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Home Birth Research
Breech Birth Research
Social Science Research on Birth Models that Work
Commentary on RCTs and VBAC research
At Understanding Birth Better, we undertake original research on home birth, home birth safety, breech birth, and international Birth Models That Work in a variety of settings.
We locate, evaluate and synthesize epidemiologic research evidence from the scientific medical literature to better understand the risks and benefits of a low-intervention approach to birth to low-risk pregnant women during pregnancy, birth and postpartum.
We produce evidence and make ourselves available as expert witnesses for inquests, trials, and legislative hearings regarding home birth and breech birth. We provide published research and past presentations on this website to make it freely available for the benefit of mothers, midwives, legislators and other groups.
RESPONSE TO THE MISLEADING HOME BIRTH META-ANALYSIS
IN THE ACOG JOURNAL
In July an American home birth meta-analysis by Wax et al. which contained many analytic problems
received undue media coverage following publication. It inaccurately reported that there was increased neonatal mortality at planned home births compared to planned hospital and then jumped to a second unsubstantiated conjecture that this ''increased mortality'' was as a result of there being less intervention at home births. The researchers neglected to use 90% of the data available to them in this conclusion, even from the very studies which they had originally chosen to use in their perinatal analysis. While we could have responded in detail to all of the problems with the meta-analysis, we chose to expose the fundamental problem that renders it such poor academia that we suggest it be withdrawn. Originally drafted as a rapid response, the BMJ has chosen to published it as a letter in their print form of the journal. This makes it much more credible and provides it with wide web attention.
The ideal opportunity to make our concerns known about the meta-anlayis arose when one of the BMJ commentators, Tony Delamothe, asked the right questions about the selective use of the available data, begging our response.
First, here is the response to him that the editors chose to publish.
http://www.bmj.com/content/341/bmj.c4699.full.html?ijkey=izCkjyeF7HV0CCG&keytype=ref
Next, here is our longer response found on the web under "Rapid Responses"
to the Tony Delamothe commentary:
http://www.bmj.com/content/341/bmj.c4292.short/reply#bmj_el_240714
Finally, here is the original Delamothe commentary:
http://www.bmj.com/content/341/bmj.c4292.extract
Outcomes of planned home births with certified professional midwives: large prospective study in North America
Bringing Back Vaginal Breech Birth
Over the last four years a major focus has been on bringing back vaginal breech birth including publishing an article and a breech birth conference.
Birth Models That Work
Edited by Robbie E. Davis-Floyd, Lesley Barclay, Betty-Anne Daviss,
and Jan Tritten
For years birth activists have been saying it: “that doesn’t work, it just doesn’t work.” By “doesn’t work,” they mean the contemporary obstetrical treatment of birth around the world. It doesn’t work. Yes, babies get born and lives that could have been lost get saved through modern obstetrics, but the price in both money and collateral damage to mother and baby is increasingly high. This price shouldn’t have to be paid, because it is based on misinformation and misunderstanding of the normal physiology of birth and how to best support it. It comes from a system that seeks to avoid mortality through the excess application of interventions while failing to recognize that those very interventions when overused cause unnecessary morbidity – and increasingly, even mortality itself –to the mother or baby. Intervention is now associated with increased maternal and perinatal mortality figures due in part to the excess use of cesarean section in many countries; the increased rate of cesareans has become the unwitting accomplice to the mortality this operation is designed to avoid (see below)
As the models described in this volume demonstrate, it is not necessary to “trade off” the morbidity associated with interventions for avoidance mortality – decreasing intervention and increasing support of normal physiological birth both serve to avoid mortality. Indeed, as we will show in these pages, some low-intervention models of birth can demonstrate lower morbidity and equivalent (or lower) mortality than high-intervention tertiary care.
Birth Models That Work…
…First and foremost, models that work do not cause unnecessary harm to mothers and babies. Each chapter presents a case study of one model that works and describes the impetus for this model’s development, the process through which it was developed, its underlying philosophy, and its specific characteristics…
The models include:
- Large-scale national systems (the Netherlands, New Zealand, Ontario, Samoa(where social and professional midwives work together)
- Local Models in Developed nations e.g. The Albany Midwifery Practice (Britain), a birth centre in England, Japan, Australia, New Mexico…
- Local Models in Developing Nations (traditional, professional, and obstetrics working together…
- Making Models Work
e.g. Centering Pregnancy@ Group Prenatal Care,
Humanizing Childbirth in Brazil
Click here for more information and to purchase the book
Betty-Anne and Robbie are presently working on the second volume, which will have chapters on Afghanistan, Guatemala, Uganda, the Canadian North, potentially Russia, China, the model of unassisted birth in Mexico, new models for breech and VBAC birth, and promising collaboration models between physicians and midwives in North America.
Other Work
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