Planned hospital birth versus planned home birth

“A new Cochrane Review concludes that all countries should consider establishing proper home birth services. They should also provide low-risk pregnant women with information enabling them to make an informed choice. In many countries it is believed that the safest option for all women is to give birth in hospital. However, observational studies of increasingly better quality and in different settings suggest that planned home birth in many places can be as safe as planned hospital birth and with less intervention and fewer complications. The updated Cochrane review concludes that there is no strong evidence from experimental studies (randomized trials) to favour either planned hospital birth or planned home birth for low-risk pregnant women. At least not as long as the planned home birth is assisted by an experienced midwife with collaborative medical back up in case transfer should be necessary. However, routines and easy access to medical interventions may increase the risk of unnecessary interventions in birth and women who give birth at home have a higher likelihood for a spontaneous labour. There are 20-60% fewer interventions e.g. fewer cesarean sections, epidurals and augmentation among those women who plan a homebirth; and 10-30% fewer complications, e.g. post partum bleeding and severe perineal tears. While the scientific evidence has been growing, the European Court of Human Rights in Strasbourg has in the case Ternovszky versus Hungary handed down a judgment stating that “the right to respect for private life includes the right to choose the circumstances of birth”. Thus the conclusion of this review is based on human rights, ethics and results from observational studies. Ref.: Olsen O, Clausen JA. Planned hospital birth versus planned home birth. The Cochrane Library, Issue 9, 2012.

The full review may be available here (depends on country):

The full review is also available as PDF: Planned hospital birth versus planned home birth.

If you want to get in contact with the authors you can reach them by mail:
Ole Olsen:
Jette Aaroe Clausen:”

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womens and midwives rights in childbirth

“Women, partners, babies, children, midwives? These are all important people right? So, why are all of them having their fundamental human rights taken from them in Britain in  2012/2013? It hardly seems believable that in Britain, a country who has founded an NHS system to provide high standard maternity care to all, we are fighting for basic rights. And there are so many fights going on in the maternity system at the moment…

Let’s try and start at the beginning. We all know at present there is a rise in birth rate and a shortage of midwives. Of course it is obvious this will pose problems and lead to substandard care. There are vacancy freezes, actual cuts in staff members, increase use of non- trained staff to fill the gap. Sadly the petition to support an increase of midwives by 5000 was supported by 76,000 signatures only. The government need 100,000 to consider the idea to be in their interest to explore. I do not understand why 200,000 plus people can click ‘like’ to a picture of a fluffy kitten on Facebook but we struggle to get half that with an issue which affects everyone’s lives. Thankfully, all three parties do acknowledge the impact that shortages of midwives has and are going to look at this situation.”

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Labor, Interrupted

Cesareans, “cascading interventions,” and finding a sense of balance

“In May 2003 came the joyous birth of Prairie Cummings Resch, first child of Zoe Cummings Resch ’92. All had gone according to plan: Resch lay down on a surgical table. An anesthesiologist inserted an analgesic into her spine, and she became impervious to pain below her waist. The obstetrician pressed a No. 10 blade into Resch’s lower abdomen, and made a six-inch horizontal cut. The doctor divided the skin, stanched blood, and, reaching Resch’s large abdominal muscle, parted it. He slipped his knife through the opening, and cut into the peritoneum, the thin membrane that lines the abdominal cavity. He sliced into Resch’s uterus. A medical resident reached in and pulled Prairie out feet first; this baby was in breech position, upside down in the womb.

Resch felt “a lot of rough pushing and pulling,” a “painless suction sensation,” as if her body were “a tar pit the baby was wrested from.” She heard the doctor say to the resident: “Hold her up by the hips,” and Resch peered down. She saw her daughter for the first time, wet and squirming. Prairie wailed. Resch’s husband held the baby next to Resch’s cheek. Resch felt “overwhelmed by emotions”—“joy, awe, anxiety, relief, surprise.” She gave thanks for her healthy baby, and for modern obstetrical care.

In the next six years, Resch would have two more babies—each by C-section, despite uncomplicated pregnancies. She says she doesn’t regret any of these surgeries: she has three healthy children and each surgery “went well.” But her story and those of a number of other women shed light on why one-third of American babies now enter the world via the knife, in operating rooms, ringed by technicians. In 1970, only 5 percent of American children were born this way.

Obstetrics in modern America is a contentious subject in general. Birth and the actions surrounding it—medical and otherwise—evoke strong emotions. The discussion is often framed ideologically as a matter of nature versus technology and which side knows best, or in stark political and economic terms as a contest of power and money. The issue of C-sections, in particular, is much contested.

It’s useful to see cesareans’ ascendance as a result of the ways doctors, patients, and hospitals perceive and react to risk—and of how medicine has developed in this context. Understanding such interactive reasons, and responding thoughtfully to them, experts say, could help reduce the procedure’s use.”

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