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That's just an ignorant response. There are plenty of board-certified midwives, birthing centers, etc. Importantly, a great deal of risk can be ascertained befo

That's just an ignorant response. There are plenty of board-certified midwives, birthing centers, etc. Importantly, a great deal of risk can be ascertained before labor, and like any other medical procedure you're either a good candidate for non-hospital birth or you're not.

jmcgough 10y ago
It depends heavily on the quality of the midwife and how well they can recognize complications. If they miss something (which very likely would turn from from a required test in a hospital), by the time the baby has stopped breathing, it might be too late to save them. "Planned out-of-hospital birth was associated with a higher rate of perinatal death than was planned in-hospital birth (3.9 vs. 1.8 deaths per 1000 deliveries, P=0.003; odds ratio after adjustment for maternal characteristics and medical conditions, 2.43; 95% confidence interval [CI], 1.37 to 4.30; adjusted risk difference, 1.52 deaths per 1000 births; 95% CI, 0.51 to 2.54). The odds for neonatal seizure were higher and the odds for admission to a neonatal intensive care unit lower with planned out-of-hospital births than with planned in-hospital birth." [1] "Midwife home births had a significantly higher total neonatal mortality risk than deliveries by hospital midwives (1.26 per 1000 births; relative risk [RR], 3.87 vs 0.32 per 1000; P < .001). Midwife home births of 41 weeks or longer (1.84 per 1000; RR, 6.76 vs 0.27 per 1000; P < .001) and midwife home births of women with a first birth (2.19 per 1000; RR, 6.74 vs 0.33 per 1000; P < .001) had significantly higher risks of total neonatal mortality than deliveries by hospital midwives. In midwife home births, neonatal mortality for first births was twice that of subsequent births (2.19 vs 0.96 per 1000; P < .001). Similar results were observed for early neonatal mortality. The excess total neonatal mortality for midwife home births compared with midwife hospital births was 9.32 per 10,000 births, and the excess early neonatal mortality was 7.89 per 10,000 births." [2] [1] http://www.nejm.org/doi/full/10.1056/NEJMsa1501738 http://www.nejm.org/doi/full/10.1056/NEJMsa1501738 [2] http://www.ajog.org/article/S0002-9378(14)00275-0/abstract http://www.ajog.org/article/S0002-9378(14)00275-0/abstract
- ThrustVectoring 10y ago
  Rounding up your first statistic slightly, that's a difference of two severe incidents per thousand births. That's a reasonably big risk factor in absolute terms, but small enough that it's not unreasonable to take in order to get other things that you care about. Like, these are "am I willing to make this tradeoff" numbers similar to choosing to drive to work daily, rather than "fuck no, go to the hospital" numbers.
  - ygjb-dupe 10y ago
    Midwives don't sell themselves on the increases risks, they talk about the (largely) cosmetic benefits of home birth. Look up earlier in the thread for my comment, but anecdotally, almost every parent that I have told my story to has changed their opinion on home birth vs. hospital birth.
scott_s 10y ago
If you're talking about certified nurse midwives (CNMs), yes. If you mean certified professional midwives (CPMs), no. I liked this NYT piece on the subject, "Why is American Home Birth So Dangerous?": http://www.nytimes.com/2016/05/01/opinion/sunday/why-is-american-home-birth-so-dangerous.html?_r=0 http://www.nytimes.com/2016/05/01/opinion/sunday/why-is-amer...
pavel_lishin 10y ago
A birthing center isn't your home.
masklinn 10y ago
> That's just an ignorant response. It's an educated and sourced one, as opposed to your flippant comment. > There are plenty of board-certified midwives Not only are there plenty of midwives which are not that, how meaningful board accreditations are depends strongly on the board, CNMs are true professionals[0], CPMs are pointless layabouts. > birthing centers The comment I was replying to was about homebirth. Birthing scenters are usually professionally staffed, attendant to hospitals, carrying necessary emergency materials and will immediately transfer to their linked hospital in case of complications. And good birth centers will plain refuse at-risk patients and direct them to hospitals. > Importantly, a great deal of risk can be ascertained before labor Which is already included in the statistics above. [0] and even with CNMs homebirth mortality is significantly higher than hospital birth.
- burfog 10y ago
  There are some very nice birthing centers that are not associated with hospitals. From what I've seen, hospital-associated ones are bait-and-switch. If you show up early, then you take longer than allowed and they transfer you to the regular hospital. If you show up late, then they also transfer you!!! (this shockingly lame excuse was actually used on a friend) Clearly, there is a purposely narrow window because the hospital makes more money if you end up in the regular hospital area. I find it strange that you think homebirth midwives don't carry necessary emergency materials. Just considering the obviously visible example, every one I've seen lugs around an oxygen tank.
  - scott_s 10y ago
    Homebirth midwives are not doctors, so carrying around "necessary emergency materials" is not enough in the case of a medical emergency.

jmcgough 10y ago

It depends heavily on the quality of the midwife and how well they can recognize complications. If they miss something (which very likely would turn from from a required test in a hospital), by the time the baby has stopped breathing, it might be too late to save them. "Planned out-of-hospital birth was associated with a higher rate of perinatal death than was planned in-hospital birth (3.9 vs. 1.8 deaths per 1000 deliveries, P=0.003; odds ratio after adjustment for maternal characteristics and medical conditions, 2.43; 95% confidence interval [CI], 1.37 to 4.30; adjusted risk difference, 1.52 deaths per 1000 births; 95% CI, 0.51 to 2.54). The odds for neonatal seizure were higher and the odds for admission to a neonatal intensive care unit lower with planned out-of-hospital births than with planned in-hospital birth." [1] "Midwife home births had a significantly higher total neonatal mortality risk than deliveries by hospital midwives (1.26 per 1000 births; relative risk [RR], 3.87 vs 0.32 per 1000; P < .001). Midwife home births of 41 weeks or longer (1.84 per 1000; RR, 6.76 vs 0.27 per 1000; P < .001) and midwife home births of women with a first birth (2.19 per 1000; RR, 6.74 vs 0.33 per 1000; P < .001) had significantly higher risks of total neonatal mortality than deliveries by hospital midwives. In midwife home births, neonatal mortality for first births was twice that of subsequent births (2.19 vs 0.96 per 1000; P < .001). Similar results were observed for early neonatal mortality. The excess total neonatal mortality for midwife home births compared with midwife hospital births was 9.32 per 10,000 births, and the excess early neonatal mortality was 7.89 per 10,000 births." [2] [1] http://www.nejm.org/doi/full/10.1056/NEJMsa1501738 http://www.nejm.org/doi/full/10.1056/NEJMsa1501738 [2] http://www.ajog.org/article/S0002-9378(14)00275-0/abstract http://www.ajog.org/article/S0002-9378(14)00275-0/abstract

ThrustVectoring 10y ago
Rounding up your first statistic slightly, that's a difference of two severe incidents per thousand births. That's a reasonably big risk factor in absolute terms, but small enough that it's not unreasonable to take in order to get other things that you care about. Like, these are "am I willing to make this tradeoff" numbers similar to choosing to drive to work daily, rather than "fuck no, go to the hospital" numbers.
- ygjb-dupe 10y ago
  Midwives don't sell themselves on the increases risks, they talk about the (largely) cosmetic benefits of home birth. Look up earlier in the thread for my comment, but anecdotally, almost every parent that I have told my story to has changed their opinion on home birth vs. hospital birth.

scott_s 10y ago

If you're talking about certified nurse midwives (CNMs), yes. If you mean certified professional midwives (CPMs), no. I liked this NYT piece on the subject, "Why is American Home Birth So Dangerous?": http://www.nytimes.com/2016/05/01/opinion/sunday/why-is-american-home-birth-so-dangerous.html?_r=0 http://www.nytimes.com/2016/05/01/opinion/sunday/why-is-amer...

pavel_lishin 10y ago

A birthing center isn't your home.

masklinn 10y ago

> That's just an ignorant response. It's an educated and sourced one, as opposed to your flippant comment. > There are plenty of board-certified midwives Not only are there plenty of midwives which are not that, how meaningful board accreditations are depends strongly on the board, CNMs are true professionals[0], CPMs are pointless layabouts. > birthing centers The comment I was replying to was about homebirth. Birthing scenters are usually professionally staffed, attendant to hospitals, carrying necessary emergency materials and will immediately transfer to their linked hospital in case of complications. And good birth centers will plain refuse at-risk patients and direct them to hospitals. > Importantly, a great deal of risk can be ascertained before labor Which is already included in the statistics above. [0] and even with CNMs homebirth mortality is significantly higher than hospital birth.

burfog 10y ago
There are some very nice birthing centers that are not associated with hospitals. From what I've seen, hospital-associated ones are bait-and-switch. If you show up early, then you take longer than allowed and they transfer you to the regular hospital. If you show up late, then they also transfer you!!! (this shockingly lame excuse was actually used on a friend) Clearly, there is a purposely narrow window because the hospital makes more money if you end up in the regular hospital area. I find it strange that you think homebirth midwives don't carry necessary emergency materials. Just considering the obviously visible example, every one I've seen lugs around an oxygen tank.
- scott_s 10y ago
  Homebirth midwives are not doctors, so carrying around "necessary emergency materials" is not enough in the case of a medical emergency.