Tuesday, September 1, 2009

Another study with positive results concerning planned home birth with a professional midwife published in the Canadian Medical Association Journal.

Here is the Abstract:

Background: Studies of planned home births attended by registered midwives have been limited by incomplete data, nonrepresentative sampling, inadequate statistical power and the inability to exclude unplanned home births. We compared the outcomes of planned home births attended by midwives with those of planned hospital births attended by midwives or physicians.

Methods: We included all planned home births attended by registered midwives from Jan. 1, 2000, to Dec. 31, 2004, in British Columbia, Canada (n = 2889), and all planned hospital births meeting the eligibility requirements for home birth that were attended by the same cohort of midwives (n = 4752). We also included a matched sample of physician-attended planned hospital births (n = 5331). The primary outcome measure was perinatal mortality; secondary outcomes were obstetric interventions and adverse maternal and neonatal outcomes.

Results: The rate of perinatal death per 1000 births was 0.35 (95% confidence interval [CI] 0.00–1.03) in the group of planned home births; the rate in the group of planned hospital births was 0.57 (95% CI 0.00–1.43) among women attended by a midwife and 0.64 (95% CI 0.00–1.56) among those attended by a physician. Wo men in the planned home-birth group were significantly less likely than those who planned a midwife-attended hospital birth to have obstetric interventions (e.g., electronic fetal monitoring, relative risk [RR] 0.32, 95% CI 0.29–0.36; assisted vaginal delivery, RR 0.41, 95% 0.33–0.52) or adverse maternal outcomes (e.g., third- or fourth-degree perineal tear, RR 0.41, 95% CI 0.28–0.59; postpartum hemorrhage, RR 0.62, 95% CI 0.49–0.77). The findings were similar in the comparison with physician-assisted hospital births. Newborns in the home-birth group were less likely than those in the midwife- attended hospital-birth group to require resuscitation at birth (RR 0.23, 95% CI 0.14–0.37) or oxygen therapy beyond 24 hours (RR 0.37, 95% CI 0.24–0.59). The findings were similar in the comparison with newborns in the physician-assisted hospital births; in addition, newborns in the home-birth group were less likely to have meconium aspiration (RR 0.45, 95% CI 0.21–0.93) and more likely to Abstract be admitted to hospital or readmitted if born in hospital (RR 1.39, 95% CI 1.09–1.85).

Interpretation: Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician.

Published online ahead of print August 31, 2009
CMAJ 10.1503/cmaj.081869
© 2009 Canadian Medical Association or its licensors

Click here for the pdf of the entire text.

Friday, February 13, 2009

Cookie Day at the Capitol - 2009!

Midwife supporters started showing up bright and early laden with boxes, baskets, crates, backpacks, and even wheeled luggage crammed full of hundreds and hundreds of packages of cookies! We lost count of just how many home baked cookies were delivered on Cookie Day, but our estimate puts it around 800 packages, or 400 dozen cookies!

Jen Keifer, FoMM VP, arrived with a wagon load of cookies and children.
Her homeborn baby, David (above) appears ready to go charm the legislators!

By 1 pm, most people had visited dozens of offices with their children and cookies and were happy to sit and listen to special speakers at our rally in celebration of legal CPMs. Many people were especially excited to hear Jennifer Block from Brooklyn, New York and many brought copies of her book, "Pushed" to be autographed afterwards. A number of legislators and various lobbyists showed up to hear her as well.
Above, Halley Watson, Legislative Chair, welcomes everyone and thanks them for coming to celebrate with us.

After receiving an emotional standing ovation from a rotunda full of homebirth parents, children, and their midwives, Senator Loudon spoke about his motivation for legalizing Certified Professional Midwives. He added, "You wouldn't believe all the people I've met through this! I have so many Facebook friends because of this issue!"

Samanda Rossi, President of Friends of Missouri Midwives, surprised Mary and Debbie by coming to the front to recognize them for their years of service and present them with beautiful bouquets, thanking them for all that they have sacrificed over the past four years to make midwives legal in Missouri.

"In their time as unpaid, volunteer lobbyists, they [Debbie and Mary] gave up a great deal for the betterment of families in Missouri and the midwives who serve them. And they did without complaint or of asking for much beyond our presence at the Capitol. They dug deep into their pockets to pay for gas and meager dinners of canned beans and donated food.... After dinner, sleep was scarce and work hours were long as they strategized and planned for the daylight hours ahead...
The intensity and selflessness of Mary and Debbie's work may never be fully understood or appreciated. But the magnitute of their work will resonate each time a midwife takes her CPM exam, each time a mother-to-be locates a legal midwife to assist her patiently and lovingly through pregnancy, and each time a baby utters it's first sounds of greeting upon birth in the great state of Missouri." - Samanda Rossi

The crowd in the rotunda, listening to Debbie tell the story of how her midwife was arrested two weeks before her due date, leaving her with nothing to do but have her baby at home alone or go to the hospital. Debbie spoke of how that experience led her to spend years of her life working to make midwives legal for every other pregnant woman in Missouri.

Debbie Smithey, Jennifer Block, Mary Ueland, Sarah Greek listen to Elizabeth Allemann, MD. "We've hunted midwives down and thrown them in prison for 50 years in Missouri," she said. "Now, we've decided that they shouldn't be criminalized. But what should Missouri do with them now? I suggest that we integrate them into our maternity care system!"

Halley Watson, Debbie Smithey, Mary Ueland, Sarah Greek - the "old" lobbyists and the "new" midwifery lobbyists!

All together with their heroes - Senator John and Dr. Gina Loudon!

Sarah and Mary discuss the Supreme Court ruling with Steve Walsh, reporter for the MissouriNet news service at the Capitol.

An interview for KWMU news. Homebirth slideshow playing in the background.

After the rally, we spent some time in a basement hearing room with
Jennifer Block, discussing the state of our modern maternity care system
and how to reach women with information and options.

Members of Friends of Missouri Midwives and Missouri Midwives Association leadership went to dinner with Jennifer Block at Panera bread to continue our conversation. We are so grateful to Jennifer Block, author of "Pushed: The Painful Truth About Modern Maternity Care" for taking time out of her busy schedule to speak at our rally, and for coming to spend Cookie Day promoting midwives at the Missouri Capitol! Thank you, Jennifer!

And lastly, a picture of Sarah Greek and Halley Watson, the new faces of midwifery seen at the Capitol every day in place of Debbie and Mary's continual presence. Their job is to make sure that Certified Professional Midwives STAY legal!
Thank you so much Halley and Sarah!

Monday, February 9, 2009

Midwifery Memoirs

I recently finished reading and reviewing a great new midwifery memoir, The Blue Cotton Gown by Patsy Harman. This book was written by a CNM who no longer attends births, so it was about the rest of midwifery--the well woman care side. It was very good.

A few months ago, I also read the very excellent Lady's Hands, Lion's Heart, another midwifery memoir (this one had lots of births and also lots of drama!). I really loved it. Very good.

In short order, I also read Labor of Love, by the CNM who was shadowed in the film The Business of Being Born.

If you get the opportunity to read any of these books, I think you'll enjoy them!

Friday, January 23, 2009

Increased C/S, Increased Complications

Interesting report from the National Partnership for Women and Families on a new study finding that the increase in C-Section deliveries coincides with increase in complications during birth.