This article made me want to scream

I must be losing my mind, or strangely jealous of all the fun, fun comments Rose got in her circumcision post, because I’m going to opine about one of those fraught subjects that tends to be intensely emotional and controversial.  Contemplating what I would write, several times the part of my brain in which my much-ignored common sense resides would remind me that I could spare myself the potential headache and just post about something else.  But it seems cowardly to have an opinion about something and decline to state it because you’re afraid people will get mad at you.  So here goes…

I’m going to write about home births, and why I am totally, utterly against them.

This article in the New York Times is what set me off.  It’s about Ina May Gaskin, the matriarch of the contemporary home birth movement:

Gaskin, a longtime critic of American maternity care, is perhaps the most prominent figure in the crusade to expand access to, and to legalize, midwife-assisted homebirth. Although she practices without a medical license, she is invited to speak at major teaching hospitals and conferences around the world and has been awarded an honorary doctorate from Thames Valley University in England. She is the only midwife to have an obstetric procedure named for her. The Gaskin Maneuver is used for shoulder dystocia, when a baby’s head is born but her shoulders are stuck in the birth canal. [emphasis added here, and in all subsequent passages]

As the article goes on to say, Gaskin not only has no medical license, she has no medical training.  None in obstetrics, and none in pediatrics.  Zero.

Unmedicated home birth is being chosen by a growing minority of women. Between 2004 and 2009, giving birth at home increased 29 percent. Most of this rise is among white women. Recent pregnancy documentaries like “Pregnant in America,” “Orgasmic Birth” and “The Business of Being Born” — all of which feature Gaskin — present hospital birth as profoundly disempowering to women.

If the only person put at risk by a home delivery in pursuit of some kind of transcendent, orgasmic experience were the mother, I wouldn’t care about this all that much.  I think that people should be free to take idiotic risks with their health.  But it’s not just the woman, is it?  There’s also a baby.  But we’ll get to that in just a bit.

Of course, comparing the Farm to hospitals is of limited value. Many hospitals deliver at least as many babies in a year as the Farm midwives have delivered in three decades. Women who give birth at the Farm are self-selected, and midwives screen them further, eliminating, for instance, women with complicated medical histories. Hospitals would undoubtedly have better outcomes if all pregnant women arrived in excellent health.

And that, right there, is the only acknowledgment in this ridiculously biased article comparing the perinatal mortality figures for hospitals and home deliveries is a fool’s errand.  Hospitals don’t have the luxury of sending premature deliveries or complicated cases elsewhere to make their numbers look better.  They take all comers, and deliver orders of magnitude more babies.

Nonetheless, Gaskin’s outcomes are compelling. Is it actually safer for a low-risk woman to give birth outside of the medical establishment, as Gaskin claims? In 2011, ACOG acknowledged that “the absolute risk of planned home births is low” but cited a meta-analysis of 12 home- and hospital-birth studies, called the Wax Paper, which reported a two-to-three-times-higher risk of neonatal death in home births than in hospital births. But critics have raised questions about the Wax Paper’s methodology; the study included unplanned accidental home births, for instance. Natural-birth advocates point to studies in countries where home birth and midwifery are part of mainstream medical care — in the Netherlands, 30 percent of births take place at home — which show home birth to be equally safe for the baby.

You know what else happens in the Netherlands?  Midwives are required to get four years of medical training.  And as Dr. Amy Tuteur (an obstetrician who blogs at The Skeptical OB) also points out in that post, for most women in the densely populated Netherlands, getting to the hospital takes about as much time as it does for specialists to assemble.  From rural Tennessee, where Ina May holes up?  An hour to the nearest NICU.

…The birth of Ina May’s first child had been traumatic. She was strapped down and given an episiotomy and a forceps delivery, standard hospital protocol at the time. Other women also had bad birth experiences and wanted to avoid hospitals. They passed around a Mexican midwifery manual and agreed to support one another in labor. Gaskin attended her first birth in a bus parked at Northwestern University, where Stephen Gaskin was speaking. Her main method initially was to “just be nice to the women.” After a couple of months, an obstetrician outfitted Gaskin with syringes and clamps and taught her basic emergency techniques. During the five-month trip, there was one death: Ina May’s son, born prematurely.

It is not clear how premature that infant boy was.  Perhaps he was too premature to live, and would have died wherever he had been delivered.  A more skeptical reading certainly makes one wonder if that dead child would have lived had he been born surrounded by medical providers competent to save him.

Lawsuits aren’t an issue in Gaskin’s world. Her midwifery clinic has never purchased malpractice insurance or been sued. For years, when the commune was a true collective, she did not even accept payment for attending births. Farm midwives give intimate intensive prenatal care and have a high degree of trust with their patients. That’s why, Gaskin said, in 2006 when a breech baby she delivered became temporarily stuck and suffered permanent neurological problems, the parents did not sue. “We thoroughly discussed the issues, and they didn’t see a reason to be punishing,” Gaskin told me.

I am going to try very hard to keep the intensely vitriolic things I want to say about this terrible, stupid paragraph limited.  Lawsuits “aren’t an issue” for Gaskin?  She’s never been sued?  She’s one hell of a lucky, lucky woman then, isn’t she?  Because God knows she could well have been, what with that permanently disabled child whose disability is entirely her fault.  Who, had he been delivered by C-section in a hospital, would not be disabled now.  How nice for her that the parents didn’t sue her for all she’s worth.  She sure had it coming.

For those of you keeping score, that’s one dead baby and one permanently damaged one.

When I visited the Farm, Gaskin was planning to travel to testify at the trial of a C.P.M., Karen Carr, who delivered a breech baby in a home in Virginia who died. Carr lived and practiced in Maryland, but Virginia requires a license in addition to certification, and because Carr didn’t have one, she was charged with involuntary manslaughter. (She pleaded guilty to lesser charges.) I pressed Gaskin about the case. Wouldn’t that particular baby have been better off in a hospital? She conceded that his life would have been saved but said that hospital birth comes with its own risks.

And we’re up to two dead babies.

Yes, hospital birth comes with risks.  Birth comes with risks.  That’s why treating as a beautiful, wonderful but potentially risky situation is appropriate.

The rest of the article is dedicated to the author’s own account of her negative experience giving birth in a hospital, whence comes the halo she gives Gaskin, I suppose.  The number of obstetricians she interviewed for her six-page article about a highly controversial subject?  Zip.  Nice balance, New York Times.

And now, a concession from me.  I am not an obstetrician, so I’m not in a position to comment with much authority on delivering babies.  It is my observation that an awful lot of babies are delivered by C-section, and that it seems many OBs are quick to go with that choice.  I suspect this is due in large part to fear of malpractice suits.  One area in which I think medical tort reform makes sense is to offer additional protections for providers who agree to perform vaginal births after C-sections (VBACs), which carries more risk but nonetheless can be done safely much of the time.  Hardly any OBs will agree to perform VBACs, and this contributes to a C-section rate that is higher than it ought to be.

I am not saying that there isn’t a lot of room for improvement in the delivery experience for women who deliver in hospitals.  And I am wholly in favor of hospital-based midwifery programs, where access to skilled medical care is a phone call away.  But home-based midwifery by people who have no meaningful medical training?  No way.

I have been in blessedly few situations where I know my presence made the difference between a patient living or dying, or being permanently disabled.  Those situations are 100% limited to being present at deliveries.  In some cases, the infant had had a bowel movement (called “meconium” in neonates) during delivery, and the meconium needed to be suctioned from its airway.  My being there meant the baby could breathe.  Had I (or any other competent pediatrician) not been there, those babies could have suffered irreversible brain damage.  Ditto for babies with difficult extractions who needed intensive resuscitation immediately after birth.  I was there, and the babies did just fine.  Had they not been in a hospital, they almost certainly would not have.  These were in otherwise totally normal deliveries, ones where there was no sign of trouble up until those very moments.  A midwife in a woman’s home would have had no reason to send those women to a hospital.  Even a very short drive would have taken enough time to have dramatically altered the infant’s outcome.

If people have chosen to become parents, then they have implicitly agreed to take the welfare of their child seriously.  I happen to believe that they are obligated to put their child’s welfare ahead of their own.  And no matter how disempowering or non-transcendent that they may find the experience of hospital-based deliveries, that is the safest place for their newborn child to be delivered.  It is their duty to put that child’s interests ahead of their own ideology.  Home deliveries by medically incompetent providers does not respect the best interests of the child.  Period.

And with that, I will hit “publish” and brace myself.

Update:  Several commenters have made reference to home births in other countries, and have highlighted a legitimate flaw with the above post.  My objection to homebirths is entirely limited to the United States.  In countries like the Netherlands (and, presuming what commenters have said is true), Canada and the UK where midwives are required to have sound medical training, then my objection is much more muted.  Similarly, if all homebirths in the United States were attended by well-trained nurse midwives, then I would have much less objection.  What I object to is midwives like Gaskin who have no medical training attending deliveries where they are incompetent to take care of the infant should complications arise unexpectedly.

331 thoughts on “This article made me want to scream

  1. I remember reading one homebirth advocate (Tuteur wrote about her on her site) say that she had a C-section in the hospital and gave birth to healthy baby and a homebirth where the baby died during delivery, and that the former was the worse experience. WTF?!?!?!?!

    I’ve had the pleasure of both vaginal birth and C-sections. Vaginal births are not without drawbacks. But clearly they are preferable for me. But how in hell can you prioritize an experience for you over a healthy, living baby? My doc was willing to do VBAC with kid 3, but his head circumference measured in ultrasound at >99th percentile. So we went with another C-section. Turns out several ultrasounds were wrong, and his head was at 50th percentile. So I was pretty disappointed. But how on earth could I be too disappointed? I have a seriously awesome lovable amazing kid, who is no less awesome and with whom I am no less in love than my vaginally-born kid. This is not a disappointment to dwell on my whole life.

    Birth may be natural. But evolution is not a designer of perfect beings. Natural does not always mean well designed. We come with some design flaws (such as an appendix which you could live without healthily, and occasionally just gets horribly infected and could kill you). All we need are enough survivors to reproductive age. Birth, historically, has been dangerous to mother and baby. Of course, hospitals suck. Of course, home is more comfortable. Of course, recovering from major abdominal surgery while you’re waking up a zillion times a night for a newborn sucks the big one. But you know what sucks more? A dead or disabled baby.

    Part of how I make my peace with my kid’s neurological disability is knowing that it could not be any other way. That is who he is. But what if my decisions, or some midwife’s decisions, were responsible?

    • I didn’t say this in a post, but I’m totally in favor of midwives at a hospital. I volunteered for six months in rural Kentucky after high school assisting midwives in underserved areas. They did great work. That and homebirth for the sake of the experience are two different things.
    • how in hell can you prioritize an experience for you over a healthy, living baby?

      This.

      I think some people conflate the two things, assuming they must be positively correlated.

      • I wouldn’t be surprised if, when all goes well, they are lightly positively correlated. However, when all does not go well, the costs can be devastating.
        • My first child was born ‘naturally’ at the hospital. It wasn’t a traumatic experience and I wasn’t scarred for life from it. (Unless you count stretchmarks)

          Child 2.0 was born abroad in Europe (Denmark), where I had midwives see me each month, with the usual doctor’s visits once in a while in between.

          I was over my due date and asked to have the membranes stripped. They had ballparked my son at over 4 kg at 40 weeks, and to say he was running out of room would be a very, very extreme understatement.

          My water finally went at 41 1/2 weeks. I was in labor for 8 hours with the midwives (at the hospital) and the OB/GYN on call said it was time to go to the operating theatre.

          Turns out that my son had partially turned. The fetal heartrate monitor which is usually at the crown of the head was instead placed just above one ear – that was how much he’d turned his head while scooting out of position for a natural birth. He’d also tucked his head into the cradle of my hips and wedged a shoulder into the other. He was, in essence, stuck.

          Had I not had the section, neither of us would have survived the birth.

          He came out at 4.4 kg and some 56 cm long. At 4, he’s 117 cm tall and 24 kg. I fear his teenage years and the grocery bill(s) we’ll be enduring.

          I, personally, would NEVER risk my health or my infant’s health by wanting to have a ‘home birth’. My home is NOT equipped for an ‘OH SHIT’ moment, and if the shit DOES hit the fan, I want to be at the hospital where there are qualified individuals there to take care of it.

          As a side note, doulas/midwives in Denmark must be educated in the profession and be licensed/approved.

          • My wife gave birth here in France. We also had qualified, medically trained midwives/nurses who helped out with the preparation and the procedure. Their training makes them capable of basically delivering a baby in optimal circumstances. However, in the case of less-than-optimal circumstances, they are all competent and trained enough to go get the OB GYN and save the baby and mother’s lives.

            Our son went into respiratory distress when my wife was only dilated at about 1 cm. We were in the hospital, expecting an extremely long labor. My wife was hooked up to a monitoring device, and the alarm started going off. Suspecting just a misplaced component, I sheepishly went and found the nearest nurse/midwife.

            The midwife ran and got the doctor (literally), and he showed up immediately, looked at the monitoring device, and said, “we need to do this right now”. They hooked up an IV and ran off so fast that her bed was smashing into the walls and blood was on the floor (from when they put in the IV). It was a pretty traumatic experience for me.

            Less that 2 minutes later, our son was born (c-section). They had to put my wife under, and it was a pretty miserable experience for both of us. HOWEVER, the only thing that matters is that our son survived and so did my wife. If we had tried home birthing, neither the baby nor my wife would have survived. I honestly can’t thank that team enough for doing their jobs.

            That is one reason I can’t stomach the pro-home birth arguments. It is true that many births can be performed by a medically trained midwife. But, if any of the millions of possible things that could go wrong do go wrong, how can anyone possibly justify sacrificing their child’s life for their own, selfish beliefs?

            And as for statistics, thank you for pointing out that hospitals have to add the mortality rates of all of those home births that go wrong and end up in the emergency room. Many of those unfortunate situations would be avoidable if the whole process was medically monitored. The worst part is that the pro-home birth statistics choose not to include any of the cases that end up in hospitals, as those are no longer home births. Thus, whenever anything goes wrong, as is unfortunately sometimes the case, the home birthers wash their hands of the whole affair and blame the hospitals for a situation brought on by their own questionable practices.

            Can we please stop pretending that doctors are trying to hurt us? I’m sure there are a few out there who are more concerned with the bottom line than their patients’ welfare, but how did doctors and hospitals become the bad guys in today’s society?

            That rant felt good. This is one topic that really gets my blood roiling!

  2. This is a little thing, but this bit suggests the writer does not know how insurance works:

    “Lawsuits aren’t an issue in Gaskin’s world. Her midwifery clinic has never purchased malpractice insurance or been sued.”

    Lawsuits may not be a problem, but Gaskin can’t buy malpractice insurance. She’s not a listened physician. I would be interested to know if she carries professional liability insurance, which is what would actually cover her from a suit. If not, even if there had been a potential suit in the past it wouldn’t have been against her, it would have been against the primary physician and/or any referring physician or medical professional – because that’s where the insurance is available. In fact, it may be possible that there have been several paid claims or even suits, and she would still be able to say she never had a lawsuit or carried malpractice coverage. (I’m am not suggesting that this is the case, mind you.)

    • Plus lawyers wouldn’t take the case anyway. Since she doesn’t carry insurance, there’s no guarantees that they’d see any money. It’s ridiculous. She can say that there are no lawsuits, when in actuality I wouldn’t be surprised if people DID try to sue but couldn’t find a lawyer to take their case.
        • It’s not an issue of finding a lawyer, it’s the issue of paying for it. These cases would generally be done on a contingency fee, where the lawyer gets a portion of the award, but if the defendant won’t be paying any award (because no insurance or assets in their own name, also very common among bad midwives), so the lawyer won’t collect. Not many people can afford to pay a lawyer out of pocket for a suit like this.
        • Check out the blog Hurt By Homebirth. Many babies have died and when mothers go to sue they find out that midwives don’t carry insurance and the only regulation is by a board of their friends. All the mothers tried suing but no lawyers would take it because there is NO insurance. They will sue a doctor because they have millions in an insurance policy while midwives have $0. So no, a lawyer won’t take a case that will consume hundreds of hours with little to no guarantee of getting anything.
  3. I’m assuming that like any culture, the home-birth movement’s culture has evolved. So I can’t speak for what it is today, but when we were taking birthing classes 16 years ago we took them from a big home-birth advocate. The literature and books we were given suggested that the issue with hospitals was that they were too, well, “male.” Which, according to the literature we were given, meant that they treated a birth as an affliction to be cured rather than a natural process to be celebrated. This sounds silly enough as I write it that I’m more convinced that the movement’s messaging has probably evolved.

    FWIW, we split the difference. My wife had a fantastic relationship with a midwife (not the one that ran the class) that was an employee of the hospital, so we had the midwife deliver the baby at the hospital. That worked well for us.

    • OH! I forgot!

      The first evening of birthing class, we were shown the opening scene from Monty Python’s The Meaning of Life (Ah, I see you have the machine that goes “ping!”) as an example of what hospital births were all about.

    • Which, according to the literature we were given, meant that they treated a birth as an affliction to be cured rather than a natural process to be celebrated.

      This is discussed in obstetrical circles, actually. That male doctors view pregnancy as a condition and female doctors view it as something else. Most of the enthusiastic cutters are notably male. I don’t think that’s the only reason why, but I do think it’s *a* reason.

      One of the funny things about the malpractice angle is that some hospitals don’t allow for midwives precisely because of liability concerns.

  4. Interestingly enough, Clancy was interested in a midwife delivery if no pre-natal hiccups occurred. I had mixed feelings, though not for the most sound of reasons. This is an area where I would of course defer to her experience. It was a long road figuring out what we were going to do (basically exhausting every other option before deciding to sign up for care with her employer). She did a lot of research on the non-traditional providers she was looking at, but I was rather uncomfortable with any provider that was two hours away.

    As I think I’ve mentioned before, Clancy has a non-interventionist philosophy when it comes to c-sections (VBACs are prohibited by the hospital, though), which is professionally not advantageous. She doesn’t have to pay for medmal insurance (directly), but she rakes in less money for the hospital (and possibly herself) and it is a burden for her to stand over a woman waiting for nature to take its course rather than to simply cut.

    From my own (not-entirely-informed) perspective, I think we would probably be well-served by making better use of midwifery. I think if it weren’t so non-traditional, we’d have a better regulatory regime (or is that “we’d better have one?”… both, I guess). But your point about midwifes and non-traditional providers being able to kick the problem cases down to the hospitals is a good one. You can’t compare statistics.

    As an aside, there’s actually an odd sort of thing out here where the more educated and well-to-do places have less trust in the medical community than the more rural or blue-collar places. There are two “cities” that we spend a lot of time in. Notably, the best and brightest from City A often move to City B or at least move somewhere the heck away from City A. City B has a pertussis problem, a lot of midwives, and so on. In City A I hear conversations about those dang reckless people who refuse to vaccinate their kids.

    • From my own (not-entirely-informed) perspective, I think we would probably be well-served by making better use of midwifery.

      We had a doula, both times, and she was awesome. The screening process to select our doula was non-trivial, though. There’s an awful lot of woo in there.

  5. You can compare statistics — you just have to get the -right- statistics. The ones on the hospital side are the hospital acquired infections, and other things that are really unavoidable parts of being in a large health care bureacracy.
    Compare that to “number of babies that could have been saved in the hospital.”

    At this point I am completely agnostic, due to lack of caring. But I’d love to see the REAL numbers. (and I’d doubly love to see them run on “birthing/women’s hospitals” versus “general practice” hospitals — PGH can’t be the only place to actually have a woman’s hospital!)

    • You can very easily do a search of the CDC birth/ death certificate data. Out-of-hospital births attended by non-CNM midwives have a shockingly high comparative death rate. You will also discover that the majority of these deaths are caused by birth asphyxia or some other related issue, whereas most of the hospital births are caused by prematurity-related causes or congenital defects. Obviously death certificate data is not and will never be comparable to a randomized, controlled trial, but there are so few homebirths in the US that it is the only way to get high enough numbers for any significance.
  6. “Because God knows she could well have been, what with that permanently disabled child whose disability is entirely her fault. Who, had he been delivered by C-section in a hospital, would not be disabled now.”

    If the woman was healthy when she went in to hospital, as she obviously had been to be attended by the farm midwives, then she almost certainly would have had a vaginal birth and ended up with exactly the same outcome. In fact, the outcome would likely be worse, as Ina May encourages women to birth upright and US hospitals encourage women to birth lying down in the most obstructive position for the pelvis. It takes time to prepare to undertake a caesarian section. About 30 minutes. Do you really think that would have helped the outcome? Or are you in favour of all women undergoing major abdominal surgery for the birth of every child whether they choose it or not?

    • If the woman was healthy when she went in to hospital, as she obviously had been to be attended by the farm midwives, then she almost certainly would have had a vaginal birth and ended up with exactly the same outcome

      I haven’t the faintest idea what you’re basing that statement on. The baby was breech. She almost certainly would have had a C-section.

      Do you really think that would have helped the outcome?

      Without question. The amount of time it takes to set up for a C-section is irrelevant. The baby was presumably in no distress until Gaskin was unable to extract it, in which case the prep time would have made no difference at all.

      Or are you in favour of all women undergoing major abdominal surgery for the birth of every child whether they choose it or not?

      What a silly question. Of course not.

      • And therein lies a problem doesn’t it, when medical providers are totally unskilled in delivering breech babies. A breech baby doesn’t necessarily require a caesarian section. I am living proof of that as I was a footling breech birth myself. Luckily, I was born in Europe.

        I’ve also been at the mercy of midwives in hospital, more interested in getting people out the door than respecting the mother’s birth choices. On reflection, there was a lot of things that could have been done to help me birth my 9lb baby without pumping me full of drugs and giving me an episiotomy. Which is why I will be staying at home next time.

        • Well, that’s obviously your decision. Suffice it to say I disagree with it. And your experience with hospital-based midwives is not consonant with the experiences of many mothers I have known. But life is a mixed bag, isn’t it?

          Regardless of how accurate or expert the risk assessment was, supposed breech-delivery expert Gaskin couldn’t do it well enough, and the child is left with a permanent disability because there were no other possible options once vaginal delivery failed, to say nothing of the lack of immediate medical support for the infant.

          • There is nothing to say that the parents would have agreed to a caesarian section if they had been in hospital though, and they would have had to consent to the surgery would they not? Surely in that case, seeing as most doctors are completely incompetent when it comes to breech birth, the result would have been far worse, or even fatal?

            What is there to disagree with, in the case of a straightforward pregnancy and home birth? I had a straightforward pregnancy. Birthing at home with my son probably would have resulted in a better outcome for both of us, in which I wouldn’t have had an episiotomy which 17 months later still causes me pain, and a sleepy infant who took several days to come round from the epidural and feed efficiently.

          • Look, H, we’re just going to continue to talk past each other. You think home deliveries are worth the risk, and I don’t. I will happily concede that most home deliveries will go swimmingly. But it’s not so terribly rare that even an otherwise uncomplicated delivery results in the birth of an infant who needs urgent medical attention immediately, and medically untrained midwives God only knows how far away from the nearest hospital are ill-equipped to deal with them.

            You want to take your chances? I can’t stop you. But I disagree wholeheartedly with your decision.

          • At what point did I say the midwives would be untrained?! I’m in the UK. I would have 2 midwives present with oxygen, entinox, and all the necessary equipment and training necessary to deliver a child. In hopsital, I’d be left to labour alone for the majority of the time.
          • Well then, H, you’re talking about a totally different situation than what is described in the article from the Times and which I am decrying in my post. If midwives in the UK have the same kind of medical training as those in the Netherlands (I’m simply ignorant of the requirements, and would be happy to have you tell them to me… really), then that’s wholly different than what Gaskin and her ilk do. As the article makes clear, they have no medical training, beyond a pointer here and there.

            Several years ago, I was lobbying at the legislature of the state where I live in opposition to licensure for so-called professional midwives, and I saw the requirements for training they were proposing. There was literally nothing stipulated about training in the care of newborns, neonatal life support, etc. Zero. It boggles my mind to think that new mothers would want their new babies evaluated and treated by people who have no training whatsoever in doing so.

          • Midwives in the UK undergo university level training for several years in midwifery or train as nurses and then specialise in midwifery. I would, however, be more comfortable being attended by Ina May Gaskin over a newly qualified OB or midwife, simply as her experience far exceeds theirs. Surely thousands and thousands of healthy mothers and children mean something? Or should we damn every hospital, doctor, nurse and midwife for their poor outcomes?

            Unfortunately, there are risks to giving birth, but it is impossible to completely diminish the risks whether you are in hospital or at home. Unfortunately babies do die, and they do suffer disabilities during birth, but it happens at home AND in hospital. Pregnancy and birth are not, in most cases, an illness to be managed, and home birth is as safe for those who are at low risk. Unfortunately, by making it harder and harder to birth legally at home, the market is growing for lay-midwives and free births.

        • “What is there to disagree with, in the case of a straightforward pregnancy and home birth? I had a straightforward pregnancy. Birthing at home with my son probably would have resulted in a better outcome for both of us….”

          Can I live in your world, H? One where a perfect pregnancy = a perfect birth? I hate to break it to you, but SHIT HAPPENS. I had a perfect pregnancy, I was 19 years old, zero risk factors….and yet my baby suffered severe brain damage from a lack of oxygen at birth (41 weeks). I had a natural, vaginal birth. He was only 8lbs 10oz. I was in a hospital with a fully stocked NICU just upstairs, a team of nurses and a doctor immediately present during labor/birth, and YET he still ended up with brain damage and cerebral palsy.

          He was born blue with the cord wrapped around his neck and shoulders, was resuscitated immediately after he was born, and then run up to the NICU and put on the CPAP because he still wasn’t breathing. I didn’t hear him cry until he was over 12 hours old, and then not again until he was 4 weeks old. He had a seizure at 36 hours from the brain damage and was airlifted to a Children’s Hospital 6 hours away. At 4 days old we were told that he was “brain dead” and he was taken off life support the next day. Through pure dumb luck, he survived past his first week (which they didn’t expect him to see), and is now 17 months old and perfectly healthy, albeit with severe developmental delays that affect him physically and mentally.

          I live in Canada, but in the area that I live in, there are no midwives. If there were, I would have gone with a midwife and done a homebirth. I live 5-10 mins from the hospital. Like I stated above, I had ZERO risk factors. I would have been a perfect candidate. But my son would have died had I been at home. It takes mere minutes for your child to suffer irreparable brain damage. Is that something you really want to play with for the sake of your “experience”? As a mother of a child with cerebral palsy, let me tell you that I would have a c-section every day of my life if it meant that I wouldn’t have to deal with the emotional pain that I live with every. single. day. My son is 17 months and yet he acts like a newborn. He can’t sit up by himself, doesn’t play, doesn’t talk, can’t crawl, feed himself, or do anything independently. It is literally torture watching babies at 3 months old doing things that he can’t, see babies from his birth club [born at the same time as him] walking and running and stringing sentences together, when I would give ANYTHING for him to just sit up by himself, just say “mama”. It’s highly likely that I will be taking care of him for the rest of his life. His life expectancy is 12.

          Now, I ask you…… is it worth the risk?

          • Like Olivia, my kid who would have died and is now severely neurologically disabled was considered no special risk. I got a C-section with him only because he was big, which I gather would not dissuade most home birth advocates.

            And, I gather also like Olivia, I am also concerned how cavalierly is treated the possibility of severe neurological damage. Some people have on this thread have talked about how depressed they were after a hospital birth. I absolutely think the hospital experience should be improved. But the depression of a desperately ill child is nothing like this. It is rough being a SN parent, and forget about how hard it is to be a kid with SN.

    • Crash c-sections are routinely initiated within fewer than 30 minutes of the decision. Thirty minutes is considered the upper-maximum in an emergency. The goal is often 20 minutes (depending on the facilities and support staff) and can be done faster sometimes.

      The rules are different for crash c-sections and planned ones.

          • Look, not all breeches are the same level of risk. What is the mother’s parity? Multiparas are safer than first time moms. What position is the baby in? Frank is safer than footling. What is the gestational age? Premature births are riskier than a term breech. Also, there is some correlation between breech position and babies with other risk factors like congenital defects (pretty serious, incompatible with life ones, sometimes). Even a trained attendant should be doing risk assessment in advance of the birth and deciding if a mom and baby are good candidates to have a vaginal breech. Not everybody is.

            One of the main causes of damage during a breech birth is having an untrained provider. You are right about that. But Gaskin is highly skilled and has thousands of catches over the last 40+ years, both vertex and breech babies.

            Re: breech training, Gaskin got training from a local family practice doctor who was a skilled breech attendant, from back in the day when doctors were taught that skill. Try finding a doctor under 40 who has that training. Now they only know how to do sections because they are easier to teach in med. school.

          • Now they only know how to do sections because they are easier to teach in med. school.

            No, they learn how to do sections more because sections are much less risky for the baby, and no hospital is going to expose a neonate to increased risk just for the sake of teaching.

          • – My friend had a vaginal breech baby, and another friend had a vaginal twin birth, one of which was breech. Both in a hospital. The “doctors don’t know how to deliver breech babies!!!1!!”/”doctors don’t know what normal birth is!!!!1!!” is a myth. It’s called risk assessment.
          • Actually, Olivia, in some areas it’s called relying on a faulty study. The Canadian College of OBs/Gyn (whatever it’s called, I always forget) helped to really kill breech deliveries in Canada. For ten years, it was against policy, until they finally realized that the study they relied upon was bunk.
    • I was squatting for birthing my daughter in the US (in 1991), before I was uncomfortable and asked to lie down to push – and my daughter was born 11 minutes later without an issue.

      They let me be in whatever position that I was comfortable in – the same in Denmark – but my son’s size and positioning wouldn’t allow for ANY vaginal birth.

      I will gladly choose major abdominal surgery each and every time it is not possible to birth vaginally. I prefer the risks of surgery to myself and my child rather than leaving me to die in agony along with my child.

  7. ” It is my observation that an awful lot of babies are delivered by C-section, and that it seems many OBs are quick to go with that choice. I suspect this is due in large part to fear of malpractice suits. ”

    My mother is involved in obstetrics pharmaceuticals, and she says that this is exactly the case. It’s why the introduction of the fetal heart rate monitor was associated with an increase in the C-section rate.

  8. “It is their duty to put that child’s interests ahead of their own ideology. ”

    I agree with this, but in my personal experience it has been the obstetric community who needs this advice. I was pressured by my perinatologist to induce my twins at 35 weeks, his reasons were that they were simply ‘done cooking’ and that it would be too uncomfortable for me and there was just no reason and only risk to go past that. I could not find any evidence to support that claim, and yes it was uncomfortable to go full-term with twins but everything I found supported full-term spontaneous labor resulting in the healthiest newborns. I really wanted my boys to be as big and strong as possible, to have as few breastfeeding issues as possible, and to stay out of the NICU unnecessarily. I also really wanted to birth them without interventions and without medication, not because I thought it was going to be ‘transcendent’ but because I the more information I read the more I felt that was the least-risky scenario. The OB who would have been my preferred backup would have insisted on pulling my second breech twin out (manual breech extraction) shortly after Baby A was born, I read about brachial plexus injuries and though this OB seemed to have a good success rate with this procedure it made me really nervous and I felt safer allowing him to be born spontaneously.

    Cesarean sections have good success rates too but they are not a perfect guarantee, injuries to both mother and infant do happen, some minor but some very serious. The decision of how and where to birth my sons was incredibly stressful, and what I found most unfortunate was the drastic gap in my options. I wish there had been a hospital that would consider my unique circumstances above their liability, and who had a staff familiar with intervention-free birth. It really distressed me that the perinatologist I saw admitted that during his time as a practicing obstetrician he had never attended a mother without an epidural, and the idea of a breech baby born spontaneously was ‘impossible’. It is clearly possible as many healthy babies have been born that way, but it is crucial that the practitioner attending their birth is knowledgeable of the process.

    I am extremely grateful to the Certified Nurse Midwife and her team who attended the birth of my sons at my home, and grateful to have a hospital down the road who’s head L&D nurse was extremely kind (and supportive of home birth) when I met with her, and assured me that in the case of transfer they would welcome us and be able to provide a high level of care.

    I hope to see more cooperation between midwives and OB’s in the future to provide safer and more evidence-based care for mothers and babies.

    As far as Ina May, in her books she talks quite a bit about the obstetricians she trained with so I feel the original article is misleading. There is however quite a big difference in qualifications for midwives, the CNM I hired had extensive medical training and years of experience working in L&D in hospitals. I am newly working as a doula and for the woman interested in midwifery care the difference in the education and scope of practice between Licensed Midwives and Certified Professional Midwives is important information for me to communicate to a client so that she can make the best decision in choosing her care provider.

    You said:
    “Yes, hospital birth comes with risks. Birth comes with risks. That’s why treating as a beautiful, wonderful but potentially risky situation is appropriate.”

    Again, I agree but in my experience it is obstetrician’s who tend to disregard the ‘beautiful and wonderful’ part and it is midwives who practice (very well!) recognizing and responding to risk appropriately.

      • Yes, I had a client in January who was told to have a c/s for her twins at 36 weeks to avoid Cord Prolapse!! Thankfully the high risk Dr. advised waiting to 38 weeks. Still though. Totally unnecessary since she’d had 3 vaginal births already, all short and easy.
    • I have no qualm at all with nurse midwives. I’ve worked with many, and have found them to be excellent in general. I heartily agree that they are medical providers whose training makes them quite competent to do what they do.

      I am extremely grateful to the Certified Nurse Midwife and her team who attended the birth of my sons at my home, and grateful to have a hospital down the road

      I am less opposed to home deliveries in rare circumstances such as this, when a trained medical professional is on hand and a fully-staffed medical center is nearby.

      • “I am less opposed to home deliveries in rare circumstances such as this, when a trained medical professional is on hand and a fully-staffed medical center is nearby.”

        This is true for every midwife-attended homebirth in Washington state.

        Again, you’re basing your knowledge of homebirth-midwifery on one person in one state.

    • Your case with the twins sounds like some of the doctors who have driven my wife nuts over the years. My wife has the opposite problem, as a provider who is reluctant to induce without a strong medical indication to do so. It’s become a part of her opening visit with patients.

      (That being said, breach=c-section, for the most part.)

  9. Our children were born in the hospital, and if we have any more, we’ll plan on hospital births as well. My wife’s pregnancies tend to be high risk, but I would opt for the hospital even if that were not the case. An immediate family member and numerous friends have done home birth, but such isn’t for us.

    Having said that, your last paragraph got me thinking about the ethics involved here, namely whether parents have a moral obligation to go the route that is reasonably thought to be the safest and/or least risky. I’m not certain of this. I’m with you all the way on putting the child’s welfare ahead of one’s own, and this clearly entails being safe, but does it mean doing what is safest? Least risky?

    • Here’s my two cents (although you didn’t ask me). I certainly agree that one need not only act in a child’s best interest. One can consider one’s own interest as well. But (although Katherine’s seems an exception), the harm to the parent and child of being deprived of a homebirth is negligible compared to the potential harm of being deprived of medical care.
    • That’s the heart of the debate. Home birthers (or Birth Center) are genuinely arguing that the home IS safer in healthy women. Home birthers aren’t staying home *in spite* of safety. It is their experience that home IS safer.
      It is possible to compare “healthy” women in hospitals with Ina May’s numbers. Ina May still has better numbers.
      Healthy babies are dying and being injured in U.S. hospitals because Doctors do not know how to deal with “gray area” situations where the need for surgery has not been decided and things get complicated quickly.
      Should Dystocia, Cord Prolapse, long pushing stages are examples. OB’s are losing their skill at attending healthy births. (gotta run, my own 10 week old is crying) ;o)
      • WHICH hospitals? Are we talking women’s hospitals? And can you please cite some peer-reviewed studies? IF NOT, please attain the correct amount of research approval to get the damn study done.
      • Haha, oh silly Heidi. Ina May hasn’t released ANY of her numbers from The Farm. The Farm is a cult, plain and simple. If homebirth was really so safe, wouldn’t you think that she would be shouting those numbers from the rooftops?
        • Not only has Ina May not released her numbers, neither has MANA – the Midwives Association of North America! They’ve collected data of over 24,000 planned homebirths from 2001-2008, and originally said they were collecting the data to show that homebirth was as safe or safer than hospital birth.

          It is now 2012; and those stats have not been released. Gee, I wonder why! Methinks the data do not show what they wanted it to show.

          • Those statistics are available here, and were published in 2005, according to the page:
            https://www.manastats.org/

            Extract:
            Midwives Alliance midwives have been collecting their statistics for research purposes for many years. Midwives Alliance midwives contributed data to a significant study of planned homebirths, “Outcomes of planned home births with certified professional midwives: large prospective study in North America,” published June 18, 2005 in the British Medical Journal.

          • b,

            MANA has published stats, but the stats about their death rates and birth injury rates are not there. Not even researchers can get that data, but they did collect it.

        • I really despise it when people who have never visited the Farm disparage it and the Farm midwives. “The Farm is cult” one of your readers says. As someone who recently birthed a child there and lived in their community for a month I can tell you that they are among the most kind, generous, and intelligent people I have ever met. It is almost like pulling teeth to get them to tell you what they think about their spirituality, beliefs, politics, etc. and in no way do they try to force what they believe on you. Therefore by common perception of the meaning of the word, it does not fit. They are just like-minded people living peacefully together. We are not forced to agree with them and their way of life and it poses no threat to us.

          The birth experience women travel to the Farm for is more than about some psychedelic dreamworld. While you may have your opinions about what it means to be a responsible parent and putting your child at risk, so do people who choose the Farm/homebirth route. People tend to put more time into researching their next cell phone than they do into researching their birth choices. I read countless books, asked 25 friends to write their birth stories for me to better understand the common experiences women face – good and bad, went to 4 different midwife practices in my area and interviewed and was examined by 5 different midwives before I made the decision to birth at the Farm. I did so because I believed I was doing what was best for me and for MY BABY.

          As for training, I would recommend you speak to the Farm Midwives about the training and experience they have rather than relying on articles you read. I would recommend you witness a birth they are attending or at the very least a prenatal exam they are performing. Ina May is regarded as she is by people like myself as well as medical professionals because they have take the time to read what she has published, listen to her speak, view the accomplishments she has had, and witness her in action. She is not a quack. None of them are.

          If the medical profession would begin to see that working together with people like the Farm midwives, other homebirth midwives, and families they would see that a better understanding of the combination of the emotional, physical, medical, and spiritual in birth experience is in everyone’s best interest. Arrogance has no place in birth and from my position and in my experience the medical professionals I spoke to are overflowing with it. This “we are always right because we have science on our side” position is narrow. Psychology, biology, physiology – it is all science and human beings are more than just cells. The mother, the baby, the care provider will all doubtlessly benefit from working together not pointing fingers at each other and proclaiming that the other is doing it wrong.

          I was fortunate that I had an amazing birth experience. My son had an amazing experience. Part of that was luck, part was preparation, part was surrendering to the natural process, part was trusting my caregivers, part of it was on a level that science could not touch. I don’t regret my decision for a moment. I don’t consider myself selfish for having risked my sons life. I feel like it would have been more at risk had I made the more typical decision.

          FYI When I came to the Farm, I was required to meet a local Obstetrician who was working with the Farm midwives in a support capacity. It was explained to me what the procedure would be should there be any complications and need for transport. My midwives had oxygen, oxytocin, and a whole kit of emergency supplies on hand. I had 3 midwives 2 of which had over 40 years of experience in birth present and over 1000 births under their belt each.

          Seriously, I say this not in a combatant way. Even if you adamantly disagree with the idea of homebirth, the Farm Midwives, and everything they stand for, visit them, call them, interview them, talk to some mothers and families who birthed there, interview the OBs that support them. Please do this before renouncing them. If you take a position it is your responsibility to know what you are talking about fully before dismissing the position you oppose and certainly before throwing stones like saying what you have about Ina May, the midwives and the Farm as a whole. The Farm is also much more than a hippy commune or even a midwifery center. The good things they have done around the world in 40 years would amaze you. Just check out Wikipedia to see some of the accomplishments. Sure they are unconventional. Yeah, I don’t agree with all of their ideas but that doesn’t mean they have no value.

          This should not be about “us and them”. It should be about mothers and babies and doing what is best for them. Surely there is room for open minds, compromise, communication, AND science.

  10. Hi Rose, for a single baby I cannot imagine an OB wanting to induce as early as 35 weeks but with twins it is different, induction is quite routine at 36 weeks. My perinatal doctor hoped for 35 weeks at the minimum for my pregnancy, at my first appointment with him he was doubtful I would make it even that far. I am not sure what his basis was for that…I assume my body size as I am on the petite side. My first two children were born at 41 and 40 weeks at 8.6 and 7.12 pounds so to me there seemed no reason I couldn’t carry twins full-term but my doctor felt that my uterus would not be able to handle more than 10 pounds of baby before labor began. I ended up carrying my twins to 41 weeks and 3 days, they were 8.6 and 8.15 pounds. I take no pleasure in proving someone wrong, but I cannot deny I am enormously proud of my big strong boys and dare I say it was empowering to experience my body being able to handle them just fine and the incredible way the three of us worked together during their birth. Two hours and ten minutes passed between their births, after my first son was born contractions pretty much completely stopped and I rested as I got to know him and had our first breastfeed. His nursing was very persuasive to my uterus which brought on contractions again and facilitated the birth of his younger brother. I am so proud of the role he played there. Breastfeeding twins had it’s challenges for sure, but the way the three of us worked together during birth gave me an extreme amount of reassurance and confidence that carried us through postpartum and beyond.

    To answer Kyle’s question, I think the underlying issue there is the idea that a mother and her child are at odds and there is a choice between acting in the best interests of one or the other. I do not believe this to be true, I firmly believe that what is good for a mother is good for her child. In every area from pregnancy to birth to breastfeeding to parenting. Barring rare and drastic circumstances, this whole business of reproducing ourselves is a mutually beneficial relationship, if we let it be.

    • My friends with twins weren’t asked to induce a healthy pregnancy at 35 or 36 weeks!

      That said, I strongly disagree that the mother’s and children’s interests are always linked. At least 17 times a day, my children’s interests and my interests diverge. Part of how I love my children is how much I give up for them, and part of how I think they learn to live with others is when they learn to give up their interests for the family’s. And it’s always painful and thoughtful work balancing their interests against each other, against my husband’s, against mine.

    • the idea that a mother and her child are at odds and there is a choice between acting in the best interests of one or the other. I do not believe this to be true, I firmly believe that what is good for a mother is good for her child.

      Obviously the mother’s and the child’s interests overlap, but their interests are far from mutual. Even in vitro there is competition between mother and child for nutrition. They are separate individuals–it is impossible that their interests would not diverge at times.

      • “In vitro”? Surely you mean “in vivo”?

        I don’t quite understand your competition argument? The mother and baby BOTH benefit from the mother being well nourished during pregnancy. Yes, they are two individuals, two lives, but the baby is reliant on the health and safety of the mother.

  11. Oh Dear…once again this ridiculous discussion comes into play. Let me tell you something I have seen and then I’ll tell you my own experiences. MIDWIVES CARE!! They are trained and they are not stupid and they care about you and your baby. I cannot truly say the same for all OBs.

    So my experiences
    Birth A: I knew nothing and did what the dr told me to do. Got the epidural, got the pitocin got the speal abotu how this IV and lying this way and not eating/drinking/thinking would ensure I wouldnt have a dead baby (oh yes when I asked a question I was asked “do you want your baby to die” (Why do I need to lie on my side it hurts so much worse” Nurse:”I need to monitor your baby, do you want your baby to die?”) and then almost lost my infant b/c of ALL OF THE INTERVENTIONS and had a c-section to save his life. So had I birthed at home in my own zone with adequate support I’d be down one scar and still have a healthy baby. Yes, this is true.

    Birth B: OB said no no no you cannot and never will be able to delivery vaginally. My records say you aren’t built right. Midwife said, I’ll help you try. We laboured at home it was easy it was amazing. At 9 cm my water broke, there was meconium so we transferred to hospital and had a healthy baby there. She did not need any help so had we stayed home most likely she’d have been fine but I’m still glad we had a place to go just in case it had gone the other direction.

    Birth C: all the way homebirth. Easily the most incredible experience of my life. Healthy baby, healthy Mommy and what more could be asked for. The biggest difference was that my midwife came and asked before touching me and left me to do what I needed to do. She was out of my sight unless she had to do a check or I had a question. Everyone who was present was there for me and I had no one take my control away. So I laboured peacefully. I had very little “pain” b/c I had no reason to tense up or fear.

    Do I recommend homebirth. Yes yes I do. I may not have a medical degree but I have experience. And experiencing labour has taught me that it can be a peaceful journey. Talking about risks during labour is like talking about the risks of any life experience. Life is inherently risky. But birth is not a medical procedure. It is a natural aspect of life and we’ve been doing it for millions of years. It’s fantastic to have a medical group of practitioners there for the births where help is needed but, for a normal birth with no complications, homebirth is an optimal birth choice.

    • I can’t speak to the particulars of your experience, Mommyfish. I wasn’t there, and I don’t know what problems occurred in your first delivery.

      As for your VBAC deliveries, I think there should have been more of an option for you to have them done by an OB. As I said in the OP, I think the fear of malpractice suits prevents many OBs from even considering them, and I’d like to see tort reform in that area to make that change. But the truth is that if you had suffered uterine rupture in your home, you and your baby could have ended up in terribly dire straits.

      And finally:

      It’s fantastic to have a medical group of practitioners there for the births where help is needed but, for a normal birth with no complications, homebirth is an optimal birth choice.

      The problem is that, as I said above, I have been at deliveries where complications didn’t manifest until the very last moments of labor or immediately afterward. For an infant delivered at home, even a short trip to the hospital would have been disastrous in some of those cases, when minutes literally made all the difference. If there were some way to have everyone’s home delivery also accessible to immediate medical support, then I’d have no beef with it. But there isn’t, so I do.

      • This. I had a perfectly healthy pregnancy and no known health risks – but my water broke prematurely and included meconium. In addition, other issues uncharacteristic of a healthy young woman created a dangerous situation that had I not been in the hospital, would have resulted in my not having the amazing child I have today. So although I am not against home-births, I concur with the good doctor in cautioning women with both the pros and cons of home birth. The biggest con which seems to be glossed over by home-birth proponents is the mid-wife’s training, knowledge, and equipment when it comes to life-threatening complications that could be avoided with a hospital delivery.
  12. I should say that with my second child, a nurse noticed two hours after he was born that he wasn’t doing well. I didn’t notice it. He was able to get on oxygen right away. He was having PPHN (his blood was bypassing his lungs and he had low oxygen saturation. If we had not been in a hospital, he might well have died or been even more severely disabled.

    So, like the other moms who have posted here, I suppose I have my own confirmation biases due to experiences.

      • Do they have endotracheal tubes, suction equipment, laryngoscopes, bag-valve masks, umbilical vein catheters, peripheral vein catheters, bags of IV fluids and vials of sodium bicarbonate? If they do, and are properly trained in how to use all them then, then they’re not ill equipped. If all they can administer is blow-by oxygen, then they’re hardly well-prepared.
        • As it happens, I know my son did need suctioning, bagging, and got an umbilical vein catheter (although that might have been later). The condition he had is rare, but not insanely rare — 1 in 700 kids has it. 15% die of it even when they are in a hospital. And of course, there are plenty of other conditions that require resuscitation.

          He’s just one anecdote, as are these all. When people say “life has risks” and wave their hands, I think they implicitly think it’s going to happen to other people — not them. It did happen to me.

          The day a child is born is the day she’s most likely to die in her childhood.

          I agree entirely with Russell. The solution is to make hospitals better, more welcoming, less stressful places. (Actually, I don’t see why this is true only for births – other hospital visits can be just as psychologically traumatic. Why do we only focus on the birth experience?) That seems win-win.

      • H, you’re in the UK. There are CPMs in the States who believe that oxygen is bad for the baby. Seriously. They are also not required to carry oxygen, have training in infant resuscitation, have a high school diploma, any formal schooling, and some don’t even wear gloves. Gross.
  13. I chose to have my child with a hospital based midwife. In fact, I chose the 3rd closest hospital and drove over an hour just to make sure I was down the hall from an amazing NICU when Junior was born. (That was a huge pain for all of those prenatal appointments.) They’re also the only hospital in the area that does water birth. I labored in water, but was unable to deliver there because I ended up needing an epidural in order to successfully complete the delivery vaginally. If my water had not broken naturally after I had been awake and active for 16 hours, I probably could have a water birth without any medical intervention, but untimately I’m glad I chose a hospital based midwife over a home birth.
  14. From Rose “My friends with twins weren’t asked to induce a healthy pregnancy at 35 or 36 weeks!

    That said, I strongly disagree that the mother’s and children’s interests are always linked. At least 17 times a day, my children’s interests and my interests diverge. Part of how I love my children is how much I give up for them, and part of how I think they learn to live with others is when they learn to give up their interests for the family’s. And it’s always painful and thoughtful work balancing their interests against each other, against my husband’s, against mine.”

    I have been shocked at the personal friends and online connections through my Mothers of Multiples Group that have had the experience of induction so early, I am encouraged you have seen otherwise! I also feel a divergence between my interests and those of my children on a daily basis, but I often recognize external social influences there and sometimes the hippie in me just wants to move to Ina May’s famous farm and not care about anything but taking care. I want to say that I am new to this blog, and so far from what I have read I appreciate the diverse and tolerant dialogue, I tend to learn the most from talking with those who strongly disagree with me. I’ll be bookmarking!

    • I cannot say I am totally surprised about the experience of these moms, as I have seen plenty of medical ignorance firsthand. There are plenty of wonderful doctors and plenty of not-so-great ones.

      I appreciate the diverse and tolerant discussion here, and love learning from those who disagree with me — when they are at least reasonably polite and have good reasons and evidence :). Your post took me from “I couldn’t imagine a situation considering homebirth” to “I wouldn’t do it in that situation (I say this, of course, unable to know the full particulars of your situation), but I understand why she did and it makes sense,” so I appreciate it.

      I do wish, however, that the solution was not that you are pressured by not-great medical decision-making (35 week babies are certainly not cooked enough, I say as a non-doctor!) into taking a homebirth route, but that a doctor was able to work with you.

      And congrats on the healthy boys!

      • I do wish, however, that the solution was not that you are pressured by not-great medical decision-making (35 week babies are certainly not cooked enough, I say as a non-doctor!) into taking a homebirth route, but that a doctor was able to work with you.

        This.

  15. I can see why you would say that the transcendent experience of a woman is not a priority over the health and survival of the baby.
    However, part of why the medical model isn’t working in the U.S. is that we define ‘health and survival’ in the strictest sense (i.e. heart rate/oxygen/blood sugar/apgar etc..)

    The psyche of the mother is being overlooked. Women are intimidated by the mindset (“be happy, at least you have a healthy baby”). Women are too intimidated to admit that they are hurt, upset, depressed.
    So what happens? We send a postpartum, fragile mom home to deal with her emotions on her own. Postpartum depression is prevalent and dangerous. And depression in general is running rampant in our country.

    The birth of the the first child is a pivotal time in a couple’s life. It can lead to a year of bonding and cohesion or it can lead to a year of major strain, self-loathing, poor communication between spouses, long-term depression. It leaves an imprint for life.

    Doesn’t every mother say, “Oh! I so remember the nights when baby would cry and cry”. If a healthy mom and a ‘typical’ baby have that. How much more – a mom who has had a very stressful birth experience.

    So, yes, I agree with you that I am not more important than my child. However, what the home birth movement is doing is reminding us that there is work to be done. We must continue to acknowledge the whole person, and the impact that childbirth has on a family and a society as a whole.

      • Money talks. Just as moms are expected to put their child’s health above their own; hospitals should be putting the woman’s health above their desire for profit.
        Instead women are induced, epi’d and given pit so that they can have the ‘bell curve’ 12 hour labor.
        The more births in a day, the more money for the hospital. That is simply fact.

        When the maternity floor is “full” – it is common for a mom in early labor to be sent home (she’ll hold up a bed that other women could be using).
        But if the maternity floor is not full – it is easy to see a woman in very early labor being given all kinds of induction meds just to “move things along”.

        The home birth movement is very much in reaction to the lack of ethics in the medical industry. And frankly – the countries who include home birth have the best outcomes (Holland, 1/3 of all births are at home). Women in Europe do not fear pregnancy/labor like Americans do. Yet, they take much more ownership of their health and responsibility. Women here are encouraged to let the Dr. do all the thinking for them. That is why we are so litigious, we don’t take ownership of our choices and then rail at the fallible Doctors.

        Some hospitals are doing it right, they know how to attend a normal functioning birth and will wait patiently instead of intervening when not medically necessary. And I gladly recommend giving birth in one of those hospitals. But I have attended births where I knew the provider was prioritizing his own comfort over the health of the mother, and I have seen those negative outcomes too. This is as heinous if not more so, than a mother fearing a hospital and taking the risk of being more than 15 minutes from a hospital.

          • We had out son at a local hospital with an excellent maternity unit. In general, we received excellent care, but one of the things that gave more food for thought was how many fewer rooms were occupied over the weekend. Like half. Now, I’ve not problem with doctors scheduling inductions and sections to fit their schedule, but there’s no way half the rooms were scheduled.
        • *yawn* we’re FIXING THIS. no more paying people for readmits on heart attacks within two years. If you want pregnancies to run on the same docket — go bitch at Sebelius.
          Pay per operation is going away.
    • If people are “hurt” because wah wah they ended up with a c-section when they REALLY REALLY wanted a vaginal birth, I have absolutely no sympathy for them.

      I am someone who says “be happy, at least you got a healthy baby”. Why? Because even though I had a natural, vaginal birth, I ended up with a child with severe brain damage which greatly affects him both physically and mentally. So stop whining about having a c-section and enjoy the fact that your child can walk.

        • If it’s to save your baby’s life? That’s a tough one. But I would report the doctor to the licensing board, and sue him for malpractice.

          Neither of which you can do with CPMs, because they have no regulatory or licensing boards (and where they do have some semblance of one, it’s a puppet board made up of the same midwives who usually trained the midwife being brought in front of them), and they usually don’t carry malpractice or professional liability insurance.

          You have recourse against a doctor; you don’t have recourse against a CPM.

          • Actually, for ten-odd years in Canada, the entire medical establishment was lying to women about the safety of c-sections, essentially forcing them to take the more dangerous course of action. The lying was policy. There was no recourse (except to work to get them to stop lying, but that’s more a macro-level solution). I have been given no evidence that the American medical establishment is any better – in fact, it seems worse. The very existence of CPMs – midwives withouth pretty basic training – and the regulatory sheme that encourages them is pretty underhanded.

            (To be clear, from all I’ve read, I don’t like the idea of CPMs. I like properly trained midwives – similar to what Dr. Saunders approves of.)

          • Sorry, but as one who also has a kid who can’t walk/talk/eat, that doesn’t entirely negate someone else’s experience. Other people have it worse than we do. We can still discuss what needs change.

            I’m with you that I worry risks of neurological issues aren’t being taken seriously by some. Others who are pro-homebirth don’t seem to be being as cavalier.

  16. I appreciate your opinion, but one thing you failed to address was the fact that Hospitals do very dangerous things and make medical mistakes all of the time. I have witnesses first hand many people die due to medical malpractice. I, for one, feel that a hospital is no safer for the low risk mother then the home.
  17. Kudos for bravely wading into this, Dr. S. I don’t have a lot of opinion on it myself, but I did learn from it. So just in case you’re feeling any regret for having posted it and suffered the inevitable criticism, keep in mind that some of us did find it well worth while to read and think about.
  18. You say you are opposed to homebirth, but note – both in your post and in one of your comments – that there is a fundamental difference between the nature of homebirth in the US and in other countries, such as the Netherlands (and Canada, for that matter: we modelled our system after the Netherlands’ success). So perhaps it would be more accurate to say that you are opposed to American homebirth. You note “for most women in the densely populated Netherlands, getting to the hospital takes about as much time as it does for specialists to assemble. From rural Tennessee, where Ina May holes up? An hour to the nearest NICU.” So perhaps it would be more accurate to say you are opposed to rural homebirth. Or maybe it’s specifically homebirth at The Farm that offends. Your sleight of hand in noting that The Farm is an hour from the nearest NICU is also worth remarking upon: not every hospital with an L&D unit even has a NICU: so perhaps even those births are too risky for your liking.

    Your exposure to the current research on homebirth appears extremely limited: I direct you to Ottawa-based researcher Betty-Anne Daviss’s study comparing outcomes for normal-risk mothers and babies in OB-attended hospital births, midwife-attended hospital births and midwife-attended homebirths. Spoiler alert: homebirths come out on top. And lest I be accused of strategically selecting studies, it is extremely important to note that the Wax study which you cite above has received a great deal of criticism and investigation. “Critics are not appeased, because many had argued that Wax’s team erred by inappropriately including or excluding studies from some of these outcomes in the first place. Epidemiologists consulted by Nature, who are not involved in the home-birth debate, agreed that there were problems with the study design.”

    Furthermore, I am not personally familiar with the mortality rates of babies born at 32 weeks gestation in 1970, so your argument – made in poor taste, I might add – that Ina May’s son might have lived had he been born properly in a hospital is highly questionable, particularly since North Platte’s hospital was only built several years after her son was born. But perhaps we return to my earlier supposition that you oppose all births that do not take place within proximity to a Level 3 NICU.

    I will not bore you with anecdotal stories of homebirths gone well, but I will answer an implied question in your post and in every other post like it. You remark that mothers are “in pursuit of some kind of transcendent, orgasmic experience”. Your dismissive, selectively-informed attitude is precisely the reason that mothers are turning to homebirth. Some may be anticipating a “transcendent, orgasmic experience” but most are simply hoping to achieve a level of care and respect not afforded them in hospitals. I am sick to utter death of doctors decrying homebirth and wondering aloud what could possibly motivate any parent to choose such a technically inferior birthplace only to express contempt and derision at a client’s right to informed choice in the next breath. Treat clients with the respect we deserve and we won’t view you as the enemy, but so long as you doctors are going to insist on protocols not supported by evidence (e.g. EFM, early inductions, early c-sections, ceasarean for breech, NPO, induction using misoprostol, lithotomy birth, automatic episiotomy) and pander to us, many of us will continue to seek care elsewhere.

    • So perhaps it would be more accurate to say that you are opposed to American homebirth.

      Yes, that is a fair criticism. I would indeed be more accurate to say that I am opposed to homebirth as frequently practiced in the United States. I am not in a position to comment about how it occurs in places where midwives have appropriate medical training, which would remove much of my objection.

      Your sleight of hand in noting that The Farm is an hour from the nearest NICU is also worth remarking upon: not every hospital with an L&D unit even has a NICU: so perhaps even those births are too risky for your liking.

      Fair enough again, to a certain degree. No, I don’t think all hospitals need to have a NICU to deliver babies. But I do think they need to have pediatricians on staff and close at hand who are competent to stabilize the baby while transport to a NICU is arranged.

      Spoiler alert: homebirths come out on top.

      Perhaps that is true. But it was also comparing outcomes when, if what you say is correct, the midwife present had appropriate medical training, and is thus not comparable to untrained midwives in the United States.

      The reference to the Wax paper is in the original article, and the citation is included as part of a block quote. As a general rule, I eschew meta-analyses, as they are often deeply flawed. None of my argument rests upon its findings.

      Furthermore, I am not personally familiar with the mortality rates of babies born at 32 weeks gestation in 1970, so your argument – made in poor taste, I might add – that Ina May’s son might have lived had he been born properly in a hospital is highly questionable

      I am sorry you feel my argument was made in poor taste. I think Gaskin’s own experience of the potentially devastating outcomes of medically unsupervised deliveries is wholly relevant. And while premature infants had worse outcomes in 1970 than they do now, 32-weekers often did very well with appropriate care. I am reasonably confident that had Gaskin’s child had proper pediatric care (which, if they did not offer at the local hospital, they should have), he would likely have survived.

      Your dismissive, selectively-informed attitude is precisely the reason that mothers are turning to homebirth. Some may be anticipating a “transcendent, orgasmic experience” but most are simply hoping to achieve a level of care and respect not afforded them in hospitals

      In discussing homebirths in those terms, I am merely repeating much of the commentary from within the cited article. I agree that hospitals should be providing better care and respect. The proper solution is improving the care, not hoping for the best in an medically unsupervised setting.

      • I am reasonably confident that had Gaskin’s child had proper pediatric care (which, if they did not offer at the local hospital, they should have), he would likely have survived.
        My point was actually that there was no local hospital at the time. North Platte is a railroad town: the med centre was constructed in 1975.

        And I generally feel that running a tally of dead babies is in poor taste. Shall we run a tally of dead babies and mothers as a result of the abuse of misoprostol? Or a tally of fertility loss due to emergency hysterectomy as a result of the same or iatrogenic MRSA infection? Or a tally on the sky-rocketing rate of iatrogenic prematurity?

        As you note, “The proper solution is improving the care, not hoping for the best in an medically unsupervised setting.” That’s a fine argument, but in the meantime the medical community is asking birthing families to lay themselves on the sacrificial altar of systemic improvement. I don’t need better birth treatment in five or ten or twenty years: I’m having my babies now.

        • Shall we run a tally of dead babies and mothers as a result of the abuse of misoprostol? Or a tally of fertility loss due to emergency hysterectomy as a result of the same or iatrogenic MRSA infection? Or a tally on the sky-rocketing rate of iatrogenic prematurity?

          In other words, should we collect morbidity and mortality information for hospital-based interventions? Of course. We do.

          • I’m trying to find a citation in response to this, the argument being that the methodology of reporting in the US is so deeply flawed that it under-represents the true rates of maternal and perinatal morbidity and mortality. As soon as I track down the link (lost in the Great Hardrive Crash of 2011) I’ll post it.
          • As I said downthread, the web filter in my office has gone totally nuts, so I cannot access any databases.

            Anyhow, I suspect you and I are probably not as far apart as my original post probably would have led you to believe. (And I was probably too strident in parts.) I agree that there are many flaws to how obstetrics is practiced in the United States, and Lord knows I’ve seen physicians screw up royally. If you want to mount an argument that well-trained nurse midwives should be licensed to deliver babies in homes, with clear emergency protocols, I’m willing to consider that perspective. My objection is almost entirely predicated on the utter lack of required medical training for CPMs.

          • From the relatively little I’ve read, the issues with CPMs (and the dual CPM/NPM streams of midwifery in some/many/most/all (?) states) unfairly tarnishes midwifery as a whole – but justly tarnishes it in the areas where the issues occur. I would not want to import the U.S. midwifery system to my home province and country.
          • Found it.“In this report, maternal mortality ratios are based solely on vital statistics data and are underestimates because of misclassification. The number of deaths attributed to pregnancy and its complications is estimated to be 1.3 to three times that reported in vital statistics records.”
          • Your link is woefully outdated. Death certificates have been updated twice since then and the definition of maternal mortality has been expanded and lengthened to encompass a full year after birth. Most of the purported “increase” in US maternal mortality that homebirth advocates like to claim is actually due to superior reporting, and that has been acknowledged by the CDC.
          • darlene,
            so when someoen dies of gestational diabetes, you blame the hospital? or hypertension?
            … yeah, pregnancies are really dangerous (a lot moreso than abortions)… that doesn’t mean it’s the hospital’s fault!
            /still skeptical of everyone, at this point.
          • Actually, that product could serve to make matters worse. Misoprostol/cytotec is being used off-label to induce labour and is connected with a marked increase in the rate of hyperstimulation and uterine rupture. Making misoprostol easier to use is hardly what I would call an improvement.
          • Misoprostol is associated with cervical rupture because crushed-up cytotec is about six times as much as you actually need, delivered in an uncontrolled fashion, and can’t be removed if hyperstimulation occurs. The product I linked, which has just come out of clinical trial, addressed all of those concerns. (I admit that people outside of the business probably aren’t familiar with this.)
      • Just another anecdote to add to the mix I am an identical twin born in 1966 (don’t do the math) and we were born at 31-32 weeks, not induced, at a hospital I weighed 4 lbs at birth and lost weight after that and stayed in hospital a month after my sister went home. Not sure I would be here if mom had a home birth.
        • I have never heard even the most absurd homebirth advocate argue in favour of homebirth at 31-32 weeks gestation. Obviously we’re all glad that your outcome was so positive, but your point is sort of a non-argument with regard to homebirth.
          • My point is actually partially a reply to a conversation up thread about inducing twins. I am so sorry I did not make that perfectly clear to you and I really so not see how your reply to me is relevant to the conversation except to be dismissive and snarky
          • You don’t see how a reply pointing out that your (apparent) argument against homebirth – in a thread about homebirth – does not relate at all to how homebirth is actually practiced in North America is relevant? Really?
    • I have heard that you are considering licensing homebirth midwives who have the CPM (certified professional midwife) designation. Before you reach a decision, there are 8 important facts that you ought to know about homebirth and CPMs.

      1. ALL the existing scientific evidence, as well as state and national statistics show that homebirth with a homebirth midwife dramatically increases the risk of neonatal death. The most recent CDC statistics for PLANNED homebirth with a non-nurse midwife has a death rate 7 TIMES HIGHER than comparable risk hospital birth.

      How about individual states with licensed homebirth midwives? Colorado statistics on planned homebirth show an appalling death rate double that of all births (including high risk and premature births), California has a mortality rate double that of low risk births, and over the past 10 years planned homebirth in Oregon has had a death rate at least 3 times higher than comparable risk hospital birth.

      2. The studies that claim to show that homebirth is safe are examples of bait and switch. The widely quoted Johnson and Daviss study (BMJ 2005) compared planned homebirth in 2000 with hospital births in papers dating back to 1969. Comparing planned homebirth in 2000 with low risk hospital birth in 2000 (the data was available) shows a death rate 3 times higher for homebirth.

      Moreover the authors do not disclose that Johnson was the former Director of Research for the Midwives Alliance of North America, and Daviss, his wife, is a homebirth midwife. They do disclose that the study was funded by a homebirth advocacy foundation.

      3. There are two types of midwives in the US, certified nurse midwives and certified professional midwives. Certified nurse midwives are real midwives with education and training that exceeds all other midwives in the world. In contrast, certified professional midwives (CPMs) are not real midwives at all. The “credential” was made up by women who would not or could not complete real midwifery training. CPMs lack the education and training required of midwives in ALL other first world countries. The CPM is not recognized and is not eligible for licensure in ANY other first world country.

      4. Most women who have the CPM designation haven’t attended midwifery school of any kind. They have completed a program of unmonitored “self-study” and paid the fee.

      5. The “thought leaders” of homebirth are a self-proclaimed midwife who has no midwifery training (Ina May Gaskin) and who let one of her own children die at homebirth, a self-proclaimed “expert in obstetric research” (Henci Goer) who has no training in obstetrics or research, and a washed up talk show host (Ricki Lake).

      6. According to the WHO, the best measure of obstetric care is PERINATAL mortality, and according to the WHO, the US has one of the lowest rates of perinatal mortality in the world.

      7. The Midwives Alliance of North America, MANA, the organization that represents homebirth midwives, spent the years 2001-2008 collecting data on the outcomes of planned homebirths. During that time they publicly proclaimed that they would release the data to show that planned homebirth is safe. Once the data was analyzed, they changed their mind. MANA REFUSES to release the death rates for the 24,000 planned homebirths in their database. It doesn’t take a rocket scientist to figure out that MANA’s OWN DATA shows that homebirth increases the risk of neonatal death and they are hiding it so that American women will not find out.

      8. Two out of three babies who died at homebirth would be saved in the hospital. Zero babies who die in the hospital would be saved at homebirth.

      Homebirth leads to preventable neonatal deaths. All the existing scientific evidence confirms this and all the available state and national statistics demonstrate this. Even MANA knows that homebirth leads to preventable neonatal deaths; they just don’t want the Massachusetts legislature and American women to find out.

      9. The Netherlands has one of the highest rates of perinatal mortality in W. Europe. A study in the BMJ found that low risk birth with a Dutch midwife (home or hospital) has a HIGHER perinatal death rate than high risk birth with a Dutch obstetrician.

      Homebirth kills babies and Gaskin has blood on her hands. The only people who are unaware of these facts are homebirth advocates.

      • Umm… you think Darlene is considernig licensing CPMs? Perhaps, “Dr.”, you should brush up on your reading comprehension skills. Darlene is not a regulatory body in and of herself, and if she was, she would probably just go be “College of Midwives of Ontario” (for even a cursory amount of research in the link provided in her name would demonstrate that she resides in Ontario… she even references a local city in her comment) – a regulatory body for a region that already oversees a healthy, regulated and safe midwifery regime.

        Sure, maybe CPMs suck (my understanding is that they often do). That’s an indictment of the health care structure of the U.S. (or at least some of the states), not midwifery.

        • It is no more an indictment of the US health system than Jenny McCarthy is an indictment of immunology. Homebirth midwifery is quackery, pure and simple.

          Sorry about the extraneous first paragraph. I accidentally copied it from an open letter I wrote to Mass. Legislators.

          • How about addressing the 9 points that I made?

            Darlene is wrong, and those points I listed are an abbreviated set of reasons why she is wrong.

            Homebirth, particularly in the US, is the spiritual sibling of the anti-vax movement. Both are driven by lay people who lack basic knowledge of the underlying medical issues (and American homebirth midwives ARE laypeople), both place a premium on definance of authority, both are impervious to the scientific evidence, both result in the preventable death of small children.and the primary product of both movements is reflexive doubt of the motives of real medical professionals.

            My personal belief is that Ina May Gaskin has blood on her hands, and not just that of her premature son who was born on the back of a bus in midwinter, struggled for 12 hours to breath and died without any medical attention because Steven Gaskin, a cult leader, did not want to go to a hospital. Until the CDC began collecting homebirth statistics, there were literally countless preventable deaths attributable to homebirth each year. Now we have hard data. The latest CDC figures show that planned homebirth with a non-nurse midwife has a mortality rate 7 X higher than low risk hospital birth.

            If I sound passionate about the issue, it’s because I am. Through my writing I am personally acquanted with dozens of women who lost babies to preventable causes at homebirth. We can only begin to imagine the agony of a mother who loses a child and then realizes it happened because she trusted charlatans like Gaskin. Her own organization, the Midwives Alliance of North America (MANA) refuses to release the death rates of the 24,000 homebirth in their database. Midwives at the upper reaches of the homebirth hierarchy in the US are well aware that homebirth at their hands leads to an appalling amount of preventable perinatal death and are doing everything in their power to hide that information from American women.

            Homebirth represents only 0.5% of American births. There is a shortage of obstetricians in the US, so homebirth represents no loss of income to them. On the other hand, homebirth represents 100% of the income of Gaskin and her colleagues. You tell me who has the stronger motivation to lie about the dangers of homebirth.

          • I question how much you have read, assuming intellectual honesty. American homebirth and midwifery may be overly dangerous and fished up. Sure, fine. Studies from other nations that haven’t cocked things up so badly demonstrate that it is relatively safe (Darlene noted one such study). So perhaps America should – rather than crapping all over homebirth – learn to do homebirth right.

            Which is, again, why the American health care structure is faulty, not homebirth.

            Your passion doesn’t trump math.

          • The data from the UK show that homebirth increases the risk of poor perinatal outcomes. The data from Australia shows that homebirth increases the risk of perinatal death. The data from the Netherlands shows that low risk birth with a Dutch midwife has a HIGHER death rate than high risk birth with a Dutch obstetrician. There are one or two studies from Canada that demonstrate that homebirth rates can be safe when transfers during labor exceed 40%.

            This is not surprising data. There are life threatening complications that can occur without warning during labor and if there is no operating room and no expert in neonatal intubation, the baby will die. It’s just that simple. There is NO reason to think that homebirth will ever be as safe as hospital birth, only that the risk might be acceptable to certain women.

            At this point 50% of obstetricians are women, and very high proportions of pediatricians and anesthesiologist are women, too. Ever notice that homebirth among them is vanishingly rare? That’s because they know it is not as safe as hospital birth.

            As for Darlene’s references, they are useless. She is quoting the papers that homebirth advocates typically quote. I’ve read every single one of those papers. Most of them have such serious flaws that they are worthless, and many don’t even show what she claims they show.

            Real babies are dying because of these charlatans. Of course, every woman has the right to choose homebirth if she wants, but she can’t possibly make an informed decision when people like Ina May Gaskin are hiding the truth.

          • I’m still waiting for you to address my 9 points or offer any data of any kind.

            As for Gaskin being a charlatan, what would you call a woman who has no training in obstetrics, nursing or midwifery, who woke up one morning and claimed she was a midwife? What would you call a woman who has allowed only one scientific paper about The Farm that made homebirth look good by comparing it to a database of high risk births (Durand, 1992)? What would you call a woman who claims that since 1992 she has had an extraordinarily low C-section rate an no neonatal deaths but refuses to publish her claims in a scientific journal?

            I feel quite comfortable calling her a charlatan.

          • Perinatal mortality and severe morbidity in low and high risk term pregnancies in the Netherlands: prospective cohort study, appearrd in the British Medical Journal in 2010. The authors explain that the study was undertaken to investigate why the Netherlands has highest perinatal mortality rate in Europe.

            “Several factors are mentioned as possible explanations for this high mortality, such as differences in registration and maternal characteristics of the Dutch childbearing population, restricted management of premature babies, and the absence of standard screening for congenital anomalies. The numbers of older mothers, multiple pregnancies, and mothers belonging to an ethnic minority are relatively high in the Netherlands. However, this can only partly explain the high perinatal mortality. Whether the Dutch obstetric care system contributes to this relatively high mortality remains unclear.”

            This is an important question because the Dutch system of maternity care relies primarily on midwives and those midwives perform a relatively high number of homebirths. This study, a cohort study of severe morbidity and mortality of term fetuses or neonates, called ATNICID (Admission of Term Neonates to Intensive Care or Intrauterine Death), was begun in 2007 with the express intent of examining the relationship between the organization of the Dutch maternity care system and the high rate of perinatal mortality.

            The study ultimately enrolled 37,735 term infants without congenital anomalies:

            “16,672 (44.2%) infants of nulliparous women (including 143 (0.9%) twin pregnancies) and 21,063 (55.8%) infants of multiparous women (including 226 (1.1%) twin pregnancies). Data on 91 (0.2%) infants were missing; we excluded these from further analysis… 18,686 (49.5%) infants were born to women who started labour in primary care as low risk, of whom 5492 (29.4%) were referred to secondary care during labour; 13,194 (35.0%) infants were born under the supervision of a midwife in primary care, and 24,450 (64.8%) infants were born under the supervision of a gynaecologist.”

            The results were astounding:

            “Of the 60 antepartum stillbirths, 37 occurred in primary care and 23 in secondary care…

            Twenty-two intrapartum stillbirths and 14 delivery related neonatal deaths occurred. Infants of pregnant women at low risk had a significantly higher risk of delivery related perinatal death (relative risk 2.33, 1.12 to 4.83), compared with infants of women at high risk whose labour started in secondary care under the supervision of an obstetrician. Infants of women who were referred to secondary care during labour had a 3.66 times higher risk of delivery related perinatal death than did infants of women who started labour in secondary care (relative risk 3.66, 1.58 to 8.46)…”

            These results are deeply shocking.

            “We found that delivery related perinatal death was significantly higher among low risk pregnancies in midwife supervised primary care than among high risk pregnancies in obstetrician supervised secondary care…”

            The authors express their concern:

            “In summary, the Dutch obstetric care system is based on the assumptions that pregnant women and women in labour can be divided into a low risk group and a high risk group, that the first group of women can be supervised by a midwife (primary care) and the second group by an obstetrician (secondary care), and that women in the primary care group can deliver at home or in hospital with their own midwife. When complications occur or risk factors arise antenatally, during labour, or in the puerperium in primary care, the women is referred to secondary care. We found that the perinatal death rate of normal term infants was higher in the low risk group than in the high risk group, so the Dutch system of risk selection in relation to perinatal death at term is not as effective as was once thought. This also implies that the high perinatal death rate in the Netherlands compared with other European countries may be caused by the obstetric care system itself, among other factors. A critical evaluation of the obstetric care system in the Netherlands is thus urgently needed.”

            In contrast to the claims of homebirth and midwifery advocates, the Netherlands is far from being the ideal model of obstetric care. The Netherlands has one of the highest perinatal mortality rates in W. Europe, and midwifery care may very well be the cause of this calamity.

    • Darlene, Ina May left her son on the side of the road. She didn’t even attempt to find medical attention. This is all in the first few pages of her book, and frankly is quite terrifying.
  19. 1. ALL the existing scientific evidence, as well as state and national statistics show that homebirth with a homebirth midwife dramatically increases the risk of neonatal death. The most recent CDC statistics for PLANNED homebirth with a non-nurse midwife has a death rate 7 TIMES HIGHER than comparable risk hospital birth.

    How about individual states with licensed homebirth midwives? Colorado statistics on planned homebirth show an appalling death rate double that of all births (including high risk and premature births), California has a mortality rate double that of low risk births, and over the past 10 years planned homebirth in Oregon has had a death rate at least 3 times higher than comparable risk hospital birth.

    2. The studies that claim to show that homebirth is safe are examples of bait and switch. The widely quoted Johnson and Daviss study (BMJ 2005) compared planned homebirth in 2000 with hospital births in papers dating back to 1969. Comparing planned homebirth in 2000 with low risk hospital birth in 2000 (the data was available) shows a death rate 3 times higher for homebirth.

    Moreover the authors do not disclose that Johnson was the former Director of Research for the Midwives Alliance of North America, and Daviss, his wife, is a homebirth midwife. They do disclose that the study was funded by a homebirth advocacy foundation.

    3. There are two types of midwives in the US, certified nurse midwives and certified professional midwives. Certified nurse midwives are real midwives with education and training that exceeds all other midwives in the world. In contrast, certified professional midwives (CPMs) are not real midwives at all. The “credential” was made up by women who would not or could not complete real midwifery training. CPMs lack the education and training required of midwives in ALL other first world countries. The CPM is not recognized and is not eligible for licensure in ANY other first world country.

    4. Most women who have the CPM designation haven’t attended midwifery school of any kind. They have completed a program of unmonitored “self-study” and paid the fee.

    5. The “thought leaders” of homebirth are a self-proclaimed midwife who has no midwifery training (Ina May Gaskin) and who let one of her own children die at homebirth, a self-proclaimed “expert in obstetric research” (Henci Goer) who has no training in obstetrics or research, and a washed up talk show host (Ricki Lake).

    6. According to the WHO, the best measure of obstetric care is PERINATAL mortality, and according to the WHO, the US has one of the lowest rates of perinatal mortality in the world.

    7. The Midwives Alliance of North America, MANA, the organization that represents homebirth midwives, spent the years 2001-2008 collecting data on the outcomes of planned homebirths. During that time they publicly proclaimed that they would release the data to show that planned homebirth is safe. Once the data was analyzed, they changed their mind. MANA REFUSES to release the death rates for the 24,000 planned homebirths in their database. It doesn’t take a rocket scientist to figure out that MANA’s OWN DATA shows that homebirth increases the risk of neonatal death and they are hiding it so that American women will not find out.

    8. Two out of three babies who died at homebirth would be saved in the hospital. Zero babies who die in the hospital would be saved at homebirth.

    Homebirth leads to preventable neonatal deaths. All the existing scientific evidence confirms this and all the available state and national statistics demonstrate this. Even MANA knows that homebirth leads to preventable neonatal deaths; they just don’t want the Massachusetts legislature and American women to find out.

    9. The Netherlands has one of the highest rates of perinatal mortality in W. Europe. A study in the BMJ found that low risk birth with a Dutch midwife (home or hospital) has a HIGHER perinatal death rate than high risk birth with a Dutch obstetrician.

    Homebirth kills babies and Gaskin has blood on her hands. The only people who are unaware of these facts are homebirth advocates.

  20. In my locality midwives study 4 year honours degrees and only facilitate home births for women considered low risk (even by your standards) and if the emergency plan meets stringent criteria. The result is more women having the births they long for, without any quantifiable difference in perinatal mortality (and trust me, our obstetricians would say something otherwise).

    Yet you are still “totally, utterly against them.”? At least European OBY’s meet us halfway.

  21. No you are not an obstetrician and thankfully so although your mindset is the same.

    Let the weak ones be told how to give birth and to bow to your expertise as a doctor. You surely cannot have much experience around babies who are birthed at home because you would actually see the proof of how much better off most of them are. I challenge you to view 100 births from start to finish – 50 at home, 50 in the average hospital and then maybe you might be a little bit qualified to open your mouth. Until then, you might as well let the rest of the male establishment do the talking for you because you have nothing really to say.

    For the record, this lioness prefers to birth on her own turf. If you really want to talk about women choosing something inferior and make a differene for the better in infants’ lives, explore why infants are given inferior food instead of being breastfed. Then and then try to change society’s mind about why women “choose” inferior food. Then see if women who birth at home or the hospital have better breastfeeding outcomes.

  22. “And that, right there, is the only acknowledgment in this ridiculously biased article comparing the perinatal mortality figures for hospitals and home deliveries is a fool’s errand. Hospitals don’t have the luxury of sending premature deliveries or complicated cases elsewhere to make their numbers look better. They take all comers, and deliver orders of magnitude more babies.”

    This criticism is often levied against independent and some charter schools when they hold up their results against public schools. And appropriately so. Cherry picking the population you work with isn’t wrong. But pretending you haven’t done so when compared to groups that don’t have this luxury or otherwise don’t engage it is disingenuous.

  23. Humbly gonna ask people to do some more complex math:
    A C-section is a preexisting condition — disqualifies women from getting health insurance outside a company.

    We know children have poorer outcomes when their parents are less healthy/stressed out.

    I’m not saying that we ought to get rid of c-sections, just that informed consent ought to involve telling someone about this fact.

    • Uhhh… now that I’ve taken the time to click through your links, JC, I’m a little confused.

      First, almost all of them related to certified nurse midwives. Please see my update in the OP. I am modestly open to the notion of home deliveries by nurse midwives.

      Re: your link about VBAC, please reread the OP.

      But are you aware that your third linked article from the bottom has this conclusion?

      “Less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate.”

      It certainly DOES illuminate and educate. (It was a study from Maine, so was almost certainly about CPMs, not nurse midwives.) I’m not at all sure it does so in the direction you meant.

  24. I’m not really sure why no FORMAL “medical” training equates with no training AT ALL in the blogger’s head?
    Not that he’d be the first one to make the mistake… I heard it from others too, especially from MDs (not necessarily on midwifery at all).
    You learn a lot outside school… from books (Ina May has a huge collection of books on the history of obstetrics and midwifery, for example), from observing others, from workshops, from colleagues sharing experiences, and from practice, yes. I guess the blogger was never a medschool student or intern making stupid mistakes and learning from them?
    I guess the comments on the hospitals dealing with high risk cases and therefore statistics being uncomparable have never taken the time to actually have a look at the existing data we have… skip the ones from the nederlands if you prefer so.
    And I guess based on the comments on the selfish homebirthers chasing their experience… that you’ve never actually seen a research paper on why they actually choose homebirth.

    Those are very interesting reads!

    • I guess the blogger was never a medschool student or intern making stupid mistakes and learning from them?

      Of course I was. In a well-supervised setting where my mistakes could be caught and corrected.

      So, if you feel the education CPMs receive is sufficient to deal with neonatal emergencies, please tell me what specific pediatric training you’ve had.

    • good lord! From BOOKS!
      Ma’am, I’ve read a book about how to treat massive thoracic injuries. I’ve read a book about how to straighten a broken appendage (and not with a butter knife, as I read recently in a hospital report…).

      I would not do any such thing unless we were far enough away that my actions would make the difference between life and death. I’ve been more than a day’s walk from the nearest road, let alone emergency room. Without a cell phone, I might add.

      I read books because it’s better than nothing, if i’m very lucky.

  25. I’ve been reading a lot of opposition lately on home births, but none of the articles I’ve read have really pointed out the types of home births they are against. I completely agree that home birth is not for everyone, including not every provider. In reading the comments, I see that the author says he has no qualms about a Nurse Midwife assisted delivery that is a short distance from a hospital. I would like to have a home birth, but if I do not meet the criteria (my health, my baby’s health, the practitioner’s education/training level, distance to hospital, working relationship of midwife and said hospital, a safe and reasonable back-up plan), it would be safer to go to a hospital or a birth center attached to a hospital. Not all home births are equal and to make blanket statements about all of them is oversimplifying the situation.

    Also, if we were more comfortable with exploring the possibility that home births are in fact safe in certain situations (and should only be done within those strict criterion), perhaps the training and stipulations of home birth would be more regulated. Instead of fear-mongering women, we should be giving them safe and regulated options to giving birth. Just as a home birth is not for everyone, a hospital birth is not for everyone either.

    As far as the issue of choosing to have an “experience” over the health of the baby, we must stop looking at the two as separate individuals or that one is more important than the other. In most cases, what is good for the mother, is good for the baby, and vice versa. And both are human lives that need to be honored and respected. How a woman is treated during labor and delivery, when she is at her most vulnerable, can have a profound affect on her. Those who are crying out about the injustices done to them during birth are often looked upon as selfish: “At least you got a healthy baby, right?” At the end of the day, most mothers say, yes, that’s what matters. But we cannot discount that the way a woman is treated and made to feel during birth also matters. Personally, I think most hospitals are missing this. OBs have a tendency to see a woman as a uterus, a passage with a passenger, and not a whole person. Many women desire to get away from that by choosing home birth, but do not explore that option without scrutiny.

    • “I’ve been reading a lot of opposition lately on home births, but none of the articles I’ve read have really pointed out the types of home births they are against. I completely agree that home birth is not for everyone, including not every provider. In reading the comments, I see that the author says he has no qualms about a Nurse Midwife assisted delivery that is a short distance from a hospital. I would like to have a home birth, but if I do not meet the criteria (my health, my baby’s health, the practitioner’s education/training level, distance to hospital, working relationship of midwife and said hospital, a safe and reasonable back-up plan), it would be safer to go to a hospital or a birth center attached to a hospital. Not all home births are equal and to make blanket statements about all of them is oversimplifying the situation.”

      I’m down with this, Carsen.

  26. We find it amusing that the author would choose to write a negative post on a topic that he really knows nothing about. If he was truly attempting to enlighten and save the public he would have researched a little deeper before making himself look so ridiculous in the public eye.
    The cesarean rate in the U.S. alone has risen to terrifying rates. If only 1% of women seek homebirth with a midwife, the other 99% are having their babies in a hospital with a surgeon with almost half undergoing major abdominal surgery to do so. WHY? Because obviously the doctors are incapable of seeing a woman through pregnancy, labor and birth without the use of their medications and surgical instruments. They just do not have the education or skills to do so.

    –World Midwives–

    • While I think Russell missed the target on the post originally (he has since tweaked his stance), it seems rather unfair to suggest it is a topic that he “really knows nothing about”. First, I imagine he does know something about it (even if I disagree with him). Second – and perhaps more importantly – the discussions around these parts aren’t just statements of opinion, but discussions. To suggest that it is amusing that Russell wrote on something that he didn’t have enough information on is to suggest that only certain people are allowed to weigh in on the discussion. It is to make certain people the gatekeepers and arbiters of knowledge and acceptable opinion.

      That sort of thing is exactly what any birth-choice movement should be against.

  27. I said this upthread. But I’d like to stress it again. Birth is not special. Hospitals can be dehumanizing places. Patients and caregivers of patients can be treated with a shocking lack of respect. My son has spent a total of six months of his 2.5 years hospitalized. I’ve been told not to cry near him, since it might upset him. I’ve been told that, although I was spending the night next to him, and in other rooms parents can sleep next to their children, the room he was in was a no-parent-sleeping room, and no, he can’t be moved, and yes, I have to sit upright with fluorescent lights full blast all night. No, the blaring alarm that indicates only that his feeding is done cannot be turned off. Only one parent can be with him, so dad, wait outside. No, you can’t be with him when he goes under anesthesia, but he won’t notice the difference anyway. Etc. Etc.

    This is not a feminist or a birth issue. It’s a human issue.

    What if all this anger and energy, much of it justified, was put to use demanding respect for patients? Both in terms of autonomy and in terms of what hospitals are like. It certainly seems effective. Pretty much the only pleasant room in a hospital is an L&D room. Agitation and patient demand works.

    • The anger and energy often is, Rose. Ontario, for example (it’s where I live, so it’s what I know) has announced that they will open at least one birthing centre. The province is becoming more welcoming of midwives (which helps mainstream them and break down animosity between OBs/hospitals/”the medical establishment” and midwives), and a number of hospitals are working to be more birth-friendly. The work of midwives and other medical professionals, activists, and other citizens helped to bring all this about.

      I don’t know what’s going on in the US, though. I don’t always understand you guys.

    • Rose-

      My wife is a nurse (formerly bedside, now working behind the scenes in informatics) and I’ll see if I can get her to weigh in here, though “blogging” isn’t really her thing. Nonetheless, I’d venture to guess she’d agree with much of your assessment here, though might be able to flesh out the rationale behind some of those protocols and procedures, assuming they exist. As in any industry, there are things that happen behind the scenes that the public isn’t privy to but impacts front-of-the-house operations. I see this often in schools, another “industry” with a huge emotional component to it. There might be a very good reason why the feeding tube has an alarm. Or why your son couldn’t be moved to a room that allowed you to sleep. That doesn’t excuse the contempt that many professionals hold for those they are charged with caring for, which I would venture to guess is a greater source of your frustration than the logistical issues you could deal with. Being tired is one thing… being tired and shat on is quite another. You’d be surprised how many teachers view children as things that interfere with them performing their job, which is so assbackwards as to make my head spin (Will and I had an interesting conversation about this on his post about subbing). It wouldn’t shock me if the same held true in the medical profession, and I’m fairly certain my wife has documented the same phenomenon.

      Your last point really resonates. But we know how this plays out. Rather than spend their time, energy, and efforts on improving the system for all, they remove themselves from the system and improve only their own lot in life. And by “improve” I mean they get to be treated like the VIPs they think they are, whether or not the method they’ve chosen is actually better.

      • Some of the reasons had to do with keeping things calm for patients sharing the room. And concurrently, making things easier for staff. Some of the reasons I suspect have to do with malpractice – kids with severe special needs undergoing anesthesia. The alarm thing was, I suspect, a power trip – other nurses were fine with me turning it off. The no-parent-sleeping room happened because the parent-sleeping rooms were full. But no one really knew why any of the rooms were not for parent-sleeping.

        I understand (some of) the reasons. But they add up together to a situation where you’re already going through hell, and no one gives a crap because so is everyone else and why should you get to be special or comfortable? And then you end up with a situation where for the first 3 months of his life, my son was never once in darkness or silence, I was never once alone in a room with him, his brother got to meet him only twice and only after I raised holy hell. And all the other stuff listed above.

        • Space issues probably account for some rooms not being for parent sleeping (was at CHP until they got the new building).

          The alarm thing might have been an “I’m not getting enough sleep, and I need that alarm to wake me up, and remidn me to do X” — I don’t know, but I try to help other people not assume that someone’s gone aroudn the bend Napoleon style if there might be other reasons.

        • “no one really knew why any of the rooms were not for parent-sleeping.”

          I’m imagining that one time somebody rolled in with McDonald’s for three, an inflatable mattress complete with sheets and a pillow, an a portable TV with a DVD player, and two rambunctious siblings fighting over one of those “whip it! bop it! shake it!” toys that was permanently on.

          And that heartless bitch of a nurse wouldn’t let them sleep next to their own sick child.

          • Yes, we did have a child life specialist. She took some pictures of my kid and stuck them on construction paper and stapled it together in a booklet so his brother could see him because he wasn’t allowed to visit him. She also gave him stuffed animals, and made sure he sat in a tumbleform once a day. That was about it.

            Kimmi – is it really the charitable thing to assume that she wanted the alarm on so she could zone out? NICU nurses have two patients each, and are really really not supposed to zone out. Better a Napoleon complex than a dozer. Plus, it makes zero difference to the patient whether the feeding tube is removed immediately after a feeding.

            And yes, DD. I do think it’s heartless not to let someone sleep next to their sick child. These were ICUs, and very sick and scared kids and very scared parents. Parents coming out of a NICU have very high PTSD rates, and not only because something was wrong with their child., but because of what NICUs are like. It is very rough on a family not to be together in a horrible situation.

            I am really having trouble reading the comments that are dismissive about what it’s like to have sick kid. I appreciate those that are well argued and thoughtful, even though I disagree. But really, a very sick kid is nothing to sneeze at.

          • I’m sorry that your experience was as awful as you describe it. Sounds like a failing on many levels. What is saddest is that the failing is at the most base level: medical professionals are in the job of taking care of people. As soon as they forget that, they have failed.
          • I don’t think I had a uniquely bad situation, given the severity of his condition. This stuff has happened in four different hospitals that serve affluent areas as well as poor ones (Washington, DC).
          • I’m not being dismissive about having a sick kid. I’m talking about parents who think they can do anything they want to do, anywhere, because sick kid that’s why.

            I mean, did my entire post just fuzz into nothing the moment you read the words “sick kid”?

          • No, your post did not become fuzzy. Please don’t condescend. I don’t think that even a family whose behavior is initially inappropriate should be prevented from being with a sick child. Of course, some families may be too disruptive. But the first instinct of providers should be to work with families, not simply bar contact for everyone.
          • Rose,
            if you’re pulling a 16 hour shift, every day (dunno if she was, but you don’t know if she had other jobs), then maybe you’ve got a real reason for wanting a “wake up and checkup ” call. though, coudln’t she have used something OUTSIDE your room? 😉
  28. I am a mother of four. My oldest son was born in a hospital via use of pitocin. Do you know what that is Mr. Saunders? You don’t seem to know much, so just checking. My hospital experience was painful and while I knew I wanted to keep the use of drugs, interventions to a bare minimum I was subjected to “Can we give you the epidural now?” EVERY SINGLE EFFING TIME I HAD A NOISY CONTRACTION. And if you have any idea what pitocin is then you must know that I had a whole lot of contractions. I just wanted to have my baby. Instead I was pestered the whole way. When my son was born, they didn’t want to give him to me. They wanted to clean him, weigh him, etc. They stuck him with needles and scrubbed him raw and he screamed blood curdling cries. I missed out on something very important at that moment. I will never get that back. My son was so shaken when he finally got to see me and he didn’t see me clearly because of the gunk they put in his eyes (that wasn’t needed anyway because I didn’t have gonorrhea). I suffered depression over the ordeal of the hospital. My experience left me to feel like a shell of a person and the missed bonding time really messed up my ability to mother the way I intended and hoped. My son’s trust was usurped by hospital staff. Stop spouting about “the most important part is the baby is healthy” because you sound like a JERK. Anyway, this lasted a long time during my son’s first year. Skip ahead 10 years. I became pregnant and my first thoughts were about how much I did not want to go to the hospital. I found a midwife after my OB said he may or may not be present at the birth. WTH? I REQUIRE proper care and kindness. My baby deserves to be respected and my vagina should be left alone when I’m in labor. These seem like really ‘duh’ points to me. I have had three children since my hospital birth and they were all born at home. I got to bond properly. My babies did not get stuck with needles or have their vision blurred needlessly. No one scrubbed the wonderful vernix from my babies’ soft, new skin because we were home. I was comforted, loved, respected, quiet, fed, hydrated properly, left the hell alone! to do what my body can naturally do.
    It seems to me that you are as ignorant about what really matters as you are a man. Men should only support women and their choices regarding labor and delivery. No vagina, no opinion on the subject of the use of them!
    • “my vagina should be left alone when I’m in labor.”

      I…don’t really think that’s an option, seeing as how the vagina is pretty much where labor happens.

      • Density….. vaginal exams are intrusive, inconclusive measures of progress. By ‘leave it alone’ I mean hands off and out. I knew when it was time to push. I didn’t need stretched fingers to tell me I was ready. LOL!!
        • I guess you must be superior to all the women who have an urge to push before they are fully dilated. Push at that point, simply when your intuition tells you, and you risk inflaming the cervix shut again. But yeah, silly vaginal exams.
    • Yay! I have a vagina! I’m an expert on this issue!!
      Home birth should only be undertaken with a well-qualified midwife who can deal with complications and is humble enough to transfer quickly when they arise. I have a friend who just lost her baby this year due to an over-confident midwife thinking she could handle the situation and not listening to her client’s requests to go to the hospital. The baby didn’t actually die until it was taken off the life support machines at the hospital, so it will not show up as a home birth stat, but home birth was absolutely the cause for this previously healthy baby’s death. I’ve since gone from thinking home birth is “not for me” to thinking it’s “not for nearly all women who want healthy babies”. I’m sorry for your bad experience at the hospital, but what makes you think it outweighs my friend’s and her family’s suffering at having to bury their little one so soon? She honestly believed that home birth in the USA with a CPM was as safe as hospital birth because that’s what home birth advocates say. The advocates are ignorant at best for saying so.
      • That’s the deception of this movement; they skew statistics and lie to mothers, about the very things mothers need to know. They need to know how educated and skilled their care provider is, and the true benefits and risks for their choices.

        CPMs are unprofessional, undereducated, undertrained, glorified birth junkies. It would be comical if babies weren’t dying.

    • honestly if being asked if you want an epidural and eye gunk made you depressed for a year or genuinely prevented you from bonding with your child during that time, I think mental health treatment may have been (be?) called for. As for your newborn not “seeing you clearly” after he was born—newborns can’t see clearly, eye gunk or no.
  29. Good golly. I wake up with 95 new emails on my phone. Thanks mostly to this post. So, I think we can add midwifery to circumcision, Amanda Knox, and Lara Logan as subjects with an Internet Action Network.

    Gotta check out because I have 12 hours of driving ahead of me. It’s been interesting!

  30. A few things…first, kudos on softening your stance WRT homebirths.

    While I agree with you that it would be nice if CNM’s were allowed to attend homebirths, the simple fact is, in most states, they are not allowed. There is a lot of political “stuff” involved in the whole thing, but it boils down to them not being allowed to.

    With my first, I had an OB that I thought was woman friendly. As it turns out, they unintentionally started labor, I got pit, a misplaced epi that caused issues, and you know the end, an unnecessarean. I have read Ina May’s books since then, and become more informed simply because I *knew,* in my gut, that I wasn’t treated like a person, and what happened didn’t have to. The problem now that I’m pregnant again becomes finding a truly VBAC-friendly provider (not simply someone who says they do VBACs…I’ve heard countless stories from patients at my former OB where they said yes to a VBAC, and then managed to find a reason to cut again at 38 weeks). It’s been a struggle, let me tell you. And it’s a struggle for now, thousands/millions of women all over this country, as the C-section rate goes up every year.

    I considered a home birth with this one. Ultimately, I decided it wasn’t for me at this time. However, I’ve been flat out told not to go to the hospital until in transition/ready to push, by a variety of professionals. Why? Because there are natural variations in FHT during labor. However, as a VBAC, you MUST get continuous EFM as a condition, and any deceleration in FHT is assumed to be a rupture and you’re cut.

    As has been mentioned, the fact is that women are treated as a number. For most, pregnancy IS a natural process, that requires minimal intervention. You mention your experiences in labors. I’m curious, how many of them were allowed to naturally progress? And by that, I mean, no AROM, no pit, no epidural, no clock put on the woman, a dark, quiet room where she was allowed to labor in peace, no unnecessary fingers in the vagina, allowed to push in the position the WOMAN felt most comfortable in, as opposed to what the OB preferred, etc.? I’m going to guess very, very few were that sort of birth.

    You seem to be coming around to what many women who believe in having the *option* for home birth want…a less medicalized model. A model in which CNMs are the standard for birth, with an OB available as needed. A model in which the high-risk cases are transferred to OBs for care. An option in which a woman isn’t bullied into making decisions, because honestly, that’s not truly informed consent. The problem is, that isn’t available in most corners of this country. And that’s what women are starting to demand. And until the medical community realizes this, there are going to be more and more home births. It’s a sad commentary on our country when a woman’s choices are a home birth with a non-medically trained person, or a highly interventionist, medical, impersonal birth.

  31. http://mothering.com/canadian-homebirth-study
    http://www.cbc.ca/news/health/story/2009/08/31/midwife-home-births.html
    These are articles regarding home birth studies done in Canada, specifically in British Columbia, where I reside. You say you are referring only to the USA, but we are your neighbor so I thought I would include these in an effort to shed light on your opinion.
    I find it in extreme poor taste to smear Ina May Gaskin, as well as to bring dead babies into your article. As someone as said already, babies die in hospitals too, as do mothers. So, why is it that that is what is always brought up as the reason not to birth at home?
    Birth is safe at home for low risk healthy pregnant women. The Netherlands and other countries have proven that. We have proven that here in British Columbia and elsewhere in Canada.
    As to discrediting Ina May Gaskin, she was trained by a doctor in the early years at the Farm where she was essentially apprenticed by him. He attended the homebirths of the Amish women in the community there. He encouraged her to learn and practice midwifery and passed along valuable skills and knowledge to her and the others who also wished to be midwives there. Experience is a great teacher. Academic learning is one thing, but actually attending births, like practicums, give students a much better foundation. All midwifery training has this component as well as book learning.
    Ina May Gaskin received much of her training by being at births. And yes, the women were healthy. This is a basic requirement for any midwife when a client asks about home birth. Here only low risk, healthy woman are considered as candidates for home birth. If something changes during their pregnancy, which would affect the outcome, a midwife decides that home birth is not an option.
    And since we know that 85-90% of the time birth works, larger numbers of women could safely birth at home, if that was their choice. WHO states that cesarean sections should be at about 10-15% for all births, but sadly this is not the case either in Canada, or the US. Rates are climbing.
    So, what is wrong with the system? We have more and more healthy pregnant women having high tech births which are increasing the use of medications, interventions and inductions and ultimately leading to cesareans. One way to reduce the risks is to offer low risk healthy women the opportunity to birth with midwives – in either a home, birth center or hospital setting. It’s not only the setting, but the type of caregiver that is important. Midwives are the guardians of normal birth. Their training specializes in facilitating the normal healthy physiologic progress of labor & birth. Whereas, for example, obstetricians are trained to aid in labors when a complication does arise and their particular skills are needed, such as surgical ones.
    That’s why in countries like the Netherlands, healthy pregnant women work with midwives for the majority of births, while an obstetrician is involved in the high risk cases or when during labor an intervention is called for. Makes sense!
    Please take the time to do more research before you make such statements and inflammatory remarks about someone who deeply cares about what is happening to birthing women in the United States. Birth, as we know it, is being lost. Women are being disempowered, losing their autonomy, their right to give birth in the way that they choose, failing to be fully informed in order to make the best decisions for themselves and their babies.
    Here in Canada we are not seeing the same practices as in the United States and I am thankful for that. What I have seen go on in the United States as standard routine care of a woman entering the hospital to give birth simply strips her of her rights and treats her and her birth as a medical event, when it is not. The more medicalized birth has become, to make birth ‘safe’, has led to more interventions and increased cesarean sections, yet has shown no better outcomes. In fact, the outcomes are worse for healthy birthing women and their newborns in hospitals.
    We are at a tipping point. We need to change the way we present birth – not as something that is dangerous and to be feared. American women are being terrorized by this view. It has to stop or eventually all babies will be born by cesarean section, much like Brazil with a rate of 95%.
    For someone to create change they don’t need to have a degree. or be an ‘expert’. The ones who are creating change for birthing women are women themselves – mothers, or pregnant women desiring a family experience, not a medical event; those who have had a traumatic birth experience and want a better birth; midwives, doulas & childbirth educators…… It’s happening now and it’s been a long time coming.
    • as well as to bring dead babies into your article

      Since unnecessarily dead babies are the crux of my objection to untrained people trying to care for neonates, it would be absurd to exclude them.

      One way to reduce the risks is to offer low risk healthy women the opportunity to birth with midwives – in either a home, birth center or hospital setting.

      I have already indicated I am tentatively open to the idea of home births with trained nurse midwives. Gaskin and her CPM spawn are not trained nurse midwives.

  32. Availability of emergency care facilities is one reason hospitals perform better in SOME births. However, you don’t address how many medically-unneeded and scientifically-unsound practices take place in the hospital, often whether or not the laboring mother actually wants them. You also don’t talk about the lack of care, bullying, and outright violence that occurs when the mother is treated as a number who has to meet a “normal” curve to avoid the interventions, and how providers will present their opinions/preferences as medical “fact” to force a mother to do what the providers want/follow hospital policy. I read recently, I believe in the commentary on the study that labors today take 2hrs or so longer than labors in the 1950s, that the US is now inducing 2/3rds of all mothers. There are hospitals where the c-section rates is 40-50%, and many places where although the mother is a good candidate for a VBAC there are NO medical professionals who will support her in doing so. Yes, there are cases where mothers and babies truly need those interventions, but we are suffering overall from overuse of technology and interventions, often in ways that aren’t supported by actual scientific research (such as continuous fetal monitoring, denial of food/drink during labor, and laboring in bed on one’s back).
    • A “no interventions” philosophy is great right up until you get sued for not having intervened.

      And I’d like to hear your explanation for how continuous fetal monitoring is a bad thing. “It’s associated with an increase in c-sections!” Yes, because now you can hear the irregularities in the baby’s heart rate, and think “okay, well, if the kid turns out to be a vegetable, then they can only say I didn’t do everything I could have done if I don’t do everything I could have done, better pull the pin just to be safe”.

      • Fetal monitoring can force a woman to stay immobile, which isn’t a good thing. It can also increase stress, because the mother is worrying about the monitor (and if it shifts and starts getting “bad” results, it can cause a lot of unnecessary stress).
          • True story about how a psych experiment caused a heart attack.
            They hooked up a standard heart meter to someone (the type that beeps per beat).
            The researcher said, “My, that sounds a little fast”
            The guy starts to get stressed, and a bit scared — his heart beat increases.
            That started a nice little feedback cycle, which caused cardiac arrest
            (ugg, not a heart attack.)
          • Thanks.

            That seems like the ‘White Coat Syndrome’, where a patient’s blood pressure when you start measuring it. In fact, my wife had that very problem in our last pregnancy. We had to devise a strategy to distract her right before we measured it. The difference was crazy.

        • I hemorrhaged after my first and totally healthy kid was vaginally born. I gather this is not uncommon. It was a five minute fix in the hospital which I’ve barely remembered since, and would have been a potentially terrifying ambulance ride for a home birth. Stress caused by choosing the other route can go both ways.
      • Probably because there’s been no evidence to actually show it’s beneficial to either mother or baby. All it’s really done is increase the rate of Cs.

        Oh, and it allows the nurse-patient ratio to go higher, because a nurse no longer has to be present with a mother while she’s laboring, she can watch the tracings on the screen from a central monitoring station. And then run in and YELL at the mother (yes, I said, yell, BTDT) when she DARES to move and knock off the monitor.

        • As I have said before in a similar “comment” posted by someone else, I have approved this comment, but I would prefer you mount an actual argument instead of simply barfing up a handful of links. Make a case or don’t, but don’t make everyone else do your work for you.
        • I like that NYT article, because it confirms my contention that the increased C-section rate associated with FHM is an example of defensive medicine.
        • The reply asked for scientific studies regarding fetal monitoring, so that’s what I provided.

          Taken from various summaries of the linked studies:
          The infant outcome was measured by neonatal death, Apgar scores, cord blood gases, and neonatal nursery morbidity. There were no differences in the infant outcomes in any measured category between the electronically monitored group and the auscultated group. However, cesarean section rate was markedly increased in the monitored group.
          There was no significant difference between the two groups (continuous fetal heart rate monitoring with intermittent auscultation) in neonatal deaths, Apgar scores, maternal and neonatal morbidity, and cord blood gases.
          For low-risk mothers there is a good case for a return to the traditional method of intermittent auscultation with its lower false-positive rate, lesser incidence of intervention, and opportunity for greater contact between the maternity care staff and the mother.
          The only clinically significant benefit from the use of routine continuous EFM was in the reduction of neonatal seizures. In view of the increase in cesarean and operative vaginal deliveries, the long-term benefit of this reduction must be evaluated in the decision reached jointly by the pregnant woman and her clinician to use continuous EFM or intermittent auscultation during labor.

          And regarding the vegetable comment, as the NY Times article discusses – most of the time the physicians they asked couldn’t even agree with themselves on what the heart rate tracings were telling them, so they can’t be that helpful.

  33. I think there are valid arguments on both sides, to be honest, as well as benefits and risks.

    For hospital birth, the obvious benefits are that you have immediate access to NICUs, and cesareans if they become necessary. However, the risks include unnecessary interventions that can cause problems for mothers and babies. When a woman goes to the hospital in labor, she is on the clock. If she is taking too long to progress, they will break her water and start pitocin (which can cause fetal distress). She is subjected to repeated vaginal checks which increase the risk of infection. If she gets an epidural, she has to stay in bed, which can cause labor to take longer. Eventually, she might have to be “saved” via cesarean, which could have been avoided by staying home. The US has one of the highest rates of maternal death in the developed world. No doubt because we also have one of the highest rates of cesarean.

    Now, homebirth has risks as well. Obviously if something is wrong, it can turn tragic very quickly if you are far from the hospital. A woman who hemorrhages can bleed out in minutes without proper care (note that many midwives carry pitocin with them to stop bleeding). If you have a midwife that is not experienced (note, I did not comment on licensing. I feel that years of experience is just as valid as a piece of paper), there is a risk of her missing the signs of distress and transferring to the hospital too late.

    But, there are incredible benefits to home birth. A woman is able to labor as she wishes and let nature unfold. She can walk, eat, drink, shower, etc. She is in control. Babies are born without pain medications. They are more likely to breastfeed well. etc.

    I have had both experiences. I had a hospital birth with my oldest. Lots of unnecessary interventions. Eventual epidural, episiotomy, etc. Normal, vaginal birth…but we had lots of problems breastfeeding, jaundice, slow growth, etc. I had baby blues for a few weeks. Essentially, I felt like a failure as a woman. Healthy mom, healthy baby? Sure…But I wasn’t complete.

    4 weeks ago, I had an amazing homebirth. There were no interventions. I progressed at my own pace. I was in tune with my body. I had the amazing support of my midwife and her assistant. Best of all, I had no pain whatsoever, unlike my birth with my first baby. My midwife came fully prepared with emergency equipment if necessary, and I live only 5 minutes from the hospital. My baby was born in the water and has no problems with breastfeeding and growth. Oh, and I only had 2 days of baby blues.

    Hands down, the homebirth was the better of the two, and any future babies will be born at home with a midwife.

    I think the biggest problem with birth right now is the mentality that it is a medical emergency. Birth is a normal event, and quite safe for the majority of women and babies. We are designed to give birth. For low-risk women, home birth is a valid option.

    Truly, we need to work on both sides of the equation to make it better. For hospitals, train them in natural birth and lower the number of interventions. Don’t push things on her. For homebirth, make sure midwives get the training and experience they need. Make it legal in all states for them to attend births in the home. Ultimately, make it safer, no matter where you give birth.

    Just my two cents…

    • Again: It is not like these “interventions” are something that doctors just do for kicks. Each intervention is justified by the blood of dead babies.

      People arguing for home birth because there’s fewer interventions are saying that they don’t want to know about any bad scary things, that they want birth to be a wonderful mystery that just happens naturally, and sometimes the wonderful mysterious natural process kills the baby but that’s just the wonderful nature of mystery, nothing that could be done, God’s will, amen.

      “But then we should train home-birth providers in how to recognize, deal with, and avoid complications!” Sure! Nobody’s actually arguing against that. But it’s important to keep in mind that the lack of interventions by an unqualified provider is not a signifier that these interventions aren’t necessary or justified.

    • … no pain whatsoever? Can I ask you to get someone else to comment on what you looked/acted like during this period? It strikes me that you might have been in a somewhat altered frame of consciousness…
      • Some women have orgasms during birth. Do you doubt their stories, too?

        We’ve been trained, in this country, to think of birth as painful and awful. It’s absolutely to have a birth that is not that bad, that is pain free, that is even orgasmic.

        • no, a woman can have an orgasm during birth, just as one can have one during breastfeeding, or during rape.
          It is not a terribly odd idea to ask for independent confirmation of people having epileptic episodes that sometimes lead to blackouts.
          • to be clear, I’m not doubting the sensations experienced, just judging that those sensations may have severely affected her mental state.
      • Kimmi- I used hypnobirthing during labor. Relaxing and welcoming the contractions instead of fighting and tensing up made it possible to have a pain free labor. I burned during crowning, but that didn’t last long.

        My husband says that I looked asleep. LOL

          • No, hypnobirthing is self hypnosis. You are fully conscious the whole time.

            You can learn more here

            http://www.hypnobirthing.com/

            I was able to focus and concentrate during the contractions, and use breathing and relaxation techniques to ensure that it was not painful. I was very much in tune with my body and everything that was happening during labor. 🙂

    • “If she is taking too long to progress, they will break her water and start pitocin (which can cause fetal distress). ”

      Unless I’m wildly off-base on this, I don’t think there are many jurisdictions in the United States where a doctor can do *anything* to you if you state that you don’t want it.

      We had two nurses (one strongly, one much less so) and a doctor quietly suggesting to my wife that they be allowed to break her water on her second birth, and she was quite adamant that she didn’t want this done. In retrospect, she probably made the wrong call… when her water *did* break, she had the baby about 2 minutes afterwards. Nobody even said, “I told you so”.

      • A laboring mother may or may not actually be capable of informed consent, and the doctors/etc can definitely skew any consent given to get “approval” for what they want to do. They can definitely fail to give alternatives and talk sufficiently about risks, as well as fail to mention that nothing is a valid option.
        • And I forgot to mention that every now and again, I hear a story about a hospital calling Children/Family Services into a birth to force the mother to consent to a procedure.
        • Exactly B. A laboring women is very vulnerable. If suggestions are coming from an authority figure, she is more likely to submit to them. I know from my hospital birth, I was never told the risks of procedures before I consented.
          • We had a doula, and I was there.

            We’re now getting pretty far afield of “homebirth vs. hospital birth”. You’re now talking about people who can or cannot make valid informed decisions. Well, heck that applies both ways.

            Case in point: if you’re a very vulnerable laboring woman, might you not make very bad decisions at a home birth?

          • Thanks,
            you’re remidning me to know the risks of probable events before going in (not that I’m pregnant now), and to not go to a doc who won’t give me the rundown.
        • > They can definitely fail to give alternatives and
          > talk sufficiently about risks, as well as fail to
          > mention that nothing is a valid option.

          Granted. This is a common feature of any information asymmetry. My response to that is, “If you’re pregnant, you may want to get yourself informed about your condition if you want to be involved in a responsible way.” If you aren’t aware of the real risks and alternatives, your choices are “listen to the doctor or don’t”.

          This applies to any condition that winds you up in a hospital. The doctors (bless ’em) have a particular agenda that may not align with yours, particularly if you have very significant ideas about quality of life and end-of-life decisions. It’s on you to inform yourself prior to potential events.

          • Your comment regarding informing yourself beforehand is, for many people, impossible. It sounds as though you would prefer every prospective mother pass the tests to be a childbirth professional prior to labor. That is simply impossible, when you can easily find medical professionals currently in the field who are not up to date on current best practices or research. If I hire a professional, why should I have to know all of their field as well? Why is it on me to practice defensive medicine against them?
          • > Your comment regarding informing yourself beforehand
            > is, for many people, impossible.

            Quibbling about “many” outside, more or less granted. It’s certainly logistically a bad time investment for many people.

            > It sounds as though you would prefer every prospective mother
            > pass the tests to be a childbirth professional prior to labor.

            Well, no. Not at all. Or rather, if *I* was pregnant, I’d be panicked thinking I don’t know enough, and I’d probably remain mildly panicked regardless of how well informed I was able to make myself, but that’s just me.

            > That is simply impossible, when you can easily find medical
            > professionals currently in the field who are not up to date on
            > current best practices or research.

            You are going to have to provide a citation for that one. The medical profession, in fact, has requirements for ongoing education (at least, in most states with which I have familiarity, YMMV). Now, it may be the case that some of them are not constantly always seeking out every possible avenue of education. It may also be the case that not all of them take all of their responsibilities seriously, too. Sure.

            > If I hire a professional, why should I have to know all
            > of their field as well?

            You’re setting up a false dichotomy there.

            Look, it’s a given that there’s N best neonatal doctors out there, somewhere. The total number of neonatal doctors is N+M, and that M includes passing neonatal doctors, marginal neonatal doctors, and probably pretty bad neonatal doctors.

            I will go out on a limb and state that even the worst neonatal doctor, who spends the least amount of time reading research but still *practices* medicine, will have a better idea of possible risks than a huge percentage of the self-informed civilian population.

            Now, for any given doctor and any given patient, that may not be the case. But this is an unlikely enough event that I would say that most people who *do* think they know better than their doctor are very, very likely to be wrong.

            Not all of them. But most.

            > Why is it on me to practice defensive medicine against them?

            It’s not. It’s on your to practice defensive non-treatment against them. Because it’s their job to treat people. By default, it’s what they’re going to do. And they do that for *very good reasons* for the most part. So if you don’t want the treatment, you’re going to have to be adamant about turning it down. Of course they’re going to try to convince you otherwise: in the overwhelming majority of cases that *they* see, they know more than the patient.

            I understand the psychological problems that roll out in these particular problem domains, but that’s just the way things are. If you want people to dedicate themselves to being experts, you have to assume at the other end you’re going to have practitioners who believe themselves to be experts.

          • >> That is simply impossible, when you can easily find medical professionals currently in the field who are not up to
            >> date on current best practices or research.

            I know this is anecdotal and not directly birth-related, but I have heard any number of times about incorrect/out-dated information on breastfeeding given by pediatricians/family practitioners. More directly birth-related, I recently read about a situation where the OBs were unaware of new practice guidelines put out by ACOG regarding VBACS.

            > If you want people to dedicate themselves to being experts, you have to assume at the other end you’re going to
            > have practitioners who believe themselves to be experts.
            Of course, but one of the arguments often used by home-birth proponents is the number of interventions used by the experts that aren’t needed or evidence-based, as I mentioned before.

            >> If I hire a professional, why should I have to know all of their field as well?
            > You’re setting up a false dichotomy there.
            How so? That certainly sounded as if it was what you were advocating – creating lay-experts out of mothers regarding all possible options that may occur during their labor. I think in many cases the education available to parents regarding childbirth and the education for medical professionals do not match up. The parental education is focused more towards uncomplicated, vaginal births, with some nods towards the most used interventions, although there is a wide range available through any number of organizations. Medical professionals are trained for the worst case, major intervention required cases, in presumably a more standard system. Where do those two systems met?

          • >> It’s not. It’s on you to practice defensive non-treatment against them. Because it’s their job to >> treat people.
            This is also a common benefit people mention for home births – that they will not have to spend their labor constantly having to tell the medical staff that they do not want X or Y or Z. At home, those things aren’t available, and so there’s no distraction/stress over having to tell the medical staff no over and over.
  34. I think I can tell my story. I was caesarian. I was going to be a buttocks breech but, hey, it was the 70’s and they caesarianed pretty much everybody at the drop of a hat.

    Well, twenty some years later, I lost my hair. It was awful. However, the fact that I was caesarian means that I look better bald than most of the “play-doh fun factory of life” kids out there who are all lumpy.

    So mothers out there, you should think long and hard about this next question: How likely is *YOUR* child to lose his hair? If you think he probably will, you should consider getting a c-section.

  35. I read this article with interest, and it actually made me want to scream. My biggest complaint about this article is the comment you (Russell) made several times about midwives without medical training. I do not need “medical training” to make me competent and safe to look after pregnant women. I am a qualified nurse, midwife and have an MSc in midwifery (in the UK). In two weeks I will be presenting a large quantitative study at an international obstetric conference. I am highly educated but at no point have I EVER had medical training. I have had midwifery education, I have been trained to deal with emergencies, and I have been involved in training medical staff in how to deal with neonatal resusciation, breech deliveries and shoulder dystocia. I have an extensive factual knowledge but it is (thankfully) mediated by what makes midwives totally different from obstetricians. Obstetricians (for the most part) view pregnancy and birth as a pathology, a risky situation from which women and babies need to be rescued. Midwives believe that birth is normal and the most of the time, women and their babies are more than able to cope with the stress of labour. Interesting point: Dutch midwives don’t receive medical training either. In fact, Dutch midwives who look after women at home have LESS midwifery education than those midwives who are based in the hospitals, as it is felt that only high risk women will give birth in hospital and therefore only those midwives need more education. Let me be clear, obstetricians, paediatricians and anaesthetists have their place in the care of pregnant women. I have no problem referring women to their care if necessary. HOWEVER, for the most part women don’t need these specialists. The truth is that studies have shown that midwifery led care minimises intervention, reduces the caesarean section rate and does not increase poor outcomes for mothers and babies; the Birthplace in the UK study (2011) is an excellent example of this, comparing low risk women who gave birth in hospital, midwifery led units and at home – comparing like for like, which is something you used to discredit the good outcomes that The Farm has as you think that hospitals only have bad outcomes because of premature babies or high risk women. You argue that you are not against midwives with medical training, but rather those midwives who conduct homebirths, who have no medical training. I take exception to this. It is a rather typical (and arrogant) medical opinion that assumes that medical training is the best and safest. The truth is that I have learned to be a good midwife through experience NOT through my education, by working in a setting where women labour at their own pace, there is no intervention, and we work with women and their bodies. I left a busy, medicalised obstetric led unit to work in a stand alone midwife led unit. Turns out, when left to their own devices women are AMAZING at giving birth. Turns out, when labour isn’t augmented, women cope beautifully with very little pain relief. Turns out that babies cope beautifully with labour (such a change from worrying over abnormal heart rates because of a labour speeded up with drugs, or those flat, shocked babies forced out of women because of time constraints). The truth is that in this setting (and at home), major emergencies and catastrophies just don’t happen as often as in hospitals. And not just because the women are low risk, but because unnecessary interventions cause problems. So what is midwifery knowledge exactly? Factual knowledge, yes. But there is an intuitive aspect to midwifery which comes with experience. To me, that intuitive aspect of midwifery is FAR more important to the care of pregnant women than any education I received in university. There is an intuition and art of midwifery which cannot be quantified or measured and therefore is largely discounted as invalid knowledge by the medical profession. I practice evidence based care, but there is a time when my purely intuitive midwifery skills are far more useful. So that instead of examining a woman when she starts to feel expulsive contractions (so that she can be “allowed” to push), I have learned to watch and listen, watch those external signs of progress and trust what nature can do so well. If labour is progressing slowly, I have learned practical measures to get things back on track, rather than resorting to drugs, to have faith when intuition hints that things will be fine, but to also recognise those warning signs that medical help may be necessary. And so, the main point I am making is that you should not be so quick to discredit that which you do not understand. Ina May Gaskin is a traditional midwife with a lot to offer. She may not have formal education, but she has a wealth of knowledge which has served her (and the women in her care) well. I find it interesting that you rely on anecdotes (the two births mentioned above) to back up your assertion that homebirth with these midwives is dangerous. Large studies comparing like for like should be the evidence that you quote if you really want to write an unbiased article. Or perhaps your rather arrogant medical bias is clouding your judgement? There is nothing wrong with women wanting both safe care and to give birth in a comfortable environment (such as home). I would far rather Ina May looked after me in labour than an obstetrician, or for that matter, a newly qualified midwife, even one who has had formal education such as we have in the UK, or in Holland; and I’d be hard pushed to choose between Ina May and one of my experienced colleagues. Both my midwifery knowledge and my belief in birth has led me to that informed, educated conclusion.
    • I am a qualified nurse, midwife and have an MSc in midwifery (in the UK).

      So you’re a nurse midwife with medical training. You and I may use different terms, but that’s the bottom line.

      I’ll say this for what I hope is one of the last times before I board a plane for Vegas and leave this thread to its own devices — my objection to births at home under the care of a provider who has no training in neonatal emergency care (which you, apparently, have had) is that in those rare but not all that rare occasion of an unforeseen emergency they are totally ill-equipped to manage it.

      • Totally patronising. Obviously you totally missed the point behind my objections to the word MEDICAL. And totally missed my point about what constitutes midwifery knowledge and education.
        • Fine. If the semantic point is worth so much to you, you “win.” So long as the content of your training makes you competent to deliver care that I would call “medical,” then I couldn’t possibly care less what you call it.
          • Is it really JUST about semantics? You’re right, I object to the way you use the term “medical” in your article because it implies that “medical” is best. I happen to believe that midwifery training is something completely different, not better or worse than medical training, but definitely not the same. Just out of curiosity, I wonder if obstetricians would object to receiving “midwifery training” or have their studies referred to as such… I bet they wouldn’t be too happy about it… You have reduced my post to look like a “gripe” about semantics. When actually what I was trying to explain is why midwifery is more than just factual knowledge, it is what you believe about birth, and how you look after women in labour. The medical way of looking after women often isn’t enough – women need to know that birth can be fulfilling and empowering AND safe. Sadly, obstetricians and other medics often dismiss these very important issues for women, because THEY don’t think they are important. I wonder if you just reduced it to semantics because you really didn’t “get” what I was trying to explain…
          • OK, obviously I haven’t explained myself clearly. My point is, that in spite of having training which you approve of, what makes me a “proper” midwife is knowledge and experience which I have gained throughout my career. Have you ever been helped out by a nurses aid, technician or nurse who maybe didn’t have the same level of education or formal training you did, but through years on the job know a lot more about dealing with a situation than you did? I know I have. I also know it would be incredibly arrogant of me to ignore their help. I also know that in some situations I would have trusted them to look after patients better than doctors or midwives. Yet you discount completely one midwife’s knowledge and experience just because she does not have formal training that you can approve of? Interesting that she has been recognised throughout the world by many organisations that know an awful lot more about obstetrics and midwifery than you do. Perhaps others can recognise the value of education and training that is not gained in classroom, where you get handed a certificate at the end of it. I know my midwifery education did not prepare me for the suble, complex, and amazing process that is birth. What helps me be a good midwife in that situation is the kind of knowledge Ina May has. Many things that have been adopted in midwifery care come from people like Ina May, who read, analyse and work out for themselves a better way of doing things. I am not offering a carte blanche defense of all midwifery practice in the US – there are probably some midwives there that I would not want looking after me, because I feel that their level of knowledge and experience is not good sufficient, just like there are midwives and doctors I would not want looking after me, because even though they may have the knowledge and education, do not really understand what birth is all about.
    • women can do it all by themselves! women are heroes!
      Hanawalt, Barbara, Growing Up in Medieval London (Oxford University Press, 1993), p. 43 and 234. The author cites 14.4 maternal deaths for every 1,000 births in 15th century Florence. This figure rises to approximately 20% when deaths resulting from complications of pregnancy or some condition related to child-bearing, rather than the birth process itself, are added.
      • women can do it all by themselves! women are heroes!

        Half of this statement is true.

        As to the other half, a plane on autopilot can land itself. If nothing goes wrong. So I like that there’s a pilot on my plane. Similarly, giving birth can happen all by itself. You can fill in the rest of the analogy.

        Do you need a doctor, with an M.D. and board certification in obestrics and gynecology, and sub-specialties? Well, I think the point has been conceded up and down this comment thread that in a significant number of cases you do not — but if something goes does wrong you need someone with specialized knowledge, skills, and training. That someone might be a midwife in most cases.

        Let’s say that in that last sentence, “most” means that in 99.99% of all childbirths, the level of knowledge, skills, and training possessed by an OB/GYN are not needed, and that in 99.99% of all childbirths, the medical equipment and facilities of a hospital are unnecessary and go unused.

        If we were talking about my wife giving birth, or someone giving birth to my child, then 99.99% safety represents an unacceptably high risk. I’d have insisted on the doctor and the hospital, even after hearing of Bethany’s excellent experience.

        Despite this, I’m sincerely happy for Bethany that she had such a great home birthing experience and I wish her and her family all the best, and I offer similar best wishes to other mothers who had similar good experiences and good outcomes.

  36. Just for the record, if stuck on the side of a road, with a broken down car and no one around for the birth of my baby, I’d trust a MW who had spent years sans the “technical” equipment surrounding her to safely deliver my baby, over the OB who had only been trained in a hospital, comfortably surrounded by things that beeped and clicked.
  37. IN response to your comment about dead babies – babies die in hospitals with well trained experts. So, what would you have them do? It’s a fact of life in birth – sometimes babies die. At home births midwives will transfer the woman when they determine that labor is not going well or if a problem is occuring. Because they are low risk pregnant women to begin with, this lowers the odds of a problem but yes it can occur. Couples, when making an informed choice, realize this is a possibility. They make that choice.
    And again, Ina May Gaskin is not an untrained, unskilled midwife. She is not advocating that high risk women birth at home, nor does she believe home birth above all costs or considerations. No one would do that. A couple who are considering home birth have spent much more time thinking about it and have the best interests of their baby and the baby’s safety at heart. Even more so. Ultimately, it’s up to the parents. But home birth is safe. And yes, sometimes babies do die. In hospitals and at home. But I don’t think in any case you are going to view this differently. Yet, we cannot use as our argument ‘but if I was at the hospital, my baby would have lived. ‘
    • So home births are safe except when they aren’t, and intervention is never required except when it is.

      “we cannot use as our argument ‘but if I was at the hospital, my baby would have lived.’ ”

      uh…what? Dead babies who’d be alive if they were in the hospital is not an argument that mothers should go to the hospital?

      If anything, you’re the one who’s throwing up her hands and saying “welp, sometimes babies die, nothing you can do, God’s will be done, amen.”

    • No, let’s use the stronger argument.
      If you do this, X% of the time, your baby will die a preventable death.
      The good doctor has noted that there are plenty of problems that can’t be corrected without prompt medical treatment (5minutes).
      When his internet is working again, we can quantify what the hell that means.

      Informed consent means being able to bloody well fucking cite the risk that you’re killing your baby through your decision.

    • The thing is, three times as many babies die at home than do in the hospital, and the ones at home were to low risk, healthy mothers. The ones in the hospital are the preemies, the ones with genetic abnormalities incompatible with life, the high risk mothers, and yes, the disastrous home birth transfers. The hospital number, which is still one-third of the homebirth number, includes ALL of those deaths, while the homebirth number includes generally healthy, term babies.

      Two out of three babies that died at home would have lived if they had been born in a hospital. The “babies die in hospital too” is disingenuous and misleading, at best. And it’s obnoxious.

      • can you drop me a cite on this stuff?
        also, I’d love to see the preventable deaths in hospital that would have probably not occured at home.
        /skeptic
        • I’d say that what that post neglects to discuss is the original point regarding the lack of emergency care. If we don’t allow our home birth midwives access to the appropriate life-saving equipment, then they can’t handle certain emergencies at home. If they don’t count as medical professionals, as they don’t in a number of states, then they can’t bring simple things like oxygen or pitocin for hemorrhaging or anything that an EMT would have in an ambulance with them to the birth, and therefore, there is more mortality.
          • That’s a valid point. But there is a solution to that problem: get medical training.

            You can take EMT II courses here in California ($500 at PCC!) and pass an exam and have a license to carry all sorts of medical gear.

            I’m spectacularly unconvinced this is an insurmountable barrier for the midwife community.

          • Granted, I fully submit that some states may have ridiculous barriers towards dual-licensing or whatnot.
  38. Well, that’s it for me. In a few minutes, I’ll be heading off to the airport to fly to Vegas this evening. (Confidential to RW — my iPhone just totally died, in a case of truly spectacular timing.) I will no longer be responding to comments with any consistency.

    Thanks to everyone for participating in this conversation, which has been predictably… lively. It will have to go on without me. If anyone would like to call me an arrogant, idiotic, phallocentric woman-hater, now’s your chance. I’ve said all I care to say, and so now’s a perfect opportunity for me to bid you all adieu.

  39. The important numbers are “preventable deaths by percentage of birth type”.

    There is a risk to going to a hospital. There is a risk to having a birth at home. You cannot compare the lack of risk in one case to the existence of risk in the other.

    If you have 100,000 births in a hospital, and 1% of babies/mothers die because of doctor malpractice, or complications from a C-section, and you have 10,000 home births, where nobody dies from doctor malpractice or complications from a C-section but 1% of the babies die from conditions that would be alleviated in the hospital, it’s a wash… (unless you have a precondition that would put you in the “likely to have complications” group, but that’s outside the bounds of this comparison). Your actual risk of bad stuff happening is 1%.

    If you have 100,000 births in the hospital, and 1000 fatalities, that’s 1%… if you have 1000 home births and 10 fatalities, that’s 1%. It’s not 1000 vs. 10. It’s 1% vs. 1%.

    However, it’s *not* a wash if, in addition, 10% of home births also *complete* at the hospital. It depends on how rigorously you differentiate between what qualifies as a home birth vs. a hospital birth.

    IIRC, some of the studies comparing home to hospital births suffer from this methodological flaw. Also, there is a problem with data limitations wherein deaths need to be properly categorized as “preventable”.

    Comparing, as well, home births somewhere where ready access to a fully-staffed hospital is minutes away to here in the U.S. is problematic as hospital access in the U.S. has a socioeconomic vector that may be more pronounced than elsewhere, as well as the training differential that the good doctor points out.

    My understanding of all of that collective evidence is that it is more risky for the average person in the U.S. to have a birth outside the hospital than inside one.

  40. FYI, the statistics for neonatal death for home birth does not account for planned vs. unplanned. 1/4 of all home births are unplanned and unassisted. The incident of death for infants is understandably higher in these scenarios. If they would only give the statistics for planned, prepared home birth with a midwife, the rate of death would be much lower.
    • Oh, please, Bethany. What unplanned homebirths are attended by a midwife? It defies all logic to claim that you cannot tell the difference between planned and unplanned births based on the stats, when you can remove all births that weren’t attended by a midwife. It is THESE stats we are talking about. The overall homebirth death rate is even higher.
        • Well then, when you consider the numbers of all the non-CNM midwives who are willing to identify themselves as such, you get 3x the hospital death rate. No doubt if you add in the illegal ones, it would be even higher. And of course, you also aren’t getting those deaths that were caused by homebirth but happened in the hospital (transferred before death, but too late to save baby). This would also increase the homebirth death rate. Either way, the rate of perinatal death is AT LEAST 3 times that of low-risk hospital birth.
          • I don’t think you understand what I am saying. The number of infant deaths that is being cited in here – the 3X greater rate- INCLUDES the home births that weren’t planned, and the ones where the mother chose to have a home birth without a midwife (unassisted childbirth). 1/4 of all homebirths are made up of those scenarios. If you would factor them out and only look at the number of deaths for planned homebirth with a midwife, the number would be lower. For low risk women, home birth is a safe choice.
          • You’re making half a correction, Bethany.

            Yes, you’re correct, the number of home births would need to be corrected for unplanned births.

            However, the corresponding correction would be that you’d have to correct the *hospital* births for “births that started at home, went downhill, and came into the hospital well off the normal treatment track that resulted in a bad outcome.

            So it’s not a given that you’d wind up with a lower number. In fact, it could very well be higher. I don’t know enough about the problem space to hazard a real guess.

          • Bethany, I understand exactly what you’re saying. You are the one misunderstanding. I’m not talking about *all* out-of-hospital births, including those at the side of the road. If you include those, the death rate is much higher than 3x the hospital rate. I’ve run the numbers myself, and I’m talking only about those births where the attendant is in the “other midwife” (i.e. not CNM) category. These are not unassisted births, they are births where a midwife is present!!! It you have a midwife there, it is clearly not unplanned.
  41. “The number of infant deaths that is being cited in here – the 3X greater rate- INCLUDES the home births that weren’t planned”

    No it does not. Virtually every scientific paper that compared PLANNED homebirths with low risk hospital birth has shown that homebirth has a perinatal or neonatal mortality rate that is 3-7 times higher than hospital birth.

    That has been confirmed by national statistics and by statistics in the states that collect them (Colorado, California, Missouri, Oregon [collects complaints about homebirth midwives]). The ONLY people who think that homebirth is safe are homebirth advocates.

    Colorado has had a rate of homebirth death that exceeds that of the state as a whole (including premature babies and women with pre-existing medical conditions) AND has risen in every year since they licensed homebirth midwives in 2006. California has a homebirth death rate that is double that of low risk hospital birth. In Missouri, the risk of intrapartum death at homebirth is nearly 20 times higher than hospital birth. Oregon has received complaints on 19 deaths, nearly 4 times the rate expected in the years the data was collected. And North Carolina is vying to be the homebirth death capital of the US: they had 5 publicly reported homebirth deaths last year for a rate 12X higher than low risk hospital birth.

    Do you notice any neonatologists recommending homebirth? How about pediatricians? These are the people whose sole interest is in caring for babies and they know that homebirth is not as safe as hospital birth.

    MANA (Midwives Alliance of North America) has collected safety statistics on 24,000 homebirths. During the years they were collecting those statistics, they publicly promised members that they would release them to “prove” the safety of homebirth. Then they analyzed them and reversed themselves 180 degrees. They now refuse to release the death rates of those 24,000 planned homebirths. It doesn’t take a rocket scientist to figure out that even MANA knows that homebirth death rates are abysmal.

    Consider the source: is there any professional homebirth advocate who isn’t making 100% or nearly 100% of their income from it? I can’t think of anyone, can you? Do you really think they would acknowledge that homebirth is dangerous?

    And who are the “thought leaders”? Gaskin, a self proclaimed “midwife” with no training in obstetrics, midwifery or nursing, who let her own baby die rather than seek medical attention. Henci Goer, as self proclaimed “expert in obstetric research” who has no training in obstetrics or research, and Ricki Lake, a washed up talk show host. Why on earth should anyone believe them?

      • Michel Odent is a general surgeon with no training in obstetrics. He has published no papers in reputable scientific journals. He makes up theories and feeds them directly to lay people. His most bizarre claim to date?

        In April 2008, Odent declared:

        ” That there is little good to come for either sex from having a man at the birth of a child.

        For her, his presence is a hindrance, and a significant factor in why labours are longer, more painful and more likely to result in intervention than ever.

        As for the effect on a man – well, was I surprised to hear a friend of mine state that watching his wife giving birth had started a chain of events that led to the couple’s divorce?”

        What is the genesis of this theory? Dr. Odent’s personally discomfort with attending the births of his children.

        “As it happens, at the exact moment our son arrived in the world, the midwife was on her way down the street and I, having made my excuses realising he was about to be born, was fiddling with the thermostat on the central heating boiler downstairs.

        My partner did not know it, but I had given her the exceptionally rare, but ideal situation in which to give birth: she felt secure, she knew the midwife was minutes away and I was downstairs, yet she had complete privacy and no one was watching her.”

        I raise the issue to point out that Michel Odent fabricates his theories about childbirth out of thin air. In this case, as in the case of his offensive claims about childbirth and bonding, he announced a brand new scientific theory without any research and without any evidence. He seemed to think that it was enough that the theory made sense to him and confirmed his personal preferences.

        It is easy for lay people to understand that Odent’s “theory” of fathers at birth is nothing more than a projection of his own anxieties and prejudices. It is important for lay people to understand that his “theories” of natural childbirth and bonding are also nothing more than projections of his own anxieties and prejudices.

  42. “Marsden Wagner, M.D. former director of the WHO; Dr. Michel Odent, ob-gyn and researcher”

    Marsden Wagner is a pediatrician who has worked for the WHO. His major “achievement” was claiming that a 10-15% C-section rate is optimal. In 2009, the WHO quietly retracted the recommendation acknowledging that there had never been any data to support it.

    Wagner’s books are written for lay people and he makes money from them. In addition, he appears at homebirth conferences. He does not publish scientific papers and does not appear at scientific meetings to defend his claims since most of them are indefensible.

  43. Thankyou for writing this post. I find it unbelievable that people still worship under-educated midwives such as Gaskin.
  44. I have to nit-pick something:

    While you did manage to differentiate between some European countries and the USA’s training of midwives, it should be noted that Midwifery training/licensure varies VASTLY from state to state in the USA. The training (usually a four year medical-college program,) licensing and (required) insurance that happens in Washington state, for example, would all be ILLEGAL in a state like Georgia.

    Judging all midwives and their knowledge in the USA by using a single person as an example is like judging all roads in the United States by a one-mile section of one main street.

    • RTFP. ” [I]f all homebirths in the United States were attended by well-trained nurse midwives, then I would have much less objection. What I object to is midwives like Gaskin who have no medical training attending deliveries where they are incompetent to take care of the infant should complications arise unexpectedly.”
  45. Wow, Russell, you really stepped in it with this post, but I thank you. I don’t have reams of statistics or anything, but I’m fairly confident I would be a single father — or perhaps just a sad would-have-been-but-not-a father if not for modern medical facilities for childbirth.

    Our first was delivered naturally but that was after pitocin induction following forty hours of intense labor. It just wasn’t going anywhere. My wife’s a tough lady.

    Our second was going ok and then she started to bleed badly. Ultrasound revealed placental abrupta(?). It’s where the placenta is covering the cervical opening. Without emergency C-section I likely would have lost both of them.

    As it is, thanks to modern medicine, we had two perfectly healthy (9.9 Apgar) girls. Home birth used to be the norm. Lots of dead mothers and babies was the norm too.

  46. this post was thoughtful and so well said. ina may kinda makes me wanna puke in my mouth. i hate when women reject science and say its empowering. so many otherwise smart women i know have fallen for the snake oil she is selling. they avoid hospitals to avoid episiotomies, IVs and cathaters, never giving any thought to the very real possiblity of postpartum hemorrhage or obstetric fistula.
    keep fighting the good fight.
    • “homebirth is quackery”? That’s a bit of a sweeping statement….I had a wonderful home birth with my 3rd child by a qualified Midwife in England. My first two births were straightforward and in hospital, I did not enjoy this experience, I was treated as though I was one of many, almost like a conveyor belt of labouring women and I was left alone for long periods, scared and nervous in the artificial surroundings of the hospital. Homebirth with a registered Midwife (where there are no complications) is a wonderful experience.
  47. This whole article and its comments made me really very cross until I took a deep breath and realised that THANKFULLY I live in the UK where things are different.

    Russell Saunders: I just want to ask (in a completely neutral way) what your knowledge of European midwifery and birthing is, seeing as you did say you were mainly talking about the US? I also just find the way things are run in American birthing a bit confusing, and if you could explain it to me a bit more I’d appreciate it. Sitting here in the UK and reading about how people can choose a midwife-led birth seems a totally alien concept to me because of the difference in how things are done.

    But midwives here aren’t lunatic quacks. If anything, the paediatricians here are. That wasn’t a dig at you, Russell, by the way, it’s just that women in the UK generally deal with either midwives, registrars or paediatricians during labour and the paediatricians don’t seem to be as helpful (they love to prescribe honey for colic- I can name you a whole hospital that would do that). And that’s pretty much it. I can’t think of a single person I have ever met or known that has met an OB in the hospital when they gave birth.

    Naima Van Swol: How do you know, you haven’t said how many of her books you’ve read or how many conversations you’ve had with her.

    On a side note, people in the UK (not just random people, but professionals) take a dim view on Amy Tutuer. People here think of her like you think of Ina May Gaskin. I’m not saying whether I agree or disagree because I don’t know enough about her.

    • In brief, I know very little about midwifery in the UK. From what I’ve been able to gather, midwives in the UK are required to have relatively thorough medical training, which is the primary deficit I perceive with CPMs in the United States. So long as midwives are required to have training to deal with the various exigencies that can arise with little or no warning in even the most typical-seeming deliveries, I don’t have any objection to their attending deliveries. I am wholly unconvinced that an entire class of midwives in the US are so trained. I cannot pronounce with authority about the UK, but my understanding is that their training is sufficient to alleviate almost all of my objections.

      And it is insane to prescribe honey for colic. Honey can cause infantile botulism in infants under one year of age.

  48. Yes, it is more than relatively thorough. Obviously, the NHS is flawed in its own ways, but to become a midwife here you have two options: become a registered adult nurse and then do the 18 month midwifery registration course, or do a midwifery degree and become registered at the end of it. The training consists of 3+ years of 6 weeks at uni, 6 weeks on placement (maternity wards, health clinics, in the community etc) rotations and to pass you MUST pass your exams, coursework, assignments etc AND have attended 40 births during your placements. They place equal weight on practical and theory. Then after that you can work for the NHS or be an independant midwife (although you must do the same training as an NHS midwife and keep up to date with policy), but there are talks about changing the system so that midwives are only allowed to work for the NHS.

    I would imagine the training would be enough to alleviate your problems with homebirths, because obviously the NHS isn’t an obstetrics-led model so when you give birth here, if it’s low-risk then SVD then you will probably only ever see midwives. You might find it interesting to know that homebirths here are also a bit different- first time mothers and women with previous difficulties in childbirth are discouraged from giving birth at home, but if you do decide to have one then you’re attended by a community midwife (which is either an independant midwife or an NHS midwife that works in the community). But they aren’t pigheaded when complications arrive, they call an ambulance and then you get rushed to hospital if they suspect you need more assistance.

  49. http://www.bmj.com/content/341/bmj.c5639.full

    Conclusions Infants of pregnant women at low risk whose labour started in primary care under the supervision of a midwife in the Netherlands had a higher risk of delivery related perinatal death and the same risk of admission to the NICU compared with infants of pregnant women at high risk whose labour started in secondary care under the supervision of an obstetrician. An important limitation of the study is that aggregated data of a large birth registry database were used and adjustment for confounders and clustering was not possible. However, the findingsu are unexpected and the obstetric care system of the Netherlands needs further evaluation.

    http://www.ranzcog.edu.au/publications/oandg-magazine/doc_view/762-16-trouble-in-paradise.html

    In addition to this, an editorial about USA homebirth states…
    http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Safe-at-home-Probably-not/ArticleStandard/Article/detail/751425

  50. Pingback: This is the paper of record?

  51. If this midwife, Gaskin, has been practicing for 20 + years with the (independent) oversight of obstetricians, and has assisted in thousands of births, than doesn’t that constitute (informal) medical training? At some point her experience became worth something. The midwives that go through medical training programs in this country, and other countries will have less medical knowledge by the end of their training and accreditation than Gaskin has achieved in her many years working as a midwife. Considering that formal training for midwives is a fairly recent offering it is likely that many of the instructors of these midwifery training courses were not trained formally themselves, but informally, in the field, experiencing real births, Just like Gaskin. Considering that she has been practicing for a longer period of time than it takes an OBGYN to complete their own training I would venture to say she is more than qualified to handle fairly uncomplicated childbirth, as well as many of the unforeseen complications she has run into over the years that have not resulted in the loss of an infant. You stated that the midwives send women with high-risk pregnancies to hospitals so that they can keep their numbers up. That is absurd. It is standard midwifery procedure to send someone with complications to the hospital in order for the patient to receive proper medical care pertaining to the complication. Midwives are for women who have normal pregnancies. OBGYNs are for women who have complicated pregnancies. Midwives are skilled in assisting knowledgeable women, who understand the process of labor and delivery very well, in uncomplicated childbirth. They are well-trained in noticing irregularities that indicate possible complications far in advance of them occurring, in order to send women who are at risk of complications to the hospital . They educate their patients on every issue, and the patient makes all of the executive decisions, which is why Gaskin has never worried about malpractice suits. She has made it very clear to her patients that they make the call, she just keeps them extremely well-informed. Her patients are accountable. If a complication occurs which results in damage or death of the child, the parents were probably very well informed throughout the process about the possible risks involved, and had the choice at many different points to continue laboring at home, or to go to a hospital. The parents made the informed choice to continue with the home birth. It was as a result of their choice, not their midwives, that the complications resulted in such dire conclusions.

    The fact is, there is no law stating that women must give birth in hospitals. That would be unconstitutional. Women have a right to give birth unassisted, with the assistance of a midwife, or with the assistance ob an OBGYN. The fact is that OBGYNs aren’t trained very well about handling normal childbirth. They are pathologists. They study pathology. they look for something wrong, and often find error where none exists. They look to hard, nd in doing so create complications. If I was confident that an OBGYN would just leve me the hell alone while I gave birth in a hospital until a complication arose, I would be glad to birth there but the fact is that an OBGYN is going to monitor you every step of the way, pump you full of mandatory but unnecessary fluids and drugs, force you to sit still for up to 20 minutes at a time to check the babies vitals (slows/stalls labor), have your dialation checked every hour (intoduces infection, slows down labor) disallow you from eating (resulting in lack of nourishment and energy when your body needs it most, for the last stages of labor). All of these things are not done because it is good for you and the baby (in fact is proven that the more you are monitored, the higher your likelihood of receiving a c-section) but instead in order to avoid malpractice suits. When someones main goal is to avoid malpractice, choices are made not in the best interest of the patient, but in the best interest of the doctor.

    My midwife had 4 years of formal medical training, and 7 years of experience without a single death. At no point during my Homebirth was the life of my child at risk.

  52. Although she does not have medical training in obstetrics, Gaskin has hands on experience with real women having natural births in a non medicals setting which is a lot more than anyone can say for many obstetricians that care for many of America’s pregnant women. Instead of criticizing, I feel ashamed of how messed up the training is for Americas medical professionals in maternity care that they don’t know how to facilitate a natural birth. One unlicensed woman is doing so much more for American maternity care than thousands of doctors. What does that say about our medical system?
  53. Fear is powerful and sadly in the US it is the controlling factor. The medical industry is messed up and women should do some research before they go to a dr and sign up for some unnecessary medications and procedures. Ina May rocks. Do some research and look at the stats; what she is doing clearly works. I mean why in the world would you hire a surgeon to deliver a baby; especially when childbirth DOES NOT require surgery. Fear is sad and will hold you back.
  54. So non-hospital birth advocates criticize obstetritions for not being well versed enough in natural birth, yet only want to use obstetrition services in crises. Sounds contradictory to me. Also, why is the hospital such a horrible place up until one needs it? Hmmm. Lastly, not all complications can be predicted and midwives cannot equal the speedy emergency response of a hospital team. Period. In my opinion, choosing to deny children that are being born access to readily available and timely medical treatment that may be necessary is child endangerment, and not ethical.
    • By your argument you should go straight to the ER whenever you take a car ride because you could end up needing medical attention at some point right? Allergic to bees? You should have your picnic outside the hospital. Its the only responsible thing to do right? Oh what’s that? You only want to go to the ER if you have an emergency? What a hypocrite. SMDH.
  55. So I missed Rose’s circumcision post when it was originally posted, and I just spent a few minutes reading through the comment thread. As a result, I’ve picked up a new game. Read through the thread and see how many words you need to read to determine which side of the snip/no snip divide the drive-by commenters are on. It’s amazing! In the space of a single comment thread you can identify buzzwords and talking points that you had never heard before, and then use them to filter out which posters are and are not actually participating in a real discussion. it’s a fantastic meta-commentary on political discourse…with dick jokes.
  56. Here’s a better idea. Men, stay out of my decision making. Its my choice to go to a hospital or birth at home. Why does this have to be a public issue at all? Why is the attitude still that women do not know enough to make their own life choices? Have your baby the way you want and I will have mine how I want. The need to control the choices of others makes your motives in taking a stand suspect. We silly little women can decide for ourselves.

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