BlogHer - Midwives & Doulas - Comments

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

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.

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.

Questions

kateh — Thu, 19 Jun 2008 13:11:33 -0500

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.

Fact check, please!

esthermarie — Thu, 19 Jun 2008 12:30:02 -0500

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.

Thought on the Statistic Chart Above

teresabelle — Thu, 19 Jun 2008 11:54:04 -0500

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.

Safety of Homebirth

teresabelle — Thu, 19 Jun 2008 10:16:18 -0500

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.