Changing tides of Birth in America

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The world started with home births; most of the Presidents of the United States were born at home; according to wnd.com, only three known presidents were born in hospitals. They are Jimmy Carter (1924), Bill Clinton (1946), and George W. Bush (1924); it is unsure where Barak Obama was born because his birth certificate has been undisclosed.

Home birth has been in existence since the First Couple was created or evolved. It is not a sickness or disease that should be cause to race to the hospital for a healthy labor and delivery. A thought-provoking quote from the movie, “The Great Gatsby” by Robert Redford, “Pregnancy is not a condition; it is a consequence!”

Below is part of a research paper I did when I was seeking alternative methods for friends of mine. For me, after giving birth by cesarean section four times, I had unpleasant experiences with my next two natural hospital births from physicians who mocked my choices and family size. When my family subsequently moved to Pennsylvania in 1989, I sought and used the same midwife for my next five home births. My youngest was born in New York State with the assistance of my midwife’s original teacher. I thank G-d for each that there were choices for me to make.

 

In my class of Health Communications, our text (du Pre 2010) also brings to the front the concept of “paternalism,” (p 212) whereby physicians or caretakers give orders to the patient regarding healthcare. Women in today’s society wish to make their own choices and decisions about how to plan their births, so many have decided to remove themselves from health facilities and give birth at home.

  1. # 1 –  Research Studies Done

A.  Eligibility Requirements for Home-Birth (Study from British Columbia, Canada)

1. Absence of pre-existing diseases such as diabetes, heart disease, hypertension, genital herpes, placenta previa, or antepartum hemorrhage

2. The birthing mother would have only a singleton fetus.

3. The head of the baby could only be in cephalic presentation.

4. Mother has had no more than 1 previous cesarean section.

5.  Labor is spontaneous or induced on an outpatient basis.

6.  The mother has not been transferred to the delivery hospital from a referring hospital.

B.  Results of Research

1. Study is from January 1, 2000 until December 31, 2004.

2. Rate of perinatal death for planned home-birth was 0.35 and planned hospital birth was 0.57 (Relative Risk)

3. According to CMAJ (Canadian Medical Association Journal, 2004), “Newborns in the home-birth group were less likely than those in the midwife-attended group to require resuscitation at birth or oxygen therapy beyond 24 hours.”

4. “The findings were similar in comparison with newborns in the  physician-assisted hospital births; in addition, newborns in the home-birth group were less likely to have meconium aspiration and more likely to be admitted to hospital or readmitted if born in the hospital.

5. “The decision to plan a birth attended by a registered midwife at home versus in hospital was associated with very low and comparable rates of perinatal death. Women who planned a home birth were at reduced risk of all obstetric interventions assessed and were at similar  or reduced risk of adverse maternal outcomes compared with woman who planned to give birth in hospital accompanied by a mid wife or physician.”

6. “There were no perinatal deaths at home.”

Point #2 – Reasons to Give Birth at  Home

  1. The Cost-Effectiveness of Home-birth

1. According the the Journal of Nurse-Midwifery, January-February 1999, there would be $150 billion reduction in Medicaid cost.

2. The average uncomplicated birth is 68% less in a home than in the hospital, including a lower rate of cesarean delivery.

  1. Perineal Outcomes in a Home-birth setting

1. From a study based on 1068 women who gave birth at home, 69.6% of the women had an intact perineum, 15 women (1.4%) had an episiotomy, and 28.9%  had first or second degree lacerations, and 7 (0.7%) had third or fourth degree lacerations.

2. Conclusions were with use of hands-and-knees position at delivery and manual support of the perineum were associated with intact perineum.

E. Washington State has Significantly Lower Birth Weight in Home-births

1. “Overall, births attended by licensed midwives out of hospital had a significantly lower risk for low birthweight than those attended in hospital by certified nurse-midwives”

2. “ The results indicate that in Washington state…..may be as safe as that of physicians in hospital and certified nurse-midwives in and out of hospital.

F. Comforts of Home and Family at Home

1. Only natural germs from unknown sources are home.

2. Mother and partner plan the birth with midwife.

3. Less medical intervention at home.

4. Comforts of home such as food, movies, music, fridge, and bed.

5. No travel expenses from home to home.

Point #3 – How to Plan a Home Birth

  1. Prospective Parents Meet with Midwife

1. Pre-screen for viability of low-risk birth

2. Formulate a birth plan.

a. water birth possibility

b. positions of birth

c. choose a place to give birth (bed, sofa, floor)

3. Have name and number of emergency back-up doctor.

4. Plan for emergency run to hospital.

a. prepare cab money.

b. have address and phone number of nearby hospital.

5. Shop for list of home-birth supplies.

6. Countdown to baby!

Conclusion – When a family researches the choices of home-birth with a midwife and the options of hospital birth with a midwife or physician, it is important to know the risks of either decision that is made. Strong research has shown that it may be equally as safe to birth at home as it is in the hospital under pre-screened conditions.

August 2002. Journal of Obstetrics & Gynecology:“Outcomes of Planned Home Births in Washington State: 1989-1996” by Pang, Heffelfinger, Huang, Benedetti & Weiss.

 

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