Here's a story we just wrote for TIME about homebirth, which as you'll recall from June's 'My Homebirth Was a Felony' conversation is super controversial. An excerpt:Obstetricians in the U.S. are concerned about the recent push by direct-entry midwives to receive licenses so they can practice their craft without fear of prosecution. This summer, Missouri reversed its 25-year ban on non-nurse midwives. Twenty states have similar legislation they are either introducing or planning.
It's a really intense time for people on both sides of the issue: the doctors who are afraid the rate of death during childbirth will rise with a rise in homebirth and the midwives who are afraid their work will be further regulated or even criminalized. Read the full story here.
Reader Comments ( Page 1 of 1)
1. The doctors are really just worried about losing their business to midwives. In any case, isnt it the mothers decision where to have the baby? And who delivers it?
I heard an interview with a doctor about c-sections vs regular birth/home birth. It was interesting, maybe someone can comment. The doctor stated that many women are pushed to get a c-section for convience. mainly the doctors. A c-section can be scheduled so that the doctor can still see x number of patients and get their full pay for any given day. Regular births are not scheduled so a doctor might have to cancel some patients and hence, lose some money.
any comments?
CaptainCack at 11:01AM on Aug 11th 2008
2.
Ada I miss your Wdnesday in-box oddities.
JefFlyingV at 11:16AM on Aug 11th 2008
3. I'm glad to see this topic brought up.
While the AMA claims to have concerns that maternal and neonatal mortality rates will increase with more access to home birth, the fact is that the choice of how and where to give birth should clearly be a family's choice, not a legal mandate. The AMA is very fear-driven and its entire industry is simply a business model, not a healing model.
With better education, more cooperation amongst practitioners, and proper training for midwives, this does not have to be such a polarizing problem.
In fact, there was once a period of successful relaxation of the lines between the sides: we saw ob-gyn's IN FAVOR of nurse midwives taking over more responsibility in deliveries is when it was convenient and beneficial to their own interests. This began in the 80's, when malpractice insurance costs began to skyrocket, when we saw a brief trend of cooperativeness coming from the side of the ob's towards the midwives.
What was presented as a sincere desire on the AMA's part to be sensitive to family's right of choice was in truth, a timely scheme to offset their practioner's liability.
Oh well.
From this article, it sounds like we have not progressed very well. More work needs to be done educating the public.
cc at 1:20PM on Aug 11th 2008
4. Ada--you have it backwards. Midwives are fearful of all the complications of the hospital affecting childbirth (hospital borne infections, mothers who have a hard time giving birth in tense places like hospitals) and the AMA is doing this cause midwives are taking their business. Don't take my word for it--do the research, dig. You will find that it is not so great having a baby where people could care less about you.
Sarah Del Rosso at 2:25PM on Aug 11th 2008
5.
Women have been having babies outside of hospitals for about 60,000 years longer than they've been having them IN hospitals.
.....So, what's the question again?
ex-christian at 3:21PM on Aug 11th 2008
6. There are at least 3 critical facts that women need to know about homebirth, and most homebirth advocates conceal these facts.
1. All the existing scientific evidence shows that homebirth increases the risk of neonatal death. Sure, there are papers that claim that homebirth is a safe as hospital birth, but they do so by comparing homebirth to high risk hospital birth (instead of low risk hospital birth) or by comparing homebirth in one year to hospital birth decades before (as in the Johnson & Daviss BMJ 2005 study).
Johnson & Daviss claimed to show that homebirth with a CPM in 2000 was as safe as hospital birth, but they compared it to hospital birth in a bunch of out of date studies extending back to 1969. Johnson & Daviss simply left out the fact that homebirth in 2000 had almost triple the neonatal mortality as moderate risk hospital birth in 2000.
2. Homebirth midwives belong to a second, inferior class of midwives with less education and training than ANY midwives in the industrialized world. American CNMs and European midwives deservedly have excellent reputations. They have rigorous educational requirements and extensive hospital based training in the diagnosis and management of childbirth complications.
Homebirth midwives (direct entry midwives including CPMs) try to trade on the reputation of other midwives. However, homebirth midwives have grossly deficient education requirements (they can obtain their education by correspondence course) and grossly deficient training, lacking any training in the diagnosis and management of complications. American women need to understand that American homebirth midwives cannot meet the requirements to be licensed in ANY first world country.
3. The Midwives Alliance of North America (MANA) the trade union for direct entry midwives, has been collecting extensive statistics on the safety of homebirth since 2001. Those statistics have been publicly offered to anyone who can prove they will use them for the "advancement of midwifery". Even then you must sign a legal non-disclosure agreement preventing you from revealing any data to anyone else. It does not take a rocket scientist to suspect that MANA is suppressing its OWN data because it shows that homebirth with a direct entry midwife increases the risk of neonatal death, and possibly the risk of brain damage as well.
Unless and until women contemplating homebirth understand these three points, they cannot make an informed decision about homebirth.
Amy Tuteur, MD at 3:51PM on Aug 11th 2008
7.
I wish I could have had a home birth. Unfortunately, my daughter was breech and wouldn't turn, so I had to have a scheduled c-section that was scheduled for 10 days before she was due. If I knew then what I know now, I would have put the c-section off until the last minute in hopes that she would turn.
What I didn't realize was that the moment my baby was born, my trusted doctor had no say in what happened to her. I was given one glance at her, then she was whisked away for cleaning, shots, whatever all they do. And I didn't see her again for THREE HOURS!
Even then, I am convinced the main reason they finally brought her to me was because I was pitching a fit that everyone in the maternity unit could hear and my husband was ready to throttle somebody.
If I had had another baby, I would definitely have tried harder to do it at home.
Doofus at 4:53PM on Aug 11th 2008
8. This is a great topic, Ada. Why don't you (or anyone else, for that matter) do the research and see what it shows?
Fact: The United States has the 2nd highest newborn fatality rate in the world. An Overwhelming majority of these babies are born in the hospital.
Here's a good place to start. See Ricky Lake's excellent documentary, The Business of Being Born.
http://www.thebusinessofbeingborn.com/
My wife and I had both of our babies delivered by Midwives. It was the best experience that I have ever had in my entire life. Our first was born at a birthing center and our second was delivered at home. Both were amazing experiences.
Don't listen to the AMA's ridiculous scare tactics. Research it for yourself and choose what is best for you and your family.
By the way, both pregnancies were considered "at risk" by doctors because my wife had her first at age 37 and the second at age 39. Our two year old and 4 month old are healthy, happy, and were brought into the world without drugs or interventions.
Andy Malcolm at 7:23PM on Aug 11th 2008
9. I had both of my children in a terrific hospital. I had an wonderful OB/GYN. I was in labor with my son for 24 hours, and yes I had an epidural. He was born healthy and remains healthy. I was in labor with my daughter for 2 hours in the same hospital. I did not have time for an epidural. She was born healthy and remains healthy as well. I personally would not want to have any of my children at home, because life is uncertain. A perfectly healthy pregnancy can turn deadly in seconds. In the case of an emergency I want a medical doctor to take care of it. But,it should be a personal decision. If one chooses to have their children at home, then they should be able to. As much as anyone wants to stress how darn beautiful childbirth is...it really isn't. A woman should be comfortable, whether she chooses to have a hospital birth, a home birth, drugs or no drugs.
Dee at 1:32PM on Aug 12th 2008
10. I used to think it should be a mother's decision whether to have a home birth with a midwife or to have a hospital birth. But it is not just the mother's life that is at stake here. If a hospital birth is safer for the baby, then babies (in countries with good hospitals) should be born in hospitals. I have known women who had babies wisked off to NICU right after birth due to heart and other problems. Would these babies have survived home birth?
Val at 4:54PM on Aug 12th 2008
11. Our bodies are extremely responsive to our thoughts, so when women grow up in a culture that fears birth there are bound to be problems regardless of where the birth takes place. This is because fear hormones literally shut down birth hormones. Homebirth statistics are better in European countries not because the midwives there have more training. They're better because homebirth is more accepted there and consequently women cooperate with the birth process rather than fight it. As women in this country learn to trust themselves and their bodies, our homebirth statistics will naturally improve.
Laura Shanley at 5:26PM on Aug 12th 2008
12. I was frankly disappointed in the Time piece. I understand the need for journalists to find "balance," but you failed to check out the sources that people are using to back their claims, and the doctors groups are abusing their power and misrepresenting what the numbers really tell us.
And perhaps more importantly, you missed the point that many home birth families face real problems, but not what the doctors' private trade organizations (AMA, ACOG) are trumpeting ...
In about half of the United States, home birth families face a real problem: they have no access to licensed home birth care! The answer: licensing home birth midwives who pass the national board certification exam for Certified Professional Midwife (CPM). Twenty-four states allow CPMs to practice. No state has ever repealed a low, nor has any state agency reported bad results from licensing CPMs.
In spite of this obvious solution -- helping home birth families find qualified care providers -- private trade organizations, such as the American Medical Association (AMA), are hopping mad and fighting tooth and nail for every penny that American women spend for maternity care. Anyone who's read negative comments from doctors, scratched your head, and wondered how the docs could be wrong ....
One the one hand, you have dozens of studies that show overwhelmingly that planned home birth in a low risk population is AT LEAST as safe as low risk women in the hospital. (I know, it doesn't seem possible but bear with me.)
On the other hand, doctors opposing home birth, tell scary stories to prey on people's fears and can only cite a paltry two studies --
ONE study is from Washington State, authored by Pang et al. This study itself states that its methods are flawed b/c it relied on birth certificate data, which makes it impossible to remove unplanned emergencies that accidentally took place at home or unsassisted births, from planned home birth with a midwife.
THE OTHER study is from Australia, and included higher risk mothers in extreme rural Australia. This study states, "The two largest contributors to the excess mortality were underestimation of the risks associated with post-term birth, twin pregnancy and breech presentation..." This study also admits that it contradicts "[studies of] home births elsewhere."
A recent development in the physcians' private trade groups (like the American College of Obstetricians and Gynecologists) smokecreen, is to quote raw homebirth data from the CDC. This data makes it difficult to discern the truth for people unschooled in research statistics (like weeding out congenital anamolies which have no chance of survival). Just like a good study takes out high risk hospital birth moms, so, too, you have to remove things that have nothing to do with planned home birth for low risk women with a midwife in attendance.
WHY DO THE DOCS CARE? Since their stance is contrary to the evidence, one has to look for other reasons. Childbirth is a multi-billion dollar industry. Money compells people to do dastardly things, and this is no exception.
Contrast that (a private trade organization protecting its turf) with those promoting licensure of CPMs -- home birth moms and dads. That's right, the move to license CPMs is a true blue grassroots movements made up of (mostly) a bunch of moms taking on the AMA.
SHAME ON THE AMA and their ilk, including their very own internet troll, the so-called Dr. Amy (who seems to be fond of muckraking so low as to insanely accuse home birth families of hiding dead bodies in their yards!!!???) If you really cared about home birth moms and babies, you'd stop pushing two very flawed studies and let moms choose what we know is best for our own babies -- no matter where that happens to be!
Morning Jones at 10:10AM on Aug 14th 2008
13. Each side on this issue is entitled to its own view of what the statistics mean, but in the long run, where to give birth should be the parent(s)' choice, no one else's. The law recognizes a mother's right to choose, from the moment of conception, whether to terminate her pregnancy or not - if she opts not to, the death rate for the fetus is (almost) 100%, not to mention risks for the mother herself. If a pro-choice woman can make the choice to END her pregnancy, then one who chooses to CONTINUE her pregnancy should certainly have the right to determine where that baby will be born and who (if anyone) will assist at that birth. There are risks inherent in birth no matter WHERE it occurs - no 100% guarantees - and informed consent means that the parent(s), after being informed of all relevant risks in all locations, then have the right to choose which set of risks they prefer to take. If the mom has the choice of whether her unborn child lives or dies prior to birth, she certainly has the right and the intelligence to decide where she wants its post-birth life to begin.
Kerry at 12:38PM on Aug 15th 2008