Considering Home Birth? - Article from Huff Post LA

When I was pregnant, I seriously considered home birth. My husband and I ended up planning a hospital birth and we were thankful for that based on my labor progress and outcome. I came across this article today and although I do think it's a little one-sided (leaning toward hospital birth) I found it overall informative. The original article can be found online here: Considering Home Birth Article - Huffington Post, but I've copied the full text below for convenience.

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If you're a trend-watcher, there's an intriguing statistical uptick that's worth a second glance and it involves women, their health and where they're giving birth.

Before I dive into this topic more fully, let's take a brief detour into history as to why human females need help birthing their babies. Let's go back a few million years to Lucy, the fossilized remains of the hominid representing our first human ancestor to walk on two feet. OK, to keep a long story short, when Lucy and her prehistoric peers stood up, evolution began the task of rearranging just about everything in the human body.

For women and their babies, upright posture meant an altered female pelvis and a narrower and more circuitous birth canal. Where once it was a roomy, straight shot from uterus to cervix, as it is still for our closest cousins, the apes, human birth evolved into a tight, carnival-like ride with the baby forced to twist and turn head and shoulders on the way out. Ape mothers can still reach down during delivery and pull their babies out. But if human beings try that, they risk injuring the infant.

This biological truth demanded that we evolve socially as well, into people that need each other from day one. Women need help giving birth. And for millennia, up until the last 100 years or so, we know that that help came to the mother's own bedside in the form of a person -- almost always a woman -- experienced in supporting, coaching and catching.

From Home to Hospital

In 1900, almost all babies in the U.S. were born at home. In 1940, 44 percent of births still took place at home, but by 1969, that figure was 1 percent. Physicians and hospitals had taken over the task of helping mothers give birth. That percentage slightly dipped through the 1980s, and home births are still rare, with less than 1 percent of babies born at home. But they've gone up between 2004 and 2009, from 0.56 percent to 0.72 percent. In real numbers, that means 29,650 of the 4,137,836 babies born in 2009 were born at home. While that's a small actual number, it represents a 29 percent increase in home births during that time.

For a national, expert perspective on this issue, I talked with my colleague, Sarah Kilpatrick, MD, the Helping Hand Chair of Obstetrics and Gynecology at Cedars-Sinai. "In the U.S.," she says, "the safest place to have your baby is in the hospital. But women can make informed decisions on their own." She adds this major caveat: "As long as they're knowledgeable about the risks of home birth." Her thoughts are in line with the American College of Obstetricians and Gynecologists' recommendations: True, it's each woman's individual choice. Also true, she should be well aware of all the risks.

What Are the Risks?

There are two sets of risks: to the baby and to the mother. The most serious risks fall to the infant. The ACOG's Committee on Obstetric Practice cites an analysis of studies comparing planned home births to hospital births. They found, most key, that planned home births carried two to three times the risk that the baby would die compared to planned hospital births. "What women sometimes forget is that even in the most low-risk circumstances, emergencies still happen. The baby can still get in trouble," says Kilpatrick.

The ACOG committee's research also found that first-time mothers were far more likely to need a last-minute transfer to a hospital -- 25 percent to 37 percent of them, compared to only 4 percent to 9 percent of home birthing women who had had at least one other child. The transfers resulted from lack of progress in labor, concerns about the fetus, a need for pain relief, hypertension, bleeding and a poorly positioned fetus.

Mothers themselves had fewer medical interventions like epidurals for pain or fetal monitoring in the home births. No maternal deaths at home were reported in the analysis. In fact, mothers did better with fewer medical procedures: they were less likely to suffer lacerations and infections. But, as noted, this decreased risk to the mothers comes with a greater risk to their newborns.

Planning Helps

When I talk about home birth, I mean a birth that is planned with all due cautions. Despite the best intentions, sometimes babies deliver in surprising fashion. Just last month, Christy Henry gave birth in a car on the I-5 as her husband sped to a hospital in San Diego. Neither hospital nor home, that counts as an unplanned birth location, and fortunately the 6-pound early arrival was fine, as was his mother.

Most, but not all, home births are planned. A study published last year looked at about half of all the home births in the U.S., or 11,787 home births recorded in 2006. Of those, 9,810 were planned. Those that were unplanned more likely involved mothers who were young, unmarried, foreign-born, smokers, lacked a college education who had received no prenatal care and were attended by people who were neither doctors nor midwives. Not surprisingly, unplanned home births had worse outcomes than planned home births.

So naturally, for women considering home birth, what's the evidence that matters? It's that women should plan and ensure there's a qualified attending at the birth.

Who Is Planning a Home Birth

According to national health statistics, home births are half as likely to be preterm births or result in low birth-weight babies, and less than 1 percent of home births are for twins. That lower risk profile most likely results from women and their attendants deciding that it's best for a hospital obstetrics unit to deal with the higher risks associated with premature birth, the birth of twins or multiples or births where it's known the baby is small for its gestational age. We know that healthy women with uncomplicated pregnancies are the best candidates for a home birth and they seem to be the ones considering such deliveries.

Most home births are to older, white, married women who already have one or more children. They are more common in rural counties, and in rural states. The states with the highest home birth rates are Vermont, Oregon and Montana, each with about 2 percent of deliveries at home. The rate in California of 0.40 percent is lower than the national average. When looked at by age, few teens plan home births, and the rate goes up with age. Women, older than 45, have the highest percentage of home births at 1.4 percent. Ironically, risks to both mother and baby also go up with the mother's age. "They have a higher rate of medical problems, and higher rates of C-section," Kilpatrick says of mothers over 35. But again, while the percentage of home birth goes up for older women, the actual numbers are exceedingly low. New mothers older than 45 are a tiny group regardless of where they give birth; only about 7,000 babies a year are born to mothers that age, and, according to 2006 national data, 98 of them were born at home.

With Risks in Mind, Who Is a Good Candidate?

Women who consider home birth have a strong sense that they want to be in familiar surroundings with family and friends around when they deliver. Some may have equally strong religious or cultural leanings toward home birth. All those feelings deserve respect. "My personal bias is that women who decide to deliver at home really believe they can control their delivery and are nervous about going into a hospital where that control is taken away," says Kilpatrick, chair of Cedars-Sinai's Department of Obstetrics-Gynecology. "But they also have the expectation that every baby born is going to be perfect." And that, sadly, is beyond anyone's control.

Women planning a home birth need to know that while it's still overwhelmingly likely that they and their babies will be fine, their infants have a statistically greater chance of dying if delivery occurs at home. If unexpected breathing or heart problems appear, for example, it's unlikely any home attendant would be equipped and prepared for the life-threatening emergency.

Women should understand that good candidates are healthy women having a normal, healthy pregnancy with no known increased risks; they'll likely do better if they've had at least one baby before; they should be attended by a certified midwife, certified nurse midwife or physician (fewer than 8 percent of home births were attended by a physician in 2006, down from about 22 percent in 1990.)

It's important, Kilpatrick says, to pick the right person for a home birth, and that is someone approved and certified by the American Midwifery Certification Board. In 2006, about 45 percent of home births were attended by uncertified midwives, and another 30 percent were attended by a category called "other," that includes family members, emergency medical technicians and unlucky taxi drivers.

Whoever attends the birth should be backed up by consultation with an obstetrician who is affiliated with a nearby, well-equipped hospital. And it's crucial that there's a transportation plan to get the mother and baby to a hospital, pronto, if the need arises.

A Word About What Hospitals Have Learned

The desire to give birth at home stems at least in part from women's fears of hospitals. They've heard stories. They're afraid they'll lose all control over the kind of birth they want.

Hospitals have listened and tried to respond. "Over the years, more and more hospitals have midwives," says Kilpatrick. "We have one midwife here with a private practice, and about eight midwives employed by Cedars who don't have their own practice, but help care for patients, many with a collaborative practice with physicians."

Hospitals offer Lamaze classes to help women cope with pain, and staff work with women to help coordinate a plan for the kind of birth each woman wants. For pain control, the pendulum has swung in sync with women's desires. Forty years ago, women often were over-sedated to the point they weren't even aware of the birth. Then, things swung to natural birth with no pain control. Now, epidurals have been refined to the point where many women can be awake, aware and have good pain control.

Hospitals are imperfect, but they are far and away the safest places to be for a baby's delivery. For an unfortunate few, the slight increase in risk of a home birth can result in a lifetime of regret. "When babies don't do well, it's because things can go bad very quickly in labor," says Kilpatrick. "If a woman has a home birth and has a bad outcome, she has to live with that decision for the rest of her life. Things like that can happen even to women who believe they're healthy."

Food Dye & Children's Behavior

"Some of the studies are difficult or imperfect. ... But there is this body of literature that does suggest that food colorings are not as benign as people have been led to believe."

- Andrew Adesman, developmental and behavioral pediatrics expert

 

Great Article on the topic here: FDA Probes Link Between Food Dyes, Kid's Behavior: NPR

What You Put Into Your Body...

I received this article via email from Maren Schmidt at Kids Talk News...   A newspaper article written by a physician summarized a discussion on health with these words:  It's about what you eat and what you drink, what you breathe and what you think.   What you eat.  Putting the right food into our bodies is essential to good health, as well as physical and mental development.  Today we understand more about human nutrition than in the history of mankind.  In contrast, we've never had the opportunity to eat so many foods that are detrimental to our health.  A nutritionist half-joked with me, "If you see it advertised, don't eat it."  It is true enough though that fresh fruit and vegetables get very little advertising time compared to processed and fast foods.  When you have a choice eat more fresh than processed foods.   What you drink.  The best beverage we can drink is Earth Juice, aka as water or H2O.  Certain teas and coffee can have beneficial health benefits.  Juices and soft drinks can create high blood sugar levels that affect the body's ability to metabolize the sugar in the drinks.  The body is about 90% water so it seems to make sense to drink water for optimum health.   What you breathe.  In the past 30 years our society has made great strides in cleaning up our air.  Cigarette smoke is now banned in most public places and the detrimental effects of second had smoke are well documented.  Industrial pollution has been reduced but is still high enough in urban areas to affect our health.  Indoor pollution, in either urban or rural areas, of household scents, animal dander, mold and petroleum by-products can affect the quality of the air we breathe and contribute to headaches, asthma, sinus problems, allergies, ear infections and more.  We need to think about what we breathe, indoors and out.   Also how you breathe is important.  Most of us do not take deep enough breaths to fully oxygenate our blood.  Feeling a bit in a mind muddle? Ten deep diaphragmatic breathes can bring needed oxygen to our brain, resulting in clearer thinking.   What you think.  Attitude is everything.  If we have a happy and healthy outlook on life, obstacles look like bumps in the road instead of insurmountable barricades.  We need to cultivate an attitude of positive optimism.  There will always be things that are wrong in our world.  Learning to focus on the good and the positive, while knowing that the unpleasant is still there, keeps our life moving in a forward direction.    Focusing on these four things-what you eat, what you drink, what you breathe and what you think-might just sum up how to have a happy healthy life.

Discovering the Train Whistle

Big Ol Watermelon!

Every Monday, these little ones bring their fresh fruits & veggies to share with friends - this friend was VERY excited about the watermelon! He practiced picking it up over and over :)

From a Crawler's Perspective...

I came across this article from Maren Schmidt at Kids Talk News from September 2012. I enjoyed re-reading it and thought I'd share... It reminded me to be aware of what the house looks like to a crawler. The Prepared Environment

"Pretend that you just found out that you'll have to be in a wheel chair for a year, possibly longer. What adjustment would you have to make to your home to accommodate this change? This week crawl around your house, through every room, and make a list of changes that you would make. That's your homework. See you next week."   Off I went on my hands and knees, antennae up. The things we do as parents. As I crawled, though, I developed some insight into what it might be like to be small and not able to take care of myself.     On the floor, it was not pretty. My kitchen was a dark canyon, with workspace out of reach. Food and dishes were in the upper cabinets. The refrigerator was inaccessible. Unless I tilted my head way back, there was nothing attractive to see. All my favorite art posters looked distorted from this vantage point.     The dining room was a forest of chair legs. The living room was easier to maneuver, but the couches and chairs were impossible to climb into without standing up. The coffee table and end tables were at a dangerous and eye-poking height.     In the bedroom, I couldn't get into bed by myself. I couldn't open my dresser or the closet doors. In the bathroom, I couldn't climb onto the toilet, reach the sink, or easily get into the bathtub, much less adjust the showerhead. I snagged my pants on the transition piece between the bathroom and hallway.     Negotiating the steps to the garage was treacherous. The trip was rough and dusty, and my hands, along with my clothes, got filthy. The stairs off our wood deck were steep and full of splinters.     Dirty. That was my overall impression of crawling around. With weekly cleaning, I considered my home to be tidy. On my four-legged journey, I discovered grimy lower cabinets, crumbs in the corners, fuzz balls, scribbling under the dining room table (which still surprises me to this day) and splattered windows.     The only objects of interest on this expedition were a bowl and magazines on the coffee table. Pictures and mirrors were hung too high to have any esthetic impact. Doorknobs and light switches were unreachable. The floor was cold and the thermostat might as well been on Mt. Everest. Food and drink were invisible. In my home, I discovered a lowland where I wouldn't want to live. My children were going to spend many years in this land under the table.     Our next parenting session focused on preparing a child friendly environment. Crawling along four months pregnant with our second daughter opened my eyes about creating a special place for our children. A child friendly environment would give my children a home where they could live in dignity and tranquility while learning to manage independently on their own, along with having their own space to work and have meaningful experiences. Experiences beyond finding fuzz balls in the corners.     My husband and I moved the dishes in the kitchen to lower cabinets and found a shelf for snacks. We installed a bottled water dispenser, so our toddler could get her own water easily. We put a small table with chairs in our kitchen and set up a low shelf with puzzles, blocks and other activities.   In the living room we removed the sharp cornered tables and found a Japanese style square coffee table. We added floor pillows, lowered our artwork, put extenders on our light switches and added interesting touchable items to the room, such as woodcarvings, and baskets of dominoes and wooden blocks.     In the bathroom we added a plastic step stool that our one-year-old could move to wash her hands, and later brush her teeth and reach the toilet.     In the girls' bedroom, we placed a twin mattress on the floor, and bought a light comforter so Dana could learn to make the bed herself. We removed the closet doors and added lower shelving and rods so the girls could hang up their own clothes and dress themselves.     Of course, we also childproofed cabinets, electrical outlets and moved the "untouchables" to higher cabinets or closets.     These are a few of the efforts we made to prepare a home for our daughters, now in their own homes. To paraphrase a Zen proverb: The journey of a thousand smiles begins with a single crawl.

8 Month Old & Wooden Chimes

Almost Crawling!!

 I just LOVE this little guy!!

I remember telling his parents to keep hime 'sockless' at home so he could get some traction on the carpet/floors. Within a week, he was crawling. :)

 

Turkey Meatloaf, Salmon Cakes, Basil & Cheese Pizza, Veggie Pasta

Shapes & Object Permanence Box

Measuring, Pouring, Whisking

 

She made pudding. :)

Three 19 month olds Harvesting Vegetables

15 month old Pouring & Drinking from a Cup

 

Parsnips & Butternut Squash

5 Month Old Grasping

I love how this 5 month old is moving her whole body during this activity - rolling from side to side, grasping the ring & pulling the ring which has an elastic ribbon to allow for arm strengthening.

6 Month Old & Tummy Time Fun

Smallest to Biggest