Homebirth Safety: Jennifer Block helps make sense of faulty study findings

Check out Jennifer Block's (awesome author of Pushed) new post, Home Births Under Fire Amid Outcry Over Wax Paper, in The Daily Beast

“Wax Paper” is what home birth supporters have taken to calling a metaanalysis that appears in the September issue of the American Journal of Obstetrics and Gynecology. A research method that has come under criticism in the past, a metaanalysis pools together data from several studies, and this one comes to a hotly contested conclusion: that babies are three times more likely to die if born at home, said the study, whose lead author is Joseph Wax, M.D....

...Several researchers and providers are lambasting the study as not only “deeply flawed” but “politically motivated,” the result of “intense medical lobbying.” (See: MOMS legislation introduced to the House last month.) Two independent experts who looked at the study for Time found it “weak and methodologically flawed.” The main criticism of the metaanalysis is its inclusion of old, discredited data that did not distinguish between planned, attended home births and accidentals on the kitchen floor or back seat, which have worse outcomes to be sure. And while the study was presented as being based on “hundreds of thousands of births,” its banner finding, that home birth is “associated with a tripling of the neonatal mortality rate,” is based on just 9,811 home births. And most of those deaths come from said poor data

There is a great recap of studies and ACOG's bias in saying that home birthers are being self-indulgent and unsafe - do check out the whole article. One birthing mom sums it up,

“Women are not merely participants in this process, we are the process. All women want to have healthy babies.”

(I don't know who took the image of the hearts...but it's made from wax paper...the kind of wax paper that's useful! ;-)

my review:20/20

So I thought the 20/20 segment on Orgasmic Birth was pretty fantastic (but not the show as a whole). I do wish there had been a clear soundbite about how orgasmic birth does not have to mean that actual climax is achieved...they may have said this & I missed it, but I felt the segment seemed to indicate that an actual orgasm was a necessary part of the ecstatic birth experience rather than just the happy icing on the already-awesome birthday cake. Anyway, way to go, Debra!

But I have complaints on the show as a whole (of course!): First, the warning that the Orgasmic Birth segment might be inappropriate - wow - what about giving that warning when showing a highly interventive technocratic birth? That could certainly be more dangerous to one's psyche than seeing some women smiling and laughing.

I know the show was about "extremes" in motherhood but why the need to find such unusual examples to put with Orgasmic Birth? The piece on unassisted birth really pissed me off because they lumped in The Business Of Being Born and all homebirth with unassisted birth. I'm not commenting negatively on people who wish to have UC, but the births they showed, aside from Laura Shanley's birth footage appeared to be from BoBB and attended by midwives (at least one of which was filmed in a hospital birth center, not even at home)...UC is a small portion of homebirth and I think to suggest otherwise is at best misleading and sloppy and serves to reinforce the just-now-changing-for-the-positive mainstream opinion that homebirth is selfish (in fact that was a comment/question posed to Ricki Lake on the homebirth /UC piece last night) and foolhardy. Most people who birth at home do so with extremely qualified medical assistance. I found that segment quite hostile.

Same with the breastfeeding piece - people who are nursing 9 year olds are quite rare & that's why they make the news. But the piece started with a woman nursing 3yo twins - not rare at all, given that the average age of weaning world-wide is 4 years (props to 20/20 for mentioning this)...yet it was still portrayed as though the twins mom was doing something a little bit weird or wrong. And then there was the whole "what does your husband think - isn't he left out sexually" angle that was pretty lame, imho.

The life-like dolls...hmmm - I don't quite know what to say other than the segment made me feel a little sad. And once again, I did not appreciate the created context of "wacky/screw loose people" in which to view Orgasmic Birth & homebirth.

What about you? Please share your reactions!

Business of Being Born + The Farm

Check out the great update of The Business of Being Born's website about Abby Epsein & Ricki Lake's visit to The Farm in TN to meet with Ina May Gaskin & The Farm midwives. Lots of great pictures and insights.

natural birth in the news

A story in today's NJ Star Ledger talks about the films, Orgasmic Birth and The Business of Being Born, the play, Birth, midwives, the Anna Verwaal seminar we had recently and more...

Support for Home Births

In a letter to the editor of US News & World Report, the world's best known doula organization, DONA International, comments on ACOG & AMA's attacks on homebirth. (above image from Ricki Lake's The Business of Being Born) Yeah!

Support for Home Births
August 01, 2008 04:49 PM ET | Permanent Link

You covered Ricki Lake's controversial documentary about homebirths which instigated a growing battle between the American College of Obstetricians and Gynecologists (ACOG), the American Medical Association (AMA), midwives, and patients ["Ricki Lake Fires Back in Debate on Home Birth," "On Women," usnews.com].

The conflict is about the perceived safety of home births and the use of Certified Professional Midwives (CPM) or "lay" midwives. Last month, the AMA issued a resolution asking for legislation against home births and against "lay" midwives. DONA International, the oldest and largest association of doulas in the world, represents the thousands of women who cherish their ability to choose where they give birth and with whom. We also question the evidence supporting the ACOG and the AMA's statements that "the safest setting for labor, delivery and the immediate post-partum period is in the hospital." The largest, most respected study of home births found that among 5,000 low-risk pregnancies, babies were delivered just as safely at home with a CPM as in a hospital. Because most doulas work with midwives and physicians in a hospital setting, DONA International has no financial interest in the outcome of such legislation called for by the AMA. Our interest is in the scientific evidence and in maintaining the conviction that pregnant women, just as all other patients, are intelligent enough to give informed consent.

Debbie Young
President
DONA International
Jasper, Ind.

UPDATE: Dr. Phil

Here's more on the story...apparently the show has tried to recruit the producer & director of the birth documentary, The Business of Being Born for this show condemning homebirth.

One of the associate producers, Judith Sanchez, is working on the project. She solicited Ricky Lake and Abby Epstein to appear on the show and they have declined. If you would like to write to her and give her your opinion, you can email her at judith.sanchez@cbs.com or call her at (323)956-8289.

Note the comment that has a different view of what the show might be like since Dr. Sears will possibly be a guest.