Tag Archives: midwives

The Debate Goes On: Homebirth vs. Hospital Birth

Last week, in response to a blog post I wrote entitled In the News:  Stores About Childbirth, I received some heated comments from one of my frequent readers.  The sentiments in her comments are highlighted here:

“This article from the UK just today…

“Home births are three times riskier for babies than those which take place at hospital, new research suggested yesterday.
Doctors warn that women could be putting their unborn children at risk by not given birth on traditional maternity wards with specialist care and equipment on hand.”

Read more: http://www.dailymail.co.uk/health/article-1291085/Home-birth-trebles-risk-babys-death.html#ixzz0sXTsUTpU

Also this for consideration of all sides to the debate..

“A newborn baby died from an infection just days after two midwives told the mother not to bother giving him antibiotics.”

http://www.dailymail.co.uk/news/article-1162704/Newborn-baby-dies-infection-days-midwives-tell-mother-ignore-prescribed-antibiotics.html”…

***

(She added a third comment, pointing to the same article above, as if it was evidence of another study.)

So, here’s my response:

Yes, of course, you can always find a study to support your point of view.  Just like this article, from the very same newspaper “Shelly” referred to, about a newborn who died of hemorrhage and heart failure do to a lethal overdose of hospital-administered glucose.

And what about and this study, published in the same medical journal as the study referred to in Shelly’s second point,  which concludes, “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.”?

And how about this article (again, same newspaper as referred to above) about a new mom who died hours after giving birth to her son, following a legal narcotic overdose administered by hospital staff?

Shall I go on?

How about this article on CNN.com about how the US has the second worst newborn mortality rate in the developed world (incidentally, maternal mortality rate here is 15.1/100,000–worse than several northern European countries, Australia and Japan–many of those communities in which midwife-attended births are more common than here).

Have you ever heard about the Safe Motherhood Quilt Project by esteemed midwife Ina May Gaskin?  Go here to see actual quilt squares that represent hundreds of women who have died surrounding their baby’s births–a vast majority of them having delivered in hospital.

An article on Our Bodies Ourselves reviewed a couple recent studies (one being the study from BMJ–referred to above) including a study published in the Canadian Medical Association Journal (follow link above to OBO website, then click on link to CMAJ article–mid way through the post) about a retrospective study of almost thirteen thousand women who gave birth at home with a midwife, in hospital with a midwife and in hospital with a physician in attendance.  Although outcomes were similar, the neonatal mortality rates (death of the infants) were best among the home birth cohort, second best among those who delivered in hospital with a midwife and third best when attended by a physician.  (The leap of an implication is, of course, that the physicians handled the more complicated cases and, therefore, realized higher rates of neonatal mortality.)

And yes, there are also other articles and studies out there that will further defame the practice of midwifery (heck, The American College of Gynecologists has an official statement on their website denouncing the practice of delivering babies in a home environment.  In some cases, I totally and completely agree with this:  when a pregnant woman is deemed high risk–due to cardiac or other significant health conditions, gestational diabetes requiring insulin, moderate to severe high blood pressure to name a few–she absolutely should have her baby’s birth attended to in a hospital and most likely by an OB.  (other definitions of high risk are well outlined in the OBO article, linked to above)  But for low-risk women with no foreseeable complications, birth should not be attended to as if it is a medical disease state from which she needs saving.

Delivering a baby in a hospital includes having quick access to medical intervention.  In the small percentage of cases when in-depth intervention becomes life saving, there is, in my opinion, no legitimate argument against this (that’s why the best of the best midwives out there always have some transfers each year to the hospital from a home birthing environment.)  But the truth about medical interventions (aka-hospital births) is that much of the high-tech/high intervention practices (labor induction/augmentation, breaking the bag of waters, constant fetal heart beat monitoring, episiotomies, c-sections) are employed unnecessarily…carrying with them well documented risks.

Take labor induction with the use of Cytotec, for example.  While prohibited in some hospitals due to its risk of uterine rupture, uterine over stimulation and fetal stress, Cytotec is widely used in other hospitals as a labor induction medication.  From nursingcenter.com, regarding labor induction medications including Cytotec:

“Cytotec, a brand of misoprostol, is FDA approved for prevention of nonsteroidal anti-inflammatory drug-related gastric ulcers. It is listed as Category X (not to be used) in pregnancy. Physicians in the United States, however, may use FDA-approved drugs for “off label” indications. Hofmeyer and Gulmezoglu (2003) recommended further research to establish the ideal route of administration, dosage, and safety for this drug and stated that information on informed consent for misoprostol use and women’s views of the drug are “conspicuously lacking” (Hofmeyer & Gulmezoglu, 2003).

The risk of maternal or fetal death among Cervidil, Prepidil, and misoprostol is comparable. In 25 trials that involved 3,651 subjects, however, misoprostol was shown to be more effective and had more rapid onset of action. There was an increased rate of uterine hyperstimulation with FHR changes and meconium-stained amnionic fluid. Clinicians were advised in this study to be concerned about this apparent increase in uterine hyperstimulation, because it might increase the risk of uterine rupture (Hofmeyer & Gulmezoglu, 2003). These same authors found that the cesarean birth rate for failed induction after misoprostol was not significantly reduced compared to the other prostaglandins or oxytocin. Evidence for its use, aside from cost savings and rapidity of action, is no stronger than for other prostaglandin preparations.”

Translation?  US doctors are granted the privilege, by the FDA, to use approved medications for non-FDA researched purposes.  (In some cases, this IS a good thing–but that is the topic for another post.)  While Cytotec forces a woman into labor quite efficiently, it puts both mom and baby at risk because of how hard and fast the uterus begins to contract.  Cytotec is a Category X medication for pregnancy–meaning there is no way, no how a pregnant woman should be consuming this medication.  And yet, despite all facts above, it is still widely used intervaginally to synthetically begin a woman’s labor for her.

My point here?  Allopathic medicine is not infallible, either.  Nobody is.  That’s a part of being human and having the power of choice.

Are there midwives out there employing less than best-practices maternity care?  Sure. I had a sixteen-year-old young lady attend my Lamaze class series a couple years ago, as a part of a distance learning midwifery program.  If she graduated from said program “on-time” she’d be practicing home birth midwifery by the time she was nineteen.  She may have been extremely smart, applied, motivated and well instructed in one form or another, but she was sixteen.

The potential of this scared the heck out of me.  Because, really, how many teenagers in present-day USA do you know who have the maturity to safely and logically handle the (rare) birth-related true emergency–like a retained placental postpartum hemorrhage, a severe shoulder distocia, or a newborn in respiratory distress?

My very long-winded point here is this:  it’s easy to quickly cite one or two articles or studies and use those to make a big, sweeping statement that supports your opinion.   But before doing so, I would encourage anyone to look closely at the data:

1.  Is the study/article truly unbiased?

2.  Does the study compare apples to apples?  (similar patient populations in each cohort)

3.  Are the numbers and percentages represented statistically significant?

4.  Are individual articles cited worthy of applying to a whole system or group of people, or are they just that–individual stories about isolated events?

5.  Do larger bodies of work support conclusions made by smaller studies?  Is the result of a study reproducible?  What do studies conducted by organizations like the World Health Organization, National Institutes of Health and Cochran Database say?

I have always been leery about sweeping generalizations and I would encourage you, dear reader, to follow suit.
I also encourage and invite feedback on my thoughts contained herein.  What are other folks out there reading/teaching/learning?

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Filed under Childbirth Issues, From One Mother to Another, Mommy and Motherhood, natural childbirth, pregnancy

Keeping Childbirth Safe–No Matter Where it Takes Place

The world finally gets it (OK, some parts of the world). Childbirth does not have to be as dangerous as it is for many women and fetuses in developing countries.  For that matter, it does not have to be dangerous for the vast majority of women in developed countries, either, but that is a whole other ball of wax (in short, think: high rates of medical intervention in low-risk women have the propensity to create more problems that require fixing, than they necessarily do solve or prevent potential problems).

Here is yet another example of a relatively simple technology with a focus on reducing perinatal maternal mortality, as presented at the American College of Nurse Midwives‘ annual convention.  The device?  A strap-on belly with uterus, baby and blood contained within.  The goal?  To get as many birth attendants around the world–especially in areas like Afghanistan, the Central African Republic and rural India– trained with basic life-saving knowledge of how to catch a baby (or help to deliver a malpositioned fetus) and intervene when postpartum hemorrhage is occurring.  Truthfully, most of the life-threatening scenarios surrounding childbirth can be handled successfully, as long as the knowledge of how to handle those scenarios is there, and well practiced.

As described in this article, “Using both hands, the teacher wearing the device can move the baby through the birth canal, which is formed from a flexible plastic frame. Simulated blood flows out of the vagina, controlled by a thumb-operated roller valve. To simulate the contraction of the uterus after delivery, the teacher squeezes air from a large bladder into a smaller one while pulling the latter lower in the pelvis. She can tap on a piece of hard plastic inside the mannequin to create a heartbeat, varying the rate and loudness to simulate fetal distress. In all cases, the sense of reality is heightened because the equipment is connected to and manipulated by a human being.”

The “Mama Natalie” simulator can even replicate a retained placenta fragment–the primary cause of third stage and postpartum hemorrhage.  When would-be birth attendants know how to recognize this condition, they can also learn how to remedy it (by manually removing the left-over piece of placenta that is stuck to the internal uterine wall, thus allowing continued bleeding).  In extremely rural areas or home birth scenarios where high-tech intervention is miles away, the performance of this relatively simple procedure, and appropriate follow-up techniques and care, can be a matter of life and death.

Kudos to Laerdal Medical for creating this device, making it available to poor countries at cost ($100/each), and adding to the overall trudge toward the Millennium Development Goal 5 which “seeks to cut the 1990 maternal mortality ratio of 320 deaths per 100,000 births by 75 percent.”

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Filed under Childbirth Issues, cultures, From One Mother to Another, General Health, Mommy and Motherhood, natural childbirth, pregnancy, prenatal health

Women’s Day

I swear…I’m not MIA!  I’m just still recovering from the holidays…and, working my a** off to finish my second book.  I’ll give ya’all a sneak peek soon.

But for now, I HAD to share this little article from the weekly children’s/family newspaper (Kidsville News – Jan. ’09) that circulates around schools and coffee shops in our area:

“In Greece, January 8 is Midwife’s Day or Women’s Day, also sometimes called Women’s Rule.  On this day men do all the housework and take care of the children, while women go out for the day, relaxing in cafes and coffee shops and playing card games.  Events during the day focus on midwives who parade through the streets on carts.  In some villages, men who are caught outside, and not home doing chores, are chased by women and drenched with a bucket of cold water!”

Perhaps our version of Women’s Day is Mother’s Day….except for the fact it kinda leaves out all women who aren’t mothers.  Perhaps we should lobby for the institution of Women’s Day in America.  With all the pork barreling that goes on in the U.S. Congress…I’m sure we could get this one added to a ticket in no time.

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Filed under From One Mother to Another, Mommy and Motherhood, politics, Writing and Publishing

Childbirth Stories

As Andrew succinctly captured in his post today, we had an awesome party at our house yesterday afternoon with several of the Lamaze class couples I have taught in the past several years, along with their kiddos.

Because of the work I do, (okay, because of one of the several hats I wear) I get to hear some really amazing childbirth stories.  Three top my list right now.  In brief, this how they went down:

Story # 1:  Amy* and her husband waited and waited for labor to start…refusing to seek an elective medical induction…and finally having labor start on its own right around her 42nd week of pregnancy.  As planned, they headed to the hospital and met their cherished doula there.  As the end of her 24 hour labor neared, she began the pushing phase of delivering their son.  7 hours later…yes, 7 hours of pushing…their son was born healthy as a horse, and Amy didn’t accept a drop of pain medication, Pitocin, or any other significant medical intervention in the process.

Because of the baby’s abberrant heart beat pattern, she even avoided being hooked up to the fetal monitor for long periods of time.  Her nurse simply listened to the baby’s heart rate once in a while with the doppler.  End of story:  Mom and baby were awesomely healthy!  Go Amy!

Story #2:  One of the mom’s at our party yesterday had another whopper of a story to share.  Pregnant with her second child and also planning for a hospital birth, all the while remembering that her first (induced) labor was relatively quick, she immediately took note when her labor started one weekday morning.  Once her husband helped her time contractions, and they found them to be 1min. long and four minutes apart, Jane* decided it was time to think about heading into the hospital.  Her husband decided to run their 2 y.o. son to day care first–with the anticipation of getting back home quickly at which point he’d take his wife up to the hospital.

As Jane continued to labor at home alone, things started to pick up quickly.  As she went to visit the restroom, she realized the contractions she was now experiencing were PUSHING contractions.  Three contractions later, Jane caught her own baby while kneeling on the bathroom floor.  “The good thing was she cried right away,” Jane recalled of her three-month-old daughter’s birth.  Minutes later her husband arrived back home, and heard his wife “talking baby talk” in the bathroom.  He rounded the corner to find mom and baby resting comfortably in the bathtub.

Story #3:  Elena* had been anxiously awaiting the home birth she, her husband and their older son had been anticipating for weeks.  With a gradual start to labor, and a continually gradual progress throughout labor until the last hour, she had a wonderful experience at home with her hubby, son, two midwives and a doula/friend.  Spending the last hour of labor in a warm water birth tub, she worked through the final stages of labor with her awesome birth support team at her side.  Her son was there to witness the birth of his five-years-younger brother, and Elena’s hubby caught the baby as he slid out without even so much as a single push from mom.  Mom and baby have gone on to practice lotus care, along with a traditional, but nearly long-lost practice in this culture:  a 40 day lie-in for mom and baby.

Bravo to all of the women sited in these stories, along with their husband’s and extended labor support teams for incredible childbirth experiences!  It is stories like these that remind us childbirth can be safe, normal and lovely (even if unexpected in one way or another) all at the same time, when the process is protected and lovingly cared for.

* Names changed for protection of privacy

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Filed under Childbirth Issues, pregnancy

A Weekend of Midwives and Ina May Gaskin

Man, has it been a busy few days!  Over this Labor Day weekend, I managed to splice in a few incredible, and nice, and lovely events.

On Saturday, I had the esteemed honor to sit in on a fifteen-person conference in Billings, MT (made up mostly of midwives from the Rocky Mountain region, plus a few childbirth educators and doulas) for which the keynote speaker was none other than Ina May Gaskin. If you don’t know who Ina May is…oh, good Lord…PLEASE follow that link and find out!  She’s only the most famous midwife across the entire planet.

Modest, brilliant, compassionate and heart felt, Ms. Gaskin spent the first hour + of the conference discussing her Safe Motherhood Quilt Project, by showing us square after quilted square of the now 200 piece tribute to women who have died surrounding the time of pregnancy and childbirth–deaths that occurred largely due to inadequate care and/or treatment delivered by western medicine providers and environments.

The primary goal of Gaskin’s self-directed project is to raise awareness of the maternal death rate in the United States which is drastically under-reported by insufficient processes and procedures currently in place in our country.  (The presently stated maternal death rate is ~ 15/100,000 but even the CDC contends that this number is potentially 2-3 times too low.)  To find out more about this project, visit Ina May’s site.

This afternoon, I was privileged once again to participate in another midwife-driven event:  the blessing and open house for the Bozeman Birth Center.  This makes it only the third birth center for the entire state of Montana!

A casual passer-by of this blog might assume these events were attended by only the crunchiest, hippiest, dread locks wearingest…people because, after all:  natural birth practices are only embraced by this type of person, right?  Wrongo, my friend!

I was pleased to be surrounded by people of all different ages, hair styles, footwear, sexes, creeds and colors during these two historic events.  And as Ina May, or Ricki Lake, or any of the grandma and grandpa types, corporate types and teacher types, stay-at-home-mom types and full time working mom types who were at either or both of these events will tell you: midwives and natural birth and dignity for the woman and gentle births for babies aren’t just for hippie chicks anymore.  They are for everyone.

And me?  I’m not much of a hippie chick myself.  Yes, I do own a pair of Birkenstock sandals…but they hurt my feet and I don’t wear them anymore.  I prefer my Keens instead.  I don’t wear long flowing skirts without underwear beneath, and I brush the tangles out of my hair every day.  I have never smoked marijuana (for real) and I don’t even like the smell of patchouli.  But I’m sold.  I’m a former allopathic medical provider convert who believes the hype.  I don’t teach my childbirth education students to “birth naturally, or don’t birth at all,” but I can kinda see why some folks do.

The women in our society that practice midwifery…they are something else.  Are each any every one of them perfect and infallible and brilliantly skilled?  Certainly, no.  But there are some pretty damned good ones out there.

Here’s to you, Ina May.

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Filed under Childbirth Issues, Living

The Debate Over Childbirth Safety in America

Wow.  I’ve been in a rather heated, on-line debate over the past week.

On the women’s self-advocacy and information-sharing, on-line community called EmpowHer.com, I recently posted an entry to the Maternity/Parenting forum called, “If You’re An Expectant Mom, or Know One, Please Read This!!!”

It was based on an article recently released by midwife Ina may Gaskin about the maternal mortality rate in the US (15.1 women/100,000 will die in chidlbirth overall…36.5/100,000 for African American women).
No less than four hours after my original post, an obstetrician named Amy Tuteur chimed in, and boy did she have a mouthful (a page full) to add.

From there, the debate commenced:  Discussions on childbirth safety here in the US in the hospital vs. in the home setting with midwives, comparing the US maternal mortality rate to that of other countries around the world, the life saving techniques and technologies perfected by the obstetrical community and whether or not those advances deserve a place in all births, or only the rare 10% or so that really require their use.

The debate got hot.  And then hotter.  A few more folks joined in.  Statistics were flying.  Sweat was collecting on the brow of each and every participant, I’m sure.

But the debate is not over.  It never will be.  As long as women and babies still die in childbirth; as long as there are still drastically different opinions about how women should be cared for before, during and after their childbirth experiences, the debate will go on.

What are your thoughts?  Visit EmpowHer.com and follow this link to the debate.

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Filed under Childbirth Issues, From One Mother to Another, Living