[Rancid]

Like I said, house birth in the US is less common so I admit I am not 100% familiar with it, but I don't think a midwife that specializes in this would have the time or energy to attend to more than 2, maybe 3 birth per day. Compare that to at least ~10 in a tiny hospital and you'd get your answer. (This ofcourse might not apply to very rural areas where there is no a close hospital). Furthermore, when complications do occur (often to no fault of the midwife) they are hopelessly unequipped to deal with the problem, they won't do an emergency c-section.

I would not want my wife to be someone's 10th baby of the day. They are likely exhausted.

[XogGyux]

I would not want my wife to be someone's 10th baby of the day. They are likely exhausted.

Another reason why it is safe to go to the hospital. Even in the tiny hospital, I was working, the labor floor had 2-3 midwives, 10+ nurses and OB/GYN on call that would show up within 10mins. Blood bank available for transfusions if needed, etc. You are guaranteed to have fresh, ready-to-go people. Yes, maybe the person taking your wife is on the last 2 hours of her shift, but if things get messy/prolonged they will have a large pool of people to bring refreshed and experienced people back on board.
An uncomplicated/uneventful labor can extend for hours. What happens when your wife goes into labor at midnight?

[Rancid]

Another reason why it is safe to go to the hospital. Even in the tiny hospital, I was working, the labor floor had 2-3 midwives, 10+ nurses and OB/GYN on call that would show up within 10mins. Blood bank available for transfusions if needed, etc. You are guaranteed to have fresh, ready-to-go people. Yes, maybe the person taking your wife is on the last 2 hours of her shift, but if things get messy/prolonged they will have a large pool of people to bring refreshed and experienced people back on board.
An uncomplicated/uneventful labor can extend for hours. What happens when your wife goes into labor at midnight?

In the US, C-section rates are abnormally high (OB/GYN's love to use their surgery skills). Interventions like drugs are also abnormally high. In the US, it's about money, and it's a business.

I'll stick to my midwife, thank you very much.

[XogGyux]

In the US, C-section rates are abnormally high (OB/GYN's love to use their surgery skills). Interventions like drugs are also abnormally high. In the US, it's about money, and it's a business.

I'll stick to my midwife, thank you very much.

We do certainly end up doing a lot of stuff that it is wasteful and certainly not superior. This can be seen in the fact that we spend a lot of money on healthcare while not having much better outcomes in general. Other things also have big influence such as drug-use (and that includes tobacco and alcohol BTW) and pregnancy which certainly worsens our outcomes and also the Taboo around birth control and abortion which disproportionate lower our outcome by taking to term pregnancies that would not be viable or that the mother is not prepared, mentally or physically, to handle.
And as for your point. Yes we have an unusually high number of C-sections but I would not necessarily blame it all on OB/GYN. Some women don't like their vaginas to be destroyed by an 8lbs baby and make the choice when technically normal delivery would have still been viable.

As for your situation, I'd suggest it is not you the one deciding but rather you let YOUR WIFE make such decision, or at least 90% of it ( I'm OK with your contribution, after all, it is also your child). But ultimately it is her body and she is the one that is potentially at risk of bleeding, having a complication or unlikely (and hopefully not) even dying.
I admit i am a bit ignorant about non-hospital based midwife practice in the United states, after all it is not common. But I would take an educated guess that they have limited ability to properly identify serious complications during labor. For instance, HR monitoring, blood work (is the mom going into HELLP syndrome/pre-eclampsia, are platelets dropping or mother going into DIC?), does the baby need NICU support after birth, intubation. Are the lungs matured enough or does the baby need steroids to help him. That's not to say early peri-delivery care of otherwise healthy children, like vaccinations, phototherapy for jaundiced kids or even screening for birth genetic defects such as phenylketonuria sickle cell, etc. Again, other countries have managed similar outcomes, but they also have a far more robust system than what it is practiced in the US a such, so be careful drawing conclusions.

[anasawad]

No.
Neither me nor my wife agree with this type of practice in the current day; but even if she did want to try it at some point if we decided to have other kids, I wont accept or allow it.
Child birth can have many negative complications that could harm either the mother or the baby or both at birth, as such it is a must to do it in a hospital with trained doctors and experts that can quickly attend any such event with all the necessary and needed equipment and meds.

Anyone who thinks their private home is a safe and good environment to give birth in clearly doesn't understand the implications of something going wrong and why we as a civilized group of nations are moving further and further away from such practices.
Its dangerous and unnecessarily harmful and should be, at best, considered criminal negligence on the behest of the parents.

[Victoribus Spolia]

@Rancid, Sick 'em!! ^^^^^^

[One Degree]

What have you guys got against going to the hospital for 2 hours and being charged a full day for 3 rooms (2 of which you never saw) and 2 doctors and an anesthesiologist you never saw?
I did it, why shouldn’t you? They also let me see where they stored the afterbirth to be sold for cosmetics. That was neat. Apparently I was not entitled to a percentage.

[Rancid]

No.
Neither me nor my wife agree with this type of practice in the current day; but even if she did want to try it at some point if we decided to have other kids, I wont accept or allow it.
Child birth can have many negative complications that could harm either the mother or the baby or both at birth, as such it is a must to do it in a hospital with trained doctors and experts that can quickly attend any such event with all the necessary and needed equipment and meds.

Anyone who thinks their private home is a safe and good environment to give birth in clearly doesn't understand the implications of something going wrong and why we as a civilized group of nations are moving further and further away from such practices.
Its dangerous and unnecessarily harmful and should be, at best, considered criminal negligence on the behest of the parents.

A lot of the civilized world is going towards midwifery and home birth.

On a serious note, midwives will only birth at home if the mother is in good health and not a high risk. For example, the collective of midwives we used for our home birth doesn't do women over the age of 35 (pregnancy above age 35 is considered higher risk by most medical professionals). Also, if they find any thing that is off during the prenatal checkups, they bow out and refer you to a doctor.

This isn't something that's being done willy nilly at home.

[anasawad]

@One Degree
Safety, health, security, etc.

You're seriously saying that you're welling to risk the health and safety of your wife and new born child to save money ?
Sure, the US health care is a bit too expensive so its an exception to the norm, but you borrow money, you manage it anyway you can and you pay it.

What if something wrong happened to your baby during birth ? you think a nurse with minimal equipment and tools at her disposal is a good choice to handle any complications ?

What if the baby was going feet first instead of head first ? or the umbilical cord tied around his\her nick at birth ? Both of those have significant potential to cause a lack of oxygen intake to the kids brain and could cause life long disabilities and brain damage, and neither of those the nurse of midwife can handle at a private home.

And there are many scenarios where things could go wrong in child birth. There is a reason in the old days a significant portion of children died at birth.

[Finfinder]

What have you guys got against going to the hospital for 2 hours and being charged a full day for 3 rooms (2 of which you never saw) and 2 doctors and an anesthesiologist you never saw?
I did it, why shouldn’t you? They also let me see where they stored the afterbirth to be sold for cosmetics. That was neat. Apparently I was not entitled to a percentage.

Maybe because they think you have a bad seed .

Interesting topic politically because it requires an element of hypocrisy to have a strong opinion. If we are going to make this a black and white issue (in the US ) D vs R, logic would think that Repub's would be more against this than the Dem's but I'm not sure that is how the poll would turn out.

[anasawad]

@Rancid
You mean a less than 1% of all births happen at home ?
Yup, I can see the trend forming already.

And not everything shows on pre-birth checkups, it is not uncommon to have perfectly healthy mother having to have c sections because something went wrong during the final stages or even during birth.

The difference between people who choose hospital and those who do it at home is that when those things happen in the hospital, the mother and the baby generally get out fine; At home on the other hand you'll probably end up with a dead baby and potentially cause significant medical problems for the mother.

[Rancid]

The difference between people who choose hospital and those who do it at home is that when those things happen in the hospital, the mother and the baby generally get out fine; At home on the other hand you'll probably end up with a dead baby and potentially cause significant medical problems for the mother.

Bullshit.

Complications during birthing are almost never an extreme emergency. Moving to a hospital from home during some issue usually doesn't result in any negative affects to mother or baby.

[anasawad]

@Rancid
Home births have double the rate of child mortality and they're almost exclusively attributed to complications during delivery and labor and infections.

[Victoribus Spolia]

You mean a less than 1% of all births happen at home ?
Yup, I can see the trend forming already.

Current % is not a measurement of a trend.

So thats stupid.

If you wanted to argue against it being a trend you would need to show a lack of increase in rate of planned home births.

Home births have double the rate of child mortality and they're almost exclusively attributed to complications during delivery and labor and infections.

This is patently false.

Delivery by mid-wife has much lower rate of complications.

Abstract

Background

Studies of planned home births attended by registered midwives have been limited by incomplete data, nonrepresentative sampling, inadequate statistical power and the inability to exclude unplanned home births. We compared the outcomes of planned home births attended by midwives with those of planned hospital births attended by midwives or physicians.

Methods

We included all planned home births attended by registered midwives from Jan. 1, 2000, to Dec. 31, 2004, in British Columbia, Canada (n = 2889), and all planned hospital births meeting the eligibility requirements for home birth that were attended by the same cohort of midwives (n = 4752). We also included a matched sample of physician-attended planned hospital births (n = 5331). The primary outcome measure was perinatal mortality; secondary outcomes were obstetric interventions and adverse maternal and neonatal outcomes.

Results

The rate of perinatal death per 1000 births was 0.35 (95% confidence interval [CI] 0.00–1.03) in the group of planned home births; the rate in the group of planned hospital births was 0.57 (95% CI 0.00–1.43) among women attended by a midwife and 0.64 (95% CI 0.00–1.56) among those attended by a physician. Women in the planned home-birth group were significantly less likely than those who planned a midwife-attended hospital birth to have obstetric interventions (e.g., electronic fetal monitoring, relative risk [RR] 0.32, 95% CI 0.29–0.36; assisted vaginal delivery, RR 0.41, 95% 0.33–0.52) or adverse maternal outcomes (e.g., third- or fourth-degree perineal tear, RR 0.41, 95% CI 0.28–0.59; postpartum hemorrhage, RR 0.62, 95% CI 0.49–0.77). The findings were similar in the comparison with physician-assisted hospital births. Newborns in the home-birth group were less likely than those in the midwife-attended hospital-birth group to require resuscitation at birth (RR 0.23, 95% CI 0.14–0.37) or oxygen therapy beyond 24 hours (RR 0.37, 95% CI 0.24–0.59). The findings were similar in the comparison with newborns in the physician-assisted hospital births; in addition, newborns in the home-birth group were less likely to have meconium aspiration (RR 0.45, 95% CI 0.21–0.93) and more likely to be admitted to hospital or readmitted if born in hospital (RR 1.39, 95% CI 1.09–1.85).

Interpretation

Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2742137/

Indeed there is a strong argument to be made, that it has been thanks in large part to mid-wives that the rates of infant mortality have decreased so much in the developed world CONTRA the United States.

In Great Britain, midwives deliver half of all babies, including Kate Middleton's first two children, Prince George and Princess Charlotte. In Sweden, Norway and France, midwives oversee most expectant and new mothers, enabling obstetricians to concentrate on high-risk births. In Canada and New Zealand, midwives are so highly valued that they're brought in to manage complex cases that need special attention.

All of those countries have much lower rates of maternal and infant mortality than the U.S. Here, severe maternal complications have more than doubled in the past 20 years. Shortages of maternity care have reached critical levels: Nearly half of U.S. counties don't have a single practicing obstetrician-gynecologist, and in rural areas, the number of hospitals offering obstetric services has fallen more than 16 percent since 2004. Nevertheless, thanks in part to opposition from doctors and hospitals, midwives are far less prevalent in the U.S. than in other affluent countries, delivering about 10 percent of babies, and the extent to which they can legally participate in patient care varies widely from one state to the next.

Now a new study, a systematic look at what midwives can and can't do in the states where they practice, offers new evidence that empowering them could significantly boost maternal and infant health. The five-year effort by researchers in Canada and the U.S., published Wednesday, found that states that have done the most to integrate midwives into their health care systems, including Washington, New Mexico and Oregon, have some of the best outcomes for mothers and babies. Conversely, states with some of the most restrictive midwife laws and practices — including Alabama, Ohio and Mississippi — tend to do significantly worse on key indicators of maternal and neonatal well-being.

"We have been able to establish that midwifery care is strongly associated with lower interventions, cost-effectiveness and improved outcomes," said lead researcher Saraswathi Vedam, an associate professor of midwifery who heads the Birth Place Lab at the University of British Columbia.

Many of the states characterized by poor health outcomes and hostility to midwives also have large African-American populations, raising the possibility that greater use of midwives could reduce racial disparities in maternity care. African-American mothers are three to four times more likely to die in pregnancy or childbirth than their white counterparts; black babies are 49 percent more likely to be born prematurely and twice as likely to perish before their first birthdays.

"In communities that are most at risk for adverse outcomes, increased access to midwives who can work as part of the health care system may improve both outcomes and the mothers' experience," Vedam said.

That's because of the midwifery model, which emphasizes community-based care, close relationships between providers and patients, prenatal and postpartum wellness, and avoiding unnecessary interventions that can spiral into dangerous complications, said Jennie Joseph, a British-trained midwife who runs Commonsense Childbirth, a Florida birthing center and maternal care nonprofit. "It's a model that somewhat mitigates the impact of any systemic racial bias. You listen. You're compassionate. There's such a depth of racism that's intermingled with [medical] systems. If you're practicing in [the midwifery] model you're mitigating this without even realizing it."

The study, published in the peer-reviewed journal PLOS ONE, analyzes hundreds of laws and regulations in 50 states and the District of Columbia — things like the settings where midwives are allowed to work, whether they can provide the full scope of pregnancy- and childbirth-related care, how much autonomy they have to make decisions without a doctor's supervision, and whether they can prescribe medication, receive insurance reimbursement or obtain hospital privileges. Then researchers overlaid state data on nine maternal and infant health indicators, including rates of cesarean sections, premature births, breastfeeding and neonatal deaths. (Maternal deaths and severe complications were not included because data is unreliable).

The differences between state laws can be stark. In Washington, which has some of the highest rankings on measures such as C-sections, premature births, infant mortality and breastfeeding, midwives don't need nursing degrees to be licensed. They often collaborate closely with ob/gyns, and can generally transfer care to hospitals smoothly when risks to the mother or baby emerge. They sit on the state's perinatal advisory committee, are actively involved in shaping health policy, and receive Medicaid reimbursement even for home births.

At the other end of the spectrum, North Carolina not only requires midwives to be registered nurses, but it also requires them to have a physician sign off on their application to the state for approval to practice. North Carolina scores considerably worse than Washington on indices such as low-birthweight babies and neonatal deaths.

Neel Shah, an assistant professor at Harvard Medical School and a leader in the movement to reduce unnecessary C-sections, praised the study as "a remarkable paper — novel, ambitious, and provocative." He said licensed midwives could be used to solve shortages of maternity care that disproportionately affect rural and low-income mothers, many of them women of color. "Growing our workforce, including both midwives and obstetricians, and then ensuring we have a regulatory environment that facilitates integrated, team-based care are key parts of the solution," he said.

To be sure, many other factors influence maternal and infant outcomes in the states, including access to preventive care and Medicaid; rates of chronic disease such as diabetes and high blood pressure; and prevalence of opioid addiction. And the study doesn't conclude that more access to midwives directly leads to better outcomes, or vice versa. Indeed, South Dakota, which ranks third from the bottom in terms of midwife-friendliness, scores well on such key indicators as C-sections and preterm births. Even North Carolina is average on C-section rates, breastfeeding, and prematurity.

The findings are unlikely to quell the controversies over home births, which are almost always handled by midwives and comprise a tiny but growing percentage of deliveries in the U.S., or fears among doctors and hospitals that closer collaborations with midwives will raise malpractice insurance rates. In fact, said Ann Geisler, who runs the Florida-based Southern Cross Insurance Solutions, which specializes in insuring midwives, her clients' premiums tend to be just one-tenth of premiums for an ob/gyn because their model of care eschews unnecessary interventions or technology. Far from being medical renegades, the vast majority of midwives want to be integrated into the medical system, she said.

Generally, licensed midwives only treat low-risk women, Geisler said. If the patients become higher risk, midwives are supposed to transfer them to a doctor's care. Since many ob/gyns only see midwife patients when a problem emerges, she said, they may develop negative views of midwives' skills.

https://www.npr.org/2018/02/22/58795327 ... etter-care


So, under your reasoning of "harm to the child"

I would turn your conclusion against you @anasawad :

If you have your baby as a hospital you should be punished, because its dangerous and unnecessarily harmful and should be, at best, considered criminal negligence on the behest of the parents.

How do you like them apples son?

@Finfinder

Conservatives only tend to oppose things like this because they are "unusual" in the same manner that some conservative populations don't like "homeschooling."

However, that kind of conservatism is merely a rearguard action of defending the status quo.

In reality, from the principle of both "traditionalism" and "limited government" it makes very little sense for conservatives to oppose people choosing to have their kids at home.

[Rancid]

Home births have double the rate of child mortality and they're almost exclusively attributed to complications during delivery and labor and infections.

A lot of the studies I've seen are inconclusive. That is, some say more kids die, other's say they don't. The data is all over the place.

[One Degree]

@anasawad
No, I always convinced my wife to go, but she never wanted to after the first one. I was wrong. She was right. There was never a serious problem.
I am overly protective and see nothing wrong with it, but that does not mean it is the rational choice. Especially since three of mine were ‘out of pocket’ births.

[anasawad]

https://www.reuters.com/article/us-heal ... SKBN12X293

[Victoribus Spolia]

A lot of the studies I've seen are inconclusive. That is, some say more kids die, other's say they don't. The data is all over the place.

Check out the study I posted above.

He is full of shit.

Likewise, the question of parental rights also needs to be addressed.

Should I not be allowed to let my kids climb trees or ride bikes because of the risk of injury or death?

The risk is much higher with those activities than being born to a midwife.

[Victoribus Spolia]

@anasawad

I think we have better reason to trust an actual study from the National Institute of Health with cross references than a fucking article from Reuters.

From the link I cited earlier:

Perinatal mortality
The rate of perinatal death per 1000 births was very low and comparable in all 3 groups: it was 0.35 (95% confidence interval [CI] 0.00–1.03) among the planned home births, 0.57 (95% CI 0.00–1.43) among the planned hospital births attended by a midwife and 0.64 (95% CI 0.00–1.56) among the planned hospital births attended by a physician. There were no deaths between 8 and 28 days of life.

Here is a question for you, should parents be held responsible for criminal neglect for letting their kids risk falling, like in climbing trees? (the 12th leading cause of death for 5-9 year olds) Yes or No?

[anasawad]

@Victoribus Spolia
Yea, fuck that stupid article with it referencing all those multiple studies and sources to give facts.


Did the parents push or force the kid to the tree ??
So, strawmen already ?