Warm Southern Breeze

"… there is no such thing as nothing."

Study: Half of all Pregnant Moms may not need hospital birth

Posted by Warm Southern Breeze on Thursday, November 24, 2011

For many years I’ve remarked sarcastically that, it’s amazing the human race has existed this far.

According to the University of California San Francisco Medical Center, “High-risk complications occur in only 6 percent to 8 percent of all pregnancies.” The University of California Ervine Medical Center says that, “As many as 10 percent of pregnancies are considered high risk, but with expert care, 95 percent of these special cases result in the birth of healthy babies.

Some states – like Alabama – forbid home birth. Yes, that’s true.

How many obstetricians have you ever heard of whom delivered a child anywhere else other than a hospital? We hear about taxicab drivers, police officers, EMTs, and others delivering babies in backseats of cars, at homes, and in a variety of locations other than hospitals. But NONE of them are obstetricians. And good luck getting a doctor to come to your house… for any reason.

In stark contrast, Nurse Midwives, traditionally the providers of choice for pregnancies and birth, are non-existent in Alabama, while in Tennessee – Alabama’s northern neighbor (for the geographically challenged) – state law allows midwives to perform birthing services, and at midwife owned birthing centers.

Let’s put this in perspective, and cut to the chase, shall we?

The site AlabamaMidwives.com provides the best explanation of any.

“”Lay midwifery” was formally recognized by Alabama law in 1919, under the old Alabama Code, Title 46, Section 168. That statute was repealed, however, in 1976, and replaced with the current law, Alabama Code Section 34-19-1, et. seq. The current law allowed for “lay midwives” to continue practicing as long as they had a license from the Department of Health, but our understanding is that the Department of Health issued its last “lay midwife” license in 1984. The Department’s position is that it will not issue licenses to “lay midwives”; that to receive a license one must have a formal nursing degree; and that the repeal of the old statute recognizing lay midwifery means the Legislature intended to phase out lay midwives in favor of nurse midwives. Of course, this is the Department’s opinion, not necessarily the law. No court of law has ever ruled upon whether the Department of Public Health retains authority under the current law to issue licenses to “lay midwives.” It is our opinion that it does.

   No one knows at this time if there has ever been a “midwifery program” in the State of Alabama, but we do know that the Alabama Code specifically recognized lay midwifery from 1919 – 1976. In 1976, when the new law was enacted, the Alabama Department of Public Health renewed licenses to those lay midwives then practicing, but refused to grant NEW licenses unless the individual had a formal nursing degree.”

There you have it. The practice of midwifery in Alabama was made illegal in 1976.

But more importantly, this is the state telling you that you do NOT have the freedom to choose. Does that make you happy?

Is it any wonder that Alabama’s state slogan is “Thank God for Mississippi!”?

England study: Low-risk births don’t need hospital

By MARIA CHENG | AP – 2011-11-25T00:02:23Z

LONDON (AP) — A new study in England shows little difference in complications among the babies of women with low-risk pregnancies who delivered in hospitals versus those who gave birth with midwives at home or in birthing centers.

Based on the findings, researchers said women with uncomplicated pregnancies in England should be able to choose where they want to give birth — and one expert said about half of all pregnant women here could potentially safely give birth outside a hospital.

But they sounded a note of caution for first-time mothers and their infants, who may face a higher risk if they choose a home birth.

“I would never say women should give birth in a particular place, but hope this gives women more information to make an informed choice,” said Dr. Peter Brocklehurst, director of the Institute for Women’s Health at University College Hospital in London, one of the paper’s lead authors. He conducted the research while at Oxford University.

“Birth isn’t an abnormal process, it’s a physiological process,” he said. “And if your pregnancy and labor is not complicated, then you don’t need a high level of specific expertise.”

Brocklehurst added that about 50 percent of pregnant women in England — those who are low-risk — should be able to choose where to have their baby.

More than 90 percent of pregnant women in England now give birth in a hospital. Some officials say the new study should prompt women to consider alternatives.

“This is about giving women a choice,” said Mary Newburn of NCT, a U.K. charity for parents, one of the study’s authors. She said midwife-run birth centers in England have a more homelike environment, with privacy, sofas and birthing pools.

In Britain, midwives deliver more than 60 percent of babies already. Similar care is provided in the Netherlands, where about a quarter of all births happen at home. Elsewhere in Europe, most births are led by doctors, although midwives may also be involved.

In the United States, however, less than one percent of births happen at home. The American College of Obstetricians and Gynecologists does not support planned home births and warns evidence shows they have a higher risk of newborn death compared to planned hospital births. The training of midwives in the U.S. varies by state — and some have no regulations.

Brocklehurst and colleagues collected data for nearly 65,000 mothers and babies between 2008 and 2010 in England. Of those, there were 19,706 births in hospital obstetric wards, 16,840 births at home, 11,282 births in “freestanding” midwifery units — independent clinics where there are no doctors or access to anesthetics — and 16,710 births in “alongside” midwifery units, often housed within hospitals.

All the pregnancies were low-risk, meaning the mothers were healthy and carried their baby to term. Women planning C-sections or expecting twins or multiple births were excluded from the study.

In the U.K.’s hospital obstetric wards, most low-risk women don’t see a doctor during labor and are only treated by midwives.

There didn’t appear to be a difference for the infants’ health based on where the mothers planned to give birth.

But researchers found a higher risk for first-time mothers planning a home birth. Among those women, there were 9.3 adverse events per 1,000 births, including babies with brain damage due to labor problems and stillbirth. That compared to 5.3 adverse events per 1,000 births for those planning a hospital birth.

The study was published Friday in the medical journal, BMJ. It was paid for by Britain’s department of health and another government health research body.

Dr. Tony Falconer, president of the Royal College of Obstetricians & Gynaecologists, said his group supports “appropriately selected home birth.” He noted the higher risk of problems among first-time mothers choosing a home birth and said that raised questions about where they should deliver.

For Emily Shaw of Oxfordshire, northwest of London, giving birth in a hospital wasn’t appealing. She wanted home births for both her sons but because her first baby was induced into labor, she had to deliver him in a hospital in October 2008.

Shaw delivered her second son at home in April. “I felt much more comfortable there,” she said. “Instead of getting into a car to go to the hospital, the midwives came to me.”

“It was nice to have the home comforts during labor,” she added, saying she could eat in her own kitchen and use her own bathroom. “And unlike the hospital, they didn’t kick out my partner in the middle of the night.”

____

Online:

http://www.bmj.com

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