Link to the latest Cochrane review is in the article for those who are interested.Birth is no reason to go to hospital
A new Cochrane Review concludes that all countries should consider establishing proper home birth services. They should also provide low-risk pregnant women with information enabling them to make an informed choice. The review has been prepared by senior researcher, statistician Ole Olsen, the Research Unit for General Practice, University of Copenhagen, and midwifery lecturer PhD Jette Aaroe Clausen.
The outcome of a planned home birth: smile,
satisfaction and a deeply concentrated baby.
Photo: Camilla Lauritsen
In many countries it is believed that the safest option for all women is to give birth in hospital. However, observational studies of increasingly better quality and in different settings suggest that planned home birth in many places can be as safe as planned hospital birth and with less intervention and fewer complications.
“If home birth is going be an attractive and safe option for most pregnant women, it has to be an integrated part of the health care system,” Ole Olsen says and adds, “In several Danish regions the home birth service has been very well organised for several years. This is not the case everywhere in the world.”
The updated Cochrane Review concludes that there is no strong evidence from experimental studies (randomised trials) to favour either planned hospital birth or planned home birth for low-risk pregnant women. At least not as long as the planned home birth is assisted by an experienced midwife with collaborative medical back up in case transfer should be necessary.
Fewer interventions in home birth
Everything ready for a planned home birth.
Photo: Thomas Kingo Larsen
Routines and easy access to medical interventions may increase the risk of unnecessary interventions in birth explaining why women who give birth at home have a higher likelihood for a spontaneous labour. There are 20-60 per cent fewer interventions, for example fewer cesarean sections, epidurals and augmentation among those women who plan a homebirth; and 10-30 per cent fewer complications, for example post partum bleeding and severe perineal tears.
"Patience is important if women want to avoid interference and give birth spontaneously," says Jette Aaroe Clausen. “At home the temptation to make unnecessary interventions is reduced. The woman avoids for example routine electronic monitoring that may easily lead to further interventions in birth.”
Jette Aaroe Clausen adds that interventions in childbirth are common in many countries, but also that there is a growing concern internationally because interventions may lead to iatrogenic effects; iatrogenic effects meaning unintended consequences of the intervention. Routine electronic monitoring may for example lead to more women having artificial rupture of membranes which in turn can lead to more interventions.
Evidence and human rights
While the scientific evidence from observational studies has been growing, the European Court of Human Rights in Strasbourg in the case Ternovszky versus Hungary has handed down a judgment stating that “the right to respect for private life includes the right to choose the circumstances of birth”. This is quoted in the review.
Thus the conclusions of the review are based on human rights and ethics as well as on results from the best available scientific studies.
Ref.: Olsen O, Clausen JA. Planned hospital birth versus planned home birth. The Cochrane Library, Issue 9, 2012.
The full review may be available here (depends on country):http://onlinelibrary.wiley.com/doi/1....pub2/abstract
The full review is also available as PDF: Planned hospital birth versus planned home birth.
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Results 1 to 10 of 32
22-09-2012 05:37 #1
Birth is no reason to go to hospital
22-09-2012 08:21 #2
The first step a healthy woman makes towards intervention in labour is the one she takes out her front door.
22-09-2012 08:37 #3Senior Member
- Join Date
- May 2006
I think any woman birthing in a way that she doesn't feel comfortable is bound to run into difficulties. I think all women should be able to choose the birth they want. Including homebirth, birth centre, hospital, c/section etc.
22-09-2012 08:46 #4
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22-09-2012 08:52 #5
I agree with the thread title, but only in places where home birth is properly supported and resourced. Also, geographically, I don't believe the thread title is true for Australia. If intervention is required, many people are too far away to transfer.
A hospital I could have had my baby at has a home birth program, however, I live to far away to have been considered to use it. Maybe if Australia had more stand alone midwifery run birth centres I would agree, but presently no. If you live in a remote community eg. the Torres Strait Islands, you are actually encouraged to fly out weeks before your due date to be nearer hospital. In Australia, for many women, birth is a very good reason to go to hospital.
22-09-2012 08:55 #6
It's nice to hear posts saying women are 100% supported in their choices to often I hear women should only be able to homebirth if they fit into the tiny pigeon hole the government provides.
And of course your right, a woman should always birth where she feels safest I just wish all women were offered evidenced based care in hospital. A lot of women go to hospital because that's where they feel safest but as this study shows our intervention rates in hospitals are a lot higher than at home yet both have the same outcomes mortality wise. The morbidity rates are the issue.
22-09-2012 09:05 #7
Yes, the Cochrane review findings support having home birth as a valid choice for low-risk women when supported by an experienced midwife, and ******lined transfer in case of issues. But ethically I believe that the choice ultimately lives with the woman, always.
At present there are several issues making home birth harder for women to access. Including hospital staff being notoriously unhelpful toward home birth. How does that help anyone? What good can possibly come of home birth versus hospital birth rather than equal choice supported for all women. I just don't get it.
I was lectured by a GP about how irresponsible I was being for my PLANNED HOME BIRTH with a midwife with thirty years experience. WTF? I had a perfectly healthy pregnancy. How could a general practitioner I had seen once for seven minutes know what was better for me? These are the attitudes that need to change. I would love to feel I could access both sides of the maternity service world during pregnancy and birth - but you can't without being lectured, ridiculed, attacked, threatened. Maybe some can and have but I fear it is rare. Doubtless this could lead to poor outcomes.
I hope findings like this will improve birth choices for women in Australia, and soon.
Last edited by BornToBe; 22-09-2012 at 13:22. Reason: changing "all" women to "low risk" women
22-09-2012 13:00 #8
Everywhere in the article it talks about homebirth for 'low risk' women. So I disagree with your statement born2be, that the review supports homebirth for ALL women.
i am a supporter for homebirth for low risk women. I would consider it for my next baby.
22-09-2012 13:21 #9
Yeah, you're right, soz. I muck it up because I don't agree with it. It's unethical to force a woman to birth anywhere - it needs to be her choice - in my opinion. Obviously not the opinion of everyone else, sadly.
22-09-2012 14:13 #10
It's good to have some sort of review backing homebirth. It may not be for everyone, but it's perhaps the most difficult for a woman to choose to have... And so I'm happy with any positivity that comes its way.
We will he homebirthing any baby we have in future...
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