"It was the most cozy, lovely, lush experience."
That's a description of childbirth, accomplished at home, by candlelight, with the help of a midwife. It's pretty when it's pretty, but what if the baby dies, and it wouldn't have died in the hospital? Indiana is prosecuting a midwife:
Stacey A. Tovino, who teaches at the Health Law and Policy Institute at the University of Houston Law Center and has written on midwifery and the law, said prosecutions of midwives almost always started with a tragedy.Every birth is a potential disaster! So is every car trip. Lots of us assume we will be lucky, especially when the odds are in our favor. That's why when we lose we say "Why me?" We rarely think to say "Why not me?" The question is whether the state ought to save us -- and our children -- from our relentless optimism.
"No one complains until a baby dies or a mom dies," Professor Tovino said. But once the issue arises, she said, legislatures often become involved as well, with doctors and midwives engaging in a bitter struggle over the proper regulation of midwives, one driven by a mix of motives that are difficult to disentangle....
"Midwifery is an autonomous profession," [a midwife, Mary Helen] Ayres said. "It's an art and a science that predates the medical model of care. Midwifery sees birth as normal and basically safe.
"It's made safer by reliance on the woman's power," she continued. "The medical model assumes the woman is passive and her body needs to be acted upon. Every birth is presented as a potential disaster from which every woman needs to be protected and potentially rescued."
Labels: Indiana
posted by Ann Althouse at 8:48 AM
84 Comments:
I personally think the wiser choice is a hospital, but I also think it should be up to the parents.
"The question is whether the state ought to save us -- and our children -- from our relentless optimism."
In a word, NO.
No mention is made of the cause of death. Would a hospital birth have made a difference here?
Why would they publish a story with such a gaping hole?
My two were born in a hospital, but with a midwife for the second.
I think it's interesting that the midwives cast the debate in terms of the ancient traditions of home birthing v. male doctors and their clinical, dehumanized notions of medicine. Is something better simply because it's older, particularly when superior medical treatment is available? After all, we're not Druids.
Personally, the gross-out factor is pretty compelling. Would you sleep in a bed where someone had given birth? I hope they threw out that mattress...and the box springs, just to be safe.
Also, "midwiffery" (as it's pronounced) is a funny world.
Er, "word." Sorry.
"No one complains until a baby dies or a mom dies," Professor Tovino said.
Interesting quote, since no one involved in the case is complaining. The parents do not blame the midwife for the child’s death and she is not being charged in connection with the child’s death. This is not a standard-of-care case.
Instead, this case is about two things:
1) Under Indiana law it is legal to have a home birth and it is also legal to practice as a licensed midwife; however, doctors and nurses by-and-large choose not to perform home births and Indiana does not provide a licensing process for non-nurse midwives or recognize (as many other states do) national certifications for midwives.
The Indiana House several times has passed a bill to license midwives, but it has not been allowed out of committee in the Senate (the Health committee chairwoman is a nurse and very opposed to midwives).
2) Prior to the prosecution of Jennifer Williams, there were a couple of deaths from untrained midwives delivering high-risk babies (e.g. two months premature) and the parents not obtaining appropriate medical care for the child after it was born.. There are a lot of religious issues connected with the other deaths and since Indiana does not license midwives, there is no way to distinguish between trained and untrained practitioners. I am having trouble posting a link, but if you search for “Doris Mae White” it will pull up one of the cases.
People choose to not use medical services all the time, whether the child who is at risk matters, I would say yes and that should be a factor. But not everyone feels that way.
(the Health committee chairwoman is a nurse and very opposed to midwives)
I really enjoy the little tidbits one learns in a blog.
Lots of studies show that for a normal pregnancy, birth at home is as safe, or even safer than a hospital. Countries where this practice is used often have some of the lowest infant mortality rates. Some good stats on this are in Sheila Kitzinger's books - she's an anthropologist who has done research on this.
Obviously meant to add developed countries where homebirth with a trained midwife is used have lower mortality rates, not just any home birth!
Childbirth is certainly normal, but it's a bit ironic to claim that it's basically safe while criticising modern health care. Childbirth is now basically safe, but primarily because of modern health care. (Though I'm guessing there's probably a debate there)
patrick--
You say that no one involved in the case is complaining; remember that one person involved is dead & it's hard to complain when you're dead. (I'm assuming that when you say no one is complaining, you mean it's therefore not the state's business)
Obviously meant to add developed countries where homebirth with a trained midwife is used have lower mortality rates, not just any home birth!
There is a real problem comparing infant mortality rates between countries. This is because different countries have different ways of reporting a "live birth"
In the US, any infant who takes asingle breath before expiring is a live birth and their death counts in infant mortality rates.
In France, Germany and other countries, it is not a live birth until the baby is registered. This normally occurs 3-5 days after actual birth. An infant who dies in that period does not get included in infant mortality rates.
In Russia, low birthweight/premature babies who die before reaching a certain weight are not counted.
In other words, I would be VERY careful in drawing any conclusions from comparing infant mortality rates.
My other point is that if it were only the mother involved, I have no problems with whatever medical or non-medical practices they choose to indulge.
In this case, there is a baby who has no say in the decicision. It is a fully legitimate function of the state to protect that infant's life. This may mean protection against the mother's ignorance or negligence.
So as a liberal/lbertarian,I have no problem with requiring medically trained personnel at birth.
John Henry
My mother is certified nurse-midwife (master's from Columbia U.) who practices in hospitals with full medical backup in cases of complications, which of course are relatively frequent in childbirth.
Her opinion as a feminist who believes in empowering women is that anyone who has a birth at home is an idiot, and the "lay midwives" (as she calls them) who help them are in over their head and grossly irresponsible.
And if somebody dies when you are practicing medicine without a license (as opposed to being a cab-driver who had no choice but to help with the delivery), you deserve to be prosecuted. The Times stressed that the midwife "is not charged with causing or contributing to Oliver's death." Well, sure, that's hard to prove. The prosecutors took the easy case.
Sad, very sad, all around.
(Oh, a good friend of mine has two healthy young children who were delivered in her living room. Everyone was delighted with the experience. Everybody has a story.)
Dear Professor Althouse,
I can't say if mortality rates are the same for home-birth of an uncomplicated pregnancy v. hospital birth. It certainly makes sense though since hospitals are notorious for their nasty antibiotic resistant bugs and my impression is that complications are fairly rare in routine pregnancies.
My wife had our first two children in a hospital with midwives and we were happy with the experience. Our third daughter was born at home, but not on purpose. Other than the terror of actually having to perform the delivery myself, the third birth experience was far better than the first two. The quiet privacy and familiarity of our own home and the lack of idiot orderlies constantly bursting in made for a memorable and moving experience.
If it is the case that the risks are the same for home-birth v. hospital birth, then there is a good arguement for home-birth.
Best regards,
dbp
"It's made safer by reliance on the woman's power."
Invoking the "it's okay because a woman is superior" rule again.
The state should not save you from your "relentless optimism". However, midwifery is illegal in IN unless the midwife is a physician or nurse with the proper qualifications, and this midwife deserves to be prosecuted. Had the parents chosen a midwife who had the legal qualifications to be a midwife in that state I would have nothing really to say about any of this.
And one issue that I haven't seen discussed is how this midwife represented herself to the parents in the first place. I'd have to believe that she didn't tell them she was not a legal midwife, or I'd think the parents would be in some legal jeopardy as well.
Should the state save us from our relentless optimism? I guess the question is where should the state draw the line. It allows pregnant women to get in a car as often as they like despite the fact that two-thirds of pregnancy trauma is the result of car accidents.
I wonder if more babies would be saved by disallowing pregnant women from the use of a car than would be saved by disallowing home births.
I wanted to have my second child at home. Not because of the cozy, lovely, lush experience, but because the hospital where I had to give birth had killed off and permanently disabled a jarring number of babies and mothers in the six months before my due date. Killed off, mind you. Actually caused the deaths and disabilities through the stupid mistakes of its own staff.
However, as a military dependent, I didn't get to make the choice.
Although this is beside the point, those of you who advocate for government managed centralized healthcare might want to consider this anecdote.
I have friends whose baby died during a home birth from causes that probably would not have resulted in death had the birth taken place in a hospital. The state prosecuted the unlicensed midwife, against the wishes of the parents. That process horribly complicated their grief, which was already bad enough. Their marriage did not survive the experience. It was a nightmare, and enough to put me and everyone who knew them off home birth once and for all.
eye doc, on your question about the parents' knowledge -- my friends, at least, were fully aware of their midwife's unlicensed status. They wanted a home birth, disagreed with the state's position on license requirements for midwives, and took the risk. There were no legal consequences to them, but their identity was made public in the course of the proceedings against the midwife, and their judgment was called into question -- so it was all quite painful.
I am not normally a fan of the state interfering in decisions of this kind but I agree with the commenter who pointed out that there is a baby involved in this decision who does not get a voice. In this case, it seems to me, reasonable state regulation may be justifiable.
One reason I believe in hospital deliveries is that you never know. One kid I know went into distress during her delivery. It was, of course, picked up immediately on the fetal monitor, and was solved by giving her mother oxygen. If that had not worked, they were ready for a C-section. But in most home deliveries, it would have gone unnoticed, and the baby born with potentially some brain damage. Most likely not noticable, but there.
Then, upon birth, a complication was discovered than ended up with her in the infant ICU for a day or two. Two pediatricians were there immediately. Yes, she could have been rushed to the hospital, but this was much, much, better.
So, how many home deliveries do end up with some minor damage to the babies that is not readily detected? I know another kid who was delivered at home by midwife, and has the emotional maturity of a kid 4 or so years younger. It could be fetal-alcholol syndrome, or it could be an undetected problem with the birthing - something that would routinely have been detected in a hospital.
During that entire article, I kept thinking of the scene in "Airplane!" that parodies the public-access cable talk show, with the female 'guest' saying "If this country were run by vegetarian women, instead of flesh-eating men..."
(accompanied by a sign-language translator, who gives up halfway through and just starts making "jerk-off" motions...)
CB patrick--
You say that no one involved in the case is complaining; remember that one person involved is dead & it's hard to complain when you're dead. (I'm assuming that when you say no one is complaining, you mean it's therefore not the state's business)
As I said in my original comment, this is not a standard-of-care case. Neither the parents nor the state is complaining about the care given. You can read my comment for the context this remark was made in. This quote sums up what the case is about, if you are interested:
“After an investigation, Williams was found to have acted appropriately both in the delivery and her response to the emergency; but she was later arrested for practicing medicine without a license. . . .
“I acted completely appropriately,” Williams says. “The charges are not about the baby, or because of anything I did or didn’t do at the birth, but because the state of Indiana requires midwives to be licensed, but does not provide a way for that to happen.” . . .
http://www.nuvo.net/archive/2006/01/25/desperate_midwives.html
Having a baby is a pretty big deal. I can't imagine not wanting the full resources of a hospital at your disposal in case complications should arise.
That said, having a baby is not, in itself, a complication. Giving birth or assisting someone who is giving birth is not practicing medicine.
I'd keep the state out of it.
Had the parents chosen a midwife who had the legal qualifications to be a midwife in that state I would have nothing really to say about any of this.
Eye Doc, the problem is that the state only licenses Nurse Midwives, and as the article states, Nurse Midwives generally do not provide home births.
I have a cousin who lives in Indiana and had her second child at home. Her first child was born in a hospital, and was taken away from her moments after it was born. It was an hour before she knew whether her child was dead or alive. It turned out that it was fine, and had just been taken for a standard exam, but no one was available to tell her that. She had what was probably the worst hour of her life because of the medical profession treated her baby like a tumor that needed to have a biopsy run on it.
She didn't want that to happen with her second child. She knew about the law but she disagreed with it on principle, and so she was willing to work with someone who was flouting it.
How many women and newborns are harmed by having the birthing process in hospitals? I imagine it would vary from hospital to hospital and the *actual* quality of care and resources available. It doesn't make sense for me to make this decision at a state-wide level unless there can be some really tight quality assurance in hospitals that really shows a lower rate of complications for women who are forced to give birth in hospitals versus women who are allowed to choose to give birth at home.
Ross: My mother is certified nurse-midwife (master's from Columbia U.) who practices in hospitals with full medical backup in cases of complications, which of course are relatively frequent in childbirth.
Not to question your mother, but maybe her perception of the frequency of “complications” is influenced by practicing in a hospital. A study following 5418 women (98% from the U.S. the rest from Canada) who planned to deliver with a midwife at home found:
“Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.”
(go to www.bmj.com and search for Daviss as author), summary of intervention rates at:
http://www.cfmidwifery.org/pdf/CPM2000.pdf
A lot of the “complications” in hospital births are self-created. Inducing labor (approximately 20% of low risk U.S. hospital births) leads to substantially more complications than if labor is started naturally.
http://www.expectantmothersguide.com/library/pittsburgh/EPGinduction.htm (discussing Belgian study of 15,000 births) found:
“The women with induced labors used significantly more pain medication and had more cesarean births due to both fetal distress and stalled labors. That group also had more forceps and vacuum births and had more babies admitted to intensive care.”
These are big studies tracking thousands of births and they don’t demonstrate a lot of medical advantages to giving birth in the traditional “hospital” way. On the other hand, using lots of unnecessary procedures and interventions is a good way to shield the doctors and hospitals from legal liability if something does go wrong
I think it should be noted that the midwife being prosecuted in Indiana could legally practice in more than 30 states based on the certification she already has (provided she applied for the particular state's license). Indiana chooses not to recognize this certification (or, more appropriately, the chairwoman of the Senate Health committee chooses not to recognize it).
This not so much a case about standards-of-care as about market regulation, which Indiana is within its rights to do, but where is the research supporting hospital births? Anecdotes are nice, but when the research doesn't support a position rational people should take a step back and reconsider.
One of the benefits of federalism is that states are allowed to experiment. Most states have chosen differently from Indiana without suffering undue negative consequences. If horrible consequences follow from allowing Certified Professional Midwives to deliver babies at home, shouldn't these consequences already be occurring in the many states that legally allow this to occur?
This is just an anecdote.
Our daughter (19 days old today!) was delivered by a pair of nurse-midwives, in a hospital environment, with an assist from a nurse specialized in fetal monitoring.
I consider this to have been the best of both worlds. Had we delivered at home, our daughter likely would not have survived - her cord was true-knotted. Had we delivered with a traditional doctor, we likely would have ended up with a caesarean - my wife's water broke 24 hours before labor really started.
The politics of how easy it is to get licensed as a midwife aside, midwives need to be medical professionals, and should be trained and licensed accordingly.
Sorry, my son's birth was not any less magical or special because he was born in a hospital instead of at home. It's not the location that makes a birth special!
I think some of the fears of hospitals expressed here may be exaggerated or old. My son was born a little less than a year ago, and our hospital was a really nice environment with labor rooms that looked like a luxury hotel. There were not orderlies running in and out or any form of chaos; it was a very smooth and nicely handled process. I realize not all hospitals were like this in the past, but, it is a big trend right now for hospitals to build special birthing centers that are much nicer and much more sensitive to patient concerns than in the past. Our selection of a hospital felt like a college recruiting visit: a tour of the facilities, reception with the doctors, prepatory classes, etc. If you aren't stuck with an HMO or government care, please, shop around!
Oh, and my son came out not breathing, without any particular birth trauma or previous signs. With a home birth, he would not be alive. He spent a couple days in the NICU and he has been just fine ever since. He and his being alive are infinitely more special than any romantic delusion about how nice it is to have a home birth.
p.s. Do the parents above who aren't complaining about the quality of care when a child dies have any medical, nursing, or midwifery training enabling them to assess the quality of care? I wouldn't necessarily take their word for it.
If we're going to rely on well-documented research then, as Patrick points out, for low-risk pregnancies home birth is at least as safe as hospital birth.
If we're going to rely on anecdotes, here's one about a woman who entered a hospital to give birth and was subsequently transferred to another hospital where both her arms and both her legs were amputated without her prior knowledge or consent. Speaking about her baby boy, she said,
"I want to pick him up. He wants me to pick him up. I can't. I want to, but I can't. Woke up from surgery and I had no arms and no legs. No one told me anything. My arms and legs were just gone."
Apparently her limbs were amputated because of a very bad infection, but the details are not clear because the hospitals have refused to give the woman access to her medical records. As of the writing of the article, she still did not know what had happened.
So all of you who like spending time in hospitals, go for it. But I'll continue to support people who want to have their babies at home.
Trying to either "empower" or "pamper" yourself by experiencing childbirth without all available medical technology at hand, is dangerously, stupidly self-indulgent, to my mind.
Sure, most childbirths come off without a hitch, but why take that sort of risk?
I think if the midwife is being prosecuted, the parents should too, though I'm sure they're suffering horribly for their decision already...
"a woman who entered a hospital to give birth and was subsequently transferred to another hospital where both her arms and both her legs were amputated"
Oh, gimme a break.
gj: That's horrible. I note that it happened in Florida. Personally, I would dread medical care in Florida, based on my family's experience. Doctors can do some terrible things. It's true! But staying away from them can be even more devastating. The trick is to find good doctors and good hospitals!
I must say that when I had my second Caesarean, I went into a state of hypotension, and I never learned how serious it was, but I was in a situation where I was wondering if I was dying. I wasn't allowed to move, and medical personnel were walking about talking about my condition in a way that I couldn't quite understand. Afterwards, I had the question, so was I sort of dying back there? But they never gave me a straight answer. The fact is, I didn't die, so what's the good of knowing?
Trying to either "empower" or "pamper" yourself by experiencing childbirth without all available medical technology at hand, is dangerously, stupidly self-indulgent, to my mind.
Knoxgirl: I think you're probably right that some women are pampering themselves by giving birth at home. But, I think there are many women who believe that its a safer and healthier option.
I think the research posted in the comments here bears out their belief.
I think its clear that some people would have been much better off steering clear of a hospital. Others should not have given birth at home.
I'm not sure its stupid and self-indulgent to weigh the particulars of your own situation to make a decision.
Knoxgirl, according to the Centers for Disease Control, "In hospitals alone, [Healthcare-associated infections] account for an estimated 2 million infections, 90,000 deaths, and $4.5 billion in excess health care costs annually."
Don't get me wrong, I'll be the first to go to the hospital when I need the services they provide. But hospitals also have their downsides, and shouldn't be used more than they're needed.
(more here)
Most insurance does not cover labor and delivery. Hospital births are very expensive.
Still, I think it depends on the age of the mother since older mothers are at greater risk for complications.
Women are having babies at an older age today, and probably need the services of traditional obstetrics more than, when the average age of childbirth was a woman in her 20s....and a midwife would suffice for that back then.
Peace, Maxine
Truly said: Personally, the gross-out factor is pretty compelling. Would you sleep in a bed where someone had given birth? I hope they threw out that mattress...and the box springs, just to be safe.
No fear! This mattress can be saved!
What you do is: you put sheets on your bed. Then, you cover those sheets with a flannel-backed vinyl tablecloth. On top of that you put on a set of old sheets.
After you have the baby, when you're ready to clean up, you hop in the shower. Your midwife takes the top layer of sheets off the bed, and throws the tablecloth in the trash. When you come back from the shower, you're nice and clean, and so is your bed.
On their way out, the midwives throw your sheets and towels in the laundry, and they usually turn out just fine.
Of course, most people having homebirths don't actually have their babies in the bed. People have them in the tub, on birthing stools, on their hands and knees, even standing up.
"People have them in the tub, on birthing stools, on their hands and knees, even standing up."
Oh, good lord! How about standing on their head? Is this really the time to be showing off?
Showing off? No.
It's just that it's hard to have a baby lying on your back. You have to push AGAINST gravity. (That would also be an argument against having a baby while standing on your head.)
The baby comes out much easier if you're more upright when you're giving birth.
I'm a cautious person, so I'll be going to the hospital to give birth. Luckily, my local hospital not only has a good reputation, but has recently re-done the birthing rooms. There's even whirlpools in the birthing room.
In our health care system a woman usually works closely with a midwife who is present throughout the labor. A nurse is also in the room. The OB/GYN comes into the room for the birth when the baby is ready to be born. (Or the doctor comes if something is going wrong.)
I also understand people's caution about unnecessary medical intervention. It's scary when forcepts (or a vaccum birth) causes head injuries. But I'd rather be at a site with readily available medical equiptment in case of an emergency.
I do think that the state should pay for labor and deliveries for uninsured women. People may stay at home because it is expensive to give birth in a hospital if they don't have health care.
Ann: No, showing off would be giving birth on a trapeze. Use centrifugal force to assist the birth!
My opinion of most home-birthing, based on little personal research but a lot of anecdotal evidence, is that it's more of a Momzilla thing than anything else. This woman is so desperate to be at the center of a big dramatic event that she'll create a set piece, with herself as the lead actress and the baby as a prop.
No, showing off would be giving birth on a trapeze. Use centrifugal force to assist the birth!
And the baby could bounce into the world!
Holojonesfan,
I don't know - in any labor everybody is pretty focused on the woman. I mean - people want to take PICTURES & Tape videos of things that I know I don't want recorded.
"...many women who believe that its a safer and healthier option. I think the research posted in the comments here bears out their belief."
If the hospital(s) you are restricted to are butchers, by all means, have the baby at home! But I seriously doubt this is the norm. Trying to scare women with gorey, if true, stories about hospitals is just wrong.
Having a baby is not a complication---nor should it be a political act of woman power! -- like a lot of feminists want to make it.
What a vaginal birth does to a baby's head -- if you did anything like that to your child after it was born -- with your hands, I mean, not your vagina -- it would be horrific child abuse. You can say it's "natural" -- but it's an extreme thing to do to a baby and it can cause permanent damage. To treat it as a spiritual experience for the adults is creepy.
But those who are doing home births to save money -- I really feel sorry for them.
Those who are impressed by posh "birthing rooms." You do realize the reason hospitals dump so much money into this? They know it influences women choosing their insurance plans. You're then stuck with the rest of the hospital. But they know you'll notice this.
If the hospital(s) you are restricted to are butchers, by all means, have the baby at home! But I seriously doubt this is the norm. Trying to scare women with gorey, if true, stories about hospitals is just wrong.
I think you're being a wee bit obtuse here. The research I was referring to was the posted evidence in this thread that home births don't result in a higher rate of injury or death than hospital births.
Trying to guilt women into using hospitals by calling them stupid and self-indulgent is no less wrong than scaring them with gory stories.
Those who are impressed by posh "birthing rooms." You do realize the reason hospitals dump so much money into this? They know it influences women choosing their insurance plans.
Ann: Exactly! And we fall for it, don't we?
For the same reason, hospitals for those of us who don't have a choice don't bother with the luxury. I still had to do the stupid exam room, labor room, recovery room progression. And I got to share my recovery room for two days with another couple and their child. Good times!
Knoxgirl: I should clarify that I wouldn't have thought I would consider home birth for myself either. It's not something that would have been my "style".
I just think its a kneejerk reaction to summarily dismiss the option for other people based on your own preferences when evidence supports their decision.
Jennifer:
I'm not trying to guilt anybody! There are real risks involved.
1. If your childbirth goes smoothly and you're at the hospital, chances are overwhelmingly good that you and the baby will be safe. Same with home birth.
2. If your childbirth does NOT go smoothly, at the hospital there are medical personnel and equipment to address the issue. At home, there is nothing but 911.
I cannot find the evidence in this thread you are referring to?
Anyway, FWIW, if we had universal health care, I'd be the first one having babies at home, believe me.
ann althouse wrote: What a vaginal birth does to a baby's head -- if you did anything like that to your child after it was born -- with your hands, I mean, not your vagina -- it would be horrific child abuse. You can say it's "natural" -- but it's an extreme thing to do to a baby and it can cause permanent damage.
Are you trying to be a troll on your own blog?
Knoxgirl:
The evidence you are looking for is in Patrick's post at 12:58 p.m. yesterday. He references large-scale studies showing that for low-risk births, homebirth is just as safe as hospital birth.
How is it possible that homebirth is just as safe, given that hospitals, as you say, are equipped to handle complications?
The only answer consistent with the study data is that there are ways in which homebirth midwives handle birth better than hospitals and are safer than hospitals. Not that they handle every aspect of birth better, but that they handle some aspect of births better, but enough to balance any safety benefits provided by hospitals.
And of course a big advantage of midwives is that they provide the same record of safety with significantly fewer interventions. For example, the British Medical Journal study Patrick pointed out found that the c-section rate for low-risk attempted homebirths was about 4%, compared to about 20% for the comparable hospital population. Lowering interventions shortens recovery time and hospital stays and significantly lowers costs.
I understand having the feeling that having a baby at home is risky. But for low risk pregnancies, that feeling is not supported by the evidence. The fact is, a baby is just as likely to die or have complications in the hospital as at home.
P.S. What does universal health care have to do with your home birth choices?
What does universal health care have to do with your home birth choices?
I suggested that the state should pay for uninsured women to give birth in a hospital with appropriate medical care. I also suggested that the economic costs could encourage people to choose home births.
Giving birth in a hospital is expensive if one does not have insurance. So, I suggested that the state ought to pay for those without means.
For example, if Indiana is going to criminalize home births, then IN should pay for hospital births for the uninsured.
Re me being my own troll...
Interesting idea!
I do act a little different in my comments persona.
This post has been removed by a blog administrator.
(sorry...)
raisa,
I've yet to meet anyone expressing the interest or desire to have their baby at home who says it's for "safety reasons" ...but ok!
I'm sure if you're "low-risk" then it is indeed relatively safe to have your baby at home. But the key word is "risk". As in, "still risky."
I was actually expressing agreement with Jennifer in my comment about universal health care....
as a midwifery student studying to be a homebirth midwife, i made it through about half of these comments before not being able to stand it anymore. so, a couple of things...
first of all, anyone who is wondering about the safety of homebirth where babies are being delivered by lay midwives (midwives without nursing degrees), please take the time to read this. i'll give you a hint...
"Conclusions Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States."
http://bmj.bmjjournals.com/cgi/content/full/330/7505/1416?ehom
second of all, to me, what is more disturbing is the cesarean section rates in this country which are now up to 1/3 of all births. These are not necessary and are based majorly on the doctor's failure to have patience with the birthing process or the need to get home for dinner. so, my question is why would someone want care from someone who barely has the time for them?
Midwives provide an environment that is all about patience and self-awareness and informed choice. that is truly what midwifery is all about. it is about allowing women to reclaim their right to choose what is best for them given all of the information.
so, my question is why would someone want care from someone who barely has the time for them?
I *can* see this point of view. Doctors are VERY into inducing labor these days. I always thought the high rate of c-sections was attributed to doctors getting nervous about being sued when complications arose.
Knox girl wrote: I'm sure if you're "low-risk" then it is indeed relatively safe to have your baby at home. But the key word is "risk". As in, "still risky."
Entirely eliminating risk in birth, as well as in life, is impossible. But if you're a low-risk woman, data show you're not increasing your risk by having the baby at home.
If it feels riskier to have a baby at home, that's because there is a cultural message that homebirth is dangerous -- a message that is not consistent with current medical research.
Oh, and I had a baby at home partially for safety reasons. Every woman on my street seemed to be having a c-section, and I really did not want that. I was afraid of surgery, I didn't want a scar, and I wanted to be able to hold my baby immediately.
I always thought the high rate of c-sections was attributed to doctors getting nervous about being sued when complications arose.
There are lots of reasons why the c-section rate is so high.
Picture this: you are an obstetrician. You have a crazy call schedule. You get paid more for for doing a c-section than for a vaginal birth, even though a vaginal birth may drag on for hours and hours, and a c-section is over and done with in an hour tops. Furthermore, you have crazy high malpractice insurance rates, which will only get higher if you get sued. You know that you are much more likely to get sued for failing to perform a c-section than performing an unnecessary one. You might even get a discount on your malpractice insurance if your c-section rate is high enough.
It is 4:00 in the afternoon and you have one woman in labor, with no signs of being done anytime soon. You are tired and there is a playoff game on at 7:00.
You sincerely believe everything is going fine with the woman's labor, but you have the slightest twinge that something might be wrong. What are you going to do?
Might you do something different if it were noon, you feeling awake, and you had somebody else laboring who would prevent you from going home, anyway?
Obstetricians are only human. And they are under a lot of stress. They're mostly going to do their best to make sound medical judgments.
But when there's ambiguity about what is the right decision, is there wonder they consistently err on the side of more interventions? No. And that's why intervention rates in obstetrics are sky-rocketing, without a concomitant improvement in outcomes (which have remained stalled for two decades).
The embattled status of the obstetric profession does no service to women or babies.
Raisa,
"The embattled status of the obstetric profession does no service to women or babies."
I remember hearing a piece on NPR about how there weren't enough OBs in Nevada--maybe it was just Vegas, not sure--to deliver all the babies, and there were pregnant women who had no doctor to go to, because of malpractice insurance rates there.... yikes
In Massachusetts, insurance pays for hospital births but not for home births. I believe the situation is similar in most states. So when someone has health insurance but wants a home birth, at least in Mass, it costs them about $3,000 out of pocket.
By the way, my wife just delivered a very healthy baby boy, at home, yesterday. Arrival time was 2:55 pm, weight 7 pounds 3 ounces. Mother and child are doing well. After the birth we made a $100 contribution to the Mass Midwives Alliance.
gj,
Congratulations! I hope mom and baby are doing well.
I agree that if you have insurance, homebirth is usually more expensive.
But for people who don't have insurance, homebirth can be cheaper. Here in Indiana we have a large Amish community. The Amish don't get insurance for religious reasons, and they prefer homebirth to save money. Both of the midwives mentioned in the New York Times article have large Amish practices.
NY Times story on Indiana prosecution of home birth midwife RE: The question is whether the state ought to save us -- and our children -- from our relentless optimism.
I started my professional life relentlessly optimistic about the benefits of hospital-based medical care for normal childbirth. I was an L&D nurse in a big busy hospital and it was a fact of everyday life that complications could and did suddenly occur. My opinion about planned home birth mirrored all the derogatory comments read here and elsewhere – mainly that it was “only for idiots”. However, working for two decades in the hospital-based obstetrical system relentlessly stripped me of optimism about ‘modern’ obstetrics. The public’s perception about medicalized childbirth in hospitals is wrong. It is TV obstetrics and not real life.
After just a few years in a high-volume L&D I began to see the connection between obstetrical interventions routinely applied to healthy laboring woman (70% of all pregnancies) and a steep increase in the need for additional interventions, unexpected complications, operative deliveries and breathing difficulties for the baby. Immobilizing a laboring woman in bed in anti-gravitational positions, hooked up to IVs and electronic fetal monitors, is not a biologically-effective way to facilitate normal childbirth.
I remember only to well racing down the hall with a stretcher, frantically trying to get a patient with a ruptured uterus to the operating room before she died. Eventually an emergency hysterectomy was necessary to save her life. As a young and inexperienced nurse, I initially thought this disaster proved that the biology of normal childbirth was dangerously defective. Afterward the older nurses talked about this ‘accident’ of childbirth, privately admitting among themselves that the Pitocin electively used to speed up her labor is what caused her uterus to rupture. I saw similar situations in which it was the baby who suffered permanent disability. However, all the families would ever learn was that the mother or baby was the victim of a life-threatening obstetrical emergency and that the quick response of the medical team had saved their life. Even though these emergencies were a known side-effect of obstetrical intervention, no acknowledgment of that important fact was made to the family.
I began to wonder if other things that we all took for granted were also causing iatrogenic complications. By paying close attention I soon noticed a direct correlation between the use of drugs and anesthesia and the need for assisted delivery (episiotomy, forceps or Cesarean section). I saw a direct correlation between the use of Pitocin to speed up labor, fetal distress in the baby and excessive maternal bleeding or even hemorrhage after the birth. I also saw a big spike in babies who had trouble breathing when their moms had narcotics during labor or other interventions such prolonged pushing (due to anesthesia) and /or delivery by forceps or C-section. All of these personal observations were also acknowledged in the drug company inserts or confirmed in the scientific literature.
My efforts to change the hospital culture failed miserably so I eventually cross-trained into community-based direct-entry midwifery. Counting my experience in both home and hospital, I have been present at approximately 3,500 births over the 40 years of my professional life. I can testify to the improved safety for both mothers and babies of physiological (vs. medical) management. Physiological management refers to care “in accord with, or characteristic of the normal functioning of a living organism”. This non-medical, non-interventive form of care depends on continuous one-to-one social support, ‘patience with nature’, the right use of gravity and a commitment not to disturb the natural process. Presently, physiological management is only available in an out-of-hospital setting and midwives are the only caregivers a mother can turn to for non-interventive maternity care. Planned home birth (PHB) always includes a skilled birth attendant and appropriate access to medical services when indicated or requested by the mother.
Midwifery as an organized body of knowledge preceded the modern discipline of medicine by more than 5,000 years. Midwifery principles recognized as effective and still valid in our own time were found among ancient Egyptian hieroglyphics dating back to 3,000 BC. Today, physiological management is the scientific backbone or evidence-based model of maternity care used world wide by midwives, except in the US where medicalized care eclipses all else. Physiological management is actually protective for both mothers and babies. Nationally certified direct-entry midwives (CPMs) using physiologic management in a domiciliary setting, reduced the episiotomy / operative delivery rate (and associated complications) from approximately 72% to approximately 5%, with an identical or even slightly improved perinatal mortality rate. It is efficacious -- that is, both safe and cost effective.
Nothing that modern allopathic medicine has to offer – no routine use of drugs or surgical procedures, no electronic devise such as continuous electronic fetal monitoring, no ‘preemptive strike’ such as universal hospitalization or the routine elective use of Cesarean section, has been able to create a system that is better or safer than the routine use physiological management for healthy childbearing women. However, these methods don’t belong to midwives per se. They belong to science and to society, to be used by anyone regardless of professional affiliation, including physicians.
One must question how the ancient and honorable tradition of midwifery came to be obliterated almost to the vanishing point by the medical profession and then claimed by the medical profession to be an illegal practice of medicine? What brought about the wide-spread but uncritical acceptance of an unscientific method such as interventionist obstetrics for healthy women? The medicalization of normal labor triggers a chain of inevitability that starts with the ‘domino-effect’, in which the unintended consequences of routine interventions make childbirth progressively more complex, eventually requiring the use of injurious interventions and sometimes progressing on to serious complications. When injury to mother or baby does occur, the biology of normal birth gets the blame. The complications of these obstetrical interventions are often cited as proof that “I would have died if I hadn’t given birth in the hospital”. This chain of inevitability, multiplied by forth years, has ended in an ever sky-rocking Cesarean section rate, which was a 30% for 2004 and is projected to be 34% by 2006. This is the disheartening background of most midwife/home birth prosecutions, which are inevitably based on medical politics instead of credible scientific evidence.
Like the midwife in the Indiana prosecution, I am a CPM, that is, a nationally certified professional midwife. CPMs are experienced direct-entry midwives who trained directly in midwifery instead of becoming a nurse first or becoming certified as a nurse-midwife. The statistics from the CPM study published in the British Medical Journal (June 2005), include those from my own home-based practice, as well as Indiana CPM Jennifer Williams and 500 other CPMs in the US and Canada. The BMJ study confirmed again the consensus of the scientific literature, which consistently identifies that planned home birth, when compared to hospital-based care for healthy women, is equally safe for the baby and reduces maternal interventions by as much as ten times.
Unlike the recently arrested Indiana midwife, I am also licensed in my state of California but only because mothers and midwives in our state spent 30 years fighting an uphill battle against organized medicine to get midwifery decriminalized. Finally, in 1993, the California Legislature passed the Licensed Midwifery Practice Act. The LMPA officially recognized that the greatest safety for healthy mothers with normal pregnancies is to provide them with access to professionally-trained and licensed midwives.
In my opinion, the relentless optimism that needs to be addressed in America is not false optimism about normal birth but the unfounded idea that the current obstetrical model is the most appropriate one for healthy childbearing women. Most important, everybody in society, even those who would never use a midwife or plan a home birth, benefits from preserving and promoting physiological management. In a perfect system, medical educators would learn and teach the principles of physiological management to medical students. Practicing physicians would utilize physiological management as the standard of care for healthy childbearing women. Hospital labor & delivery units would be primarily staffed by professional midwives, with incentives for current L&D nurses who wish to retrain as hospital-based midwives to do so at minimal expense to themselves. This would dramatically reduce rate of injurious interventions and the cost of maternity care while increasing good outcomes and satisfaction of families served.
In the meantime, community-based midwifery needs to be legal for both mothers and midwives. If the problem is the law, then the law needs to be changed, as it must be kept in mind that the basic purpose of medical practice legislation is consumer safety, not as a political tool for promoting a medical monopoly. Enforcing medical practice laws in a manner contradictory to common sense and the well being of the public is not in the interest of childbearing families or a civil society.
More info is posted at www.sciencebasedbirth.com. See ‘April 06 Info for Bloggers – midwife controversy’.
NY Times story on Indiana prosecution of home birth midwife RE: The question is whether the state ought to save us -- and our children -- from our relentless optimism.
I started my professional life relentlessly optimistic about the benefits of hospital-based medical care for normal childbirth. I was an L&D nurse in a big busy hospital and it was a fact of everyday life that complications could and did suddenly occur. My opinion about planned home birth mirrored all the derogatory comments read here and elsewhere – mainly that it was “only for idiots”. However, working for two decades in the hospital-based obstetrical system relentlessly stripped me of optimism about ‘modern’ obstetrics. The public’s perception about medicalized childbirth in hospitals is wrong. It is TV obstetrics and not real life.
After just a few years in a high-volume L&D I began to see the connection between obstetrical interventions routinely applied to healthy laboring woman (70% of all pregnancies) and a steep increase in the need for additional interventions, unexpected complications, operative deliveries and breathing difficulties for the baby. Immobilizing a laboring woman in bed in anti-gravitational positions, hooked up to IVs and electronic fetal monitors, is not a biologically-effective way to facilitate normal childbirth.
I remember only to well racing down the hall with a stretcher, frantically trying to get a patient with a ruptured uterus to the operating room before she died. Eventually an emergency hysterectomy was necessary to save her life. As a young and inexperienced nurse, I initially thought this disaster proved that the biology of normal childbirth was dangerously defective. Afterward the older nurses talked about this ‘accident’ of childbirth, privately admitting among themselves that the Pitocin electively used to speed up her labor is what caused her uterus to rupture. I saw similar situations in which it was the baby who suffered permanent disability. However, all the families would ever learn was that the mother or baby was the victim of a life-threatening obstetrical emergency and that the quick response of the medical team had saved their life. Even though these emergencies were a known side-effect of obstetrical intervention, no acknowledgment of that important fact was made to the family.
I began to wonder if other things that we all took for granted were also causing iatrogenic complications. By paying close attention I soon noticed a direct correlation between the use of drugs and anesthesia and the need for assisted delivery (episiotomy, forceps or Cesarean section). I saw a direct correlation between the use of Pitocin to speed up labor, fetal distress in the baby and excessive maternal bleeding or even hemorrhage after the birth. I also saw a big spike in babies who had trouble breathing when their moms had narcotics during labor or other interventions such prolonged pushing (due to anesthesia) and /or delivery by forceps or C-section. All of these personal observations were also acknowledged in the drug company inserts or confirmed in the scientific literature.
My efforts to change the hospital culture failed miserably so I eventually cross-trained into community-based direct-entry midwifery. Counting my experience in both home and hospital, I have been present at approximately 3,500 births over the 40 years of my professional life. I can testify to the improved safety for both mothers and babies of physiological (vs. medical) management. Physiological management refers to care “in accord with, or characteristic of the normal functioning of a living organism”. This non-medical, non-interventive form of care depends on continuous one-to-one social support, ‘patience with nature’, the right use of gravity and a commitment not to disturb the natural process. Presently, physiological management is only available in an out-of-hospital setting and midwives are the only caregivers a mother can turn to for non-interventive maternity care. Planned home birth (PHB) always includes a skilled birth attendant and appropriate access to medical services when indicated or requested by the mother.
Midwifery as an organized body of knowledge preceded the modern discipline of medicine by more than 5,000 years. Midwifery principles recognized as effective and still valid in our own time were found among ancient Egyptian hieroglyphics dating back to 3,000 BC. Today, physiological management is the scientific backbone or evidence-based model of maternity care used world wide by midwives, except in the US where medicalized care eclipses all else. Physiological management is actually protective for both mothers and babies. Nationally certified direct-entry midwives (CPMs) using physiologic management in a domiciliary setting, reduced the episiotomy / operative delivery rate (and associated complications) from approximately 72% to approximately 5%, with an identical or even slightly improved perinatal mortality rate. It is efficacious -- that is, both safe and cost effective.
Nothing that modern allopathic medicine has to offer – no routine use of drugs or surgical procedures, no electronic devise such as continuous electronic fetal monitoring, no ‘preemptive strike’ such as universal hospitalization or the routine elective use of Cesarean section, has been able to create a system that is better or safer than the routine use physiological management for healthy childbearing women. However, these methods don’t belong to midwives per se. They belong to science and to society, to be used by anyone regardless of professional affiliation, including physicians.
One must question how the ancient and honorable tradition of midwifery came to be obliterated almost to the vanishing point by the medical profession and then claimed by the medical profession to be an illegal practice of medicine? What brought about the wide-spread but uncritical acceptance of an unscientific method such as interventionist obstetrics for healthy women? The medicalization of normal labor triggers a chain of inevitability that starts with the ‘domino-effect’, in which the unintended consequences of routine interventions make childbirth progressively more complex, eventually requiring the use of injurious interventions and sometimes progressing on to serious complications. When injury to mother or baby does occur, the biology of normal birth gets the blame. The complications of these obstetrical interventions are often cited as proof that “I would have died if I hadn’t given birth in the hospital”. This chain of inevitability, multiplied by forth years, has ended in an ever sky-rocking Cesarean section rate, which was a 30% for 2004 and is projected to be 34% by 2006. This is the disheartening background of most midwife/home birth prosecutions, which are inevitably based on medical politics instead of credible scientific evidence.
Like the midwife in the Indiana prosecution, I am a CPM, that is, a nationally certified professional midwife. CPMs are experienced direct-entry midwives who trained directly in midwifery instead of becoming a nurse first or becoming certified as a nurse-midwife. The statistics from the CPM study published in the British Medical Journal (June 2005), include those from my own home-based practice, as well as Indiana CPM Jennifer Williams and 500 other CPMs in the US and Canada. The BMJ study confirmed again the consensus of the scientific literature, which consistently identifies that planned home birth, when compared to hospital-based care for healthy women, is equally safe for the baby and reduces maternal interventions by as much as ten times.
Unlike the recently arrested Indiana midwife, I am also licensed in my state of California but only because mothers and midwives in our state spent 30 years fighting an uphill battle against organized medicine to get midwifery decriminalized. Finally, in 1993, the California Legislature passed the Licensed Midwifery Practice Act. The LMPA officially recognized that the greatest safety for healthy mothers with normal pregnancies is to provide them with access to professionally-trained and licensed midwives.
In my opinion, the relentless optimism that needs to be addressed in America is not false optimism about normal birth but the unfounded idea that the current obstetrical model is the most appropriate one for healthy childbearing women. Most important, everybody in society, even those who would never use a midwife or plan a home birth, benefits from preserving and promoting physiological management. In a perfect system, medical educators would learn and teach the principles of physiological management to medical students. Practicing physicians would utilize physiological management as the standard of care for healthy childbearing women. Hospital labor & delivery units would be primarily staffed by professional midwives, with incentives for current L&D nurses who wish to retrain as hospital-based midwives to do so at minimal expense to themselves. This would dramatically reduce rate of injurious interventions and the cost of maternity care while increasing good outcomes and satisfaction of families served.
In the meantime, community-based midwifery needs to be legal for both mothers and midwives. If the problem is the law, then the law needs to be changed, as it must be kept in mind that the basic purpose of medical practice legislation is consumer safety, not as a political tool for promoting a medical monopoly. Enforcing medical practice laws in a manner contradictory to common sense and the well being of the public is not in the interest of childbearing families or a civil society.
More info is posted at www.sciencebasedbirth.com. See ‘April 06 Info for Bloggers – midwife controversy’.
One reason I believe in hospital deliveries is that you never know. One kid I know went into distress during her delivery. It was, of course, picked up immediately on the fetal monitor, and was solved by giving her mother oxygen. If that had not worked, they were ready for a C-section. But in most home deliveries, it would have gone unnoticed, and the baby born with potentially some brain damage. Most likely not noticable, but there.
Ok...first off...you seem to think that homebirths are unmonitored. Homebirth midwives monitor the baby and DO catch the same "distress" that you are referring to.
secondly..you mention that it was "solved" by giving the mother oxygen. Bull. Homebirth midwives carry oxygen - but that in no way saved this baby, I assure you. If the mom's pulse ox was 98-100% (which it almost universally is), what benefit do you think putting oxygen on her did? nothing...just made the mother feel like they were doing something.
you said that if it didn't resolve they would have done a cesarean. Same thing with a homebirth. Something starts to look funky, you transport. Not a big deal.
You don't mention WHY the baby was in distress. Was mom being induced? (not happening at a homebirth) Was her water broken for her? (not happening routinely at a homebirth) Did she have anesthesia - an epidural? (not happening at a homebirth)
You say this baby was at risk...but how do you know that baby wasn't at risk BECAUSE of the hospital and the things we do to to them.
I see a lot of fear of homebirths based on the proverbial "what if"...but I also fear the "what if" of hospitals, since the #1 cause of complications is iatrogenic! We start messing with mom (inducing, strapping to monitors, restricting movement, restricting food/fluids, giving analgesics, giving anesthesia, breaking her water...) and then a complication occurs that wouldn't have otherwise.
THAT is what I think more people should find scary.
Thanks Faith, for a really well thought out post. I appreciate seeing all the accurate info you took the time to write down.
I think it's amazing how we all form such strong opinions on things we know so little about. We can't each be experts in everything, of course. And knowing this, we have to take somebody's word as the expert we choose to believe. Something like childbirth is so socialized, we tend to align our belief system with, say, our sister or neighbor, rather than take the time to educate ourselves. The evidence is out there, folks. But each of us has to choose to dig it up, read it, and then be able to critically examine what that means to us.
The fear about the baby's head being a 'battering ram' originated long ago when mothers were out cold when giving birth. It has long since been proven over and over again that a vaginal birth has many benifits for the baby in prepairing it for those first breaths, and life outside the uterus.
Home or hospital isn't the question so much as what 'style' care your provider is going to give you. Expectant management? Agressive treatment? Defensive Decisions? There are so many decisions in the many months of pregnancy and childbirth, each practitioner has their own paradigm from which they make decisions for your care. And each decision has a big impact on the safety of both mother and child. Each birthing woman and her family should take the time to educate themselves just enough to at LEAST know which style of management they want, and find a provider who'll give it to them.
I am impressed by the thoughtful, informed and informing responses to my April 4th comments. Usually I am talking to myself when addressing any aspect of this unpopular topic. I have to admit that this is the first time I’ve ever posted anything to a blog, as my handlers usually keep me chained up in the basement, nose to the grindstone, and won’t let me ‘waste’ time with such foolishness. But the NYT article on the Indiana midwife had a link to Ann Althouse’s blog and I clicked just to see what it was all about. Imagine my surprise! Cherrie and Elfanie’s replies are so good and worthy of being quoted. So I’m officially asking – may I quote you both?
The actual hot issue of the day is not the prosecuted midwife in Indiana but the draft report by the National Institute of Health subsequent to their “State-of-the-Science Conference on Cesarean Delivery on Maternal Request” (which they kindly reduced to ‘CSMR’ for the keyboard challenged). The conference was held March 27-29 in Bethesda. One of the most interesting aspects is that a government agency officially released a report at 5pm on March 29th, the last day and last minute of a conference. [www.consensus.nih.gov] Obviously, the report had already been written, which means the input of the participants was just a feel good move and window dressing for a predetermined agenda.
The NIH draft report concluded that mothers are demanding C-sections in greater numbers (good data says not true!), which ‘explains’ the 29% percent C-section rate for 2004 (and the projected 33% C-section rate for 2005!). The report went on to infer that there isn’t really any good data to determine if C-sections are better or worse than vaginal birth, but if you’re only planning one or two children, the odds are about even.
The illogical conclusion was that if you want to, go ahead and have all your babies by scheduled C-section (something about consumer convenience and giving mothers ‘control’ over their birth), never mind that it doubles maternal mortality and costs twice as much. Rumor has it that one of the things fueling this conference was a push for a CPT code (Current Procedural Terminology) for patient choice CS. This would permit them to hide a lot of poor obstetrical practices under the banner of women’s reproductive freedom and a woman’s ‘right to choose’. How poetic.
The NIH’s official conclusions are a great way to distract the American public from the real issue, which is physician fear of normal birth, spurred on by lack of education or experience in physiological management of spontaneous labor and birth, hospital policies that make physiologic process hard or impossible for either mother or physician to use in an institution, run away litigation, pressure on doctors from malpractice insurance carriers not to ‘allow’ mothers with VBAC, breech and twin pregnancy to deliver vaginally (docs get a ‘good driver’ discount if they agree) and astronomical malpractice premiums. This is all wrapped up in the notion that Cesareans (referred to as ‘vaginal by-pass surgery') are safer and better than normal birth (referred to as “delivery from below” – uck!). All these spurious ideas come to us courtesy of a dis-information campaign by many spokespersons within the obstetrical profession, who go on the Today show and NRP and assure us that vaginal birth is very bad for the mother’s pelvic floor (under anti-gravitational obstetrical management I agree!) and the baby and that “Cesarean is safer for the baby”.
Mind you, I’m not anti-obstetrician or anti-hospital. I have several physician friends that are obstetricians, even ones that are politically active in ACOG. They are all honest dedicated people. I am however ‘anti’ the politics of organized medicine, which includes methods of mass deception and the ill-informed idea that the best way to prevent complications is the “pre-emptive strike” -- routine use of potentially injurious interventions on healthy women and a form of malpractice insurance referred to by OBs as “when in doubt, cut it out”.
American mothers don’t have a “C-section defici