Thursday, April 28, 2011

Back to the Home Birth Topic

So, recently in the May 2011 addition of the ACOG journal (American College of Obstetricians and Gynecologists) were two articles discussing the topic of planned home birth. I'd like to share some key points from their articles as things to consider with homebirth. However, it appears they have based their information off of only one study in the Netherlands and the rest of their research has to do with the physicians ethical practice of medicine and what they feel is in the best interest for patients.

They state that "planned home births were associated with a twofold increased risk of neonatal death." They further state that the cause of this may be largely in part due to distance from a hospital in the event of an emergency (many patients studied lived >20 minutes from hospitals). They also state that the majority of home deliveries there are not attended by Certified Midwives, but rather by lay midwives who lack experience and the skill to save a baby or mother if needed. They also stated percentages of complications were higher in first time pregnancies in women laboring at home versus those who had experienced other births.

The College does however, note the right of the patient to make an informed medical decision being fully aware of her risks to herself and to her baby. They also advise physicians not to participate in home birth, but to give care and advice during pregnancy despite where the patient decides to deliver and to be willing to provide emergency care in the hospital when needed if a patient participating in home birth necessitate emergency hospital care.

So here are my thoughts. I respect ACOG's present position and generally I try to follow their guidelines for care of my patients. However, I don't feel that they have enough research on other areas (like Sweden) where they have Certified Midwives providing home births in areas close to the hospital etc. I still believe there are places where home birth is safe and effective for LOW RISK women.

I've decided if any of you out there would like to try home birth, I may be willing to deliver you at home if you see me throughout pregnancy for your care, are extremely low risk and remain that way throughout pregnancy. You would also have to live within 15 minutes from the local hospitals that I have privileges at, be willing to sign arbitration and home birth consent forms and pay out of pocket for this service if your insurance does not cover home birth. Further, I will likely not exceed 2-3 home births/month as this may complicate things with my other patients, hospital deliveries, and office/clinic schedule. This is open as a trial period and I may stop if I feel it is putting you, your baby, or myself at too much risk.

I welcome all comments!


Jones' said...

I thought this was going to be me. I am a perfect mama-to-be for an at-home-birth. However, I am too much of a wuss and need drugs for the pain. I'd like to think I could go natural, but there came a time in both my previous deliveries that I just couldn't take the pain anymore.

Erin said...

christy-- a short story for you: a friend of mine down here in tx just had her first baby from her home. the baby was 2+ weeks overdue, my friend labored for 40 hours, and the baby came weighing in at 12 pounds and 24 inches long. amazing/crazy, right? she told me she was really humbled.

Becky Mendoza said...

I think it's awesome you're considering home births! I think you would be a perfect provider to do home births to low risk women. The fact that you're a certified nurse midwife, rather than a less educated midwife really puts my mind at ease. I hope you'll get some home birthers and I'm sure their births will go smooth! :)

Jessie said...

I am interested in home births and live in Ogden close to both hospitals. If you would like to contact me I would love to chat about my options. Thank you!

Elizabeth C. said...

I cannot tell where you are located Christy... But I can tell you about me. I am 27, 28 in less than two weeks. I and 36 weeks pregnant with my 3rd son. I have a perfect medical history in all pregnancies and births I have had. I live in Ogden, UT.
I've just moved back from England, where natural/homebirths are quite common. I had my 2nd son in a birth center, no drugs.
I am doing a Homebirth this time around and honestly dont mind the idea of not having medical people around. The hospital here is less than 5 minutes drive from my house... if I have an emergency, my husband, mom or friends can get me there or dial 911 just as quick as any midwife. MY problem is this... My husband would like a midwife to be present, provided she take the "sit on her hands" approach. And that the midwife not charge him a fortune. I spoke with and interviewed a midwife here and she quoted us 1500 just to be there! I have Molina Insurance but the midwife here for some reason isnt covered by it/them. I dont entirely understand this. If I am in an area you work in, and you would be willing to simply watch/be present in the home at time of birth, I would be happy to provide you with an unassisted "free-birth" experience. feel free to email me and let me know. :)

Christy Francis, CNM said...

Hey Elizabeth-I did respond to your email. Let me know if you didn't get it.
For the rest of you,I'm back on the fence about doing home birth. I just think it will not flow well with my clinic practice and managing everything and we can achieve such natural great deliveries in the hospital these days that I will continue doing deliveries here for now- as well as at Mckay-Dee. Thanks!

The Cowgills said...

Are you sure?! I just came across your blog and was so excited to come in and talk to you at my appt next week about the possibility of doing a home birth with you!! I hope you change your mind! :)