From: anne@dolores.Stanford.EDU (Anne Paulson)
Subject: Re: Homebirth vs. Hospital birth
Organization: Stanford University
	<ANNE.92Dec20213836@dolores.Stanford.EDU>
	<1992Dec23.204219.19144@crd.ge.com>
Date: 29 Dec 92 12:42:45

In article <1992Dec23.204219.19144@crd.ge.com> kellihmt@daisymae.crd.ge.com (Margaret T Kelliher) writes:
[Discussing the safety of home birth]

   We had severe late decelerations (ie baby's heart rate *plunged* and
   stayed down after contractions), an emergency C-section (ie general 
   anesthesia done *now*), and a blue baby who needed to be resuscitated 
   more than once.  Had we been at home, and required a 45 minute trip to the 
   hospital after the trouble had been detected, I fear Colleen would have 
   had very severe problems due to oxygen deprivation. She almost did anyway.
   No explanation has been found for our difficulties.

There are all sorts of factors that will rule out a home birth.  One
of them, for many midwives, is being more than 25 minutes from a
hospital.  Each midwife has different criteria, but some
others are:  multiple births, breech baby, premature baby, very small
term baby, maternal hypertension, maternal anemia, maternal toxemia.
No one is claiming that all babies should be born at home.

I'm very glad that your daughter is OK.  My guess is that if you had
decided to have a home birth and had found a midwife willing to do it,
the midwife would have checked you out very early in labor, because
you were so far from the hospital.  Then you would have been whisked
off to the hospital for the C-section, probably having it about the
same time as you would have had you gone to the hospital when you were
in active labor.  But there are no guarantees.

In a previous message, I wrote:
   |>obviously home birth is as safe for births that turn out to be
   |>uneventful, but it turns out that it is as safe for births where
   |>something out of the ordinary happens.]

Margaret writes:
   I have trouble believing this. Can you point me to your source?

Alas, I couldn't find the cite.  Could somebody with Medline access
help me out?  There are several relevant studies, but the one I'm
thinking of is fairly recent and was a comparison between some
midwives' practices and some OB's practices in Detroit.  The OB's only
took low-risk patients, so the midwives' clients and the doctor's
patients were similar.   There is also data from the Farm, a new-age
commune (or something like that) where most of the babies are born at
home.  Their birth statistics are amazingly good.

Doctors like to point to horrifying homebirth statistics.  Watch out:
the statistics often used conflate planned home births and births that
accidentally happened at home.  Of course, unplanned home births
include all sorts of sad events, such as very very premature babies
for whom the outlook is not rosy.  

   IMHO, you are playing the odds whichever you choose. I obviously believe
   the hospital provides better odds for emergencies, and am willing to run
   the risk of unnecessary intervention which I consider more of an affront
   than a true danger to either mother or child. 

There is no guarantee of a healthy baby, no matter whether the baby is
born at home or in the hospital.  There are risks either way.  My
interpretation of the available  evidence says that for mothers who
meet the criteria for home birth, home birth is safer.  

-- Anne