Birth Wars
Whos really winning the homebirth debate.
Mention that you are planning a home birth and it might be as if you had just brought up Sarah Palin or Palestine: brace for family feuds, public denunciations, and offhand remarks that imply you are selfish and stupid, your midwife is a quack, and your unborn child is a victim already in need of social services.
If you’ve made a documentary that is critical of standard American hospital maternity wards and portrays home birth in a decidedly more flattering light, you might be likened to Nazi propagandists by an obstetrician, as Abby Epstein and Ricki Lake were after they screened their film The Business of Being Born at St. Luke’s Roosevelt hospital in New York City. Or if you appear as a pro-home birth guest on a TV show hosted and produced by doctors, perhaps called The Doctors, get ready for opprobrium of this sort: “You don’t want to be responsible for the death of your baby or the death of your wife!”
That’s also the bad-parent card played by the American College of Obstetricians and Gynecologists, the standard-setting professional organization of doctors for women: a woman who chooses a home birth “puts herself and her baby’s health and life at unnecessary risk,” says a 2007 statement on the subject. “Choosing to deliver a baby at home . . . is to place the process of giving birth over the goal of having a healthy baby.” Ouch.
Such is the pitch of the “home birth debate” in the United States. And yet, the the research evidence suggests a more nuanced conversation. Home birth by choice among healthy women in industrialized countries has been studied for four decades. There have been dozens of studies published. The largest to date, published in April in the British Journal of Obstetrics and Gynecology, looked at more than 500,000 births to healthy women in the Netherlands and found that no more babies died among those who planned to give birth at home than those who chose the hospital. “The opinion that a hospital birth is the best option for every woman is increasingly being challenged,” write the study’s authors. “These results should strengthen the policies that encourage low-risk women . . . to choose their own place of birth.”
A 2005 study of 5,000 planned home births in North America, published in the British Medical Journal, also found that babies were born just as safely at home, and that the mothers did much better than compared to similarly low-risk women who had intended a typical hospital birth – with a C-section rate five times less (4% v. 20%) and with hardly any inductions, episiotomies, epidurals, vacuum extractions, or forceps. (A proportion of women who plan home births transport and deliver in the hospital, mostly for non-emergency reasons, depending on how integrated the system is. In the States the rate is around 12%, in the Netherlands around 30%.) In a 2007 review of twenty-eight studies of planned home birth, The American College of Nurse Midwives found such optimal outcomes and safety among home births to be true across countries, health systems, and midwife credentialing systems. In other words, the available body of research suggests that for healthy women with access to care, home birth is a low-risk, high-benefit choice.
This body of research evidence has been enough to convince the American Public Health Association: “Recognizing the evidence that births to healthy mothers . . . can occur safely in various settings, including out-of-hospital birth centers and homes,” the organization ” . . . supports efforts to increase access to out-of-hospital maternity care services.” The international consensus is that women should have the option. The Royal College of Obstetricians and Gynecologists, together with the Royal College of Midwives, says that there is “ample evidence” to “support home birth for women with uncomplicated pregnancies.” The 2007 joint statement continues: “There is no reason why home birth should not be offered to women at low risk of complications and it may confer considerable benefits for them and their families.” The British government, in fact, is now nudging healthy women to stay home. ACOG, meanwhile, likes to pass out a bumper sticker to its members: “Home Deliveries are for Pizza.”
Melissa Cheney is an assistant professor of medical anthropology at Oregon State University. Last year, she got a call from a physician from a county in Southern Oregon with a higher-than-average rate of poor baby outcomes and deaths. “He was trying to explore the hypothesis that midwives and home birth were what was driving deaths in their county,” says Cheney. He told her he knew of three deaths related to home births. Cheney got institutional review board approval from the university to investigate his hypothesis. She was given access to the county’s vital records and hospital databases, and followed this with interviews of medical staff where a death was believed to occur. An independent statistician reviewed the findings. But she could find no deaths. “The physicians were saying that there was a ‘stream of dead babies.’ My question was, where are they? There were no vital records, no death certificates, no statistical evidence of them.”
Cheney asked the physician who had called her if he personally knew of the three deaths. “It was, ‘Such and such doctor told me . . . ‘,” she says. Basically, it was a rumor mill: stories of women and midwives who had transported in labor from home to hospital that had become stories of dead babies. But it hadn’t happened. “We found zero deaths,” says Cheney.
Her findings didn’t go over so well with the task force of 15 physicians that had chosen her – nor did the fact that she is a certified professional midwife (she got the credential so that she could have access to the midwives she wanted to study for her dissertation). “There was a lot of disbelief among the obstetricians of our findings,” she says. “They called me a baby murderer, they accused me of pseudoscience. I thought, these people are not going to be convinced by the data.” Which led her to do a qualitative study of providers from the community. “What we found is that the animosity is so high between midwives and obstetricians that all kinds of rumors spread that are unsubstantiated. A woman and her midwife would transport for something relatively benign, and three or four OBs away, the story was that the baby came in half-dead. You know that game Telephone? That’s the folklore, that’s what becomes the institutional memory.”
When she asked the physicians if they were familiar with the large studies suggesting that home birth is safe, that an emergency transport is the exception to the rule, they admitted that the research evidence did not match up with their lived experience. (After all, they only see the transports, not the 88% of women who give birth uneventfully in their living rooms.) It doesn’t help, says Cheney, that our vital records are threadbare and that we have no standardized surveillance of infant or maternal death in the United States. This enables medical staff to operate on anecdotal data, which are the transports. “They’re using these to judge the entire home birth movement,” says Cheney. This is a natural human tendency, to base knowledge on anecdotal experience, “and we have science to help us get around it. But for this topic it’s not happening.”
“What’s interesting is why these twenty-nine studies have not swayed public opinion and not been integrated into the medical establishment,” she says. “People deeply, deeply believe that a baby cannot be born without massive amounts of medical intervention, and it’s nearly impossible to overturn that cultural norm. There’s something blocking people from operating on the basis of the balance of evidence. There’s much more evidence on the safety of home birth than there is for elective cesarean section or so many of the other things that we do as a matter of course. So why is that? That’s my work.”
In the case of Amy Tuteur, MD, Cheney has her work cut out for her. For several years, Tuteur, better known online as “Dr. Amy,” ran the web site Homebirthdebate.com, whose tag line was “countering the misinformation of homebirth advocacy.” From 2006 to early this year, she posted to this site almost every day, entries titled like “Another Homebirth; Another Baby Dies a Preventable Death,” and “How to Tell if a Homebirth Midwife is a Quack.” But she also ventures off-turf, to the Chicago Tribune, to Slate, to Lamaze’s blog, to Huffington Post and Babble – to anywhere a story about home birth pops up. And there in the comments section she tries to whack it down.
Then there’s the name-calling. “The most important piece of information that every woman should know about homebirth is that all the existing scientific evidence to date shows that it has an increased risk of preventable neonatal death,” she wrote on Slate.com. “Even the studies that claim to show that homebirth is as safe as hospital birth, actually show the opposite.” This is a typical Tuteur declarative. She has read the data and done her own calculations, and she believes a different number than the one that was peer-reviewed. This is usually challenged by several readers or activists, some of whom have been summoned like a volunteer fire department to respond. A “debate” then ensues, in which Tuteur charges that the study’s authors are, simply, wrong. Then there’s the name-calling. The researchers, which she often names, are “biased,” pulling a “bait-and-switch,” and women are falling for it. “I have written repeatedly about the fact that while homebirth advocates claim to be educated . . . they are easily duped because they lack the most basic knowledge about science, statistics and childbirth itself,” she writes.
So omnipresent has Dr. Amy been on the boards that she began to take on a mythical status among the home birth community. Some activists believed she wasn’t real, that her picture and bio were fake, that she was a mere avatar for some sort of underground ACOG propaganda machine (rumors live on all sides).
But “Dr. Amy” is real. I sat with her, face to face, for nearly three hours at a Starbucks off Route 1 south of Boston a couple years ago. She is not a researcher, not an epidemiologist, and probably not on anyone’s payroll; she is an obstetrician-gynecologist who left private practice more than a decade ago because, she told me, she’d had it with HMOs and wanted to spend more time with her four kids (she let her license lapse in 2003, according to the Massachusetts Board of Medicine). And for some reason, which I never quite got to the bottom of, she believes in every cell that Home Birth Kills Babies (that’s in fact the title of her most recent post on her new site, The Skeptical OB), and no amount of research evidence will convince her otherwise.
Though the American medical establishment doesn’t go as far as Tuteur in denouncing the evidence base, it also won’t be convinced: “Studies comparing the safety and outcome of births in hospitals with those occurring in other settings in the US are limited and have not been scientifically rigorous,” states ACOG in a press release that renews their “longstanding opposition” to home birth. ACOG’s statements are generally made without reference to any studies, and after I emailed the organization asking for references and clarification on what “rigorous” entailed, they still did not provide any citations. “The highest level of evidence come [sic] from randomized, controlled trials,” they wrote back, adding, “As a health/medical writer, one would expect you to know what qualifies as ‘rigorous.’”
The randomized controlled trial provides the evidence base for “evidence-based medicine,” the movement toward employing only those treatments that have passed rigorous clinical study. Considered to be the gold standard, the highest quality research evidence obtainable, the RCT is basically the classic high school science experiment: divide two groups of subjects with the same characteristics, assign one to treatment A and one to placebo, and observe the outcomes. ACOG’s response is doubly ironic because obstetrics has arguably been the slowest specialty to adopt the philosophy of evidence-based care – indeed, most labor interventions became routine without any study whatsoever, and several, like continuous electronic fetal monitoring and episiotomy, continue to be used even though copious evidence has proved them unnecessary and potentially harmful.
These policies may increase the risk to women and babies. They do have a point about there being no RCTs on home birth, which is often the same point Tuteur makes when she criticizes a study for not comparing apples to apples. But there’s a good reason for it: how many women would agree to be randomly assigned to where they will give birth? Not many, researchers have found. “It has been shown that conducting a randomized controlled trial is not possible,” write the authors of the Dutch home birth study. “Good quality observational studies are therefore the only source of evidence on this subject.” In evidence-based medicine, observational studies are second-tier (because the characteristics of groups A and B are not tightly controlled), but with home birth – and breastfeeding, and other large questions about childbirth for which women will not be subjected to random assignation to answer – they are best evidence possible.
Which brings the debate over safety to a bit of an impasse: if the only research that will satisfy those with authority and power is research that is unfeasible, the controversy will never be resolved. There could be 20 more large, observational studies that come to the same conclusion as those that already exist, but they still wouldn’t be randomized controlled trials. The home birth advocates would continue to say “The research proves it’s safe!” and the American medical establishment would continue to say “The research isn’t good enough!”
The physicians are of course entitled to their opinion, but this opinion is often presented as fact, with the weight of medical authority. An American Medical Association resolution passed last year states without qualification that ” . . . the safest setting for labor, delivery, and the immediate post-partum period is in the hospital” or accredited birth center, and promises legislative action to discourage birth outside it. Again, there is no research cited to back up this claim – because there isn’t any. “We don’t have evidence that home is safer than hospital, or that hospital is safer than home,” says Soo Downe, a researcher with the Cochrane Collaboration, the international authority on evidence-based medicine. “There’s absolutely no evidence either way at the level of randomized controlled trials.”
One of the reasons the medical side has a hard time accepting home birth is that they forget that there are risks to being in the hospital. “It appears that being in a big and busy place with the attitude that birth is dangerous until proven otherwise may bring risks to women,” says Downe, like higher rates of unnecessary surgery and invasive procedures, separation of mother and baby, and emotional trauma. Melissa Cheney calls this phenomenon “multiple interpretations of risk.” “The physicians are talking about dangers to baby, while the mother might be talking about the dangers to her own body, or the danger of feeling victimized by an unnecessary cesarean, and having to go on and parent from a position of victimization. Her definition of risk tends to be much broader.”
Cheney would like medical staff to see the home birth population as a cultural group, with its own language and value system, and for the staff to have a degree of cultural competency. The lack of cross-cultural understanding breeds hostility in the community and in the delivery room during a transport. “There can be a lot of mother blaming or midwife blaming,” says Cheney. “This can produce a very very hostile environment, just at a time when it is crucial that the doctor and midwife communicate across that divide. The outcome is very dependent upon that communication.”
Meanwhile, more and more American women want to give birth outside the hospital setting – and economists have shown huge potential cost savings in terms of health reform – yet physicians’ groups are fighting to keep certified professional midwives marginalized, and in some states, criminalized. The ACOG and the AMA policies prohibit physicians from collaborating with CPMs, which contributes to the hostility, and which may in fact contribute to a birth outcome that’s worse than if a woman’s choice had been supported and the midwife and physician had been encouraged to collaborate. In other words, these policies may increase the risk to women and babies.
Many physicians do support home birth midwives, and they are furious that their professional organization would not only try to dictate what women should do, but also how they should practice. In an open letter castigating ACOG and AMA, Canadian obstetrician Andrew Kostaska, MD, urged the American obstetric establishment to “join the 21st century.” “Informed choice is the gold standard in decision making, and it trumps even the largest, cleanest, randomized controlled trial,” he wrote. “Science supports home birth as a reasonably safe option. Even if it didn’t, it still would be a woman’s choice . . . As scientific evidence supporting its safety mounts, however, [ACOG and AMA] will be forced to accede or get left behind.”
More great info from Jennifer Block. Thanks for writing/publishing. There should not be “wars”, though. Women should be able to make informed decisions about what they want without pressure from either side. I think that if more women were aware of the facts and taught beforehand what to really expect and how to deal with birth, they’d realize it was NOT typically a medical event and be more empowered to go the midwifery route. This is a case of what’s old is new again information. Read The Red Tent! Read Misconceptions. Read Ina May’s Guide to Childbirth. “Natural” is not some cruncy/lifestyle tag, it means what it meansthe way women were meant to give birth.
1 in 74 women in Pakistan will die from pregnancy related complications. Doesn’t sound too safe to me.
http://www.nytimes.com/2009/07/30/opinion/30kristof.html?_r=2&scp=1&sq=crisis%20in%20the%20operating%20room&st=cse
“About 1,600 Afghan women die in childbirth out of every 100,000 live births. In some of the most remote areas, the death rate is as high as 6,500. ”
http://in.reuters.com/article/southAsiaNews/idINIndia-33312820080430
I wonder how many with dead babies or women that died would have wanted a hospital assisted birth.
Walking down the street in some areas of Pakistan or Afghanistan is not safe, Ali. Typically, we thinking people do not compare statistics from war-torn or developing countries with those of Western, industrialized countries to come to conclusions about things.
Why has the rate INCREASED in the U.S. since 1975…maybe because of increase interventions?
http://www.infoplease.com/ipa/A0004395.html
Why do other Western, industrialized countries have lower death rates than the U.S.? Could it be there is better integrative care and fewer interventions?
http://www.wrongdiagnosis.com/c/childbirth/deaths.htm
I don’t know, but just putting more data out there.
I wonder, and if there has been some info, someone please point me to it…how much does the rate of Female Genital Mutilation play into the rate childbirth-related deaths in the two countries mentioned? Sorry to go off on a tangent, but it makes sense to me that the extreme trauma suffered by many women in Islamic countries would make their birth experience exponentially more dangerous, just as a repeat c-section is more dangerous than a first, a third more dangerous than a second, etc.
So, the article didn’t actually answer the question it posed: who IS “winning” the homebirth debate? Probably not women or babies, since they’ve become contested spaces rather than people. Shame shame.
well, myanna, here is but one study:
http://www.bio-medicine.org/medicine-news/Female-Genital-Mutilation-May-Lead-To-Difficult-Childbirth-3ARep-10838-1/
although I don’t think it is so prevalent in Afghanistan
i used to agree witha lot of principles in this article until my own homebirth in 2007 went awry due to my midwives not properly recognising that my water had broken. three days later finding myself in the hospital in septic shock, and waking up after a three day coma to take my child off of life support because she did not survive the massive infection from the chorionamnionitis was obviously not at all what i understood as a risk with homebirth, especially after a completely normal and uneventful pregnancy. it could have all been so easily avoided. in my circle it was totally a given that a woman was meant to give birth at home and to mistrust the hospital birthing system and everything else that came along with it. i regret my blind faith, and find myself resentful towards articles like this for personal reasons obviously, but ultimately hope that no matter what choice a woman makes that she is fully informed of her options and to not take the process of childbirth for granted. whether in a hospital or at home or in a field, be informed.
I’m all about statistics. If there is no proof that home birth is less safe than hospital birth then so be it, I’m inclined to believe it.
However, why take the chance? You’re talking about your wife and your soon-to-be-born son or daughter. What if something happens that isn’t “natural” and your wife starts bleeding profusely? The mid-wife’s gonna cauterize the bleed and then suture her up? What if the baby is breech? What if the baby’s heart rate drops and/or can’t be located?
Aside from the breech birth, this is what happened when my wife gave birth to our son. There was blood everywhere, he was premature and his heart rate was weak - and it was f–king scary. Thankfully, we were surrounded by a team of excellent physicians who treated her and my son and both are fine five years later.
No way in God’s green earth I would choose for her to deliver at home when there is a safer alternative down the street. Even if it’s just “perceived” to be safer, so be it. It may be just as safe, but I would never choose it.
This is really about choice. I do not want anyone else but me and my husband to make choices about where, when and how I give birth. Not to mention what shots or drugs I or my child takes. But it requires an educated, informed decision. It requires people to read and do their homework, more than just reading “What to expect when your expecting”. Visit the hospital, meet the nurses and other doctors who will most likely be present when you give birth, meet midwives and doulas, lots of them.I went to Canada to have my second baby because my insurance company and hospitals were making decisions for me. Please check out the film “Pregnant In America”. http://www.pregnantinamerica.com.
Dear Ms. Block,
Let’s make it very easy for women to compare and contrast the claims:
I challenge you to a public debate on the safety of
homebirth in any neutral forum of your choosing, whether print, other
media or a public appearance.
We can address these specific points:
1. All the existing scientific evidence (including the Johnson and
Daviss BMJ 2005 study) shows that homebirth with a direct entry midwife
has nearly triple the rate of neonatal death for comparable risk women
in the hospital.
2. American direct entry midwives do not meet the standards for
licensing in ANY first world country. They do not meet the standards in
the Netherlands, the UK, Canada, Australia, anywhere.
3. The Midwives Alliance of North America, the group that collected
the statistics for the BMJ 2205 study) has continue to collect safety
statistic from 2001-2008. They are currently hiding those statistics
from the public. They should be required to release those statistics so
women can decide for themselves if CPMs are safe practitioners.
4. According to the World Health Organization, the US has one of the
lowest levels of perinatal mortality in the world, lower than Denmark,
the UK and the Netherlands.
I welcome publicly debating you or any other homebirth advocate in
any neutral setting. I’m not holding my breath though; neither you nor
any other homebirth advocate will agree to a public debate because you
know my data is correct and my case is airtight. No one in the world of
homebirth advocacy can risk the embarrassment.
For complicated reasons, my husband and I choose to get pregnant during
my third year of medical school. By amusing happenstance, I completed
my 6 weeks of basic clinical obstetrics during the third trimester of
my pregnancy. Let’s just say it was easy to focus on the study
material!
Being pregnant while delivering other women’s babies created an easy
connection, and often the women would ask me about my own preparations
for birth. As always, I kept the conversation focused on them because
that’s what we are taught is professional, but this time there was an
additional reason: I planned a homebirth and didn’t want to start an
emotional discussion.
My obstetrics professors were very straightforward about the lack of
evidence behind most labor protocols. I admire that. Early on, I hit
PubMed and the Cochrane database and started looking things up for
myself. I thought about what the evidence told me would be the best
possible birth. I watched several deliveries. I pulled Federal data
about hospital handwashing and computer keyboard hygiene. I saw many
women asked to push on their backs, despite evidence that the pelvic
outlet is larger in the squatting position. I saw Code Whites – the
local lingo for a crash cesarean – and vacuum deliveries. I saw cord
accidents and babies stillborn in the hospital. I saw many women happy with their epidurals, and babies saved by medical intervention.
Neither place could be 100% safe. It’s a trade off. In one setting I
am 10 minutes further from the OR, in the other I am at risk for MRSA.
In one I can’t get morphine or an epidural, in the other I can’t change
position to ease labor or get away from the incessant overhead paging.
As the evidence shows (500,000 births in the Netherlands!) the actual
outcome of morbidity and mortality is a wash. The risks assumed in
each setting actually do statistically balance evenly.
As it turned out, I had a lovely delivery. There were a few
interventions which really helped me out that were only available
because of the setting I chose.
Fortunately, some homebirth midwives in my area are putting a great
deal of effort into healing this breech (apologies for the pun). At a
recent evening interest group for 1st and 2nd year medical students
considering fields which include obstetrics, the panel included an OB,
a Family Doc, and a DEM (homebirth midwife). The OB was civil, at
least, and all three agreed that 95% of women probably could deliver
safely at home, there was just some polite disagreement about who was
going to decide who the other 5% were. I was so glad to see that
discussion happening. I think the divisiveness and rancor creates an
unsafe environment for women.
just curious…amy tuteur, are you really no longer licensed, a SAHM who is obsessed with homebirth just for funsies? what got you started???
I think many home/natural birth detractors don’t get what really happens during some homebirths…when I read on the WHO website and Dr. Amy’s blog that “the WHO specifically recommends screening tests, routine
ultrasound, Rhogam, intensive screening for pre-eclampsia and external
version for breech”
it suggests that midwifery doesn’t include these things in its protocols..which is odd because I had all those sorts of things when I went through a midwife practice…
like all things, there are degrees of quality in practices…maybe a midwife/natural practice isn’t for everyone, if they are not the type who wants to dig in to stuff…and also, quality midwives aren’t available to everyone or to everyones insurance…
all that said, I think the whole home birth/natural birth thing is very misunderstood
Having participated in dozens of births at my medical school (I’m not an OB, but the hospital where I did my OB rotation is the place where 16,000 births take place every year, so we saw a lot!), and delivered two of my own little beasties in the hospital, I wouldn’t want to have the baby at home. Granted, at our hospital there was a whole midwife ward where the uncomplicated pregnancies went. We rotated over there, but a lot more babies were born on the complicated side. Having seen what things could go wrong, and go wrong SO quickly – it would have to be the grand poobah of all midwives to get me to have a baby outside the hospital. I recognize that I’m obviously very comfortable in the medical setting, I understand what’s going on there and I feel empowered there, and how another woman without an MD could very easily feel overwhelmed and left out of her own birth experience. But hey, birth is an overwhelming experience anyway.
Birth is also super messy – I liked an environment where no one could possibly ask me to clean up afterwards
GP: right on! I had rhogam after my homebirth, and received all routine screens. I think people just don’t realize.
I’ve known too many women who have needed emergency c-sections to save the life of the baby (including myself) to ever recommend a home birth. Giving birth is a medical procedure.
Different people prefer different things. What may be right for one family may not be right for another. Instead of passing judgement why don’t we embrace the diversity of birthing routines and welcome the many wonderful lives they bring.
In as much as the Cheney would like to have this group treated as a
cultural group, and they probably should, seeing as how it’s treated
with religious-like zeal, they would still be held in the same contempt
as any other religious group who withholds medical treatment for their
children.
Can someone answer Tuteur’s points?
medical treatment is for sickness and disease
pregnancy and birth is not sickness nor disease
@GP-I also had various screening tests, screening for pre-eclampsia, RhoGam, and ultrasounds during my care by a homebirth midwife. After the birth (which went very smoothly at home), I had minimal stuturing and a few remedies to stop slightly heavy bleeding. Close attention was paid to my bleeding with pre-preparation for hospital transport made by my midwife and her assistant in the event that the bleeding had not stopped as quickly as it did.
@Emily Brideau-I realize this is only a minimal point in your overall comment, but although birth is messy, my husband and I did not have to clean up ANYTHING after our daughter’s homebirth. The midwife and her assistant cleaned the bathroom (where my daughter was born) changed sheets on the bed, helped me to clean myself as necessary, prepared a little food for us after and did the dishes, put a load of laundry in, and did not leave until 1. they felt the baby and I were medically ready 2. they felt my husband and I were emotionally ready and 3. there was no evidence whatsoever that a birth had just occurred in our house.
GP - Pregnancy and birth may not be sickness or disease, but it sure does kill a lot of women.
Honestly I think the one thing people keep missing on this whole debate is that OB/Gyn practices have such a high rate of malpractice suits many of them frivolous or overblown. This is why most OB’s are so quick to cut or call for a c-section. Maybe if they weren’t in fear of their jobs half the time they would develop protocols for introducing new research and procedures and phasing out the old.
Frankly I don’t think homebirth is the answer, no matter how easy your pregnancy has been the facts still are that Mom could bleed out in less than ten minutes and baby could suffer permamant brain damge after only two minutes without oxygen. No one lives close enough to a hospital to get there if in that kind of time period. Until the transporter from Star Trek becomes a common feature in our homes, homebirths will carry a big element of risk.
I find it interesting that the article’s only focus on death’s since there are many other possible negative outcomes from childbirth. How many homebirths result in Cerebral Palsy? How many hospital births result serious infections? This is something that effects this debate immensely and are much more likely to happen but its so often ignored.
Thank you, Ms. Block, for your informed research and writing on this topic.
I’m a scientist. I can read and understand statistics. Please, for the love of women’s health, let’s make the statistics available! Why do we have to go to other countries to find consistent data on maternal morbidity and mortality? An OB/GYN is going to have a point of view based on the births, including those following high-risk pregnancies, that he or she has seen. A midwife is going to have a point of view based on the births she has seen. I, as a mom, am ultimately responsible for the health and wellness of myself and all of my children. I would love access to standardized data on the risks to life and health of moms and babies born at home, born at birthing centers, born in hospitals, born vaginally, born via C-section, assisted by epidurals, assisted by Pitocin… let’s gather the data in a consistent way and make it available!
I think is is so wasteful that people cannot be more accepting of all birth choices and respect women’s rights to choose. Home birth advocates are not trying to make all women home birth, they merely want their choices legal and safe.Homebirth is rightly an emotional issue for the ACOG board whose primary mission is to protect the financial interests of its members above anything else, but for everyone else, what is the problem?
“Mom could bleed out in less than ten minutes and baby could suffer
permamant [sic] brain damge[sic] after only two minutes without oxygen”
I guess it’s pretty awesome then that midwives carry oxygen rigs with
them and have multiple meds ready for injection in the event of
hemorrhages. (plus lidocaine for repairs, electric pumps for clearing
airways, etc, etc, etc.)
The thing most med focused people don’t realise is that a home birth is
equipped with exactly the same tools as a primary care hospital is.
And, noone is freaking out about women delivering in primary care
hospitals. Frankly, a crash c-section at a primary care hospital in
off hours could prove as devestating as requiring a crash c-section at
home.
I’m a doula in a large Canadian city where our midwives have hospital
admitting privileges, good working relationships with the Obstetric
community and well-defined parameters for determining what is and isn’t
high risk (and believe me, for all their “natural ways” these midwives
are very conservative when it comes to suspecting and consulting for
possible complications). I am one of a solid dozen women practicing for
up to 12 years in this city and that’s a lot of births we’ve attended.
The only fetal demises anyone’s ever experienced have been in OB led
births in hospital. The midwives here have amazing outcomes.
Personally I think it’s very telling observing the modus operandi of groups like ACOG and individuals like Amy Tuteur – they’re entire focus is on discrediting home birth stats, seeking to limit women’s choice and viciously attacking anyone who is supportive of home birth as a option for childbearing women. These people are not interested in the health and safety of women and babies, they are interested in controlling women and babies.
Let’s start with the US government data. In 2003, place of birth was required on the birth certificate for the very first time. The first data set (available on the CDC Wonder website) includes 2003-2004. The neonatal mortality rate for DEM (direct entry midwife, another name for homebirth midwife) assisted homebirth is 1.15/1000, almost double the neonatal mortality rate for hospital birth with an MD (0.61/1000). This is all the more remarkable when you consider that the hospital group contains women of all risk levels, with all possible pregnancy complications, and all pre-existing medical conditions. An even better comparison would be with the neonatal mortality rates for CNM assisted hospital birth (0.37/1000). The risk profile of CNM hospital patients is slightly higher than that of DEM patients, but CNMs do not care for high risk patients. Compared to CNM assisted hospital birth, DEM assisted homebirth has TRIPLE the neonatal mortality rate.The data for 2005 has recently become available. Homebirth death continues to be far higher than death in the hospital for comparable risk women. In 2005 the neonatal death rates were CNM in hospital 0.51/1000, MD in hospital 0.63/1000 and DEM attended homebirth 1.4/1000.
The think I’ve always wondered… why is it that “people” assume that nothing will go wrong at the hospital, that the OB/GYN will never a mistake, that mid-wives are “less knowledgeable”.Someone above pointed out that a woman can bleed out in less than 10 min. and that a baby will be brain damaged if oxygen deprived for more than 2 min…. You don’t think these same things can happen at a hospital? I’ve given birth in hospital twice… with absolutely no interventions/problems but I can still see how being in a hospital wouldn’t be innately ‘safer’. I personally spent 20 min of my very short (45min) active labor all by myself in a hospital room….. all kinds of bad things “could” have gone wrong. I think if all of the politics were set aside, babies and their mommies would be best served by a combined co-operative midwife/OB system.
Amy, so actually, women should really have a CNM as their primary care giver in the hospital, and OBs should only handle the highest risk profile patients, since the CNMs have the best numbers, per you.
You also ran a set of numbers up on your site that showed that when OBs attended home births, they had a higher mortality rate the the DEMs. If anyone can catch a baby, and OBs are so much smarter that DEMs, how come they couldn’t prevent more deaths?
Personally, I believe that women should be given the information as neutrally as possible and allowed to decide for themselves, based on their needs/wants, where they want to give birth. Birth plans, within reason, should be followed by their attendees (be that an OB, a CNM, or a DEM). And they should be supported in their decision regardless of where that is. Trashing women for giving birth at home or at the hospital is unhelpful to say the least. Babies and moms live and die in both places.
To clarify Amy’s 2nd post on infant death, I too, just input the same query into the CDC Wonder website and chose 2005 deaths broken down by care-provider and see that the rate ofCNM attended births is 2.88MD is 7.17other midwife is 3.69 deaths per 1,000 birthsAmy will pick and choose her data to satisfy her scare tactics. For those of you who aren’t familiar with the omnipresence of her aggressive posts like this, she is not one likely of sound mind. It saddens me that she chose to stop practicing medicine to be with her four children but the number of hours this woman is on line ranting and raving is far more than what could be considered “healthy”.Dr. Amy go get some help for the sake of your family. And yes, this is the first time I have posted to you, having seen your work elsewhere. Sigh…..
Meagan said: “OB/Gyn practices have such a high rate of malpractice suits many of them frivolous or overblown.”
Can you back that claim up with data?
Also, how sure can you be that your will receive the emergency care you need in an actual emergency while in the hospital? You are aware that a surgeon is not always readily available to perform a crash c-section on admitted patients, right?
“so actually, women should really have a CNM as their primary care giver in the hospital, and OBs should only handle the highest risk profile patients, since the CNMs have the best numbers, per you.”No, that’s not what those numbers indicate. The MD group includes all the high risk patients. It includes all the C-sections for fetal distress, all the serious pregnancy complications, and all the serious pre-existing medical conditions, as well as the CNM and CPM patients who developed complications and needed to be transferred to MDs.”You also ran a set of numbers up on your site that showed that when OBs attended home births, they had a higher mortality rate the the DEMs. If anyone can catch a baby, and OBs are so much smarter that DEMs, how come they couldn’t prevent more deaths?”MD out of hospital births include births in the parking lot, the emergency room, by the side of the road, etc.
“To clarify Amy’s 2nd post on infant death,”
You’ve made one of the most common errors committed by homebirth advocates. You’ve looked at infant death (from birth to 1 year), instead of looking at neonatal death (from birth to 28 days).
In addition, you need to correct for risk factors so that you are comparing like to like. Therefore, you need to exclude premature babies, severely underweight babies, and those that have maternal risk factors like being very young or old. In addition, virtually all homebirths are to white women and race is a risk factor, so African-American women must be exclude from the hospital group as well.
This is why professional homebirth advocates refuse to appear in any setting where the audience might be familiar with medicine and statistics. It sounds impressive to a lay person to claim that infant mortality is high in the US, but it’s not so impressive if you know that’s the wrong statistic to use.
Can someone answer Tuteur’s points?Generally we don’t feed trolls.
What about fetal distress caused BY the hospital’s interventions “Dr” Amy? Whether coincidental or ON PURPOSE?
This link has links to other sites that talk about this:
http://pregnancy.about.com/b/2009/07/10/pit-to-distress.htm
And, there’s the gloriously gentle way infants are treated:
http://www.youtube.com/watch?v=WATnDPSs3iI
I say, no thanks, hospital!
DEM, direct entry midwives, are not the only midwives to assist homebirths. CPM, certified professional midwives also assist home births.
It’s about informed choice. Women should have access the the best care regardless of when they choose to birth. That goes for the hospital as well.
Amy, you were well advertised in this article and you are living up to the reputation. I’m sure if someone wants to find you, or your site, they will.
“What about fetal distress caused BY the hospital’s interventions “Dr” Amy? Whether coincidental or ON PURPOSE?”
What about it? The death rate at homebirth is higher.
Even if you think interventions cause problems (and you’ve supplied no scientific evidence that they do), the death rate at homebirth is higher. So if you are worried about the “dangers” of the hospital, you should be appalled that the dangers at home are worse.
Amy,
Your first point, about OBs handling high risk & the emergencies and those counting towards their mortality, doesn’t negate my point that CNMs should handle the low risk (and qualified high risk) and the OBs focus on the high risk. Wouldn’t that be a better use of the resources too, since OBs require a lot more training (it is a surgical specialty, isn’t it?)? Why waste their talents on low risk women giving birth to babies that, as you’ve pointed out, a tax cab driver could catch? Why can’t OBs act like cardiologists, who are referred patients whose conditions indicate the need for a specialist?
As for your second point, it actually helps my opinion that using stats available online like this does not present a real picture of what is going on. Honestly, I didn’t think about the unplanned/emergency births. In order to compare those stats, I would only want filters showing the planned births vs low risk births for OBs. It’s not fair to the OBs to attack their numbers when they include unplanned births or high risk births. I would want to know how many home births became transfers, and of those which became emergencies (and/or resulted in maternal or infant mortality and morbidity), and somehow reflect those numbers in the home birth group & hospital group. But no filters I’ve seen on either side do that.
Who is winning the birth wars? I think it is personal injury lawyers…in the mid-to-late 1990s, a surge of successful lawsuits alleging that cerebral palsy was a “birth injury” made these predators a mint. The unintended result is that inductions and c-sections have gone up exponentially for traditional OB patients, while the rate of CP hasn’t budged. The women who speak out after undergoing these procedures have caused a very justifiable backlash toward birthcenters, midwives and home-birthing….but midwives (for whom I have a great deal of respect, by the way) will not be safe from these bottom-feeders, either. Mark my words, by 2015, these providers will be as regulated, malpractice-insured and expensive as traditional OBs are now.
Why does anyone even care how another woman chooses to give birth?I admit I can get very frustrated by people who choose to not vaccinate their kids, but that is because its effect on public health and the fact that the data is so clear on the benefit of vaccines. When it comes to homebirth/natural birth/epidural/C-section, etc. – why does anyone even care? Even if you do believe that the maternal/perinatal death rates are higher (something that does not seem clear to me at this point), this still does not affect you or your family.I personally chose to give birth in a hospital because I was more comfortable there and I wanted access to pain meds in case I wanted them. A lot of women are more comfortable at home. Why does this have to be turned into a “war”?
http://www.cfmidwifery.org/pdf/MFCevidencehighlights13B.pdf
http://www.motherfriendly.org/pdf/CIMS_Evidence_Basis.pdf
Information from http://www.motherfriendly.org/downloads.php, the Coalition for Improving Maternity Services. Includes detailed evidence-based research… a near 100 page report.
part of why this discussion is so difficult is that homebirth advocates are knowledgable about hospital birth AND homebirth, but OB’s are only knowledgable about hospital births. They can’t, truly, even understand that birth is its’ own event, and it looks different in different settings. They keep picturing their hospital version of birth in a home setting, and then shudder the thought. Can homebirthers imagine a hospital birth in their bedroom? Complete with sterile drapes, stirrups, newborn bassinet warmer, EFM, IV pole, etc…? Shudder the thought! Once you see birth as its’ own event, the absurdity of unnessary procedures begins to put you on a slow burn. The hospital setting can only offer their own version of what they think birth should look like. The home setting offers an environment in which birth is allowed to occur in its’ natural state, which has the most promise of safety. It’s not as if all those interventions have no inherent risk to them. Look up the work iatrogenic. Can we ever begin to calculate that into hospital birth statistics? You bet your booty they cause some of the very problems they “save” women/babies from.
Okay first off Saaraaa 1) I have actually heard about the fact that American Ob/Gyns have the second highest number Malpractice suits of all the specialities from a couple of sources but the most recent place I have heard this is from is Dr. Dave of The Mom Show on the Discovery Health channel. Its also noteworthy that the reason they get sued so often is because problems in deliveries develop in a matter of minutes and when things do go wrong the results are often truly catastophic. This is also somethingof a problem for all branches of medicine (plastic surgery is number 1 in terms of the number of malpractice suits) in your country since the laws about this don’t do much to protect doctors.
2)The difference between giving birth in a hopital or clinic versus a home isn’t the surgeon its the packs of 0-neg on ice. No midwife carries blood and when your losing it at a rapid rate the single pack of fluids they might carry, won’t cut it. Also I think its imporatant to mention that not every midwive would carry even that,(or be able to get it since they have no official status) since their are often little to no standards on such things in many parts of the US.
I know some think freestanding clinics are a good compromise but the problem I have with that is it seems to be an inefficient use of resources to build an entirely new structure for only one purpose. Not to mention there is something very Handmaid’s Tale about isolating giving birth that way.
Meagan H,
Things can go horribly wrong in a matter of moments, true, but that’s not why OBs get sued left and right. They get sued because sick babies are great money makers (what percentage of birth-related lawsuits are for dead babies? I bet fewer than 5%). You would imagine that rise in intervention would lead to a decrease of lawsuits, but I don’t believe that is happening. Too much money can be made. Personally, I’m for tort reform to protect doctors, hospitals, and insurance companies (because every lawsuit they go through increases their fees to you and me) from multi-million dollar lawsuits. I bet a $500K cap would bring the number of lawsuits down.
If having a freestanding clinic is inefficient, isn’t it inefficient to tie up hospital beds with women who don’t want/need an epidural, or are having a tame labor? Wouldn’t those nurses and doctors be better put to use putting all their energies into the woman with pre-e, or the twin delivery, or the woman having severe contractions? I don’t think all women should give birth at home, and I don’t think all women should give birth in a hospital. I do think it would be cheaper and more efficient to have the low-risk population treated by the non-surgical specialists. Or should everyone with a stomach ache go see a gastroentemologist (SP)?
Clementine, your post is actually a very good example of the lack of information the general public has about what home birth midwives bring to the table.
No, CPMs don’t carry blood transfusions. But this does not mean they aren’t well-prepared for the possibility of hemorrhaging. For that situation, they carry methergine and pitocin, the latter not used for augmenting or inducing labor, but specifically for hemorrhage. There’s also a technique called bimanual compression which, especially combined with pit, would be used until further medical assistance in the event of a transfer.
So many people STILL really do think midwives show up with candles and incense and a wooden spoon to bit down on. In addition to the above example, they carry oxygen, suturing kits, lidocaine, resuscitation equipment, and on and on.
YIKES, the above post was meant to address Meagan, not Clementine. The formatting of the names after the posts befuddled me. Apologies!
So what Dr Amy is really saying is that 99.5% of babies born in hospital survive and 98.6% of babies born at home survive. So really, both are pretty much as good or bad as each other and so really, 98.6% of women who want a home birth should be allowed a home birth. Thanks Dr Amy!
If hospitals weren’t so depressing and nurses so busy and overworked then maybe more people would be willing to give birth at the hospital. I truly believe if I had recovered at home and not at the hospital I would have been more successful at getting my breast milk supply to come in. My recovery in the hospital was miserable and depressing and Kafkaesque. We live in Brooklyn, NY and the hospital at which I gave birth is located in one of the most fashionable neighborhoods in the city, and yet the hospital is a total dump. If the medical community wants women to choose hospitals then give us better hospitals. Doctors should put their influence and pressure there, not towards scaring pregnant women who are simply trying to choose what’s best for them.
So now readers have learned a piece of information that homebirth advocates like to pretend does not not exist. According to the US government statistics, homebirth with a direct entry midwife has almost triple the neonatal death rate of low risk hospital birth. In fact, the most dangerous form of planned homebirth in the US is homebirth with a direct entry midwife.
Now let’s address another point, the difference between American homebirth midwives and other first world midwives. Many people are confused on this point. The majority of midwives in the US are CNMs (certified nurse midwives). They are excellent healthcare providers and are equivalent to the midwives of Europe, Canada and Australia.
Only a tiny fraction of midwives are direct entry midwives. CPM (certified professional midwife) are direct entry midwives. They have completed a certification course and a brief apprenticeship. They are a second, inferior class of midwife and the credential does not meet the requirements for licensure in the Netherlands, the UK, Canada and Australia, or ANY first world country.
The
American nurse midwifery degree is a masters level degree. The
European, Canadian and Australian midwifery degrees are college level
degrees. Homebirth midwifery is a post high school certificate. In fact, the courses for the certificate are not accepted for college credit at most colleges because they are not considered college level courses.
Let’s look at clinical experience? The following is a comparison of the
clinical requirements for European midwives and homebirth midwives:
EU midwife————————- homebirth midwife
100 —– pre-natal examinations—– 75
40 —– deliveries—– 25
40 —– caring for high risk patients—– none
100 —– postpartum patients—– 40
40 —– newborns who need special care—– none
So
when it comes to clinical requirements, homebirth midwives have 25-60%
LESS experience caring for healthy women, and NO experience caring for
pregnancy complications and NO experience caring for newborn
complications. This illustrates one of the central shortcomings of
homebirth midwifery training; there is no experience diagnosing and
managing complications.
Anyone can catch a baby; no special
training is required. The most critical function of a birth attendant
is to diagnose, prevent and manage complications. Homebirth midwives
have literally no clinical training in doing so.
Amy, those numbers for clinical requirements are not true in every state. In Washington state, for example, midwives must attend 100 deliveries to get their license, so actually more than twice the number that an EU midwife requires. And obviously, in caring for those 100 women through their childbearing year, they will also have more prenatal and postpartum experience than the EU midwives by the time they are licensed. They won’t get experience caring for high-risk patients, since that’s outside scope of practice, but they will get experience identifying and transferring women who present signs and symptoms of no longer being low-risk.
@birthandbundle…
I would like to clarify your claims about personal injury cases that concern babies being money makers…That is incorrect. Any first year law student will tell you, that they learn in torts class, that infant death is not a money maker. Civil suits, or torts, are based on the ability to earn income….a baby is not considered a “damage” to the family, financially. (emotional damage is certain, however is not considered much in the law). That is why most of these suits are filed for malpractice on the mother, not on the baby. If the doctor is found to have committed malpractice, the family is eligible for punitive damages (punitive means punishment). That is where the money lies…and that is the choice of the client, not the attorney to seek such.
Personal injury is an important part of the civil procedure…How would you feel if you were hit in the head by a falling can at the grocery store, became incapacitated, unable to work, and risked losing your home and life in 6 months or less because of the negligence of someone else? I think you would seek out a “bottom feeder” pretty quickly in that scenario. These laws protect people and may be abused by some, but have a place for everyone, including you.
legal eagle – but who makes these decisions? Juries? I am not an attorney, but it would seem that emotion could sway a jury, who wouldn’t necessarily understand medical/scientific information and not understand when someone was being truly negligent.Please clarify if there is something I misunderstand.
I think we need to stop treating pregnancy as an illness or a disease. It is neither of those things; birth is a natural process that should not take place in a hospital setting. Hospitals are great for treating illnesses and disease; if they can follow their own sanitary guidelines. OB’s are trained to get a baby out, and are a great resource for complications; but those are not the norm. A healthy baby is not a tumor that needs to be removed surgically. Many women still feel the need to deliver their babies in a hospital, becasue we have all been conditioned to believe that we can’t handle this very natural process. The whole system of obstretics needs to be re-evaulated. Pumping a women full of drugs to “manage” her delivery is dangerous to the mother and the baby. I don’t think it is on our best interest as a society to contiinue to treat pregnancy as an illiness and to take a woman’s choices and rights over her body and her baby away from her.
In response to Amy Tuteur: It is my role as a journalist to report
on the evidence
base–that is, published, peer-reviewed research, and published,
peer-reviewed critique of that research. I encourage you to publish your
findings in a peer-reviewed journal. Non-scientists “debating” the
science does a disservice to both
the science and the women caught in the middle. (See brilliant comment
above:
“Who IS ‘winning’ the homebirth debate? Probably not women or babies,
since they’ve become contested spaces rather than people.”)
Pulling numbers from the CDC Wonder web site to compare the outcomes
of place of birth and birth attendant is not appropriate for a number
of reasons, first because there’s been no analysis to control for confounding variables, and also because there’s no mechanism to
separate
births that were intended to happen out-of-hospital from those that
were
unattended accidents. Your statement about birth certificates doesn’t
check
out. This from Melissa Cheney:
“Oregon did not start collecting data on
planned homebirth until 2008,
and that data is not available to researchers yet. I know because I am
first on the list to receive it. The US standard birth certificate is
not used in all states and even with it, there is no way to distinguish
between assisted and unassisted home deliveries. No one in the research
world thinks vital records is adequate for tracking homebirth outcomes.
It is simply not designed for that.”
In response to the accusation that the Midwives Alliance of North America is “hiding statistics,” it is my understanding that there are close to 18,000 records on planned, CPM-attended home births that the organization is working to make available to researchers, so that statistics can be gleaned. But like many databases, it will not be available in its raw form to the general public. Researchers will have to apply for access by submitting protocols, which is common in the research world.
Jennifer Block
childbirth is not an illness, this is certainly true, but it is an accident-and-trauma-prone situation. Wouldn’t it be nice if all accident-prone events could take place with well-trained hospital staff and state-of-the-art equipment at the ready?
I was a healthy 31 year old during my uneventful, low-risk pregnancy. The delivery went very smoothly but was unfortunately followed by massive hemorrhaging and uterine inversion. I lost 50% of my blood volume and because I was in a hospital I not only walked away with my life, but with my uterus as well. I would not have survived if I didn’t have immediate access to blood (I had 5 tranfusions in total). Also, my doctor was able to reposition my uterus because it was still flexible; most women who go through what I did lose their uterus. Statistically, home birth seems to be as safe but personally, knowing I was almost that 1 in 100,000 (or whatever the maternal death rate is), I would only want to give birth in a hospital. When you are seconds away from death, all statistics go out the window. What matters is that someone has to be that 1 and that 1 could be you. Why risk it? Especially now when most hospitals are more open to a woman’s preferences. If you find the right doctor and hospital you can avoid drugs, bring your doula, use a ball, tub, birthing stool, etc.
I continue to be baffled that people think their anecdotal experiences are relevant to “prove” something, scientifically or not.
I am sorry for people who underwent medical trauma, and for the poster who lost her child. Those must have been terrible things to experience and it makes sense that they could emotionally shape and bias your perceptions.
However, this does not mean that your individual experience outweighs actual evidence and statistics and should be used as a decision making factor on whether or not home or hospital birth is better for women in general.
“why risk it?”
Why risk not being able to move? Why risk not being able to eat or drink? Why risk not being permitted to birth in a position comfortable to you? Why risk having someone give you a drug you don’t truly understand? Why risk not being in control of what happens to your body and your child? Again, it is about choice. If you don’t want to birth at home, don’t. But women who want to, should have access to quality care and back-up care, just as women who birth in the hospital should have access to informed choice and refusal and have their wishes respected.
Nice, Jen.
CEA’s points mirror my own. Why take the chance of something bad happening when that can be avoided?
As ridiculous as our health care delivery system is, capitalism and a lack of direct government financial support put hospitals are in direct competition with one another. Since we enjoy our status in the US as one of a just a handful of countries with a positive birth/death replacement rate (more births than deaths), there’s lots of babies being born out there and lots of hospitals that would like to have the business. To that end, as CEA points out, you can find a hospital that will cater to your preferences. Everyone is trying to get you in the door, just like any other business.
I agree women should have the choice, but man, seems like a dumb choice to me. Sorry if that offends, but wow…what a tragedy that could have been avoided.
I continue to be baffled by people who comment on other people’s posts without fully reading them (ann05). No where in my post do I attempt to “prove” anything. In fact, I concede that statistically a home birth seems as safe as a hospital birth. My point was that “I” am not a statistic and if you are that 1 in whatever where something goes wrong, then no amount of statistics or scientific evidence will make you feel better.
Birthing isn’t about hard numbers. It is personal experience that varies from individual to individual. The hospital isn’t right for everyone and the home isn’t right for everyone. There is no “one size fits all” answer to this question. Women are bombarded from both sides about what they “should” do. What women need is to have control over and support for their birthing experience. I was simply sharing my experience, not trying prove anything.
Im disappointed in your unwillingness to debate, Ms. Block, but Im hardly surprised; I predicted it.
Non-scientists “debating” the science does a disservice to both the science and the women caught in the middle.
Im a little confused. You obviously think you know enough science to write a book promoting the safety of homebirth, run a website promoting the safety of homebirth, write articles in magazines and across web promoting the safety of homebirth, but you dont think you know enough to debate the scientific evidence about the safety of homebirth? If you dont know enough to debate me, how do you know homebirth is safe?
It is my role as a journalist to report on the evidence base–that is, published, peer-reviewed research, and published, peer-reviewed critique of that research.
Then why do you consistently ignore the overwhelming majority of papers published in peer review scientific journals that show that homebirth increases the risk of neonatal death?
Pulling numbers from the CDC Wonder web site to compare the outcomes of place of birth and birth attendant is not appropriate for a number of reasons
Then youd better call Johnson and Daviss and tell them to retract the BMJ 2005 paper since they used the CDC data for 2000 in their paper.
it is my understanding that there are close to 18,000 records on planned, CPM-attended home births that the organization is working to make available to researchers, so that statistics can be gleaned. But like many databases, it will not be available in its raw form to the general public.
Thats flat out false. MANA has ALREADY offered the raw data publicly back in 2006. According to an announcement placed in the NARM (North American Registry of Midwives) Summer 2006 Bulletin.
… aggregate statistics describing births contained in the Midwives Alliance (MANA) database … These items include number of births, numbers of transfers, cesarean sections, etc
The data made available from the Midwives Alliance Statistics Project can be very useful for lobbying or regulatory purposes. It puts the control of the data in the hands of the midwives. Having state level data can be useful when trying to get a bill passed, but it can also be useful to show that midwives are involved in self-assessment and accountability. In other words, it shows your numbers but also that you are on top of things and will be in the future. It is much stronger than just a flash of numbers at bill-passing time, and might boost your chances of avoiding your regulatory board feeling the need to monitor you in some other way …
So the numbers are freely available to anyone who wants to use them to lobby on behalf of homebirth, but they remain hidden from the general public.
Finally, Ms. Block, this is not about the right to have a homebirth. Any woman can have a homebirth if she chooses. This is about the right to have accurate information so women can make informed decisions. Your 3 page Babble article is typical of homebirth advocacy information: it is filled with mistruths, half truths and outright deceptions. And it is notable for the dramatic omissions such as the failure to mention that CPMs (certified professional midwives) do not meet the educational and training standards for midwives in ANY first world country (unlike CNMs who meet and exceed those standards).
Women are ethically entitled to accurate information. If you are willing to publicly proclaim that homebirth is safe, you ought to be prepared to defend that claim publicly. Your unwillingness to do so, indeed your claim that as a non-scientist you are not qualified to do so, speaks volumes.
Funny, I had a “1 in 1000″ event during my birth as well: my daughter was born ‘in the caul’ as my water never broke. Yes, someone has to be the “1″ that something happens to, but if actions should be taken in fear of that “1,” then no one should do anything. For those posters who had something go wrong during labor, you have my sympathy, but that does not negate that home birth can still be a safe option for low risk women. We can trot out our horror stories of hospital birth or home birth and use those to illustrate our point, but anecdotes don’t prove anything.
Amy: “If you are willing to publicly proclaim that homebirth is safe, you ought to be prepared to defend that claim publicly”
Here the catch, how do you define “safe?” Note I am not saying “safer than,” but “safe.” I consider that having a +98% chance of having an uneventful labor and delivery as being safe. You don’t. Who sets the lower limits for safety, you or me? I don’t disagree that 99% is greater than 98%, mind you, just that 98% is pretty darn safe and I’m will to “take the risk” as some here would say. Shouldn’t the judgement of safety be left to the individual?
Birth Works… because it’s ancient
P
Aren’t cats, dogs, horses, cows, elephants, monkey’s and all the other female mammals of the animal kingdom so unlucky that they don’t have the opportunity to give birth in hospitals… to scream out in pain because they feel so unsafe and to have their babies taken away from them for tests and made to bleed because they haven’t been given respect and privacy to keep them safe. Those other mammals really don’t know what they’re missing out on. Maybe we should hunt them out and force them to give birth at a veterinary clinic. Then they’ll birth ‘properly’ the way nature intended.
on another note… let’s get homebirth midwives properly trained then! why force women to birth in a hospital? why not make it safer to birth at home where we’ve been doing it since time began. at some point in evolution there must’ve been people who knew how to help a labouring/birthing woman without having to have a bachelors degree. it’s great that obstetrics can save so many lives, but lets make midwifery more skilled so they don’t need to be saved in the first place. i think it’s sad that we’re all fighting against Dr Amy since we all have the woman and the baby’s best interests at heart. i think Dr Amy needs to think outside the box a little and maybe set up a school for homebirth midwives to learn the warning signs early on so there’s no emergency or panic. women need to feel safe during birth to make birth safer but obstetricians and hospitals don’t always do that. all over the world midwives are not being taught the crucial information they need to keep birthing safer. let’s change that rather than automatically turning to obstetrics.
on another note…. I think we need to all stop fighting and start educating. Dr Amy has a point… IF homebirth midwives aren’t being trained properly then let’s train them! Dr Amy as well as everyone else on this website has women and baby’s best interests at heart. Maybe if she started thinking outside the box a bit and set up her own school to train midwives properly to learn the warning signs early on so that homebirth can be safer we would get somewhere. We can’t stop anyone from birthing where they want to and we shouldn’t make them feel guilty or ashamed of it… but we do need to give them good information and good medical support. Let’s train midwives even better so we don’t have to rely so much on obstetricians. Women need to feel safe and supported during birth so that birth is safer. Obstetricians and hospitals don’t always do enough to make a woman feel safe… that needs to change. It’s better education all round that we need… not arguing on who’s better than who.
Great article. Thanks Jennifer. I believe that women should have the right to birth where THEY want! Give them information and let them decide. Don’t try to scare them into choices.
I just wrote a post about restaurant wars and birth wars. How do they connect?
http://enjoybirth.wordpress.com/2009/08/04/restaurant-wars-and-birth-wars/
Enjoy!
CEA, I read your post. And believe it or not, I had a traumatic birth too and was glad for the hospital’s interventions.
However, this doesn’t mean I should dictate to my friends (most of whom had successful home births) that they need to make their choices based on my experience or my opinions.
In fact, my experiences DON’T MATTER in comparison to actual reason and science. But many studies have proven it’s hard for humans to take reason and statistics over anecdotal experience and gut feeling (i.e., we worry more about guns killing kids than swimming pools).
I’m sorry for anybody whose birth didn’t go the way they wanted it to, believe me, but anecdotal evidence is simply not relevant, and how you think people should feel about the experience based on your own is also simply not relevant.
Personal experience.
1 horrid mis managed hospital birth leaving me traumatized and violated.
4 amazing sacred homebirths.
Not “proper research” but very very real.
I think the point of this website is to inform and promote conversation about various issues affecting childbirth, parenting and families. I have read many interesting articles on this site but this is the first one that compelled me to comment as I had a relevant experience.
When I was pregnant and deciding what birthing experience I wanted to have, I didn’t pull out the latest compilation of birthing statistics… I read several books and more importantly, I talked with other women. I spoke at length with my sister who had an emergency c-section, my sister-in-law who opted for forceps over an emergency c-section (I didn’t even know forceps were a possibility, yikes!), my co-worker who introduced me to Hypno-Birthing, my other co-worker whose wife delivered in a tub at a birthing center and it was these stories that prompted me to discuss all sorts of scenarios with my doctor and my husband, so they knew exactly what was or was not acceptable to me. It was these stories that helped me formulate my birth plan.
Actually birthandletbirth, my Hypno-Birthing teacher also delivered her baby in the water sac and so when the resident wanted to break my water I said no as I knew it wasn’t necessary, because of my teacher’s anecdote. Unfortunately, my entire birthing experience did not turn out like I expected although the part that mattered the most – the delivery of a healthy baby girl – was perfect. And that is why I shared. Sometimes the unexpected happens.
My husband and I are considering moving. And yes, I looked up the school placement and crime stats for the neighborhood but another important factor in our decision making will be the experiences and opinions of others who already live there.
Again, I am not trying to “prove” anything, just offering another experience for consideration because I think anecdotes are worth considering, in conjunction with other information and data, and that this forum is the appropriate place for them.
Amy Tuteur MD: You offer nothing to back up anything that you claim; you offer no sources.You have done nothing to prove your point. You are the FOX news of the anti-home-birth movement. Congrats. You have propagandized your self in such a way that nothing you say will ever be redeemable on this site ever again. Enjoy being the sham of the sheep industry. Baaah.
CEA, you are absolutely right. I take back my previous statement and amend it with yours:
“I think anecdotes are worth considering, in conjunction with other information and data….”
The opinions of individuals influences many of our choices. I don’t buy things just because they are the best per the manufacturer, but how it compares with others and what users think of it. And I know I’m not the only one who does that.
What does disturb me that almost all the moms I’ve known have put more effort in getting information on their new car, or TV, than on the doctor or hospital where they gave birth. They can tell you all about how their vacuum cleaner works, but ask them what GBS is, or what the potential side effects of an epidural are, and they look at you like you have three heads. Invariably it seems they have traumatic labors ending in C/S. There’s something wrong with that picture.
can someone OTHER THAN AMY TUTEUR please parse all this stuff about neonatal mortality vs infant mortality for me. i’m too stupid to figure this all out. also, what about stuff like babies being injured seriously? are there stats on babies who suffer irreversibly in hospitals from interventions/infections? Or at home?
“why risk it?”
Ask VM, BJ, and JMG, who gave birth at St Barnabas Hospital in NJ.
Another risk to hospital birth – pissing off the doctors and the state kidnapping your baby.
Ok ~ probably NOT gonna happen…but it has, and more than once.
And if you want to talk risk…why risk driving? I believe you have a greater chance of dying in a car accident than in childbirth (oh, and a hospital birth requires a drive, probably not under the best of driving circumstances). Why risk sitting in your home? You could be invaded and robbed. Why risk going to work? You could end up like the people in the World Trade Center towers. Why risk getting pregnant? You could get sudden eclampsia and you and the baby die, and no one be able to stop it, even IF you plan a hospital birth. Why risk a hospital birth? MRSA is rampant in hospitals and kills. (Just to name one risk of hospital birth that is almost non-existant at home).
My point is…life is full of risk. And the only sure thing in life is that it will end in death, be it prenatally or after 100+ years outside the womb. All people die. It is tragic for the family when a baby dies, but we need to understand that death and risk are a part of life. Life itself is risk. My guess is many of the people judging women for taking “unnecessary” risks of homebirthing think nothing of breaking the speed limit or talking on the cell phone (or both at once!) while their kids are in the car. Why risk it, I ask?
People who choose homebirth have by and large done the research and realize that we COULD be a statistic. BUT, we also realize that we could be a statistic in a hospital. The thing it comes down to, is who are you willing to trust? Your (God-created or evolved via natural selection) body, or some guy with a college degree that may not listen to a word you’re saying or respect that you are the expert on your own body? Trust in God/nature, or trust in a medical specialty that uses many practices that are not evidence-based, and some of which have been shown to be potentially harmful?
Home birth, hospital birth. Both have risk. Both are as safe as life gets. Regardless of your decision, you trade one set of risks for another. No one should be able to make the decision about what’s best for me or my baby, except ME.
CEA, you are right, and I would have given birth at a birth centre or hospital that was supportive of natural birth and allowing the option to follow what evidence-based research supports for a low-risk mother and baby. However, this was not available to me, so I chose a homebirth with a midwife. (I’m living overseas, so am not speaking about a US setting.)
I wonder why Dr. Amy hasn’t written a scientific article published in a peer reviewed journal that “debunks” all the latest research on homebirth? Isn’t that what most credible and dedicated scientists in a field do?
Also, it would be interesting to see her publish a book that scientifically counters the other books out there that identify what evidence-based research has shown is best for the labour and birth of low and high risk women and babies.
For a stay-at-home-mom who doesn’t appear to want to practice medicine anymore, has no professional affiliations, and isn’t doing academic work at any university faculties in the field of obstetrics and gynecology, she sure does a lot of reading of the research and has supposedly kept herself “current” in the field over the last decade that she’s been out of professional life and ferrying kids to soccer practice. It is truly surprising that she hasn’t channeled all that energy and time staying current into a body of reputable academic work like journal articles or books. Instead she merely posts internet blog entries and writes feedback on other blogs etc. If she wants people to take her seriously, maybe she should be more serious about her pursuits?
One traumatic home birth: a thirteen minute shoulder dystocia, managed properly by skilled DEMs, and a baby who emerged with no vitals and was revived within a minute by those same attendants. I am also not a statistic, but I wonder how well we would have fared in a hospital, with an elevated stress response, limited mobility, a supine position, restricted food intake, and possibly drugs in our systems. How fast would my baby have revived under the effects of my epidural? However, none of this matters, as with my thirteen pound baby I never would have been “allowed” to attempt to birth “naturally”. (Women, beware of any environment that as a matter of policy removes your basic human rights!) I am much more concerned over the numbers associated with elective cesarean than home vs. hospital.
The same week my baby was born, another baby was born under the same complication in a local hospital and the dystocia lasted nine minutes, with a much less fortunate outcome. This of course is anecdotal, but we must remember that people are not statistics and a hospital does not guarantee anything, not even that the dyad received the best possible care. This is too subjective. Whatever the outcome, the primary person to live with the effects of her decision is the mother, which is what makes it inappropriate to restrict her choices. I do not understand the language that is being used when one expresses that to birth at home is to take a chance, and that the ideal is to birth in a hospital with state of the art equipment “just in case”. It is almost as if an accident that happens at home is the fault of the mother or midwife, yet if an accident or tragedy occurs in the hospital, it must have been unavoidable. We must not put any group on that high of a pedastal. The hospital environment alone cannot give me that level of peace of mind. Nothing guarantees a perfect outcome, but keep your laws off my body, please. If your criticism is the training level of DEMs, the answer is not to restrict the freedoms and rights of the consumers. Question everything.
I wish it were possible to give families/future families the information they need to make an informed decision about birth and prenatal care with out a “war”.
Breastfeeding war
birthing war
stay at home vs out of home working
The list is now far to long.
I happened to do little to no research for my older child’s birth(hospital) turned out his birth was “fine” no “emergencies” but I was still left with questions. I am now pregnant again and having researched, read (books,studies on and on) for 3 years, my husband and I feel/believe a home birth is what is best for us at this time.
I don’t know that every one would choose to home birth, but I strongly believe that we all DESERVE THE OPPORTUNITY TO MAKE THAT CHOICE. The medical & insurance system does not leave room for choosing to birth out of hospital.
I would like to take all of the collective fire from these posts and join in making choice a reality for all (even if your choice is not the mirror image of mine.)
I would be happy to debate Dr. Amy, as long as she agreed to attend (just standing in the corner, not as the care provider!) 10 homebirths prior to the debate.
You know not of what you speak, Amy.
Very well done article, Jennifer – comprehensive and balanced. My only gripe is that the title feeds the culture of pitting women against each other, but that’s media for you.
Mrb1:
Again, it’s about choice. If you don’t want to birth at home, then don’t. No one shoudl force you to do it either way. But that is what’s happening when a woman is told she can’t VBAC because it’s against hospital policy, or if the doctors covered by your insurance don’t support natural birth. Not all women can just find a doctor/hospital that would work for them. We all should be able to choose where we birth and how. And we should all have access to optimal care, in case of an emergency, yes, but also to support a normal (re: intervention-free, natural birth) if the mother wants it. Which, by training, OBs don’t have. They are taught how to manage a birth with interventions and how to do surgical procedures. Midwives are taught about the normalcy of birth, re: that is takes time, movement, food & drink, support, the mother’s comfort and trust, etc. to assist and mother in labor.
Doctors and midwives need to work together. Women and their babies are being forgotten in all this.
Women in Pakistan, Afghanistan, and other third-world countries have more morbidity and mortality from pregnancy and birth because they often don’t have enough FOOD TO EAT. Furthermore, Muslim populations (particularly in African countries) are often further hampered by female circumcision, which usually creates such unstretchable scar-tissue that a baby literally cannot get out without surgical assistance; so if there isn’t someone who knows how to give surgical assistance available, births are frequently disasters. Most Americans are not plagued by these problems. Meanwhile, the AMA and ACOG are, at best, trade unions serving the financial interests of their members, who happen to be doctors and obstetricians. So why should anyone in their right mind assume that either organization has the best interests of anyone else at heart? Why is everyone conned into believing that the only “safe” choice a mom can make is to place blind faith in her OB/hospital and follow their orders?
Amy Tuteur MD: You offer nothing to back up anything
that you claim; you offer no sources.You have done nothing to prove
your point. You are the FOX news of the anti-home-birth movement.
Congrats. You have propagandized your self in such a way that nothing
you say will ever be redeemable on this site ever again. Enjoy being
the sham of the sheep industry. Baaah.
posted by : PeanutsMama on 8/4/2009 at 10:18 PM
Huh? Go back and re-read. She listed several citations which is more than the pro-home birth folks have cited. Come on.
I think I’ve made it clear that my wife and I personally would never take such a risk with her or our child’s life, but I also would not take away that option from other people. I agree that hospitals should be more willing to accept alternative methods and that doctors and midwives should work together.
However, keep this in mind: we are not dealing with a crisis of baby deaths in hospital delivery wards. We birth more people in America than die each day. Our neonatal mortality rate is very low comparatively speaking. Since the vast majority of women are giving birth in hospitals and not at home, this means there isn’t some real problem with babies or mothers getting sick or dying while giving birth in an American hospital.
Keep things in perspective.
Few questions are more politically charged.
No, there are not RCT to compare homebirth and hospital birth. You are also going to be hard pressed to find RCT used to prove vaccine safety too. This does not stop vaccination policy recommendations, so it should not impede protocol recommendations for birth. So you must rely on the data that you do have. And that data, in a robust way, despite Amy Tuteur’s proclamations, indicates that for healthy low-risk mothers, home birth and hospital birth have the same outcomes. With home birth having a much lower rate of intervention. These interventions themselves have complications that need to also be incorporated into the calculations of outcomes.
So when people ask, “why take the risk?” there is a cognitive error going on, on understanding probability (in the vein of Tversky and Kahneman). The risk is the same for home birth and hospital birth. The risk is incorporating the possibility already that there may be a complication. Given the much higher rate of intervention in a hospital, one may conclude that things “go wrong” more often in a hospital setting to begin with and only because of the technology available are they able to provide the same outcomes as you achieve from staying at home. You could also ask, “why take the risk” of a hospital birth – same chance of a good outcome, much more likely to undergo a c-section.
Ari Nave, Ph.D.
http://www.unorthodoxdad.com
Amy’s the Ann Coulter of birth discussions.
“Women are ethically entitled to accurate information.”
If this is so, Amy, why do you regularly refer to “homebirth midwives”- a term that has no technical definition and dumps all midwives into one broad category, muddling your allegedly accurate statistics?
BTW, you still haven’t provided me the info I requested on your site. I’m starting to think that you can’t. I mean, finding an accurate, scientifically sound piece of evidence to support your oh-so-ethical statement that “homebirth kills babies” can’t be as easy as you claimed.
You’ll gladly debate anyone until your theories are debunked. Then you get awfully quiet…
Hey, Ali, Want to know about dead babies? Let’s look at the facts compiled by the CIA.
Fourty-four countries have a lower rate of infant mortality than the US. Our rate is 6.26 per thousand.
Singapore has 2.3 per 1000; Macau has 3.2 per 1000; Malta, 3.8; Chezk Republic, 3.8; Slovenia,4.32; New Zealand, 4.9; Taiwan, 5.35; Cuba, 5.82 per 1000 – just a sample, and every country in Europe is way below our rate.
Note: our babies are not dying in homes; they are dying in hospitals.
The US government has two things to say about our infant mortality rate:
Infant mortality is a good indicator of the health of a country, and
“It appears unlikely that differences in reporting are the primary explanation for the United States relatively low international ranking.”
In addition, our maternal mortality rate, though low, is going up for the first time in decades.
And our maternal morbidity rate is among the highest in the industrial world.
So much for safe birth in the US
For more info go to http://www.childbirthconnection.org, and be sure to see the report of the US Reform States Group and the Milbank Fund, “Evidence Based Maternity Care: What it is and What it can do.”
Get the facts.
Susan Lane,
Minneapolis, MN
I think homebirth advocates are missing the mark when it comes to what the solution and the problem are in this situation. The issue is that Hospital’s are not focusing on patients needs when it comes to childbirth, the need for emotional support and a feeling of safety. The fact that these things are not being provided is mostly due to the fact that the medical system is broken not because hospitals are incapable of it. The reason for the neglect many women feel in maternity wards is often because the staff is overworked and dealing with a crushing beuracracy. If hospital’s aren’t understanding why not fight to make them better instead of reverting. A hundred years ago childbirth was the number one killer of women I don’t see how going back ever fixes anything.
I also think their is an overemphasis on the wonderful magical birth experience, when that doesn’t happen for everyone. Childbirth is one of those cases where it’s the destination nit the journey. Ultimately when so much uncertainty is involved there is always going to be a unlucky group who finds the process traumatic no matter where it takes place.
@jeaherendeen I am once again shocked by the unbelievable ignorance of some of the people posting here. Women in Pakistan and Afghanistan are not put through the torture of female genital mutilation, and it is wrong to generalise that “Muslim populations (particularly in African countries) are often further hampered by female circumcision”. I am a Pakistani Muslim, and I do not know of any women in my country (or in Afghanistan) who are circumcised. It is certainly not a common practice, and as far as I know it is a traditional practice in some parts of Africa with Muslim populations, although certainly not prescribed by Islam. I am sorry to go off on this tangent in this fairly interesting discussion but it really does make me crazy.
Dooce done it…
http://www.dooce.com/2009/07/13/labor-story-part-one
@ Cali mom
“legal eagle – but who makes these decisions? Juries? I am not an
attorney, but it would seem that emotion could sway a jury, who
wouldn’t necessarily understand medical/scientific information and not
understand when someone was being truly negligent.
Please clarify if there is something I misunderstand.”
That’s a great question! If a civil case goes to trial (meaning it was not settled out of court, which is usually the desire of both plaintiff and defendant) then it will be heard by a jury and that jury will decided what “number” to come back with. However, that dollar amount has limits based on the kind of injury, degree of negligence, etc…that is predetermined by the law. The judge will instruct the jury of how high it can go with damages and punitive damages, if they are justified. So, even if a doctor is found negligent, and the plaintiff is very sympathetic, the jury can still only award a set amount of money. Which, because the law defines a damage in death as the ability to earn income, babies and children are not highly recompensed.
Also, Dr’s win more than not in malpractice suits. It is difficult to find doctors who want/will testify against another doctor. Furthermore, the doctors and hospitals have good paper trails….documentation of forms, files, charts, notes, etc…Plaintiffs don’t usually have those sorts of things to stand up in court. And since lawyers generally take these kinds of cases on contingencies, they can put in years of work and still not win, which means they don’t get paid. So, it must be a pretty good solid case for any attorney to accept it. OB’s did get sued a lot in the past, for frivolous reasons, but that has curbed considerably. But because most OB’s are surgeons (or perform surgical procedures) as well, they must carry a certain level, often also determined by a hospital or group practice.
And, please also let it be known to all, that attorney’s are also required to carry malpractice insurance. There are high cannons of ethics placed on attorney’s as well, and it is unfortanate to me that these sorts of attorneys, who gamble their homes and businesses to fight insurance companies and big businesses, are seen as “bottom feeders” by some.
I hope I answered your question Cali Mom (any anyone else who is curious).
Meagan H, that problem with some of the things you say is that some of us don’t want to fight. I don’t want to have to argue with the nurses about not laying on my back. I don’t want to have to argue with them about holding my baby longer than 10 minutes or keeping the baby our of the nursery. I’ve had a baby in the hospital, a birth center and at home. After I have a baby I am susceptible to do whatever anyone else tells me to do and that has been the reason for me getting postpartum depression, twice. After my homebirth they told me get in bed and be with my baby. No one made me feel like a horrible person for wanting to be with my baby when I did feel that way at a hospital. That’s great if some women want to fight and people say its the end result, the healthy baby, not the journey but sometimes it isn’t. If I can get through my delivery and after with support and not policy’s, I am less likely to have postpartum depression after, which does affect me and my baby.
So you can say we shouldn’t revert, but what are we supposed to do when the hosiptals are going off tradition rather than what actually works to take care of a woman?
“Since the vast majority of women are giving birth in hospitals and not at home, this means there isn’t some real problem with babies or mothers getting sick or dying while giving birth in an American hospital.”
But there is more at stake than the physical health of mother and baby. There can be emotional damage done as well. Of course, this can happen in any setting, including those that are supportive, since labor and childbirth is very hard. However, inadequtae care, lack of support, being forced to have interventions you don’t want, being told you aren’t important, etc. harms a mother’s psyche terribly. It happens way more than people realize. Women just don’t talk about it, or put it in the back of their minds, because they are told, “at least you have a healthy baby.” Ask any woman about her births and most times there will be something that affected her negatively (for my mother it was having her waters broken without her consent. For my MIL, it was being forced to have a spinal when she didn’t want one and then it not working in time for the birth and not being able to hold her baby) that was because her control of what was happening to her was lost. It matters just as much as being healthy and having a healthy baby. Sending a mother home to care for a child after she was mistreated and denied her birthing rights is cruel.
Rights of the Child-bearing Woman: http://www.childbirthconnection.org/article.asp?ck=10084
Look, I have several friends who have given birth at home, or in birthing centers, I’m a big fan of Ina May, and I think home birth sounds like a lovely choice for some women that should be available to any woman that wants it.That said, homebirthers, please stop assuming that because I CHOSE to have my baby in a hospital with an OB that I must be either too stupid or too lazy to be properly informed. I read all the books I could get my hands on, I interviewed friends and total strangers about their birth stories, I attended a friend’s birth, I got my pharmacist friends to explain all the details of all the possible drugs to me, and I interviewed countless possible OBs and toured several hospitals. I made the choice that was right for me and my child and had a lovely, medicated, idyllic hospital birth in which my exceedingly competent doctor gave me an episiotomy (horrors!) and used vacuum suction to extract my baby (how primative!). Considering that I felt great, healed fantastically, felt completely in control of the process (because the “evil” epidural didn’t impede either my control over pushing OR over being able to get in any position I wanted to, which was also allowed by the hospital, where they had birthing balls, a tub, and those monkey bar thingys available in the room), and was well aware of possible side effects, I find it really irritating to have it continually implied or stated that these things only happened because I didn’t know better than to be “mistreated and denied my birthing rights.” I chose to put my trust in a professional, a woman with children of her own, who spent ten years in school and another ten in practice to be the respected doctor she is, and I don’t think my choice should be discounted just because you didn’t make the same one. Maybe YOU should be better informed about what a hospital birth really is like if you do the research. See how that sounds? Not nice. I’m happy to support your choice. Please don’t disparage mine to make your point.
Can someone explain something to me? I am asking this because I am honestly curious– I am not here to attack any person or position.Why does the topic of childbirth choices spur this kind of debate? I see it everywhere these days. Every woman has (or should have) the right to choose where she gives birth. Period. If YOU feel homebirth/hospital birth is not right for you, then don’t do it! Why spend time fighting about it– just make the choice that’s right for you. Why do you need to attack others for the choices that they’ve made?
The article is not about the right to make your own choice. Choice is a matter of personal opinion.
The article, on the other hand, specifically claims that homebirth is as safe as hospital birth. That is an empirical claim, not a question of opinion, and it is factually false.
Have a homebirth if you want, but just understand that homebirth increases the risk of neonatal death. Unless you know that you can’t make an informed decision. Unfortunately, homebirth advocates are either unaware of this fact, or those who are aware of it deny it.
@adjm: “But there is more at stake than the physical health of mother and
baby. There can be emotional damage done as well. Of course, this can
happen in any setting, including those that are supportive, since labor
and childbirth is very hard. However, inadequtae care, lack of
support, being forced to have interventions you don’t want, being told
you aren’t important, etc. harms a mother’s psyche terribly. It
happens way more than people realize. Women just don’t talk about it,
or put it in the back of their minds, because they are told, “at least
you have a healthy baby.” …It matters just as much as being healthy and having a
healthy baby. Sending a mother home to care for a child after she was
mistreated and denied her birthing rights is cruel.”
So your issue is that for a couple people you personally know it wasn’t touchy-feely enough in a hospital? Sounds to me like they didn’t speak up enough and/or didn’t do proper research into how the hospital handles births. Unless you have been legally declared unfit to make decisions for yourself, medical treatments are not forced upon you.
about the journey….during said journey, the mother and baby are one “motherbaby”. the aware baby responds to its mother’s physical and emotional environment. facilitating a stress-free, peaceful, physiologic, uninterrupted setting for the journey is not an ethereal “woo-woo” idealistic notion. it is not a self-centered desire. it is a way to promote optimal health for mother AND child. this is something that all midwives know (regardless of their official title or initials).
that does not mean that the ideal stress-free environment is the same for all women. nor does it mean the birth attendant (midwife or doctor) should sit back and do nothing (unless it does). monitoring the well-being of the motherbaby dyad means that intervening is sometimes necessary.
but going back to the basics of unhindered birth is not a reversion. “radical” means from the root. the root of birth is that, most of the time, it works beautifully just the way it is.
Why is it that people love to use the term “If it isn’t broken, don’t fix it.” when it comes to other things in life, but when it comes to birth they think it needs to be fixed and improved with medical interventions for all low-risk women coming to birth at the hospital. It shouldn’t be considered “radical” if some women ask to be left unhindered to birth unless there are indications that medical help is needed. To me it is just common sense.
What a relief it must be to American homebirthers that Melissa Cheney found NO homebirth deaths in an unnamed, sparsely populated county in southern Oregon. Now women across the country can give birth at home without fear. Phew!
So, to sum up, Jennifer Block: ignorance and anti-intellectualism are winning the homebirth debate? Good to know.
So your issue is that for a couple people you personally know it wasn’t touchy-feely enough in a hospital? Sounds to me like they didn’t speak up enough and/or didn’t do proper research into how the hospital handles births. Unless you have been legally declared unfit to make decisions for yourself, medical treatments are not forced upon you.
No that is not my issue. My issue is that women have the right to choose for themselves, where ever they birth. The stories I mentioned were just examples of what happens to many women and not just in a hospital. Care providers that force their ideals on their patients happen anywhere. You last sentence is not true at all. CP coerce parents to make all kinds of decisions with mistruths like, “your baby is too big”, “you are too small”, “you shouldn’t go past your (estimated) due date”, “c-sections aren’t risky”, “c-sections are safer than vaginal birth”, “doulas just get in the way”, “you should agree to the treament I suggest otherwise you are being difficult and are not doing the best for your baby”, “your baby will die if you question what I say”, etc. A woman navigating her birth choices should be able to find a place that works for her, hospital, free-standing birth center (if your state even has one), or home.
This is really a matter of women’s rights. Of course, a healthy baby and healthy mom are important outcomes. But our preferances and bodies need to be respected. If I want to move during my labor, I shouldn’t be badgered into staying still for the convenience of the staff. No one shoud have to fight while they are in labor. No one should have something done to them that they don’t want done, especially when they are at their most vulnerable.
Did you look at the link I provided in that post?
@adjm: Yes, I did look at the link. I respect the rights of women to give birth how they want. As you note, it’s their body and their child. I certainly would never have told my wife what to do…we made the decision together where to give birth. Choosing a hospital was never in doubt, it was just which one. So, we agree there – in most every thing in life, choice is preferable to the alternative.
However, you state:
“CP coerce parents to make all kinds of decisions with mistruths like,
“your baby is too big”, “you are too small”, “you shouldn’t go past
your (estimated) due date”, “c-sections aren’t risky”, “c-sections are
safer than vaginal birth”, “doulas just get in the way”, “you should
agree to the treament I suggest otherwise you are being difficult and
are not doing the best for your baby”, “your baby will die if you
question what I say”, etc.”
To me, this is plain and simple you thinking you know better than a trained medical professional. Which I personally find ridiculous. Yes there are quacks out there, just like in any profession. That’s why you do your research before hand and then choose wisely and only after you’ve educated yourself. This reminds me of the autism/vaccination phantom link. Suddenly, all these people who have no medical nor research training know better. It’s silly.
You know what I have a huge problem with? All these people who are pro home birth, that claim they just want women to be able to have choices and be educated about birth. Ok, that’s great. I don’t think anyone would disagree with that. So, what if I have educated myself as to all the options and I choose a CS or a RCS? Can any of you honestly say that you would think that was just fine? Would you respect my wishes to give birth via cesarean with no sly comments? My comment in purely anecdotal, obviously. But I find that those that bark the loudest about home birth and “education” and “choice” are often the harshest and most judgemental towards other women who share different birthing priorities or philosophies. You want rights and understanding in your direction for what you feel is important but are unwilling to give it to others. Just a rant, with a lot of generalizations, I know. But it all gets so old.
OK mrb1. My point is that there are women, not all, but many, who do not know all of their options, regardless of where they birth and CPs, of all kinds tend to take advantage of that and lead a mother to do something that she may not want to do. That’s all. I respect all choices. I just hope they are educated ones. And I hope my choices are respected as well. Peace. I’m done.
Have a homebirth if you want, but just understand that homebirth increases the risk of neonatal death. Unless you know that you can’t make an informed decision. Unfortunately, homebirth advocates are either unaware of this fact, or those who are aware of it deny it.
Amy, you say this as if it applies to all women equally. It doesn’t. Some women are better off at home because the hospitals in their region are low quality. That is the case where I live. Generalizations help no one, and to say that for ALL WOMEN homebirth is more risky than hospital birth is inaccurate. As someone who encourages accuracy, I would expect your position to be more nuanced than it is.
Further, why is it so important to you for “homebirth advocates” to state that homebirth increases the risk of neonatal death? People who choose a homebirth are well aware of the risks related to birth (more so than those who birth in a hospital, I bet) because they have to prepare for complications in ways that hospital moms don’t. Do you really think you care more about women’s bodies and the lives of their babies than they do? Newsflash: You don’t. And you don’t know more than them–until I see your name on a peer-reviewed journal article on the subject, you’re just another woman who surfs the internet and forms an opinion.
I had a hospital birth. My choice. But I appreciate that I had the choice to have a home birth. I may choose a home birth with my next child, depending on whether I think it is best for me and my baby. And I can guarantee that you do not know what is best for me or my baby, because you don’t even know me. So stop acting like you do. You assume that I’m uneducated. I’m not. And you’ve chosen a “side”, which renders you useless as a source of helpful or objective information.
No one is going to win this “war”, because it requires us to know “what could have been” (e.g., that a baby would have survived if born in a hospital, or would have died if he wasn’t born at home). At the end of the day, we need trained, capable individuals to be able to deliver babies in hospitals and in homes, as for some women a hospital is better whereas for others, a home is better, and I trust those women to know who they are and what is best for their babies. If we can’t trust a woman to choose the best place to bring her child into the world safely, how can we trust her to be a mother to that child?
Dr. Amy, just a question. Have you ever attended a home birth? I interviewed Marsden Wagner a perinatologist and epidemiologist and former
Director of Women’s and Children’s Health in WHO(The World Health Organization. He speaks to doctors frequently about birth. He says the minute he says the words home and birth in the same sentence there is unrest. He goes on to say he will ask for a show of hands of anyone who has witnessed a home birth. No one raises a hand. He says he tells them they are like geographers who try to describe a country that they are to afraid to go to.
Are you afraid to go there?
http://www.facebook.com/pages/Progressive-Parenting/68510647716?ref=ts
“Have you ever attended a home birth?”I don’t understand. How would attending a homebirth make me think that it was worth a nearly triple risk of the baby dying?”He goes on to say he will ask for a show of hands of anyone who has witnessed a home birth. No one raises a hand. He says he tells them they are like geographers who try to describe a country that they are to afraid to go to.”Do you see that this is an effort to divert attention away from the fact that homebirth kills babies by suggesting that you don’t need to listen to the very people who are most knowledgeable about the risk?Dr. Wagner is another person who is not completely forthcoming n the subject of homebirth. He trades on his former position at the World Health Organization, but he does not tell people that his claims about homebirth are his personal opinion and not the official position of the WHO.In a book chapter written by Dr. Wagner about himself, entitled “Confessions of a Dissident,” he acknowledges that his claims are his personal opinions and do not represent the WHO. In addition, he proudly describes how he was repeatedly criticized by officials of the WHO and other public health organizations for personal pronouncements that were directly contrary to the recommendations of the WHO. The WHO specifically states that homebirth increases the risk of perinatal death.Dr. Wagner has also publicly acknowledged, in a peer reviewed scientific paper, that his recommendation that the ideal C-section rate should be 10-15% was not based on any data. In the paper “Rates of cesarean section: analysis of global, regional and national estimates” (Paediatric and Perinatal Epidemiology, 2007; 21:98-113) explicitly acknowledges that the 10-15% was made without any data to support it. In fact, Wagner and his co-authors report that the paper is the first that attempt to compare international C-section rates with maternal and neonatal mortality. Like most celebrity homebirth advocates, Dr. Wagner does not deny that the scientific evidence and national and international statistics show that homebirth increases the risk of neonatal death. He just offers a series of flimsy emotional appeals that are designed to divert your attention.The fact that a doctor might not have attended a homebirth tells us nothing about whether homebirth leads to preventable neonatal deaths. Only the scientific evidence can tell us that.
Dr. Amy you are picking and choosing what the WHO says to further your own agenda. Where do they state homebirth increases the risk of perinatal death? (Not the actual rate, just the risk?)
I am going to pick and choose my WHO quote as well:
“WHO does not recommend any particular setting for giving birth. Home delivery may be appropriate for a normal delivery, provided that the person attending the delivery is suitably trained and equipped and that referral to a higher level of care is an option.”
from the World Health Organization, 2008.
http://www.who.int/whosis/indicators/compendium/2008/3bsn/en/
Yikes. Sorry, but choosing a well staffed birth center or telling your OB that you are choosing to labor with a ball or squatting, and not lying down hooked up to monitors is completely different than choosing to birth at home. I get it….it seems beautiful and natural and all that, but still….you are putting your WANT for a certain kind of delivery over your baby’s safety. My grandmother thought it was unnatural for me to not hold my baby in my arms in the car. I wanted to hold my baby, too, but the safest thing (even given that the chance of an accident was relatively low) was to place him securely in his car seat. That’s the evidence, and the only real benefit to be gained from a home birth is a better “experience”. Of course Amy wouldn’t attend a homebirth just to watch—anectdotal evidence doesn’t prove anything. And even though she may have let her license lapse, it would be hypocritical of her as a physician to stand idly by while a woman put herself and her child at serious medical risk.
All the personal stories are nice to hear, but come on. I have 6 uncles who smoke like chimneys and don’t yet have lung cancer or heart disease–doesn’t mean smoking doesn’t cause cancer.
What makes a “well-staffed birth center” safer than birthing at home with a CPM?
Health Evidence Network http://www.euro.who.int/HEN/Syntheses/antenatalsupp/20051219_8“Home-like settings for childbirth are associated with reduced likelihood of medical intervention… However, the evidence shows an increased risk of perinatal mortality, the reasons of which are not fully established.”In addition, the WHO would find American direct entry midwifery practice to be woefully inadequate. The WHO has published guidelines on antenatal care . The following tests and procedures (among others) are recommended for routine antenatal care on the basic of the scientific evidence: screening for pre-eclampsia with a comprehensive strategy including an individual risk assessment at first visit, accurate blood pressure measurement, urine test for proteinuria and education on recognition of advanced pre-eclampsia symptoms; anti-D given during 72 hours postpartum to Rh-negative women who have had a Rh-positive baby; Downs syndrome screening; screening and treatment of asymptomatic bacteriuria during pregnancy; screening of hepatitis B infection for all pregnant women and delivery of hepatitis B vaccine and immunoglobulin to babies of infected mothers; screening for HIV in early pregnancy, a short course of antiretroviral drugs, and caesareansection for infected mothers at 38 weeks, to reduce vertical transmission; screening for rubella antibody in pregnant women and postpartum vaccination for those with negative antigen; screening and treatment of syphilis; routine ultrasound early in pregnancy (before 24 weeks); external cephalic version at term (36 weeks) by skilled professionals, for women who have an uncomplicated singleton breech pregnancy;Indeed, the World Health Organization profoundly disagrees with a fundamental admonition of homebirth advocacy to “trust birth”. The WHO does not find birth to be trustworthy at all. In addition the WHO specifically recommends screening tests, routine ultrasound, Rhogam, intensive screening for pre-eclampsia and external version for breech.The bottom line is that the WHO agrees that homebirth increases the risk of perinatal death, does not advocate “trusting” birth, strongly supports routine screening, including routine ultrasound, and believes that vaginal breech delivery should be avoided by attempted version. In other words, American direct entry midwifery principles and practice violate the recommendations of the World Health Organization.I said it before and no one, including Jennifer Block, has denied it. American homebirth midwives (CPMs) have less education and training that any midwives in the industrialized world. They could not meet the basic licensing requirements for the Netherlands, the UK, Canada, Australia, anywhere.
Trusting birth and helping intelligent pregnant women to make informed decisions about their care, including diagnostic screening, are not mutually exclusive concepts.
My idea of a well-staffed birth center includes an obstetrician with a hands-off-untill-absolutely needed philosophy, a nurse-anesthologist, and all kinds of other well-trained individuals who would not fit comfortably into a normal-sized bedroom.
Amy Tuteur I have done my due diligence, looked up all your half baked misquotes and the WHO never states any of the junk you’re trying to sell. I’m getting back to my life, as I have one. I have children that I’d like to spend time with and don’t have the time to sit around and wait for you to type something you’ve concocted.
I will go on to educate women about normal birth, and you must go on trying to spread your apparent ministry of antifeminism. When I asked around about you, I’ve been told that you were a hysterical fanatic, even a lunatic. I don’t think you are either. There is a special term for what it is you do and how you do it. I feel sorry for you. Good luck on your mission to lie about something you know nothing about or have ever witnessed. I would have had some tiny bit of respect if you said you witnessed at least one for the sake of your research into the topic, if only so you can further your effort to try and frieghten someone from it.
By the way, not as if Dr. Marsden Wagner needs any defending, but he is a real doctor who actually cares for women. He’s an OBGYN who was asked if he had ever witnessed a home birth, said “no”, but was curious and got to see one. His life was changed completely after witnessing one. He discovered how women have had their power stripped from them. Ladies, I encourage you to read his brave book BORN IN THE USA How a Broken Maternity System Must be Fixed, to read more about his transformation froma doctor that really knew nothing about birth to a mother and child advoctae. Miss Tuteur you would do well to have a life changing experience.
My heart felt sympathies to you in light of your blindness to the truth.
You’re wrong about even the most basic information. Marsden Wagner is a pediatrician, not an obstetrician.
from an author bio:
Marsden Wagner, MD, is a perinatologist and perinatal epidemiologist from California and an outspoken supporter of midwifery. He was director of Women’s and Children’s Health in the World Health Organization for 15 years.
methinks this guys knows of what he speaks.
He is a pediatrician, not an obstetrician. His claims about homebirth are his own personal opinions, in direct contradiction to the official opinion of the World Health Organization.
“methinks this guys knows of what he speaks.”
Oh, please. The overwhelming majority of pediatricians, perinatologists, obstetricians and the World Health Organization itself strongly disagrees with him, but you think that he is the one person who knows what he is talking about? What evidence do you have for that claim, beyond the fact that he supports your personal beliefs?
Listen you crazy beyotch, Amy Tuteur, you keep saying “the
WHO specifically recommends screening tests, routine ultrasound,
Rhogam, intensive screening for pre-eclampsia and external version for
breech.” Well, I had a home birth and I had all that stuff except the Rhogam because I did not need it. You know, CNM’s can do homebirths, too…
How about everyone can just have the birth they want! And while they are at it, not have a holier than thou attitude about it! And then everyone can just shut their yappers about it. You are not any better than the person next you, for how you choose to birth. Your not gonna get a medal either way. If you want to be a legend in your own mind, great. C-section, great! Epidural, awesome! A home birth, just fantastic! The real challenge is for women to put their ego’s aside and support other women. This is where the trouble comes into play. Everyone wants to be right and assume they had the best, most life altering, mecca of an experience compared to the next person. Everyone thinks they are more informed and educated than the next person. There are all kinds of variations and preferences, as well as resources and availability to different women when it comes to child birth. So flippin get over yourselves. What a gigantic waste of time.
“Pulling numbers from the CDC Wonder web site to compare the outcomes of place of birth and birth attendant is not appropriate for a number of reasons, first because there’s been no analysis to control for confounding variables,” J. Block
Some journalist. Obviously, you have never looked at this database. Or, you are too uninformed about medical risk factors and the statistics you claim to report on to use it.”and also because there’s no mechanism to separate births that were intended to happen out-of-hospital from those that were unattended accidents.” J Block
Gee, why not try that button that allows you to select out “other midwife” or the (gasp) series of three clicks that will allow you to separate out out of hospital births by birth attendant? Midwives and their proponents are soooo scientific, but they can’t figure out how to use a database.
BTW, that same database doesn’t have any record of about 90% of the deaths described in the Johnson/Daviss study. I guess the circumstances of those deaths really weren’t as unavoidable as the midwives claim. And the database suggest there were more of them. Of course, those type of problems are well-known when data is self-reported, especially whent the party has an interest in the outcome.
That’s midwifery “evidence”. Don’t tell about some of your deaths, make excuses for the ones that remain. Drop the “excused” ones from your data. Compare to higher risk hospital patients. BINGO. Midwives are safe!!!
And you wonder why this stuff isn’t catching on.
Manda, it isn’t about people claiming that their birth is better. It is a war about who is right about safety, and protecting women’s rights to birth how they want, both in or out of a medical setting.
What happened to the 2 posts where Jennifer Block made a huge mistake and it was pointed out?
She (Block) claimed that the CDC database (which records all deaths in the US, not just the ones midwives choose to report, like the Johnson and davis study) couldn’t differentiate between homebirths with midwives and accidents or risk factors. There’s a bunch of filter buttons on the entry page that let you do just that.
This egregious error highlights that Block just repeats baseless midwifery propaganda. She clearly never looked at this database. She just pulled out a bunch standard issue criticisms to match her standard issue rhetoric.
She’s not journalist reporting on research. She doesn’t know enough about research in the first place. (check out her laughable explanation on why we can just skip randomized controls!!). And she only “reports” on baseless claims of midwifery as if they were research.
Block never talks about all the dropped/unreported deaths of this so-called midwifery research. She never “reports” on the contrast between that and complete national databases.
Most of the deaths claimed by the Johnson and Daviss study are desecribed in detail. Most can’t be found in the national database (where you can set the filters to look for them in detail). Isn’t that a story that a *journalist* should be interested in? As you hit the “flag for abuse” button to silence valid criticism, think about why you want to hide this information so badly.
Thanks to whomever for putting the missing posts back.
Needless to say, it shouldn’t have happened in the first place.
Now, can someone on the pro-midwife side tell us if they are still claiming this is “safe” when it has 3X the neonatal death rate (per J and D raw data self-report — before they scrubbed all the data — and national records) and 10X the intrapartum death rate (per their own self-report, compared with prior hospital studies, just like J and D did for post-natal deaths)?
The silence is deafening.
I also find it laughable that Ms. Cheney highlights the shortcomings of birth/death records, yet embraces self-reported data from those with a great self-interest in the outcome! And it’s data no outsiders can see. It sounds more like the midwifery avoidance of transparacy and accountability.
Some how I have trouble with the Johnson Davis because:
1) two of the “fatal anomalies” it lists aren’t really fatal anomalies. They’re just anomalies.
2) 90% of the deaths described don’t come anywhere’s close to matching death certs.
3) Neonatal SIDS is rare as hen’s teeth in the rest of life, yet occurs in spades in homebirth midwifery deaths. In fact, it seems that it doesn’t happen anywhere else. Maybe avoid homebirth midwives because they increase this rare unheard of neonatal SIDS. Shouldn’t this be part of informed consent? ; )
4) A stillborn child somehow or other has a positive apgar score. Don’t you have to be born alive and then die to get that?
Can someone explain all this to me?
After delivering my third child in a hospital with a high as a kite, violent and abusive doctor in attendance, i chose to deliver my fifth and sixth and seventh children in alternative places – with my fourth i had no choice, i had just moved the night before 12 hours away, and my husband was not prepared to help with an unassisted homebirth. #5 i had a beautiful waterbirth with a midwife and a nurse in attendance at a hospital – #6 we had at home (#5 was a 1 hour birth start to finish, and 45 minutes was the drive to the hospital -we lived in the boonies) – in water again, with my mom and husband there – #7 just my husband and i, and a hot pool of water.Thing is, i was not safe or respected in the hospital – a baby was stolen from my sister’s hospital room (they found the baby alive and safe three days later, but my husband had to testify in court about the people we saw), another sister got c. difficile in the hospital. One sister delivered her stillborn child alone, crying for help, in the hospital while nurses mocked her cries. She was also the one who was tied down, 1950s style with a big klieg light in her eyes, manacles on both legs and arms. This is just my own family. We are educated people who have lived in places that are smaller and maybe more backward (in Canada, where we have less choice in our free health care)…My births have been pretty uncomplicated, and i know basic infant resuscitation and carry herbs that are extremely effective, esp for post partum hemorrhage, as the numbers indicate that this is something i should prepare for, especially as i have more children…My births (the last two) have been exactly the way birth should work – there haven’t been strangers around when i’m naked, i’ve been able to reach down and feel the baby’s head with out fat childless women telling me i’m “contaminating the field”. I can go pee without asking some arrogant man’s permission (and him saying no, so i hold it). I deliver the baby in water, into my own hands, and no stranger gets to hold my baby before me. My other children get to meet their new sibling within minutes, get to see the placenta, get to sing to baby as we gently massage in the vernix.Hospital birth is archaic, violent, and very anti-woman. Some women need the medical intervention, but for a lot of us, birth happens. It’s natural, it’s normal, and it’s not a medical emergency. And we lose something by acting as though it is. We lose our sense of wonder, of the spiritual side of a new life joining us that until now has been mostly experienced by mama. We lose the sense of this being a family event, and instead it’s all bureaucracy and papers to sign and strangers handling my breasts roughly, and demanding to see the baby’s poopy diaper. I miss nothing about hospital birth.
“One sister delivered her stillborn child alone, crying for help, in the
hospital while nurses mocked her cries. She was also the one who was
tied down, 1950s style with a big klieg light in her eyes, manacles on
both legs and arms.”
BS. Ridiculous. Were you in a medieval hospital? Your comments are outrageous.
I’m perplexed by the constant references to WHO encouraging the use of routine ultrasound. WHO’s own Reproductive Health Library article on ultrasound (http://apps.who.int/rhl/pregnancy_childbirth/fetal_disorders/prenatal_diagnosis/jbcom/en/index.html) says “Routine use of ultrasound scanning in early pregnancy (before 24 weeks)
results in earlier detection of multiple pregnancies and reduced rates
of induction of labour for ‘post term’ pregnancy, but there is no
evidence that it improves substantive clinical outcomes.” So let’s just make sure we push that on all women, shall we?
So far, Amy Tuteur is the only one who makes any sense in this discussion. Looks like she’s the only one who actually looked at the data and tried to understand what it shows, not just coaxed it to show what she wants. Intuitively, homebirths have always seemed to me to be higher risk (in cases when medical help is needed immediately, obviously, no matter how close to a hospital you are, it will still take longer than if you’re in a hospital). At the same time, I think people should be able to choose freely where they deliver, I can’t imagine forcing somebody to a hospital against their will. At the same time, I think that people need to understand the risks involved. As another poster mentioned, it is also very annoying when homebirth advocates scream to give women “choice”, but when that choice happen to involve something that they disagree with (like, a hospital and an epidural), then all of a sudden that woman becomes “not educated”. “Educated” in their world somehow involves making choices that they agree with.
passerby mom, not all of us think that way. Choice is choice, no matter if I agree with it. I just hope women educate themselves and demand quality care, regardless of where they birth with whom they birth.
The fact that this conversation is even happening is a good thing, IMO. There are horror stories on both sides. Babies are lost on both sides. Women can be mistreated on both sides. Positive experiences can be had on both sides.
mrb1, while I don’t know mamazee73′s story, I wouldn’t be so quick to call it bullshit. Terrible, terrible stuff can happen. This is just anedotal, but I am friends with a woman that tried to VBAC and when she showed up pushing, the hospital she chose told her she had to have a c/s, even as the baby was crowning. She told them no. They threatened to take her baby and toddler away. The OB was a friend of her family. She felt trapped. She agreed to the c/s after going back and forth with them. She’s traumatized this this day because of how she was treated. She was even scared everytime there was a knock at the door, for fear of it being CPS.
I’m not saying all hospitals/OBs are bad. I’m saying the standard of care needs to be improved so that all women (of all races and economic standing) can choose what happens to their bodies and their babies. There’s got to be a way to combine both worlds and have a great result.
Wow. I just sat through and read every response. “Dr.” Amy comes across as a nutcase who skews statistics to meet her own personal opinion. She is no longer a licensed physician and does not work in the medical field and has not for a long time. I would rather take information from those who still are physicians and do it for a living. Other posters do the exact same thing as Amy but in a less fanatical way. The people who I feel have it right are the ones who say do whatever is most comfortable for you. Hospitals should allow for different options. I think they may be the best places for birth if they allow for the woman to have a “home” birth unless something traumatic happens. I know I don’t want to be on my back when having a baby because it makes more sense for me to squat as it willbe easier for the baby to come out due to gravity. Birth is a special event but can be very traumatizing to the woman as she endures extreme pain and to the baby so all that matters is safety.
Women become so defensive when any birth experience, other than their own, is being promoted as possibly being better or healthier, because the only way they can feel validated in their birthing decisions, is by convincing others they were the right decisions.
If women want to have a home birth, let them. I don’t see anyone threatening you with a court order to make you have one. Wait a minute…
Dr. Tuteur writes below that “Marsden Wagner is a pediatrician, not an obstetrician.” which is true but a bit misleading as a counter to siting him. Marsden Wagner was UCLA Hospital Chief resident physician in pediatrics, UCLA Hospital Post-doctoral Fellow of National Institutes of Health in perinatology (Obstetrics and Neonatology) and perinatal epidemiology at the UCLA Schools of Medicin and Public Health M.S. Post-graduate degree in perinatology (Obstetrics and Neonatology), perinatal epidemiology and reproductive science, UCLA
I don’t have any issue with women choosing a home birth. What I do have an issue with is women who think that they are ‘more of a woman’ because they birthed at home. Home vs. hopsital is the new pain meds vs. natural debate. I trusted my doctors and felt more comfortable delivering at a hospital just in case there were complications (which there were). If you feel more comfortable giving birth at home that is your business. Personally I think that child birth is a dangerous thing. Prior to modern medicine the mortality rate was astronomical for mothers and children during child birth. I think a lot of things can go wrong. Do what you think is best but don’t judge me for feeling it was safer to deliver in the hospital than at home.
My child died in a hospital surrounded by the best equipment and several NICU doctors and nurses after a short life. If this baby was born at home or in a birth center this child would have died en-route to the hospital and I would have regretted it for my entire life. It was a short life, but I gave that child every chance. My birth experience was not about me. It was about my baby.
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Hey. At least 30% of births in the Netherlands take place at home, attended by independent midwives. The Netherlands has WAY better birth outcomes than does the U.S., where over 90% of births take place in hospitals. Obviously, planned homebirth can’t be all that lethal.
Both my brother and I were born at home. My parents were ready to go to the hospital if anything happened, but nothing happened that the midwife wasn’t prepared for. The people against this are silly….what do they think the people of the world that don’t have regular access to hospitals do? What do people think women did for thousands of years before C-sections and inductions came to be? Blind fools.
I am often perplexed by the reason some people are SO anti-home birth /natural birth. I am wondering if they wanted a natural birth, but couldn’t do it for some reason, and they feel a guilt and resentment, that turns in to anger?