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Misconceptions Surrounding the Safety of Home Birth and Hospital Birth Misty D Louisiana State University LSU Digital Commons LSU Master's Theses Graduate School 2002 Misconceptions surrounding the safety of home birth and hospital birth Misty D. Richard Louisiana State University and Agricultural and Mechanical College, [email protected] Follow this and additional works at: https://digitalcommons.lsu.edu/gradschool_theses Part of the Veterinary Pathology and Pathobiology Commons Recommended Citation Richard, Misty D., "Misconceptions surrounding the safety of home birth and hospital birth" (2002). LSU Master's Theses. 770. https://digitalcommons.lsu.edu/gradschool_theses/770 This Thesis is brought to you for free and open access by the Graduate School at LSU Digital Commons. It has been accepted for inclusion in LSU Master's Theses by an authorized graduate school editor of LSU Digital Commons. For more information, please contact [email protected]. MISCONCEPTIONS SURROUNDING THE SAFETY OF HOME BIRTH AND HOSPITAL BIRTH A Thesis Submitted to the Graduate Faculty of the Louisiana State University and Agricultural and Mechanical College in partial fulfillment of the requirements for the degree of Master of Science in The School of Veterinary Medical Science through the Interdepartmental Program in Pathobiological Sciences By Misty Dawn Richard B.S., Louisiana State University, 1999 August 2002 Dedication This work is dedicated to the midwives Sherri Daigle, Anne LaStrapes, and Shelley New for giving me the pleasure of working with you and to Emmy Trammell and Pauline Lerma for letting me experience the joy of a home birth I will forever be indebted to your kindness and generosity ii Table of Contents Dedication........................................................................................................................ ii List of Figures...................................................................................................................v List of Maps ...................................................................................................................vi Abstract.......................................................................................................................... vii Introduction.......................................................................................................................1 Chapter 1. Obstetricians, Midwives, and the Use of Evidence-Based Practice………... 4 1.1 Introduction……………………………………………………………….......4 1.2 Men Replace Midwives: History Through the 19th Century…………………5 1.3 1900-1960: New “Advancements in the Field of Obstetrics and Their Subsequent Tragedies…………………………………………… 11 1.4 The Current Era: 1970’s to Present................................................................27 1.4.1 Electronic Fetal Monitoring.............................................................29 1.4.2 Amniotomy ......................................................................................31 1.4.3 IV’s and Nothing by Mouth..............................................................32 1.4.4 Cesarean Section and Vaginal Birth After Cesarean (VBAC)…….35 1.4.5 Pain Relievers ..................................................................................51 1.4.6 Lithotomy Position and Episiotomies..............................................56 1.4.7 Ultrasound…………………………………………………………63 1.4.8 Induction…………………………………………………………..67 1.4.9 Summary of the Present Era………………………………………74 1.5 Midwives, Home Birth, and Evidence-Based Practice……………............... 76 1.5.1 Safety of, Outcomes of, and Other General Information About Home Birth………………………………………………..83 1.5.2 Detailed Analysis of Studies on Home Birth……………………...87 1.5.3 Conclusions About Home Birth…………………………………...97 Chapter 2. Home Birth in Louisiana………………………………………………….103 2.1 Introduction...................................................................................................103 2.2 Rules and Regulations Concerning Midwife-Attended Home Births...........104 2.3 Purpose of the Study .....................................................................................112 2.4 Materials and Methods……………………………………………………..113 2.4.1 Participating Midwives…………………………………………..114 2.4.2 Data Collection………………………………………….………..114 2.4.3 Geocoding and Analysis………………………………….………116 2.4.4 Reference Group…………………………………………………116 2.4.5 Definitions………………………………………………………..117 2.5 Results From Midwives’ Database………………………………………...118 2.5.1 Sociodemographics of Women Choosing Home Birth..................118 iii 2.5.2 Characteristics of Women Referred Out and Those Voluntarily Leaving Midwifery Care…………………………..126 2.5.3 Back-Up Physician………………………………………………128 2.5.4 Characteristics of Labor and Delivery…………………………...130 2.5.5 Complications of Labor and Delivery…………………………...139 2.5.6 Transports………………………………………………………..140 2.5.7 Characteristics of Infants………………………………………...150 2.5.8 Mortality……………………………………………………...….154 2.5.9 Maternal Satisfaction…………………………………………….154 2.6 Comparisons to East Baton Rouge Records and National Data…………...159 2.7 Discussion………………………………………………………………….166 References.....................................................................................................................172 Appendix A. Cytotec Letter.........................................................................................186 Appendix B. Midwives Model of Care........................................................................188 Appendix C. Perinatal Care Index ...............................................................................189 Appendix D. Data Collection Forms ...........................................................................193 Appendix E. Maternal Satisfaction Survey Forms ......................................................195 Appendix F. Confidentiality Issues………………………………………………….204 Vita................................................................................................................................205 iv List of Figures 1. Percent of women completing 1st stage within the designated period of time.........132 2. Cumulative percent of women completing 1st stage by time...................................133 3. Percent of women completing 2nd stage within the designated period of time........134 4. Cumulative percent of women completing 2nd stage by time ..................................135 5. Intact perineum or degree of laceration ...................................................................137 6. Initiation point of hospital transports.......................................................................141 7. Place and type of delivery among women beginning labor at home .......................142 8. 1-minute Apgar scores of infants born at home.......................................................151 9. 5-minute Apgar scores of infants born at home.......................................................152 10. Weight of infants born at home .............................................................................153 11. 1-minute Apgar scores given to infants born at home and in the hospital.............162 12. 5-minute Apgar scores given to infants born at home and in the hospital.............163 13. Birth weights of infants..........................................................................................165 14. Place of delivery and corresponding method of delivery ......................................166 v List of Maps 1. Legal Status of Midwife-Attended Home Birth.........................................................99 2. Racial Distribution of Home Births in East Baton Rouge Parish ............................119 3. Marital Status of Home Birth Clients ......................................................................120 4. Distribution of Home Births Attended by Midwives Licensed in Louisiana ..........124 5. Distribution of Home Birth Locations Attended by East Baton Rouge Parish Midwife in 1990 (Before Other Midwives Were Practicing) and in 1999 (After Other Midwives Began Practicing .............................................................125 6. Location of Women Having a Home Birth or Transport.........................................145 7. Proposed Transport Locations of Home Births in East Baton Rouge Parish ..........146 8. Actual Transports and Hospitals of Destination ......................................................148 9. 50-Mile Radius Circles Originating From Hospital of Transport............................149 vi Abstract Much debate surrounds the topic of women choosing to deliver their infants at home with the services of a midwife. The outcomes of women beginning labor at home, ultimately delivering at home, and the infants born at home were studied in order to determine the safety of home birth among expectant women choosing to be attended by a midwife licensed to practice by the state of Louisiana. Trends associated with those choosing home birth and the frequency of home birth were also analyzed. The study was conducted using retrospective records of clients accepted during the study years 1986- 2000. During the study years, the midwives began care on 284 women. Of those women, 225 delivered at home, 31 were transported to the hospital at some point, 7 voluntarily left the midwife’s care, and 20 were referred out for various reasons. The only cause of infant mortality in the home births was congenital anomalies. There were no maternal deaths or significant maternal morbidity. The years with the largest number of home births were 1997, 1998, and 1999 with 32, 35, and 32 births respectively. During these three
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