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					The Myth of a Safer Hospital Birth for
Low-Risk Pregnancies
July 26 2012
By Dr. Mercola
   Do you believe that a hospital is the safest place to give birth to a baby? Society
   certainly paints the picture this way, portraying the hospital as the savior of sorts
   where women must rush off to in the middle of the night at the first sign of labor.
   However, a growing number of women are choosing to buck the status quo and
   deliver their babies right at home.
   And wouldn’t you know it … this isn’t a new fad, it’s a return to the way women
   have been birthing babies for ages – and the research shows it’s often the safer
   way, too.
Home Birth is Safer for Most Low-Risk Pregnancies
    In an article written by Judy Cohain, CNM, she highlights 17 studies conducted
    over the last 15 years that show attended planned home birth is safer for low-risk
    women than hospital birth. In 12 of the studies, rates of perinatal mortality (deaths
    that occur before, during or immediately after birth) were either lower or similar
    for home birth, while rates of maternal morbidity were significantly lower,
    compared to hospital birth.
    She pointed out five studies that appeared to show home birth as less safe, but this
    was because they included high-risk cases in the mix. Cohain stated:1
        “Another 5 studies claim home birth to have a higher perinatal mortality
        rate compared to hospital birth but they all include high risk births in the
        planned homebirth group.
        Instead of excluding the high risk births from both groups, they include the
        home birth outcomes of premature births at 34-37 weeks gestation, breech
        and twins, lethal anomalies incompatible with life, unattended home
        births, unplanned home births, or women who became risked out of home
        birth by becoming high risk at the end of pregnancy, had hospital births,
        but are included in the home birth group.
        These 5 studies conclude that home birth is less safe than hospital birth,
        when what these papers actually found is that low risk births are safer at
        home but premature births have better outcomes in hospital.
        Possible explanations for the false conclusion of these studies could be
        paternalistic power games over women or hospital birth being not only the
        most common but also the most profitable reason for hospitalization.
        Remove the high risk births from those studies and they also confirm that
        home birth is safer for low risk women than hospital birth.”
What Makes Hospital Births Risky for Low-Risk
Women?
    When you enter a hospital setting, birth, an inherently natural experience, is
    automatically turned into a medical condition. Many women are given the drug
    Pitocin, a synthetic form of oxytocin, to jumpstart labor and intensify
    contractions, or their membranes are artificially ruptured, which then can set off a
    cascade of biological changes that increase the need for more medical
    interventions, and ultimately Caesarean section (C-section).
    C-section is the most common operation performed in the United States, and
    accounts for nearly one-third of all births. According to the World Health
    Organization, no country is justified in having a cesarean rate greater than 10
    percent to 15 percent. The United States' rate, at nearly 32 percent, is so high that
    even The American College of Obstetricians and Gynecologists admits it is
    worrisome.
    This is actually the highest rate ever reported in the United States, and a rate
    higher than in most other developed countries. One study in the British Medical
    Journal found that a woman's risk of death during delivery is three to five times
    higher during cesarean than a natural delivery, her risk of hysterectomy four times
    higher, and her risk of being admitted to intensive care is two times higher.2
    C-section rates are lower among home births, as well as midwife-attended births.
    At one small hospital run by the Navajo Nation, where midwives deliver most
    babies born vaginally, the C-section rate is only 13.5 percent. According to
    Cohain, these are some of the factors that may make a hospital birth more
    dangerous for a low-risk pregnancy:
Planned           Increased fear       Unfamiliar              Hospital      Lower access to
delivery in       releases             environment,            staff         food, drink can
hospital          adrenalin and        strangers, people       reservoir     cause hypoglycemia
indicates         other                in uniform,             of            and dehydration
women fear        adrenergic           unfamiliar smells       bacteria,
a bad             neurotransmitte      during labor            which the
outcome,          rs which can         counter                 mother/b
which can         slow down or         mammalian birth         aby lacks
be a self-        even stop the        instinct                immunity
fulfilling        birth process                                to
prophesy
Car              Fear and            Collusion among        Lack of       Laying on back
accidents on     unfamiliar          hospital workers       accounta      compresses the
the way to       environment         takes precedence       bility of     aorta and vena cava
hospital         increase pain       over commitment        staff to      decreasing oxygen
                 level, which        to client and safe     patients      delivery to fetus
                 sends stress        protocol               contribut
                 signals to fetus,                          es to poor
                 provoking                                  outcomes
                 negative
                 influence on
                 fetal heart rate
Continuous       Hourly vaginal      Overuse of              Artificial    Induction can cause
fetal            exams push          antibiotics kills       rupture       cord prolapse,
monitoring       bacteria up into    healthy flora,          of            uterine rupture,
increases        uterus, causing     lowering immune         membran       amniotic fluid
pain,            increased rate      system capability       es            embolism,
decreases        of infection                                (AROM)        increased
oxygenation      after 3 exams                               can cause     postpartum
of fetus,                                                    cord          hemorrhage
decreases                                                    prolapse,
mobility and                                                 increased
increases                                                    infection
anxiety                                                      and pain
Epidural         Episiotomy can      Vacuum increases        Shoulder      Cesarean can cause
causes fever     cause               rate of third and       dystocia      maternal and
in 15% of        hemorrhage,         fourth degree tears,    because       perinatal death, and
women,           third and fourth    causing life long       of            increased maternal
which            degree              incontinence of         deliverin     and fetal morbidity,
increases        extensions,         urine and feces and     g in a        lifelong scar pain,
neonatal         permanent           sexual disability       hospital      infertility,
seizures,        disability.         and increased           bed           adhesions,
which can                            hemorrhage and          instead of    decreased nursing
cause brain                          for the baby:           on all 4s     success, increased
damage                               intracranial                          stillbirth and
                                     hemorrhage, scull                     placenta accreta on
                                     fractures, and,                       subsequent
                                     rarely, brain                         pregnancies.
                                     damage or fetal
                                     death
What Conditions are Better Dealt With at the Hospital?
   Ruptured uterus and placental abruption most often occur in high-risk cases,
   which ordinarily should not be considered candidates for home birth, which leave
   essentially only two acute conditions that have better outcomes in the hospital
   versus at home: cord prolapse and Amniotic Fluid Embolism (AFE). So while
   there are certainly cases where a hospital birth is preferable, this typically applies
   to most high-risk cases, along with the four emergency situations:
        Cord prolapse
        Ruptured uterus
        Amniotic Fluid Embolism (AFE)
        Placental abruption
As home births have been increasing (by nearly 30 percent from 2004 to 20093) it is
   common for the media to highlight the rare home birth tragedies, when a baby
   might have been saved had the birth taken place in a hospital. This does occur, but
   it is rare … far more rare than babies who end up dying due to unnecessary
   medical interventions or hospital errors.
  Cohain concludes:
     “The deaths caused by rare acute condition at planned attended low risk
     home birth that might have had a better outcome in hospital are
     outweighed by the deaths and morbidity due to common acute conditions
     caused by hospital interventions. Planned attended home birth outshines
     hospital birth for low risk women in every category of acute emergency.
     Today research wrongly considers hospital birth as the gold standard.
     Bias towards hospital births causes the majority of researchers to ignore
     the fact that women could achieve even better outcomes than hospital
     birth, at planned attended home birth.”
Are You Interested in Having a Home Birth?
  In the United States it often takes a lot of diligence and determination to go
  against the norm and find a physician or midwife who performs home births. It is
  rare to find an obstetrician that will agree to a home birth in the United States, and
  while certified nurse midwives (CNMs) can legally attend home births in any
  state, most do not and choose to practice in hospitals instead.
  Only 27 states currently license or regulate direct-entry midwives (or certified
  professional midwives (CPMs), who have undergone training and met national
  standards to attend home births. In the other 23, midwife-attended births are
  illegal, however women often end up finding a midwife on the "black market,"
  who because of a lack of any type of regulatory oversight may or may not have
  adequate training.
  It is certainly possible to find highly qualified and trained midwives practicing on
  the underground market. These women often believe strongly in women's right to
  choose home birth, and risk being arrested and prosecuted for practicing medicine
  or nursing without a license to offer their services.
  There are also people practicing as midwives who have not received adequate
  training that can also be found in this underground home birth market, so if you
  do go this route it's imperative that you thoroughly check out and reference the
  person you are working with. A campaign is currently underway to expand state
  licensing of CPMs so that women who want a home birth can choose from a
  qualified pool of applicants, but until that happens you have a few legal options
  for home birth:
       • Find a certified nurse midwife (CNM) who attends home births in your
           state or in a nearby state (then travel to that state to give birth)
       • Find a CPM who is either licensed by your state or in a nearby state (then
           travel to that state to give birth)
       • Use a CNM but give birth in a hospital or birth center (a compromise). If
           you decide to go this route, make a detailed birth plan. This is a document
           that states the expectant mother’s or couple’s interests or desires for their
           birth experience.
  It is not a legal document but is an important way of letting the doctors and
  hospital staff know of your wishes regarding medical interventions for mom and
  baby. Discuss your birth plan with your doctor or midwife ahead of time, and also
  be sure your nurse and any other hospital staff receive a copy upon admittance.
   To find a midwife in your area, try:
      • Midwives Alliance of North America
      • Mothers Naturally
      • American College of Nurse-Midwives
      • Midwifery Today
      • BirthLink (Chicago area)
References:

   •   1 Green Med Info July 5, 2012
   •   2 British Medical Journal October 30, 2007
   •   3 NCHS Data Brief, January 2012, Number 84

				
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