Edmonton
VBAC Support Association/ICAN of Edmonton
News Release July 14, 2005
Elective Cesarean Sections in Alberta
are Free but Home Birth Is Not
Edmonton (July 14, 2005) – Albertan families
choosing an elective cesarean birth do not have to pay one
dollar, but Albertan families choosing home birth must pay
out-of-pocket an average of $2,600 plus GST to a registered
midwife (RM) since the Health Care Insurance Plan does not
cover it. Cesareans, elective or not, can cost Albertan taxpayers
about $10,000 or 4 times as much as a home birth. A June
18, 2005, study proves that planned home births can reduce
the risk of a cesarean section by as much as 5 times.
A landmark study published June 18 in the
British Medical Journal (BMJ) shows planned home births with
Certified Professional Midwives (CPMs) result in significantly
lower cesarean rates than planned hospital births. The 2000
study by a Canadian epidemiologist and a CPM tracked more
than 5,000 pregnant women in the United States and Canada
planning home birth. The result was a 3.7 percent cesarean
rate among all mothers and a 1.7 percent cesarean rate among
women who previously gave birth vaginally.
“Based on these study results, women who
want to avoid a cesarean should consider planning a home
birth with a Certified Professional Midwife,” said Tonya
Jamois, president of the International Cesarean Awareness
Network (ICAN). “Double digit cesarean rates subject women
and babies to the risks of preventable surgery and drive
up the cost of health care for everyone.”
The Centers for Disease Control documented
a 23 percent cesarean rate for the U.S. in 2000, the same
year in which the study was conducted. The most recent figures
available show the U.S. with a 27.6 percent cesarean rate
in 2003 and Canada with a 24 percent rate in 2002.
“We hope the positive results of this home
birth study will move the American College of Obstetricians
and Gynecologists (ACOG) to review their protocols and guidelines
to support women who choose home birth and to integrate Certified
Professional Midwives into the healthcare system,” Jamois
said. Currently, ACOG opposes home birth.
The largest study of its kind to date found
that “planned home births for low-risk women in the United
States are associated with similar safety and less medical
intervention as low-risk hospital births” (See http://bmj.bmjjournals.com/cgi/content/abridged/330/7505/1416 or
study abstract below).
ICAN recognizes that when a cesarean is
necessary it can be a lifesaving technique for both mother
and baby and worth the risks involved. However, a cesarean
is major surgery and should be used only when necessary because
it does introduce risks. Potential risks to babies include:
low birth weight; prematurity; respiratory problems; and
lacerations. Potential risks to mothers include: hemorrhage;
infection; hysterectomy; surgical mistakes; re-hospitalization;
dangerous placental abnormalities in future pregnancies;
unexplained stillbirth in future pregnancies and increased
percentage of maternal death.
ICAN is a nonprofit organization whose
mission is to improve maternal-child health by preventing
unnecessary cesareans through education, providing support
for cesarean recovery and promoting vaginal birth after cesarean.
There are more than 70 ICAN Chapters in the U.S. and Canada
, which hold education and support meetings for people interested
in cesarean prevention and recovery. For more information,
visit http://www.ican-online.org or
call ICAN President Tonya Jamois in San Diego, CA, at (760)
744-5260 or the ICAN office at (800) 686-ICAN.
CANADIAN MEDIA NOTE
Registered Midwives (RMs)
are primary caregivers in maternity care and are recognized
and regulated professionals in BC, AB, MB, ON, QB, NU, and
NWT. Alberta is the
only province or territory out of the above list that
does not have and/or plan for public funding of midwifery
care. For local information contact Claudia Villeneuve, Director
of the Edmonton VBAC Support Association/ICAN of Edmonton
at home (780) 444-3041 or cellular (780) 232-9213 or edmontonvbac
@ yahoo.ca.
REFERENCE STUDY
Outcomes of planned home births
with certified professional midwives: large prospective
study in North America
Kenneth C Johnson , senior
epidemiologist 1 , Betty-Anne Daviss , project
manager 2
1 Surveillance and Risk Assessment
Division, Centre for Chronic Disease Prevention and Control,
Public Health Agency of Canada, PL 6702A, Ottawa, ON, Canada
K1A OK9,2 Safe Motherhood/Newborn Initiative,
International Federation of Gynecology and Obstetrics, Ottawa,
Canada
Correspondence to: K C Johnson ken_lcdc_johnson
@ phac-aspc.gc.ca
Abstract
Objective: To evaluate the safety of home births in North America
involving direct entry midwives, in jurisdictions where the practice is not
well integrated into the healthcare system.
Design: Prospective cohort study.
Setting: All home births involving certified professional
midwives across the United States (98% of cohort) and Canada , 2000.
Participants: All 5418 women expecting to deliver in 2000
using midwives with a common certification, who planned to deliver at home
when labour began.
Main outcome measures: Intrapartum and neonatal mortality,
perinatal transfer to hospital care, medical intervention during labour,
breast feeding, and maternal satisfaction.
Results: 655 (12.1%) of women who intended to deliver at
home when labour began were transferred to hospital. Medical intervention
rates included epidural (4.7%), episiotomy (2.1%), forceps (1.0%), vacuum
extraction (0.6%), and caesarean section (3.7%); substantially lower than
for low risk US women having hospital births. The intrapartum and neonatal
mortality among women considered at low risk at start of labour, excluding
deaths concerning life threatening congenital anomalies, was 1.7 deaths per
1000 planned home births, similar to risks in other studies of low risk home
and hospital births in North America . No mothers died. No discrepancies
were found for perinatal outcomes independently validated. Source: BMJ 2005;330:1416 (18 June),
doi:10.1136/bmj.330.7505.1416
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