Tuesday, June 27, 2006

Homebirth and postdates

One of the most recent studies of homebirth involved women with a previous C-section.

A description of the management and outcomes of vaginal birth after cesarean birth in the homebirth setting. Latendresse G, Murphy PA, Fullerton JT. J Midwifery Womens Health. 2005 Sep-Oct;50(5):386-91.
Our objective was to describe the outcomes of intended home birth among 57 women with a previous cesarean birth. Data were drawn from a larger prospective study of intended homebirth in nurse-midwifery practice. Available data included demographics, perinatal risk information, and outcomes of prenatal, intrapartum, postpartum, and neonatal care. The hospital course was reviewed for those transferred to the hospital setting. Fifty-three of 57 women (93%) had a spontaneous vaginal birth, 1 had a vacuum-assisted birth, and 3 (5.3%) had a repeat cesarean birth. Thirty-one of 32 (97%) women who had a previous vaginal birth after cesarean birth (VBAC) had a successful VBAC; 22 of 25 (88%) women without a history of VBAC successfully delivered vaginally. Fifty (87.7%) of these women delivered in the home setting, whereas 7 (12.3%) delivered in the hospital setting. None of the women experienced uterine rupture or dehiscence. One infant was stillborn. This event was attributed to a postdates pregnancy with meconium. Certified nurse-midwives with homebirth practices must be knowledgeable about the risks for mother and baby, screen clientele appropriately, and be able to counsel patients with regard to potential adverse outcomes. Given what is presently known, VBAC is not recommended in the homebirth setting. It is imperative in the light of current evidence and practice climate to advocate for the availability of certified nurse-midwife services and woman-centered care in the hospital setting.
The death rate is this study was very high, and as a result, the authors conclude that VBAC is not safe in the homebirth setting. Interestingly, the death in the study was not a complication of VBAC, but was a complication of postdates.

Homebirth advocates often claim that doctors arbitrarily induce women for postdates and there is no reason to do so. It seems to me that the homebirth studies have a particularly high rate of deaths in postdates pregnancies.

For example, Murphy & Fullerton say in their original homebirth study: "Intrapartal mortality during intended home birth is concentrated in postdates pregnancies with evidence of meconium passage."

In the Johnson & Davis study 2 of the 11 neonatal deaths were postdates pregnancies.

In the Bastian study 7 of the 50 deaths were in postdates pregnancies.

I think there is an important message here: homebirth midwives who refuse to accept the fact that postdates pregnancies are at high risk are irresponsible and wrong. By ignoring what doctors have already discovered about postdates pregnancy, they have contributed to the deaths of these babies at homebirths.

1 Old Comments:

Thinking out of the box when Buying owl gifts for your girl just
now doesn't cut it for you, Here are some creative ways to facilitate the new brides in your lap Begin married lifespan.

My site :: owl earrings

By Anonymous Anonymous, at 8:41 AM