I'm tired of hearing people talk about the Ricki Lake doc and say "See, all doctors are EEEEVIL, no one should have babies in hospitals," since I'd have probably stroked out if I wasn't in one for my son's birth.  I don't have a problem with your home birth, you don't get to decide I can't go to the hospital if I want to, let's all just move on.

HOWEVER, I don't think the AMA is doing themselves any favors by acting like this. How is this going to encourage women who want to have a home birth to make sure they have appropriate medical resources available as needed?

Model legislation in support of the concept that a hospital or freestanding birthing center is the safest place to have a baby - what exactly would that look like?

That's where people need to focus their attention if they're concerned about this issue. See what they come out with, and then keep an eye on your state legislative process to see where it turns up.

I just blogged this earlier today - Home birth is a choice the AMA wants to outlaw

I think for the AMA to deny women the right to choose where to give birth is to deny them their basic rights. Birth is not one size fits all and women and their babies deserve to have options. I think AMA and ACOG are scared and this is the only way they can regain control.

For anyone who's interested in spreading the word about this, I have a button that says "Home birth is a choice" that you can add to your blog. It is in the post linked above. 

Thanks for blogging this. Welcome back. :) 

Amy
Crunchy Domestic Goddess
BlogHers Act contributing editor

 i wish homebirth was more common that hospital births,

even if they sent a nurse to your house with medical equipment.

the ama needs the money they make from births + pushing epidurals.

they can also afford lawyers, so i hope they can't make homebirth illegal. 

mod*mom

p.s. congratulations on your new little person + surving his birth 

I'm going to make a bad analogy, explain why it's bad, and hope for the best.

The laws on the books against violating speed limits while in cars are there because some people can't handle driving that quickly, especially not around slower-moving vehicles, without becoming dangerous to other people and to themselves. Their existence only indirectly implies that no one can handle driving safely in excess of the speed limit. Nonetheless, I often think to myself, "Self, that law is dumb. There is no reason why I should be restricted from driving at any speed I can safely maintain." But in a world where exceptions to the law would make enforcement of the non-excepted too difficult, I have no hope of ever legally being able to drive 100mph on I-5.

The analogy here with home-births is of course that even though the AMA coming out against home-births as unsafe does, indirectly, imply that no one should do it, the real statement is just that it is too difficult to figure out beforehand who will be just fine delivering at home and who will have complications too severe to survive at home.

Now, the analogy breaks down when it becomes clear that in speeding laws, we are protecting not only ourselves, but those around us, when we legislate to the lowest common denominator (horrible drivers). An anti-home-birthing law would have to come out pretty strongly on the "protect the baby" side if it is to pass muster. But protecting the baby to that degree is too close to infringing on basic human rights that we've been trying to define through courts and legislation for decades.

So I don't think we can get away with legislating to the lowest common denominator in this case. Slippery Slopes may be fallacious argument schemes, but what we have here is not a slippery slope but a wide-open window overlooking a snake-pit: if we start saying that we have to deliver all babies in the hospital, and for the reason that it is in the best interests of the baby to do so, and that a violation of the mother's autonomy and discretion is acceptable, then we no longer have a reason to say that we can't confine all pregnant women to Pregnancy Chambers for 9 months just to be on the safe side. I know it looks like a slippery slope argument, but it isn't, really.

http://backpackingdad.blogspot.com

Homebirth advocates would like women to think that the issue is "choice" and that the AMA is attempting to "outlaw" homebirth. Neither of those things is true.

Why are homebirth advocates lying about this? As usual, it's because the lie is so much better than the truth. Here's what the AMA actually said:

1. Homebirth is not as safe as birth in a hospital or licensed birth center.
2. Midwives should be licensed to the standards of the American College of Nurse Midwives.

If homebirth advocates attacked the resolutions on what they actually said, they'd be forced into a discussion they would lose. Homebirth is NOT as safe as hospital birth. All the existing scientific evidence shows that homebirth has an increased risk of neonatal death. The ACNM standards for midwives ARE the appropriate standards. They are consistent with midwifery standards in EVERY other country in the industrialized world.

Homebirth advocates like to imply that homebirth midwives (direct entry midwives) are just like certified nurse midwives or just like European midwives. That's not true, either. Homebirth midwives are a second, inferior class of midwives with far less education and training than ANY midwives in the industrialized world. American homebirth midwives would not be eligible for licensure anywhere else.

You really have to wonder about people who twist the truth in order to promote their cause. There is not, there never was, and there could not be any effort to "outlaw" homebirth. The AMA opposes homebirth on safety grounds, and it opposes homebirth midwives because they don't meet the world-wide standard for midwives. These are the real issues, the ones that homebirth advocates are trying to hide. 

Amy TuteurMD

I believe that Dr. Tuteur is also twisiting the truth to benefit her argument.

I totally disagree with her comments about homebirth midwives as being a second, inferior class of midwives.

I had a VBAC homebirth with a lay midwife, she was far, far superior to my first CNM that I had with my first birth which ended up in a C-sec.

Dr. Tuteur, professes to know everything about Homebirth midwives but in actuality does not have any experience with lay midwives or homebirths.

as she says:

"You really have to wonder about people who twist the truth in order to promote their cause."

This is complete hogwash. It is not possible to generalize about all Hombirth midwives anymore than it is to generalize about all Doctors abilities. Some Drs' are not fit to practice medicine, even if they met a supposed "worldwide standard".

This is just another grasp by the medical community to limit a woman's right to choose her own healthcare.

Erin Ely

http://elyorganics.com/

Quit citing that Washington homebirth study- they only counted the transfers.  It's obviously flawed.  

 Someone needs to fight the AMA for scaring women and monopolizing childbirth.  These are mothers and babies.  Birth isn't flawed, or dangerous.  Interfering with birth is dangerous.  YOU- dear amy twist the facts to scare people every single day and it's pathetic to watch. 

If your dear precious medical model of birth is so successful and safe, why is the US so far down on the scale of "safe places to give birth" and European countries with a higher rate of homebirths and midwife attended births have more survivors

 Miss Amy is lying when she states that European midwives follow the same medical model ACNM follows.  Simply lying.  It's an entirely different story over there, a different nature of cooperation.  Some midwives do work within hospitals an in England and France it's very similar to here in the U.S. except more babies and mothers live to tell about it (perhaps because they're not forcing a supine position?)  In the Netherlands and in Sweden, most births are at home.  Germany, Russia- not a good place ot give birth,

Someone- please find that article about giving birth around the world- it tells this story far better than I do.  Dr Amy- you are pathetic.  sad, hysterical, totally missing the point.

Lisa Russell

http://mrshannigan.blogspot.com

Because the specific, factual claim that Her Bad Mother makes in her post is that the AMA is supporting or supportive of legislation that has a particular goal: ensuring safe delivery of babies by acknowledging that hospitals (or care centers) are the best setting.

The specific, factual claim that Dr. Tuteur makes in her comment is that the AMA resolution simply claims that: "Homebirth is not as safe as birth in a hospital."

If the resolution does indeed contain language about supporting legislation that will ensure safe deliveries by acknowledging the superiority of hospitals, then at the very least Dr. Tuteur is mistaken in what she claims the AMA is merely stating. Because supporting legislation that will contain specific language or goals is doing more than making some statement of a motto: We like hospitals!

If the resolution does not contain any such language about supporting legislation, then Dr. Tuteur is absolutley correct to point out that the issue may be blown out of proportion.

I'm a bit lazy to go looking at the language right now. But my point here is just that whatever controversy exists in this thread right now owes its existence to the question of what language is actually contained in the resolution. I'm going to go ahead and lay a wager though, that the language in the resolution is significantly (in a philosophical sense) stronger than Dr. Tuteur is making it out to be. Supporting legislation that acknowledges the superiority of hospitals is only insignificant if the legislation that is supported merely states something like: "Yay hospitals!" But who is going to waste their time passing such a law? Laws are there to proscribe behavior, in some way, so if the AMA sees the need to support legislation, unless they are merely in support of "Yay hospitals", empty legislation, then they are in support of something that is a restriction on behavior. Now, what behavior might they end up being in favor of the restriction of?

As I say...I'm too lazy to go looking at the language (but not too lazy to do an XKCD "Someone is wrong on the internet!" comment, obviously.) But I have $5, collectible at BlogHer, that says the language isn't as innocuous as Dr. Tuteur needs it to be for her factual claim to be correct.

http://backpackingdad.blogspot.com

The issue is clearly that of choice.  Anyone who has done any research whatsoever on homebirth knows that having a planned homebirth with a trained midwife is as safe, if not safer than a hospital birth.  I have had three children, two of which I birthed in a hospital by choice (and lack of education).  The third I chose a midwife, even though they are outlawed in Alabama, and planned to drive out of state to have my baby.  My midwife taught me more about how to prevent problems of pregnancy than any of my ob/gyns ever did.  I had the healthiest pregnancy of them all.  My midwife was also trained to handle many things that occur during pregnancy and birth because she had attended many, many unmedicated births.  When I birthed my other two children in the hospital, unmedicated, they actually sent nurses and students in to the room to see me and the baby because no one ever gets to see a natural birth anymore.

Midwives are not, as some want to believe, uneducated women, with no medical training.  My midwife had pitocin available if needed, was able to birth breech babies, could do neonatal recussitation and knew when it was necessary to transport a mother if the labor was not going well.  She had a much lower infant and mother death rate than any hospital.

The problem is, no one knows about all of this stuff unless they research it or know someone who will tell it to them.  That is why it will probably be so easy for the AMA to use their scare tactics, smear campaigns and anything else they need to in order to keep the money flowing into thier greedy little paws.

How can the AMA decide that homebirth is not as safe as a hospital birth for millions of women, when they don't even know these women's medical histories?  Shouldn't homebirth be decided on a case to case basis, when a patient seeks a medical opinion from her OB on the subject? 

Doctors won't even confirm you are pregnant until you come into their office- if they won't even accept that basic piece of information without examining a patient, how can they boldly and arrogantly make the statement that the safest setting for mothers and babies is (always) in a hospital?

The CDC has case after case of infectious diseases being caught and transmitted in hospitals- from affluent areas down to the poorest hosptials.  Just because you have your baby in a hospital, it doesn't guarantee that either the mother, baby, or both, are "safe." 

The US still has one of the highest maternal death rates in the WORLD.  From the CDC: In 2003, it was 12.1 deaths per 100,00 live births.  It says, "despite this tremendous overall improvement, maternal mortality continues to be a significant public health issue and commands an enormous amount of attention."

We have one of the higest maternal mortality rates in the world, despite 99% of the births occuring in hosptials.  Hospitals the safest place to have a baby?  The facts speak for themselves, and clearly the hospital is not always the safest place to have a baby.

Why is the AMA issuing such an erroneous statement, when the CDC statistics clearly states maternal death is a significant public health issue?  If hospitals truly were the safest place to have a baby and 99% of the women in this country have their babies in the hospital, we should have one of the lowest maternal death rates in the world.  But we don't- the opposite is true.  It doesn't take a genius to figure out who is telling the truth, and who isn't.     

I want to add that the report from the CDC where they list the maternal death rate that I used in the above comment was from the February, 2007 Vital and Health  Satistics Issue. This appears to be the most current year (2003) the CDC has information on- even later issues of this report, still use the year 2003.

In 2003, the US birth certificate was revised to include place of delivery and birth attendant. The first set of statistics from those years were recently made available on the CDC website. The statistics show that PLANNED homebirth with a homebirth midwife (DEM) has double or triple the rate of neonatal death as hospital birth. In 2003 the US standard birth certificate form was revised to include place of birth and attendant at birth. Now the CDC has made the entire dataset available for review and the statistics for homebirth are quite remarkable.

As this chart shows, the neonatal mortality rate for DEM assisted homebirth is almost double the neonatal mortality rate for hospital birth with an MD. 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. 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.

It is not suprising that the AMA opposes homebirth. Homebirth with a homebirth midwife is dangerous; it increases the rate of neonatal death.

Amy TuteurMD

Isn't that the big question here?? People like Dr. Tuteur and org's like the Big Brothers ACOG and the AMA like to make us think that it's *all* about safety and NOT choice but really it is. We live in the United States of America where we were founded upon the ideals of the inaliable rights of life, liberty, and the pursuit of happiness. I'd like to highlight the definition of "liberty" here for this discussion (thank you dictionary.com):

LIBERTY:

1.freedom from arbitrary or despotic government or control.

2.freedom from external or foreign rule; independence.

3.freedom
from control, interference, obligation, restriction, hampering
conditions, etc.; power or right of doing, thinking, speaking, etc.,
according to choice.

4.freedom from captivity, confinement, or physical restraint

So what is happening to our liberty here?? I understand Backpacking Dad's analogy of keeing other people safe and that's where the line gets fuzzy. The gov't is saying that it's *their* "duty and responsibility" to keep children safe from their own parents and that their parents can't make safe decisions on behalf of them. While this is true of some parents it's certainly not true of ALL parents and if we are going to go this route with the first major choice we have to face as parents, then we better extend the time commitment of the Pregnancy Chamber BPD mentioned for a whole lot longer than the first 9 months of their conception because we might REALLY screw them up. <sigh>

Sorry for the tangent but again, it's more about our freedom to choose and care for ourselves and our own children than anything else in my opinion. Organizations like ACOG and the AMA can make recommendations and present factual information and so can midwives and their alliances. Let families choose for themselves which options feel right to them. Trust people again for heaven's sake. There are bumper stickers and posters saying "Trust Birth" and we really need to begin there so that we can trust in people again. As for Dr. Tutuer mentioning the "flawed" stats that the homebirthing community offers up, she fails to mention why that is. Many homebirth stats aren't turned in to the gov't because many midwives are forced to welcome babies illegally. Many babies are born at home perfectly safe and well and we'll never know because the govt is determined to *think* that it's unsafe. Dr. Tutuer often talks about flawed stats but she's really not telling the whole truth either.

Dr. Tutuer, I do have to ask if you are secretly working on behalf of midwives across the world. Really, I bet that doctors cringe when they find out the filth that you are spreading around the internet. Why? Because you are really showing women what a lot of us are talking about, what we are avoiding and what we will also fight against. You are an elitist. You're pushy, degrading and plain rude. You seem to think that just because you have gone to school to learn how to "save us all with your scapels and knives" that you are better and smarter than we are. Many other doctors share the same attitudes that you do but there are some really good drs out there that probably just want to bean you on the head because you are turning more and more women off with your attitude more than turning them on by your "facts".

Also don't forget Amy Tutuer, many of us given birth at home and have done so safely and no matter how much you try to prevent other women from having the same blissful experiences you will never, ever be able to take our experiences away from those of us that have had them. We will continue to fight to help others know that it's possible to give birth on their terms no matter what the law, ACOG or the AMA says.

It makes me sad to the deepest depths of my soul that you are a woman that tries to scare other women in to thinking that they are weak, flawed, and inable to do the one thing that our bodies are perfectly capable of doing and doing well...giving birth to little children that we have the responsibillity of caring for. That seems to look very different to you than it does to me and that's completely fine with me. That's the difference between the homebirthing and hospital communities. One tries to build up confidence and choice and the other is in to reliance on others and limited choice.

I could go on forever but will stop now so that people actually read this post. ;) Thanks to all of the bloggers out there who are working to make birth and homebirthing stories a positive thing. Birth will never be normal until more families start talking about the positive aspects of their birth rather than the terrible, scary, icky ones. Even in birth stories that didn't go as planned women can find wonderful things to talk about and I wish that more of us would focus on those. That is another first step to making birth a beautiful, peaceful experience. I mean, it should be no matter where it happens. After all, it's the first entrance to this world for another human being.

is clear - the AMA wants model legislation:

RESOLVED, That our AMA develop model legislation in support of the
concept that the safest setting for labor, delivery, and the immediate
post-partum period is in the hospital…

Read it here. 

If women have a right to choose if they want to even have a baby,  they have the right to choose how and where to have that baby.  Myself, I'm giving birth in a hospital.

Labor and birth have risks in any setting.  I'd wager a guess and say that complications cause more fatalities in home births than in hospital settings.  These are - based on the CDC information posted above - facts.  There is no arguing with facts.

But it is the woman's body and the life of her child.  She has the right to make the decision on how the baby is brought into this world.  No fancy talk about safety and wording is going to change that they are actively trying to take that choice away from mothers.

These are the types of decisions you will see legislatures and medical groups make for us if and when we go to government provided health care.  They do tend to make decisions based on the lowest common denominator.

To those questioning the safety of homebirth:

1- Have you actually watched the documentary? If homebirth is less safe, why is the country in the #1 spot one that 1/3 of their births take place at home. That is a SIGNIFICANT amount and their rates are considerably better than ours and clearly influenced by the homebirth statistics in their country.

2- 1% of births take place at home in the USA...it's not the homebirths in our country that are making the rates higher than other countries, it's hospital births.

3- If hospital births are so safe, then why do doctors regularly and routinely do unnecessary c-sections on women, the most dangerous procedure when it comes to a normal birth? 1 out of 3 women are having c-sections. Why would I want to go somewhere where I have a higher chance of dying? I know a woman who has died from a routine c-section, a c-section that she did NOT need. The only reason they ended up having one is because the doctors had to "save" her from all the interventions they were doing to her (such as pitocin, epidural, etc), which caused her baby to go into distress and "require" a c-section. I know they are sometimes necessary, but an almost 30% chance of having one if I go to the hospital is completely ridiculous and unsafe.

CPM's aren't the only midwives that attend homebirths. CNM's do as well. They are both very well trained to handle emergencies. I hemorrhaged and they very quickly reacted and controlled the bleeding. My baby ended up needing open-heart surgery (we had had the normal ultrasounds by a doctor to rule out anything was wrong, but nothing was detected with the heart, which we've later learned is very common when it comes to the heart), and the midwives discovered it immediately and took very good care of both of us.

I do agree that there are some midwives out there who are not well trained and not capable of handling emergencies like they should, but I think the same about doctors. Over all, midwives are incredibly well trained and if you let the body do it's thing and stop trying to intervene, there will be better results. The mother should get to choose who she has at her birth.

I am grateful to hospitals and doctors because they are there when there is REALLY a need for them. But overall, worldwide statistics DO prove that it is safer for the mother and the baby to be out-of-hospital in low risk birth situations. I could go on and on about the ridiculous, routine things hospitals do to women/babies - harmful, damaging things...

Point being, I don't think it's just an issue of choice, it is also an issue of safety. I think each woman/family should get to decide how they feel about the safety of out-of-hospital birth and make that choice for themselves. Some women in the end will feel safer in the hospital, and I think they should definitely have their baby in the hospital then. But there are plenty of women who feel safer out-of-hospital, and I think it is their choice to choose where they feel safest.

All homebirths are not reported to the CDC. There are states where it is illegal for midwives to attend a homebirth, but they do anyway. Those statistics are certainly not included in the CDC report, as I'm sure the midwives would never report those. I know there are other midwives out there (in states where it may not be illegal, but it is frowned upon) who also do not report their statistics. It's not because they have such terrible statistics, but it's because they are given a hard time for attending homebirths, and they choose not to deal with it by keeping to themselves more. There are many midwives who don't report their statistics. Of course, there are almost many midwives who do report their statistics. I'm not suggesting it's right for them to not report it, just stating that under-reporting certainly is a big issue when it comes to understanding the true statistics of homebirths.

If a baby dies during a homebirth, there is an investigation and that is almost always for sure reported since it's no longer up to the midwife to choose to report it or not, which is why it might seem like a lot more babies die at home when if they had all the successful homebirths as well, they would find the percentage is actually much lower. All the successful homebirths, those are not all reported. So, while the CDC is certainly reporting honestly, they are not given all the information they need in order to portray what the true statistics of homebirth is.

It would be interesting to know what the true homebirth statistics are in the USA. In countries where homebirth is not seen as unsafe and were a large percentage of women have them, you see that they have much better results than the USA (this is comparing for all USA births, which are mainly hospital births). As I mentioned in my previous comment, the country in the #1 spot for safety (was it Holland? I honestly can't remember), 1/3 of their births are at home. Since it's so common there and not looked at as unsafe, you can almost guarantee that most, if not all, homebirths are reported. They have excellent results.

So...that's kind of why that chart above doesn't really state much to me on the safety of homebirth. How can it when there is an under-reporting of homebirths and the statistics simply aren't accurate? I guess that's where I look to other countries and see what their statistics are and see how great they are. Also, when looking for a place to birth (out-of-hospital), you can often ask the midwife what her statistics are and only go with a place with great statistics. That's what we've done both times.

I just went to the site that Dr. Tuteur linked.  I knew before I clicked that I had something to say about using statistics that judge home birth via Direct Entry Midwives.  It's just bad logic.  My midwife is an RN, CNM, Nurse Practitioner.  'Cause I'm like that.  I really go in for education.  And it is MY choice.  There is no causal relationship between at-home birth and the education level of the birth attendant.  

What the AMA is really afraid of is that we'll change our idea of what is 'qualified' and leave that oh-so-lucrative standard-procedure medical intervention out in the cold.  But that isn't what I came to say. 

I went to the site that Dr. Tuteur linked.  And here's what I found.

CDC Linked Birth/Infant Death Records, 2003-2004 

CNM: Deaths, 909; Births 308,113; Death Rate per 1,000, 2.95

MD: Deaths, 25,351; Births 3,571,460; Death Rate per 1,000, 7.10

DO: Deaths, 1,069; Births 185,981; Death Rate per 1000, 5.75

Other: Deaths, 352; Births 19,711; Death Rate per 1000, 17.86

Other Midwife: Deaths, 52; Births 17,786; Death Rate per 1000, 2.92

 So... wait, where did you get your numbers?  Because this looks like the infant mortality rates are twice as high with doctors than with any kind of midwife.  And this came from her link!  

Go see for yourself.  Dr. Tuteur is counting on your trust.  She thinks you won't go look.

In fact, I'd challenge anyone to come up with a study that shows that out-of-hospital birth resulted in worse outcomes provided women were pre-screened for risk factors and had a planned birth with a trained attendant.  I don't think there are any. 

I also have to call out the logic on: "I'd have probably stroked out if I wasn't in [a hospital] for my son's birth."  I hear this one a lot.  It goes like this, "Because something bad almost happened to me in the hospital, it most certainly would have happened in just that way except worse had I been at home." But that isn't actually founded, because you can't possibly know what would have happened because it didn't happen!  And, it overlooks the medical intervention that may have caused the problem in the first place.  People tell me I was so lucky because my first labor was four-and-a-half hours, I didn't tear and after giving birth I immediately had a big fat burger and washed my own dish.  I say, it wasn't luck.  I wasn't drugged, kept in a still position, panicked, stressed-out or induced.  

The AMA wants you to think that I would have had just that birth had I been in the hospital. I don't believe that to be true.  I wouldn't have been sitting on my own comfy couch when I hit transition.  I wouldn't been at my breakfast table eating eggs at 4 1/2 centimeters.  And I wouldn't have had a highly qualified midwife tell me on practically the first contraction that my baby was posterior and I should do a modified downward dog for twenty minutes to help him turn.

The AMA doesn't want you to question the way we do it.  They play the 'dangerous for your baby' card, as if moms are willfully putting their babies at risk.  I don't believe that's what we're doing.  If you're considering a home birth, I support you and trust you to make the best decision for yourself and your baby. 

Don't let them spoon-feed you your facts, ladies.  You're much too smart for that. 

So, I suppose I have a different take on this because I'm the daughter of Perinatologist, which is a high risk specialist OBGYN doctor.  My dad delivers all high risk babies of women over 35, twins, crack babies, and even babies who have been shot.  Now, I know how doctors can be total assholes, I've seen it, but my dad is one of those rare-refined doctors out there who still cares about people and won't just say things to scare you.  He's not 100% against birthing at home, in fact I'm sure there are definitely times where the midwife is better than the ass-hole doctor.  However, I know that he doesn't feel that the patient is qualified to make that decision.  The sad truth is that it is riskier to deliver a baby at home, and knowing the enormous number of complications that can take place during delivery I would say that, as a pregnant woman, you should be extremely careful whatever decision you make.  Consult lots of doctors instead of just one, and make sure you do your research, however you may have issues that simply can't be dealt with outside of a hospital no matter how much you want to have a home birth. (i.e. premature labor, a baby with any sort of disorder, etc.)

Also, when noting all the statistics of who dies in hospitals, if you check a lot of them you'll notice that education is directly linked with maternal and newborn mortality.  In other words, less educated women have more problems during pregnancy and delivery and higher rates of death, so don't be one of them.  Additionally, remember that America is a really unhealthy country compared to many of the European ones, and one of the major labor complications that occurs often is obesity, which we all know runs rampant in America.  

 And I know a lot of doctors suck, but some of them are nice.  and remember, part of protecting their own interests means recognizing that its not so simple for doctors.  For example, say a woman choses to have a home birth and has a complication, rushes to the hospital, but the baby dies while the doctor is helping them.  That doctor can still be sued for malpractice even though it was not necessarily his fault the baby died.  The high number of lawsuits in this field is the reason that California had to put a cap on the amount that a woman could sue for for Pain and suffering about 5 or so years ago because they were losing so many doctors to other states.  Anyways, I'm all for women having choices, but I think everyone should remember that this is by no means a simple, cut and dry issue of choice vs. safety.  Its a balance, and it requires a greater understanding than a few statistics on death rates in the US.  Its different for every woman, so like comment above me says, "Don't let them spoon-feed you your facts."  Don't let anyone spoon feed you facts.

Well Thank goodness for blogs and the internet. The AMA should not be allowed to control our lives. Women have been having babies since the beginning of humankind. We know what we are doing.

One of the biggest problems with homebirth advocacy is that it is based in large part on mistruths, half truths and outright deceptions. Homebirth advocates repeat these false claims over and over to each other and no one ever bothers to check if they are true.

There are multiple examples of such false claims in the comments about my post showing that homebirth with a DEM has double to triple the neonatal mortality rate of hospital birth with an MD or a midwife.

For example:

"If homebirth is less safe, why is the country in the #1 spot one that 1/3 of their births take place at home. That is a SIGNIFICANT amount and their rates are considerably better than ours and clearly influenced by the homebirth statistics in their country."

The Netherlands does NOT have the lowest perinatal mortality rate. In fact the Netherlands has a HIGHER perinatal mortality rate than the US. I know that's not what homebirth advocates tell each other, but that's what the World Health Organization 2006 report on perinatal mortality shows. The country with the lowest perinatal mortality rate is Japan and they have virtually no home births.

"% of births take place at home in the USA...it's not the homebirths in our country that are making the rates higher than other countries, it's hospital births." 

Actually, less than one quarter of one percent of births in the US are homebirths with a DEM. However, if the homebirth rate were to rise to 10%, homebirth would become one of leading causese of neonatal death, vaulting over most of the other major causes of neonatal mortality.

"All homebirths are not reported to the CDC"

That's false. The CDC data comes from birth certificates. If you apply for a birth certificate, the birth is reported to the CDC. 

"In countries where homebirth is not seen as unsafe and were a large percentage of women have them, you see that they have much better results than the USA"

First of all, all other industrialized countries have midwives trained to a far higher standard than American DEMs. American DEMs could not meet the licensing requirements for any other country in the industrialized world.

Second, according to the WHO report I mentioned above, the US has a BETTER perinatal mortalty rate than Denmark, the UK and the Netherlands. 

"I went to the site that Dr. Tuteur linked.  And here's what I found"

That's because you didn't exclude premature babies as I did. You didn't exclude babies under  2500gm like I did. You did not look at neonatal mortality (death from birth to 28 days), you looked at infant mortality which includes deaths from 28 days to 1 year. Infant mortality is the wrong statistic for evaluation of obstetric care.

The bottom line remains the same:

Homebirth increases the risk of neonatal death, and American DEMs are grossly undereducated an undertrained compared to midwives anywhere else in the industrialized world. 

Amy TuteurMD

If mothers can "elect" to have c-sections, which are known to be LESS safe for mother and child (mother because it's major surgery and child because their lungs are not squeezed of excess fluid on the way out), then mothers should be able to choose to labor at home. It's really that simple. Their use of safety as an argument falls flat on its face when compared to unnecessary c-section rates in this country.

FireMom from Stop, Drop and Blog

I have to weigh in on this one just to say that I agree with the poster above who took to task the other poster who stated "I'd have probably stroked out if I wasn't in [a hospital] for my son's birth.".  This is just such a ridiculous statement. The other poster is quite correct - you didn't give birth at home so you can't say what would have happened if your had. 

It seems to me as if women love and need to justify all the horrifying things that doctors do them during and after they give birth so that they can come to terms with such a through violation. 

But to make this point, I will chime in with a horror story of my own: I did give birth with a midwife in a freestanding birth center and I DID have a postpatum hemmorhage.  The midwives calmly took all of the necessary steps of dealing with the situation including a call to the back up ob to discuss what was happening, IV fluids and careful monitoring.  The situation resolved itself and I went home 12 hours later with my baby in my arms. I did not "stoke out'.  I did not require a blood transfusion and I did not need a hysterectomy.  

 The scare tactics are what they are.     

In my humble opinion, I think just about everyone is manipulating the numbers to their own advantage. My favorite is when home-birth advocates compare success of home births with hospital births when almost all high-risk, complicated pregnancies deliver in a hospital. Birthing centers won't accept women with risk factors, so they can't compare their success with hospitals who take on these cases.

My own personal truth and experience with the doctors and nurses who helped me with my difficult, high-risk pregnancy and births is that they genuinely did the best they knew how to help me and my babies. The weren't out to get me or do unnecessary procedures or make extra money. 

I think the medical industry isn't perfect and it is a business and women need to educate themselves about their options, but what really bothers me is the sweeping generalities about the medical industry being evil. In at least my case (I won't use statistics, I'm just talking about me), my nurses and doctors were not evil, they helped save one of my twin baby girls and they were angels.

Carol Marie Ramsey
Finding balance and peace in parenting at Graceful Parenting

Let's face it--our country's medical practices regarding labor and delivery are a little whacked.  I mean,how many moms do you know that still labor and attempt to deliver in the supine position (flat on their backs), which doesn't allow for good pushing, doesn't utilize gravity, and doesn't do the pelvis any favors?  Hospitals love to hook you up to those monitors, too, making it challenging to move around, and push drugs on you like crazy. 

And our C-section rate is simply disgusting.  Do you really, honestly think that one-third of women NEED a C-section?   What the heck is wrong with us?  Honestly, some doctors just want to fit everything tidily into their schedules, and by setting up a C-section, they can do that.  Even WHO is on our case to get the rate down.

And don't even get me started on the induction rate.  I think some doctors simply disregard that the fact that drugs can have side-effects.  Uterus-bursting side effects. So if you're a day late, they start harrassing you to get acquained with Pitocin.  Maybe if we could at least change the parameters of the "normal" gestation time for a first pregnancy, it would be helpful.   

Am a biased?  You bet.   had my first child at a hospital and my second child at home.  I had similar issues with both births (cord wrapped around the neck), but much different results.  Due to a lot of misinformation and confusion,  baby one ended up drugged out in the NICU at birth, while baby two did wonderfully at home.

I"m not saying that some births don't belong in a hospital---high risk pregnancies and the like---but I am saying that homebirths should remain a viable option. 

And I think the medical field needs to approach birth as a natural occurence performed by healthy women, not a disease.

Debra Driza  MSPT

My blog:   http://www.houndrat.com

Very valid points here, coming in a little late.  Maybe the key is to not dismiss Home Birth but for the goverment to look at ways to have safer home births, allow women to have the choice by making it a safer choice.  I think were alot of anger comes is that the AMA is dismissing Home Birth altogether.

My first child I had in a hospital.  I did not know what to expect.  When it came to my second I knew my body and I thought of having a Home Birth.  My Dr. was so supportive, he even stated he wished he could do home births.  After hearing him state that I decide to stay with him through my 2nd pregnancy and delivered in the hospital, because I knew I could trust him.   

http://lilmomthatcould.com/

I am the mother of three; two birthed in seperate hospitals and my third birthed at home.  All were good births.  All had their own merits. 

After my home birth experience, I don't believe I will ever birth in a hospital again.  My home birth experience was 100% more satisfying than either of my previous births.

It saddens me to think that this choice could be legislated away.  I believe that there is a place for hospital births.  But I also think that the vast majority of hospitals treat pregnancy, labor and delivery as an illness instead of a healthy bodily process. 

I firmly believe that midwives, birth centers and home births should remain a choice so that we can be treated with the respect that this process deserves.  We're not getting it from the hospitals, that's for sure and now the AMA is certainly continueing with that trend.

Jessica

www.momshots.com

The more aggressive a culture gets the more that culture interfers with birth. Several themes have come up in the writings so far. What constitutes safety, and who has the right to determine safety and the type of birth.

As a midwife of many years, I learned that safety had little to do with a midwife's ability to practice in a medicalized system. Midwives had more than documented safety in providing safe and satisfing care. Midwifery care(being with woman) is ancient and modern. Medicine, specifically doctors, became involved in birth stating that they provided safer care because of a specific body of information that was held tightly within a male dominated educational system that prevented women from attending. Then birthing insturnments were highly protected and the public was lead to believe that technology provided them safer birth. Statistics did not agree with that and still do not agree, but we all know that statistices can be quoted for every point of view. By moving into technology our culture perceived that technology could control nature and this control belief got into the birthing scene. Our medicalized system does not allow for normal vs abnormal. When medicine, then liability, got involved in decision making, birth became pathology. As long as we continue to see birth as pathology there will be a domination of medicine in the normal process of pregnancy and birth. Yes, there are women who have medical issues that risk their life and their babies life. For these women we have an excellent medical care system. But the majority of women are healthy.  Pregnancy without all the interference that technology brings would do well to stay away from medical perception that there is pathology in every pregnancy and birth. Women need to consider who they view as an authority over their body- is it medicine? or is there room for each women to be an expert of their own body. Pregnancy is more than the physical event that medicine has reduced birth to and every woman is aware of this. Yet pregnant women have been convinced that the MD knows more than they do about an universal female event- giving birth. It seems to me that women need to reclaim their own authoritative power in order to work in a system that sees them as pathology and dollars.

dolly