Home Birth and Home Birth Safety Research

At Understanding Birth Better, we undertake original research on home birth and home birth safety.

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, as provided primarily by midwives to low-risk pregnant women during pregnancy, birth and postpartum.

We produce evidence regarding the safety of home birth and make it 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the meta-analysis, we chose to expose the fundamental problem that renders it such poor academia that we suggest it be withdrawn.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

• Our major effort earlier in the decade was the CPM2000 study of 5,418 planned home births published in British Medical Journal in 2005.
  
  
• This study is available online, free, at http://www.bmj.com/cgi/content/full/330/7505/1416.
  
  
• The study can be downloaded in English, French, Spanish, German or in a larger print version.
  - French Translation
  - Spanish Translation
  - German Translation
  - EXTRA LARGE PRINT VERSION
  - Hebrew translation coming - check in mid July for it
  
  
• There are also 19 letters to the editor regarding the study from around the world after scrolling down through the study text or at http://www.bmj.com/cgi/eletters/330/7505/1416.
  
  
• A short BMJ editorial about the study and 5 additional to letters to the editor are available at http://www.bmj.com/cgi/content/full/330/7505/0-a.
  
  
• We have produced an FAQ: "Frequently asked questions about the study are answered".
  
  
• We have also produced a more detailed assessment of neonatal mortality and reduced prematurity: http://understandingbirthbetter.com/section.php?ID=24&Lang=En&Nav=Section.

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
  

Other Work

• Inuit Birth
  
  
• Risks and Benefits of Randomized Controlled Trials in Midwifery Research