Rayner11,

As I pointed out to you before, Midwifery Today is not a peer reviewed scientific journal. It is a trade paper for direct entry midwives and their supporters.

As regards your citations, all 6 are from the same people, all 6 are retrospective investigations of small numbers of individuals and most suffer from the inability to obtain large numbers of records (more than 25% of the relevant records are missing in some cirumstances). The citation of Odent is a letter, not a scientific paper. That letter is an attempted defense of the type of retrospective investigation that it thoroughly condemned in the Lancet.

Sorry, Rayner, but this is typical of homebirth advocacy. Your claim is unsubstantiated. The research you cite is poorly done, missing information, and cannot justify its own conclusions.

The bottom line continues to be that homebirth has an increased risk of neonatal death compared to hospital birth.

Amy, I would like to see the studies proving the opposite. At the very least narcotic use in labor can disrupt infant breathing and make the mother and baby tired, yet provides little pain relief. Why then offer medications that are of so little help to the mother when all they do is detract from her ability to stay awake and aware of her body and could possibly hurt the baby.

Demerol is a class B drug but is a class D drug when taken over a long period of time or in high doses at term.

* Crosses the placenta.

* Maternal addiction causes neonatal withdrawal.

* No adequate data in first trimester exposure but reported association with inguinal hermia, polydactyly and hypospadias.

* Causes neonatal respiratory depression if used in labor.

* Because of slow elimination of the drug from the neonate, impaired behavioral response and EEG changes may persist for several days.

Many Drs will not ok the use of anything more then tylenol during pregnancy because of the risks to the baby, so why then use a narcotic like this at then end? There are safer alternatives like hot showers, jacuzzis, heck an epidural has less of an effect on the baby.

Anonymous:

"I would like to see the studies proving the opposite."

One of the most objectionable aspects of homebirth and "natural" childbirth advocacy is the need to feel superior to other mothers. Instead of acknowledging that homebirth or unmedicated childbirth are simply personal preferences, no better than the personal preferences of other women, there is a profound need to vilify women who make different choices. Hence the unfounded, mean spirited and, in some cases, vicious claims about the "risks" of medication in labor.

If you believe that medication in labor has risks, then YOU must demonstrate, with appropriate scientific evidence, that those risks exist. YOU need to show the incidence of those risks, the consequences, the dose response curves, the epidemiologic data, etc. before you can make such claims. You can't and shouldn't make unsubstantiated claims.

Moreover, regardless of the supposed "risks" of hospital birth, the neonatal death rate at homebirth is HIGHER. So whatever the dangers you believe to be associated with hospital birth, women choosing homebirth are putting their babies at INCREASED risk. Avoiding the supposed "risks" of hospital birth isn't much of a justification for exposing a baby to the increased risk of DEATH at homebirth.

Re. the safety of homebirth with midwife attending compared to hospital birth: every single study done (many matched-population studies, and some quite large,) has shown that homebirth with a midwife attending is statistically as safe as hospital birth in terms of mortality, and far *far* safer in terms of complication rate. The only study (the Pang study, which ACOG was quick to tout as "proof" of the danger of homebirth) that has shown otherwise had numerous methodological flaws, as the study authors themselves were forthright about. Anecdotally, nearly everyone I know who has had a hospital birth has experienced some complication of birth, and nearly everyone I know who has had a homebirth has experienced relatively normal (i.e. safe) birth.

Very simply, this is because environment and style of management make a huge difference in how the body functions in birth. Hormonally, birth is a sexual process, deeply affected by the psychology of the mother. Sarah Buckley MD writes:

"Undisturbed birth is exceedingly rare in our culture, even in birth centers and homebirths. Two factors that disturb birth in all mammals are firstly being in an unfamiliar place and secondly the presence of an observer. Feelings of safety and privacy thus seem to be fundamental. Yet the entire system of Western obstetrics is devoted to observation of pregnant and birthing women, by both people and machines; when birth isn't going smoothly, obstetricians respond with yet more intense observation. It is indeed amazing that any woman can give birth under such conditions. Some writers have observed that, for a woman, having a baby has a lot of parallels with making a baby: same hormones, same parts of the body, same sounds, and the same needs for feelings of safety and privacy. How would it be to attempt to make love in the conditions under which we expect women to give birth?"

Michel Odent MD explains that the reason for this is that stimulation of the neocortex (with things such as a clinical environment, fear, anxiety, bright lights, clinical touch, the feeling of being observed, being hooked up to machines, conversation, orders, etc.) interferes with the functioning of the primal part of our brains. Yet it is within that primal part of the brain that the hormones responsible for normality in birth are regulated. It follows logically that the hospital environment and obstetric style of birth management is in itself a risk factor in birth. In other words, in the very act of trying to protect against something bad happening in birth, we create that something bad. This is not a small issue, yet people who author websites like homebirthdebate.com completely gloss over it in the hysterical attempt to discredit homebirth. The intellectual dishonety displayed by such people is staggering.

The fact is, birth is not foolproof, yet all childbirth options carry risks specific to them, and there is no one choice that has the most ideal risk/benefit ratio for all women. The woman whose out-of-hospital birth ended in a need for transfer and emergency care knows this very well. The woman whose iatrogenically dysfunctional birth with damage done to her and her baby knows this very well also. There are no guarantees. All we can do is make the best choices we can given our scientific knowledge of the birth process, the birth attendants available to us, and our unique individual circumstances. And for some people, that makes homebirth the most reasonable choice.