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andrewducker ([personal profile] andrewducker) wrote2011-11-25 11:00 am
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Interesting Links for 25-11-2011

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[personal profile] andrewducker 2011-11-25 12:24 pm (UTC)(link)
This single study being the largest one carried out in the UK, covering tens of thousands of births. If you want to dispute its findings then feel free to point to opposing data.

Looking at the data for second children:
For multiparous women, there were no significant differences in adverse perinatal outcomes between planned home births or midwifery unit births and planned births in obstetric units.

For multiparous women, birth in a non-obstetric unit setting significantly and substantially reduced the odds of having an intrapartum caesarean section, instrumental delivery or episiotomy.

So your outcomes are as good at home, and the odds of you not being sliced open are better.

https://www.npeu.ox.ac.uk/birthplace/results

[identity profile] dalglir.livejournal.com 2011-11-25 12:49 pm (UTC)(link)
We're still talking about general odds here. None of which are satisfactorily granular for me.

There were complications when dalglia was born. Suddenly. He could have died or been permanently mentally disabled. Fortunately, we were already in the NRIE and within seconds a medical team was in the room. They acted like poetry in motion, like they were telepathically linked. Stuff happened. And dalglia was delivered safely.

Would I want to have waited for an ambulance? No. dalglia could have died. Would I want to have waited for the ambulance to reach the NRIE from the wrong side of the city? No. dalglia could have died.

I realise this experience may skew my opinion but: fuck that study.

Forget the statistics for a moment: can adding 30 minutes of delay to treatment of an ongoing life threatening situation increase the risk of death? Let's say... ::shakes magic 8-ball of deadly childbirth complications::...massive bleed out from mother after birth due to tearing.

[identity profile] laplor.livejournal.com 2011-11-25 10:26 pm (UTC)(link)
If we're going anecdotal, my son nearly died due to complications caused and worsened by hospital procedures and conditions. For one thing, the hospital had no air conditioning or hot water - I'm not kidding! I had both at home.

Then they saved him, then he had an 8 minute seizure. He's only marginally impaired.

I was very tempted to have my second baby at home, but lived more than an hour from hospital so decided it wasn't prudent. He was born with no doctor in the room because I had him so fast they didn't have time to get there from down the hall.

In light of my experience, I absolutely believe that, in the case of a healthy woman who has been screened for complications and attended by a midwife, home within reasonable range of a hospital is just as safe as hospital.

[identity profile] anton-p-nym.livejournal.com 2011-11-25 03:29 pm (UTC)(link)
Apparently there's a saying going around Microsoft now; bowdlerized, it's, "the average person has one breast and one testicle." It's a caution against relying on statistical models without examining the context.

I strongly suspect that the reason second-child home-births have the same complication rate as hospital births is that those who were most prone to complications (as demonstrated the first time) went to the hospital. This skews the result heavily... indeed, I'm surprised that home-birth for second children doesn't show a greater safety rate because of that bias.

Of course I haven't seen the study design or how they controlled for this so perhaps I'm being unfair.

-- Steve's not a stats genius in any case.
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[personal profile] andrewducker 2011-11-25 03:33 pm (UTC)(link)
Yup, that's what I'd expect.

Which means that the sensible thing to do is to have your first child in a hospital, and then make a decision about the second child based on the results of that experiment.

[identity profile] del-c.livejournal.com 2011-11-28 01:16 pm (UTC)(link)
Because complications are rare, pulling complications out of the home birth pool is like pulling tokens out of a bag with a lot of tokens. So removing the mothers who had complications the first time shouldn't affect the home birth statistics positively enough to detect. Which is just what we observe: home births rise to the safety level of hospital births on and after second birth, but do not exceed it, despite the theoretical skew from first-birth complications electing hospital the second time around.
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