Transcript The Homebirth Midwife said What??!!

THE HOMEBIRTH MIDWIFE SAID WHAT??!!
10 Astounding Claims Made by Homebirth Midwives
Amy Tuteur, MD
The Skeptical OB
At the conclusion of this course, participants
will be able to:
Describe the different types of midwives in the US,
their education and training
Summarize the literature on homebirth
Explain the origin of the natural childbirth movement
Anticipate the most common claims of homebirth
midwives
Debunk the most common claims of homebirth
midwives
Commercial Affiliation:
NONE
1. I’M JUST LIKE THE MIDWIVES IN THE NETHERLANDS
1. I’M JUST LIKE THE MIDWIVES IN THE NETHERLANDS
No other country has a 2nd class of midwife
 Less education than ALL other midwives
 Less training that ALL other midwives
 Not eligible for licensing in the UK, the
Netherlands, Canada, Australia of ANY other
first world country
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2. HOMEBIRTH IS AS SAFE AS HOSPITAL BIRTH
2. HOMEBIRTH IS AS SAFE AS HOSPITAL BIRTH
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All the existing literature shows that homebirth
increases the risk of perinatal death
CDC statistics: homebirth with a non-nurse midwife
increases death rate 3-7X
Birthplace Study: homebirth increases the risk of poor
outcomes
Oregon licensed midwives: death rate 9X higher than
comparable risk hospital birth
Homebirth increases the risk of a 5 minute Apgar of 0
by 1000%.
CDC Wonder Linked Birth/Infant Death File. http://wonder.cdc.gov/lbd.html
Rooks, Judith. Testimony before Oregon Legislature; March 15, 2013.
https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeMeetingDocument/8585.
Grünebaum, et al. Apgar Score of Zero at Five Minutes and Neonatal Seizures or Serious Neurologic Dysfunction in
Relation to Birth Setting, in press, published online, http://www.ajog.org/article/S0002-9378%2813%29006418/abstract
3. PRIMITIVE WOMEN HAVE PAINLESS CHILDBIRTH
3. PRIMITIVE WOMEN HAVE PAINLESS CHILDBIRTH
Grantly Dick-Read made that up
 A eugenicist worried about “race suicide”
 “ The mother is the factory.”
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4. COUNTRIES WITH HIGH HOMEBIRTH RATES HAVE LOW MORTALITY RATES
4. COUNTRIES WITH HIGH HOMEBIRTH RATES HAVE LOW MORTALITY RATES
The Netherlands has high perinatal mortality
 Low risk midwife birth has higher mortality than
high risk obstetrician birth
 Irrelevant since homebirth only small % of
births in most developed countries
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5. CHILDBIRTH IS INHERENTLY SAFE
5. CHILDBIRTH IS INHERENTLY SAFE
Childbirth is inherently dangerous
 7% neonatal mortality
 1% perinatal mortality
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6. WATERBIRTH IS SAFE; BABIES WON’T INHALE UNDERWATER
6. WATERBIRTH IS SAFE; BABIES WON’T INHALE UNDERWATER
No primates deliver in water
 Dive reflex occurs in cold water
 Multiple deaths due to aspiration
 Multiple deaths due to hyponatremia
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7. PRE-ECLAMPSIA CAN BE PREVENTED & TREATED WITH DIET
7. PRE-ECLAMPSIA CAN BE PREVENTED & TREATED WITH DIET
Brewer diet
 No evidence to support it
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8. BABIES AREN’T LIBRARY BOOKS, DUE ON A CERTAIN DAY
8. BABIES AREN’T LIBRARY BOOKS, DUE ON A CERTAIN DAY
Library books don’t self-destruct
 Stillbirth rate rises
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9. NO ABX FOR GROUP B STREP; PUT GARLIC IN YOUR VAGINA
9. NO ABX FOR GROUP B STREP; PUT GARLIC IN YOUR VAGINA
Or wash vagina with chlorhexidine
 No evidence for effectiveness
 Multiple GBS deaths at homebirth
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10. BREECH, TWINS, VBAC ARE JUST VARIATIONS OF NORMAL
10. BREECH, TWINS, VBAC ARE JUST VARIATIONS OF NORMAL
“Normal” is anything a midwife can do
 Midwives reclassify everything as variations of
normal
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Bibliography
Birthplace in England Collaborative Group. Perinatal and maternal outcomes by planned place of birth for healthy
women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ
2011;343:d7400.
De Jonge A, van der Goes BY, Ravelli AC, Amelink-Verburg MP, Mol BW, Nijhuis JG, et al. Perinatal mortality and
morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births. BJOG2009;116:117784.
Evers AC, Brouwers HA, Hukkelhoven CW, Nikkels PG, Boon J, van Egmond-Linden A, et al. Perinatal mortality and
severe morbidity in low and high risk term pregnancies in the Netherlands: prospective cohort study. BMJ
2010;341:c5639.
Amos Grünebaum, M.D., Laurence B. McCullough, Ph.D., Katherine J. Sapra, M.P.H., Robert L. Brent, M.D., Ph.D.,
DSc (Hon), Malcolm I. Levene, M.D., FRCP, FRCPH, F Med Sc, Birgit Arabin, M.D., Frank A. Chervenak, M.D. Apgar
Score of Zero at Five Minutes and Neonatal Seizures or Serious Neurologic Dysfunction in Relation to Birth
Setting, in press, published online, http://www.ajog.org/article/S0002-9378%2813%2900641-8/abstract
Jacoba van der Kooy, MD, Jashvant Poeran, MD, Johanna P. de Graaf, MSc, Erwin Birnie, PhD,
Semiha Denktas¸, PhD, Eric A. P. Steegers, MD, PhD, and Gouke J. Bonsel, MD, PhD. Planned Home Compared
With Planned Hospital Births in The Netherlands; Intrapartum and Early Neonatal Death in Low-Risk Pregnancies.
Obstet Gynecol 2011;118:1037–46.
Rooks, Judith. Testimony before Oregon Legislature; March 15, 2013.
https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeMeetingDocument/8585.
Wax JR, Lucas FL, Lamont M, Pinette MG, Cartin A, Blackstone J. Maternal and newborn outcomes in planned
home birth vs planned hospital births: a meta-analysis. Am J Obstet Gynecol2010;203:243.e1-8.