From the BBC, yesterday:
Home births 'as safe as hospital': The largest study of its kind has found that for low-risk women*, giving birth at home is as safe as doing so in hospital with a midwife. Research from the Netherlands - which has a high rate of home births - found no difference in death rates of either mothers or babies in 530,000 births. Home births have long been debated amid concerns about their safety. UK obstetricians welcomed the study - published in the journal BJOG - but said it may not apply universally...
From the BBC, today:
Midwife numbers 'to fall short': Many health authorities are not on track to provide the midwives needed for one-to-one care, figures obtained by the midwives' trade union suggest. The Royal College of Midwives wants one midwife for every 28 births, but says only four Strategic Health Authorities (SHAs) will hit or better this by 2012...
Think about it: if the RCM can persuade women to have babies at home (an act of madness, if you ask me, but each to her own), and home births require more midwife-hours than hospital births (twice as many? three times as many?), then what's the effect on the number of midwives that have to be employed?
* Well, duh, obviously, that's how you define "low risk".
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7 comments:
Who thought this idea up anyway?
Your guess is as good as mine. It doesn't seem like a coincidence though.
I am sure that there's something to be said for this - but I also think that many midwives know how flawed maternity care is in NHS hospitals.
It tends not to kill women, but supposed hospital efficiency leads to unnecessary (costly?) intervention - it is also often a pretty horrific, dehumanising and unhygienic experience. I would suggest this is why the majority of women who choose homebirths do so, not ignorance or pursuit of a deeply spiritual experience.
If it really is more cost-effective for women to give birth in hospital, fine, restructure maternity services accordingly. But what passes for "care" at moment is in many cases shocking, and self-defeating.
can midwives give epidurals?
Hospital death rates should be higher because that is where all the dangerous and complicated births (should) go.
But using death rates as a guage of care seems rather primitive.
? ok if your uterus drops out - as you are not dead??
Malpas, I have no doubt that death rates in hospitals are higher for that reasons; it's overall levels of safety that are comparable, which shows that being in a non-hospital environment (of one's own volition) may counter any negative impacts the increased distance one is away from emergency care should one actually requires it.
You are right, mortality rates are a crude metric given our excellent standards of sanitation, nutrition and standard antenatal care. If you drill down and look at other (undesirable) outcomes, such as tearing, episiotomy, assisted delivery and caesarean rates (not to mention PND etc) then hospitals perform shockingly on the whole, even taking into account adjustment for the dangerous and complicated births they rightly treat. Standard hospital procedures and protocols (such as managed labours, nil by mouth etc) often *make* low-risk births more dangerous and complicated!
The plus side is that they offer a better selection of pain relief, which, given the circumstances, you tend to need anyway.
Anon 02:07
No. "Epidural anaesthetics are carried out by experienced anaesthetists and other healthcare professionals, such as orthopaedic surgeons, and specialists in managing chronic pain." NHS leaflet.
Sticking a canula in to a tiny gap which is perilously near the spinal cord is specialist work, hence access to an epidural may depend on there being an anaesthetist available. Once the needle and line is in place a midwife can top up the anaesthetic safely.
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