Hi there JuJu,

I can certainly sympathise with your position. I worked in paediatric oncology for six years, and I often reflected with dismay that so very many children had cancer! But when you put it into context, you realise that your views are somewhat affected by your position; we took almost every case of childhood cancer in the entire state, for instance, so what we saw was only a tiny proportion of the paediatric population (thank goodness!) Working in a Level 3 NICU, I'm sure you receive referrals from a very wide geographical area and a large population. When you only see the worst of the worst, it is easy to become accustomed to seeing that as the "norm".

While the focus of this thread was on midwifery-led care, as opposed to home birth, I guess you could argue that homebirth is simply midwifery-led care in a home, rather than a separate centre, and you raise some points that I think it is important to address.

A very skilled mid-wife that is able to pick up on fetal distress that requires hospitalization may still run the risk of long term or permanent damage to the baby. In a emergency situation there needs to be interventions taken with-in seconds to minutes to guarantee the most optimal outcome for the baby.
I'm sorry, JuJu, but that is simply not backed up by the research. There are no midwifery or obstetric interventions that have to be performed within "seconds" to ensure the well-being of mother and baby during the birth. Complications are rare during labour and birth in a normal, healthy woman, and when they do present, they present with early warning signs that an experienced and adequately skilled midwife will detect. Thomas et. al. in 2004 examined a cross-section of births that occurred in the US that ended in caesarean, and compared the time interval between the decision being made to perform a caesarean, and the procedure actually happening; they found that there was a 75 minute window between the detection of complications and the commencement of a caesarean, for best outcomes.


We are talking all it takes is a few minutes of decreased oxygen supply to the baby to cause permanent brain damage. People who delivery their babies at home may have no ideal that there was fetal compromise during delivery, if they were not hooked up to a fetal monitor during the delivery.
During normal labour, it is not possible for the baby to be deprived of oxygen. It receives oxygenated blood from the mother's placenta. The "danger period" for oxygen deprivation is during and immediately after birth. Once more, in a midwife-led setting, the use of opioid-based pain relief for the mother is reduced, active labour and birth reduces time spent pushing and birthing the baby, and as a result the baby is not as likely to suffer respiratory depression at birth or immediately after. In terms of monitoring, the Cochrane Review in 2006 by Alfirevic et. al. showed continuous fetal monitoring has been shown to be no more effective at preventing neonatal complications as the periodic doppler monitoring that midwives use. It also restricts movement, which actually increases the likelihood of some birth complications.

As for me, I would not take the risk of compromising my baby delivering at home.
Once more, your opinion is not supported by the current evidence. As far back as 1997, analysis of the existing literature at that time by Olsen indicated that there was no difference iin fact hospitals had a higher incidence of low Apgar scores (babies which are slow to breathe and move after the birth) and serious penineal tears than hospital births. These results were backed up by Ligtermoet in 1998. The same year, Murphy & Fullerton examined home births in the US and found that they were as safe as hospital birth as long as hospital support was available for transfer in the event of complications. More recently, in 2002, Parratt & John examined home births in Victoria, and found that they were equally as safe as hospital births; in 2005, a very large study was conducted in the US by Johnson & Daviss, which found overwhelmingly that homebirth with appropriately skilled midwives was as safe or safer than hospital birth. They even went so far as to make the statement that "There can be no more doubt about the safety of homebirth" in a media release about their research findings.

Not to say bad things don't ever happen in the hospital, and a lot people have wonderful deliveries at home. You don't know if you are going to have a smooth delivery until it's over.
Statistically, actually, you do. Homebirth midwives follow quite stringent admission criteria to screen women who may be at higher risk during birth. It is for this reason that the results are as they are; because with appropriate screening, advice, and support during pregnancy, you do know that you will have a trouble-free birth, or at the very least, that if something changes, you will have time to deal with it.


I think you have much better outcome for you and the baby at a hospital with a highly skilled doctors and staff.
That may be your personal opinion, but it is certainly not the reality of our current health care system.

References
1. Olsen O. Meta-Analysis of the Safety of Home Birth. Birth. 1997;24(1):4-13.
2. Ligtermoet H. Safety in childbirth. Birthings. 1998:9-12.
3. Murphy P, Fullerton J. Outcomes of intended home births in nurse-midwifery practice: a prospective descriptive study. Obstet Gynecol. 1998;92(3):461-470.
4. Parratt J, Johnston J. Planned homebirths in Victoria, 1995-1998. Australian Journal of Midwifery: Professional Journal of the Australian College of Midwives Incorporated. 2002;15(2):16-25.
5. Johnson KC, Daviss B. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ. 2005;330:1416.
6. Alfirevic Z, Devane D, Gyte GML. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour (Cochrane Review). (Date of most recent substantive amendment: 24 April 2006). The Cochrane Database of Systematic Reviews. issue 3, 2006.
7. Thomas J, Paranjothy S, James D. National cross sectional survey to determine whether the decision to delivery interval is critical in emergency caesarean section. BMJ. vol 328, no 7441, 20 March 2004, pp 665-668.