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Ina May Gaskin’s Proposal for Better Maternal Healthcare in the U.S.

Ina May Gaskin's vision for the future

By Ina May Gaskin |

Every country I have visited (except Brazil) has a reverse ratio of midwives to physicians compared to what we have here, meaning that their midwives far outnumber physicians involved in maternity care. People who live in countries where there has always been a midwifery profession consider it a rational health care policy for midwives to be the providers of maternity care for approximately 70 percent of pregnant women. By contrast, people in the U.S. tend to think that every pregnancy requires an obstetrician and that midwives are some kind of more recent fad.

Ina May Gaskin shares 8 ways in which she believes maternal healthcare in America needs to change:

1. Revise medical education

The best obstetricians are those who had midwives as teachers of normal birth, who gave them a good grounding in the normal process of labor and birth before they entered the part of their training pertaining to obstetrical pathology. With midwives as teachers, doctors in training would be able to learn some of the ancient midwifery techniques that would help to lower C-section rates if they were applied across the country. These ingenious techniques include the all-fours (or Gaskin) maneuver to solve the complication of shoulder dystocia (stuck shoulders), which I learned from indigenous Guatemalan midwives who told me they had learned it from God; the use of a long shawl called a rebozo to change a baby’s position; massage techniques; and the use of upright postures and movement during labor. Techniques of manual assessment of pelvic dimensions, fetal size, and breech delivery need to be revived and taught.

2. Establish maternity care standards

We need medical practice standards at both the federal and the state level that would address C-sections performed without medical justification and assure more mother-friendly births and fewer medical interventions during labor. Brazil has already begun to establish such measures, such that hospitals receive less payment from government insurance if their C-section rates exceed the standards.

3. Physicians should be salaried and not paid by the number of births they take on

The rationale for this recommendation is that it would prevent obstetricians from taking on more births than they should, along with the gynecological surgeries they are additionally responsible for. The nearly unchecked freedom many now enjoy means that many women’s labors are accelerated, or they are pressured to consent to a C-section that is really unnecessary, so the physician can go home for family time or a good night’s sleep. It’s a national disgrace that the CDC’s statistics now show that more C-sections are performed between 5:00 and 6:00 pm than at any other time of day.

4. Birth centers are needed in all parts of the U.S.

Women giving birth in a birth center can expect their midwives to stay with them throughout the course of labor, whereas in a hospital they can be on the point of giving birth when they have to say good-bye to the midwife who had been with them for hours because of a shift change. Women using birth centers have far fewer induced births (since midwives are less likely to push for induction) and fewer C-sections. Their babies are less likely to be taken away from them just following birth, because habitual hospital routines such as unnecessary separation of mother and baby have not been instituted at birth centers. Despite the good results of birth centers and their popularity with women, extremely high malpractice insurance rates and physician opposition have forced many independent birth centers to close their doors. Birth centers need protection from the economic and legislative advantages currently enjoyed by hospital corporations. In the early eighties, there were 400 freestanding birth centers. In 2005, there were only 160.

5. Every maternal death must be counted and reviewed

It is simply unacceptable that a U.S. woman giving birth today has a greater chance of dying than her mother did. We have to set up – for the first time – a national system that makes it possible to identify and count every maternal death. Unless every death is identified and reviewed, it is not possible to know the causes of all deaths or their actual frequency, and then to work to prevent them. At present, we have nothing more than an honor system of maternal death reporting, which produces such inaccurate numbers that the CDC reported in 1998 that the actual number could be three times greater than the number officially reported each year. Other countries, with less wealth than ours, have created systems that achieve accurate counts of maternal deaths, so no one can argue that this task is impossible.

6. Reduce the U.S. maternal death rate

A “To Do” list for the revolutionary change required to gather accurate maternal death information and then to use it to prevent those deaths, where possible:

  • Make every one of the fifty states use the U.S. Standard Death Certificate, so that for the first time in our history, we would have consistency in how data on maternal death is gathered.
  • Create effective penalties for misreporting, misclassifying, or falsifying information on death certificates.
  • Create and require training programs for doctors and anyone else authorized to fill in a death certificate in maternity hospitals. Special training is necessary for filling out death certificates, according to the CDC. In its recent publication, Strategies to Reduce Pregnancy-Related Deaths, the CDC reports that “[p]hysicians receive minimal training in how to correctly complete death certificates. The cause of death on many certificates does not adequately reflect the events leading to the death, as evidenced by the under-assessment of pregnancy-related deaths when case identification is based solely on death certificate data.”
  • Pass legislation at the national level to provide confidentiality to state maternal mortality review committees.
  • Require that insurance companies pay for an autopsy following the death of a woman of childbearing age in every case where the family agrees to the autopsy, to help contribute to research that will prevent deaths in the future. Countries with national health care systems do this as a matter of course, since it contributes to preventing more deaths (their main priority).
  • Encourage the American Congress of Obstetricians and Gynecologists to emulate the example of its UK counterpart, the Royal College of Obstetricians and Gynaecologists, by periodically publishing a detailed and informative book as part of its effort to identify, review, study, and learn from maternal deaths in the U.S.

7. Postpartum home visits must be recognized as a necessity

Postpartum home visits are important for many reasons: to detect early signs of postpartum depression, which sometimes escalates to postpartum psychosis; to help with breast-feeding problems; to answer questions the new parents might have about early infant care; to check for an infection that might not have been apparent on discharge; and to make sure that mothers, especially those who have had C-sections, are not showing signs of deep vein thrombosis. We cannot expect new mothers or family members to diagnose their own postpartum complications. Home birth midwives provide postpartum visits during the days following birth as part of their routine services. However, it is relatively unusual for U.S. hospital maternity services to include even one postpartum home visit. Instead, most services provide only for a six-week checkup at the doctor’s office.

8. We must give more consideration to a category of mothers who need it

In 2010, a new television series was launched in the U.S. entitled I Didn’t Know I was Pregnant. The series is teaching people that intelligent women can be pregnant and go into labor without realizing that they have a baby coming. However, when that same phenomenon happens in the case of a teenager and complications arise (for example, her baby doesn’t spontaneously breathe at birth), the young woman is judged according to a standard that no one would ever ask of someone giving birth in a hospital to an expected baby. Whereas giving birth is ordinarily considered to be so painful that our culture doesn’t think that women are in their right mind if they give birth without pain medication, these young women are expected to be skilled at newborn resuscitation and other obstetrical and midwifery skills immediately after giving birth unaided. We literally have no idea how many young women are serving long prison sentences in the U.S. because they failed to resuscitate their babies and were charged with manslaughter or even murder. Trying to deal with this problem using the harsh punishments given these women does not serve as a deterrent. It only illustrates how much work we have to do to make it clear that women becoming mothers must have full human rights.

I am convinced that it will be possible for women to agree on at least some of the changes that I have outlined in my book. It doesn’t have to take forever to get maternal deaths counted right, the postpartum needs of mothers recognized, the punishment regime modified to fit realities, and the positive role that midwives could play in birth fully utilized in the U.S. Let’s make all these changes happen.

This excerpt from Birth Matters: A Midwife’s Manifesta is reprinted and condensed here by the kind permission of Seven Stories Press.

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About Ina May Gaskin

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Ina May Gaskin

Called "the midwife of modern midwifery" by Salon, renowned midwife Ina May Gaskin has practiced for nearly forty years at the internationally lauded Farm Midwifery Center. She is the only midwife for whom an obstetric maneuver has been named (Gaskin maneuver). She is the author, most recently, of Birth Matters: A Midwife's Manifesta.

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67 thoughts on “Ina May Gaskin’s Proposal for Better Maternal Healthcare in the U.S.

  1. Anonymous says:

    it’s pretty shocking that our maternal care system in america is so bad. i had no idea.

  2. Anonymous says:

    As the spouse of a practicing OB, I cannot count the number of times my husband has missed meals, family experiences, children’s plays and school functions, and sleep to help his patients. I take exception to the idea that husband enjoys “unchecked freedom”, especially since the well being of his patients often in places restrictions on the freedom of the entire family. Additionally, why isn’t the need for legal reform mentioned? I know that physicians see the need to balance medical intervention with the possibility of legal recourse by patients and over eager lawyers.

  3. eponymous says:

    All of these shortcomings and failures, and yet we still insist every woman in America birth their child. It’s murder otherwise…. : /

  4. Amy TuteurMD says:

    Ms. Gaskin,

    You assert that maternity care would be improved by greater reliance. How can you justify that in light of the fact that:

    1. The Netherlands, the first world country with the greatest reliance on midwives, and a 30% rate of homebirth, has the WORST perinatal mortality rate in Western Europe and a high and rising rate of maternal mortality.

    2. A recent study in the British Medical Journal shows that the death rates for Dutch obstetricians caring for LOW risk women is HIGHER than that for Dutch obstetricians caring for HIGH risk women.

  5. Melania says:

    Are there any studies to back up this assertion: “The best obstetricians are those who had midwives as teachers of normal birth”
    Further how does one determine which C-Sections are “necessary.” OBs go on the information they have at the time. Our understanding and ability to monitor the womb is limited but when there is an indication of a possible problem, OBs play better safe than sorry not to get home to dinner on time but rather to save lives. It would be irresponsible to avoid a particular c-section just to satisfy some subjective criteria about acceptable rates.

  6. Anonymous says:

    Around here, the OB ARE salaried, their pay is NOT based on number of babies delivered.

    And I realize this article is addressing maternal health, not infant health, but the health and safety of both mother and infant need to be taken into account and some actions taken to prevent risk to the mother (limiting Csections for example) may lead to more injury/death of the infant.

  7. Drugfreex3 says:

    WTH? No mention of tort reform? Unbelievable in light of the fact that Gaskin mentions high insurance rates for birthing centers. Why not take care of THAT huge problem first? That would also free up gneral practicioners to deliver (I know that our family doc quit delivering b/c the insurance rates were too high). I don’t know if this omission is politically motivated (Democratic legislators generally oppose tort reform), a careless omission, or if Gaskin doesn’t see it as “an issue,” but I think that is a shame.

    Other than that, I agree with every one of these things, EXCEPT for forcing physicians to be salaried. Perhaps hospitals should figure out a way to limit the number of births that a physician attends, but I see two major problems with salaries. 1) What’s the incentive for a good doctor to really keep working hard? If he/she knows that pay is limited, I do think that quite possibly quality of care would suffer. Which is not to say that I think that docs are only after money, but I do think that they should be rewarded for their hard work. 2) Forcing docs onto salary would effectively limit my choice as a woman. If I’ve heard fantastic things about one doctor, but she’s already filled her quota of births, I have to find a different doctor, for the simple fact that there are external limits.

  8. Mom of a dead homebirth baby says:

    1. You truly expect doctors to learn from a woman who learned by watching indiginous lay midwives?? Why are lay midwives of a higher class than obstetricians? How about lay midwives getting a real education by learning from an obstetrician and doing clinicals in a hospital?

    2. The maternal mortality rate is incredibly low considering the amount of women with high risk conditions. That infant mortality rate for low risk pregnancies is 54 times higher than the maternal mortality rate. What do you think of this?

    3. You want all maternal deaths counted appropriately. What about infant deaths?? Are you willing to share how many infants die due to CPM’s? Are you willing to release MANA’s data? We want these babies counted and reviewed.

    Please reconsider the safety surrounding homebirth in this country instead of hiding the real data.

  9. Florence says:

    What is this thing about data being hidden???? WHy on earth would data behidden????

  10. Anonymous says:

    My child went into heart failure when I was four centimeters dilated and would have suffocated if we did not opt for the C-Section. I thanked God that I had chosen a fully able obstetrican and not a midwife to deliver my baby. Thanks to my obstetrician I had an easy and quick healing and I have a wonderful, healthy and strong child as a result. This article as a lot of opinions without any solid research or data to support.

  11. German Mum says:

    As someone who just gave birth in Germany, where midwives are paid for by insurance and there during delivery (alongside obs), I agree very much with Ms. Gaskin and don’t understand the vitriol here. Midwives in Germany don’t just do homebirths — they work in every hospital delivery room (including C-section surgical units) and visit new moms every day for the first 10 days to ensure everything is going well for mom and baby. 100% covered by insurance. The US could do this, too, and we’d have a lower infant mortality rate if we did.

  12. Becki says:

    “With midwives as teachers, doctors in training would be able to learn some of the ancient midwifery techniques that would help to lower C-section rates if they were applied across the country. These ingenious techniques include the all-fours (or Gaskin) maneuver to solve the complication of shoulder dystocia (stuck shoulders)”
    First of all, and someone please correct me if I’m wrong … I don’t think a maneuver to solve shoulder dystocia would do anything to lower c-section rates, would it? Isn’t it too late for a c-section by the time you get to that point? Or do you mean that people who have had previous shoulder dystocia incidents would not require a scheduled c-section because the Gaskin maneuver is guaranteed to solve the problem if it occurs again?
    Also, “ancient midwifery techniques” include whipping a woman to induce labor, sprinkling salt on the newborn and putting babies with birth defects outside so they will die from exposure. I’m not convinced that “ancient midwifery techniques” are better simply because they are “ancient.”
    “We need medical practice standards at both the federal and the state level that would address C-sections performed without medical justification and assure more mother-friendly births and fewer medical interventions during labor.”
    Agreed. Let’s try to reduce the rate of truly unnecessary c-sections. But how can you call for hospital reform without also calling for reform of the horribly broken US system of midwifery? Why not establish medical practice standards at both the federal and state level that would address problems like: 1) the low qualification standards and lack of medical education for CPMs and DEMs and 2) the fact that midwives arent required to carry malpractice insurance, so that when something does go wrong as a result of a grossly under-qualified midwife attending a homebirth, parents have no legal recourse.
    “Their babies are less likely to be taken away from them just following birth, because habitual hospital routines such as unnecessary separation of mother and baby have not been instituted at birth centers.”
    Huh? Can’t we just address that problem within the hospitals? Why do we need to establish brand new institutions to deal with a problem that can easily be resolved within the system we already have?
    “Despite the good results of birth centers and their popularity with women, extremely high malpractice insurance rates and physician opposition have forced many independent birth centers to close their doors.”
    Doesn’t that tell you something about birth centers though? Extremely high malpractice insurance rates are indicative of extremely high incidents of malpractice. What “good results” exactly are you referring to? Statistics please?
    “We have to set up for the first time a national system that makes it possible to identify and count every maternal death.”

    Good idea. Let’s also track newborn death rates *and* make sure to always indicate whether the death occurred during a homebirth, during a hospital birth, or with a mom/baby who was laboring at home but transferred to the hospital because of an emergency.
    “Home birth midwives provide postpartum visits during the days following birth as part of their routine services.”
    Can I just ask for how many days? Don’t hospitals address this issue by keeping women who have just given birth for 24 to 48 hours?
    “We literally have no idea how many young women are serving long prison sentences in the U.S. because they failed to resuscitate their babies and were charged with manslaughter or even murder.”
    This statement is really mind-boggling. “Failing to resuscitate” a baby is not the same thing as “failing to call 911 once you realize you are giving birth and have no one to help you and your baby.” I can almost guarantee, the women that you’re referring to are in jail not simply because they didn’t know what to do, but because they didn’t try, they didn’t ask for help and when it was over they tossed their poor dead baby into a dumpster. Im sorry, but being a poor, undereducated teenager is not an excuse. Teenagers know right from wrong. This statement really just seems like a thinly veiled attempt to justify the death of not just “surprise” babies but any baby born to a UC mom (or even a mom attended by an under-qualified midwife) who dies as a result of gross negligence.
    I am really astonished by how you failed to talk about the health and survival of babies in this call for reform. When I gave birth to each of my four children, I didn’t give a crap about myself. That’s not to say that mom’s health isn’t important–without mom, baby grows up without one of his/her caregivers. But I would have gone through anything, done absolutely anything to ensure the health and safety of my baby because *that* was why I was pregnant. It had nothing to do with me. In my mind it was always, baby comes first, me second. So I don’t think you can really talk about maternal health without also addressing neonatal health.

  13. mom of 2 says:

    I am always amazed at how much fear and panic accompanies the process of birth when these topics come up. Birth is a wonderful, amazing experience and from the moment that pregnancy test shows a plus sign, we begin the panic of “what if something goes wrong!” We are happy to turn over our pregnancies to OBs because our culture insists that we distrust the process, that we disbelieve that birthing is natural and that most of the time nature will take its course and all will be well. I do think it would be a wonderful thing for doctors to have to at least rotate through a midwifery practice as part of their training if for no other reason than to show them what it looks like without all the monitors, IVs, instruments and apparatus. The truth is, your average OB doesn’t do natural birth. It’s not on the menu and it’s really not an option. Women should know that upfront, rather than being told to arm themselves with doulas (not that I think doulas are bad ideas, I just think in hospital settings they’re often trying to practice yoga on top of a speeding bus) and birth plans that no one is ever going to seriously look at. When I was pregnant with my first baby I told my OB I wanted to try to birth naturally and she scoffed at me and said, “Labor hurts. Trust me, you don’t want to do it. You’ll change your mind.” Another OB in the practice, told me, “As far as I am concerned, a natural birth is one without makeup.” This is not how I approach birth or my life (I also don’t typically wear makeup and wasn’t at the time). My first labor was full of all sorts of interventions that I was too nervous, too alone (my husband was with me, but he was too deer in the headlights to advocate), and in too much pain to fend off (rupture of membranes, pitocin, epidural) and yes, I got a healthy baby, but there was something strange about it. That’s not who *I* am. My birth was a hospital procedure. It was not *my* birth. I know people get all bent out of shape when I say things like this and tell me how lucky I am that I had a healthy baby and that they can’t imagine why in the would I would second guess the decisions my doctors made, but I am fairly confident that I would have had exactly the same outcome either way. A healthy baby. I don’t think I was ever at any risk, I think it was simply that I got the standard birth my OB does, and I think that’s the point. Is the standard birth the proper standard of care? Is it really woman friendly, or does it stand on the platform of Healthy Baby and scream that if you don’t sign on you’re an evil, self-absorbed woman? I happen to think it’s the latter. I don’t think the average doctor has any idea what a typical, non-medicated birth with no interventions looks like. And that’s a shame. My second baby was born with a midwife at a birthing center and was a lovely experience. I never felt that either my baby or I was in any danger. I was supported in having the birth that I wanted at least partially because I chose the practitioner who does that kind of birth. Of course you can’t predict what will happen in birth, any more than you can predict what will happen when you get out of bed tomorrow, but the vast majority of low-risk pregnancies in women who have had good prenatal care go on to have healthy babies without need for any medical intervention. If you are in this situation, I highly recommend finding a good midwife and allowing you and your baby to experience natural birth. It’s good for both of you and it feels good. It’s an experience worth fighting for.

  14. Amy TuteurMD says:

    “The truth is, your average OB doesn’t do natural birth.”

    Really, how would you know that? Exactly how many hours have you spent in obstetrics training?How many hundreds of births have you observed?

  15. April says:

    Personally, I want my kids delivered by an expert who understands science – not someone who goes for a bunch of mysticism about wise indigenous women. I’m not knocking those indigenous tribes’ midwives, by the way – they provide the best care available for women in remote areas (although I would love to be able to send an OB there for those women!). But I don’t want to live like I’m in a remote Guatemalan village. I don’t want to turn my back on all of the information that scientists in this country have learned.

    Also, as far as postpartum visits – I am not sure why the same provider should be providing checkups on both mom and baby. I actually had an extra OB checkup to check on a minor complication; my son had extra pediatrician visits to check up on his jaundice. I wanted an expert in womens’ bodies to see me and an expert in babies’ bodies to see my son. Midwives are neither.

  16. April says:

    Oh, also, the thing about c-sections so the doctor can get home is total bologna.

  17. mom of 2 says:

    Hello Dr. Tuteur,

    You’re right. I should not use the word “average.” It implies something larger than I can attest to. It was my experience as a pregnant woman seeking an OB in NYC in the early 2000s, I could not find one that would support me in my desire to have a natural delivery. Many put it in my court and said I could certainly try if I wished, but none could say that they regularly attended women who had unmedicated deliveries and practiced natural birthing techniques. The hospitals they delivered in have standards of care which require continuous fetal monitoring, blood pressure monitoring, and, often, IV fluids. There are at least two large midwifery practices in Manhattan who have highly successful outcomes and, quite frankly, women rave about them. In my personal research simply for the purposes of my own delivery, it was fairly clear to me that choosing the practitioner that regularly attended the type of birth I wanted to have would most likely yield the outcome I desired. In my case, that was a midwife.

  18. Becki says:

    “Midwives in Germany don’t just do homebirths — they work in every hospital delivery room (including C-section surgical units)”

    German Mum: You’ve actually identified the problem. In the US, most midwives (CPMs) do not attend planned hospital births, they certainly don’t attend C-sections, and they don’t even go to med school. In fact, a medically trained and certified midwife is derisively known as a “medwife,” because in this country midwives actually pride themselves on having no medical training, performing no medical interventions and avoiding hospitals even in cases where a transfer is strongly indicated. That’s what the vitriol is all about. If our midwife model was like you say the German one is, a lot fewer people would be complaining about it.

  19. mom of 2 says:

    Hi Becki, again, I don’t think that’s entirely true either. My midwife had a degree in midwifery from Columbia University. She was not practicing witchcraft, she is an exceptionally well-trained practicioner who established her own practice and has been delivering babies for around 20 years with an exceptional record of successful births. The notion that all midwives are backwoods, untrained crazy women who are going to put you and your baby at risk to prove a point is a myth. If you want a midwife assisted birth, do your reasearch. No, this is not the American model and it may take some digging, but very good midwives do exist. People shouldn’t let the ooga-booga of the naysayers scare them away from even considering midwifery an option.

  20. NoHysteria says:

    There are many different kinds of midwives. Some, as Becki claims, probably DO pride themselves on having no medical training. Some practice without a license. Those that I’ve birthed with, however, are highly trained professionals. They get their nursing degrees and then continue their education in midwifery in a formal, clinical setting AND they deliver (thousands of!) babies in hospitals. Midwives aren’t for everyone, but women who seek a natural, drug-free, supported birth can still have such a birth in a hospital setting, with a trained professional. “Midwife” does not equal anti-medicine hippie.

  21. Anonymous says:

    While there ARE incompetent midwives out there, there are also incompetent OBs. Either way you go, you need to do your research regarding your care provider. That said, I don’t think many people realize the extent of care a good midwife provides. My (homebirth) midwife brings, among other things, both oxygen and pitocin (for stopping bleeding after if necessary). She keeps very careful records before, during and after birth and actually makes you sign a waiver stating that you will not fight her decision to transfer if she feels it is necessary. The pediatrician’s office was surprised at the amount of info I handed them on that first visit. I know a home birth is not for everyone, but know that there are very competent, very qualified, very professional home birth midwives out there that take the risks seriously and plan accordingly.

  22. Becki says:

    “Those that I’ve birthed with, however, are highly trained professionals. They get their nursing degrees and then continue their education in midwifery in a formal, clinical setting AND they deliver (thousands of!) babies in hospitals.”

    Then your midwives were CNMs, or Certified Nurse Midwives, vs CPMs (Certified Professional Midwives). CNMs are highly trained, have nursing degrees, and often deliver babies in hospitals–otherwise known in certain circles as “Medwives.” I have nothing negative to say about CNMs, I think they are qualified to do what they do. However, I would venture to say that most homebirths are attended by CPMs. CPMs scorn “medwives” because they are too much like OBs, ie., they have too much medical training. CPMs don’t go to nursing school, they have little or no medical training and so they are unequipped to handle medical emergencies. If you want the safest home birth possible, a CNM is your best option.

  23. cm says:

    “You truly expect doctors to learn from a woman who learned by watching indiginous lay midwives??” I’d like to offer a short part of a potentially very long answer to this– the statistics from Ina May Gaskin’s 30 year+ midwifery practice in TN (3000 births) are exemplary and make a very sold case for the use of midwives in low-risk pregnancies (they are published in Birth Matters and are truly astonishingly good). Also, many obstetricians *have* learned from her. There are stories in her book all about productive collaborations with doctors. Before criticizing this “witch,” I’d recommend reading one of her books. I think you’ll be surprised.

  24. Jenn says:

    I just feel the need to share that I have delivered three times in two different hospitals, all Canadian and where trained Canadian midwives practice, although I had an ob each time. Thanks perhaps in part to the old-school empowerment movement each experience respected any wishes I had, were fine with intermittent monitoring, had birthing balls and different labour positions etc. Mum and baby were not separated and breastfeeding was supported. I have no trouble thanking women who have helped get birth there as a choice. That said at this point in time I really think the natural movement has descended into an anti-evidence, anti-scientific fatalistic movement that is actively attempting to remove choices for women. I wish that the cause of high professional standards and reduction of negative outcomes for mother and baby both could remain more central than ideology.

  25. Kelly says:

    Dr. Tuteur, you should read Ms. Gaskin’s book new, where she very soundly refutes that Dutch ‘study’ you mention (as should everyone else here).

    And as some others seem to indicate, Ms. Gaskin is not a crazy lady who has seen a few women in Guatemala give birth and proclaimed herself an expert. She has 40 YEARS of experience in midwifery, has authored 4 books (that have been translated into several languages), and spoken to audiences around the world – if you listened to her speak or did any sort of research on her, you would come to realize pretty quickly that she knows what she’s talking about (why don’t you start by checking out the birth statistics at the Farm birthing center).

    And I honestly cannot believe that there are people here refusing to acknowledge that the system of birth in the US is broken. Ina May is not calling for midwives to attend all births – she is calling for them to attend normal, low-risk births – which happen to be a majority. Obstetricians are surgeons who are there to attend high risk situations, and for that they are needed. But birth itself is not an illness – it should not call for automatic medical treatment in 100% of cases, no questions asked.

    My own pregnancy and pre-natal care was handled by a highly trained midwife. My care was transferred to an OB because I was induced, and my baby’s first carer was the midwife. I absolutely plan to have a home birth next time.

    My prenatal visits were 45 minutes to an hour long – chances for me to ask the many questions I had concerning my pregnancy. My friends were telling me their prenatal visits with their OBs were 5 minutes long. That, to me, is not care – not the kind of care I want during my pregnancy, labor, birth, or postpartum. I want that kind of quickness when I need surgery – not when I don’t.

    I support Ina May 100%, and dearly hope her reforms come to pass.

  26. mom of 2 says:

    In response to cm: Thank you! I had never heard of Ina May Gaskin until I had already decided to go with a midwife but I think it is important to say yes! Of course doctors can learn from indiginous lay midwives! What we forget is that birth is, in and of itself, not a medical procedure, it is a natural one. We can intervene, monitor, and, in extreme cases, salvage it when it goes awry, but in its essence it is still exactly the same biological process it has always been. The application of medical science does not change the foundation of biological process. Lay midwives assist biological process. How can anyone watching that not learn something absolutely fascinating? How can grounding doctors medical training in images of birth as a whole, self-sufficent, empowering process have anything but a positive effect?

  27. publicrelations says:

    Jen– What do you mean by this, “I really think the natural movement … is actively attempting to remove choices for women.”? I am genuinely interested in this as I believe America would be a lot better off if our citizens had births like you described that took place in Canada. I think midwives supported by back-up obs is awesome. But in the US we’re so far from that. Women who want to have births like you experienced may not have that choice. I see lots of midwives working very hard to constantly provide evidence for the safety of various midwifery practices. In fact, the footnoting gets obsessive in the books about midwifery care just b/c the assumption is going to be that these women are “anti-scientific.” Having said all that, I am so interested in the question of midwifery PR I would like to hear more about how you think the natural birth movement could win over some fans.

  28. Jenn says:

    PR – I lost my first baby (in hospital) to a poorly managed nuchal cord accident. I had taken a prenatal natural childbirth class. When I called the instructor to let her know what happened and to talk a bit about how “avoid a csection” is not the highest goal in labour she essentially told me I manifested my outcome. That was in 2004. In 2005 when I was pregnant again my first inclination was to schedule a csection. When I voiced this opinion in a crunchy group I was pretty much told I was mentally ill. Online I had much the same response. (my high-risk old white guy ob left me the choice and just presented the risks). After deciding I would try for a vaginal delivery I looked for a doula to support my husband and I and was honest that if the labour was too scary I would go to a section. 4 doulas refused to support us on that basis. I did end up birthing naturally but it was despite the comments and lack of support.

    Starting around 2009 I began to tell my story of my first labour online. I have been told by CPMs that there is “no way” a 2x nuchal cord caused my daughter’s death. That a csection would not have saved her. I have talked about the stats on cord accidents with midwives who clearly cannot do basic math on the numbers. I’ve seen denial that babies attached to placentas can “strangle” (well ok but if the blood does not flow through the cord…)

    I have witnessed people being told to “trust birth” over and over. Well, I did the first time. My daughter died.

    Midwives have my respect when they are well trained, understand science, manage risk appropriately, do not minimize the real finely balanced biological and physics-based event that is birth, and hold each other accountable to high professional standards. In the U.S. I would be lost with all the strange designations and lack of regulation.

    But also the NCB movement has got to stop pretending that birth is always just a-ok. It really really hurts women who have poor outcomes or even just need interventions. It has become a very very woman-blaming movement if a perfect birth is not achieved…just look at Kate Tietje’s posts on this site anoint lack of bonding to see how the few hours at birth are thought to determine everything.

  29. J Braidz Housewife says:

    I cringed when I read the suggestion, in point 2, about adopting policies similar to Brazil’s, where “hospitals receive less payment from government insurance if their C-section rates exceed the standards.” I do not live in Brazil, but in Norway, where hospitals are also under pressure to keep their C-section rates down. The result? Many women are forced to give birth vaginally in spite of one or several risk factors, or in spite of a previous traumatic birth experience. A person has to apply for a C-section first, then argue for it. Some hospitals are more restrictive than others. Often the woman does not receive an answer before, say, the last week or two of the pregnancy, when it’s difficult to make plans to switch to another hospital. (They do have free choice of hospitals here in Norway, and this is actively used by people wishing caesareans. But the procedure is as follows: Switch hospitals first, THEN apply for a caesarean at your newly-chosen hospital. If no, repeat procedure at a third hospital… Obviously this is self-limiting. How many hospitals can one apply to as full term approaches??)

    My own experience: I encountered one doctor who wanted me to birth vaginally in spite of breech, being a first-time mother at age 39 3/4, a big baby, and a high probability that I would be induced. Fortunately this doctor was overruled by his supervisor, who let me decide. This was in the early nineties, some things in the system have changed since then, many have not. Because there has been so much talk about too liberal caesareans, there has been a backlash at some hospitals. (I.e., some have become more restrictive than ever, even when there are strong reasons for performing a caesarean.) At the same time, there are for a number of reasons more people with a legitimate need for caesareans. There are more twins (because of IVF), more older first-time mothers, more persons with diabetes, more overweight. So I think it is wrong to compare today’s C-section statistics with previous statistics.

    I do not know whether the hospitals here in Norway actually lose money (directly) if they perform too many caesareans, or if they just lose prestige in their field. (I am sure the latter could ultimately result in getting fewer funds appropriated, cutbacks, etc.)

    Lastly, I want to tell what these restrictive policies on C-sections have done to one family. They had two complicated births among very close relatives. The family wanted a caesarean both times, but the answer was no, because of these restrictive policies. Both children suffered brain damage, and one of these children cannot walk or talk. The family member who has told this (to me and to anyone else who will listen) developed depression and alcohol problems in the face of these two tragedies which could easily have been avoided.

  30. cm says:

    J–”I cringed when I read the suggestion, in point 2, about adopting policies similar to Brazil’s, where “hospitals receive less payment from government insurance if their C-section rates exceed the standards.”" — I’m so sorry to hear about the negative experiences in Norway but it’s worth noting that Brazil’s c-section rate is 93% in private hospitals. It seems that what we need to do all over the world is adjust the balances. C-sections are life-saving but as they come with risks are not recommended as a routine surgery for all women having babies. On the other hand, there are places where c-sections are not available (in parts of Africa) and women are dying. Seems like the idea is that we keep on eye on the percentage, we make sure that women and babies are put first (not big business) and that obstetricians and midwives can participate in a way that makes best use of their respective training.

  31. Amy TuteurMD says:

    “I’d like to offer a short part of a potentially very long answer to this– the statistics from Ina May Gaskin’s 30 year+ midwifery practice in TN (3000 births) are exemplary and make a very sold case for the use of midwives in low-risk pregnancies”

    Actually, her published statistics are TERRIBLE.

    There has only been one study of The Farm published in a peer review scientific journal (Durand, 1992). The Farm study (which is referenced on Ms. Gaskin’s site) compares homebirth to the 1980 US National Natality-National Fetal Mortality Survey and concludes that homebirth is safer. BUT, the NN-NFMS is not the mortality rate for the comparable years, it is a study of HIGH risk birth!

    The NN-NFMS deliberately oversampled high risk births. This fact is acknowledged within the Durand paper, but it is not explained. It means that the sample used in the NN-NFMS has a higher risk level than the population in general, and is much higher risk than any lower risk group. As expected, the neonatal mortality rate in the NN-NFMS sample is HIGHER than the overall neonatal mortality rate for the entire country in 1980.

    That mortality rate at The Farm is terrible and the only way to make it look good was to compare it to high risk births and hope that no one would notice. And most homebirth advocates have never noticed.

    How about Ms. Gaskin herself? She has no formal training in midwifery, nursing or any other form of patient care. She is a primary exponent of feminist anti-rationalism, which claims that invisible and unknown “forces” and “energies” control birth and that rational thought is only “one way” to understand birth.

    Her main claim to fame is the “Gaskin maneuver” which she didn’t invent and which is NO MORE effective than any of the traditional maneuvers for resolving shoulder dystocia.

    Ms. Gaskin was among the group that invented the CPM credential and then gave it to themselves in place of a college degree. She is behind MANA, NARM, MEAC and Midwifery Today. In her role as a principle of MANA, she is involved in hiding the death rates from the 18,000 planned CPM attended homebirths in the MANA database.

    I have mentioned all of these issues in public discussions with Ms. Gaskin in the past. She has denied none of them. Therefore, it’s up to women to decide if they wish to believe someone whose primary claims to success rests on the deceit in the The Farm paper.

  32. Curious says:

    I’m also interested in hearing about this hidden data. Ina May, can you speak to that?

  33. argh says:

    Amy, Have you seen the recent statistics from The Farm? Have you read Birth Matters? I’ve read comments where you accuse Ina May Gaskin of being a member of a “cult.” I think your judgment is clouded. I’d prefer to hear criticism from someone less irrational.

  34. J Braidz Housewife says:

    Dear Ina May,
    I agreed very much with your point 8 (unlike point 2, with which I already voiced my non-agreement further down). Regarding point 8, some women CAN AND DO go through pregnancy and go into labor without knowing that they are pregnant. This can happen for a number of reasons, and often because of a combination of the following:
    - Some women do not have regular periods (and sometimes not any periods) anyway, for various reasons. So when they get pregnant and don’t have periods, it doesn’t look all that different to them.
    - Or, conversely, some women keep on having periods during the pregnancy. Rare, but I understand that it does happen.
    - In addition to some of the other factors, they may have taken a pregnancy test and it was negative. (Too early.)
    - They were overweight before they got pregnant. So it looked like they gained some weight, but that’s not always something new.
    - Or conversely, they were thin, and did not gain that much weight during the pregnancy.

    Looking at documented stories of such pregnancies, I think the evidence weighs in favor of women who say that they did not know they were pregnant — as you said. And I felt that it was only fair to say this.

  35. Mama Tao says:

    Yay!! Midwives with only high school diplomas for everyone!! Whoooooo. We’ll show those evil Medwives who rules this birthing world! We could take it one step further and make all women have to take midwifery in high school so that they are midwives upon graduation!! That way we can all UC our little birth reminders at home!! Ina May, I am sooooo excited !! Let’s get this party started!!

    themamatao.blogspot.com

  36. Laughing at Ina says:

    Hey Ina Mae, I love how your CV in the past mentioned that you were a “visiting fellow, Morse College, Yale University.” Sounds impressive, right? Except some of us actually have familiarity with Yale and know that Morse College is what most people would call a dorm, and all it means is that you were a speaker at a dorm function, not endorsed by or affiliated with Yale. Way to go!

  37. Jenifer says:

    @argh- You don’t have to take Dr. Amy’s word for it, you can just look up The Farm study for yourself. They report 17 deaths from a sample of 1707 births at The Farm. That’s a pretty abysmal considering the low risk population involved. It was back then and it is now. And they clearly state right there in the methods section that “The NNS/NFMS is a probability sample of births in the United States in 1980 for which a birth or fetal death certificate was filed. Low birth weights (less than 2500 g) and fetal deaths were deliberately oversampled” If more recent data from The Farm has been published in a peer-reviewed journal, please point me in that direction. As far as I know, this is the only data they’ve published – and the numbers certainly don’t lend any support to the idea that home birth with a midwife is as safe or safer than birth in a hospital. BTW, I have no problem with highly trained midwifes fully integrated into the medical system. I’m currently pregnant with my second child and seeing a CNM in my OB/GYN group. But to pretend that there’s something superior in the safety of birth with a lay midwife outside of the medical model of care does a disservice to women. I think Ina May’s right in that there are some items on her list that we can agree on. That doesn’t mean it’s okay to sneak in some talking points completely unsupported by the evidence.

  38. NoAdditives says:

    In all honesty, there is no such thing as a normal, low risk birth. Even with a healthy mother and baby any number of complications can arise during labor. And if such a complication arises, do you want to be at home or at a birthing center when you need to be in a hospital? Do you want to endure a ride in an ambulance and hope that everything turns out ok? Or would you rather be in a hospital where a doctor can attend to any problems that may arise?

  39. frustrated says:

    The basic problem is that most hospitals (in my experience and according to the research in my area) won’t let you just show up and birth on your own. When you walk into a hospital in labor you basically accept that hospital’s protocal or prepare yourself for a big fight, and laboring women are not in a position to wage war against a hospital. So the choice has to happen in advance. Are you going to buy into what your OB and hospital consider “normal” or are you going to go outside that to find other options. I was very lucky to be pregnant near an in-hospital birthing center with a fabulously well-educated and experienced midwife. I had the best of both worlds–a completely natural experience unencumbered by monitors and tubes and hospital beds, yet only an elevator ride away from a fully-equipped labor and delivery unit that could accomodate any emergency. Why do we put women in this all or nothing position? Why can’t hospitals embrace the birthing center/midwife model? Because they make more money not to. That’s the only reason I can come up with. I completly understand why women want to homebirth. After having a “typical” hospital birth, I completly get it. I wasn’t going to do that again unless someone came up with a really good reason why I needed to. I do think lots of women would embrace midwife attended, birthing center births if they could feel as safe as I did, however. Let’s not let extreme cases muddy our perspective. We can absolutely do better than we do with our current medical system. Stop raging and start thinking. It benefits everyone, babies and moms.

  40. Jenn says:

    I don’t know why US hospitals don’t do that, but I wonder if it really would reduce their profit. I’d assume midwives are paid less so wouldn’t that mean more money per birth in the hospital’s pocket?

  41. Extremely happy with a CNM assis says:

    CNMs have a huge role to play in the course of normal births. I chose a midwife practice with extremely low intervention rates, but also about a 10% transfer to hospital rate. A trained CNM will know when a normal birth needs to be transferred. I certainly wouldn’t advocate for a home birth if one fell into any risk category, but in my case having a normal birth it was fine.

    The U.S. c-section rate hovers around 30-40% and medical costs are out of control. Birth is the #1 reason for hospitalization and yet our maternal care outcomes are some of the worst in the world. It is the rampant fear about birth and the tendency towards unnecessary interventions that keep us on this track.

  42. J Braidz Housewife says:

    Regarding the comment posted Mar 26, 8:08 PM, from “Laughing at Ina” – I looked up the subject of fellowships at Yale, it appears that these fellowships are indeed connected to the name of one of the “colleges” (meaning dorms, in this case). This would seem to suggest that Ina is telling the truth (although I could not find as much information on the subject as I would have liked). Take a look:
    http://www.yale.edu/yalecol/academics/fellowships/winners/index.html
    http://www.yale.edu/yalecollege/academics/fellowships/winners/2009-2010.html
    All of the “colleges” mentioned in connection with these fellowships (and not just Morse college), appear to be dorms from what I could find out. The format appears to be: The name of the fellowship, the name of the person winning it, and finally the name of the collge (dorm). I just want this debate to be fair. Having said that, I have already (further down) voiced disagreement with point 2, and could have expressed my disagreement with more, but others have done that…

  43. MsFortune says:

    Ms Ina May is being deliberately vague on what she means by “midwife”. If you read some of what she posted and think of a CNM (certified nurse midwife), and you think of a medically trained, post-BS professional performing that role, some of what she posted seems very reasonable, or at least not objectionable. CNMs work within hospitals and birth centers and work together with OBs. Some of them do home births as well (this varies by state and other things). They carry malpractice insurance. They are the equivalent to midwives in most of Europe in their education.

    But Ina May represents direct entry midwifes, not CNMs. She deliberately avoids mentioning the distinction. Direct entry midwives have created a designation for themselves, Certified Professional Midwife. They certify one another and require very little education or practical experience to achieve this designation. A CPM requires a GED or high school diploma, as well as either some coursework (which can be done as correspondance / oinline) or an internship. Check out the classes offered in CPM midwifery programs – they are a joke.

    CPMs typically do not have malpractice insurance, and do not practice in hospitals or birth centers.

    I think I, and other women, deserve high quality, medically qualified professionals, not hobbyist women who birth babies for fun, with little to no relevant education, limited oversight, and most of whom are infected with a ridiculous dogma about how safe and natural birth is.

    Birth is natural and wonderful and all that, but it is also dangerous and has throughout time until now been one of the main killers of women. Modern obstetrics has been responsible for a huge reduction in these deaths.

    You will take my OB away (and replace with some uneducated, self-certified CPM) when you pry my OB out of my cold, dead hands.

  44. Mom to a dead homebirth baby says:

    Actual, CPM’s do NOT need a GED or HS Diploma!! So a kid flipping burgers could just decide to be a midwife with no actual training or education! They can’t hardly get your order right and you want to place the lives of mothers and their babies in those McHands??

  45. German Mum says:

    I guess I understand that if there is no regulation, there is a problem — just wondering why the EU has a midwife’s required training written into their laws (3+ years, plus attending a number of assisted births before going solo) and the US doesn’t bother to regulate. Oh, that’s right, because Americans believe they can do everything better themselves than with government regulation. Sorry to be tart here, but this is one element that could be added to healthcare reform and instead, people bitch (inaccurately) about added costs.

  46. Lisa Tao says:

    @German Mum–we DO have regulated midwives. They are called Nurse Midwives. In many states CPMs and DEMs are working illegally. How about that, Ina May? Let’s start with having the midwitches obey the law?

  47. kat says:

    preach on, sister!!!

  48. J Braidz Housewife says:

    If all of these policies are adopted, then I’m worried about women’s freedom of choice regarding how they want to give birth. I see that these suggested policies are adapted to the preferences of SOME women (i.e., those who DO NOT want epidurals, low-threshold caesareans, etc.). But I suspect that a much larger portion of moms DO want these things, and they have been hard-won. 10-20 year ago, there were more women who begged and pleaded for an epidural (or a caesarean) than there are today.

    Here in Norway, a number of hospitals have started low-risk, low-intervention units. They offer more personalized follow-up and the same midwife all the way, but NO chemical forms of pain relief. Some women want this type of maternity care, but it’s NOT FOR EVERYBODY. Unfortunately now, because the hospitals sometimes have trouble with filling these low-intervention units with enough patients, some patients have been forced (more or less) to go there. One example: The regular birth unit was full, but one option was available for this woman: She COULD be admitted to their low-risk, low-intervention unit. It wasn’t what she wanted, she had actually applied for a caesarean but been turned down. (This happened in Bergen, Norway’s second-largest city.) And then, in Stavanger, another of Norway’s largest cities, the low-intervention unit apparantly had trouble getting enough patients. The solution? They decided that everyone who has had an uncomplicated birth is offered only the low-intervention unit. They have the option of applying for admission to the regular unit, and the answer they get will depend on the capacity there!

    They point I am trying to make is that sometimes building more low-intervention capacity is done at the expense of more conventional maternity care. Lots of women want the more conventional treatment, after all. They regard epidurals, and relative ease of getting a C-section if things get difficult, as a benefit which should not be lost. I am worried that some of the agenda above (especially points 1 and 4) will be at the expense of some of the advantages which many women appreciate, and do not want to lose, as they approach childbirth.

  49. Lisa Tao says:

    @ J Braidz…it’s as easy as getting a NURSE midwife and saying “no drugs, please”. You don’t have to have a under-educated DEM or CPM to get that. BTW, what Ina May is talking about IS reducing birth choices, just in a way that you happen to agree with.
    I don’t want to deliver my kids with a midwife who got her certification online, thanks.

  50. Lisa Tao says:

    J Braidz–I just realized that I misread your post. Sorry! Just disreguard the post above yours. My bad!

  51. cm says:

    I thought this was interesting from the Wall Street Journal today: “According to the latest data from the American College of Obstetricians and Gynecologists, nearly 91% of ob/gyns have had at least one liability claim filed against them, and 62% of the total claims were for obstetrics care, involving such cases as neurologically impaired or stillborn infants.”

  52. J Braidz Housewife says:

    Lisa Tao — No problem, and thanks for sending a correction to clear up the misunderstanding. My writing is sometimes a little bit disorganized, AND they eliminate paragraphs here. That is, I try to make my posts a bit more readable by dividing them into paragraphs, but all the paragraph formatting gets eliminated once I post it. Sigh!

  53. Lisa Tao says:

    @CM–Interesting study. It is quite common for people to get sued in this business. I would certainly be interested in seeing how many of that number actually lost the lawsuit, so we would know the amount of frivolous lawsuits vs. real ones. I am sure that a significant portion of them were dismissed.
    But his also further proves that medical practitioners are willing to carry insurance in case they get sued. Just the lawsuits being brought to court means that the families have a legal option. Unlike in midwifery where the parents are shooed away because the CPMs and DEMs have not insurance thus no money to pay off the lawyer and trial costs. Only families with disposable income are usually able to sue these midwives. And Ina May wants this for all of us! Yay!

    @ J Braidz–No the fault was all mine. I was skimming and not reading well. You write lovely! And yes, I have no problems admitting when I am wrong. It’s the right thing to do.

  54. Rufus Griscom says:

    Wonderful piece … some wise advice in here. I think, however, that we have to be careful when we glamorize other nations with higher percentages of midwives. While it’s true that we have things to learn from Guatemalan midwives, it’s also true that their infant mortality rate — 32.6 per 1,000 in 2009 — is more than 5x that in the US. Their infant mortality rate, much like that around the world, has plummeted in the last 50 years largely because medical care has been professionalized. The international infant mortality rate is currently about one third what it was 50 years ago because of the professionalization of heath care. Has the birthing process become less warm and romantic? Probably. Can we make the experience better and reduce the incidence of unecessary c-sections and other problems? Sure. But I think most rational people who have looked at the data would much rather deliver a baby in a hospital in a first world country — or at least near a hospital in a first world country — because nothing is more important than mother and child surviving the experience.

    here’s a link to infant mortality data:
    http://en.wikipedia.org/wiki/Infant_mortality

  55. Liberty Belle says:

    I would prefer to live in a FREE country, where women are FREE to birth where ever, and with whom ever they choose. Doctor, midwife, nobody or anybody – FREE to choose – where ever and with whom ever.

    If at first you don’t secede…

  56. Annie says:

    @Lisa Tao: In regards to your comment about illegal/uneducated midwives. It’s the mother’s fault if she allowed a woman incapable of birthing her child to birth her child. There are rigorous midwife certification programs across the nation that many women have, can, and will take advantage of. There are people performing back-alley abortions for money, there’s black market organs, and there are midwives operating illegally. It’s a serious job only to be undertaken by someone with the proper training and knowledge. I’m training to work as a doula right now, and I will feel in no way that I will ever be equipped to birth a woman’s baby just because I know the in’s and out’s of childbirth. MAKE SMART DECISION. Interview midwives, doulas, nurses. Hell, interview your damn OB. But don’t complain about women’s babies dying because of an ill-informed midwife because SHE’S the one who didn’t care enough to check out the credentials.

  57. Scarlett K says:

    I know I shouldn’t be, but I’m always surprised by how much venom flies around when it comes to discussion about out-of-hospital birth. I had two home water births with a very competent Certified Professional Midwife (CPM). I know other parents that used her and could attest to her ability to handle both easy and difficult births with skill. When Ina May and her friends started up The Farm, they were completely making it up as they went along, using experience, medical texts and friendly doctors as guides along the way. That’s not something that most of us would feel comfortable with, but for that bravery, I will be eternally grateful because Ina May Gaskin was not only able to give birth back to women, but to do it more safely than most hospitals are doing. She may not be a nurse, but she knows more about normal birth than just about anybody in the world right now.
    And what she’s saying about maternal deaths should be taken very, very seriously. Maternal death in the US is far higher than it should be and it’s not from out-of-hospital birth. People tend to go around and around about whether or not home birth is safe, without ever discussing whether hospital birth is safe. Medical errors are much more likely in a hospital when you’re messing around with anesthesia, analgesia, IVs, pitocin, misoprostol/Cytotec etc. and these errors can cause injury or death and are the elephant in the room. I applaud Ina May for using her considerable status to be a reasonable voice in the conversation and call for improvements that will help consumers (and OBs and hospitals in many cases, too).

  58. Anonymous says:

    @Lisa Tao, MsFortune, et al – As someone who’s pursuing her degree, certification, and licensure as a midwife in the absence of a nursing degree (thus becoming one of the “undereducated” CPMs you mentioned), I have to take extreme issue with that part of your statement. I am entering a rigorous and extremely challenging three- to five-year course of study through an accredited college – in other words, legit. I’m not majoring in midwifery through the University of Phoenix; I’m studying the coursework outlined by a nationally recognized school of midwifery under the tutelage of CPMs and CNMs who’ve been in practice for years upon years, delivering in homes, birthing centers, and hospitals. Midwives don’t go from flipping burgers to birthing babies, people – not any more than nurses or doctors do. I’ve known this is what I wanted to do with my life since I was a child and have been working exclusively in women’s health and wellness – alongside more ob/gyns than midwives, as a matter of note – since I was seventeen. It’s a calling. People don’t do things on the fly that they have passion for, and if you don’t have a passion for midwifery, you won’t last thirty seconds of an education program, let alone certification and licensure. Is birth generally a safe and natural process? Yes. Can birth go wrong? Abso-freaking-lutely; I’m alive because of an obstetrician’s knowledge and skill. Women with medical conditions which require obstetrical oversight absolutely should not be under midwifery care. All women who elect to receive care from an obstetrician over care of a midwife should do so and have their right to choose respected unquestionably. However – and this is a big however – women should unquestionably have that option whenever medically possible. Unless medical condition of mother or fetus dictates that she MUST be under an MD’s care and deliver in-hospital, she should ALWAYS have a choice of who cares for her through pregnancy and labor and birth and where she gives birth to her child – and that choice should be respected, without judgment or condemnation. I could not be any less anti-obstetrics if I tried; I have extreme respect for the field and the people in it. I simply want to offer women another option – not better or worse or indifferent to the care an obstetrician provides. I am not a “hobbyist woman who births babies for fun,” nor am I “infected with a ridicules dogma about how safe and natural birth is,” and that implication is offensive in the absolute deepest terms. The profession of midwifery is being painted with a very broad brush, and it’s incredibly upsetting. I’ve wanted to be a midwife since I was five years old. This is the work I feel called in life to do. Women will want to see me, just like they want to see existing CPMs, because of my credentials and because of how I do what I do. If it’s not for you, please continue to see your OB with my blessings.

  59. MsFortune says:

    Anonymous, I applaud your passion. Back it up with a real medically based education as a CNM or an OB if you want to be taken seriously. A CPM is an inferior option to an OB. I’m sorry that this hurts your feelings but it does not make this less true.

  60. Alecto says:

    “Medical errors are much more likely in a hospital when you’re messing around with anesthesia, analgesia, IVs, pitocin, misoprostol/Cytotec etc. and these errors can cause injury or death and are the elephant in the room.”

    Really? Do you know this because you have a medial degree, or because you read some posts on an Internet message board?

  61. Lorette Lavine says:

    What a lot of controversial comments. What we want is a healthy mom with a healthy baby…that requires a healthy pregnancy.
    I think that Ina has some good points but would have to see the evidence based studies to back up her claims before enacting some of her suggestions.
    One thing I would like to see is uniform courses of study for midwives, the education requirements should be the same as should the licensing just as we have in other professions. Unfortunately when professions are educated on different levels as nurses are the playing field becomes murky.
    I would encourage pregnant women to choose carefully where and who they want to be involved in the birth of their child. It is one of the decisions of a lifetime. http://www.parentingintheloop.wordpress.com

  62. mom of 2 says:

    @ Anonymous–I am very pro-midwife and birthed with a CNM, but I am curious about something that I thought you might address. You sound young and clearly your calling to midwifery has been something you’ve knownn since you were very young. For someone like you, who can choose one of several paths toward midwifery, why choose the CPM route rather than the CNM route? I am not judging one over the other, I guess I always thought of CPMs as something closer to a career change, meaning that they would have had to repeat educational levels already passed to get to the CNM and for practical reasons chose not to start over entirely. (I don’t know why I think this–I may have just made it up.) Anyway, I would love to hear someone like you talk about choices when it comes to this career path. What are the benefits of the CPM route to someone just starting out? How do you make the choice between the two? And, ultimately, is there a difference in approach or methodology that people should be aware of? And honestly, I would love someone to speak to this–I feel there is so much confusion over the different “types” of midwives and that creates a lot of the conflict and argument we see in these comments and in the midwifery issue overall.

  63. metalmum says:

    I agree with her especially when it comes to medical education. Nowadays, most obgyns don’t even know how to induce labor naturally.

  64. Anonymous says:

    As a mother of a child with a severe heart defect that went undiagnosed during pregnancy I am personally grateful for the system we have in the US. My little came out pink, crying, 7 lbs 6 ounces, 10 fingers, 10 toes… Seemingly perfect. I really do not believe a midwife would have caught this or at least not soon enough. I am glad they took my little boy out my room less than 45 minutes after being born to take his oxygen, pulse, etc if they hadn’t or had they given me the hours of bonding I had initially thought I wanted before doing these tests he might not be here. While your points are valid, and I was once an almost believer (to the point I was supposed to deliver at a different hospital that did not believe in separation of mother and baby, but they were full when I went into labor)I am ultimately grateful for the system here because it might just save some innocent babies lives.

  65. K says:

    This is my fist pregnancy but as an American who is a New Zealand resident I can tell you that from what I hear from you all state-side I consider myself so lucky to be birthing here. First of all we have a wonderful government subsidized healthcare system here which provides free midwife care for every pregnancy. Pregnancy visits with my GP are free, I just met with an obstetrician this week for free including an ECG scan, ultrasounds cost $25. Hospitals have a breastfeeding policy (if you feel strongly about bottle feeding you must provide your own formula) Also because I may likely suffer from Postnatal depression I have been referred to Maternal Mental Health who are going to visit me post birth at the hospital and make home visits. We also have a plunket program where nurses visit the home’s of babies to help mothers/answer questions. I think that Anonymous below has the wrong idea about midwifery- this doesn’t mean that you don’t have full hospital care if that is what you want or required for you birth -midwives work with your doctors.

  66. Lena says:

    Private hospitals in Brazil will not be affected by the government regulations; most public hospitals in Brazil cater to the poor. No middle to upper class Brazilian woman would dream of going to a public hospital for anything.

  67. Heather says:

    The smart thing to do is to ignore “Dr” (she does NOT hold any sort of medical license, and hasn’t in a very long time) Amy. She makes it her mission to find every article out there about midwives and try to stir up trouble, generally making claims that no one but she, herself, supports. Somehow, she has an inordinate amount of time to spend on this activity.

    For those who don’t know, the Cochrane Collaboration, the western world’s premier medical impartial research analysis body, has analyzed the available research on midwife-attended home birth vs hospital birth and come to the conclusion that, for a low-risk mama/baby, homebirth is not more dangerous than hospital birth. Yes, when attended by a CPM!

    To answer questions, midwives generally make home visits daily for two or three days after the birth, then at a week and 2 weeks, and, at least in CA, one brings the baby to the midwife’s office for the 6 week visit. They are, of course, trained in newborn care, just as they are trained in normal pregnancy and birth, and when to transfer because things have left the realm of normal. Why would a midwife need the rest of a nurse’s training? Most of it has absolutely nothing to do with labor and birth–and the anatomy study and such that do ARE part of the CPM program. It is a fantasy dreamed up by “Dr” Amy, and a few of her cohorts that CPM’s are not trained. They have both textbook and apprenticeship training, in fact.
    (And, frankly, if I were MANA, I wouldn’t give “Dr” Amy the time of day, let alone access to my data! Why? So she can twist conclusions out of it that are clearly not supported by the data?)

    http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000352.pub2/abstract;jsessionid=2E90867002D4E5503C03B6CDA53A1CF8.d03t03

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