Teen bond overcomes girl's heart transplant fear (AP)

WASHINGTON � Courtney Montgomery's heart was failing fast, but the 16-year-old furiously refused when her doctors, and her mother, urged a transplant.

Previous surgeries hadn't helped and the North Carolina girl didn't believe this scarier operation would either. It would take another teen who's thriving with a new heart to change her mind.

"I was like, `No, I don't want this. If I'm going to die, I'm going to die,'" Courtney recalls. "Now I look back, I realize I wasn't thinking the way I should have been."

Teenagers can add complex psychology to organ transplantation: Even though they're minors, they need to be on board with a transplant because it's up to them to take care of their new organ. Depression, anger and normal adolescent pangs � that tug-of-war with parents, trying to fit in � can interfere. It's not just a question of having the transplant, but how motivated they are to stick with anti-rejection treatment for years to come.

"The decision-making process that we go through, in terms of our ability to weigh factors in a rational sense, probably doesn't mature until you're in your late 20s," says Dr. Robert Jaquiss, pediatric heart surgery chief at Duke University Medical Center, where Courtney eventually was transplanted. "It introduces an enormous level of complexity to caring for these kids."

Then there's the sense of isolation. Far fewer adolescents than older adults undergo an organ transplant, making it unlikely that a teen has ever seen how fast their peers can bounce back.

Between 700 and 800 adolescents, ages 11 to 17, have some type of organ transplant each year. That's nearly 40 percent of the roughly 2,000 annual pediatric transplants. Teens fare better than any other age � child or adult � the first year after surgery. But long-term, adolescents do a bit worse than younger children, and the reason isn't biological, Jaquiss says. It's that teens, and young adults as well, tend to start slipping on all the required follow-up care.

One study found up to 40 percent of adolescent liver recipients eventually miss medication doses or checkups. It can be normal development, as teens start sleeping late and simply forgetting morning doses, or sometimes it's rebelliousness. Then there are medication side effects that Jaquiss says can be especially troubling to this image-conscious age group: weight gain, acne and unwanted hair growth.

And at the Children's Hospital of Pittsburgh, separate research with heart recipients has found chronological age is unrelated to "medical maturity." Young patients who had a hard time accepting a transplant as normal and who avoided family discussion of problems, for example, were less likely to stick with care.

Courtney's mother, Michelle Mescall, said that when the medical center advised that her daughter needed to agree to go on the transplant waiting list, "I said, `Well she's a minor, what do you mean? I'm going to make this decision.' I was just floored that it was now her decision."

Legally, the hospital could have proceeded with mom's OK. But clinical social worker Shani Foy-Watson says if that happened, Courtney's resentment could have torpedoed her recovery, setting up just those kinds of problems with follow-up care.

Foy-Watson says it's not unusual for kids who've lived with serious illness for years to have a hard time imagining normalcy � at the same age when it's normal to seek more independence from their terrified parents.

Courtney, of Asheville, N.C., was diagnosed at age 8 with hypertrophic cardiomyopathy, a thickened and hard-to-pump heart that's the leading cause of sudden death in young athletes. Her mother tried to shield her from doctors' death warnings, but says Courtney became anxious and depressed early on.

She had a defibrillator implanted and later heart surgery that offered only temporary relief, fueling resentment of her mother's medical choices. Courtney eventually had to give up her beloved cheerleading, and last year required home-schooling.

As a few weeks passed with Courtney still resisting a transplant, the social worker tried a new tack: A 17-year-old football player had received a new heart at Duke a few months earlier because of the same condition, and already was back at school in Raleigh. Would he meet with Courtney?

It was a gamble. No one told Josh Winstead, now 18, the reason for the meeting, and they might not have hit it off. But they did, and Courtney immediately changed her mind.

"I guess me doing what I do, being a kid, helped out the most," says Winstead, who took Courtney to his prom a week before her surgery. "It was more just showing her how normal my life is."

You hear all the advice from friends and doctors, Courtney says, "but it doesn't hit home like when Josh would tell me, `I have the same scars you do and this is how it felt and this is how I feel now.'"

She got her new heart last month. She's recovering well and exercising in hopes of getting back to the cheerleading squad.

Her mother's helping Courtney learn to handle a whopping 33 pills a day, and is proud of how her daughter has rallied: "I'm just dealing with how to let go and let her fly, but also be the parent of a 16-year-old."

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EDITOR'S NOTE � Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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Baby boomers fueling boom in knee, hip surgeries (AP)

SAN DIEGO � We're becoming a nation of bum knees, worn-out hips and sore shoulders, and it's not just the Medicare set. Baby boomer bones and joints also are taking a pounding, spawning a boom in operations to fix them.

Knee replacement surgeries have doubled over the last decade and more than tripled in the 45-to-64 age group, new research shows. Hips are trending that way, too.

And here's a surprise: It's not all due to obesity. Ironically, trying to stay fit and avoid extra pounds is taking a toll on a generation that expects bad joints can be swapped out like old tires on a car.

"Boomeritis" or "fix-me-itis" is what Dr. Nicholas DiNubile, a suburban Philadelphia surgeon, calls it.

"It's this mindset of `fix me at any cost, turn back the clock,'" said DiNubile, an adviser to several pro athletic groups and a spokesman for the American Academy of Orthopaedic Surgeons. "The boomers are the first generation trying to stay active in droves on an aging frame" and are less willing to use a cane or put up with pain or stiffness as their grandparents did, he said.

A huge industry says they don't have to. TV ads show people water skiing with new hips. Ads tout "the athletic knee," "the custom knee," "the male knee," "the female knee." Tennis great Billie Jean King, 67, is promoting the "30-year" Smith & Nephew knees she got last year.

"I wanted to make sure whatever they put in me was going to last," she said. "I'm not trying to win Wimbledon anymore. I'm trying to get my exercise in," play a little tennis on the clay courts in Central Park, and walk to a movie or a restaurant. "If I'd known what I know now, I would have had it 10 years ago."

Joint replacements have enabled millions of people like King to lead better lives, and surgeons are increasingly comfortable offering them to younger people.

But here's the rub: No one really knows how well these implants will perform in the active baby boomers getting them now. Most studies were done in older folks whose expectations were to be able to go watch a grandchild's soccer game � not play the sport themselves, as one researcher put it.

Even the studies presented at a recent orthopedics conference that found knee replacements are lasting 20 years come with the caveat that this is in older people who were not stressing their new joints by running marathons, skiing or playing tennis.

Besides the usual risks of surgery � infection, blood clots, anesthesia problems � replacing joints in younger people increases the odds they'll need future operations when these wear out, specialists say.

"We think very carefully about patients under 50" and talk many of them out of replacing joints, said Dr. William Robb, orthopedics chief at NorthShore University HealthSystem in suburban Chicago.

But many don't want to wait, even if they're not much beyond that:

_Karen Guffey, a 55-year-old retired civilian police worker in San Diego, plans to have a hip replaced in September. "I can't exercise the way I want to. I have to go slow, which is really aggravating. I want to go full force," she said. "I'm not worried about how I'm going to feel when I'm 75. I want to feel good now."

_Karen Cornwall, a Havertown, Pa., nurse who played a slew of sports since childhood, had both knees replaced last year when she was 54. "I just felt like I was too young and too active to be in pain all the time," she explained.

_Bill McMullen, a former Marine and construction worker from suburban Philadelphia, had seven knee repair surgeries before finally getting a knee replacement at age 55 a decade ago. He took up weightlifting to spare his knees but damaged a shoulder and had it replaced two years ago. "People ask me if I'm happy and I say, `If you have pain, go and get it done,'" he said of joint replacement. "It was the best thing for me. I have no pain."

People are urged to exercise because it's so important for health, but there are "too many wannabes" who overdo it by trying to imitate elite athletes, said Dr. Norman Schachar, a surgeon and assistant dean at the University of Calgary in Alberta, Canada.

"They think if they've got a sore knee they're entitled to having it replaced," he said. "I think surgeons are overdoing it too, to try to meet that expectation."

Dr. Ronald Hillock, an orthopedic surgeon in a large practice in Las Vegas that does about 4,000 joint replacements a year, sees the demand from patients.

"People come in and say `this is what I want, this is what I need,'" he said. "They could buy a cane or wear a brace," but most want a surgical fix.

The numbers tell the story. There were 288,471 total hip replacements in 2009, nearly half of them in people under 65, according to the federal Agency for Healthcare Research and Quality, which tracks hospitalizations.

Knee replacements soared from 264,311 in 1997 to 621,029 in 2009, and more than tripled in the 45-to-64-year-old age group.

"Five or 10 years ago, a very small number of people under 65 were receiving this surgery. Now we see more and more younger people getting it," said Elena Losina, co-director of the Orthopaedic and Arthritis Center for Outcomes Research at Brigham and Women's Hospital in Boston.

She analyzed how much of this rise was due to population growth and obesity, and presented results at an orthopedic meeting in San Diego in February.

From 1997 to 2007, the population of 45- to 64-year-olds grew by 36 percent, but knee replacements in this group more than tripled. Obesity rates didn't rise enough to explain the trend.

"At most, 23 percent of the 10-year growth in total knee replacement can be explained by increasing obesity and population size," Losina said.

"This is a very successful operation. The only caveat is, all the successes have been seen in the older population," who usually put less stress on their new joints than younger folks who want to return to sports. "It's unclear whether the artificial joint is designed to withstand this higher activity," she said.

If you have a good result from a joint replacement, don't spoil it by overdoing the activity afterward, experts warn. Better yet, try to prevent the need for one.

"Being active is the closest thing to the fountain of youth," but most people need to modify their exercise habits because they're overdoing one sport, not stretching, or doing something else that puts their joints at risk, said DiNubile, the "boomeritis" doctor.

Experts recommend:

_Cross training. People tend to find one thing they like and do it a lot, but multiple activities prevent overuse.

_Balance your routines to build strength, flexibility, core muscles and cardiovascular health.

_Lose weight. "Every extra pound you carry registers as five extra pounds on your knees," DiNubile said. "The good news is, you don't need to lose a lot of weight" to ease the burden.

_Spend more time warming up. Break a sweat and get the blood flowing before you go full blast.

_Let muscles and joints recover and rest in between workouts.

_If you've had a joint replacement, do the physical therapy that's recommended.

"I tell patients, 20 percent of the outcome is the technical stuff I do in the surgery, and 80 percent is them," said Hillock, the Las Vegas surgeon. "I can do a perfect surgery, but if they don't do the rehab they're not going to have a good outcome."

__

Online:

Consumer info: http://www.orthoinfo.org

and http://www.aaos.org/research/stats/patientstats.asp

__

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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'Jeopardy!'-winning computer delving into medicine (AP)

YORKTOWN, N.Y. � Some guy in his pajamas, home sick with bronchitis and complaining online about it, could soon be contributing to a digital collection of medical information designed to help speed diagnoses and treatments.

A doctor who is helping to prepare IBM's Watson computer system for work as a medical tool says such blog entries may be included in Watson's database.

Watson is best known for handily defeating the world's best "Jeopardy!" players on TV earlier this year. IBM says Watson, with its ability to understand plain language, can digest questions about a person's symptoms and medical history and quickly suggest diagnoses and treatments.

The company is still perhaps two years from marketing a medical Watson, and it says no prices have been established. But it envisions several uses, including a doctor simply speaking into a handheld device to get answers at a patient's bedside.

Watson won't be the first such product on the medical market, however, and one rival company says it isn't impressed.

At a recent demonstration for The Associated Press, Watson was gradually given information about a fictional patient with an eye problem. As more clues were unveiled � blurred vision, family history of arthritis, Connecticut residence � Watson's suggested diagnoses evolved from uveitis to Behcet's disease to Lyme disease. It gave the final diagnosis a 73 percent confidence rating.

"You do get eye problems in Lyme disease but it's not common," Dr. Herbert Chase said. "You can't fool Watson."

For "Jeopardy!" Watson was fed encyclopedias, dictionaries, books, news, and movie scripts. For health care, it's on a diet of medical textbooks and journals. It could also link to the electronic health records that the federal government wants hospitals to maintain. Medical students are peppering it with sample questions to help train it.

Chase, a Columbia University medical school professor, says anecdotal information � such as personal blogs from medical websites � may also be included.

"What people say about their treatment ... it's not to be ignored just because it's anecdotal," Chase said. "We certainly listen when our patients talk to us, and that's anecdotal."

Chase and other experts say cramming Watson with the latest medical information will help with a major problem in modern health care: information overload.

"For at least 30 years it's been clear that it's not possible for us to know everything," he said. "Every day, doctors have questions they can't find the answers to. Even if you sit down at a search engine, it's so labor intensive and it takes so long to find answers."

Carl Kesselman, director of the Health Informatics Center at the University of Southern California, says the "deluge of information" is a significant problem.

"Advances in medicine are increasing rapidly: genomics, specialized drugs, off-label uses, increasingly finer-grained classifications of disease," said Kesselman, who is not involved with the Watson project. "The ability to ask `Jeopardy!'-style questions and get that kind of information retrieval, to sort through all the stuff out there and point you to the latest literature, would be of potentially huge value."

Michael Yuan, chief scientist at Ringful Health, a medical consulting company in Austin, Texas, that has worked with IBM, cited a 1999 study of 103 doctors that found they fielded more than 1,100 questions a day, of which 64 percent were never answered.

"That's a huge potential for people to make mistakes," he said. "Watson is the type of solution that can really reduce that."

In "Jeopardy!" Watson was asked for one correct answer, whether it was answering questions about Sir Christopher Wren, the Lion of Nimrud or the Church Lady from "Saturday Night Live."

But in its medical guise, when presented a set of symptoms, Watson offers several possible diagnoses, ranked in order of its confidence.

"In medicine, we don't want one answer, we want a list of options," Chase said.

Kesselman said having options might help doctors accept a computer's findings.

"Will a physician ever blindly accept a diagnosis coming out of a computer? I don't think that will happen anytime soon," he said.

Chase said seeing more than one choice might also help doctors move away from what he called "anchoring," or getting too attached to a diagnosis.

"If a person has a 95 percent chance of having disease X, there's still a one-in-20 chance that they have something else," he said. "We often forget what's in that 5 percent. But Watson won't."

The treatment application works much like the diagnosis application. In the demonstration, Watson first suggested the antibiotic doxycycline for treating Lyme disease, then switched to cefuroxime when told the patient was pregnant and allergic to penicillin.

Chase said Watson will know the latest treatment guidelines � which are complex and often updated � "and can see if they're not being met."

"You have to match the right treatment with each unique patient," Chase said. "You can't treat everybody with high blood pressure the same way � a 75-year-old man with prostate cancer who felt dizzy last week and a 32-year-old woman."

Yuan said Watson's influence will depend on "how widely it is adopted."

"You have to wonder if a hospital is going to plunk down a couple of million dollars," he said.

IBM's Dan Pelino, general manager for global health care, said clients won't have to buy a complete Watson system. He said possible future uses include:

� Allowing a doctor to connect to Watson's database by speaking into a hand-held device, using speech-recognition technology and cloud computing;

� Serving as a repository for the most advanced research in cancer or other fields;

� Providing an always-available second opinion.

"You can imagine someone asking Watson a question on an iPad as they're walking down the hall," Chase said. "It might get updates like a GPS."

An existing private medical database known as Isabel is already used by some multi-hospital health systems. Co-founder Jason Maude of Isabel Healthcare said that from what he's heard about IBM's plans for Watson, "It's kind of what we've had for about 10 years."

An online demonstration of Isabel showed similarities to the Watson model � symptoms are entered, and the computer searches through a database for a possible diagnosis. Maude, who named Isabel for a daughter who escaped a serious misdiagnosis as a child, says Isabel's database has been "tuned and honed" over time.

He said prices for using Isabel range from a few thousand dollars a year for a family practice to as much as $400,000 for a health system.

Pelino said Watson is much faster and Chase said Watson is better at understanding non-medical terms.

"Watson knows that `difficulty swallowing' is `dysphagia,'" he said.

Isabel has been used at the Orlando Health hospital network in Florida since last fall, and "has had its successes," said Dr. Jay Falk, chief academic medical officer. He said less experienced doctors use it under the guidance of senior clinicians "who can make some judgments about the likelihood of what's given on the list of diagnoses."

"There's no question that there's a need for a tool that will help in this regard," Falk said. "Whether Isabel itself is the answer is unclear." Overall, he said, "We're enjoying learning with it."

IBM said Watson can answer some medical questions in the same few moments it took on "Jeopardy!" Yuan noted studies have shown that "If it takes more than two minutes, it won't get used."

As on "Jeopardy!" � where Watson identified Toronto as a U.S. city and Picasso as an art period � the computer occasionally bungles a medical question.

"I think once we were asking what type of drug we should use and the answer was a person's name," Chase said. "In fairness, I think it was a person associated with the drug."

And of course there are things Watson cannot do. It won't know a patient's appetite for risk, for example, or feelings about end-of-life treatment.

"That's why you have to emphasize that the decisions aren't coming from the computer, they're coming from the patient," Chase said.

Chase's suggestion that medical blogs be included may have something to do with his own medical history.

Several years ago, fighting a cholesterol problem, he took Lipitor and was soon plagued with insomnia. He suspected a connection but found nothing in textbooks or journals.

"I go to the blogosphere, and it was like, `You moron, don't take Lipitor before you go to bed because you'll never sleep again!'

"Now it's five years later, and if you Google Lipitor and insomnia, it's all over the place," Chase said.

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CDC's 'zombie apocalypse' advice an Internet hit (AP)

ATLANTA � "Zombie apocalypse." That blog posting headline is all it took for a behind-the-scenes public health doctor to set off an Internet frenzy over tired old advice about keeping water and flashlights on hand in case of a hurricane.

"You may laugh now, but when it happens you'll be happy you read this, and hey, maybe you'll even learn a thing or two about how to prepare for a real emergency," wrote Dr. Ali Khan on the emergency preparedness blog of the federal Centers for Disease Control and Prevention.

Above the post is a photo of what appears to be a dirty-fingered female zombie.

Khan's postings usually draw 1,000 to 3,000 hits in a week. This one � posted Monday � got 30,000 within a day. By Friday, it had gotten 963,000 page views and was the top item viewed on the agency's Web site, thanks in part to media coverage that began mid-week.

As of Friday morning, the traffic showed no signs of abating.

"The response has been absolutely excellent. Most people have gotten the fact that this is tongue-and-cheek," Khan said.

More important, CDC officials said, it is drawing interest from teens and young adults who otherwise would not have read a federal agency's guidance on the importance of planning an evacuation route or how much water and what tools to store in case a major storm rolls in.

The idea evolved from a CDC Twitter session with the public earlier this year about planning for disasters. Activity spiked when dozens of tweets came in from people saying they were concerned about zombies.

Dave Daigle, a veteran communications specialist, proposed the idea of using a zombie hook to spice up the hurricane message. Khan, director of emergency preparedness, approved it immediately and wrote it himself.

"Most directors would have thrown me out of their office," Daigle laughed. "Ali has a good sense of humor."

In the blog, Khan discussed what fiction has said about flesh-eating zombies and the various infectious agents that different movies have fingered as the cause.

His favorite zombie flick is "Resident Evil," but his interest in unpredictable terrors is driven more by his decades of work tracking real-life infections like Ebola hemorrhagic fever, bird flu and SARS.

CDC officials said the feedback they've gotten is almost completely positive, including a nice note from the boss, Dr. Tom Frieden.

Almost as rewarding was a nice comment Daigle said he received from his 14-year-old daughter, who has shown little interest in her dad's work but saw the zombie post and said, "This is cool!"

There have been few comments asking whether this is the best way for the government to spend tax dollars. The agency is under a tight budget review at the moment and facing potentially serious budget cuts. But the zombie post involved no extra time or expenditure, CDC officials said.

"We have a critical message to get out and that is CDC saves lives while saving money. If it takes zombies to help us get that message out, then so be it," said agency spokesman Tom Skinner.

Whether the message sticks still has to be determined. The agency is planning a follow-up survey to see if people actually did prepare emergency kits or follow Khan's other advice.

CDC deserves credit for trying something like this, said Bill Gentry, director of the community preparedness and disaster management program at the University of North Carolina's school of public health.

But that doesn't mean the agency should start using vampires to promote vaccinations or space aliens to warn about the dangers of smoking.

"The CDC is the most credible source out there for public health information," he said. "You don't want to risk demeaning that."

___

Online:

CDC's emergency preparedness blog: http://bit.ly/ikth7k

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Kept in chains: Mental illness rampant in Somalia (AP)

MOGADISHU, Somalia � Hassan Qasim lies shackled to a wall in a hallway with 25 other patients at a clinic for the mentally ill. He whispers under his breath and spits at his neighbors. Torn and dirty clothes hang off his skinny frame.

Doctors say the 25-year-old's brother and sister were killed in front of him, and that he was abducted and tortured by gunmen. Soon after, Qasim began wandering the streets naked, lashing out at passers-by.

In this Horn of Africa nation that has been mired in anarchy and war for two decades, nearly all families have been touched by tragedy. The World Health Organization estimates that one in three Somalis have suffered from some kind of mental illness, a rate that is among the highest in the world.

Gunfire crackles every few seconds in Mogadishu at night, and mortars scream out of the sky.

"We believe every bullet or mortar will cause more people to become mentally ill," said Dr. Abdirahman Ali Awale, a Somali psychiatrist.

Somalia's civil war also has simultaneously destroyed health care infrastructure to treat the traumatized. A World Health Organization report found that the country has only three psychiatrists and no psychologists working at its five main mental health facilities.

As a result, some Somalis have been chained up in mental wards for as long as eight years, according to the WHO. At one mental health facility, almost 50 percent of patients were chained. At other clinics, doctors recite the Quran to patients, hoping it will improve their condition.

This year, WHO began giving medicine and other supplies to the Habeb mental hospital, the only facility that treats patients without detaining them.

"Our treatment is chain-free. We never restrain them," said Dr. Abdirahman Habeb. He says the facility has treated more than 9,000 psychiatric patients using a combination of medicine and counseling. Still, the majority of mentally ill people in Somalia face much grimmer prospects.

The Somali government, which is consumed by political infighting and battling an al-Qaida-linked insurgency, is unable to even assert control over all of Mogadishu much less help its traumatized population. It relies on 9,000 African Union peacekeepers to retain control of half the country's capital.

Dr. Rizwan Hamayun, who helped write a WHO study earlier this year examining mental health in Somalia, said the chaos has resulted in a loss of jobs, family, homes and property which in turns can contribute to mental illness. His latest new patient was a shepherd who attempted suicide after losing all his animals not to war but to a natural calamity � an ongoing drought.

While poverty and fear are the main triggers for mental illness, some also have been intimidated by continuous threats made by insurgents over mobile phones. Insurgents call and threaten people they suspect of collaborating with the government. As punishment for alleged crimes, insurgents saw off captives' hands and feet in public squares and stone people to death.

The insurgents accused Ibrahim Nuraddin of selling phone credit, bread, and other small items to Somali soldiers. The elderly former shopkeeper had a mental breakdown after receiving frequent death threats, relative Ibrahim Farabadn said.

Nuraddin had already spent one year imprisoned in his family's house or tied to a tree. Finally, relatives sought treatment after hearing that a Mogadishu clinic was taking patients. Three hefty men dragged Nuraddin into the clinic but he struggled to escape. They quickly chained him up.

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Home births up, driven by natural birth subculture (AP)

ATLANTA � Home births rose 20 percent over four years, government figures show, reflecting what experts say is a small subculture among white women toward natural birth.

Fewer than 1 percent of U.S. births occur at home. But the proportion is clearly going up, study by researchers at the Centers for Disease Control and Prevention found. The new figures are for 2004 to 2008. Home births had been declining from 1990 to 2004.

The increase was driven by white women � 1 in 98 had their babies at home in 2008, the most recent year for which the statistics were available.

Only about 1 in 357 black women give birth at home, and just 1 in 500 Hispanic women do.

"I think there's more of a natural birth subculture going on with white women � an interest in a low-intervention birth in a familiar setting," said the lead author, Marian MacDorman of the CDC's National Center for Health Statistics.

For all races combined, about 1 in 143 births were at home in 2008, up from 1 in 179 in 2004.

Geographically, 27 states had significant increases during those four years. Montana, Vermont and Oregon had the most home births � about 1 in 50 births were at home in those states.

Alaska's rate was nearly as high, and it's clear that some home births occur because women are in remote locations and are not able to get to hospitals in time for delivery.

The increase is notable because doctors groups have been increasingly vocal about opposing home births, The American College of Obstetricians and Gynecologists has for years warned against home births, arguing they can be unsafe, especially if the mother has high-risk medical conditions, if the attendant is inadequately trained or if there's no quick way to get mother and child to a hospital if something goes awry.

Doctor participation in home births declined by 38 percent from 2004 to 2008. The percentage of home births attended by certified midwives and nurse-midwives grew, meanwhile.

Home births increasing? "From our perspective, that's not the best thing for the overall health of babies and women," said Dr. George Macones, an obstetrician at Washington University in St. Louis who chairs ACOG's Committee on Obstetric Practice.

Exactly how unsafe home births are is a matter of medical controversy, with studies offering conflicting conclusions. And some argue that hospitals present their own dangers of infection and sometimes unnecessary medical interventions.

The CDC researchers did find that home births involving medical risks became less common from 2004 to 2008. Home births of infants born prematurely fell by 16 percent, so that by 2008 only 6 percent of all home births involved preterm births. That's less than half the percentage in hospitals.

The study was done by two CDC researchers and a Boston university professor. It was electronically published Friday by a medical journal called Birth: Issues in Perinatal Care.

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