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Wednesday
Mar092011

Comment to "Are Home Births Safe?"

I stumbled upon an article yesterday in the Charlotte (North Carolina) Creative Loafing, an offbeat "news" magazine (thanks Google Alerts!); I commented after the article, but it was subsequently pulled. So, here I am, writing my comment where they cannot touch it. (Can you see me sticking out my tongue at them?)  

"Are Home Births Safe?" by Tara Servatius takes potshots at the movement in Charlotte to demand the legalization of non-nurse midwifery. The demonstrations and copious Letters to Editors came about because Emily Medwin (called Amy) has been brought up on charges of practicing medicine without a license. This wasn't her first time and this recent charge came about because of two babies having bad outcomes. The parents did not charge Amy; the authorities did.

But, the demonstrations are not for Amy/against the babies; they are to demand a mechanism for legalizing the education and experience women acquire to oversee normal births in the home. Women are going to have babies at home. We can keep non-nurse midwives illegal and be guilty of shoving families to choose to birth at home unassisted or we can buck up and take a hand at creating a safer environment for these babies to come into. If anyone thinks the illegality of non-nurse midwifery will nudge (push) women to birth in the hospital, they are sadly mistaken. Women want... need... deserve... to have a choice on where they want to deliver.

Delivering at home is not about the selfishness of the mother... wanting her own clothes and bathtub to labor in... but about a mother making the conscious, educated decision to have, what she has found to be, a safer location for that birth.

Tara's article, in part, says:

"Since doctors rarely consent to supervise a home birth, where they will lack the equipment to save the baby's and mother's lives in an emergency, home birth is essentially illegal here unless you want to do it without assistance."

Uh, not true (about the emergency equipment). (See my full comment below.)

"Previous studies that showed no increased risk to the baby were flawed, the study found, because when complications arise and a woman is rushed to the hospital, which happens about 40 percent of the time during home birth, the death or injury to the child is recorded as a hospital birth."

EXCUSE ME?!?! "...a woman is rushed to the hospital, which happens about 40 percent of the time during home birth..."?!?! Where the HELL did you come up with that number?! (See my full comment below.)

She continues:

"Is putting your child at that kind of risk child abuse? Should it be? Home birth advocates, who are some of the most militant people I've ever encountered (HAHA!), claim studies like this can't be trusted because they are engineered by doctors profiting off services that aren't really needed. They say women should give birth where they feel most comfortable, and that childbirth has only recently been done in hospitals."

Yeah, doctors ONLY say these things to grab the 1% of women who birth at home... because that 1% is going to make or break their financial statements, right? Criminy, we know doctors believe wholeheartedly that birthing at home is dangerous the way we are just as sure as birthing in the hospital includes a buttload of interventions that have zero to do with life and death, but that cause problems that wouldn't happen in the home. (See comment below... you get the gist.)

She concludes with yet one more statement about how moms just want to have couches and their own kitchens while they labor:

"When a child's life is involved, it's not about what makes mom feel comfortable anymore. It's about the baby. That's why the state should leave the law just like it is — to protect babies from mothers who should know better. If Medwin wants to deliver babies, she should get a nursing degree."

I am just sick and tired ("and tired" always goes along with "I'm sick..." so says Bill Cosby) of this stupid belief that women birth at home because they want to be "comfortable." That is a sweet side effect, low on the totem pole, of the benefits to both mother and child. Let's begin the list of needless interventions, shall we?

- Continuous monitoring (that has never been shown to improve outcomes)

- Starving a mom (that has never been shown to improve outcomes and, in fact, has been shown to cause problems of fatigue and frustration... "...but the IV supplies all you need!" Bull caca.)

- Having an IV for the duration of labor (an open port, I'll give you, but the bag and pole? No thanks.)

- A 90+% pitocin rate sometime during labor and a way higher rate immediately postpartum (It's shocking that over 90% of women's bodies cannot figure out how to contract their uteri properly. My, how fast evolution has changed the human biochemistry!) Pitocin, of course, brings risks of fetal distress, a ghastly amount of pain for mom -which leads to pain medication... risks that get their own space, risk of postpartum hemorrhage, DIC, amniotic fluid embolism... and that's just a look at the biggies.

- Immobility - whether because it's inconvenient to have moms "wandering the halls" as I've heard a zillion times over the years, or because her tummy and legs are paralyzed by medication, being in bed has been shown, over and over and over, to not be a good thing for mom, the baby or labor. 

- Speaking of paralyzation, gotta yack about pain medication... sedatives, narcotics, regional anesthesia, oh my! Can't dare have an oyster, piece of sushi, a tuna sandwich, some brie on toast or fried bologna... and god forbid you should even consider a sip of wine during pregnancy! But, once you're in labor, the pharmacy is unlocked and ready to be loaded right into your veins... or spinal cord. What the hell kind of skewed thinking makes that alright?

- Putting women in a physical position that is atrociously uncomfortable... oh, but it's fine and dandy for the doc and that is what counts, right?

- Springboarding off the last awful position, taking women's legs and shoving them back, stretching the perineum beyond it's true need, causing tears that might not have happened had the women been "allowed" to birth in their own choice of positions. But, can't have the doctor disoriented with a mom on hands and knees; he might not know where to catch the baby!

- And off that one, doctors incessant belief they need to cram their hands in the woman's perineum and s t r e t c h it so angrily it makes my choo-chatch hurt watching. (I want to SLAP their hands; let me tell you the self-control that takes.)

- We cannot talk about pushing on one's back, knees in the ears, hands crammed in the vagina without mentioning the SCREAMING everyone (but the mom) seems to think must be part of any birth no matter if mom is medicated or not, if the baby is coming slowly or fastly, it matters not. SCREAMING is one hospital ritual that makes me want to scream. And not "Take a deep breath, let it go. Take another deep breath and PUSH! (and then in screeching voices, rarely in unison) 1-2-3-4-5-6-7-8-9-10! Do it again!!!"

Ugh. I'm stressed just from writing about those pointless interventions that have zero to do with the crucial operating room down the hall... THE reason given for not birthing at home. I'm too exhausted to even start down the after-the-baby's-born path, which is, sometimes, three times as long as the mom's!

But, rest assured, many more women having all that extra "care" mentioned above will visit the operating room, so apparently, the medical folks do see its necessity a lot more than homebirthing women do. What is behind the curtain, however (and not just the one during a cesarean), is the doctors, administrators, insurance companies and all sorts of "well-meaning" (but delusional) people standing on each others' shoulders... like cheerleaders at a football game... each one demanding their own rules, their own regulations, their own reasons for doing what is done. What a flipping mess of confetti all their rules, regulations and requirements make.

This, dear reader, is what the homebirthing woman is seeking to avoid... the cacophony of stupid, pointless, and, dare I say, potentially dangerous crap that comes with "the hospital ride." Sometimes, we just want to say, "Who in their right mind takes the hospital ride on purpose?"

(I swear, birth in the hospital has to change. It's simply absurd all the [can I say crap again?] crap they do to women that has no impact on the safe outcome they all seem so worried about.)

Finally, here is my response to the article mentioned wayyyy up there, above my rant. The response that was deleted. Wonder why?

<my letter>

I am a Licensed (in California) and Certified Professional Midwife who does believe the midwifery process needs higher standards and more experience before sending new midwives out on their own.

However, it is really important to be aware of the distinction between midwifery care and medical care. Many states (CA, FL and WA for example) make clear distinctions between the two. Midwifery focuses on the normal in childbirth whereas medicine takes the more complicated cases. It is true that cases can become complicated mid-stream, so if they were having a homebirth (midwifery), they would transfer to the hospital (medical care) to receive advanced medical care.

I take great exception at Tara's saying that 40% of homebirth clients transfer or are transported to the hospital. In over 25 years of attending births, I have never heard a higher rate than 15% from any homebirth midwife. Any midwife who had a 40% rate, needn't be practicing homebirth midwifery because she's taking on wayyyyyy too many high-risk women.

It's also important to know that in most states where midwifery is legal, midwives do have life-saving equipment... from oxygen and neonatal resuscitation skills (required by law) to medications for a hemorrhage or antibiotics if mom needs them for her GBS prophylaxis. Licensed Midwives can suture (and yes, we do carry and use Lidocaine), have experience with sudden emergencies such as a shoulder dystocia or a surprise breech baby.

It is crucial for all midwives to be honest with their skill set and their knowledge limitations, but for those who are well-educated, keep learning over the years, adhere to the community standards of care and practice within their abilities, helping a healthy woman who wants one to have a homebirth is a valuable gift to women in our communities.

None of this speaks about the complications that can occur in the hospital because of the routines, many (most?) of which have zero to do with an emergency. Starving women, keeping them in bed, and anesthetizing them all have risks that do not occur in the home.

Women are not just choosing to have a homebirth for selfish reasons. Women are choosing to have a homebirth because they have weighed the pros and cons after informing themselves completely and deciding that, for them and their babies, a homebirth is safer.

Therefore, the women marching in your state are not marching to celebrate the midwife who's having troubles, but are marching to bring the awareness of the incredible importance of licensing and legalizing midwifery in North Carolina. Women are going to have homebirths. Women who are, deserve to have a woman with a proven record of education and experience behind her. It is when midwives are legitimized that intercommunication between the midwifery and the medical models are able to provide the very best care... individualized care... so mothers AND babies are kept healthy and safe.

<end comment>

So there. sticking my tongue out again  

 

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Reader Comments (13)

It is embarrassing when a comment on an article is better researched than the article itself. They need to retract that article (except that then no one could read your comment)

March 9, 2011 | Unregistered CommenterZoie

I am in Charlotte and from what I understand, the author of the Creative Loafing article had two C-sections. I don't know whether the first one was an emergency, an "emergency," or scheduled; but I know the second was scheduled because I remember her writing about it.

She may be a woman and a mother, but she is hardly someone with a stake in the legalization of homebirth midwives.

March 9, 2011 | Unregistered CommenterAmelia

I honestly have not been well-educated on homebirth and did not understand why women were choosing them. After reading this article I can say I better understand why some women choose this method. What I can't understand is why your comment was pulled, other than the fact you dared *gasp* to have an educated opinion different than the writer of the article. Your comment was to the pont and informative and pointed out that women have the right to choose their delivery method. Each family needs to research and choose the delivery method best for them and be prepared to adapt their choices if medically necessary. Thank-you for a little extra insight!

March 10, 2011 | Unregistered CommenterMelissa

Great post. Can I ask why you're in favor of a port for an IV during labour? Do you think ALL women should labour with a port?

March 10, 2011 | Unregistered Commentermichelle

I posted a comment too. It's not the ignorance of the author that makes me mad, it's the fact that she is spreading it without thought as to the consequences.

March 10, 2011 | Unregistered CommenterSuzanne

I think what makes me saddest is the photo at the end, because the mom (and dad) looks so much like a friend of a friend who was recently induced (AFAIK, no medical indication). She was a primip, got to 3 hours of pushing with baby at a negative station the whole time, and was sectioned for "CPD." And yet...

In any event, I have very little doubt that the 40% number came from an OB, L&D nurse or someone in a similar position, and was completely pulled out of the ether (to put it politely). In that context, I'm almost heartened that they didn't go ahead and make it 80% or 99%, but I guess there's something about 40% that sounds more believable.

I've been trying to twist myself into a pretzel at how any sort of real statistical analysis could even SEEM to indicate a 40% transfer rate, even misleadingly, but I'm not seeing it. It really sounds like an "observation," at best.

The only thing I could think of would be... if we assume that A) a hospital actually officially tallies the number of women who are HB transfers, B) babies whose BCs indicate they were born at home also have associated info on whether the HB was planned, and C) that those moms are far more likely to lie and claim the HB was unplanned (possible). That would skew the proportion significantly, if you took out "unplanned" HBs, whether they actually were unplanned or not.

The only other thing I can think of would be if there were some sort of statistic like this which existed (doubtful), and it included any woman or baby who visited a hospital for any reason within 2 weeks postpartum. Like a post-birth transfer for stitches, a circumcision, etc.

But even then...

Occam's Razor tells us "40%" is a guess by a hospital admin, nurse, doctor, etc.

March 10, 2011 | Unregistered CommenterDreamy

A port for an IV during labor is not necessary. If there is an emergency, any drugs needed (like Pit) can be given by shots.

I heard some childbirth educators encourage their students to pack a snack bag for the father. The educators encourage the students to eat while in early labor at home. Once at the hospital, the hospital will not feed the laboring mother. The students are told that research doesn't support "nothing oral". Some of the laboring mothers might raid the father's snack bag. =-) I know of one childbirth educator said to pack some sugar sticks or lollipops for the laboring mother.

I am grand multipara (5 or more term pregnancies). I am "risk-out" for a homebirth with midwives. Lucky I found an OB who is laid back. He said that I don't have to have the port of an IV as long as I don't get dehydrated during labor.

Dealing with hospital staff might be another story. I am planning on protecting my right to refuse any intervention I don't want.

March 10, 2011 | Unregistered CommenterMartha Ellen

EXACTLY! arrgghh, it is so frustrating. We recently had a Dr write an OP-ED for our local paper in response to a HB (the New Years Baby born at home).... he titled his response "Homebirth Still Risky Business." I wanted to write back, but it is so frustrating to know where to even start. I wanted to say EVERYTHING you said above, it just drives me crazy that people can't handle it! People against HB think it is so simple, so black and white. I just had my 3rd HB two weeks ago... it is not about comfort. I laugh at that one bc I had the living room all set up, nice comfy bed on the floor, plenty of room for attendant, husband, and other kids.... we end up having the baby in the half bath with me leaning over the counter and everyone else trying to cram in! LOL!

March 10, 2011 | Unregistered CommenterAndrea W

Martha Ellen: Um, that is 100% NOT true that all emergency medications can be given via IM injection. And, most certainly, blood cannot.

That said, no I do not feel a port is 100% necessary. What I *was* saying was, among that list of totally not-emergency procedures the hospital does for zero reason except their convenience or old old wives tales, a Saline Lock (port) *can* be something that can be considered helpful in an emergency.

And, if we're on the hospital ride and have to pick and choose what we're going to be annoyed with and what we're going to refuse, the lock isn't the worst thing to give in on. Yeah, yeah, sucks all the way around that there's game playing, but let's also be realistic, okay? I'd rather have the lock than being kept in bed or induced for someone's convenience, kwim?

But, with informed consent, each woman gets to make her own compromises (or not). I do know compromises can make a tense relationship with the nurse a whole lot softer. It's *much* nicer to labor and birth with softness.

March 10, 2011 | Registered CommenterNavelgazing Midwife

Thanks for this post. Unfortunately, the author of the article is also a radio talk show host and has been so skewed on her view of our situation here, I have to think she has let her own personal experiences and biases get in the way of honest reporting. She also stated that MANA would not release it's HB infant morality stats, which is not true and is easily googled and found in 5 min flat. Amy is one of the most experienced and best midwives in this state. But it isn't all about her, is it? We have been fighting for years here and it's exhausting. And stressful. Yet I do it, we do it, keep serving the mamas and babies. I can't even imagine being able to practice openly. I hope change is coming. Because it could have been any of the CPMs here instead of Amy. Women in NC deserve what most all other women in the world have, access to legal competent midwives.

March 11, 2011 | Unregistered CommenterCPM in NC

Wonderful post. I wrote about my home birth (my first baby!) here: http://amyelizabethsmith.wordpress.com/2010/12/07/my-home-birth-of-ezra/ I felt safe and confident that I could birth my son without a medical interventions! It is so sad how much people are scared into giving birth in hospitals.

March 15, 2011 | Unregistered CommenterAmy

Thank you, thank you, thank you! I have been a homebirth midwife for 30+ years. Ten years ago I got my CPM which did not change anything I do, it just made me "more acceptable" in some situations. I NEVER HAVE HAD A 40% TRANSFER RATE! I would stop doing what I do if this were true.
karen, Washington State

April 18, 2011 | Unregistered Commenterkaren

I totally agree with everything you've said above. Doctors definitely do pointless things when "assisting" women in birth. I had the pleasure of having my 3rd baby at home with a midwife and the only thing I regret about the decision is NOT having a home birth with my first two kids. All of my family, including in-laws, were very afraid for me to have a home birth, but my husband knew I had already made up my mind. My mother-in-law even asked me if I had to get permission from the hospital to have birth at home! Thank God for mid wives, because I plan on never having another baby in a hospital......I have about 3 more to go!

January 2, 2012 | Unregistered CommenterShundrekia Smith

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