BlogHer - Midwives, home birth proven safe - contrary to ACOG's false assertion - Comments

The vaginal birth is the one

bobloblaw — Tue, 09 Sep 2008 15:49:45 -0500

If given birth normally, the kid might present complications with the cord around his neck.

what?! you must be a man. women have been giving birth vaginally for literally, thousands of years. NO woman would chose a c - section over a vaginal birth.

My best friend had her first 2 children in a hospital, drugged up, and was miserable. she felt like both the doctors, nurses and staff didnt really care about her or her baby. She felt disconnected qto her children b/c they were taken away.

Her third child (and last to date) was born at home with a midwife, and she LOVED the experience. even said it made giving birth fun.

I was born myself in a boothing center via midwife, but, alas - i do not remember much of it. lol.

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The vaginal birth is the one

maryadavis — Wed, 09 Jul 2008 19:11:59 -0500

The vaginal birth is the one that seems more violent for the child. Imagine his trauma trying to squeeze out. A C-section is less painful for both the mother and the baby. There aren't any big risks to this procedure. If given birth normally, the kid might present complications with the cord around his neck.
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Homebirth

Anyshe — Thu, 19 Jun 2008 14:41:46 -0500

Given my family history of very very short labor, homebirth looked like a good option to me. After working with an OB that got upset and harassed me for refusing an amnio, I called a local homebirth CPM/ By this time the OB was talking about a planned c-section because the baby was going to be 'too big'. I thought that was stupid as my mother birthed a 9 pounder who was breech - she is 4 foot 10 in , so I wasn't worried. My mom worked with the original doctors in the 60s that advocated natural birth (names witheld to proctect privacy).

My 8# 10oz son was born in under 90 min, from first contraction to placenta - first child. Since there were no regular contractions, there is no way I would have made it to the hospital - a full 45 min drive.

I fully believe that childbirth should be attended. For me and my family, homebirth is the safest option to ensure that our babies are not born unattended. We haven't had a labor over 2 hours back three generations.

Lots to ramble on about....

BrandyL — Tue, 19 Feb 2008 16:50:13 -0600

There are a lot of things rolling around in my head right now. First I'll start with how I agree with the "demons" post in that it's not about being convinced. There is absolutely nothing that Amy T. can say that would change my mind or opinion about home birth. I'm sure that it's the same for some with Amygeekgrls thoughts. At least Amygeekgrl has said that home birth isn't for everyone and that parents should do their own research, whatever that may be.

Amy T, birth isn't all about statistics and numbers. It's about emotion, feeling, love, the feeling of *personal* safety and well being. Many women are tired of having pushy OBs patronizing them, telling them that they know what's best for them and their children, along with the fear that they feel when they think of the word "hospital". Who are you or any others to say how a woman should birth, where they should do it and what will make the "safest" birth for them? Surely even you can agree that fear plays a part in the birthing experience. If a woman is fearful her cervix tightens up. Fight or flight comes in to play in a very big way and this is a HUGE factor in a lot of birth scenarios. Mind you I am not saying that all unexpected circumstances come from a mother or a baby, please, please understand that I am not in the least bit saying that. I am painfully aware that there are situations in which a mother does everything "right" to ensure a safe and healthy delivery only to have a situation that dictates everything is just the opposite.

However, I AM saying that when women are fearful, whether it be of the pain of child birth, of their doctor, of a c/s or whatever, it makes birthing that much more difficult. If a woman is terrified of birthing with an OB or in a hospital what right is it for any of us to force her in to a hospital or tell her she's "stupid" for doing so? A medical degree does not automatically counter intuition and I'm so very disheartened with the way our society has bled that out of women by telling us that we are weak and stupid unless we have initials after our name that said we have read a lot of books, taken a lot of tests, and *witnessed* births more times than we have given it. It's sad and it pains me that you, Amy T, can't see the inherent beauty of a woman's abilities to birth her baby. It seems to me that you aren't taking in to account what safety and security do for a woman while she gives birth. That's a big part of why home birth works for most women, despite the "stats" that you claim have been "misrepresented". Speaking of misrepresenting stats, you mention quite a few tidbits of "never have been proven" statements or "that's false again" quips but you never include any resources yourself. Amygeekgrl is really benefitting from you tossing these quips out as she's able to continue to do more research to say quite the opposite. I find it amusing to say "never" been proven and that some people just skew information to meet their agenda. It's amusing to me because doctors and the pharmas do the same thing. There are medications used during birth that are NOT proven safe for birthing women and babies yet they are used to meet the agenda of those "helping" them give birth. Women are being harmed by these drugs but it's being ignored because the medications aren't "proven" to harm women. Could it be due to the fact that the FDA never approved it for birthing women? My point is that stats, safety, etc. can be skewed any which way one person wants to skew it. You say Johnson and Daviss are skewing it and they probably say you are skewing what they say. Birthing women have no one to trust but themselves by the end of the day.

Another thing that I have to say to Amy T. and then I'll move away from her negativity is that it again saddens me to see how you are treating people on this thread. I don't know why you feel you have to "force" yourself upon any of us or "force" us to believe that you are right. You are only reinforcing, as an "MD", what a lot of homebirthing women feel and in turn, what they want to avoid...a doctor that forces themselves on their patient, telling them that they are dumb by saying "duh" when they present information on what they say feels right to them, and by telling them that they are stupid because they don't have the degree and you do. It's sad that a lot of good, respectful doctors are getting a bad wrap because of doctors that act towards women just as you are acting now. You are not doing your field any favors and end up being a great cause of the polarization that one person mentioned earlier.

On a positive note, I had a fabulous home birth with my second child. I wish that I would have known people still had babies at home when we had our first. My midwives were perfectly capable and trustworthy. Never for a moment did I doubt their capabilities or their care. I hope my children and their partners are able to experience wonderfully peaceful, quiet homebirths with their own children. There is absolutely something to be said about having a baby in your own peaceful, safe place, using your own shower and tub, being able to use your own soft towels and blankets to welcome your baby in, to be able to climb in your own bed that night and snuggle with your loved ones.

I'm sorry that not everyone gets to receive this experience and agree that at the end of the day safety is the top priority. No one sets out to have a bad birthing experience or have their child die. Children die. Women die. They die in hospitals and at home. Some would have died no matter where they were and no matter who would've been there to save them. That's the risk we all take when we conceive and birth a child. As parents we have to decide whether we feel safer in a hospital with a doctor caring for us or at home with a midwife. Why does it have to be that we all pit each other against the other when making that decision? The beauty of our free country is supposed to be that we get to make that decision based upon what we feel is right for us and for our children free of skewed statistics and people trying to make us feel stupid.

Thank you Amygeekgrl and others for sharing your positive experiences here. It's the only way that birth in America will change for the better. Once women start to hear that peaceful birth is possible, whether in a hospital or at home, the more that women will over come their fears and make choices based on what they feel and learn and less on what others spoon feed them. Some OBs are going to feel extremely threatened with more women choosing midwifery care and that's to be expected unfortunately. It is just my hope that women continue to have experiences worth living and repeating.

Statistics & Healthy Babies

amamasblog — Tue, 19 Feb 2008 01:25:32 -0600

What I have taken away from this discussion, is everyone has their viewpoints and feelings. For some, statistics like Dr. Amy cites, may change someone’s mind on whether home birth is for them or not. For others, it won’t. I think it is important to be aware of all the current research and statistics when making a decision, but I don’t think a lot of women base their birthing decisions on statistics alone.

I was fully aware of all the current statistics when I opted for a VBAC. Yes, the overall uterine rupture rate is slightly higher for VBAC births than for a repeat Cesarean section. At the time (in 2006) I believe it was 0.05% higher. To me that was a minute point. After having an awful recovery period with a C-section, I knew in those weeks immediately after, that with my next baby, I would be attempting a VBAC birth. I didn’t care if the statistic was 50% higher- I knew I did not want to have another C-section unless it was medically necessary to save my baby’s life, or my life.

What isn’t taken into account in a lot of these studies and statistics is the aftermath. If a “hospital birth” is “safer” than homebirth, but a mother hates being in the hospital, doesn’t want to be connected to a monitor, doesn’t want an IV, etc. and has a bad experience, which results in her becoming sad, anxious, or depressed, these statistics don’t take that into consideration on the infant’s well being. If a mother is so tense, nervous, etc. during birth, that can affect the birth outcome. If she is tense and can’t dilate, can’t that result in more medical interventions, including a C-section for failure to progress? If she is more comfortable with giving birth at home with a midwife, than despite statistics, home would be a safer place for her. Likewise if a woman was not comfortable with the idea of giving birth at home, and would feel more comfortable in a hospital, then I believe a hospital birth is safer for her.

The problem with using statistics entirely to make or break a case is statistics can be skewed to basically show the outcome of your side. I think they are an important tool, but are only a small piece of the puzzle that goes into deciding what kind of birthing environment you are most comfortable in.

I also think it is important to point out here, while talking about statistics is, NO two births are exactly alike. The statistics that are in the Johnson & Daviss study were based on those women’s experiences. It would be highly improbable that if the study was done again that the results would be identical. Every woman labors and gives birth differently- every time. I think for statistics like these to be taken seriously, several long term studies need to be done, on a variety of women of different ethnicities, backgrounds, and ages. Then those should be compared to hospital statistics for a true comparison. Dr Amy herself said, “As far as I know, no one is keeping statistics on long term outcomes of homebirth.” Until statistics like this are available, I don’t think anyone can say for sure.

As a side note to Dr. Amy- I am curious about your background though- I don’t have time to “research” you, but what kind of doctor are you? Are you an OB/GYN? I think others would be interested as well.

I also wanted to mention in regards to alyssaroyse’s post- she mentions many good points and questions. When she asks, “why must both sides demonize each other so much. seems to me that both sides are looking to be right at the expense not only of each other, but at the expense of a nurturing collaborative birth environment. is there some good reason why midwives and dulas can't be working to design birth environments and practices that are more natural in a medical environment that is likely more safe? is it not possible to learn from each other, work together and advance the cause for all of us, rather than just for each side?”

I think there ARE so many fundamental differences in these perspectives on giving birth, it is very hard for all sides to put aside their viewpoints in order to learn from each other.

In my town, I was thrilled to find out there was an OB/GYN practice that employed midwives and they DID work together for 20 years, assisting women in births at the hospital, until the doctors and administrators at the local hospital came down with over 12 pages of new regulations for the midwives. If they didn’t follow *every* new regulation, they risked being “kicked out” of the hospital, unable to attend births.

The midwives said the regulations were too restrictive and unnecessary- the doctors and nurses in the hospital didn’t have to adhere to these regulations- only the midwives did, who were all CNM’s. Some had even been labor and delivery nurses before becoming midwives. Rather than deal with all of these regulations, which would have compromised their patients care, because they would have had to pay attention to all the countless regulations instead of their patients, the midwives quit.

The practice went from 4 CNM’s who could attend births at the hospital down to one, who does not attend births. Sadly, this is the norm, not the exception. Many hospitals will not allow certified midwives to attend births. Why?

I also agree with her when she says, “birth, really, is about giving birth to a healthy child.” That is the ultimate goal for every woman and birth. But to achieve that goal, birth IS about the mother too. If a mother is in distress, her baby will also be in distress. If a mother is in distress, the first thing they do is check to see how the baby is doing. The mother and baby share a body, so they are connected. If a woman is not comfortable, relaxed, and happy with her birthing situation (whether that is at home or in a hospital), those feelings get transferred to the baby as well.

As mothers, it is our job to speak up when our choices in birth are lacking. If we have the circumstances WE want in order to give birth, (versus what a doctor tells us what we have to have) chances are we will be happier when the time comes to give birth, which can result in a better, less- stressed birth. If we want midwives in hospitals, the option of VBAC, or midwives to attended breech births, instead of an automatic C-section, how will these changes ever come to be, if the women, who desire them, don’t make their wishes known? What should women do, who feel the current state of birthing in this county doesn’t allow them to give birth in a way that they feel is best for their babies do? I am reminded of that quote which says, “If not me, who? If not now, when?”

Of course there are fantastic doctors, but they can only do so much when it comes down to the hospital’s policy and procedures on birth. In the end, they have to adhere to the hospital’s policies, despite what a patient may request, even if it is in the best interest of the patient. Furthermore, I have yet to meet or hear of an “ incompetent and selfish midwive(s)” but have met plenty of close minded and arrogant doctors.

It is our right as mothers to seek to change the system when the system is not working for us, or for our babies. It is the only way to bring change for us, and for those who will come after us. There will always be women who are happy and content giving birth in the hospital and that is their right and their decision, likewise for the women who chose homebirth. In the end, every mother gets to decide what the best option is for her baby.

Why must there be demons?

alyssaroyse — Mon, 18 Feb 2008 10:31:46 -0600

As I have read this thread, I've been struck by how hard each side is trying to demonize the other, and that strikes me as a problem that is as fundamental as any other. It really sickens me.

I will readily admit by bias - both my daughter and I would have died in childbirth had we not been in a hospital. But, be that as it may, I am offended at the suggestion that we were somehow "duped" into our hospital birth and that OB / GYNs are inherently as callous and disrespectful as the home birth contingent seems to insist. Painting a diverse group of people with such a broad homogeneous taint is the hallmark of prejudice that makes it impossible to look at the actual issues.

1. birth, really, is about giving birth to a healthy child. ideally it is a blissful and wonderful and peaceful experience for everyone involved. but, at the end of the day, it is a mother's first real opportunity to realize that she has to sometimes set aside her ideas and desires in order to look out for the health and well being of the child. that is not a statement in support of either side, but in support of the child. stop using dogma to design theories and justify behavior, create a situation that is healthy and safe for the child. again, that could be used to support either side, and i intended it that way. it's not about you or your dogma, it's about the child. period.

2. if you are trying to change an established modality - or, indeed, the establishment - you cannot do it by fighting against them, calling their names and claiming conspiracies. you have to bring about constructive dialog. tit for tats like this rarely advance understanding and collaboration.

3. there are as many fantastic and open-minded OB / GYNs as there are incompetent and selfish midwives. and vice versa.

4. is this really an either / or proposition? i gave birth in a hospital. in a room that felt very much like my living room. with my friends and family around me, the music and movies of my choosing. i chose every thing that was done to me and was not done to me. (i did not want nor have a catheter, for instance.) i had a great dula with me.... but, when my daughter's heart stopped beating, followed by my heart not beating, we were damned glad that we were in the hospital. neither one of us would be alive today had we been at home.

which brings me back to the fundamental question - why must both sides demonize each other so much. seems to me that both sides are looking to be right at the expense not only of each other, but at the expense of a nurturing collaborative birth environment. is there some good reason why midwives and dulas can't be working to design birth environments and practices that are more natural in a medical environment that is likely more safe? is it not possible to learn from each other, work together and advance the cause for all of us, rather than just for each side?

it's not about YOU. and until that's internalized, nothing is going to change. you'll all be so busy proving each other wrong that you don't take the time to take what's right and combine it into an experience that is greater than the sum of it's parts.

i wasn't going to say anything because i am not a doctor nor a midwife. but i do know that it is impossible to come together on the fertile common ground that could unite us when both sides are standing on the border throwing barbs.

sorry to be so bitchy, but this dialog was just making me really sick. it's not about any of you, it's about having a healthy baby. that comes first - and it starts before that child is born.
___________
Alyssa Royse
JUST CAUSE
make some good news!
www.JustCauseIt.com

You just accepted J&D's ridiculous explanation without question

Amy TuteurMD — Mon, 18 Feb 2008 09:10:36 -0600

amygeekgrl:

"As a consumer in search of the truth, I like to do my own research, not just accept what is handed to me regardless of who it is coming from."

Really? You just swallowed Johnson and Daviss' desperate attempt to salvage their study.

As they say in politics, it's not the crime, but the cover up. Johnson and Daviss are now acknowledging that they used inappropriate data for comparison with homebirth, but claiming that the correct data was not available at that time. The relevant data was in their possession the entire time, and it was even released publically years before they made their erroneous comparisons. It is is difficult to imagine a legitimate reason why a professional statistician would deliberately use the wrong statistics for comparison when the right statistics were available and actually in his possession. It seems to me that the only possible explanation is that they knew all along that their study showed that homebirth has an increased risk of preventable neonatal death compared to hospital birth.

Having acknowledged the real neonatal death rate in the hospital in 2000 of 0.9/1000, they face a serious problem; their study reported a neonatal death rate at homebirth of 2.6/1000 (uncorrected for congenital anomalies). Once again, they resort to disingenuous and deliberately misleading claims.

Let's look at their efforts to extricate themselves from the inevitable conclusion that homebirth is not as safe as hospital birth and why those attempts are misleading and invalid. Johnson and Daviss claim:
"A crude comparison of the CPM2000 death rate to the neonatal mortality rate among U.S. Non-Hispanic White women with 37 week plus births would also require the following exclusions:

5 intrapartum deaths need to be removed as the NIH data report only on live births and thus include only neonatal deaths"

According to Johnson and Daviss (farther down the page): Intrapartum Mortality - baby who died during labour (before birth). So a true intrapartum death is one in which the baby is born without any sign of life at all, not even one pulsation of the umbilical cord. Yet if you look at the descriptions of the "intrapartum deaths" in the BMJ study, it is clear that some, if not all of them are misclassified. For example, one baby is even listed as having an initial Apgar score of 1. It is very important to understand that a baby who cannot be resuscitated is NOT an intrapartum death. Unless Johnson and Daviss can show that these babies were born and had absolutely no sign of life, and therefore never received birth certificates, we must assume that these are neonatal deaths.

Johnson and Daviss also try to exclude congenital anomalies from the homebirth group, even though they are included in the hospital birth group:

"3 neonatal deaths caused by fatal birth defects need to be removed. All three of these deaths would have occurred regardless of whether the birth was planned at initiation of labour to be in hospital or at home."

If congenital anomalies are in the hospital group, they MUST be included in the homebirth group, no matter how much or why Johnson and Daviss wish to exclude them. However, their excuse for excluding them is particularly unpersuasive and disingenuous: "Had these three birth defect deaths occurred among the hospital population in the present medical culture, they would have been far more likely than not to have been induced or terminated before term." This is an absurd claim: fully 25% of the neonatal deaths in the hospital group were due to congenital anomalies. There was actually a lower rate of congenital anomalies in the homebirth group than in the hospital group, not an artificially higher rate.

Finally, they also want to exclude "1 home birth neonatal death that was among the 286 Hispanic and African-American births in the dataset. Both the death and 286 births need to be removed from the comparison as they did not fit the non-Hispanic white women category provided by the NIH." That's perfectly legitimate, but that doesn't mean that we don't need to take that death into account. It simply means that we must compare the death rate among Hispanics and African-Americans at homebirth to the same groups giving birth in the hospital.

The bottom line is that the 5 "intrapartum" deaths and the 3 congenital anomalies CANNOT be removed from the homebirth deaths. The comparable death rate is not 5 among 5,132 but 13 among 5,132 for a homebirth death rate of 2.5/1000. The homebirth death rate is almost triple that of the hospital death rate for low risk white women at term.

The Johnson and Daviss 2005 BMJ study always showed and continues to show that homebirth has a higher neonatal death rate than hospital birth. Indeed, the rate is almost 3 times higher. Johnson and Daviss deliberately and disingenuously tried to obscure that fact in the original article. They now acknowledge that they used an inappropriate comparison group, yet their explanation is completely unbelievable. They claim that the appropriate data was not available, even though it had been published 2 years before. In addition, they are now making new invalid and misleading claims in attempt to avoid the inevitable and obvious conclusion that their study showed that homebirth has an increased risk of neonatal death.

Amy TuteurMD

Even more misinformation

Amy TuteurMD — Mon, 18 Feb 2008 09:07:55 -0600

amygeekgrl:

" With CPMs, it is common practice to leave the umbilical cord attached to the baby until it stops pulsing. By doing so, the baby continues to receive oxygen from the placenta (as well as stem cells), until he/she is breathing on his/her own"

You have misunderstood the rationale for delayed cord clamping. The claimed benefit is NOT continuing oxygenation through the placenta. The claimed beneft is decreased risk of anemia.

"We note that the premature birth rate for the NIH (U.S. National Institutes of Health) non-Hispanic white births in hospital was 11.3%, more than double the rate for the women cared for by Certified Professional Midwives (CPMs)."

As my teenage children like to say: "Duh". Prematurity is a high risk condition and CPMs don't care for high risk patients. What's suprising is not that the prematurity rate in the homebirth group is only half the hospital group; what's suprising is that there is any prematurity in the homebirth group at all.

"However, if the woman has had an epidural and cannot feel her legs, moving into this position is much more difficult (which is probably why OBs use the McRoberts leg-lift maneuver before trying the Gaskin maneuver, but that's just my speculation). "

That's the problem with speculation; it's often wrong. The Gaskin maneuver has never been shown to have any advantage of the other maneuvers for shoulder dystocia. Therefore, there is no medical reason why it should be used in preference to any other maneuver.

Amy TuteurMD

You may find this

JenInShanghai — Mon, 18 Feb 2008 05:53:54 -0600

You may find this interesting (also from the same study) - "We note that the premature birth rate for the NIH (U.S. National Institutes of Health) non-Hispanic white births in hospital was 11.3%, more than double the rate for the women cared for by Certified Professional Midwives (CPMs). Higher prematurity is a serious concern for the U.S. hospital births, because prematurity is associated with much higher perinatal mortality and morbidity."

This could be a bit skewed of a statistic due to the fact that most CPM's do not stay involved in so called "high risk pregnancies" which are more likely to result in premature birth and since many CPM's services are not covered by governmant funding, low-socio-economic (higher risk for prematurity) women would also not be included.
I am a speech and language pathologist that focused on feeding and swallowing disorders most of my career (prior to becoming an ex-pat tag-a-long spouse in China). The 5 years prior to moving here I provided developmental care and feeding intervention to our neonatal intensive care unit and while I certainly do not have the statistics, I can only remember a couple of times in that five years that we had an infant admitted from a planned home birth that had complications. While the complications were not fatal, the results were devastating. The overwhelming majority of infants in our NICU were born in a hospital (not ours as it is a Children's hospital).

When you look at the issues of disibilities from birth trauma it is increasingly more common that there is litigation involved and this has to be part of OB/GYN's hesitancy to relinquish some of the control over the delivery. Many of the infants, toddlers and children I used to see for therapy on a weekly basis had lawsuits pending against the physician or hospital involved in their infant's birth. I see your point about CNM's and their training involving less invasive medical procedures in a birth to prevent some of these injuries, but would love to have some long term statistics to support it.

I am still on the fence about home birth. The naturalist in me wants to think it is the way it was intended, therefore the best, but the medical training I have had tends to make me lean toward having the technology readily available should the occasion require it. In both of my pregnancies, I really was in it "just for the goods" and it would have been difficult to convince me that home birth was the safest way to a healthy baby.
As for CPM's, CNM's, CNP's , I am completely supportive of them. Mainly because I feel they have excellent training and because the majority are women and I think that they will have the patience and insight to help you adequately prepare for birth (might be a tad sexist of me). My second pregnancy was managed by both an OB/GYN and a CNM. They were in practice together and it was a wonderful arrangement. I chose to have a second c-section (both recommended VBAC) and they both worked together during the delivery. My very healthy baby girl got to snuggle with me right away and then her daddy got to hold her and take her to the warmer bed to be checked over. She is now 7 and my ID picture. I know I made the best decisions that I could for her birth (the first one was an emergency so I had no decisions to make) and would change nothing about it.
Thanks for a very interesting discussion! Even though my "baby shop" is closed it is a great topic and somewhere down the road I hope my daughter will ask for advice and I can look to both research and millions of other women who have had home births to give her an informed opinion.
Regards,
JenInShanghai

interesting to note about home births

Amy Gates — Sun, 17 Feb 2008 22:46:29 -0600

JeninShanghai,

Thank you for your comments. :)

You said: "I read the statistics about higher risk of neonatal death in home deliveries..."
I believe these statistics have been misrepresented by Dr. Amy. Please read my response above for clarification. The study concluded that home birth is just as safe as hospital birth and "the neonatal death rate in both datasets was just under 1 death per 1000."

While I don't know if any statistics are available on long term disabilities from home birth, I think a couple things about home birth are worth mentioning. With CPMs, it is common practice to leave the umbilical cord attached to the baby until it stops pulsing. By doing so, the baby continues to receive oxygen from the placenta (as well as stem cells), until he/she is breathing on his/her own. My son who was born at home, took around 20-30 seconds (I'd guess) before he started breathing on his own. The cord had been wrapped around his neck three times. One of my midwives gave him a few puffs of air mouth-to-mouth, while we talked to him, rubbed him and he responded and started breathing. All the while though he was still connected to the placenta and still receiving oxygen. My experience in the hospital where my daughter was born was different in that despite the suggestion I made to my OB that I'd like to let the cord pulse out before it was cut, it was cut nearly immediately after the birth, as the OB saw no benefit of leaving it attached. (How about to get those stem cells and oxygen-rich blood?)

Also, when a baby suffers from shoulder dystocia, there is a technique called the "Gaskin maneuver" (named after midwife Ina May Gaskin) where the woman is asked to get on all fours which helps dislodge the baby's shoulder. Getting into that position is not difficult if the woman is not under the influence of paralyzing drugs. However, if the woman has had an epidural and cannot feel her legs, moving into this position is much more difficult (which is probably why OBs use the McRoberts leg-lift maneuver before trying the Gaskin maneuver, but that's just my speculation).

Amy
Crunchy Domestic Goddess
BlogHers Act contributing editor

I disagree

Amy Gates — Sun, 17 Feb 2008 22:14:15 -0600

As a consumer in search of the truth, I like to do my own research, not just accept what is handed to me regardless of who it is coming from.

According to Johnson and Daviss's summary copied and pasted below, which can also be read here, home birth was found to be AS SAFE AS hospital birth.

I encourage you all to read the summary and/or any of the additional information on that page, and then make up your own minds.

(bolding below for emphasis is mine)

Summary

We compare the CPM2000 neonatal mortality rate among planned homebirths to the U.S. National Institutes of Health (NIH) neonatal mortality rate for births in hospital to U.S. non-Hispanic white women of 37 weeks plus gestation in the year 2004. Adjustments are made to ensure that the comparison is as close as possible to comparing like with like. This includes removal from the CPM2000 death rate of intrapartum mortality, 3 deaths involving lethal birth defects unlikely to have been carried to term in the hospital population, and 1 death and 286 births among African-American and Hispanic women. After making the necessary adjustments that were possible, the neonatal death rate in both datasets was just under 1 death per 1000. Our conclusions remains unchanged from those in the original article -- the neonatal mortality rate for low risk women in North America using certified professional midwives is similar to that for low risk women in hospital in the U.S., and the intervention rates are much lower. We note that the premature birth rate for the NIH non-Hispanic white births in hospital was 11.3%, more than double the rate for the women cared for by Certified Professional Midwives (CPMs). Higher prematurity is a serious concern for the U.S. hospital births, because prematurity is associated with much higher perinatal mortality and morbidity.

Amy
Crunchy Domestic Goddess
BlogHers Act contributing editor

That's why my experience was amazing!

MommaMary — Sat, 16 Feb 2008 21:44:46 -0600

What I have learned here is that I had a VERY unique experience. I gave birth with a midwife, in a hospital, in a room that looked more like a hotel room than a hospital room (minus the hospital bed.) I was not strapped to a bed for monitoring more often than I was comfy with, I did not have to have an IV, none of that was required of me because I was giving birth using a midwife, rather than a doctor. My midwife worked with an OB so that if their patients needed a C-Section, in she came. The hospital I gave birth in had worked with mothers, doulas and midwives to create labor & delivery rooms that were amazing. I think I got the unique experience of having the best of both worlds. I was in the hospital 'just in case' but comfortable and happy during labor and delivery..

Now, recovery.. that's a whole different story... I thoroughly enjoyed my 43 year old hospital bed in the room reeking of mildew where I was awakened every 2 hours by nurses checking in and every hour by someone from the nursery coming to stab my sweet baby boy in the heel because he had the misfortune of being born over 9.5 pounds (even though he nor I had any signs of diabetes, etc.). Baby was born 5:24AM Monday, at noon on Tuesday we left. A full day earlier than they wanted me to, but I was done. We all joked that we went from the Ritz Carlton (Labor and Delivery) to a shoddy Motel 6 (recovery).. I was able to look past recovery though, because I had my baby.. it didn't matter.

There are no statistics on long term outcomes of homebirth

Amy TuteurMD — Sat, 16 Feb 2008 08:38:01 -0600

JeninShanghai:

"where are the statistics about delivery and immediate peri-natal problems that go untreated and that result in long term disibilities not death?"

As far as I know, no one is keeping statistics on long term outcomes of homebirth. We have literally no idea whether homebirth increases the risk of perinatal asphyxia (brain damage) or Erb's palsy (shoulder injury) or not.

Amy TuteurMD

A Debate That Is Divorced From Reality

Sandradginzburg — Fri, 15 Feb 2008 21:46:00 -0600

What ACOG, Amy Tuteur (MD - hah!) and her ilk all ignore in this endless debate and tossing around of statistics is the actual experience of woman who give birth in contemporary America. Here's mine: I wanted to give birth to my third child in a hospital based birth center with a midwife. (My first two were born in a free standing birth center that had closed because they could no longer afford their insurance coverage.) I was told that I would be "disqualified" if (a) my pregnancy went past 41 weeks, or (b) the midwife guestimated that the baby's weight was over 9.5 lbs. This was of concern to me because my first baby was born at 41 weeks, 2 days (weighing all of 6 lbs 2 oz and without any signs of postmaturity, but whatever.) In addition, I was told that I would have to submit to a test strip of fetal monitoring and if it was "of concern" I would be transferred to the hospital with or without my consent. My GST test came back at 131 (even ACOG allows practioners to set the threshold at 140) and I was told that I could not have my baby in the birth center unless I agree to have the three hour GTT. At that point, I'd had enough and switched to a free standing birth center. I didn't have the GTT and I had a healthy 8 lb baby at 40 weeks and 2 days but that is besides the point.

If doctors believe that all women need to have their babies in hospitals "just in case" then why can't a woman just show up at a hospital and be left alone with a midwife to deliver a baby in a room that looks like a bedroom? In hospitals in America today, unless you arrive with a baby crowning, you will be required, at a minimum, to be hooked up to a monitor (which can be excrutiating for a woman in back labor, just for one example) and you will be required to have an IV or a hep lock. That is at a minimum. We all know that most women have much more than that done to them in today's hospitals. It is utterly impossible to go to a hospital to have a baby and to be left alone to do it. Birth in hospitals today is more accurately descibed as a "fetal extraction from an adult female" than it is as an actual birth.

So what we have here is a dichotomy - have your baby in the hospital where you will be at the mercy of a profession that is practicing "CYA" medicine. (ACOG's suppossed concern about the well being of women and babies is so obviously disingenous in the face of the organization's tolerance of the American c-section rate and it's tolerance of elective c-sections. On the subject of c-sections there is no scientific ambiguity. C-secitons DO pose very well documented medical risks to both mother and baby.) Or have a baby at home, with no integration with the medical profession should the unlikely complication arise. In fact, should a complication arise, you might be dumped at the ER and treated like a freak.

Is this really all there is???? Don't women deserve better than being forced to choose between these two equally unappealing options???

More statistics requested

JenInShanghai — Fri, 15 Feb 2008 20:46:57 -0600

I too am a lover of mother nature and feel that the most natural way to do things is by far the best in most situations. I read the statistics about higher risk of neonatal death in home deliveries, but have to ask where are the statistics about delivery and immediate peri-natal problems that go untreated and that result in long term disibilities not death? I worked in a children's hospital for over ten years as a speech therapist and I would guess at least half of the children we worked with were being seen due to birth trauma causing a lack of oxygen to the brain (cerebral palsy). I know that this can happen whether in a hospital or not, but I would like statistics showing that it is more or less likely to be a concern with home birth. Anyone have any ideas?
I also do not believe that the physicians are solely to blame for the desire for hospital births I think that many of them agree that less medical intervention is better. None of them WANT to risk a woman's life by performing an unnecessary c-section, just as none of them WANT to lose their license and career because they made the most informed decision they could at the time, it just happened to be wrong. If the ACOG endorses then it will ultimately be to blame also.
There has to be a middle ground and it seems that that must include CNM's CPM's, OB/GYN, Local Hospitals and Insurance companies all working together to support a pregnant woman.
As someone with 2 c-sections, one emergency and one by choice, all we all really want out of pregnancy is a healthy little one to hold so lets try to get some cooperation amongst the providers to get us there.

Midwives, home birth proven safe - contrary to ACOG's false assertion

Amy Gates — Tue, 12 Feb 2008 13:10:55 -0600

Last week I wrote about The Big Push for Midwives, a national grassroots campaign pushing for the regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states, Puerto Rico and the District of Columbia. As it currently stands, there are 26 states that ban CPMs. If caught practicing there, midwives could be subjected to fines, jail time, even face the possibility of a felony conviction in Missouri.

Despite the fact that other developed countries in the world that have adopted midwives as the primary care providers for healthy pregnant women, the United States has yet to catch on. One percent of American women choose to give birth at home. Just last week the American College of Obstetricians and Gynecologists (ACOG), a trade union representing the financial and professional interests of obstetricians, released a statement reiterating their opposition to home births and CPMs, and suggesting that mothers who give birth at home with a midwife are choosing the birth experience over the health of their baby. Rather than advocating for "quality health care for women" as the group claims is part of their work on their about page, the entire statement perpetuates FUD; Fear, Uncertainty, and Doubt.

The Big Push for Midwives campaign countered with their own press release stating the ACOG is Out of Touch with Needs of Childbearing Families and said not only do they claim "out-of-hospital birth is 'trendy,'" but they also try to play the “bad mother” card. The International Cesarean Awareness Network also issued a statement "condemning" the ACOG for their statements, as did the Childbirth Connection who states ACOG Place of Birth Policies Limit Women's Choices Without Justification and Contrary to the Evidence.

In addition to these organizations, many other sites and blogs have done an outstanding job of weighing in on this topic and have covered it in much more detail than I can attempt in this single post. Therefore I'm going to stick primarily with addressing the safety "concern."

The ACOG says, "It should be emphasized that 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." This, however, is a false assertion. According to Citizens for Midwifery, a number of rigorous scientific studies published in leading medical journals have found that for a healthy woman having a normal pregnancy, a planned, midwife-attended home birth is as safe as a hospital birth and with far lower rates of medical interventions. The most recent is also the largest study - with 5418 women participating - based on prospective reporting for all the births attended by Certified Professional Midwives in 2000, published in 2005 in the British Medical Journal. ("Outcomes of planned home births with certified professional midwives: large prospective study in North America." Kenneth C Johnson, senior epidemiologist, Betty-Anne Daviss, project manager. BMJ 2005;330:1416 (18 June).

The study also states:

What is already known on this topic

Planned home births for low risk women in high resource countries where midwifery is well integrated into the healthcare system are associated with similar safety to low risk hospital births

Midwives involved with home births are not well integrated into the healthcare system in the United States

Evidence on safety of such home births is limited

What this study adds

Planned home births with certified professional midwives in the United States had similar rates of intrapartum and neonatal mortality to those of low risk hospital births

Medical intervention rates for planned home births were lower than for planned low risk hospital births

If that study isn't convincing enough, then one need only look to other developed countries like Denmark, Sweden and the Netherlands, where midwifery is the primary model of care.

The organization of maternity services in Denmark, Sweden, and the Netherlands was studied under the sponsorship of the World Health Organization European Headquarters Office of Maternal and Child Health. Midwifery care is highly respected and is a central feature of obstetric care in each of these countries. In Denmark and Sweden, almost all births are in the hospital, and autonomous midwives are employed by national health services. About three-quarters of Dutch midwives are in independent practice, and 34% of Dutch women give birth at home. In each country midwives provide "the first line" of care for normal pregnant women and are viewed as essential to the excellent perinatal outcomes these three countries enjoy."- Models of midwifery care. Denmark, Sweden, and The Netherlands.

Also worth noting is Denmark's maternal mortality rate was 5 deaths per 100,000 live births according to the World Health Organization's Maternal Mortality in 2000 report. Compare that to the United States where the maternal death rate was 17 deaths per 100,000 live births.

The United Kingdom, another developed country, also supports home birth for women in uncomplicated pregnancies. The Royal College of Obstetricians and Gynecologists and the Royal College of Midwives Joint Statement No.2. from April 2007 states:

"The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) support home birth for women with uncomplicated pregnancies. 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. There is ample evidence showing that labouring at home increases a woman’s likelihood of a birth that is both satisfying and safe, with implications for her health and that of her baby."

Thanks to Rixa at The True Face of Birth for looking up and sharing that information.

The World Health Organization (WHO) itself recognizes the important role that midwives play in prenatal and birthing care. In the WHO's Department for Making Pregnancy Safer 2006 Annual Report, it is noted that there is a great need for midwives in both the industrialized and developing nations. "Evidence for the decisive role of skilled birth attendants (SBA), and particularly midwives, in reducing maternal mortality is plentiful from both the industrialized and developing countries."

I found it particularly interesting that the WHO is working to reduce maternal mortality in these developing nations and is looking to the training of more midwives to achieve this task, citing an example of how midwives have already helped in Malaysia and Sri Lanka. "In a study of how Malaysia and Sri Lanka successfully reduced their maternal mortality rates since the 1960s, it was noted that the outstanding feature of maternity-related health services in the two countries has been 'the pivotal role of trained and government-employed midwives. They have been relatively inexpensive, yet they have been the cornerstones for the expansion of an extensive health system to rural communities. They have provided accessible maternity services in hospitals and communities, gained respect from the communities they serve, and are described with affection and admiration by the managers and policy makers in each country.'”

In summary, we have a large North American study citing midwife/home birth safety; Denmark, the Netherlands, Sweden, and the United Kingdom looking to midwifery as the primary model of care; Denmark with a home birth rate of 34% and a lower maternal mortality rate than the United States; as well as the World Health Organization supporting midwifery in many developing nations around the world. All of these things seem to indicate that midwives and home birth are a very safe choice. So why is the ACOG so against it in the United States? Are American pregnant women any different from pregnant women elsewhere in the world?

The truth is that safety is not the ACOG's biggest motivating factor. It's money. Money makes the world go around. As Belly Tales points out, "ACOG is a professional organization supporting and marketing the services of its members: obstetricians. In other words, a lobby. ...the bottom line is always the bottom line."

If the ACOG would acknowledge that these studies and practices in other countries are very relevant and support the legalization and regulation of midwives, as well as call on physicians to work with them and provide back-up support rather than against them, it is then that they would truly make birth safer for all women.

The positive thing here is that people are taking notice and questioning the status quo. Celebrities are talking openly about their home birth experiences and mainstream magazines are covering it. Women and their partners are seeing The Business of Being Born and learning that there IS another way. Women are talking. They are asking questions. And the ACOG is getting nervous. Let's keep the buzz going.

"In every country where I have seen real progress in maternity care, it was women's groups working together with midwives that made the difference." - Marsden Wagner, MD, MSPH

If you'd like to write a letter to the ACOG, please direct it to:
American College of Obstetricians and Gynecologists
409 12th St., S.W., PO Box 96920
Washington, D.C. 20090-6920
202-638-5577
Or email: communications@acog.org

Finally, if you've had a home birth and feel strongly about this, I encourage you to spread the word and write about it on your own blog, then leave a link to your post here in the comments. Also, if you've blogged about your home birth experience, please leave a link to that post in the comments as well. Thank you.

Additional resources:
The Big Push for Midwives
Citizens for Midwifery
International Cesarean Awareness Network - ICAN’s Response to ACOG AND AABC Statements on VBAC and Homebirth
The Compleat Mother - Homebirth: As Safe As Birth Gets
The Birth Book Blog - Latest ACOG statement against home birth
Belly Tales - ACOG's statement on home births
Pushed Birth - Parsing the ACOG Statement Against “Cause Célèbre,” Home Birth
Refuse to be a womb pod - What do I think about ACOG's homebirth statement?
The True Face of Birth - 10 responses to ACOG's statement on home birth

Contributing editor Amy Gates also blogs about attachment parenting, activism, green living and photography at Crunchy Domestic Goddess.