Saturday, June 14, 2008

World Health Organization says homebirth increases perinatal mortality

The recent discussion of Marsden Wagner and his pronouncements on midwifery and homebirth made me wonder whether Wagner's positions are merely personal opinions or whether they represent the official position of the World Health Organization. Evidently, Marsden Wagner's claims are his opinions and nothing more. The World Health Organization specifically states that homebirth increases the risk of perinatal death. The relevant document is here:
Home-like settings for childbirth are associated with reduced likelihood of medical intervention. The evidence shows that the number of spontaneous vaginal births is higher, breastfeeding initiation more common and maternal satisfaction better in home-like institutional birth settings compared to conventional institutional settings. However, the evidence shows an increased risk of perinatal mortality, the reasons of which are not fully established. Thus, there is an increased need for monitoring early signs of complications in these home-like settings. (my emphasis)
In addition, the WHO would find direct entry midwifery practice to be woefully inadequate. The WHO has published guidelines on antenatal care. The following tests and procedures (among others) are recommended for routine antenatal care on the basic of the scientific evidence:
• screening for pre-eclampsia with a comprehensive strategy including an individual risk assessment at first visit, accurate blood pressure measurement, urine test for proteinuria and education on recognition of advanced pre-eclampsia symptoms;
• anti-D given during 72 hours postpartum to Rh-negative women who have had a Rh-positive baby;
• Down’s syndrome screening;
• screening and treatment of asymptomatic bacteriuria during pregnancy;
• screening of hepatitis B infection for all pregnant women and delivery of hepatitis B vaccine and immunoglobulin to babies of infected mothers;
• screening for HIV in early pregnancy, a short course of antiretroviral drugs, and caesarean
section for infected mothers at 38 weeks, to reduce vertical transmission;
• screening for rubella antibody in pregnant women and postpartum vaccination for those with negative antigen;
• screening and treatment of syphilis;
• routine ultrasound early in pregnancy (before 24 weeks);
• external cephalic version at term (36 weeks) by skilled professionals, for women who have an uncomplicated singleton breech pregnancy;
Indeed, the World Health Organization profoundly disagrees with a fundamental admonition of homebirth advocacy to "trust birth". The WHO does not find birth to be trustworthy at all. In addition the WHO specifically recommends screening tests, routine ultrasound, Rhogam, intensive screening for pre-eclampsia and external version for breech.

The bottom line is that the WHO agrees that homebirth increases the risk of perinatal death, does not advocate "trusting" birth, strongly supports routine screening, including routine ultrasound, and believes that vaginal breech delivery should be avoided by attempted version. In other words, American direct entry midwifery principles and practice violate the recommendations of the World Health Organization.


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