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Mar172013

Scathing Commentary About Oregon's OOH Births

Here is a link to commentary by Judith Rooks, CNM, also a CDC-trained epidemiologist, regarding the status of out-of-hospital births in Oregon in 2012. The statistics themselves are horrid, but her commentary is what I want to highlight.

She says:

"But out-of-hospital births are not as safe as births in hospitals in Oregon, where many of them are attended by birth attendants who have not completed an educational curriculum designed to provide all the knowledge, skills and judgment needed by midwives who practice in any setting."

"Many of them" she says. Not a few. Not some. Many.

To those who make comments about babies dying in the hospital, she addresses you, too:

"There are very few term IP (intrapartum) fetal deaths in the hospital. Most fetuses in prolonged distress are delivered by cesarean section. Estimated rate of IP fetal deaths is 0.1-0.3 from the authoritative literature, based on studies in Canada and Europe. Data on all term fetal deaths cannot be substituted for IP fetal deaths."

She also points out that while she removed one baby from the stats that had congenital anomalies, those babies are not removed from the hospital statistics.

I'd love to see Judith Rooks have a national job doing this for all 50 states and the District of Columbia. Think we could gather enough money to hire her?

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Reader Comments (7)

I'd gladly pitch in on that effort. Thanks Judith for your honest review. I hope the conversation that comes from it can be improving educational standards and safety for better options in OOH birth.

March 17, 2013 | Unregistered CommenterSara Snyder

Your link somehow didn't come through, but I think I found the original post through Google; I'd love to see what you linked to.

I'm not 100% comfortable talking about this publicly, as I'm not strong enough right now to defend my reputation, so I apologize for the anonymity.

As a labor & postpartum doula in Oregon, I've been appalled by what my clients have shared about and by what I've seen from CPMs and DEMs in my state. I feel helpless when a client shares a story about a midwife's mismanagement -- usually not so blatant as to be something one could easily sue over (and what postpartum mother wants to get involved in a lawsuit?). All I can do, as someone often in a position about hearing of these things secondhand, is send them the necessary information to file a complaint with the state licensing board and the certifying organization.

I've watched acquaintances start the PEP process, and listened to apprentices talk about things the midwives they're working with have said. To my knowledge, yes: these women are extremely well-versed in what normal labor and healthy mamas & babies look like. They are equally poorly versed in what it looks like when things go wrong, AND they are often so afraid of mainstream Western medicine that they hurt their clients. I think this is appalling when we have the number one nurse-midwifery program in the nation right here in state -- how can direct-entry midwifery education be so poor?

That being said, I am again choosing to work with homebirth midwives for my second delivery. My first baby involved a transfer, and I'm hoping to avoid one this time. But the midwives I am working with are a rare blended CNM-CPM practice. They are possibly the most conservative (in terms of medical well-being) midwives around. When I was interviewing them with my first, the founder explicitly said: "Our priorities are healthy mama and baby, vaginal delivery, and homebirth. In that order." Their actions bear that out. I am thrilled to see them constantly teaching and apprenticing new midwives, because their values are the ones I want midwives everywhere to espouse.

Oregon needs better education for direct entry midwives and increased collaboration between mainstream birth professionals and homebirth midwives. In terms of choices, Oregon is one of the best places in the country to give birth. The education of its direct entry midwives should be up to those standards. I wish I knew how best to advocate for that.

March 17, 2013 | Unregistered CommenterAnonymous

Judith is an amazing midwife & epidemiologist and it was smart of Oregon to collect that data and get her to present the results. She is an advocate for out of hospital births, she was the PI on the National Birth Center study that was published in NEJM. She ties science and compassion together in her advocacy of *safe* out of hospital birth, which is not what we have in Oregon right now. Thanks for posting this information. Often OBs & hospitals are railed against for their non-evidence based care. Time to look in the mirror and turn that fervor toward the improvement of out of hospital care.

March 17, 2013 | Unregistered CommenterLarissa

I would love for Judith to do that, too. She is well respected on both sides of the issue!

March 17, 2013 | Unregistered Commenterareawoman

Hey! I have been reading your blog for the past 1.5 years or so and I've never commented, but love your blog! I am a Certified Nurse Midwife, I just graduated in December 2012 and have been searching for a job that allows me to truly practice the midwifery model of care. I am very interested in working in Oregon and have been considering practices that also have CPM's (and a few LM's) and do both freestanding birth center births and homebirths. However, I also want to be as safe as possible while also giving the woman choices in birth (which is hard, especially in the southeast). Are the statistics that you posted for DEM's only? Do you have any stats on CNM's attending OOH births? I do have to say that my opinions of OOH dramatically changed while in school.....I do think that women should have access to them and believe that they CAN be safe, but also realize that the USA doesn't allow many of them to be safe....transfers, credentialing of providers, etc. Any advice you can give for a new CNM on OOH birth practice is welcome!

March 18, 2013 | Unregistered CommenterNewCNM

I'm very much ready for this conversation to enter the realm of midwives - so midwifery can make the necessary improvements in regard to safety and standards of practice.

A mature group of professionals would recognize that data collection exists to inform the profession - not solely to validate what it's already doing.

Since the data does not support the assertion that "OOH birth with a midwife is safe, if not safer, than hospital birth" they sit on this data and hope and wish and pray that no one is paying attention.

March 19, 2013 | Unregistered Commenterex-apprentice

And that's why we chose a birth center in Portland with a CPM who was very clear with us that if she knew she couldn't handle the situation, we'd be heading to the hospital. And we did, with a cord prolapse. Everything turned out fine, and kiddo will be seven this June. I'd be happy to share more if you're interested.
-J

March 24, 2013 | Unregistered CommenterJanelle

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