March 27, 2012 2:07 am at 2:07 am #862955
There are so many things that can and do go wrong at even the most normal births that it really is not responsible for someone to put themselves or their baby at risk. This can happen to prescreened individuals and candidates for home birth as well.
What do people tell themselves when a baby is lost due to not being in a medical setting at birth. Or, how about when a mother starts hemorraging so severely that best case scenario is that an emergency hysterectomy is done after a wild ambulance ride to the OR effectively destroying the woman’s chances of have more children.
Do they say “Oh well, at least I was comfortable and I had a beautiful birthing experience.”? or, “It was all worth it. No nurse woke me up at 3 am to take my blood pressure.”March 27, 2012 4:57 am at 4:57 am #862956
pcoz -“Here is a comment from Dr M. Chalk of Gateshead z”l from a letter sent to the British Medical Journal;
“For myself, I feel that absolute safety is non-existent.
And to have given the mother peace of mind and happiness (of a home birth) is a very great thing.””
You fail to address the issue that you’re comprimising the baby’s safety by having a home -birth!March 27, 2012 2:04 pm at 2:04 pm #862957
avhaben- yes- I can even drive on Shabbos to get there if necessary. I have yet to here a response – why doesnt your husband just run down the block to the nearest midwife/obgyn/hatzolah member?March 27, 2012 2:21 pm at 2:21 pm #862958Avram in MDParticipant
Again, giving birth is sakonos nefashos- which is why you are allowed to be mechalel shabbos to drive to the hospital.
So what? Should I drive my family to the hospital if our furnace goes out on Shabbos in January? Where have I said that melacha should not be done for a woman in labor?
Lets define “preferable”. To the comfort of the mother- maybe for some, and only if they dont want any pain relief medication.
Pain medication dramatically increases the likelihood of cesarean section in the hospital. C-section increases the risk for maternal mortality. U.S. is 41st out of 171 nations in maternal mortality rates, and the rate is increasing dramatically (along with the C-section rate). In fact, it has quadrupled. At some hospitals the C-section rate tops 50%. And if you think, “well, C-sections are better for baby, at any rate!” think again. For a singleton presenting head down at full term, the risk of neonatal death is 0.62 per 1000 when Hashem’s designed delivery is used. That risk jumps to 1.77 with a C-section. Did our Creator really design us so poorly that almost half of women need to be cut open to get the baby out? Also, 66% of “emergency” cesareans are performed during the daytime (e.g., normal business hours – most convenient for the OB). Why?
So a women who decides on a home birth, is most definitely increasing the risk to herself,
The exact opposite seems to be the case.
and exponentially so to the infant.
Exponentially? Really? Not even Health made that claim.
Here’s the results of a study called Outcomes of Intended Home Births in Nurse-Midwifery Practice: A Prospective Descriptive Study, which was published in Volume 92, No. 3 of The American College of Obstetricians and Gynecologists:
Of 1404 enrolled women intending home births,
6% miscarried, terminated the pregnancy or changed plans.
Another 7.4% became ineligible for home birth prior to the
onset of labor at term due to the development of perinatal
problems and were referred for planned hospital birth. Of
those women beginning labor with the intention of delivering
at home, 102 (8.3%) were transferred to the hospital
during labor. Ten mothers (0.8%) were transferred to the
hospital after delivery, and 14 infants (1.1%) were transferred
after birth. Overall intrapartal fetal and neonatal
mortality for women beginning labor with the intention of
delivering at home was 2.5 per 1000. For women actually
delivering at home, intrapartal fetal and neonatal mortality
was 1.8 per 1000.
By comparison, the overall neonatal mortality rate for whites (the rate is significantly higher for blacks) in New York in 2007 was 3.27 per 1000 births. In Maryland it was 3.54, New Jersey 2.86. For women intending to deliver at home under the care of certified nurse midwives, including those who were transferred to hospitals for delivery due to problems with either mother or baby, the rate was 2.5.
Not sure where this tripling (or exponential increase) of the infant mortality rate is coming from. Probably home births that are not properly supervised, which we all agree is a bad idea.March 27, 2012 3:09 pm at 3:09 pm #862959
Health – not sure why you keep saying the danger is only to the baby. There are plenty emergency scenarios that can go wrong with the mother as well. OBs are there to treat mothers not babies.
Avram – Do you think it is possible to take a minute and think for yourself without quoting statistics or medical journals who are trying to push an agenda? Your logic is so twisted it would be laughable if not so serious a subject.
A. Nobody forces anyone to take pain medication. It is a choice. There might be pressure but ultimately it is the patient’s choice. You don’t get pain medication until you sign some forms.
B. Can you figure out any reason why they might be screening candidates for a planned home birth? Because they know that there is a significant risk with delivering at home so they try to minimize the casualties. I don’t know what your experience with birth is. But I can tell you that anyone that is semi educated or responsible that was in a delivery room knows about the many surprises that come about.
C. Why are we only measuring deaths? Are all other consequences, long term effects, or handicaps not important?March 27, 2012 3:11 pm at 3:11 pm #862960
If you’re so obsessed with having a natural birth in a quiet atmosphere, go to an out of city hospital and deliver there with a midwife. The most important thing is to be in a setting where there is sufficient medical help in c”v needed.March 27, 2012 5:07 pm at 5:07 pm #862961Avram in MDParticipant
This is B”N my last post on the matter.
Do you think it is possible to take a minute and think for yourself without quoting statistics or medical journals who are trying to push an agenda? Your logic is so twisted it would be laughable if not so serious a subject.
I’m guessing you tuned in at my last post. I encourage you to read the rest if interested. It’s fair to say that I am wrong – there are two legitimate sides to this debate – but I have not twisted my logic. Also, you think I haven’t thought about this? I used to be firmly on the opposite side of the issue!
By the way, the Green Journal quoted in my post above is the official journal of the American Congress of Obstetricians and Gynecologists. If they had an “agenda”, it would actually tilt against home births! If a research paper in their journal establishes that monitored and screened home births are a safe option (which was the conclusion of the paper), then I think that can be taken as an unbiased source. And mothers choosing that option should not be shamed by people like you any more than mothers who opt for C-sections out of convenience or fear of pain, based on evidence that that procedure increases both fetal and maternal risks.
Can you figure out any reason why they might be screening candidates for a planned home birth? Because they know that there is a significant risk with delivering at home so they try to minimize the casualties.
I actually agree with the vast majority of this statement, though not the wording. It’s apparent that you are not following my position on the issue, either because of a preconceived notion of my position, or because you’ve just arrived to the thread. Screening and fetal monitoring are a vital part of a planned home birth, IMO. It would be unwise to not undergo such screening. Home birth is definitely not for everyone. By the way, “they” try to minimize casualties in hospitals too:-)
The reasonable argument here is whether the medical mitigation of risk available at an established LOW RISK home birth attended by certified nurse midwives with a transfer plan to a nearby hospital is as good as being on site at the hospital from the start of active labor. My contention is yes. Others contend no. The only way to find out is through research – the statistics and medical journals you disapproved of my citing.
I know that our upbringing in this country is to automatically assume that risks in hospital < risks at home. But these assumptions can be verified through studies. To this point, nobody has offered clear evidence that the very specific form of home birth I am describing has greater risk than a hospital birth.
In the Netherlands, home birth is the norm. Hospital births are utilized in higher risk situations. Their neonatal mortality rate puts the U.S. to shame. This wouldn’t be the case if home birth “tripled” or “exponentially increased” the risk to the baby.
I don’t know what your experience with birth is. But I can tell you that anyone that is semi educated or responsible that was in a delivery room knows about the many surprises that come about.
A not-so implicit insult – which was uncalled for.March 27, 2012 5:40 pm at 5:40 pm #862962a.d.m.Participant
As for the “LOR” shaila, it should be known that Rav Isaac Kahn, one of the leading poskim of the BD”Z-Jerusalem, has had a 45 minute conversation with a known midwife for 25 years in Jerusalem with a very known/famous doula. Rav Kahn gives heterim to those asking him.
Also, Rabbi Baum, the known mohel in Jerusalem, when we asked him what he thought of a homebirth, asked, “Who are you using?” We told him, and he said, “I heard Plonis is better, but she’s also good.” Didn’t blink an eye. In fact, most of his Hilchos Horaion/Hilchos Yoledes shiur was spent explaining many of the halachic problems that doctors attempt to force onto mothers in a very vulnerable situation, including ziruz leida and epidurals, which he said most Rabbanim he talked to are against except in the most extreme cases.March 27, 2012 8:44 pm at 8:44 pm #862963
a.d.m- From R’ Baum’s response it seems that he didnt tell you if you should or shouldnt but if you are then at least you are using someone that is good.
Secondly, R’ Baum could qualify as your LOR, but I wouldnt put him in the category of the gedolei hador that anyone in the CR could blankly rely on.March 27, 2012 8:59 pm at 8:59 pm #862964NaysbergMember
Yungerman – why do you need to ask this shaila to Rav Elyashev? Previously you said your LOR suffices. R’ Baum thus qualifies.March 27, 2012 9:03 pm at 9:03 pm #862965
Avram: I don’t know if you’re reading this but I’ll post anyway.
First of all, I’m sorry if I insulted you. Perhaps my wording came out too harsh. I meant to say that anyone witnessing a birth would know about the many things that could go wrong even in the most common ones. Never meant to insult your intelligence. I do appreciate your candidness in responding to my post. You’ve responded with equanimity – something my post did not deserve. Thank You.
The logic I wasn’t following was moving your whole family into the hospital or the car on shabbos in case of no heat. Childbirth puts a mother in very grave danger, as noted above. Just because something is natural and supposed to happen, it doesn’t mean that it is not dangerous. It just means that it will generally happen on its own. It doesn’t mean that that there wouldn’t be any negative consequences.
I do believe that less intervention is better. And as long as everything is fine you should let nature take its course. However, that is only once there are all types of personnel and equipment available for just in case. I am extremely apposed to scheduled c-sections or any section for that matter that is not done after all other options have been ruled out.
As far as the green journal stuff: It doesn’t make any point as well as the Netherlands stuff. Like I said before, people are prescreened to see if they are a candidate for home births. So the comparisons of mortality rates don’t make any sense. I just wonder what event, where it happens and what the effects were would disqualify people from being candidates.
I never said anything about home births exponentially or tripling mortality rates. Wrong address.March 27, 2012 9:19 pm at 9:19 pm #862966a.d.m.Participant
yungerman1, correct, he did not say whether we should or shouldn’t. He just clearly held the decision wasn’t silly, stupid or rash. He is just holding cup in the issue, and it’s no worse than consulting a likut sefer.
But HaRav HaGaon Isaac Kahn SHLIT”A is one of the leading poskim of the dor and you can really rely on him in these matters. To that you cannot have a ta’ana. He’s one of the biggest poskim in the BD”Z in noshim and niddah (hence, the doula and midwife went to talk with him).
Why are you nitpicking? If you noticed, I placed Rav Kahn before Rabbi Baum. Have you asked YOUR Competent Orthodox Authority, or are you guessing? And I want to hear from Rabbonim who are holding cup in the issue.March 27, 2012 10:25 pm at 10:25 pm #862967pcozMember
“Health – You fail to address the issue that you’re comprimising the baby’s safety by having a home -birth!”
Not necessarily, see Mishlei 17:22 – ?? ??? ????? ???
The mother’s psychological state has a lot to do with a successful birth which is why the poskim are matir a husband to accompany his wife in an ambulance to the hospital on shabbosMarch 27, 2012 11:56 pm at 11:56 pm #8629682scentsParticipant
They are mattir a husband to travel, however in no way shape or form is a mother allowed to endanger her childs life for her comfort!
Dont tell me that you cannot comprehend that!March 28, 2012 2:02 am at 2:02 am #862969pcozMember
If the mother staying at home would endanger her child’s life then she definitely would not be allowed to have a home delivery. The question is if this is assur because it is shchiach hezeika or not. There is probably not one single answer to this question which is why you have to ask your rav.March 28, 2012 2:41 am at 2:41 am #862970
big deal -“Health – not sure why you keep saying the danger is only to the baby. There are plenty emergency scenarios that can go wrong with the mother as well. OBs are there to treat mothers not babies.”
Simply because wherever you give birth -the maternal death rate is extremely low. So this really wouldn’t be a factor in this debate.March 28, 2012 2:47 am at 2:47 am #862971
Is death the only concern for mothers?March 28, 2012 2:52 am at 2:52 am #862972
The reason why I mentioned it is because there is one thing you might want to clarify. A mother’s life always comes before a baby. From your posts you make it sound as if you have to put the baby first.March 28, 2012 2:57 am at 2:57 am #862973
Avram -“By comparison, the overall neonatal mortality rate for whites (the rate is significantly higher for blacks) in New York in 2007 was 3.27 per 1000 births. In Maryland it was 3.54, New Jersey 2.86. For women intending to deliver at home under the care of certified nurse midwives, including those who were transferred to hospitals for delivery due to problems with either mother or baby, the rate was 2.5.”
You just did the old trickeroo. You compared overall mortality to home-birth mortality.
“Not sure where this tripling (or exponential increase) of the infant mortality rate is coming from. Probably home births that are not properly supervised, which we all agree is a bad idea.”
Now you might be right, but this Non-properly supervised is still supervised by a mid-wife. This misunderstanding on your part might even be accidental. It’s hard for Non-medical people to understand these research articles -so I just post the revelant parts.
The bottom line is – planned hospital births is safer for the infant than planned home-births, even after screening the mothers and diverting them prior to a hospital. There remains a 2-3 times more risk of death in the home-birth setting!March 28, 2012 2:58 am at 2:58 am #862974
Nobody likes hospitals. Personally, I think that if there was better advocating on patient’s behalf people would feel more comfortable in a hospital setting.
What we need to do is to educate people as to what their rights are as a patient and to know that if something doesn’t feel right, they or the accompanying person should speak up and advocate on their behalf.
Before you choose a doctor, set up an appointment with him/her and prepare all the questions about their mehalach in medicine to see if that suits you. If you’re not comfortable find a different doctor. Don’t use them because everyone else uses them.March 28, 2012 3:04 am at 3:04 am #862975
big deal -“The reason why I mentioned it is because there is one thing you might want to clarify. A mother’s life always comes before a baby. From your posts you make it sound as if you have to put the baby first.”
Actually I’m not sure what you mean here. It seems you’re talking about the Din of Rodeph. This would not apply to the discussion here. The mother’s life is not really in any more danger in either setting! This being the case -it’s really only the baby whom’s life is at stake and therefore I’m discussing the infant mortality rate.March 28, 2012 3:22 am at 3:22 am #862976
No. I was actually talking about the Halacha that a mother’s life comes before an unborn child. Even if it means an abortion. But that’s besides the point. Again, I ask you, is death the only bad thing that we’re afraid of? No, there are plenty of horror stories you hear from people that are still alive but have to live with the sad reality of not being able to bear more children because it took too long to get the care they needed.March 28, 2012 3:36 am at 3:36 am #862977
big deal -“No. I was actually talking about the Halacha that a mother’s life comes before an unborn child. Even if it means an abortion. But that’s besides the point.”
So it should be a “Yes”. The reason the mother’s life comes first is because of the Din Rodeph.
“Again, I ask you, is death the only bad thing that we’re afraid of? No, there are plenty of horror stories you hear from people that are still alive but have to live with the sad reality of not being able to bear more children because it took too long to get the care they needed.”
No, it’s not. But these things that go wrong with the mother out of the hospital is Not statistically significant more than when things go wrong in the hospital. In other words – it doesn’t make a difference where you are, no matter what you say.March 28, 2012 12:59 pm at 12:59 pm #862978
“Do you really want to rely on one or two midwives for infant resuscitation? What if medication is needed? Who will treat the mother in the mean time?”
Indeed. That’s also what I wonder about – that last sentence. Sure, your midwife may be great, sure, she may have all of the first-aid kit needed to support the baby for a few minutes (note she will NEVER have the same equipment as a hospital).
But if the mother starts hemorrhaging and the baby doesn’t breathe – then what is the amazing super-trained midwife going to do in your home?March 28, 2012 1:16 pm at 1:16 pm #862979popa_bar_abbaParticipant
Did you know that a male midwife is also called a midwife?
Do you think that’s weird?
Well, it’s not as weird as a male wanting to be a midwife!March 28, 2012 2:48 pm at 2:48 pm #862980
pba- LOL!! I was waiting for you to inject some levity into this emotionally charged conversation!
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