|July 16, 2014|
Volume 16, Issue 15
|Midwifery Today E-News|
“Birth Centers or Homebirth?”
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In This Week’s Issue
Learn about the Anthropology of Reproduction with Robbie Davis-Floyd
Attend this all-day workshop to get an overview of the exciting sub-discipline of the anthropology of reproduction from its early beginnings to its latest findings. The class will concentrate on anthropological studies in four major areas: childbirth, midwifery, the new reproductive technologies, and the politics of reproduction. Robbie’s goal is to provide a stimulating overview of these anthropological sub-disciplines for midwives and others who want to know what the social scientists are up to, and to accompany that overview with an extensive annotated bibliography that will provide a helpful template for further exploration and research.
Quote of the Week
If women lose the right to say where and how they birth their children, then they will have lost something that’s as dear to life as breathing.
— Ami McKay, author of The Birth House
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The Art of Midwifery
When giving birth, all mammals have strategies to avoid feeling observed—privacy is one of their basic needs. At the same time, all mammals need to feel secure. For example, in a wild environment, a female cannot give birth as long as a predator is around. Physiologists easily explain that in such a situation the female releases hormones of the adrenaline family. This activation of the fight-or-flight system blocks the release of oxytocin, the key hormone in childbirth—the birth is postponed until the time when the female can feel secure. We are in a position to claim that today the priority is to mammalianize childbirth.
— Michel Odent
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I would love to see homebirth make a comeback in our culture. I loved my homebirths—they were the best experiences in my whole life. I like to say that homebirth provides a non-drug-induced high! A good birth, no matter where it takes place, lets mom start mothering on a solid foundation, and we all know that happy mothers make for happier families! An optimal birth may be the best thing we can do for the health of our society, and since I am a believer in the sanctity of homebirth, I think more homebirths would equal a healthier society.
As midwife Carla Hartley says, “More babies prefer homebirth.” But!…we have to hold to a standard that is outside of medical protocols and really think about what is safe in birth care. We are letting women down when we routinely give over care at 41–42 weeks because our license is beholden to a particular protocol. Maybe the mom has a long cycle and isn’t really due; this is where using evidence is helpful because our protocols are often not based on evidence. We cannot raise the number of homebirths if we are transferring the women who already want a homebirth to hospitals because they carry their babies longer than 41 weeks (most first-time moms usually do go past 41 weeks!).
Homebirth can be the gold standard of birth care when we midwives use wisdom based on evidence while honoring a mother’s choices. We need to find ways to change our direction—the regulations ruling us are effectively taking mothers’ choices away. How can we increase the number of homebirths in California when midwives cannot serve in twin, breech or VBAC births? There are really no options for these moms in California if midwives are not allowed to serve them. Homebirth can only increase if we change some of these protocols. Perhaps it is time to work harder on these political issues so homebirth numbers can really rise.
Home really is the best place for birth in most cases. Let us work to improve the numbers!
— Jan Tritten, mother of Midwifery Today
Jan Tritten is the founder, editor-in-chief and mother of Midwifery Today magazine. She became a midwife in 1977 after the amazing homebirth of her second daughter. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world, or join her online, as she works to transform birth practices around the world.
The National Birth Center Study II: Research Confirms Low Cesarean Rates and Health Care Costs at Birth Centers
As health care costs and the rate of cesarean births for expecting mothers have escalated over the past two decades, a new study published in the January/February issue of the Journal of Midwifery & Women’s Health, the peer-reviewed journal of the American College of Nurse-Midwives, shows that clients of midwife-led birth centers pay less in health care costs and are less likely to have cesarean births compared to women in the same risk category who give birth at hospitals. Conducted by the American Association of Birth Centers (AABC) and authored by Susan Rutledge Stapleton, CNM, DNP, Cara Osborne, CNM, SD, and Jessica Illuzzi, MD, MS, “Outcomes of Care in Birth Centers: Demonstration of a Durable Model”—referred to as the National Birth Center Study II (NBCS II)—explores outcomes associated with more than 15,500 births to clients of midwife-led birth centers. That’s the largest study of midwifery care outcomes since NBCS II’s 1989 predecessor, the first National Birth Center Study published in the New England Journal of Medicine.
NBCS II reinforces longstanding evidence that midwife-led birth centers provide safe and effective health care for women during pregnancy, labor and birth.
“This study is momentous for the midwifery profession and the women and newborns we serve,” said ACNM President Holly Powell Kennedy. “As midwives, we are intimately acquainted with the benefits of midwifery care, but current data about the outcomes of midwife-led care is what proves to other health care providers, payers and policymakers that our care is safe and effective.”
The results of NBCS II are overwhelmingly positive. The study monitored and recorded outcomes for 15,574 women who received care in 79 midwife-led birth centers in 33 US states from 2007 through 2010. Eligibility criteria for birth center birth included singleton full-term gestation in vertex presentation with no medical or obstetric risk factors precluding a normal vaginal birth or necessitating interventions such as continuous electronic fetal monitoring or induction of labor. Of the women planning a birth center birth at the onset of labor, 13,030 (84%) successfully gave birth at birth centers while 2544 women (16%) gave birth at a hospital. Results were collected using AABC’s Uniform Data Set, an online data registry developed by AABC with a taskforce of maternity care and research experts.
The study found that fewer than 1 in 16 (6%) of the participants required a cesarean birth compared to nearly 1 in 4 (24%) similarly low-risk women cared for in a hospital setting (Menacker 2005). Only 1.9% of transfers to hospitals were due to emergencies, the rate of fetal and newborn mortality was comparable to those in low-risk hospital care and there were no maternal deaths. NBCS II shows that even women who leave birth centers and are transferred to hospitals to have their babies after labor begins have excellent birth outcomes and significantly lower cesarean rates.
Because payments for care are nearly 50% greater for women who have cesareans versus those who give birth vaginally, study findings suggest that birth centers also decrease direct and indirect costs to the US health care system. Given lower costs in the birth center setting, as well as low rates of cesarean birth, the 15,574 births in this study may have saved more than $30 million in facility costs alone based on Medicare/Medicaid rates, not including further savings in costs of additional providers, anesthesia and newborn care in hospital settings.
— Melissa Garvey
Read this article from Midwifery Today magazine, now on our website:
Q: For midwives and doulas who have worked both in birth centers and in homes, which setting for birth do you prefer and why?
— Midwifery Today
A: Home. We have all the same tools in both places, but I move from place to place, not the family in labor. It is their space. The husband isn’t looking for random food/coffee/towels. He knows where to find what he is looking for!
— Courtenay E. Grabowski
A: Home, and even though a birth center is as homelike as possible, it isn’t the mother’s space. It brings a totally different mindset to be invited into the mother’s intimate space; it invites respect for the birth process and encourages the partnership within the birth team.
— Vicki Taylor-Breheim
A: I love homebirths, but there’s one birth unit near me in Scotland where I’m equally happy. The midwives work with good autonomy and have taught me loads about physiological birth. They support me, as a doula, and I am very comfortable in their company. I can go make tea and toast without asking. The mutual trust makes the difference.
— Karen Law
A: There are benefits to both: privacy at home; privacy in birth center if home is full of people. Wherever mom feels secure, cared for and surrounded by only those she trusts is the best place for her to birth.
— Gail Johnson
A: It has been my observation, over the years, that the less interference with birth, the more the mother is able to follow her own inner guide and, therefore, the fewer the complications. In your own home, you are the decision-maker. You don’t like how I’m acting as your midwife? You can ask me to leave, and I am legally obliged to do so. This gives a whole different tone to our interaction than in a birth center or hospital, which I think gives an inherent advantage to mom and family. [A birth center or hospital intrinsically has] more power, and power over the woman giving birth is a problem in childbearing, in my opinion. Birth center and hospital birth can only hope to imitate homebirth in order to obtain the best results—like formula trying to imitate breast milk. That’s why I like the saying, “Homebirth; the standard of care.” I would like to add that the best place of birth is where the mom wants to be. Even while I was writing this, I was thinking of a mom who had some troubles at home who happily birthed in the hospital and stayed for three days. Her teenage daughter came every day after school, sat by mom and did her homework and chatted. The daughter told me once during that time, “I love it here.”
— Marion Toepke McLean
A: My dream is that all the places we birth in will be like home. A woman must be supported to have her baby, where she feels safe. The home, hospital or birth center all must be heavens for motherbaby.
— Robin Lim
A: My heart is in homebirth, but I also work in a busy birth center. Since I’ve had my own babies at home, I see the benefit of not having to get up and go somewhere right after birth. For other moms, though, a birth center offers the privacy they might not get in their home, especially if they share it with many other family members. There are advantages to both, so of course we honor what families are comfortable with.
— Salli Gonzalez
A: Home. I always say that the woman walking out her front door is the first intervention. I want to be in her space and on her terms.
— Lisa Sulffridge
A: I agree with all those describing why home is the gold standard (and it is often most fun for the midwife). For women on Medicaid, homebirth is either not covered or financially nonviable, so a birth center remains the only way to escape the medicalization of childbirth for this population of mothers. Thank goodness for birth centers.
— Dinah Waranch
A: I work as a doula and I have no birthplace preference. No matter where you are, there is a laboring woman who needs lots of support and care, and that is what’s most important to me!
— Melissa Jolly
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