BlogHer - AMA To Ricki Lake: No More Babies Born In Bathtubs, Please (Ricki Lake to AMA: Stuff It) - Comments

is giving birth the only aspect of child rearing with risk?

Icha — Sun, 22 Feb 2009 17:26:44 -0600

It seems strange to point this out, but does the argument against homebirth ever substitute other things for birthplace to test its logic? For example, has anyone ever thought about requiring all parents to buy volvos and prohibit them from buying, say, a mazda sports car because an infant (and its parents) would be far safer in a volvo if they are involved in a crash? Or how about the carseat itself? Not all carseats are equal, some are much safer than others. Should parents be required to buy only the absolute safest car seat? Of course not, no one ever even considers these things, even though car crash fatalities are a leading cause of death for children and adults. These are things we are allowed to decide for ourselves based on many factors, including basic freedoms of freedom from unwarrented government surveillance and interference.

I believe that homebirths are the safest option for some people, myself included. Safety statistics aside, does society apply the same readiness to legislate to behaviors that don't have to do with women's bodies and reproductive capacity? It doesn't...the minute a woman's reproductive capacity is concerned, we (this society) think we have the right to make all sorts of laws governing what she can and can't do. Most other behaviors are left up to choice. This is not about what option is safest. It's about who gets to make reproductive choices for women: professoinal organizations, the courts, the state, other interested parties, or the woman herself.

CDC data

MinorityView — Fri, 05 Dec 2008 20:51:13 -0600

Interesting analysis of the CDC data here:

http://womantowomancbe.wordpress.com/2008/09/18/excess-preventable-morta...

The point of the analysis is that the particular set which Dr. Amy Tuteur is using to claim that home birth with a direct entry midwife has a higher rate of mortality for the baby has an oddity. A number of the deaths are due to conditions which would have resulted in death EVEN if the baby had been born in the hospital. Most of the analysis has to do with possible reasons for the existence of the fatal conditions--which can be summed up as less amniocentesis leading to fewer abortions. This is the same reason that Ireland (fewer abortions) has more babies who die shortly after birth than France (more abortions). So these numbers don't actually support midwife error or place of birth dangers as causing at least some of the deaths.

Birth is Beautiful

amon4923 — Sun, 02 Nov 2008 16:20:15 -0600

I think that the most important concept to remember is that birth is beautiful. Whether you’re delivering in a hospital or in a hut, the result of an average of nine months of pregnancy and delivery is to be able to start your lifelong journey with your baby.

I also believe that all aspects, from conception to delivery, should be viewed as another element to the extraordinary process of childbirth. With that said, I feel that the idea of a natural delivery as not only entirely safe but also an empowering process, is masked in hospitals. From being thrown into a wheelchair to hooked up to IV’s and monitoring, birth is seen as nothing short of a medical affair. This idea leads women to see themselves as patients and often allows authoritarian doctors to guide their bodies through delivery for them. It’s discouraging to hear a doctor tell you you’re not progressing “quickly enough” (leading to drugs like pitocin or cervadil – which can lead to distress of the baby – which can lead to a c-section). When women don’t fit into the “typical” mold doctors are taught they should, they take matters into their own hands, showing women that their bodies are just not good enough. When in reality, all women are different, and if doctors were better trained in NATURAL childbirth, America wouldn’t be experiencing the spike in interventions, c-sections, and who knows what other consequences our babies are dealing with because of this.

I believe childbirth to be a time for families to welcome their newest addition, and what better place than at home? For millions of years our ancestors were delivering at home, devoid of electronic fetal monitoring and epidurals, and the proof of its success is in our mere existence.

The fact of the matter is...

Colormepink — Sun, 02 Nov 2008 09:23:20 -0600

Women have been having babies... well forever. I chose to have mine in a hospital setting, but if I had to do it over again, I think I would have chosen differently. I had a terrible experience, both times and I regret it. Instead of feeling powerful and satisfied, I was made to feel weak, the drs. were disrespectful of the process and I was miserable. I couldn't wait to get home, cut and torn as I was, so that I would be in charge of myself and my child.

The idea that we're too stupid to make our own decisions is becoming so prevelant, and it seems over and over that it's big business that is perpetuating this idea in order to save themselves. I think that society as a whole is starting to turn back toward a more holistic life, our food choices, medical treatment choices, and education choices to name a few.

Technology in our homes has given us so many more choices and so much more information that it surprisingly seems to be putting an end to a lot of the "big industry" that has ruled for so long. I think we're going to see more and more of this kind of attempt at control as these "industries" struggle to remain the big business that they have been.

We must continue to stay informed and fight against this control over our choices. It is our choice and must remain so.

Christine
It's My World. Welcome To It.
Blog: http://www.colormepink.com
Homeschool Blog: http://web.mac.com/colormepink/
Jewelry Blog: http://www.starbrightjewels.com/blog

you are so twisted- DEM

rshannigan — Sat, 16 Aug 2008 18:39:11 -0500

you are so twisted- DEM stands for DIRECT ENTRY MIDWIFE, it has nothing to do with place of birth. in washington and in California, CNM's deliver at home and in hospitals, depending on what's best for the patiends. so the chart you showed isn't really saying what you're interpreting it to say.

I think you'd have a hard time finding a homebirth midwife willing to deliver a high-risk pregnancy at home. So naturally, the docs would be a little worse. However, you can't attribute the birth outcome solely to the location of the delivery any more than you can attribute it to the color of the woman's skin or anythign else.

It's not surprising that the AMA opposes homebirth. Homebirth with a homebirth midwife is cheap and safe; it trivializes the need for a medical institution that profits when people are sick and dying.

http://mrshannigan.blogspot.com

Power, economics and the medicalization of birth

drumbeat — Mon, 30 Jun 2008 13:58:19 -0500

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

A place for both

Momshots — Wed, 25 Jun 2008 01:48:52 -0500

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

Education

lilmommythatcould — Mon, 23 Jun 2008 06:45:20 -0500

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'm a homebirth believer

houndrat — Sun, 22 Jun 2008 15:35:27 -0500

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

We must protect our rights for the sake of our posterity

mamabaig — Sun, 22 Jun 2008 00:30:23 -0500

It is vital that the public understands how the medical system is positioning themselves against midwives and homebirth.

I am the mother of 7 children. I have birthed in the hospital with CNM's twice, once at home with a lay midwife and 4 times unassisted. My home births were like apples vs. oranges in comparison. So different. I love birthing at home in my own surroundings, with my family present (but not in my face) and with no strangers. At home I am able to tune into what my body needs so that I can birth without overwhelming pain. At home my baby is better cared for as he/she is not exposed to ultrasound, electronic fetal monitor, germs, etc.. and I am not pressured to give medicines that are not needed.

Because of my age, I foresee in the future that I may want to call on midwives again, either at home or in the hospital, depending on the situation. I want that choice to be available to me, my daughters and future granddaughters.

The day this story broke I had been watching a hospital birth on the tv show A Birth Story before turning on the computer and being smacked in the face with the AMA's resolution.

You can read my thoughts about the show and the "resolutions" on my blog:
http://spiritledbirth.blogspot.com/2008/06/ama-blasts-homebirth.html

Just a few comments

Graceful Parenting — Sat, 21 Jun 2008 19:12:52 -0500

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

Tired of the horror stories

Sandradginzburg — Sat, 21 Jun 2008 14:05:47 -0500

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.

Point:

JennaHatfield — Fri, 20 Jun 2008 13:53:02 -0500

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

Many false claims

Amy TuteurMD — Thu, 19 Jun 2008 23:58:24 -0500

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

Home Birth

Hulakitty — Thu, 19 Jun 2008 14:25:33 -0500

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.

AMA To Ricki Lake: No More Babies Born In Bathtubs, Please (Ricki Lake to AMA: Stuff It)

Her Bad Mother — Wed, 18 Jun 2008 14:41:06 -0500

Ricki Lake gave birth to her second child at home, in her bathtub. Which is great, but I almost did her one better by very nearly giving birth in the front seat of my husband's car while we sped down the highway at close to twice the legal speed limit. However, almost giving birth in a speeding motor vehicle - which, can I say? TERRIFYING - was not my choice. Ricki Lake giving birth in a bathtub was a choice, and one that she feels strongly about. Interestingly, the American College of Obstetricians and Gynecologists and the American Medical Association feel strongly about it, too - strongly enough to issue a statement saying that she made the wrong choice.

See, Ricki Lake made a movie about her choice, and the ACOG and AMA aren't too happy about it: ACOG released a statement, which was in turn supported in a resolution Tuesday by the American Medical Association, which said "There has been much attention in the media by celebrities having home deliveries" and which singles out Ricki Lake's film "The Business of Being Born" as part of the problem. The AMA's resolution resolves to support state legislation "that helps ensure safe deliveries and healthy babies by acknowledging that the safest setting" is a hospital, connected birthing center or other approved facility.

The problem, apparently, is that Ricki Lake, by publicizing her choice, sets the wrong example. She might, after all, influence some poor unsuspecting preggo to - gasp! - have a natural delivery at home. And that, ACOG and the AMA imply, would be wrong.

I - obviously, given that my own recent delivery almost happened in a vehicle speeding away from home - didn't give birth at home. I had a hospital birth planned, and - thanks to my husband's driving skills, but still with only seconds to spare - a hospital birth I had. And I'm glad that I did: even though a planned home birth would have eliminated the possibility of the terrifying car-baby chase, it would probably have gone badly. I had a terrible fourth degree tear that required immediate and extensive surgery and, well, that's not the kind of thing that could be dealt with in my bathroom. That said, I wouldn't want anyone to take the choice to have a home birth away from me, and I wouldn't want anyone restricting my ability to learn about that option.

So what's the deal here? Why are these organizations wagging their fingers at Ricki Lake? Some argue that it's a classic case of the medical establishment protecting their turf. "They need to protect their billion-dollar business" writes Maria of A Piece of My Mind. It's "scare tactics... they are out to protect their self-interest." Ecorazzi agrees with the claim of 'scare tactics,' noting that the AMA resolution states that women who choose to birth at home put themselves at risk of “maternal hemorrhage, shoulder dystocia, eclampsia or other obstetric emergencies," adding "nothing like taking away choices from people — or scaring the hell out of them into going your way."

Rhonda of Rants and Raves makes a similar argument:

This issue really is all about choice. I admire doctors and their many
skills. However I am getting tired of some of the scare tactics I see
being used. If every single hospital closed tomorrow babies would still
be born and most would survive the ordeal no matter whether they were
born in a bath tub or the back seat of a car.

I agree. (Mostly. That is, I agree entirely with the need for choice to be preserved, and I agree totally that the AMA should be taken to task for suggesting that anything other than a hospital or other medically-supported birth is dangerous. I don't, however, agree with any claims that home births are equally as safe as hospital births: the AMA is wrong to put a big flashing danger sign on all home births, but they're not wrong to state that in cases of obstetrical emergency, the hospital is the better place to be. If I hadn't been at hospital when I delivered my second child, I would have hemorrhaged. And no, there was likely no 'natural' way to avoid this - I had a big baby and a precipitous labor. He literally blasted his way out. It was his size and speed of exit that caused the damage. But I digress.) The AMA's effort to put their resolution into law smacks of self-interested turf-protection - and turf-protection never helps those who actually use the turf. Women are served best by having choice, and by having the information to make choices. If women are well-informed about the advantages and disadvantages of their various options (and all options in childbirth do carry both advantages and disadvantages), then they - and they alone - will be int he best position to decide how to birth their babies. They should of course be informed about the risks of delivering a baby at home - but they should also be informed of all of the benefits of doing so, as well.

Anything other than this is a step backward for womens' reproductive freedom, it really is. Shame on the AMA.

Read Ricki Lake's response to the controversy at the Huffington Post here.