Talk:Home birth

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Legality of Midwives in US

This paragraph does not make sense:

"In 37 states it is legal to acquire the services of a midwife. Many midwives continue to attend mothers in states where it is illegal, while efforts are underway to change the law."

Practicing as a certified nurse midwife is legal in all states. Is this statement meant to refer to legality of direct-entry midwifery? If so, it should be clarified. Also, I think the statement that it "is legal to acquire the services of a midwife" is misleading, as it implies that in some states, it is illegal to hire a midwife. To the best of my knowledge (and please correct me if someone knows otherwise) it is not illegal to hire any type of midwife anywhere in the United States, rather, direct-entry midwives can be prosecuted for practicing in some states.Jane Snow (talk) 22:50, 6 July 2009 (UTC)

Alabama decriminalized midwifery recently. --Lo Ximiendo (talk) 04:06, 1 June 2017 (UTC)

What is low risk pregnancy?

The page makes a couple of references to "low risk" when considering the safety of home birth. What is "low risk"? A quick googling only found one definition - from a 1997 paper by Rosenblatt et al ["Interspecialty differences in the obstetric care of low-risk women.", Am J Public Health, March 1997]. This mentioned "a major medical condition, a previous obstetrical complication, a serious risk factor in the current pregnancy, no obstetrical care in the first trimester, or were under 18 or over 34 years old." as all meaning "not low risk". According to this definition, 53% of the pregnancies in that study were "not low risk". So, what's the general definition of "low risk", and what proportion of pregnancies meet that criterion? Pvanheus (talk) 10:40, 5 December 2009 (UTC)

Research on Safety

The description of the NICE report seems unclear to me in this article. I tried to look over the report and see where some of this wording was coming from. Maybe I'm missing something, but I can't find where the report mentions that planning birth in a consultant-led unit decreases satisfaction. The section begins with the report's introduction to a set of points they think women deciding between settings should be informed about, so I think this section should be completely revised to describe an overview of these points. I think this would be clearer and more accurate. I'm going to go ahead and try to do that if no one objects. --Aronoel (talk) 16:49, 7 May 2010 (UTC)

Go for it, sounds great! -- btphelps ^{(talk) (contribs)} 19:32, 7 May 2010 (UTC)

I could not find the quote you added that was supposed to be from the NICE study. While the edit summary said, "Revised and expanded section about NICE report," it dramatically altered the tenor of the prior quote from home-birth neutral to home-birth negative. The new quote was:

"The uncertain evidence suggests intrapartum-related perinatal mortality (IPPM) for booked home births, regardless of their eventual place of birth, is the same as, or higher than for birth booked in obstetric units. If IPPM is higher, this is likely to be in the group of women in whom intrapartum complications develop and who require transfer into the obstetric unit."

When unanticipated obstetric complications arise, either in the mother or baby, during labour at home, the outcome of serious complications is likely to be less favourable than when the same complications arise in an obstetric unit.

I searched the NICE study for three different phrases in the above quote without success. Perhaps there is another source? So I reverted the change and added a ref for the existing quote from the study. The second graf is un-sourced and appears to be original research. -- btphelps ^{(talk) (contribs)} 03:08, 11 May 2010 (UTC)

If you follow this link, [1] which I included in my reference when I made the changes, and go to page 23, you will see the section of the NICE report called "Recommendations on planning place of birth" and a sub-section called "Home Birth." This is the part of the report that I quoted and summarized in my changes, and you will see that they are not original research or my own point of view.

The current part of this article describing NICE is lifted directly from this page: [2] This is a possible copyright violation and as far as I can tell, the source used isn't published and is less recent than the one I used. For these reasons and the reasons I mentioned originally I hope you restore my changes. --Aronoel (talk) 15:45, 11 May 2010 (UTC)

The information you say is lifted that could be a possible copyright vio is actually a copy of this Wikipedia article. Note the word "Wikipedia" upper right on the article.

Sorry, I didn't catch your other reference. Please re-add it but I suggest leaving the existing info as both pieces of info seem to have validity. I read page 8 of the document you provided and from what I could gather -- I am by no means an expert in this field -- some intrapartum-related perinatal mortality (IPPM) rates were higher in the UK but lower in Australia. It states, "It should be noted that the calculated IPPM rates are sensitive to transfer rates, which themselves are particularly uncertain." The quote you provided also cites "uncertain evidence." Seems to me that all of the information cannot be validated with a high degree of certainty.

On page 23, along with the quote you cite, it reports, "Planning birth outside an obstetric unit seems to be associated with an increase in spontaneous vaginal births, an increase in women with an intact perineum and improved maternal satisfaction." I don't have time to absorb all of it, but it seems like the report equivocates on all its recommendations. Women who value a vaginal birth and and "intact perineum" (i.e., a non-induced labor) would find value in some of the recommendations, while women who are concerned about possible negative outcomes due to complications would find value in other recommendations. Some kind of balanced summary of what appear to me to be inconclusive recommendations would be appropriate IMO. -- btphelps ^{(talk) (contribs)} 17:27, 11 May 2010 (UTC)

I edited that section somewhat and tried to clarify the equivocal nature of the information. You could certainly improve it. Maybe you could also fix the lede? It's much too short. -- btphelps ^{(talk) (contribs)} 17:35, 11 May 2010 (UTC)

Sorry, on second look it was clearly not a copyright violation.

I agree that the NICE report does not seem to have very certain recommendations, and it mentions many times that the evidence is too poor to have a high degree of certainty about any of the conclusions. I think the point of the recommendations was to evaluate the what little and contradictory evidence there is and create a set of information, but with caveats.

Also, I really question the validity of the "Final Draft of Guideline on Intrapartum Care" source. This is not a situation with two separate articles or reports, it's really the same report, and one version seems to be an earlier unpublished draft. If they decided to change their recommendations in the published version, I think there must be a reason why.

I agree that the points about intact perineum and vaginal labor should be included, because it's valuable information for some people. In my version I did include these points, even though I'm not sure that they technically fall under the "safety" category.

I'll work on the things you suggested, but in the meantime, do you think that it would be good if we completely restructured the section on safety so that instead of using block quotes and summarizing a bunch of different studies of dubious quality, we try to outline some basic facts and viewpoints that we find in multiple sources? --Aronoel (talk) 19:16, 11 May 2010 (UTC)

That sounds fine, please go for it. I'm on deadline with some other writing projects and won't be much help, I'm afraid. -- btphelps ^{(talk) (contribs)} 05:26, 12 May 2010 (UTC)

What about this: Caroline Lovell, 36, once advocated for midwife funding and legal protection in Australia; but in January, Lovell died of a heart attack just one day after giving birth at home to her second daughter, Zahra, the Australian newspaper Herald Sun reported? http://abcnews.go.com/blogs/health/2012/02/02/death-after-home-birth-raises-questions/ Dr. Jux 17:31, 14 February 2012 (UTC) — Preceding unsigned comment added by Juxtaposit (talk • contribs)

Apgar Scoring

Regarding the safety for the baby, it would not be helpful to use the apgar score as the measure of safety. Apgar was invented to describe what state the child was in at the time of the delivery, and has been shown not to correlate well with long-term outcomes (unless the score is very low at 10 minutes of age). [3] — Preceding unsigned comment added by 202.154.134.70 (talk) 22:20, 10 May 2012 (UTC)

Vitamin K

I came across this article and was wondering if it would be suited for this page? If not, could you point me in the right direction. Cap020570 (talk) 13:28, 1 September 2013 (UTC)

MANA death rate statistics

this research, showing a 450% higher death rate among US homebirths than hospital biths, merits inclusion but I would prefer to cite a formal paper rather than a blog (even one written by an OB/GYN). No time now - just wanted to post it here. Wormcast (talk) 16:37, 1 June 2017 (UTC)

The paper is at [4]; it's already used as cite 24, though the 2.06 number is not used. I'm hesitant to dig too far into that paper as the number of births (~17000) is so low that a single death swings each number pretty far- there's only 35 deaths in the "low-risk" table, and even the skepticalOB post, when noting the 20x death rate for breach babies, is comparing a 5 out of 222 rate to a national 0.8/1000 average- a single death would have already been 5x+. Especially as the JME meta-study from the same time period has a larger sample size and gives a 300% higher neonatal death rate instead. --PresN 17:20, 1 June 2017 (UTC)

Makes sense to me. Wormcast (talk) 03:52, 3 June 2017 (UTC)

Professional resistance

Aronoel, good addition to the lede about the American Medical Association and College of ObGYn's opposition. However, the lede is supposed to summarize the body. Can you add some content to the body describing their opposition? (Like the AMA's "Resolution 205 on Home Deliveries," passed in 2008.) Here are some possible links:

• Ricki Lake's home-birth film upsets AMA
• Thoughts on the AMA Homebirth “Ban,” Ricki Lake, and Midwifery
• American Medical Association passes resolution to outlaw homebirth
• Missouri court says midwives can continue to practice
• American Medical Association House of Delegates (A-08) p. 15.

AMA Resolution 205 in full:

Resolution 205 (1) that our American Medical Association support the recent American College of Obstetricians and Gynecologists (ACOG) statement that “the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers”; and (2) that our AMA develop model legislation in support of the concept that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the AAP and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.”

Note that self-published sources like blogs are not generally acceptable as third-party sources, although this generally applies to individually-published content. Exceptions may include professional organizations. Use your discretion.

I think the basic thrust of the arguments that the AMA and College of ObGyns have is against midwives and not home birth per se, because the midwives are competing for a piece of their business. They don't say that, but their critics do. So presenting both the medical association's and the professional midwives association's point of view should be helpful.

-- btphelps ^{(talk) (contribs)} 22:57, 13 May 2010 (UTC)

Thanks, I want to add the professional midwives association's response, but I'm having trouble finding a press release or a published article where they explain their criticism. Do you know of one or a good place to look? -Aronoel (talk) 16:44, 14 May 2010 (UTC)

Home Birth Opinions

Based on the research on home birth would some of you still recommend home birth after knowing the benefits and the risks of it to other women who wants to have home birth? — Preceding unsigned comment added by 68.63.209.120 (talk) 23:35, 2 February 2012 (UTC)

Celebrities who chose Home Birth?

How is that relevant to article about home birth? — Preceding unsigned comment added by Seriem (talk • contribs) 11:14, 3 October 2012 (UTC)

I agree that it may not be relevant, but I restored the list you deleted, renaming it "notable mothers" instead of "celebrities", in hopes that some discussion might be had before undoing so much referenced work. -- Guðsþegn (talk) 18:19, 5 October 2012 (UTC)

coming in a year after the fact, but "notables" who choose home birth is more an advertisement than reference. Cap020570 (talk) 13:26, 1 September 2013 (UTC)

Large rewrite

This article... where do I begin. Random, slanted statistics from sources, some notable, some not, some publicly rescinded journal articles, were just strewn throughout the article whether they fit the section or not. The whole thing was just unreadable. I've tried to go through and clean up the whole thing- pull non-RS sources for medical information, pull sources that were rescinded by their authors, add in statistics which were badly missing, add in new lit reviews, and try to note that you really can't conflate different countries with each other, if for no other reason than that licensing requirements vary drastically- in some countries midwives are almost specialized nurses, while in others they can just be people with some experience, good intentions, and no medical training (or high school diploma). The article could still use a lot of work- the flow is wonky, and the legal section is a complete mess still, but I'm going to ask that anyone who wants to undo the changes actually discuss them and figure out how they can make the article better, not just knee-jerk revert things to fit whatever preconceived bias they have. This is a medical-related article, and it should be held to higher standards than is has been for the past few years. No one should be taking medical advice from Wikipedia, and yet they do. --PresN 03:56, 26 January 2014 (UTC)

• I undid a wholesale removal of lots of well-cited information. This could be edited a bit, but wholesale removal seems too drastic. Sushilover2000 (talk) 17:56, 15 December 2014 (UTC)

• I'll explain myself in greater detail here. A large problem with this article, going back years, is new editors/IP addresses jumping in and adding a bunch of information that, even if it has citations, is heavily slanted towards making home births appear to be safer than the research actually suggests. This includes quotes out of context, cherry-picking facts, and so on. Additionally, the edits are often created in a vacuum, i.e. they duplicate existing material in the article, or contradict it without explanation.
• The edit(s) in question do several of these. First, it removes the line that infant mortality has fallen greatly over the 20th century- this is due to the rise of hospital/medical standards for the last 100 years, but to a home birth advocate it appears to make modern home births look unsafe.
• Second, they add a new massive text block (to the lead, no less) to contradict the existing statements. There's a few problems with this- one, the article tries whenever possible to use meta-studies (studies which combine multiple others) and large, comprehensive studies (studies that try to capture all births in an entire country in a given time period), that way we don't play the game of trying to pick out which studies are best/more meaningful. The added text uses two studies- one which is already included in the meta-studies used, and one which is about the Netherlands- the article tries to take pains to point out that you can't easily compare across countries because of different training and licensing requirements.
• Third, they add a new subsection on "medical intervention", which is complete nonsense. Yes, unsurprisingly, if you don't go to a hospital or see a doctor, no one will perform a medical procedure on you, whether you need it or not. Nothing in this section says anything about the safety or outcomes of home births.
• The home birth qualifications could use some rewriting, but I'll add it back in.
• Fifth, they add in a section in the middle of the research section, which is arranged roughly chronologically, with a poorly-worded section on opposing research. Looking at the research, however, it's a "prospective" study (i.e. hasn't happened yet), a journal of 500 woman's experiences (i.e. not actually a medical study but a survey of descriptive statements), something about breast feeding (birth type does not impact breast feeding, it's a choice), and something that might actually be usable about shorter delivery times (though I'd like to read the actual study before blindly leaving it in)
• Perhaps I'm a bit overzealous in reverting sometimes, but it's important to note that, especially in a medical-related article, that just because there's citations doesn't mean an addition is a good idea. This article has several problems, notably that it's really missing a good section on home birth rates and general opinions of it, but there are over a hundred studies out there on home births and picking numbers out of the ones that make home births look more attractive isn't one of the problems. --PresN 19:26, 15 December 2014 (UTC)

• I do agree with you that you are being overzealous. Thanks for the commitment to keep editing the page. The page won't evolve to the place that it should be if it isn't allowed to move forward. Many of your arguments seem like opinion (citations not good enough), rather than factual. It would be better to include the contradictions, than just leave one opinion. Sushilover2000 (talk) 20:51, 15 December 2014 (UTC)

Apgar score and stillbirth

An earlier version of the article incorrectly stated that a study showed a risk of stillbirth when, in fact, it showed a increase in Apgar scores of 0 at 5 minutes. I changed it to make it clear that the study focused on Apgar scores of 0 rather than stillbirth. Important given that plenty of babies survive after having a 5 minute score of 0. A further contribution clarified that an apgar score require no pulse and no breathing. I removed the clarification, because I think it might make some readers believe that it was the same as stillbirth. It's better, I think, that the follow the link to Apgar score. Just my opinion. I thought an discussion here, might be warranted. 77.99.168.133 (talk) 18:20, 15 May 2014 (UTC)

NEJM

Special article: doi:10.1056/NEJMsa1501738. Not a secondary source but will probably stir up debate again. JFW | T@lk 09:56, 31 December 2015 (UTC)

Improving content on mortality rates

Content says:

In 2014, a comprehensive review in the Journal of Medical Ethics of 12 previously published studies encompassing 500,000 planned home births in low-risk women found that perinatal mortality rates for home births were triple that of hospital births.[8] This finding echoes that of the American College of Obstetricians and Gynecologists.[17]

ACOG says:

Wax and colleagues recently conducted a meta-analysis of observational studies comparing the newborn and maternal outcomes for planned home birth with those of planned hospital birth (24) (Table 1). Although perinatal mortality rates were similar among planned home births and planned hospital births, planned home births were associated with a twofold-increased risk of neonatal death.

The paper by Wax et al. cited by ACOG is:

Wax JR, Lucas FL, Lamont M, Pinette MG, Cartin A, Blackstone J. Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis. Am J Obstet Gynecol 2010;203:243.e1,243.e8.

ACOG also says:

It is important to note that reports suggesting that planned home births are safe involved only healthy pregnant women. Recent cohort studies reporting lower perinatal mortality rates with planned home birth describe the use of strict selection criteria for appropriate candidates (21, 22).

The two citations in this quote (21, 22) are:

Janssen PA, Saxell L, Page LA, Klein MC, Liston RM,Lee SK. Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician [published erratum appears in CMAJ 2009;181:617]. CMAJ 2009;181:377–83.

and

Hutton EK, Reitsma AH, Kaufman K. Outcomes associated with planned home and planned hospital births in low-risk women attended by midwives in Ontario, Canada, 2003-2006: a retrospective cohort study. Birth 2009;36:180–9.

These three sources (Wax, Hutton, and Janssen) are not cited by the article at all. Perhaps they could be helpful.

The content says that "perinatal mortality rates for home births were triple that of hospital births" and that "This finding echoes that of the American College of Obstetricians and Gynecologists," citing the ACOG source quoted above, but the ACOG source says perinatal mortality is similar, and neonatal mortality is about two-fold, not three-fold as implied by the content. The content says something else. Later in the section, it does say perinatal mortality is similar. The section is also long and has much repetition. It also seems biased toward giving a negative impression toward homebirth. SageRad (talk) 22:34, 24 January 2016 (UTC)

For those who don't have access to the Journal of Medical Ethics source, it says:

Nevertheless, there are strong data to show that there are significantly worse outcomes for the fetus in homebirths. A meta-analysis included 12 studies and 500 000 planned homebirths in healthy low-risk women showed neonatal mortality tripled.7 This suggests that we could expect increased risk of future child morbidity—perinatal mortality and morbidity may be surrogate markers for future child risk. Surrogate markers can be objectively measured and evaluated as indicators of pathogenic processes.8

Those two references are:

Wax JR, Lucas FL, Lamont M, et al. Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis. Am J Obstet Gynecol 2010;203:243.e1–243.e8.

Woodcock J. A Framework for Biomarker and Surrogate Endpoint Use in Drug Development. Biomarkers Definition Working Group, National Institutes for Health. 1998. http://www.fda.gov/ohrms/dockets/ac/04/slides/2004-4079S2_03_Woodcock.ppt#261,6,Surrogate.

In light of this, i made this edit. There's a lot more work to do to make the section accurate to sources. SageRad (talk) 12:25, 25 January 2016 (UTC)

Restructuring the article

The article as it is written now frames home birth as a medical event. It also heavily focuses on modern Western home birth issues. While we can address these, the very ideas of birth as a medical event and framing birth as such hijacks and distorts encyclopedic information on homebirth that by definition must be free of biases and present neutral objective information (if there is such a thing in contested and hot areas of inquiry). MtUllaHistorian (talk) 16:18, 20 December 2018 (UTC)

Yeah, the article is pretty bad and not comprehensive at all. I picked it up a few years ago when it was nothing but thinly-veiled propaganda for (American) home births being not just as safe but in fact better in as many ways as the editors could squeeze sources than births in hospitals. So it's at least more unbiased in that respect, but it's still not a great article- as you say, it focuses on medical differences between home births and hospital births, primarily in America, and doesn't really touch at all on social or historical norms and practices around birthing at home or give any real global perspective on the issue, in history or modern times. Any changes you want to make in that respect are welcomed, I'll try to avoid stepping on your edits. --PresN 16:27, 20 December 2018 (UTC)

Thank you very much! It is a controversial topic but a fascinating one for sure.MtUllaHistorian (talk) 16:46, 20 December 2018 (UTC)

Classification

Currently the article is classified as Medical. There is problem with that because for most of the history birth was not medical event, thus it is very hard to discuss what birth and home birth were historically because of the previous attempts of authors to make the article into a debate on legality and safety of it from modern day perspective. While safety and legality of home birth in modern context warrants separate sections, these issues should not be the main focus of the article. I propose removing the Medical tag or at least adding some form a Social Sciences tag - Sociology? Anthropology? If anybody has other suggestions, it would be great to collaborate between several people. MtUllaHistorian (talk) 15:09, 2 January 2019 (UTC)

I'm not sure what you mean by "classified" as medical- you mean the template at the top of this talk page? That just means that it's in the scope of the medicine project; such scopes are non-exclusive, it's completely reasonable for this article to be in the scopes of both the medicine project and multiple others, such as Wikipedia:WikiProject Sociology. The presence or lack of such tags does not restrict the article content to only what would be in that focus. --PresN 15:22, 2 January 2019 (UTC)

Safety

I would suggest discussing safety and/or mortality trends in context of other causes of morbidity and mortality in a specific historical period and tied to a specific location to make discussion of birth issues meaningful in context of place and time not historical data compared to modern day statistics. This would provide for meaningful comparisons, not propaganda driven fear mongering.MtUllaHistorian (talk) 15:14, 2 January 2019 (UTC)

Untitled

I would like to remove this section in the etymology of Home Birth

“Since the beginning of the 20th century, home birth rates have fallen in most developed countries, generally to less than 1% of all births” This was a single study made in reference to the year 2010 in the United States. It should not be used to describe and overall description of Home Birth statistics. SarahJeanDixon (talk) 23:09, 3 April 2021 (UTC)

A Commons file used on this page or its Wikidata item has been nominated for deletion

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• American Home Birth.png

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This article was the subject of a Wiki Education Foundation-supported course assignment, between 21 August 2023 and 8 December 2023. Further details are available on the course page. Student editor(s): Cowgirl0987 (article contribs).

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