See full paper/study here.
Highlights from this study below.
Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.
We focused on the 5418 women who intended to deliver at home at the start of labour. Table 1 compares them with all women who gave birth to singleton, vertex babies of at least 37 weeks or more gestation in the United States in 2000 according to 13 personal and behavioural variables associated with perinatal risk. Women who started birth at home were on average older, of a lower socioeconomic status and higher educational achievement, and less likely to be African-American or Hispanic than women having full gestation, vertex, singleton hospital births in the United States in 2000.
Individual rates of medical intervention for home births were consistently less than half those in hospital, whether compared with a relatively low risk group (singleton, vertex, 37 weeks or more gestation) that will have a small percentage of higher risk births or the general population having hospital births (table 3). Compared with the relatively low risk hospital group, intended home births were associated with lower rates of electronic fetal monitoring (9.6% versus 84.3%), episiotomy (2.1% versus 33.0%), caesarean section (3.7% versus 19.0%), and vacuum extraction (0.6% versus 5.5%). The caesarean rate for intended home births was 8.3% among primiparous women and 1.6% among multiparous women.
Our study has several strengths. Internationally it is one of the few, and the largest, prospective studies of home birth, allowing for relatively stable estimates of risk from intrapartum and neonatal mortality. We accurately identified births planned at home at the start of labour and included independent verification of birth outcomes for a sample of 534 planned home births. We obtained data from almost 400 midwives from across the continent.
As with the prospective US national birth centre study19 and the prospective US home birth study,23 the main study limitation was the inability to develop a workable design from which to collect a national prospective low risk group of hospital births to compare morbidity and mortality directly. Forms for vital statistics do not reliably collect the information on medical risk factors required to create a retrospective hospital birth group of precisely comparable low risk,38-40 and hospital discharge summary records for all births are not nationally accessible for sampling and have some limitations, being primarily administrative records.
One exception, and an important adjunct to our study, was Schlenzka's study in California.22 In this PhD thesis, Schlenzka was able to establish a large defined retrospective cohort of planned home and hospital births with similar low risk profiles, because birth and death certificates in California include intended place of birth and these had been linked to hospital discharge abstracts for 1989-90 for a caesarean section study. When the author compared 3385 planned home births with 806 402 low risk hospital births, he consistently found a non-significantly lower perinatal mortality in the home birth group. The results were consistent regardless of liberal or more restrictive criteria to define low risk, and whether or not the analysis involved simple standardisation of rates or extensive adjustment for all potential risk variables collected.22
Tuesday, July 7, 2009
Saturday, June 27, 2009
The Big Lie "As long as the baby and mom are health"
The ACOG guidelines highlight a case in which four obstetricians examined 50 FHR tracings; they agreed in only 22% of the cases. Two months later, these four physicians reevaluated the same 50 FHR tracings, and they changed their interpretations on nearly one out of every five tracings.
Think about this when discussing electronic fetal monitoring with your OB at your prenatal visits. Consider why he or she insists on using EFM. Ask yourself how continuously listening to the baby's heart rate can in any way ensure a better outcome or if it will more than likely ensure you are forced into an unnecessary c-section.
Full Story:
For Release: June 22, 2009
ACOG Refines Fetal Heart Rate Monitoring Guidelines
Washington, DC -- Refinements of the definitions, classifications, and
interpretations of fetal heart rate (FHR) monitoring methods were
issued today in new guidelines released by The American College of
Obstetricians and Gynecologists (ACOG). The objective of the
guidelines is to reduce the inconsistent use of common terminology and
the wide variability that sometimes occurs in FHR interpretations.
ACOG's Practice Bulletin, published in the July 2009 issue of
Obstetrics & Gynecology, supports the recommendations of the Eunice
Kennedy Shriver National Institute of Child and Health Development
workshop* on electronic fetal monitoring (EFM) held in April 2008.
The intent of FHR monitoring is to help keep an eye on the status of
the fetus during labor and intervene if necessary. There are two main
FHR monitoring methods. The most commonly used method is EFM, which
detects the fetal heart rate and the length of uterine contractions
and the time between them. EFM allows physicians and nurses to measure
the response of the fetal heart rate to uterine contractions. A lesser-
used method is manual auscultation, which employs either a small
handheld Doppler device or a fetoscope (similar to a stethoscope) . A
normal fetal heart varies between 110 and 160 beats per minute. A
heart rate that doesn't vary or is too low or too high may signal a
potential problem with the fetus.
"Since 1980, the use of EFM has grown dramatically, from being used on
45% of pregnant women in labor to 85% in 2002," says George A.
Macones, MD, who headed the development of the ACOG document.
"Although EFM is the most common obstetric procedure today,
unfortunately it hasn't reduced perinatal mortality or the risk of
cerebral palsy. In fact, the rate of cerebral palsy has essentially
remained the same since World War II despite fetal monitoring and all
of our advancements in treatments and interventions. "
One notable update in the guidelines is the three-tier classification
system for FHR tracings (print-outs of the fetal heart rate). Category
1 FHR tracings are considered normal and no specific action is
required. Category 2 tracings are considered indeterminate. This
category requires evaluation and surveillance and possibly other tests
to ensure fetal well-being. Category 3 tracings are considered
abnormal and require prompt evaluation, according to ACOG. An abnormal
FHR reading may require providing oxygen to the pregnant woman,
changing the woman's position, discontinuing labor stimulation, or
treating maternal hypotension, among other things. If the tracings do
not return to normal, the fetus should be delivered.
"Our goal with the ACOG guidelines was to define existing terminology
and narrow definitions and categories so that everyone is on the same
page," says Dr. Macones. One of the problems with FHR tracings is the
variability in how they're interpreted by different people. The ACOG
guidelines highlight a case in which four obstetricians examined 50
FHR tracings; they agreed in only 22% of the cases. Two months later,
these four physicians reevaluated the same 50 FHR tracings, and they
changed their interpretations on nearly one out of every five tracings.
A meta-analysis study shows that although EFM reduced the risk of
neonatal seizures, there is still an unrealistic expectation that a
nonreassuring FHR can predict the risk of a baby being born with
cerebral palsy. The false-positive rate of EFM for predicting cerebral
palsy is greater than 99%. This means that out of 1,000 fetuses with
nonreassuring readings, only one or two will actually develop cerebral
palsy. The guidelines state that women in labor who have high-risk
conditions such as preeclampsia, type 1 diabetes, or suspected fetal
growth restriction should be monitored continuously during labor.
Practice Bulletin #106, "Intrapartum Fetal Heart Rate Monitoring:
Nomenclature, Interpretation, and General Management Principles," is
published in the July 2009 issue of Obstetrics & Gynecology.
* In 2008, The Eunice Kennedy Shriver National Institute of Child
Health and Human Development partnered with ACOG and the Society for
Maternal-Fetal Medicine to sponsor a workshop focused on EFM.
# # #
The American College of Obstetricians and Gynecologists (ACOG) is the
nation's leading group of physicians providing health care for women.
As a private, voluntary, nonprofit membership organization, ACOG:
strongly advocates for quality health care for women; maintains the
highest standards of clinical practice and continuing education of its
members; promotes patient education; and increases awareness among its
members and the public of the changing issues facing women's health
care.
Think about this when discussing electronic fetal monitoring with your OB at your prenatal visits. Consider why he or she insists on using EFM. Ask yourself how continuously listening to the baby's heart rate can in any way ensure a better outcome or if it will more than likely ensure you are forced into an unnecessary c-section.
Full Story:
For Release: June 22, 2009
ACOG Refines Fetal Heart Rate Monitoring Guidelines
Washington, DC -- Refinements of the definitions, classifications, and
interpretations of fetal heart rate (FHR) monitoring methods were
issued today in new guidelines released by The American College of
Obstetricians and Gynecologists (ACOG). The objective of the
guidelines is to reduce the inconsistent use of common terminology and
the wide variability that sometimes occurs in FHR interpretations.
ACOG's Practice Bulletin, published in the July 2009 issue of
Obstetrics & Gynecology, supports the recommendations of the Eunice
Kennedy Shriver National Institute of Child and Health Development
workshop* on electronic fetal monitoring (EFM) held in April 2008.
The intent of FHR monitoring is to help keep an eye on the status of
the fetus during labor and intervene if necessary. There are two main
FHR monitoring methods. The most commonly used method is EFM, which
detects the fetal heart rate and the length of uterine contractions
and the time between them. EFM allows physicians and nurses to measure
the response of the fetal heart rate to uterine contractions. A lesser-
used method is manual auscultation, which employs either a small
handheld Doppler device or a fetoscope (similar to a stethoscope) . A
normal fetal heart varies between 110 and 160 beats per minute. A
heart rate that doesn't vary or is too low or too high may signal a
potential problem with the fetus.
"Since 1980, the use of EFM has grown dramatically, from being used on
45% of pregnant women in labor to 85% in 2002," says George A.
Macones, MD, who headed the development of the ACOG document.
"Although EFM is the most common obstetric procedure today,
unfortunately it hasn't reduced perinatal mortality or the risk of
cerebral palsy. In fact, the rate of cerebral palsy has essentially
remained the same since World War II despite fetal monitoring and all
of our advancements in treatments and interventions. "
One notable update in the guidelines is the three-tier classification
system for FHR tracings (print-outs of the fetal heart rate). Category
1 FHR tracings are considered normal and no specific action is
required. Category 2 tracings are considered indeterminate. This
category requires evaluation and surveillance and possibly other tests
to ensure fetal well-being. Category 3 tracings are considered
abnormal and require prompt evaluation, according to ACOG. An abnormal
FHR reading may require providing oxygen to the pregnant woman,
changing the woman's position, discontinuing labor stimulation, or
treating maternal hypotension, among other things. If the tracings do
not return to normal, the fetus should be delivered.
"Our goal with the ACOG guidelines was to define existing terminology
and narrow definitions and categories so that everyone is on the same
page," says Dr. Macones. One of the problems with FHR tracings is the
variability in how they're interpreted by different people. The ACOG
guidelines highlight a case in which four obstetricians examined 50
FHR tracings; they agreed in only 22% of the cases. Two months later,
these four physicians reevaluated the same 50 FHR tracings, and they
changed their interpretations on nearly one out of every five tracings.
A meta-analysis study shows that although EFM reduced the risk of
neonatal seizures, there is still an unrealistic expectation that a
nonreassuring FHR can predict the risk of a baby being born with
cerebral palsy. The false-positive rate of EFM for predicting cerebral
palsy is greater than 99%. This means that out of 1,000 fetuses with
nonreassuring readings, only one or two will actually develop cerebral
palsy. The guidelines state that women in labor who have high-risk
conditions such as preeclampsia, type 1 diabetes, or suspected fetal
growth restriction should be monitored continuously during labor.
Practice Bulletin #106, "Intrapartum Fetal Heart Rate Monitoring:
Nomenclature, Interpretation, and General Management Principles," is
published in the July 2009 issue of Obstetrics & Gynecology.
* In 2008, The Eunice Kennedy Shriver National Institute of Child
Health and Human Development partnered with ACOG and the Society for
Maternal-Fetal Medicine to sponsor a workshop focused on EFM.
# # #
The American College of Obstetricians and Gynecologists (ACOG) is the
nation's leading group of physicians providing health care for women.
As a private, voluntary, nonprofit membership organization, ACOG:
strongly advocates for quality health care for women; maintains the
highest standards of clinical practice and continuing education of its
members; promotes patient education; and increases awareness among its
members and the public of the changing issues facing women's health
care.
Friday, May 22, 2009
Welcome to Womb2Grow
Welcome pregnant mothers, fathers to be who are open-minded folks interested in honest information dissemination.
On this blog you will find no agenda and it will allow no agenda or activists. You however will find information.
If you are pregnant, trying to become pregnant, love pregnancy and childbirth and want information without social pressure to make decisions for your body and your children then you've found a safe blog home here.
On this blog you will find no agenda and it will allow no agenda or activists. You however will find information.
If you are pregnant, trying to become pregnant, love pregnancy and childbirth and want information without social pressure to make decisions for your body and your children then you've found a safe blog home here.
Subscribe to:
Posts (Atom)