Regardless whatever law may be applied to the surface of women's lives, homebirth is a right. In a nod to this fact, lawmakers have carefully kept their hands off this right and gone after the homebirth attendant instead. Many women have had to go to great lengths to exercise their right, however, and homebirth midwives who are in the minority and sometimes practice illegally, work hard to help preserve it.
Women are becoming increasingly unhappy with their hospital birth experiences as the result of a multitude of factors, in particular the advent of health maintenance organizations (HMOs) and the proliferation of intervention that goes with hospital based modern health care.
The HMO system herds pregnant and birthing women through channels, leaving them without meaningful and conscientious individualized care. One-on-one care provides the physical, emotional and spiritual support so vital to good outcomes in birth, yet mainstream care continues to increase caseloads. This situation pulls away the safety net perfected over millennia and endangers women and babies daily. Increasing reliance on technology causes practitioners to lose the hands-on ability to ascertain what is really going on with a pregnant or laboring woman. The cascade of intervention that follows creates risks and events that would not have otherwise arisen.
Until recently, homebirth has been the natural mode of delivery since the beginning of humankind. It has only been in the last century that out-of-home birthing became the norm, a change engineered by ambitious men during a time when it was believed best to bring the natural world under control. What resulted in the birthing world was a surge into the hospital. It started with a fad, developed into a sign of prestige, then became pervasive when fear took over. With it came the inevitable spiral of cause and effect: the more intervention was introduced, the more it was needed, until birth was no longer recognizable as a natural process in human experience. Instead, it had been orchestrated into an assembly line procedure complete with time constraints, quotas, indifferent workers, procedures manuals, and loss of individual rights and autonomy.
Numerous side effects resulted, among them a woman's decreased ability to endure labor without drugs or direction. Over time the prevailing attitude developed that women did not have the power and ability to birth a baby naturally. Man's technology, it seemed, was better than nature's perfection. The truth is that a woman's body is designed to procreate and give birth. It produces hormones that act as pain relievers, contractions that come and go at intervals to offer respite, and many other perfect physiological responses that ensure a normal birth. Pregnancy and birth are the ultimate state of health!
If intervention arose out of need to "rescue" women from pain, results nevertheless show that under normal circumstances it is safer for mother and child to let the process of natural birth occur without medical intervention. Pain in childbirth is empowerment. Sure it may hurt, but the rewards that women recognize on a cellular level drive them. When all is said and done, that empowerment paves the path to parenthood, which is the ultimate task at hand.
Homebirth as a Viable Choice.
In a homebirth situation, parents accept responsibility and help create the standards and protocols that will frame the birth experience. This prepares the family and the midwife for a natural, uneventful birth as well as for situations like premature rupture of membranes, breech presentation, postdates, twins and so on. In the hospital, those standards already exist, and each birth must fit into that already established framework. A natural process is immediately compromised when required to adhere to rigid structures devised by strangers.
Birth is a time to feel secure and safe. When a woman births at home she is in her own nest and is surrounded by colors, textures, lighting and sounds she loves. Her own bed, where she finds solace in rest and sleep, is available for birthing. She is in the place she will soon share with her baby. What better place is there to relax in the total way she needs to in order to give way to the birth process?
The holistic way to give birth is to let it happen. At home a woman has one or more care providers who monitor the progress of her labor and the well being of both she and her baby. Providing calm, watchful and intimate care, the midwives are there for the entire duration of labor and birth. The birthing woman knows this, depends on it and it helps her feel secure. She may also have her partner and family members with her—they know best what she likes and what soothes her the most.
In the hospital, on the other hand, the laboring woman is attended by strangers. She may not get the doctor she chose and if she does, he or she may go off call before she delivers. No matter how nice the birthing rooms are, the hospital is still an institution that functions in predetermined ways, with rules, standard procedures and time tables to abide by. In order to birth in a normal, healthy way a woman must be able to go within herself, calling up a lot of inner strength for the long process ahead of her. Encouragement is vital. But it is easy to become confused by someone else's procedures and stressed and discouraged when others' time constraints have to be adhered to.
At home, progress is assessed by taking vital signs and by watching the woman's self-paced unfolding. The midwife's presence is constant and she is the caretaker from start to finish. She monitors such things as blood pressure, temperature and fetal heart tones. She makes sure the laboring woman feels fearless and secure. She gives emotional support and offers touch therapies if the woman is comfortable with that. Time becomes secondary. Taking food and drink and getting rest and sleep are encouraged. How can a woman otherwise get through a long labor if she is not nourished and rested? Yet in many hospitals, food and drink are prohibited for fear that surgery and anesthesia may lie ahead. This protocol heads the cascade of intervention that is often inevitable at the hospital: an exhausted mom is given Pitocin to increase the effectiveness of her contractions, and from there it's a collision course of medical intrusions when a snack and a nap may have staved off any problems in the first place.
A woman feels in control of her birth process when she births at home. In the hospital, institutional standards are in control. It's hard to believe that most women would choose the latter. But fear of supposed consequences and fear of responsibility and one's own power seem to discourage a lot of today's expectant women.
One of the main concerns about homebirth voiced by many women is the lack of emergency care readily available if the need should arise. A good homebirth midwife, however, is well trained in avoiding and handling complications and performing neonatal resuscitation. She has the proper tools with which to control hemorrhage if the need arises. She is well versed in normal birth and is willing and ready to transport a woman to the hospital if it becomes necessary. Because she has come to know the woman on an intimate level, having done all the lengthy prenatals herself, she is well equipped to handle emotional issues that may arise during birth. Her intuition and instinct are consciously developed and their use is a priority in the kind of care she gives. She is comfortable with offering massage and hugs and cradling the woman in her arms. When a homebirth midwife follows these simple and practical standards and techniques, statistics on homebirth outcomes look very sweet indeed.
Obstetric Myths Versus Research Realities by Henci Goer presents statistics gathered worldwide that clearly demonstrate the safety of homebirth with a trained attendant. Yet even though research has validated its efficacy, homebirth is still seen as unsafe. Cultural trends, an overzealous media, clever marketing, power mongering, rumors and fear perpetuate that view.
Without a doubt it's time for a paradigm shift. Technology should be used only when it's absolutely necessary and non-interventive, with spiritually based trust in birth as the dominant concept. Practical, experienced midwifery would be the rule rather than the exception. Parents can help achieve this by recognizing and accepting their true responsibility, by reclaiming their right to choice, by educating themselves, being determined and organized, and by choosing a midwife or doctor who will honor and abide by their wishes.
Planning a Homebirth
Compared to the external issues that surround homebirth, the nuts and bolts of homebirth seem easy! Finding the right care provider is the number one priority. A woman can ask her friends and neighbors, look in the phone book, go online or ask other alternative practitioners for recommendations. An initial interview will tell both the midwife and the pregnant woman whether the match will be a good one. In almost all cases a woman will find just who she needs. The care provider will set up regular visits, talk about pregnancy, labor and birth and possibly make referrals to childbirth classes. Classes help a couple learn about birth and parenting and can provide a network of new friends and families who are going through the same miraculous process.
As a midwife, I make a large library of books and videos available to my families to check out. Some people are avid researchers and want to know everything. But there are also those who prefer simply to live the experience. They should be honored for their own way of learning. The parents who don't want any responsibility or say in birth, however, are not homebirth candidates. They need the institution to fulfill their needs. Homebirth is a partnership in which parents and practitioners work together.
Homebirth midwives provide excellent prenatal care, spending an average of forty-five minutes to an hour on a prenatal visit. This gives us an opportunity to attain all the clinical information necessary and still have plenty of time for chatting and getting to know each other. This one on one care builds trust and friendship which will serve the birthing process well when the time comes. We take a personal interest in making each woman's pregnancy, birth and postpartum the best it can be, and because of that, our caseloads are usually small.
On the other hand, typical clinics maintain a high caseload to cover high overhead. Time spent with a client must be kept to a minimum: the average time spent on a prenatal is ten to fifteen minutes. Bonds of familiarity and trust are not a priority; volume is. But low risk is tied to thorough, multifaceted care, and clinics often do not provide it. Homebirth midwives familiarize themselves with both the physical and emotional facets of the women they serve. The acumen they gain through power of observation is an essential tool that keeps birth both normal and safe.
A plethora of instruments, drugs, apparatus, operating rooms, machines and even special clothing await a woman who births in the hospital. By contrast, homebirth midwives travel light. I have a rule not to carry anything I don't know how to use. This defines my standard and parameters of care. For instance, if I do not carry IV setups, then I call in help or transport if the need arises for their use. I personally make sure all my equipment is in proper working order. I check before, during and after births. I make a note of what gets used and what must get replaced. I keep my instruments sterile and ready for birth at all times. I also keep an extra set. I always have plenty of gas in my car. I check my pager to be sure everyone has access to me at all times.
The homebirth parents are well prepared too—it's part of their responsibility and their active participation in the process. By the time the woman is thirty-four to thirty-six weeks pregnant, they have their sterile packs ready and all their supplies in order. Their midwife has provided them with concise lists of what is needed, and together they review everything at a home visit well before the due date. This helps the parents feel ready and relaxed. Lists of phone numbers posted by the telephone ensure that attendants and others are just a call away when the woman goes into labor, and help can be called in an instant should it be needed during the birth. The lists should include the hospital emergency room number, labor and delivery NICU and any doctors who may provide backup.
Birth is a profound experience. While it includes basic physical functions like contractions, dilation, descent and emergence, the emotional and spiritual aspects play a major role in outcome. The two main models of birth—allopathic and holistic—diverge greatly in all these areas. Allopathic care, centered in the hospital, is based on institutional standards which promote separation. Holistic care, based in homebirth, promotes connection in all aspects of its care and ultimately between mother and baby. There are times when allopathic and holistic modalities collaborate effectively, such as in high risk situations. For instance if a woman is transferred from home to hospital she can bring her music or special power pieces if she wishes. She can bring a favorite nightgown, photos, blanket and pillow. She can retain her familiar holistic attitudes and a positive outlook, and stay centered and secure while using technologies that are well applied.
Once a woman is transferred to the hospital, the degree to which a midwife can continue to participate in the birth depends on individual hospital attitude toward homebirth midwives. At the least, she can remain at the hospital as a supportive presence. The midwife can be proactive by staying with the woman and encouraging her while being respectful of hospital staff, not confrontational. She should be familiar with interventions in order to help the woman make choices to take the least interventive path first. She should know the patient bill of rights. She can be most supportive by being nonjudgmental of what the woman may have to experience in order to birth her baby.
In most homebirth cases, birth will simply occur. In most cases of hospital births, the birth will be tampered with to some degree. This is fact. Hospital practitioners are trained to perform—it's commonly held that only action brings about results. At home we believe that if all is well, let it be.
Vital Statistics
Countries with the lowest mortality rates are those in which midwifery care is an integral part of obstetrical care and where homebirth is commonly practiced (see Gentle Birth Choices by Barbara Harper, RN). In the Netherlands, for example, homebirth and midwifery attended births for low risk populations are the norm. More than 70 percent of births are attended by midwives and nearly 40 percent take place at home. The infant mortality rate is 2.1 per 1,000 births. By comparison, in the United States, where the mortality rate is 10.8 per 1,000 births, only 2 to 3 percent of births occur out of the hospital with midwifery care.
This kind of information explains why more and more women are turning to midwives and out-of-hospital birth. Those women who don't rely on research for reasons often know instinctually that homebirth is a safer and wiser choice.
-->
Going into the new millennium, we have an opportunity and an obligation to create birth change. By educating the public, promoting homebirth, informing one woman at a time, and confronting the media when they get it wrong, we can enhance the homebirth movement and preserve its kind of care. Balance will be a key issue. Keeping birth normal while using technology wisely can become a true art. Guarding choice can become a priority. Midwifery care can expand and progress to answer growing consumer demand. And rightfully considerate care for all women can set the pace for better birth outcomes and healthier generations to come. I may be dreaming, but along with many, many others, I have dedicated my entire life to these visions in honor of and respect for all mothers, babies, families and the future.
References:
Arms, Suzanne. (1984). Immaculate Conception. Toronto, NY: Bantam Books.
Dick-Read, Grantley. (1959). Childbirth Without Fear. New York: Harper & Row.
Ehrenreich, Barbara & English, Deirdre. (1973). Witches, Midwives & Nurses: A History of Women Healers. New York: Feminist Press.
Frye, Anne. (1995). Holistic Midwifery Volume 1. Portland, OR: Labrys Press.
Gaskin, Ina May. (1990). Spiritual Midwifery (3rd ed.). Summertown, TN: The Farm Pub. Co.
Goer, Henci. (1995). Obstetrical Myths Versus Research Realities. Westport, CT: Bergin & Garvey.
Goldsmith, Judith. Childbirth Wisdom. Brookline, MA: East West Books.
Harper, Barbara RN. (1994). Gentle Birth Choices. Rochester, VT: Healing Arts Press.
Wagner, Marsden. (1994). Pursuing the Birth Machine. Campertown, Australia: ACE Graphics.
Ward, Charlotte & Fred. (1976). The Homebirth Book. Washington DC: Inscape Publishers. Regardless whatever law may be applied to the surface of women's lives, homebirth is a right. In a nod to this fact, lawmakers have carefully kept their hands off this right and gone after the homebirth attendant instead. Many women have had to go to great lengths to exercise their right, however, and homebirth midwives who are in the minority and sometimes practice illegally, work hard to help preserve it.
Thursday, August 13, 2009
Monday, June 29, 2009
Passports for Babies Born at Home
US government reaches agreement on passports for people delivered by midwives
Some border residents get new chance for passports
By CHRISTOPHER SHERMAN Associated Press Jun 26, 09 2:55 PM CDT
Hundreds of citizens along the U.S.-Mexico border whose applications for passports were banished to a bureaucratic black hole because their births were attended by midwives will be able to reapply.
The State Department settled a class-action lawsuit brought by the American Civil Liberties Union and immigration attorneys representing citizens whose passport applications were filed away without further action because the government suspected Texas midwives may have fraudulently registered Mexican births in the U.S.
The settlement, announced by the ACLU on Friday, awaits court approval.
Immigration attorneys, particularly in South Texas, began seeing a steady stream of cases where residents were asked to dig up all sorts of additional proof as passport authorities questioned their citizenship. The applicants ranged from senior citizens to children and even included employees of federal agencies.
Residents along the border were rushing to get passports for the first time in their lives to comply with a June 1 deadline requiring a passport or passport card rather than a driver's license to re-enter the country.
Since 1960, 75 Texas midwives have been convicted of fraudulently registering Mexican-born babies as American. At one point, the government assembled a list of nearly 250 "suspicious" midwives but never explained what made them suspicious.
Under the terms of the settlement, which both parties have signed, the State Department will have to come up with a legal justification for each midwife it puts on the list. Passport applicants delivered by those midwives may still be asked to present additional evidence of their citizenship, but there will be clearer guidelines.
"I think it's a very good and strong victory for a fairly small percentage of the people who are having problems," said South Texas immigration attorney Lisa Brodyaga, who filed the lawsuit.
Those who received letters stating their applications would be closed without further action will be able to reapply without a fee. Those who received outright denials can still reapply, but they will have to pay the fee.
Some border residents get new chance for passports
By CHRISTOPHER SHERMAN Associated Press Jun 26, 09 2:55 PM CDT
Hundreds of citizens along the U.S.-Mexico border whose applications for passports were banished to a bureaucratic black hole because their births were attended by midwives will be able to reapply.
The State Department settled a class-action lawsuit brought by the American Civil Liberties Union and immigration attorneys representing citizens whose passport applications were filed away without further action because the government suspected Texas midwives may have fraudulently registered Mexican births in the U.S.
The settlement, announced by the ACLU on Friday, awaits court approval.
Immigration attorneys, particularly in South Texas, began seeing a steady stream of cases where residents were asked to dig up all sorts of additional proof as passport authorities questioned their citizenship. The applicants ranged from senior citizens to children and even included employees of federal agencies.
Residents along the border were rushing to get passports for the first time in their lives to comply with a June 1 deadline requiring a passport or passport card rather than a driver's license to re-enter the country.
Since 1960, 75 Texas midwives have been convicted of fraudulently registering Mexican-born babies as American. At one point, the government assembled a list of nearly 250 "suspicious" midwives but never explained what made them suspicious.
Under the terms of the settlement, which both parties have signed, the State Department will have to come up with a legal justification for each midwife it puts on the list. Passport applicants delivered by those midwives may still be asked to present additional evidence of their citizenship, but there will be clearer guidelines.
"I think it's a very good and strong victory for a fairly small percentage of the people who are having problems," said South Texas immigration attorney Lisa Brodyaga, who filed the lawsuit.
Those who received letters stating their applications would be closed without further action will be able to reapply without a fee. Those who received outright denials can still reapply, but they will have to pay the fee.
Friday, June 12, 2009
Childbirth Without Choice
Childbirth Without Choice
It would seem perfectly natural that a woman could give birth naturally if she wants to. Guess what? She can't.An increasing number of hospitals in this country are refusing to offer women the option of delivering the way nature intended, if she had a cesarean section the first time around (and guess what -- chances are she has because the 31% of all births are now C-sections -- up 50% in 10 years).I wrote an article in this week's issue of Time magazine called "The Trouble With Repeat Cesareans" on the subject of women's diminishing patient's rights. I won't repeat the story here, since you can link to it here, but will give some of the back story for those who want more:This was a story I've been wanting to write for a long time. The short version is, doctors and hospitals are no longer allowing many women to have a vaginal birth after cesarean (or VBAC, pronounced "vee-back") because the "medicolegal" costs are too high. Or, as one ob-gyn put it when I asked why she and other doctors no longer allow VBACs, ""It's a numbers thing. It is financially unsustainable for doctors, hospitals and insurers to engage in a practice when the cost of doing business way exceeds the payback. You don't get sued for doing a C-section; you get sued for not doing a C-section."Now, I think most of us realize that many hospitals are for-profit institutions and that doctors need to make money too, increasingly hard in this era of managed care. It is nonetheless tough to hear a physician talk about medical care in such bare-bones financial terms. So, um, we can't get the most appropriate care because it costs too much? What's especially galling is that VBACs are actually a much less expensive "procedure" (if childbirth can be termed that way) than cesarean sections, which are major abdominal surgery and require days more in the hospital. The costs the doctor is referring to are the malpractice insurance costs passed on to doctors. And those costs aren't even reasonable, but are largely in response to a few high-profile cases of VBACs gone awry dating back 10 years, many of which involved a labor-induction drug called Cytotec, which is no longer used during vaginal births after cesarean.Meanwhile, according to the International Cesarean Awareness Network (ICAN), out of 2,849 hospitals with labor and delivery wards nationwide, 28% have total outright bans on VBAC and an additional 21% have de facto bans in that they say they'll do it but none of the doctors on staff will do it. That's half of American hospitals, but the numbers are probably much worse. Many of the rest will allow what's often termed "Cinderella VBACs" (a term coined by Henci Goer ) -- "yes, you can have a VBAC as long as you have it Monday - Friday, between 8 am and 5pm and you aren't over 40 weeks and we don't think your baby is too big".Moreover, even if the hospital allows VBACs, it doesn't mean that all the doctors there are willing or eager to perform them. Take my own case. After I had a cesarean with my first child, I made a point to find a new practice that was VBAC-friendly. (I would have stayed with my first doctor, but my insurance switched, a whole other story). The practice I eventually signed up was very encouraging, telling me that VBACS had a 60-80% success rate and that their particular practiced boasted a 75% success rate. All good. Right?Except, when I hit the 6 month point, my doctor said to me casually, "OK, let's schedule your C-section now.""Excuse me?""Oh," he said, "You know, you only have a 13% chance of success with your VBAC." He went on to explain that since I had reached the "pushing" phase of my first labor, my chances of a successful VBAC were dismally low and therefore it made no sense to attempt one.Furious at the bait-and-switch (doctors love, love, love C-sections -- in and out in an hour! No messy labor! No pesky doulas or family members hanging around!), I asked him to produce the study that said so. It turns out that the study, which dated back to 1999, was contradicted by several later studies, all of which showed a significantly higher rate of success -- between 40-60%. One study showed no difference in success rates at all, no matter where the first labor ran into trouble.The doctor on call when I ended up giving birth on Thanksgiving weekend, was, needless to say, very much put out by my inconveniencing him. His revenge? He refused to talk to me while I was in labor, and didn't answer his pager when I was ready to push. So that's an example of a hospital that allows VBAC and supposedly pro-VBAC doctors for you. The truth is, doctors who are truly VBAC-friendly are few and far between. The good news is, I gave birth, via VBAC, to a perfectly healthy little boy and had a much quicker, easier recovery than I did with my C-section (which was hell, but another story).I'll end with this story, much more dramatic than mine: After giving birth to her first child via cesarean, Alexandra Orchard, a CPA in Colorado Springs, was told her second baby measured too large to be delivered vaginally. "My doctor said, 'You're not only risking her life, you're going to break her collarbone when you push her out,'" Orchard recalls. Through tears, she scheduled a second cesarean. "I was in so much pain after each surgery that I don't even remember when I met my children." With her third child, Orchard was determined to get a VBAC, but her doctor refused. Orchard researched the risks and with the help of a midwife, labored for 30 hours and gave birth at home to a daughter, now almost two years old. Orchard is apprenticing to become a midwife because, she says, "I don't want my daughter to have to fight like I did."
It would seem perfectly natural that a woman could give birth naturally if she wants to. Guess what? She can't.An increasing number of hospitals in this country are refusing to offer women the option of delivering the way nature intended, if she had a cesarean section the first time around (and guess what -- chances are she has because the 31% of all births are now C-sections -- up 50% in 10 years).I wrote an article in this week's issue of Time magazine called "The Trouble With Repeat Cesareans" on the subject of women's diminishing patient's rights. I won't repeat the story here, since you can link to it here, but will give some of the back story for those who want more:This was a story I've been wanting to write for a long time. The short version is, doctors and hospitals are no longer allowing many women to have a vaginal birth after cesarean (or VBAC, pronounced "vee-back") because the "medicolegal" costs are too high. Or, as one ob-gyn put it when I asked why she and other doctors no longer allow VBACs, ""It's a numbers thing. It is financially unsustainable for doctors, hospitals and insurers to engage in a practice when the cost of doing business way exceeds the payback. You don't get sued for doing a C-section; you get sued for not doing a C-section."Now, I think most of us realize that many hospitals are for-profit institutions and that doctors need to make money too, increasingly hard in this era of managed care. It is nonetheless tough to hear a physician talk about medical care in such bare-bones financial terms. So, um, we can't get the most appropriate care because it costs too much? What's especially galling is that VBACs are actually a much less expensive "procedure" (if childbirth can be termed that way) than cesarean sections, which are major abdominal surgery and require days more in the hospital. The costs the doctor is referring to are the malpractice insurance costs passed on to doctors. And those costs aren't even reasonable, but are largely in response to a few high-profile cases of VBACs gone awry dating back 10 years, many of which involved a labor-induction drug called Cytotec, which is no longer used during vaginal births after cesarean.Meanwhile, according to the International Cesarean Awareness Network (ICAN), out of 2,849 hospitals with labor and delivery wards nationwide, 28% have total outright bans on VBAC and an additional 21% have de facto bans in that they say they'll do it but none of the doctors on staff will do it. That's half of American hospitals, but the numbers are probably much worse. Many of the rest will allow what's often termed "Cinderella VBACs" (a term coined by Henci Goer ) -- "yes, you can have a VBAC as long as you have it Monday - Friday, between 8 am and 5pm and you aren't over 40 weeks and we don't think your baby is too big".Moreover, even if the hospital allows VBACs, it doesn't mean that all the doctors there are willing or eager to perform them. Take my own case. After I had a cesarean with my first child, I made a point to find a new practice that was VBAC-friendly. (I would have stayed with my first doctor, but my insurance switched, a whole other story). The practice I eventually signed up was very encouraging, telling me that VBACS had a 60-80% success rate and that their particular practiced boasted a 75% success rate. All good. Right?Except, when I hit the 6 month point, my doctor said to me casually, "OK, let's schedule your C-section now.""Excuse me?""Oh," he said, "You know, you only have a 13% chance of success with your VBAC." He went on to explain that since I had reached the "pushing" phase of my first labor, my chances of a successful VBAC were dismally low and therefore it made no sense to attempt one.Furious at the bait-and-switch (doctors love, love, love C-sections -- in and out in an hour! No messy labor! No pesky doulas or family members hanging around!), I asked him to produce the study that said so. It turns out that the study, which dated back to 1999, was contradicted by several later studies, all of which showed a significantly higher rate of success -- between 40-60%. One study showed no difference in success rates at all, no matter where the first labor ran into trouble.The doctor on call when I ended up giving birth on Thanksgiving weekend, was, needless to say, very much put out by my inconveniencing him. His revenge? He refused to talk to me while I was in labor, and didn't answer his pager when I was ready to push. So that's an example of a hospital that allows VBAC and supposedly pro-VBAC doctors for you. The truth is, doctors who are truly VBAC-friendly are few and far between. The good news is, I gave birth, via VBAC, to a perfectly healthy little boy and had a much quicker, easier recovery than I did with my C-section (which was hell, but another story).I'll end with this story, much more dramatic than mine: After giving birth to her first child via cesarean, Alexandra Orchard, a CPA in Colorado Springs, was told her second baby measured too large to be delivered vaginally. "My doctor said, 'You're not only risking her life, you're going to break her collarbone when you push her out,'" Orchard recalls. Through tears, she scheduled a second cesarean. "I was in so much pain after each surgery that I don't even remember when I met my children." With her third child, Orchard was determined to get a VBAC, but her doctor refused. Orchard researched the risks and with the help of a midwife, labored for 30 hours and gave birth at home to a daughter, now almost two years old. Orchard is apprenticing to become a midwife because, she says, "I don't want my daughter to have to fight like I did."
Homebirth
Homebirth
Today America leads the world in medical technology, but they trail 27 countries for infant deaths. Unfortunately, the public in general continues to believe that the only safe place to give birth is in the hospital. All Americans need to do is take a look at these other 27 countries to see what they do different, and it is not more medical techniques or interventions. It would be found that these countries have a high percentage of homebirth/nonintervention birth. The truth is that the hospital fails to offer the environment needed for the safest birth outcome. A woman's body is specifically created to give birth; it is a part of her normal bodily functions, and should not be considered a physical problem or medical emergency. For the vast majority of women, childbirth is neither an emergency nor an illness, indicating there is no need for medical intervention.The safety of homebirth is well documented, although the vast majority of the public has never seen any of the information. Medical corporations do not profit by presenting the information. In most cases, homebirth is as safe, usually safer, than subjecting yourself to a hospital birth. Below are only a few quotations and citations. There is with a wealth of knowledge to find, you are encouraged to research the safety of home birth further, until you are confident that you know the truth, then you can be well informed to make your own decisions. Some very helpful sites are included on the resources page.Presented on October 20, 1976 before the 104th annual meeting of the American Public Health Association:So far, the largest and most complete study on the comparison of hospital birth outcomes to that of homebirth outcomes was done by Dr. Lewis Mehl and associates in 1976. In the study, 1046 homebirths were compared with 1046 hospital births of equivalent populations in the United States. For each home-birth patient, a hospital-birth patient was matched for age, length of gestation, parity (number of pregnancies), risk factor score, education and socio-economic status, race, presentation of the baby and individual major risk factors. The homebirth population also had trained attendants and prenatal care.The results of this study showed a three times greater likelihood of cesarean operation if a woman gave birth in a hospital instead of at home with the hospital standing by. The hospital population revealed twenty times more use of forceps, twice as much use of oxytocin to accelerate or induce labor, greater incidence of episiotomy (while at the same time having more severe tears in need of major repair). The hospital group showed six times more infant distress in labor, five times more cases of maternal high blood pressure, and three times greater incidence of postpartum hemorrhage. There was four times more infection among the newborn; three times more babies that needed help to begin breathing. While the hospital group had thirty cases of birth injuries, including skull fractures, facial nerve palsies, brachial nerve injuries and severe cephalohematomas, there were no such injuries at home.The infant death rate of the study was low in both cases and essentially the same. There were no maternal deaths for either home or hospital. The main differences were in the significant improvement of the mother's and baby's health if the couple planned a homebirth, and this was true despite the fact that the homebirth statistics of the study included those who began labor at home but ultimately needed to be transferred to the hospital.("Home Birth Versus Hospital Birth: Comparisons of Outcomes of Matched Populations," Dr. Lewis Mehl. Presented on October 20, 1976 before the 104th annual meeting of the American Public Health Association. For further information contact the Institute for Childbirth and Family Research, 2522 Dana St., Suite 201, Berkeley, CA 94704)"It is important to clarify that safety is measured by death (mortality) or illness (morbidity) during the labor and birth process and shortly thereafter. The United States has consistently high maternal and perinatal mortality and morbidity rates compared to other industrialized countries. In 1990 the United States was ranked twenty-third by the Population Reference Bureau, which publishes the mortality and morbidity statistics. This means that there are twenty-two other countries where it is safer for women to give birth than in the United States."("Gentle Birth Choices," Barbara Harper, R.N. . Rochester, Vermont: Healing Arts Press, 1994. Page 52.)"A six-year study done by the Texas Department of Health for the years 1983-1989 revealed that the infant mortality rate for non-nurse midwives attending homebirths was 1.9 per 1,000 compared with the doctors' rate of 5.7 per 1,000."Berstein & Bryant, Texas Lay Midwifery Program, Six Year Report, 1983-1989. Appendix VIIIf. Austin, TX: Texas Department of Health.)Records kept from 1969-73 in England and Wales indicate still birth rates of 4.5 per 1000 births for home deliveries as opposed to 14.8 per 1000 births for hospital deliveries. ("The Place of Birth", Sheila Kitzinger & John Davis, eds., 1978 Oxford University Press, pp. 62-63)"Every study that has compared midwives and obstetricians has found better outcomes for midwives for same-risk patients. In some studies, midwives actually served higher risk populations than the physicians and still obtained lower mortalities and morbidities. The superiority and safety of midwifery for most women no longer needs to be proven. It has been well established." ("The Future of Midwifery in the United States," Madrona, Lewis & Morgaine, NAPSAC News, Fall-Winter, 1993, p.30)"At the present time, 43% of all births [in Holland] remain under midwives' care: 44% of these are delivered in the hospital and 56% at home (Tew and Damstra-Wijmenga 1991:56). Perinatal mortality for these Dutch midwife-assisted births is the lowest in the world, approximately 2/1000 (Kitzinger 1988/236)."("Birth in Four Cultures: A Crosscultural Investigation of Childbirth in Yucatan, Holland, Sweden, and the United States," Brigitte Jordan, Revised and expanded by Robbie Davis-Floyd, Prospect Heights, IL: Waveland Press, Inc., 1993 (Fourth Edition). Page 48. )"The British and American experience, now powerfully supported by the Dutch results, tells us convincingly that homebirth and midwives are indeed 'safer than we thought.' Together they offer the safest option. The danger of home as a place of birth does not lie in its threat to the healthy survival of mothers and babies, but in its threat to the healthy survival of obstetricians and obstetric practice."("A Good Birth, a Safe Birth", Diana Korte & Roberta Scaer: Harvard Common Press, 1995)"Every study published shows midwives to be safer than doctors. Every study. No exceptions. If your physician disagrees with this, challenge him or her to produce the data that supports otherwise. They won't be able to do it. Such data does not and never did exist. In a nutshell, that is the strength of the case for midwifery. It is unanimous. . .[O]ver and over again, throughout history, the data shows that when doctors displace midwives, outcomes get worse." ("The Five Standards of Safe Childbearing," David Stewart, PhD. (Editor), Marble Hill, MO: NAPSAC Reproductions, 1982, 1997.)"In The five European countries with the lowest infant mortality rates, midwives preside at more than 70 percent of all births. More than half of all Dutch babies are born at home with midwives in attendance, and Holland's maternal and infant mortality rates are far lower than in the United States..." ("Midwives Still Hassled by Medical Establishment," Caroline Hall Otis, Utne Reader, Nov./Dec. 1990, pp. 32-34)"In the U.S. the national infant mortality rate was 8.9 deaths per 1,000 live births [in 1991]. The worst state was Delaware at 11.8, with the District of Columbia even worse at 21.0. The best state was Vermont, with only 5.8. Vermont also has one of the highest rates of home birth in the country as well as a larger portion of midwife-attended births than most states. . ."The international standing of the U.S. [in terms of infant mortality rates] did not really begin to fall until the mid-1950s. This correlates perfectly with the founding of the American College of Obstetricians and Gynecologist (ACOG) in 1951. ACOG is a trade union representing the financial and professional interests of obstetricians who has sought to secure a monopoly in pregnancy and childbirth services. Prior to ACOG, the U.S. always ranked in 10th place or better. Since the mid-1950s the U.S. has consistently ranked below 12th place and hasn't been above 16th place since 1975. The relative standing of the U.S. continues to decline even to the present."("International Infant Mortality Rates--U.S. in 22nd Place," David Stewart, NAPSAC News, Fall-Winter, 1993, pages 36, 38.)"Most of American obstetric practice in hospitals is not based on science but on myth. What obstetricians do may be the utmost in high-tech, but it is not true science. What you don't know about modern medicine can hurt you and your baby, perhaps permanently."(David Stewart, PhD., in the foreword of Janet Tipton's Is Homebirth for You? 6 Myths About Childbirth Exposed. Big Sandy, TX: Friends of Homebirth, 1990. {http://www.gentlebirth.org/format/myths.html} David Stewart is the Executive Director of the National Association of Parents and Professionals for Safe Alternatives in Childbirth.)Tew M. Place of birth and perinatal mortality. J R coll Gen Pract 1985; 35(277): 390-394.Using the raw perinatal mortality rates (PMR) from a 1970 British national survey, the hospital PMR was 27.8 per 1000 births versus 5.4 per 1000 for homebirths/general practitioner units (GPU). This was not because hospitals handled more high-risk births. When PMRs were standardized based on age, parity, hypertension/toxemia, prenatal risk prediction score, method of delivery and birth weight, adjusted hospital PMRs for each category ranged from 22.7 per 1000 to 27.8 per 1000 while homebirth/GPU rates ranged from 5.4 per 1000 to 10.5 per 1000.The 1970 survey assigned a prenatal risk score to predict the likelihood of problems during labor. When PMRs for hospital versus home/GPU for the same level of risk (very low, low, moderate, high, very high) are compared, the hospital PMR was lower only at the very highest risk level. All differences, except in the "very high risk" category, were significant. The PMR for high-risk births in home/GPUs (15.5/1000) was slightly lower than that for low-risk births in the hospital (17.9/1000). Moreover, the PMRs in home/GPUs for very low, low, and moderate risk births were all similar, but hospital PMRs increased twofold between categories, which suggests that hospital labor management actually intensified risks.The percentage of infants born with breathing difficulties (9.3% versus 3.3%), the death rate associated with breathing difficulties (0.94% versus 0.19%), and the transfer rate to neonatal intensive care units for infants with breathing problems who survived six hours (62.0% versus 26.2%) were all higher in the hospital (all p<0.001), further evidence that hospital interventions do not avert poor outcomes.Although no national study has been undertaken since, smaller studies confirm that increasing use of hospital confinement is not the reason for the overall drop in PMR since 1970. In fact, those years when the proportional increase in hospital births was greatest were the years when the PMR declined least and vice versa.("Obstetric Myths Versus Research Realities, A Guide to the Medical Literature", Henci Goer, Bergin & Garvey, 1995)
Today America leads the world in medical technology, but they trail 27 countries for infant deaths. Unfortunately, the public in general continues to believe that the only safe place to give birth is in the hospital. All Americans need to do is take a look at these other 27 countries to see what they do different, and it is not more medical techniques or interventions. It would be found that these countries have a high percentage of homebirth/nonintervention birth. The truth is that the hospital fails to offer the environment needed for the safest birth outcome. A woman's body is specifically created to give birth; it is a part of her normal bodily functions, and should not be considered a physical problem or medical emergency. For the vast majority of women, childbirth is neither an emergency nor an illness, indicating there is no need for medical intervention.The safety of homebirth is well documented, although the vast majority of the public has never seen any of the information. Medical corporations do not profit by presenting the information. In most cases, homebirth is as safe, usually safer, than subjecting yourself to a hospital birth. Below are only a few quotations and citations. There is with a wealth of knowledge to find, you are encouraged to research the safety of home birth further, until you are confident that you know the truth, then you can be well informed to make your own decisions. Some very helpful sites are included on the resources page.Presented on October 20, 1976 before the 104th annual meeting of the American Public Health Association:So far, the largest and most complete study on the comparison of hospital birth outcomes to that of homebirth outcomes was done by Dr. Lewis Mehl and associates in 1976. In the study, 1046 homebirths were compared with 1046 hospital births of equivalent populations in the United States. For each home-birth patient, a hospital-birth patient was matched for age, length of gestation, parity (number of pregnancies), risk factor score, education and socio-economic status, race, presentation of the baby and individual major risk factors. The homebirth population also had trained attendants and prenatal care.The results of this study showed a three times greater likelihood of cesarean operation if a woman gave birth in a hospital instead of at home with the hospital standing by. The hospital population revealed twenty times more use of forceps, twice as much use of oxytocin to accelerate or induce labor, greater incidence of episiotomy (while at the same time having more severe tears in need of major repair). The hospital group showed six times more infant distress in labor, five times more cases of maternal high blood pressure, and three times greater incidence of postpartum hemorrhage. There was four times more infection among the newborn; three times more babies that needed help to begin breathing. While the hospital group had thirty cases of birth injuries, including skull fractures, facial nerve palsies, brachial nerve injuries and severe cephalohematomas, there were no such injuries at home.The infant death rate of the study was low in both cases and essentially the same. There were no maternal deaths for either home or hospital. The main differences were in the significant improvement of the mother's and baby's health if the couple planned a homebirth, and this was true despite the fact that the homebirth statistics of the study included those who began labor at home but ultimately needed to be transferred to the hospital.("Home Birth Versus Hospital Birth: Comparisons of Outcomes of Matched Populations," Dr. Lewis Mehl. Presented on October 20, 1976 before the 104th annual meeting of the American Public Health Association. For further information contact the Institute for Childbirth and Family Research, 2522 Dana St., Suite 201, Berkeley, CA 94704)"It is important to clarify that safety is measured by death (mortality) or illness (morbidity) during the labor and birth process and shortly thereafter. The United States has consistently high maternal and perinatal mortality and morbidity rates compared to other industrialized countries. In 1990 the United States was ranked twenty-third by the Population Reference Bureau, which publishes the mortality and morbidity statistics. This means that there are twenty-two other countries where it is safer for women to give birth than in the United States."("Gentle Birth Choices," Barbara Harper, R.N. . Rochester, Vermont: Healing Arts Press, 1994. Page 52.)"A six-year study done by the Texas Department of Health for the years 1983-1989 revealed that the infant mortality rate for non-nurse midwives attending homebirths was 1.9 per 1,000 compared with the doctors' rate of 5.7 per 1,000."Berstein & Bryant, Texas Lay Midwifery Program, Six Year Report, 1983-1989. Appendix VIIIf. Austin, TX: Texas Department of Health.)Records kept from 1969-73 in England and Wales indicate still birth rates of 4.5 per 1000 births for home deliveries as opposed to 14.8 per 1000 births for hospital deliveries. ("The Place of Birth", Sheila Kitzinger & John Davis, eds., 1978 Oxford University Press, pp. 62-63)"Every study that has compared midwives and obstetricians has found better outcomes for midwives for same-risk patients. In some studies, midwives actually served higher risk populations than the physicians and still obtained lower mortalities and morbidities. The superiority and safety of midwifery for most women no longer needs to be proven. It has been well established." ("The Future of Midwifery in the United States," Madrona, Lewis & Morgaine, NAPSAC News, Fall-Winter, 1993, p.30)"At the present time, 43% of all births [in Holland] remain under midwives' care: 44% of these are delivered in the hospital and 56% at home (Tew and Damstra-Wijmenga 1991:56). Perinatal mortality for these Dutch midwife-assisted births is the lowest in the world, approximately 2/1000 (Kitzinger 1988/236)."("Birth in Four Cultures: A Crosscultural Investigation of Childbirth in Yucatan, Holland, Sweden, and the United States," Brigitte Jordan, Revised and expanded by Robbie Davis-Floyd, Prospect Heights, IL: Waveland Press, Inc., 1993 (Fourth Edition). Page 48. )"The British and American experience, now powerfully supported by the Dutch results, tells us convincingly that homebirth and midwives are indeed 'safer than we thought.' Together they offer the safest option. The danger of home as a place of birth does not lie in its threat to the healthy survival of mothers and babies, but in its threat to the healthy survival of obstetricians and obstetric practice."("A Good Birth, a Safe Birth", Diana Korte & Roberta Scaer: Harvard Common Press, 1995)"Every study published shows midwives to be safer than doctors. Every study. No exceptions. If your physician disagrees with this, challenge him or her to produce the data that supports otherwise. They won't be able to do it. Such data does not and never did exist. In a nutshell, that is the strength of the case for midwifery. It is unanimous. . .[O]ver and over again, throughout history, the data shows that when doctors displace midwives, outcomes get worse." ("The Five Standards of Safe Childbearing," David Stewart, PhD. (Editor), Marble Hill, MO: NAPSAC Reproductions, 1982, 1997.)"In The five European countries with the lowest infant mortality rates, midwives preside at more than 70 percent of all births. More than half of all Dutch babies are born at home with midwives in attendance, and Holland's maternal and infant mortality rates are far lower than in the United States..." ("Midwives Still Hassled by Medical Establishment," Caroline Hall Otis, Utne Reader, Nov./Dec. 1990, pp. 32-34)"In the U.S. the national infant mortality rate was 8.9 deaths per 1,000 live births [in 1991]. The worst state was Delaware at 11.8, with the District of Columbia even worse at 21.0. The best state was Vermont, with only 5.8. Vermont also has one of the highest rates of home birth in the country as well as a larger portion of midwife-attended births than most states. . ."The international standing of the U.S. [in terms of infant mortality rates] did not really begin to fall until the mid-1950s. This correlates perfectly with the founding of the American College of Obstetricians and Gynecologist (ACOG) in 1951. ACOG is a trade union representing the financial and professional interests of obstetricians who has sought to secure a monopoly in pregnancy and childbirth services. Prior to ACOG, the U.S. always ranked in 10th place or better. Since the mid-1950s the U.S. has consistently ranked below 12th place and hasn't been above 16th place since 1975. The relative standing of the U.S. continues to decline even to the present."("International Infant Mortality Rates--U.S. in 22nd Place," David Stewart, NAPSAC News, Fall-Winter, 1993, pages 36, 38.)"Most of American obstetric practice in hospitals is not based on science but on myth. What obstetricians do may be the utmost in high-tech, but it is not true science. What you don't know about modern medicine can hurt you and your baby, perhaps permanently."(David Stewart, PhD., in the foreword of Janet Tipton's Is Homebirth for You? 6 Myths About Childbirth Exposed. Big Sandy, TX: Friends of Homebirth, 1990. {http://www.gentlebirth.org/format/myths.html} David Stewart is the Executive Director of the National Association of Parents and Professionals for Safe Alternatives in Childbirth.)Tew M. Place of birth and perinatal mortality. J R coll Gen Pract 1985; 35(277): 390-394.Using the raw perinatal mortality rates (PMR) from a 1970 British national survey, the hospital PMR was 27.8 per 1000 births versus 5.4 per 1000 for homebirths/general practitioner units (GPU). This was not because hospitals handled more high-risk births. When PMRs were standardized based on age, parity, hypertension/toxemia, prenatal risk prediction score, method of delivery and birth weight, adjusted hospital PMRs for each category ranged from 22.7 per 1000 to 27.8 per 1000 while homebirth/GPU rates ranged from 5.4 per 1000 to 10.5 per 1000.The 1970 survey assigned a prenatal risk score to predict the likelihood of problems during labor. When PMRs for hospital versus home/GPU for the same level of risk (very low, low, moderate, high, very high) are compared, the hospital PMR was lower only at the very highest risk level. All differences, except in the "very high risk" category, were significant. The PMR for high-risk births in home/GPUs (15.5/1000) was slightly lower than that for low-risk births in the hospital (17.9/1000). Moreover, the PMRs in home/GPUs for very low, low, and moderate risk births were all similar, but hospital PMRs increased twofold between categories, which suggests that hospital labor management actually intensified risks.The percentage of infants born with breathing difficulties (9.3% versus 3.3%), the death rate associated with breathing difficulties (0.94% versus 0.19%), and the transfer rate to neonatal intensive care units for infants with breathing problems who survived six hours (62.0% versus 26.2%) were all higher in the hospital (all p<0.001), further evidence that hospital interventions do not avert poor outcomes.Although no national study has been undertaken since, smaller studies confirm that increasing use of hospital confinement is not the reason for the overall drop in PMR since 1970. In fact, those years when the proportional increase in hospital births was greatest were the years when the PMR declined least and vice versa.("Obstetric Myths Versus Research Realities, A Guide to the Medical Literature", Henci Goer, Bergin & Garvey, 1995)
Subscribe to:
Posts (Atom)
