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.
Monday, June 29, 2009
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)
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