contend that it is unacceptable to lose a single mother or child that could have been saved by delivery in a setting with the capability to deal with OB emergencies.

Quote:
Hospitals are for emergencies. Why would OB's get huffy about doing their job?
Who do you think will get sued when there is a less than perfect outcome? The sweet midwife who "did all she could" before sending mom to the hospital (and has no liability insurance) or the hospital and obstetrician with much deeper pockets because they are paying megabucks for their liability insurance.

Give the hospitals good Samaritan protection for accepting failed home birth labors and that might change.
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Old 02-03-2012, 02:56 AM
 
149 posts, read 287,319 times
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>>Give the hospitals good Samaritan protection for accepting failed home birth labors and that might change.<<

No, this will only cause doctors from getting away with malpractice.


Surgeons deal with acute cases of patients that they do not know all the time.
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Old 02-03-2012, 09:32 AM
 
4,267 posts, read 3,104,840 times
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Quote:
Originally Posted by suzy_q2010 View Post
I still contend that it is unacceptable to lose a single mother or child that could have been saved by delivery in a setting with the capability to deal with OB emergencies.
How do you know the woman would have been saved if she had chosen a hospital birth? Women die in the hospital at higher rates then they die at home despite having immediate access to "life saving equipment". Why do you feel that it is okay for low risk women to die in a hospital birth (they shouldn't since thay have immediate access to life saving equipment, right?) but it's not okay for low risk women to die in homebirth? Why do you hold homebirth to a higher standard then a hospital birth?

As for cord prolapse, midwives are trained to deal with this type of rare emergency. Yes, sometimes babies die or are injured as a result of cord prolapse but this happens both in homebirths and in hospital births.

If a woman or baby dies in a homebirth people will blame it on the homebirth. If a woman or baby dies in the hospital it's just one of those things that happens. C'est la vie.
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Old 02-03-2012, 10:29 AM
 
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If a woman or her baby runs into difficulty during a home birth.....she or the baby is rushed to the hospital and dies there, the death is counted as a hospital death. The home situation record is free and clear because she didn't die there.


Think about this: A baby is delivered. It has breathing difficulties. Is it more likely to die or have brain damage if it takes about 30 minutes to get to facilities at hospital or if it just has to be carried across a hall to a fully equiped neo-natal unit?

OR: A woman begins to hemorrage. Would she lose more blood getting to a hospital, though traffic from home, or just waiting a few minutes while the blood is brought up from the blood bank at the hospital?

OR: The baby turns at the last minute and it's goes from a normal easy delivery to a breech birth. One leg goes down into the birth canal, but the other one doesn't. Which can handle the situation better....Hospital and c-section or home, ambulance and hospital ER? They can't always be turned.

The crucial factor is always TIME. Just a two minutes of oxygen to a baby's brain can mean the difference between normal child and brain damaged child.

You may quote all the records and reports that you want. The fact remains that some normal births turn bad in just a minute or two. And if the mother or baby makes it to the hospital before death, the death will count on the hospital records. The Midwife is free of responsibility. So yes, they die at a higher rate in the hospital.
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