Whose Blog Is This?
Log onto Squarespace
« Discordance | Main | Blog-sidings »

Response to ACOG’s & the AMA’s Homebirth Resolution

The resolution says, en toto:

Whereas, Twenty-one states currently license midwives to attend home births, all using the certified professional midwife (CPM) credential (CPM or "lay midwives), not the certified midwives (CM) credential which both the American College of Obstetricians and Gynecologists (ACOG) and American College of Nurse Midwives (ACNM) recognize[1]; and

Whereas, There has been much attention in the media by celebrities having home deliveries, with recent Today Show headings such as Ricki Lake takes on baby birthing industry: Actress and former talk show host shares her at-home delivery in new film [2]; and

Whereas, An apparently uncomplicated pregnancy or delivery can quickly become very complicated in the setting of maternal hemorrhage, shoulder dystocia, eclampsia or other obstetric emergencies, necessitating the need for rigorous standards, appropriate oversight of obstetric providers, and the availability of emergency care, for the health of both the mother and the baby during a delivery; therefore be it

RESOLVED, That our American Medical Association support the recent American College of Obstetricians and Gynecologists (ACOG) statement that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers [3] (New HOD Policy); and be it further

RESOLVED, That our AMA develop model legislation in support of the concept that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the AAP and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers. (Directive to Take Action)

Fiscal Note: Implement accordingly at estimated staff cost of $1,929.

Received: 04/28/08

[1] http://www.acog.org/departments/stateleg/MidwiferyYearinReview2007.pdf, accessed March 18, 2008

[2] www.today.msnbc.msn.com/id/22592397, accessed March 18, 2008

[3] www.acog.org/from_home/publications press_releases/nr02-06-06-2.cfm, accessed March 18, 2008

I respond:

It’s true. Hospitals are a safer place for mothers and babies to be during labor, delivery and postpartum. If unexpected emergencies appear, as they sometimes do, hospitals have more personnel, more medications and more opportunities to save a mother’s and baby’s life (cesarean deliveries, hysterectomies, ICU, etc.). Simply by virtue of being in the hospital, women have every medical, surgical or practical tool at their disposal; this spectrum of options cannot possibly be offered in the home.

When women having homebirths have complications, where do they run? To hospitals.

I can understand the thought process of doctors:

How come hospitals are so sucky as a rule, yet they are the gleaming white knights in an emergency? Why do we have to “clean up” the mess made at their beloved homebirths? Why do we legally risk ourselves when too many midwives don’t even have malpractice insurance? Why are we expected to accept patients whom we know nothing about in the middle of a life-threatening crisis and the midwife is able to release accountability and become the woman’s doula? Why, when a homebirth transport comes in, do the women still think they have a right to force us to adhere to an unrealistic and sometimes absurd birth plan? (I know you all certainly wonder) Why do women listen to midwives – women with far less education and experience than we have? How can women implicitly trust a woman with no license or a license that isn’t even nationally recognized or accepted? What do they say to get women to be so militant against doctors, hospitals and medicine?

The answer?


Hospitals and doctors make their own beds with their actions and words.

I understand there is very little to be gained on the economic front and that is not your motivation. I understand your heart-felt concern is for the life and health of the mother and baby. I understand that you feel any inconvenience should be tolerated and the “birth experience” is ancillary to the final outcome.

But, you see, the hospital “experience” is abhorrent to many women. When the experience includes procedures, medications and a dismissal of a woman’s individuality, the risk of being at home doesn’t seem so great after all. When women describe their hospital birth experiences in terms of “birth trauma,” “birth abuse,” and “birthrape,” something is terribly wrong with the system.

It is the hospital system itself that writes the homebirth script. If you want women to stop having homebirths, you are going to have to make some major changes in how you operate. I firmly believe if the hospital and physician care weren’t so egregiously offensive, cruel and inhumane, the Unassisted Childbirth (UC) movement wouldn’t be accelerating.

It is in the typical birthing experience in our country that sends women away from medical care and into the hands of homebirth midwives or planning UCs.

If I were on the committee to re-vamp the hospital system, being blunt with ACOG and the AMA, these would be my recommendations:

1. Stop de-personalizing women by putting them all in hideous hospital gowns.

I know you are probably rolling your eyes, but women HATE those gowns and understand that whatever they wear (of their own clothes) will be tossed into the garbage after the birth. Removing personal articles from women is tantamount to institutionalizing her. It’s vulgar.

2. Stop calling women “Momma,” “Mom,” “Mother,” and use her name.

It is rude at best to diminish a woman to a universally used word instead of acknowledging her individuality by remembering her name, not just the vagina, in front of you.

3. Since birth plans are so similar, perhaps listening to what the majority of them ask for would be prudent.

You know the drill… no continuous monitoring, encouraged (not just “allowed”) to ambulate in labor, encouraged to eat and drink in labor (and not assume every woman is headed to the operating room), no routine IV (most women are cool with a saline lock)… and how about bringing in birth balls, huge tubs and the accoutrements that homebirths and even in-hospital birth centers provide. If LMs, CPMs, CNMs and CMs can learn to maneuver around water labors, ambulating women and women on hands and knees, then surely educated physicians such as yourselves can.

4. Stop offering medications when women ask for them not to be mentioned.

We all know medications and epidurals are an inch away; we don’t need to be asked, “Where is your pain on a scale of 1 to 10?”. Women who want a natural birth work hard to not think of labor as pain. Again, if women in the hospital want something for pain, they darn well know they can ask for it. It is extremely disrespectful to a woman’s desire to re-frame her perception of pain in labor, all this Pain Scale stuff.

5. Educate nurses and yourselves about the importance of reverence in labor and birth.

Speak softly, knock before entering the room, look in a woman’s eyes, SLOW DOWN, listen when she speaks and THINK before you do; stop when she asks you to stop (touching her, the vaginal exam, lying to her, etc.). While this might be the 20th baby you’ve “delivered” today, it is that woman’s ONLY birth that day… perhaps the only baby she will ever have.

On the same note, when you are the surgeons during cesareans, SHUT UP about day-to-day topics and remember where you are – standing at the birth of a human being. Imagine the doctors and nurses yacking about the best sushi restaurant of the moment while your daughter (or spouse or mother) is taking her last breaths on earth. That is exactly what it feels like to many women when you act like you are cutting on an anesthetized woman. This woman lying there feels – perhaps not the skin incision; her heart and spirit are not numbed. The same respect and consideration are due humans joining the earth as humans leaving the earth.

6. Stop using your status as a means to manipulate or lie to women when they ask you questions.

Educated women are so tired of “the dead baby card.” There are times when life and death occur, but there is an enormous leap between, “We need to rupture your membranes so we can put an electrode on the baby or your baby might die,” and an abruption. Your exaggerations and attempts at –or out and out manifestations of- risks must stop. I believe the manipulations are one of the major reasons women ignore what obstetricians (and many nurses) say. If you always spoke the truth, your word would stand stronger. Crying wolf takes on a whole new meaning with physicians in the baby business. Nowhere else in medicine can you find this level of untruth streaming towards patients.

Just today a woman told me about her two mild decelerations in an eight-hour period that caused a doctor to take the husband outside and say the over-used phrase, “If she were my wife….” The doctor insisted on an “emergency cesarean,” yet the woman didn’t find herself in the operating room for another 4.5 hours. Interestingly, her surgery was at 5:00 pm. Coincidence? We are sure not. How can you wonder why she wants an out-of-hospital birth this time? Such absurd scenarios pepper your medical records; we see it all the time. Stop it.

7. Find a way to open your hearts to the pain and sadness in women whose births don’t go the way they expected.

Of course women “shouldn’t” have a cement-set vision of their births, but many women do have desires and wishes and it is deeply sad for them when things turn out differently. Try and talk to her like a human being in pain, not just a physical body that can be repaired with staples and numbed with Vicodin.

I understand your belief in the impossibility of seeing each woman as a human being. I understand you think if you hear every woman’s fears, pains and concerns you will surely commit suicide from all the pain foisted upon you. I understand that you think you just don’t have the time for all that emotional stuff. I understand that you believe listening is for a therapist, not a technician like a doctor. I understand you are busy, busy and just can’t possibly have any more time to offer women so they can whine and cry about this or that.

But, you are wrong.

The best and most beloved of doctors touch their clients… if not physically (although many do this as well), then emotionally. They take a few extra moments to listen to women, not just hear them. Re-frame your own perceptions of women speaking about sad, painful or difficult topics. It isn’t whining; she is speaking from her heart.

The great part of all of this, though, is that when you open yourself to a woman’s pain, you also have given her the space to share her joys, laughter and triumphs. It isn’t all negative “energy” that comes from pregnant, birthing and postpartum women. It is a mix of emotions, just as life is a mix of joy and sadness.

Through exquisite sadness comes exquisite joy.

8. Demand more (compassionately-trained) nursing staff in Labor & Delivery units.

Women know one reason they are encouraged to have epidurals is to keep them immobilized and quiet. (Did you know that?) It is much easier to staff a unit with women who don’t wander the halls or moan with each contraction. We know it can be disconcerting to watch women give birth without medication, especially when you believe women are suffering needlessly. But, one reason women choose midwives is we are able to BE with women in their transitory state of labor towards becoming a mother (or mother again). Being able to not just tolerate, but embrace an unmedicated woman’s labor is a wonderful gift of understanding and kindness to women. It’s okay if she’s loud. If she “scares the other women,” take the lead and explain the wonder of an unmedicated labor and birth to the frightened patient. People reflect the emotion you express, so express goodness instead of disgust or dismay when speaking to other patients regarding unmedicated laboring women. And really, if it’s so distressing to everyone, sound-proof the rooms; technology abounds.

Have nursing staff attend doula trainings to develop the compassion necessary for work in L&D units. Seeing birth from another angle can do nothing but expand her capabilities with unmedicated and medicated women alike.

9. Institute doulas in all L&Ds.

When the above goals are met, doulas become the physical and emotional augmentation for nurses in the unit. If the woman no longer has to hire a doula to fend off the medical interventions, she becomes what she was designed to be… the loving support person for the laboring couple.

10. Remember that birth is unpredictable.

You chose to be obstetricians. Birth happens during the entire 24 hour day and night. If you are one of the many that “nudges” women to birth during the daylight hours, whether with pitocin or cesareans, shame on you! If you are tired, either suck it up or find more help in your practice. If you are on-call, sit yourself at the hospital for your call time. Coming and going, wooshing in at the last second of birth, discussing a woman’s care via telephone and forcing women to stop pushing until you arrive are incredibly insensitive and sometimes cruel ways to treat a woman birthing a human being. Probably the number one complaint I hear about obstetricians is their absence in birth. Women are shocked at how little they see their doctor – any doctor - once in labor. A major reason women hire midwives is because they are physically present for labor, birth and postpartum. A nurse is not a replacement for your care. If you feel labor sitting is beneath your skills and a waste of your time, perhaps losing the OB portion of your title is called for. Women pay for your care. Isn’t it time you care?

11. Accept that as long as the System remains the way it is, women will continue having home and unassisted births.

There will always be a segment of society that desires homebirths and it behooves the medical world to do what it can to make the emergency transition from home to hospital palatable. While hearing “We want you to see we aren’t monsters in the hospital” when a woman moves from home to your L&D units is less than comforting, the sentiment behind it offers a moment of understanding in why some people choose homebirths in the first place. If all of you really want us homebirth advocates to not see you as monsters, quit acting like ones!

None of the above requests include anything about the prenatal and postpartum period. Often, your prenatal demeanor belittles a woman’s questions and concerns. It isn’t uncommon for your appointments to last mere moments after the multi-hour’d waits in the waiting and exam rooms. Calling a woman by her name and looking her in the eyes as you speak goes miles towards building trust and goodwill. Women who trust sue less. If there is no other motivation to humanize your demeanor, consider that studied fact; women who know their doctor well typically do not take them to court.

One reason midwives are rarely sued by the client, much to your bafflement, is exactly because communication between midwife and client is so extensive. Communication builds trust and trust allows the care provider to say, “We really need to do a cesarean,” and the client/patient saying, “Okay.” I know it sounds simplistic… and it is really that simple.

Risk is a part of life and those that choose homebirth are accepting that risk. Women don’t just want an “experience,” they want compassion, respect, some semblance of autonomy and the knowledge they are being seen as an individual, obtaining individualized care. It might seem selfish or bizarre that someone would take that risk, but it seems a risk to step into the hospital and be put on the production line that includes unwanted (and often unneeded) medications that are used to speed up the production line, being pressured to immobilize and be silenced and strong-arming that all too often ends in a cesarean.

While it seems I am only focusing on what you all need to do, I also know homebirth midwives could always use more education. The schools work hard, and are working harder, to include the vital information that keeps a woman safe at home and to know when a transfer/transport are necessary long before it gets to the critical stage. Midwives don’t wait until the last second; we understand the time element that can be crucial in life and death.

A glaring error in your Resolution says that CPMs are “lay midwives.” That is incorrect. A lay midwife has no formal education in midwifery, but only learns through apprenticeship or even on her own, rarely studies birth as is done now. It is rare to find a lay midwife, even in states where there is no licensing. In California, the National Association of Registered Midwives (NARM) exam (which, if passed, creates a CPM credential) is accepted by the Medical Board of California as the bar women must leap over in order to be licensed in the state. The same can be said for other states that have adopted the NARM exam as acceptable for licensing. Licensed and Certified Professional Midwives are not lay midwives. Using that sort of inflammatory language leaves the homebirth/natural birth advocates shaking their heads knowing you still don’t understand even the basics of what women want or need. I am the first to say licensed and CPM midwives’ education doesn’t equal a certified nurse midwives’, but we do have book learning, CPMs now graduating from accredited schools. We also have experience in natural birth and in knowing normal birth, we are hyper-aware of when birth deviates from the norm.

Another issue I have with your Resolution is your acceptance of out-of-hospital births with CNMs. Do you not know we carry the same equipment and medications (except for sedatives and an isolette) as what sits inside a free-standing birth center? Once again, having all the correct information before writing public pronouncements would help your image amongst those that have issues with you.

Instead of bashing midwives, wanting to outlaw homebirth and perpetuate half-(or un-) truths, understand we aren’t going anywhere and it might better serve women and babies if you supervised us (as CA law requires) or at least collaborated with us. Talk to your insurance carrier, create a resolution that you cannot be sued when patients transfer care from a midwife without taking that fact into account, find a way to tolerate (at least!) midwives so the relationship doesn’t have to be so antagonistic. We’ll also do our part in continuing to educate ourselves, create increased opportunities to practice vital skills and work towards licensing in all 50 states.

I know this is long, but I hope it’s been at least somewhat enlightening. Please consider the requests above. They will fast forward the goals you desire - to have more women birth in the hospital; the location we all know is the absolute physically safest place to have a baby. Physiologically, probably not. Interpreting the difference is paramount.

References (3)

References allow you to track sources for this article, as well as articles that were written in response to this article.

Reader Comments (66)


The women who want or need a hospital birth need to rally on their own behalf--they do not need to be rescued by you, me, or anyone. Of course, I support all the points you made about improving medical maternity services. I would sign a petition in favor of those changes, and part of my work is to encourage women's/families' understanding and empowerment when it comes to their use (or potential use) of medical services. But out of self-respect and respect for women, women's choices and women's real power, I focus on where my own passion lies--homebirth. And I fully trust that when those women who want or need hospital birth are ready, they will move to insist upon changes in med. maternity services. There is really nothing wrong with your focussing on hospital birth as you chose to do--I admit that it irks me because in my opinion, there is such a deep need for us to STOP paying attention to what medicine is doing, and to give our precious energy instead to homebirth, where it is so needed.

Regardless of the comparative numbers of births that you and I have each assisted, it is certainly no secret that birth does not always go as planned. No secret that sometimes, birth takes sudden turns for the worse, not only gradual ones. Birth is a life and death matter--we will never change that. But I did not say that homebirth is safER than hospital birth; I said that birth as designed is 'safe enough' ('as safe as life gets'). Neither hospital nor homebirth is actually safER than the other--they each have their own benefits and risks. What surprises me is that you would claim unilaterally and without condition of any sort, that hospital birth is safer than homebirth. Sorry, that is simply untrue. I cringed to read your words, not only objecting personally but also a bit horrified that you, with your apparently wide readership, would make such a statement.

Surely you, as a midwife, understand the particular situations that may make the hospital safer for some mothers/babes. But without qualifying your statement on safety, it appears that you are saying that hospitals are safer than home, across the board. And we all know that that is not true--we know all too well by now that most hospitals nowadays are the least safe place for normal healthy mothers and babies (and even for many of the at-risk ones), physically, spiritually and psychologically.

June 30, 2008 | Unregistered CommenterMaggie


I'm coming to believe you just like being contrary. I'd rather think that than you are just plain mean.

Hospital birthing women rally for their own cause? Are you kidding? I am not trying to "save" them, I am HELPING.

How is a woman who is transported at the last minute going to "rally" for her rights? How are first time moms who know nothing about the politics and ways of hospitals supposed to speak up for how they deserve to be treated?

Why wouldn't any woman who has a voice NOT want to speak up for women who can't/don't know how to speak for themselves.

If I... or anyone who has inside information... don't speak up, isn't that just cruel and morally wrong? Aren't we in a community-type of culture that watches out for others? Don't we depend on each other for information and advice?

I hear you that you think I should *only* talk about homebirth, but hospital births affect me and my clients, so, no matter how distressed you are by my decision, I will continue speaking about hospital births. If you don't like it, quit reading!

And hospitals ARE *physically* safer places to birth. You can argue all day long that they aren't; you are wrong. If they weren't, women wouldn't transport to them from homebirths. If it was safer to stay home, there wouldn't be ANY transfer or transport. But hospitals have SO much more than we homebirth midwives have access to. It's not an opinion; it's a fact.

If *you* believe homebirths are safest - for anyone - that is your prerogative. I am holding to my own knowledge and experience.

Does any of this mean I am going to stop being a homebirth midwife? No. Will I continue working towards the advancement of education for homebirth midwives? You bet. Do I think women can have healthy and wonderful homebirths? Of course!! Or I wouldn't be there.

Women... ALL women... deserve to have amazing care... whether it is at home or in the hospital.

June 30, 2008 | Unregistered CommenterNavelgazing Midwife

Well, Barb--

I do like to challenge people sometimes. I also like to be challenged...we can all help each other out that way. Contrary? Mean? I guess it's all in the eyes of the beholder. I heard some good things about what you'd said on this topic (from other blogs) so I came to see. And--again--I do not disagree with any of your proposed changes to med. maternity care.

And I am bothered by some of the things you say, and how you say them. Sadly, when it comes to my challenges to those things, you have not been a good listener and have consistently responded to things I did NOT say. Which I don't really understand; this is a written medium and the words are preserved--not like in a verbal conversation, where you get one chance to hear with your ears and might hear incorrectly. Here, you actually have someone's post to refer back to, their actual words, so that you can be sure that you are really responding to what they said. And still, in both of your responses to me you have ignored the things I actually said and instead responded to some other message. This makes it seem as if you are deliberately twisting my intent.

I don't get that.

June 30, 2008 | Unregistered CommenterMaggie

Thank you so, so much for this post Barb - you really nailed it. Because of some underlying health problems, my pregnancies were high-risk. I did develop complications and all my children were born in hospitals (as will be any future children). I wish some even a few of the points you made would become the rule instead of the exception - it would make a world of difference to women like myself who have no other option.

As a woman, I believe it is critical for us to advocate for each other instead of moving toward more division. Many - not all, but many - women going through pregnancy and birth may going through the most emotionally and physically vulnerable situations they will ever encounter. Instead of being judgmental of "choices" that may not be much of a choice at all, why not try to advocate (as Barb does so eloquently here) to improve the way all women are cared for during their births?

I know all of this has been said already, but I just wanted to add a personal "bravo!"

June 30, 2008 | Unregistered CommenterAlex P.

I AM a mom of six who had a baby this last time in the hospital and spoke up for myself, I'm no young wilting wall flower. I did, while in labor, speak up for myself. Then, with nurse manipulation, felt guilt for speaking up...who knows why. I then lost my power, and submitted to many things I did not want to. I personally do not think I was a bad mom or weak woman chosing to go to the hospital instead of home birth. I don't want a home birth. I want to have my baby and be allowed to birth as I need to in the hospital. This is my choice, and what I want. Sadly, many women are epiduralized, and just eleven years after my first born baby, I believe it's causing some nurses to treat women differently. Everyone ran around like chickens with their heads cut off for me, especially since I was in pain...and was encouraged (ahem) to stay in bed. My point here is that I did speak up for myself even afterwards. I told the nurse a day later that I was violated by too many cervical checks, and because I was trying to "be a good patient" I didn't insist I could pee when I wanted, didn't insist I be in the shower, and didn't insist on no cervical checks...and very little monitoring. I was told I could sign out any procedure, and this I did not know. No one told me, why would I assume it? When I told my OB how things went, she said, "well you did have that one decel." Yep, one decel, and I was confined to bed for five hours and not allowed to go to the bathrroom, and I pooped on the sterile plane they didn't want me to put my feet in. Because of how labor goes for me, I didn't tell the nurse what I wanted, I suggested...and she ignored.

Why would I go to the hospital in the first place? Maybe I don't want to have a crowded home crowded further with people...while I'm birthing. I know my parents or my inlaws can come over. I have six children now, and for me it's not relaxing to be around them when I'm in labor. I can walk, but it was summer this last birth and it was HOT. I would have had to walk at the mall...and don't wanna do that (may do it next time given a chance). My husband doesn't want me to homebirth partly because I tend to go from laboring and handling things well to pushing baby out. I do not have warnings that we can see that baby is about to come out until baby is crowning and then out. I've had three births without the OB in the room, one was without a nurse to catch. I do not have the "bend down and catch the baby" instinct, so baby bounced on the bed and sucked in the meconium. My husband doesn't want to cut the cord, much less catch. So, if I had an unattended birth, I'm not likely to catch the baby myself. I tend to get at least a nurse in the room now after they see my chart. This to me gives some added safety for my baby at the time of birth.

I don't know any homebirth midwives, though maybe I could find one. This last birth, I was told my baby had a 1 in 53 chance of trisomy 18 and I thought I might get time with a live baby if I was in the hospital (the screen ended up being a false positive). Anyway, I thought since I didn't have amnio, if baby started to "crash" I'd get a c-section and might get to see a live baby if there were chromosomal issues. This could not happen with a homebirth midwife. Also, my home is a mess...this is my fault, I'm a natural messy. Sure, I do clean with the nesting urge, but cannot imagine getting everything ready for a birth. I actually enjoy the quiet alone time I get with baby in the postpartum period. Since I'm not much of a needy mom, nurses really leave me be and leave the baby be for the most part (okay, they do things to get my older uterus to contract...for a while on day one...but beyond that, they leave me alone most of the day). I get to nurse and hold baby and have time with just baby and me. This I will not get at home with the chaos that is my lovely life. I like my life, don't get me wrong, but as noisy as the hospital is, it's quiet and clean, and if baby has an immediate problem, there's immediate care a button away.

If I pay the bill, I should be able to birth in a humane way. I can say what I want, but the listening is short term, they move on and go back to what they were doing. I'm just a "mom who was unhappy with her birth experience" or a mom who wants natural child birth and am weird. I also only know things from the birth side of it, not from the "provider" side. It helps to have a provider speak out. I do appreciate people who are there who can say, yes Dawn, you deserve a better birth even if you go to the hospital. Really, here in KS we have the option of homebirth or hospital, and the nearest birth center is an hour and a half away. There's not much that I know about local midwives.

Anyway, I have read up on things, read many birth stories, and think homebirth is great. I just do not want to do it unless I have to. I am changing providers, and if a midwife run center opens up, I will use it. Otherwise, I plan on having a hospital birth if I ever get pregnant again, with either a midwife, or a local doctor that backs up the midwife (or maybe just the lucky nurse catching since I do not have much warning at the end). I am switching hospitals because I have a new provider. I'm trying to make a statement with my feet. I may write a bit out there in newspaper land or blog land to try to encourage more women to look at their choices, in fact I already have. I've even had the law changed in Kansas in reguards to fetal remains after miscarriage, I am no slouch of a woman. I do advocate for myself. However, I appreciate the voice Barb offers out there. She offers hope that maybe we can change the system for women who can't, won't, or don't want to stay home to birth.


June 30, 2008 | Unregistered CommenterAnonymous

In our institution we have just approved a new pain scale JCAHO approved called the coping algorithm.
See link http://awhonn.confex.com/awhonn/2007/techprogram/P1031.HTM

After looking at so many blogs I am so bothered by how women are treating each other. Of course this issue is loaded because it is a fundamental feminist issue and quite charged at that. We can all spin our beliefs and data how we want without speaking in a patriarchal and belittling way to one another.

I have enjoyed this blog and would like to comment about home vs hospital safety.

We have data that shows for the low risk women (and we must compare apples to apples) there is equivalence in outcomes in terms of perinatal morbidity and mortality between home and hospital. So if you do have a catastrophic emergency at home you may not have everything at your fingertips, this is true.This fact does not make hositals inherently safer. And if you birth in the hopital you may have interventions that lead to unneccessary surgery and a resulting catastrpohic occurence, this is true. This fact does not indeed make homebirth a safer place to have a baby if you are low risk. The issue is about risk. Both places are safe places to have your baby as a low risk women if you only measure safety in terms of live mom and live baby.

In addition,I pose the question: where are the gold standard studies that define hospitals as the safest place for low risk women to birth? We can not just infer based on technology available or not available.

A woman and her family, after being informed (this area needs considerable work in our country)should be able to decide if they feel safe at home knowing that in the case of a rare but catastrophic event there may be injury to mom or baby. They are often weighing this against the risk of multiple unnecessary interventions which could result in a catastrophic and deeply dissatisfying and disrespectful and traumatic experience. They get to decide where they feel the safest.

Even if we humanized maternity care in the hospital setting and decreased the risk of interventions and surgery in birth I think many women would choose homebirth if it were the normative model in this country as in others, but it is way too loaded here in the USA

I think when we look to the issue of 'good outcomes' in maternity care we must look beyond the notion of a live mom and a live baby. This calls us to expand our definition of safety. Much recently has been written about optimality in maternity care. Optimality is much more dynamic and complex than our oversimplification: a live baby and a live mom is the goal.Safety includes physical safety, emotional and spiritual safety, cultural safety and an optimally functioning mother-infant dyad and family unit. At the end of the day, the women and her family should choose what is safest to them. Their choices should be respected.

When they come in as a transport and still have unrealistic expectations for the birth in this way the midwife has either failed to prepare them for hospital transport and what may ensue or the client can't get beyond the control thing and is likely the reason she ended up at the hospital in the first place. We can't blame this women for not understanding and hanging onto control. This is a symptom of our deeply dysfunctional system that women feel so afraid and out of control. If we had a better system that allowed more interaction between the HB midwife and the hospital the transports would go smoother and I think there would be less of this. Often times in many town the HB midwife and client are treated so poorly they are on the defensive.

Anyway...just some ramblings and I hope we can all be more tolerant of each other's strong opinions.

July 1, 2008 | Unregistered Commentermoonbelly

Moonbelly... do you see me giving you a standing ovation?!?

You said *exactly* how I feel about the variety of topics you spoke about.

Wonderful! Just wonderful.

Thank you so, so much for taking the time to write this out. I should make it a post!

July 1, 2008 | Unregistered CommenterNavelgazing Midwife

Well thanks. I am sleep deprived and I have so many things spinning around in my brain after I surf these blogs about birth lately (New to the blogging thing...). I get saddened, angry, frustrated and hopeful to see so much attention being given to birth and a new generation of feminists coming up to bat with the wise women. I really feel like my thoughts get all jumbled and convoluted.

For me the real issue is a issue of choice and women's bodies and babies. I suspect this is also why it is such a loaded issue. The safety piece of these arguments is trumped by the reproductive rights issues.

I would like to see studies looking at Optimality in home vs hospital including women's birth intentions, rates of interventions, women's lived experience, satisfaction with experience and provider, empowered or traumatized, breastfeeding or not, separation of infant and mom or not, skin to skin etc..., and of course typical morbidity and mortality comparisons. For example, taking many of the items in the Listening to Mothers surveys and combining this qualitative data with quantitative data together in order to determine optimality in maternity care.
The Optimality Index = normalcy as the standard and points off for interventions and non evidence based care...gross oversimplification.

For more info on Optimality in maternity care check out JOGNN Nov-Dec 2006, many articles.


July 2, 2008 | Unregistered Commentermoonbelly

I am really glad that you wrote all of this. I feel exactly the same way about birth. I know that the hospital is a safe place, but with all of the lies and manipulation that some women endure, it's not exactly the most comforting place to be when giving birth.
I gave birth almost 3 months ago, and I realize that things didn't go perfectly, but no longer can I blame anyone else for that, because I knew that anything that didn't go well was because I didn't speak up. Of course, I think a lot of that comes from being intimidated by "more knowledgeable" hospital staff (aka L&D nurses). I'll be honest that even though my nurses were great during labor, when I had to push, I pretty much wanted to kick them. I had to hold my breath, sit in a very awkward position, and wear an oxygen mask.
I was in no position to try to change anything except the mask--which I eventually took off myself and refused to wear because it was actually HARDER to breathe with it on, and it didn't help that it made everything hotter, too.
Had my experience been at home, I can almost guarantee that I would have been a lot more comfortable, but because of rules and restrictions by the hospital and doctor in charge, I ended up in a lot more pain than even I could endure.
Everything you said about changing the hospital experience was right on the money.
I can't imagine a better hospital birth experience than the one you have envisioned here. It would be so wonderful to have staff who called me by name, allowed me to wear my own clothes, didn't restrict me with silly archaic rules that don't really change the risk at all.
Anyone who says that we should stop complaining ought to go her merry way and do as she pleases, but I appreciate the efforts of any woman or man who wants to help women have a better birth experience, in OR out of the hospital.

July 7, 2008 | Unregistered Commenterbetweenbabies

I know this post is about a week old but....

I'd like to say thank you for advocating humane and appropriate care for ALL women, not just the ones who subscribe to the same beliefs about birth that you do. It's disappointing to me that someone would suggest otherwise.

I am a woman who is choosing a birthing center. It's a very well respected center in my area, and advocates a family-centered birthing process. My doctor, a DO who's a bit odd to say the least, respects the choices we have made looking forward to the birth of our child. I would not feel comfortable or in-control in my home.

Not every woman who wants or needs a hospital birth does so without education. We aren't naive or ignorant of what happens in many hospital settings, it's not as if we don't know. I've made a choice between two hospitals because one had a model of care I was substantially more comfortable with, I've done my research, I know what I'm doing. I don't need someone to advocate for me because I'm misinformed, but because we should all be advocating for each other to have the freedom and respect to make the best choices for our own families.

July 7, 2008 | Unregistered CommenterJenandAsh


I don't think anyone suggested advocating for anything less than humane care for ALL women, and not just for those who share the same beliefs. I did say that I was disappointed that Barb spent time on talking about hospital birth--only for 2 reasons:

one is that homebirth, with a national rate of barely 1%, needs every ounce of attention and energy possible from those who do support it. Anyone spending time on hospital birth cannot then spend that time promoting homebirth.

and secondly--out of respect for those who want/need to have a hospital birth, I personally step back and trust them to empower themselves. I do of course support humane appropriate treatment of all women, wherever they choose to birth and for whatever reasons. Pretty much everyone I know, does! And again, I'd sign a petition if one went around in support of major changes on the hospital front. I DO actively support education and empowerment of clients (and friends and fam, regardless of their choice in place of birth) when it comes to their use of med. services. And just as I cannot 'give' a woman a good homebirth experience but only support her gift of that to herself, I also cannot give hospital birthers the power or intelligence or will to make changes for themselves in their chosen birthplace.

Barb and lots of other mws and others can say a ton about needed changes in the hospitals. But it is only when mothers themselves speak up, say no, insist on what they know to be appropriate safe care, that things really will change.

And no, this does not happen when they are laboring. It happens before and between those days of our lives--in the way we conduct ourselves at each and every visit with a doc, in letters written to docs, hosp admin, politicians, etc, and staging protests and all that stuff that people have done all over the world to make for change.

Interesting to me that first, Barb dis-interpreted what I said...repeatedly and in spite of my attempt to draw her back toward my original meanings...and that then others jumped onto Barb's dis-interpretation of my meanings, and have since spoken as if her interpretation was actually what I said. Annoying, exasperating...and interesting.

July 11, 2008 | Unregistered CommenterMaggie

Perhaps, Maggie, that we all read what you said in the same way.

Jabbing at me and the others isn't going to win anyone understanding you any better.

And it IS entirely possible to work towards humane hospital births AND support - actively - for homebirths. Your inflexible ability to see what we see is what causes you distress and a belief that I am arguing and misinterpreting what you have to say when, in fact, most of us read you the same way.

This latest post is MUCH more clear than the previous ones and had you said these things in THIS way, I believe we wouldn't have had the whole "misinterpreting" discussion at all.

I do believe, however, that you are wrong.

July 11, 2008 | Unregistered CommenterNavelgazing Midwife

Thank you so much for this concise article. I had one hospital birth in Ulaan Baatar, Mongolia and I was abused by the doctors. I was slapped, yelled at and ignored at times. I decided "never again!" I was not giving up on birth, however, and when we found out I was expecting again, we knew homebirth was the way to go. We ended up having our daughter unassisted at home. 2 years later we had our second unassisted birth at home. Those births were not without "complications" (variations) but we were able to handle them because we had educated ourselves.

I am currently working with doctors here, in Mongolia, to change the system. In our town, especially doctors are very irresponsible and babies and women die all the time without explanation. it's so sad.

I am not a "real" birth instructor but my 2 homebirths were pretty much Bradley births. I teach a condensed version of the Bradley course here and am slowly but surely changing the way couples and doctors view birth.

Kudos to you for speaking up about natural birth and home birth!

July 13, 2008 | Unregistered CommenterMelanie

For our first birth I went to a CNM at a freestanding birthcenter. She was shocked when I denied every test she had to offer me after I educated myself and found how incorrect the outcomes can be and unnecessary some are. I swear she was raised by OBs!

We had signed a form saying we didn't want any form of induction and she ended up sweeping my membranes anyway. Her midwife friend told us that she had (and the exam hurt a LOT and took forever) and then she denied it after.

We ended up with a hospital birth. I had a minor temperature that conveniently went down by the time we got some fresh air and went across the street to the hospital.

Her name is Simona. She had to leave the next day...which is probably why she was so eager to get the baby out that night.

This next kid we're planning a homebirth with a traditional midwife!

July 30, 2008 | Unregistered CommenterMrs. and Mama Knifton

Mahalo for your awesome response to their continued ignorant messages.
I look forward to the day when insurance companies will cover any birth a woman wants and hospitals and physicians will work with midwives and doulas

August 5, 2008 | Unregistered Commenterluvnbnmama22

It's not just about the hospital birth experience being abhorrent; for me, it's about the hospital interventions potentially interfering with a natural but very finely tuned and even delicate process, and causing the very complications that hospitals are designed to deal with.
I know there are complications that can occur at home, but I believed that my risk of experiencing those complications for myself and my baby was far lower at home.

BTW: I had four home births, two of which were surprise unattended births as the midwife missed the births.

March 18, 2011 | Unregistered CommenterD. Lane

PostPost a New Comment

Enter your information below to add a new comment.

My response is on my own website »
Author Email (optional):
Author URL (optional):
All HTML will be escaped. Hyperlinks will be created for URLs automatically.