10 Jan
Review: The Essential Homebirth Guide
A friend emailed me asking if I had heard of The Essential Homebirth Guide after she had spent some time on Amazon looking at upcoming book releases. I thought it sounded like something I could use before T2 comes in a few weeks since I’m giving birth at home again, so I did what bloggers do and emailed the authors asking if they’d be interested in sending me a free copy in exchange for a review on my blog. They said yes, put a copy in the mail, and I had finished the entire thing two days after I received it. Considering I average around one book per month this is pretty impressive (I couldn’t put it down!).
The book is written by Jane Drichta, CPM and Jodilyn Owen, CPM who run the website Essential Midwifery. In the United States if you’re using a midwife you’re likely going to be working with either a Certified Nurse Midwife (CNM) or a Certified Professional Midwife (CPM). I used a CPM with my first birth, but was able to find a CNM for the second birth (she delivers at a hospital for most of her births and does a small number of homebirths as well, which is rare). I don’t necessarily think one is better than the other, but working with a CNM means there is a higher likelihood that insurance will cover at least part of the cost! I went into more detail about the differences between a CPM and a CNM here.
The Essential Homebirth Guide is an incredibly apt title for this book because I kept looking over to That Husband saying “Why hasn’t anyone written this book yet? It’s everything women giving birth at home need to know.” This book is a practical description of the many factors that need to be addressed when giving birth at home. I could tell that the authors had worked hard to give evidence-based information, and the amount of advice they give is kept at a minimum. The section on Group Beta Strep illustrated this really well for me. This is a test I have waived for both pregnancies, and it’s a frustrating/complicated area because a woman gets the test at 37 weeks, but it doesn’t necessarily mean that she will have Group B Strep at 40 weeks. If she is having a hospital birth and tests positive at 37 weeks she will automatically get an antibiotic treatment when she delivers (even though technically she can test positive at 37 weeks and be negative at 40 weeks). It also means that a woman can test negative at 37 weeks but actually be positive at 40 weeks. The Essential Homebirth Guide lays all of this out very clearly, and also helps women understand what it means to be GBS positive, what it might mean for their homebirth plans, how GBS can affect the baby, and preventative measures you can take to keep GBS colonization under control.
One of the struggles I’ve had when navigating the world of homebirth is that the amount of unbiased reliable information is very small. All midwives have a particular bias that needs to be measured when advice is given, and googling things usually takes you to forums where women are giving out plenty of opinions without much evidence to back them up. In Chapter Nine: The Big Ten, I was able to read up on things like Anemia (something my midwife is watching closely with me), Rhesus Factor (I’m positive and decided to get the shot with both pregnancies) and Gestational Diabetes (a huge hurdle for women planning a homebirth because testing positive could mean that you will risk out from your midwife’s care and have to transfer to a hospital). As diabetes and large babies were discussed I read “Ultrasound has a known error rate of 13% when it comes to estimating fetal weight.” At the end of that sentence I’m pointed to a study by Nahum and Stanislaw titled “Ultrasonographic Prediction of Term Birth Weight: How Accurate Is It?” published in the American Journal of Obstetrics and Gynecology. This is one of the many reasons why I think this book is so awesome.
Other favorite chapters included Chapter Five:”She Said, I Said, They Said — Communication, which discusses how to talk to your midwife and how to talk to your family about your choice to give birth at home, and Chapter Ten: Labor and Birth at Home, which I need to go back and review once again because it’s time for me to start assembling towels and checking to make sure the birth tub doesn’t have any holes! There are also multiple appendices that discuss Questions to Ask During an Interview and Further Reading for the Homebirth Family.
I plan on giving a copy of The Essential Homebirth Guide to my midwife and I hope she starts recommending it to her other homebirth clients as well. If you’re giving birth at home I would rate this book as essential as Ina May’s Guide to Childbirth, and I can see it being incredibly useful to women giving birth in freestanding birth centers as well. It’s available for pre-order on Amazon right now.
Also:
I'm a farm-raised almost-crunchy stroller-pushing picture-taking lifestyle-blog-writing gastronomy-obsessed divine-seeking thrift-store-combing cheese-inhaling pavement-pounding laughter-sprinkling lover of individuality and taking chances.
Thank you so much, Jenna, for your lovely words. We certainly do appreciate you taking the time to read our work! This was definitely a labor of love, and we are delighted that you found it useful. We can be found over at http://www.essentialmidwifery.com, if you and your readers would like to keep in touch. Thank you again!
1Hi Jenna-
I’m a long time reader who has commented a bit in the past. I always used to read because of your religious posts. I’ve learned a lot about the Mormon faith and have been at times impressed by your commitment to your religion. I’m saying all this so you know I’m NOT a troll.
I would like to say though that I’m a bit shocked to see you call the Group B test a “frustrating and complicated area.” It makes me nervous that you would give this opinion on your blog because I really do think it needs more attention and shouldn’t be a test that you can opt out of. I mean you could opt out of it but a blood infection in a newborn is really serious and life threatening. If you can do anything in your power to avoid it I strongly feel like you should. I’m not just arguing this to argue but I’m coming at you from experience. Thankfully our baby was okay because I was on the antibiotic drip but things could have gone horribly wrong. I’m not going to get into our story because it’s private but our results would have been much different had I not been on antibiotics. I know not all births are the same and you’ve had a complicated free birth before but please, don’t advocate Group B strep testing as frustrating and complicated.
Ellen Reply:
January 11th, 2013 at 5:49 pm
Yes, I second this. It can be very serious, but is very easy to prevent.
If you are looking for fact-based information regarding home birth and statistics, you should look at http://www.skepticalob.com and the resources available there from actual studies (not just opinions from laypeople with no medical training).
Also, there is a very big difference between CNM and CPM, one is a registered nurse with generally an advanced degree who usually works in hospitals. The other is not.
Anya Reply:
January 14th, 2013 at 8:32 pm
I’m sorry, but Amy Teuter, THE Skeptical OB, is NOT a particularly good source for fact-based info regarding homebirth (or birth in general). See this Salon article for a good summary of why not: http://www.slate.com/articles/double_x/doublex/2012/07/daily_beast_and_home_birth_fear_trumps_data_in_a_new_story_on_having_babies_at_home_.html
On the other hand, the Cochrane Review, which is well-known as pretty much the gold-standard of evidence-based medicine, says that even giving antibiotics during delivery for KNOWN GBS infection (per Jenna’s original note, known as of 37 wks not at delivery) does not reduce baby deaths: http://summaries.cochrane.org/CD007467/intrapartum-antibiotics-for-known-maternal-group-b-streptococcal-colonization
Evelyn Reply:
January 20th, 2013 at 8:59 am
The definition of CPM varies a bit from state to state, but usually a CPM is certified by the state to perform their job. I have known of many CPMs who are as good, if not better, than CNMs because of their broad range of training and experience. Also, I have known of many CNMs who have never worked in-hospital, or if they were in a state that was restrictive, never delivered a baby-even in-hospital.
I want to second Anya’s comment that Amy Teuter, The Skeptical OB, is not a particularly good source for fact-based info regarding homebirth, midwives, or birth in general.
I’m sure I ran across her blog in the past but I ran across it again very recently and spent a good time reading. She is very obviously anti-midwife. She makes lots of claims and accusations, as well as damning broad generalizations… That simply are not true or are not substantiated (but she’s an experienced OB so we should just believe everything she says, right?).
So you know where I am coming from, my first was born with minimal (no?) intervention in-hospital with an OB practice. I came quite close to dying (unfortunately, this is not an exaggeration) because of the incompetence of the OBs and nurses and sought out a better option for my second pregnancy… And ended up with a great group of midwives (CNMs) in the DC area. I am seeing a CNM in UT for my current pregnancy, but interviewed a practice of both CPMs & CNMs and found them to be quite competent and trustworthy. My best friend is in the last year of her OB-GYN residency-which may seem like a silly factoid, but is more relevant than could be adequately expounded upon in an hour conversation.
Dr. Teuter makes a variety of accusations about midwives, the one that immediately comes to mind is that midwives encourage women to not take Rhogham (for the Rhesus Factor, which Jenna mentioned), yet I have never experienced this with my midwives, or heard of friends or associates in a variety of cities and states, being encouraged to *not* take it by their midwives. She may seem like a good, reliable source of information, but in my reading I have found that her attitudes and information are more colored by prejudices than facts.
Jenna Reply:
January 14th, 2013 at 1:40 pm
As I said above, the problem is that the test is unreliable (at best). If I test at 37 weeks I could test negative, but actually have Group B Strep at 40 week. Or it could be the other way around (and I read about a practice that tests at 32 weeks on a forum I keep up with, yikes!)
This doesn’t mean that people shouldn’t get the test, but I actually find it more dangerous to test women at 37 weeks without explaining the problems with the test. If you test a woman at 37 weeks and tell her she is negative, she stops paying attention to any warning signs because she’s been given the all-clear from her doctor. Educating her about what the results really mean and what to look for in an infant that might indicate she had indeed passed on Group B Strep is a much better way of dealing with the issue, IMO.
I’ve heard that they are working on tests that can be performed at birth, which is great! This would mean even more babies are saved from the illness and false negatives are significantly diminished.
I’m excited to read this! It’s always good to read the unbiased facts to see the truth. Already added it to my Amazon cart.
3Great review! I am adding this to my to-read list.
4a leading cause of death in newborns is caused by group b strep. It is preventable with an iv antibiotic infusion. Surely it is worth doing. Give the baby a chance.
5Hmm. I think the review was helpful! Enjoy reading books that have an interesting point of virw and bring to light topics from a different perspective- which just makes me/us/people evaluate what’s important to us and those we impact indirectly (like my current read is judge sotomayors memoir “my beloved world”…)
Um. But. As far as group B strep. I know that wife has said she doesnt want to make a decision based off fear but rationalization.
Personally I have seen first hand what is discussed as an RN & Pediatric Nurse Practioner. 1 client stands out most pivotal in my mind. The mother tested negative to group b yet it was a false negative. & the consequences of the illness were neurologically devastating to the baby & for the family dynamic as a whole with the subsequent treatment/hospitalization. Over all that experience for ME as a health care provider was both heart wrenching & frustrating.
I just find for myself, my intimate inner circle that if i could avoid (to an extent) any harm or minimize the severity of an illness (examples: controversial HPV vaccine, influenza vaccine… Certain treatment approaches supported by evidence based practice) i would want to do it so as not to question later “did i do enough?”
But that’s me. I would never allude that anything someone says as personal opinion is irresponsible like some commenters. But discussing logically why you would choose to do it a different way and on what basis seems much more constructive.
At the end of the day we live with the choices we make and the results. And if you are at peace with that decision for yourself then i guess that is all that matters. I am not passing judegment on tw’s opinion. I just think it’s harsh to say expressing it is irresponsible when clearly it is a process we all go thru when we make a decision about a choice.
6Just want you to know I so miss you writing girl!! I know you are making decisions for your family but just wanted you to know you are missed!!
7“Rhesus Factor (I’m positive and decided to get the shot with both pregnancies)”
I think you meant to say you are Rh negative and decided to get the Rhogam or Anti-D shots (rhesus immunoglobulin.
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