Michelle Goldberg has an important piece in the Daily Beast about home births, and how they’re rapidly gaining popularity without women knowing all the risks. I’m a fan of allowing women to make birthing choices for themselves — and one reason many women choose home births is because of frustration with the medicalization of childbirth and the lack of power that they have in the hospital — but choices should be informed, and there just isn’t a lot of great info out there on giving birth at home. What information does exist seems to point to the conclusion that home births may be more dangerous and pose a higher risk of the baby dying. Which seems logical enough. If you’re in a hospital and something goes wrong, you have many more tools at your disposal than if you’re at home. Of course, giving birth in a hospital means a higher probability that you’ll have a c-section or be given pain meds, even if that wasn’t in your birth plan.
But I have to admit that I’m skeptical of folks who are hostile to modern medicine. Yes, hospital culture is awful, and doctors can be incredibly patronizing, and I understand the appeal to giving birth at home and having full control. But the language around home birth raises some serious red flags for me. Yes, childbirth is natural and women have been doing it since the beginning of time without doctors or medical interventions; until very recently, women also died in enormous numbers because they were giving birth without medical intervention. Women still die in many parts of the world in enormous numbers because they don’t have medical help during childbirth. Childbirth is serious shit. Complaining about the medicalization of childbirth strikes me as akin to complaining about the medicalization of cancer. No, pregnancy isn’t a disease, but it’s a condition that has serious impacts on one’s health. And it can kill you. And given that, it’s not a terrible idea to at least accept the fact that medical intervention might be necessary or even good.
There also seems to be a not-small degree of overlap between homebirth evangelists and the anti-vaccination crowd. That generalized hostility toward modern medicine can be both off and dangerous. And as much as “The Business of Being Born” was a great documentary, I’m not sure it makes a lot of sense to take medical advice from Ricki Lake or Jenni McCarthy. Many of the home birth advocates strike me as just as culty and ignorant as the anti-vaxxers.
Which doesn’t mean that there’s no room for hostility toward the corporate pharmaceutical industry and medical industry; both are far from perfect, and do not always put the needs of patience first. But patients, pregnant or not, should be able to make their informed decisions about their health care needs. And as it stands, there simply isn’t enough information out there for women to make informed choices. Pushes toward a more “natural” option coupled with distrust and hostility toward doctors and hospitals are having some very negative consequences for women and their children.
enter another long thread about how mothers with preferences that might harm the fetus are selfish and stupid. maybe also Harming the Cause. /gets popcorn.
I had a med-free birth in a hospital, and I made that choice for some of the reasons you point out. I feel that a hospital is the safest place to be IF something goes wrong. I made my choice based on that knowledge.
However, I never would have understood just how horrible the common birthing practices of hospitals are if I hadn’t gone through that experience. Before giving birth, I didn’t understand what the fuss was about home births and railing against the medical industry (I am ABSOLUTELY not against vaccinations and have gotten my daughter vaccinated on schedule. I also donated my cord blood for medical research/transplants. I am not anti-medicine.) I am, however, pro-autonomy. And the hospital birth experience tried to wrench that autonomy of my own body from me nearly every step of the way, and without medical cause. It is a violation, and I don’t think it should be glossed over as easily and repetitively as it is in these discussions.
What people often miss when they argue that you should give birth in a hospital “just in case” something goes wrong is that hospitals often *cause things to go wrong.* Thus people who say, “I’m so glad I was in a hospital because I needed an emergency c-section,” might not even realize their baby’s distress was caused by the pitocin they were given that wasn’t even medically necessary.
Did you listen to the stats and actual facts in The Business of Being Born, or just write it off because of Ricki Lake? It was a research project, and I think she did a good job of building her case.
Basically, hospitals treat births like scary health crises that need intervention even when they really don’t. The safety of these interventions (thalidomide, for instance — remember that?) isn’t really characterized. For instance, pitocin is an artificial version of oxytocin, a chemical released in the maternal brain during vaginal birth. Nobody knows what effects replacing it (unnecessarily, remember!) with an artificial version has on mother or baby or attachment.
Basically, if you can have a medically trained professional attend your birth that doesn’t feel the need to MESS WITH IT unless necessary, that is highly preferable to me (whether at home or not). Medical interventions are great… unless they’re given willy-nilly and *actually hurt you.*
I think it’s wrong to frame this as a matter of hospital birth vs. home birth. Childbearing centers exist, and are usually attached to hospitals should anything go wrong.
This is not quite true, or…it’s an oversimplification of the truth. Maternal death in childbirth was certainly feared, but the stats I’ve looked at for pre-industrial Europe put the rate at about 1% per birth (so 6% to 7% over the course of the average woman’s life)…which is certainly high by today’s standards, but not that high in the context of a society in which any random injury could kill you because of the lack of antibiotics.
Women consistently outlived men, on the whole, and some of the causes of maternal death are simply far, far, far less likely in the contemporary first world. A big one was rickets, a condition brought on by childhood malnutrition that causes the uterus to become misshapen. A huge one in the 18th and 19th centuries was puerpal fever (this is the one that killed Mary Wollstonecraft), which coincided with the business of birth being shifted from midwives to doctors, because doctors at the time spent a lot of time messing around with corpses, and as the germ theory of disease had not yet gained currency, they did not bother to wash their hands before going to deliver a baby; the woman would become infected, and as there were still no such things as antibiotics, she would die. These two things are not going to happen in the contemporary US or Europe. So yes, while home birth is riskier than hospital birth, pre-20th-century birth is not really an apt comparison.
Ooh, Jill isn’t taking any prisoners among the granola crowd is she? :D
See: all the fucking whooping cough nowadays. Anti-vax/anti-medicine people are terribly ignorant and downright hostile to some really basic health practices.
For really good data and discussions on this topic (and other evolutionary ladybusiness) I HIGHLY recommend Dr. Kate Clancy of Context and Variation, now on the SciAm blogs.
Here’s her old post on the study cited in the Daily Beast piece:
http://professorkateclancy.blogspot.com/2010/09/repost-which-is-more-safe-home-birth-or.html
Perhaps home births are made “riskier” because they’re not adequately supported by the hospital system? From what I understand of the US maternity system, homebirth is a somewhat underground activity, and midwives aren’t allowed to practice in some states (somebody correct me if I’m wrong).
In my native New Zealand, a woman chooses her own Lead Maternity Carer, which can be a doctor or a midwife. The LMC is funded by the government, and each woman has the right to choose where she wants to give birth (home, hospital, community clinic). If a homebirth is chosen, the midwife has backup available, and if a hospital transfer is necessary the LMC accompanies the woman and remains involved in her care. The LMC is also checks up on mother and baby for 6 weeks post birth.
Speaking anecdotally, this model of care has had some great outcomes amongst my friends / family, and I’m told that NZ has one of the best maternity systems in the world (as opposed to the US, which seems to spend more but gets poorer outcomes). Homebirth only makes up a small percentage of NZ births (<5%), but I see no reason why it should be any more dangerous when integrated into a system that supports it.
Strange. I think this is the first time ever that I’ve submitted a comment and it just vanished — I don’t see it, but there’s no moderation message either.
I’m years away from being pregnant, but I have a general idea in my head of an ideal situation. Maybe someone can tell me if this kind of thing exists? I have the general impression that it does but that it may only exist for people with really nice insurance plans, or depend on the area you live in, or something along those lines.
Anyway, I’d like to give birth in a nice relaxed room, with maybe a big bathtub and a bed and that kind of thing, and I’d like to have some nice relaxed professionals who are not doctors in a rush in there with me – a nurse or a midwife or similar. I’d like to be allowed to drink/eat if I want to (I’ve heard doctors don’t let you drink because you might throw up if they have to knock you out for a c-section, but seriously, not letting someone laboring for hours have any fuel has got to contribute to failed labor and needing c-sections), move around in whatever position I want, etc.
BUT, I want it to be *attached* to a hospital. Like this could be the maternity wing of a hospital. And then basically as long as everything goes well you take your own time and you don’t get rushed into a c-section, but if something does go wrong, the nurse recognizes it and you are in the hospital building so you can get rushed to surgery and saved before your hemmorage.
Because basically, it seems like as long as everything is going well you don’t really need a doctor, but I want one there just in case something goes wrong! Because then you can die. And modern medicine is really good at stopping that from happening.
So, if I give birth in, say, 5 years somewhere in the US, is this something I’m going to have a shot at?
Treebeard, what you’re describing is a birthing center attached to a hospital. I know there are some in NYC, but I don’t know about the rest of the country.
I see I missed a mention upthread of birthing centers attached to hospitals. Oh well.
Also, question to those who have given birth – is it true that doctors don’t want you eating or drinking during labor? And if so, was that a hardship, or did you just not have any appetite anyway? What if it went on for hours?
Yeah, I was thinking they exist in big cities, but not necessarily something you can count on if moving around.
Faced with the choice of hospital or home I’d choose hospital, because I’m worried about that chance that something goes wrong and you bleed out in a few minutes. But I really would prefer it not to be overly medicalized as long as its going ok.
And now every time I go here, I get a sign in box that says “Enter username and password for http://tracking.sitemeter.com“! I wonder what that is.
I understand critically examining the home birth movement, but why the condemnation? Could you provide some of the studies you mention? Because critical reading of studies is important as well. Canada has a robust and healthy home birth community, it’s supported by health professionals, and has been going on long enough to provide some pretty reliable studies that have concluded that it is safe. Also, bad outcomes “in other parts of the world” have a lot to do with lack of access to a trained birth attendant and prenatal care, which are both extremely important to good outcomes…in fact they are absolutely critical. These have not been considered.
Instead of framing home birth advocates as misinformed or naive, perhaps lets acknowledge the competing research, its validity, and actual outcomes in countries that fully support home birth. I see your approach in this post as extremely offensive to women, such as myself, who would make this very valid choice. Perhaps recognizing that hospitals do pose very REAL risks to laboring women (which here in Canada, OB/GYN organizations have recognized – stating themselves that the most dangerous place for a women in early labor is the hospital due to the overuse of interventions that carry risk)
A STUDY:
Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician
Patricia A. Janssen, PhD,
Lee Saxell, MA,
Lesley A. Page, PhD,
Michael C. Klein, MD,
Robert M. Liston, MD,
Shoo K. Lee, MBBS PhD
CMAJ September 15, 2009 vol. 181 no. 6-7 First published August 31, 2009, doi: 10.1503/cmaj.081869
Interpretation: Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician.
I’ve been getting that weird sign-in thing, too, but when I shut it down, it doesn’t seem to cause a problem.
Unless you’re uninsured or don’t have the several thousand dollars it costs to give birth in a hospital and receive more than below-basic care, of course. Which….remind me again how many USians are, today?
I’m about a decade or so away from pregnancy, but I already know I want to give birth with a midwife and/or at a birthing center. I feel like as long as you do your research and get a good midwife who will know when to go to the hospital if something goes wrong, home birth is a good option. I’m not opposed to the medicalization of birth: I’m opposed to feeling rushed through labor, or of facing a potential situation where the doctor I’ve built a relationship with during my pregnancy is suddenly unavailable and I’m forced to give birth with a stranger. I would rather build long, trusting relationships with the person that I’m going to be sharing such an intimate time with. My mom was in labor with me for nearly 30 hours because I had a huge 4 lb tumor attached to my tailbone that no one knew about. The nurses were actually MAKING FUN of her and denying her simple requests because they thought she was weak. Turns out she was trying to push out the equivalent of two babies at once! And she never got an apology or better treatment afterwards. Nope, hospital birth is not for me unless something goes direly wrong, or I am pre-informed that my birthing situation will require hospital services in order to keep me and my baby alive.
Lately the tone of this blog seems to be focused on the devaluation of parenthood and the work necessary for one to exist in the public realm, that takes place in the home. I thought we had moved past this type of argument a long time ago.
I’ve got a post in mod that kind of says the same thing, but the problem with this conversation is that it acts as if all of these women are just really, really wanting a home birth at any cost. I’m sure there’s a small percentage of women for whom that’s true, but in my experience, most women would prefer a hospital birth that allowed them autonomy over their own bodies and agency in their medical care. Unfortunately, our current medical system makes that incredibly hard to get, and often with very little reason other than that it’s policy.
From the article there seem to be two things in question. One is the question of risk of home birthing. The other is the issue of unqualified/incompetent midwives. Surely these are two separate issues?
Okay, my comment above was a bit brief. Plus, being from outside the US I think I may have missed a connection. Do midwives deliver babies anywhere other than at homebirths in the US? If not I suppose the issues are connected.
In New Zealand we have midwives who deliver at home, at birthing centres or at hospitals. Incompetent midwives can harm babies in any of those places and in hospital there is no guarantee that one would call a doctor in time if something goes wrong. However, good midwives routinely conduct safe home births here and know when to go to the hospital if something goes wrong.
I know that midwives definitely work at birthing centers here and I think that they work at hospitals as well, but I wouldn’t swear to it.
Yes, there are hospitals where midwives work; I’m sure I’ve read about it.
Yeah, treebird, most medical personnel attending births in U.S. hospitals tell you not to eat or drink during labor.
Potentially boring and/or TMI birth story ahead:
As it was, I could barely eat for 9 months (constant nausea/vomiting), so it didn’t seem like it would matter much. I was wrong. With my first birth, I went 18 hours without eating or drinking. Two hours of pushing was in there somewhere, and I was so wrung out that I almost had a c-section.
Second pregnancy, I was sick all the time too, but when the time came for I active labor, I chowed down some dinner. At the hospital, I drank water whenever I wanted to. They mostly left me alone with my husband to labor anyway, so it was easy to drink anytime I wanted.
I had no drugs for the second birth, and I puked like crazy during transition, but pushing only took about 15 min. that time. I crapped while pushing, of course, but they just whisked away that pad so baby slid out onto a clean surface. Birth is messy, and is a major athletic event, so it doesn’t make sense to me, either, to not fuel up beforehand.
As my comment in moderation (unless it just vanished!) says at greater length, the reason my ex and I never had any doubt about wanting a hospital birth for our son was exactly because of the worry about something going wrong — which it did. There’s no question that he would have died or had severe brain damage had we not been in a hospital (umbilical cord choking — his heart rate went down very far, very quickly). One of the very worst moments of my life, and I’ve had a few of them.
I am also struck by all these concerned posts purporting to be oh-so-helpful to ignorant mothers who might be too befuddled to get through our days without them. At this point, I think Jill’s just being perverse for her own entertainment.
Re: Midwives in hospitals, yes. Midwives can work in hospitals, although it depends on the hospital in question. Many hospitals are hostile to midwives and many midwives who try to practice in hospital settings ultimately leave for birthing centers or private practice where possible because the working relationships are poor and they’re given little professional autonomy.
But I’ve heard stories from midwives who have great working relationships with hospitals and ob/gyns who are on-call for emergencies. So it’s possible!
It’s all those pregnancy hormones, y’know. They make us so… what’s the word I’m looking for…hysterisomething.
Though I’ve never even been pregnant, so I don’t know what my excuse is. D: I guess I’m just nuts. *big sad eyes*
It probably varies a lot regionally, but most of the hospitals I can think of with big L&D programs have midwives – specifically certified nurse midwives (CNMs). In my state, >1 in 5 vaginal births are attended by CNMs.
Also, recent CDC data on homebirths (which are still 0.8% of all deliveries, range 0.4-2.5%):
http://www.cdc.gov/nchs/data/databriefs/db84.htm
From the summary:
“Home births have a lower risk profile than hospital births, with fewer births to teenagers or unmarried women, and with fewer preterm, low birthweight, and multiple births. The lower risk profile of home compared with hospital births suggests that home birth attendants are selecting low-risk women as candidates for home birth.”
Also interesting:
“… Although not representative of all U.S. births (see “Data source and methods”), 87% of home births in a 26-state reporting area (comprising 50% of U.S. births) were planned in 2009. For non-Hispanic white women, 93% of home births were planned (10).
Women may prefer a home birth over a hospital birth for a variety of reasons, including a desire for a low-intervention birth in a familiar environment surrounded by family and friends, and cultural or religious concerns (9,11). Lack of transportation in rural areas and cost factors may also play a role, as home births cost about one-third as much as hospital births (9,11,12).”
Good question. I am wondering what exactly a “midwife” is in the US. Is it an official job description? Do you need a degree? When I hear “midwife” I think of historical fiction.
But I suspect that if you live, say, a 30 minute drive from a hospital and something goes REALLY wrong, it might be too late? Maybe they only do that for people who live near enough to hospitals?
My mom told me she would have liked a home birth in theory, but my parents were living about a 30 minute drive from the nearest hospital and, according to my mom, my dad was just too much of a worrywort for it to go well if they stayed home. I don’t think she seriously argued with him about it, I think she also realized it didn’t really make sense with where they were living. So they went to a hospital. (Personally, I think going to the hospital was a good idea. My mom was healthy but on the older side for having kids, and apparently as a newborn I did end up spending some time in one of those oxygen incubator thingies, which they wouldn’t have had at home.)
Is it Judging Mothers Month round these parts?
Can I just ask what has happened to “Trust Women”, or does that only count if you’re having an abortion?
There has been reams of research into home birth, many, many articles about women’s experiences of the birthing process (good and bad), but you’ve read one, singular article and now you’ve decided that people who want home births are akin to anti-vaxers.
Sorry if this is too mommy-moo cow to be dealt with properly, but the whole issue of maternity services (I.e, they often seriously fail women regardless of what sort of birth they want to have/ had) is one that deserves a bit more then the lazy categorisation used in the O.P.
Because home birth is so criminalized in the States, and is much more likely to be attended by people who don’t know what they are doing, it makes more sense to compare the risks in hospital vs. home birth in Europe, if you want apples to apples. The stats there say with regard to low-risk births, first births are riskier at home, but later births are not. Ideally, I think most women probably prefer birth centers anyway, and that is the safest option of all, so the decision between a horrible (and risky) hospital birth and a higher risk home birth is bullshit to begin with.
Yes. It’s a nursing degree, and you become a certified nurse-midwife. Midwives are medical professionals.
(That’s not to say that there aren’t some people running around calling themselves “midwives” and doing home births with no training, as there are charlatans everywhere, but people almost always mean certified nurse-midwives when they say midwives.)
When I was pregnant back in ’98, my daughter could have been delivered by either a midwife or an ob/gyn at the hospital their practice was affiliated with, it all depended who was on call when I went into labor. And that hospital did have a birthing room, which wasn’t something the hospital was going to allow me to use because of my history with epilepsy, so irritating L&D for me. The only patients they allowed for it were the women with no possible complications for delivery in their medical history.
But what does still amaze me, is that not THAT long ago, babies were routinely born at home. My mother is one of six kids, with a fairly large age gap between the first three and the last three, and she was born in 1941, and was delivered at home, and so were her oldest brother and her younger brother, and I think they were all ten pounders. However, her three youngest siblings were all born in the hospital. I’m not sure when exactly hospital births became seen as anything but something only deemed necessary for risky births or a luxury only the privileged or wealthy, but at some point something convinced my stubborn and set in her ways grandma to spend money and give birth in a hospital.
Okay, so, uh…. point by point, because there’s several things here that need pointing out.
I don’t think that doctors forcing people to have C-sections, or take pain medication, or not allowing them sleep or food is a question of being “incredibly patronising”. By that count, the patriarchy’s just “really rude”.
Being uninformed about pregnancy is a separate thing from home or hospital birthing. If you have doctors who give you ALL the information you need before conception, during pregnancy, before birth…during birth… then congratulations, you’ve found one in thousands. I’ve known incredibly ignorant women who delivered in hospitals and weren’t any better informed when they left, baby in arms. I’ve also known women who went for private births with doctors and midwives in attendance who were formidably well-armed with knowledge and information. Please don’t conflate the two.
Except I haven’t heard of anyone forcibly knocked out and exposed to chemo without their consent. I haven’t heard of doctors deciding to perform mastectomies without consulting or even informing patients. The level of loss of control women in labour experience is fucking horrible.
Oh, and if you really need reasons to worry about doctors or giving birth in huge hospitals that don’t give a shit about you:
How about child trafficking? http://www.dailymail.co.uk/news/article-2049647/BBC-documentary-exposes-50-year-scandal-baby-trafficking-Catholic-church-Spain.html
or http://www.illawarramercury.com.au/news/local/news/general/nowra-doctor-tells-of-stolen-children-scandal/2469572.aspx
Or just having your child taken away because you don’t speak the right language: http://radicaldoula.com/2009/06/17/immigrant-womans-baby-taken-away-because-she-couldnt-communicate-with-hospital-staff/
Or nonconsensual tubal ligations? http://www.prweb.com/releases/2005/03/prweb221186.htm
(Which aren’t new, by the way, though in this case not necessarily after labour: http://www.nytimes.com/2011/12/10/us/redress-weighed-for-forced-sterilizations-in-north-carolina.html?_r=1&pagewanted=all)
Yeah, I can’t IMAGINE why some US women don’t trust the medical establishment. It baffles, shocks and amazes me.
I saw CNMs throughout my pregnancy. They were a group practice in a hospital. I felt that that was the best of both worlds – all the awesome empathy and gentle care you expect from a midwife, but within a hospital. They even had birthing tubs and really nice delivery rooms. Unfortunately, after several hours of seemingly normal labor at home, everything got very scary very quickly when I went to the hospital, and my baby had the same issue Donna mentioned above, and I ended up getting a C-section. But that doctor was great, as were all of the L&D nurses and the midwife on duty that day…they really tried to let me have as natural a birth as possible up until that became not a safe choice. If anyone is interested I have the birth story on my blog: http://spaceshipnola.blogspot.com/search/label/birth
Overall I would recommend the CNM hospital route. Interestingly, at this particular hospital, all Medicaid patients saw the midwives (and not the OBs) unless they had complications.
Treefinger, the scenario you describe sounds very much like the labor/delivery wing of the hospital where I had my daughter. Except for the no drinking/no eating thing, which was a huge bummer. (I had no appetite but was really thirsty; the ice chips didn’t cut it.) In the end I am very glad that I went through labor and delivery in the hospital, since I experienced a complication and without a c section, both my daughter and I would have died. But my experience was quite rare, and I’m totally in favor of women having both the freedom and the necessary information to choose where and how they want to give birth.
A friend of mine had her baby in a nearby hospital which had several doulas on contract. She described it as a wonderful arrangement (she was really glad to work with a doula, and probably wouldn’t have considered it otherwise) but the doula program was cut during a recent round of budget cuts. :(
@Ashley, that’s why I think NZ and Australian information is useful. I have read the Royal Australian and NZ College of Obstetricians and Gynaecologists’ latest statement on home births (Nov 2011) and they still won’t recommend home births. They review the studies and so forth but some statements show their bias, eg: “It seems likely that birth in a ‘home-like’ setting with close proximity to hospital care can
achieve some of the aesthetic appeal of planned homebirth but with reduced exposure to risk. “aesthetic appeal”?
Thanks Safiya – I wanted to say something similar. This article is full of generalizations and I have a huge problem with lumping anti-vax and home birth together. I chose to work with two CPMs for a home birth, and though I ended up deciding to transfer and the baby was born at hospital, I’d say the prenatal care, monitoring during labor and postpartum care was far, far superior to health care I’ve received with doctors, including the OB at the hospital.
Some of those mothers and fathers WERE stupid. But they don’t reflect the majority of people wanting home births. That’s what I take issue with. Dragging out the idiots to interview so everyone looks like an idiot.
It’s an annoying trend with the media. I swear they place ads.
Wanted- utter moron for interview.
Treebeard @24 and EG @27 ~ You can also become a lay midwife through apprenticeship programs, which some practitioners choose as a path because it is a better match for their approach to birth care. There is an internal debate within the midwifery community regarding whether or not CNM training is too hospital-oriented to be useful for home-birthing.
Ina May Gaskin’s recent book Birth Matters is a thoughtful overview (with a strong perspective) by a midwife who has been in the field since the 70s. Also Peggy Vincent’s Baby Catcher and Patricia Harmon’s Arms Wide Open. Wendy Kline’s Bodies of Knowledge, a history of the women’s health movement, has a chapter on the modern midwifery movement that might be a good introduction to the contemporary politics of home birth and midwifery for those who are curious. Obviously Ricki Lake’s documentary The Business of Being Born is a widely-available introduction as well, and I particularly appreciate the global perspective of Marsden Wagner’s Born in the USA.
In NZ midwives are graduates from a 3 year degree and some might be RNs as well. I chose very experienced private midwives, one of whom had been a lecturer for the degree and felt very confident with them.
In my case the birthing centre was very close to the hospital so I preferred that option both for security and also because we get 3 (fully funded) days for recovery at the birthing centre anyway, and it’s nice not having to travel there after the birth.
Well, you know us irrational ladies. We probably aren’t always completely sold on hospital births because the window shades at hospitals are such an unappealing shade of beige.
Thanks for the recs, annajcook! I wish I were as up on these issues as I used to be, but other things intervene, alas.
This piece just seems so at odds with the previous alcohol piece, in both argument style and conclusion. I mean, in the last article it was “The research is unclear, so go with your gut!” and in this one, “The research is unclear, so definitely do Option A because UNKNOWN RISK!”
Thanks to all the people bringing up additional research and personal experiences in the comments. Much appreciated.
I had a hospital birth, fwiw. I like being steps away a level 4 nicu and blood bank. But I do find the rhetoric thrown at women with strong birth preferences really irritating (haha, let’s make fun of those ladies w/their stupid birth plans! how dare they have preferences for how their genitals and body are treated aside from the ABSOUTE SAFETY of teh babiez???) I had a birth plan. That didn’t mean I thought I had absolute control over the situation, that it would go exactly to plan, or that I’m anti-medicine. It just meant that I had a few preferences, and I wanted them respected unless I or the baby were in danger.
That said, there is a dangerous intersection of practices like home birth, anti-vaxing, and other naturalism fallacy BS worth examining. It often overlays some pretty nasty gender essentialist stuff about mothers as well (Sears).
Another issue of restricting women’s choices. I would love to see greater access to birthing centers, CNM’s, etc for women. I have a dear friend who lives in Alabama and she had to drive (luckily not that far) over the border into Tennessee in order to give birth at a hospital with a Midwife. Apparently that was not allowed in AL. She jokes about being probably one of the only women who took the Jack Daniels walking tour while very pregnant and early in labor (all that walking to get the labor to move along)
Giving birth is obviously a very natural thing and some women would love to preserve that. Keep them safe, yes. Keep the baby safe, yes. But, I see no harm in creating greater access to CNM, doulas, birthing centers and even home birthing, if that is your choice. We just need to be informed.
@EG you’re welcome! reading about this stuff has been a fascination of mine since adolescence, despite the fact my partner and I will likely never have children. Reproductive and childcare choices are such a fascinating lens through which to understand how people think about humanity and human community and inter-responsibility…
also, thanks irishup and annajcook for the recs/links. :)
I actually wasn’t trying to say Do Option A!!! I think women deserve a variety of choices. I also think that there needs to be many more studies and actual information before women can really be said to be making an informed choice. And yes, the home birth folks have a particular set of interests that they’re forwarding, just like the hospital birth folks. I’m not sure either has a moral high ground, but I do see the home birth advocates being given far more leeway in feminist spaces. I’m skeptical of “it’s good because it’s natural” as a general rule. But my point wasn’t that one choice is The Best Choice. My point was that pregnant women are making choices based on very limited data, and that’s a big problem.
“The lower risk profile of home compared with hospital births suggests that home birth attendants are selecting low-risk women as candidates for home birth.”
They do in fact “screen” women who would like a home birth – basically only low-risk women are candidates. It takes about as much time to transfer to hospital as it does to set up an OR – so while transferring, this process is undertaken and the woman can then go straight in if necessary.
In order to be a midwife, 4 years of school is necessary to make you a “primary health care provider” – midwives are highly educated, not at all a case of “historical fiction” but rather very important parts of the overall women’s health picture. Choice of birthplace is a central tenant of this type of care, which is evidence based, and supported by a number of governments in countries which have very good birth outcomes (in fact, statistically better than the U.S., which is the least supportive of primary care midwives and home birth options)
Huh? I’m not lamenting “ignorant mothers.” I’m lamenting an actual lack of information which impedes women from making fully-informed choices. I don’t know what the best choice is. If I got pregnant tomorrow, I don’t know what type of birth I would choose. The lack of accurate and holistic information is a big problem, and it’s hurting women.
I agree with the point you alluded to — if I not putting words in your mouth — that the home birth movement is often part of the cult of true woman/motherhood done granola-style.
I thought I wanted to be a natural mama with no pain meds, etc. but in my state at the time, options were limited because it was not legal to practice midwifery, so it was a choice between a home birth unattended by a certified (trained?) professional or a regular hospital birth. I was not brave enough for the home birth but my doctor was supportive of my birth plan. After many, many hours of back labor and no progress, I got an epidural at my request (no pressure from anyone) and I am so glad I did.
In other words, I got over this idea that it should be a mystical, magical experience only experienced through the haze of pain that comes from no pain meds and that I would regret having missed. I am glad I had the option and opportunity though I wouldn’t begrudge anyone their choice to go medicine-free.
Urgh. That article is full of URGH. I don’t want to read how “statistics are hard to nail down…..for some it’s really dangerous.” WTF?
From what I know, home births were/are always recommended for pregnancies that were deemed low-risk. If these people are ignoring *that* advice and having their home birth anyway, then that’s the problem, not home birth in itself.
Well, fair enough, Jill, but you’ve also gone out of your way to point out that
and
That doesn’t strike me – and this piece hasn’t struck anyone so far that I can see – as an unbiased or balanced discussion.
I’m not claiming it’s an unbiased discussion. “Unbiased” doesn’t really exist. I do think that Michelle Goldberg is an excellent and fair journalist, and I think the critiques she presents in her article are compelling and important.
@Jill, I agree that you were advocating for more information to base choices on. However, I think the article you springboarded off was pretty shoddily researched and written. It conflates issues and leaves out important context.
I think it is wrong to treat home birth safety and midwife quality as one issue so Goldberg stuffed that up.
@Selah Selah, your early comment only came out of mod a little while ago. I wanted to say that I think the NZ system is really good. Lots of choice, especially considering most of it is free! Many women choose to pay $5000 to use OBGYNs as their LMCs and that’s their choice too. We do have a midwife shortage but there is a bit of a baby boom going on.
Okay, but the article is titled “Home Birth: Popular but Dangerous”, so you have drawn and communicated a conclusion despite the lack of clear evidence one way or the other, so while you indeed discussed the need for more research, the entire thing (for me, at least) was framed under this idea of, “We need more research, but it definitely seems dangerous and is therefore probably not the best idea.” (I’m paraphrasing my impression and not literally quoting you, of course.) There was also a lot of messy conflating this lack of information with the rationales of a sub-group of people who prefer home-births whose particular beliefs and ideals you find suspect – namely, the “it’s automatically better because it fits my poorly-refined understanding of what ‘natural’ means” crowd (whom I similarly dislike). You appear to believe that this group is fairly representative of the majority of home-birth preferrers (again, my impression based on statements like, “Many of the home birth advocates strike me as just as culty and ignorant as the anti-vaxxers.”) and I question whether this is the case. You referred to other possible reasons for preferring home-births (mainly that hospitals and the whole medical infrastructure can really, really suck for some people), but that was downplayed by the end of your article in favour of referencing this “cultish” group. I question how representative this “cultish” group is. I’m sure they have their place and may even dominate in certain communities and social circles, but I hesitate to assume their dominance, especially in light of the alternative perspectives offered in the comment thread.
And, again, by focusing so much of the initial piece on beliefs and ideologies, the whole thing seemed much more geared to, “People making decisions based on rationales which I find suspect,” rather than “Problematic lack of important research so that any of us can make an informed decision on this.” It did read like a piece more about criticizing people’s choices more than criticizing lack of research on an important issue. (As did the original article.)
And, frankly, people who prefer home-births for the kinds of cult-y, anti-science reasons you describe are probably particularly unlikely to be moved by research from the same medical establishment they already abhor, so the link between the two points is lost on me.
@pheeno, I’m talking about the recent spate of feministemposts telling mothers:
Housework & child care (done by a mother) are just all in a day, so neither counts as real, valuable, feminist work;
It’s a “good thing” that women are delaying motherhood;
Drinking while pregnant is probably not all that bad for fetuses, and besides it’s just policing women to tell them about the negative effects alcohol can and does have on fetuses; and
Home-birthers are a bunch of nutjobs who don’t even vaccinate!
Nicely rounded off with steaming piles of white privilege in the comments, including “What’s so bad about mostly hiring poor WOC to work in daycare centers? Hey, they might be exploited, which is bad, but at least we are giving them JOBS that they are ‘eager’ to do.”
I used to see a CNM for my general gynecological care in a large teaching/research hospital. I felt that as a gynecological care professional she was much more responsive to my needs and more transparent about what she was doing and why than any of the ob/gyn doctors I’ve seen previously. I was curious about the letters after her name and the training, so I looked it up. They are nurse practitioners with at least masters degrees who can prescribe medications and see patients. Then, on top of that, there are the post-graduate studies to become a midwife. It seems to me that the training is broader in scope and more patient-centered than ob/gyn training.
I’m not having kids, but I wouldn’t hesitate for a moment about going with a CNM instead of an ob/gyn if I wanted to have kids. No way would I give birth at home – someone I knew ended up giving home birth to a breech baby after he flipped at the last moment and came too fast to go to the hospital. Thankfully her CNM knew how to deliver a breech baby!
@Jadey, thanks for doing the heavy lifting there.
The home birth proponents I know are ordinary, sensible types, who use ultrasounds and vaccinate their children. I’m sure that there are many people outside NZ who are the same.
I have two things informing my thoughts on this post: one, I had a baby three weeks ago, and two, my mother has been a practicing ob-gyn for 30 years.
I gave birth in a large research hospital, attended by a Certified Nurse Midwife, and had my wishes for an intervention-free birth followed by every person who entered the room. I wanted to be in charge of my labor, to make my own decisions, and to have an intervention-free birth. These wishes were respected to the utmost degree. I did not have routine IV prep, until I needed an IV for fluids because I hadn’t been able to keep food or liquids down for 18 hours. I had an epidural because I requested it – no one suggested it to me, even once, before I asked for it. Even after I had an epidural, the nurses and midwives continued to respect my wish to remain in charge of the care I received. This birth experience is possible in hospitals in the US!
I chose a hospital birth because I knew, from my mother, how horribly wrong pregnancy can go and how quickly it can go so wrong. Women should be able to choose home birth, but I agree with Jill that the risks are just not adequately addressed by many homebirth advocates, just as the risks of not being vaccinated are not adequately addressed by many anti-vaccine advocates.
That said, I think it is wrong to vilify the doctors or the women choosing home birth. Many, MANY interventions in hospitals are driven by insurance requirements and the incredibly high fear of lawsuits. When sued by parents, according to my mother, the only way to avoid liability is to have done a c-section. Only then can the doctor say “we did everything we could” and have people believe him/her.
My wife gave birth to our first kid in a hospital with the traditional OB/GYN, etc, and we’re currently about a month out from our second child, this time a planned home birth with a nurse-midwife (and doula, birthing tub, etc).
The first hospital experience, from the father’s point of view, really sucked. My wife wanted to avoid intervention, as much as possible. No pitocin, no epidural, no c-section. There’s a well documented spiral of increasing medical interventions behind the rising rate of c-sections in this country, and we wanted to avoid all that, if possible. So part of my job was to advocate for her while she was huffing and puffing through contractions.
Then, every time I turned around, I was confronted by an L&D nurse telling me I needed to convince my wife to get pitocin or an epidural. Labor is a stressful time for the dad’s too, watching the mother in pain, worrying about them, about the kid, wanting to help out (also wanting to avoid pissing off a woman hyped on adrenalin and endorphins with the strength of a bear). And getting pestered by the staff was just another straw on the proverbial camel’s back.
Since we haven’t had the home birth yet, I can’t really speak to that experience, though we’ve both researched it quite heavily and are hoping it’ll be easier. We’re geeks, and our first instinct when encountering a new situation is to find research materials. From everything I’ve seen, it’s a perfectly safe choice if done intelligently. Don’t have a home birth if you have a known complication or risk factor. Do have a hospital backup ready, in case you need full medical care. Do research the home birth options and find a true certified nurse-midwife. It can be done badly, but it can also be done well, and the information is out there for people to make informed choices. There’s plenty of ideological noise too, but that’s true of most politicized issues.
The problem, in my opinion, is how much of that noise is pseudo-science, which is very much in common with the anti-vax crowd. It sounds logical, or at least conforms to the reader’s preexisting bias. From both sides of the issue are half-performed studies and extreme examples put forward as average. People cling to authority in these cases, because it’s a pretty scary prospect. And if your gut tells you this side or that side sounds authoritative, you’ll buy it.
It’s hard to weed through the noise when you’re scared, or even just exhausted and in pain during labor. There isn’t room given for the mother, or the parents both, to make their own decisions, really. The information is there, but it just takes so much more effort to find it.
I know it’s anathema to say, but… being a woman doesn’t protect you from being ignorant. Crazy world! Women, not always knowing what they’re doing by virtue of (usually) having a uterus! Even if there’s a fetus in it!
Advocating for more research doesn’t mean women are stupid. But also, some women are stupid. It’s human nature.
In the US, you have two kinds of midwives: certified nurse midwives (CNMs), who are nurses with advanced training, and certified professional midwives (CPMs) who don’t really have that much training at at and aren’t allowed to prescribe medications. CNMs mostly work in hospitals, but some with do home births, and CPMs can only do home births because they aren’t qualified to work in the hospital. CPMs are dangerous–the Colorado CPMs, who are required to release their death rates, lose 1/61 of the babies the deliver. Frankly, I don’t think they should be allowed–they don’t have the training to make birth safe at all.
The other problem that this article didn’t mention is that the homebirth movement isn’t really about choice–it is about demedicalization of childbirth, and it criticizes women who want a medicalized childbirth. Frankly, if I were to get pregnant now, I’d be discussing a maternal request c-section with my OB, and even if I decided on vaginal, I’d want a epidural placed right away. Those choices aren’t supported at all by the leaders of the homebirth movement, even though both are miles safer than a homebirth.
“even though both are miles safer than a homebirth.” – do you have a citation for that? Plus, are you saying C-sections are safer than vaginal deliveries at home?
In the US, you have two kinds of midwives: certified nurse midwives (CNMs), who are nurses with advanced training, and certified professional midwives (CPMs) who don’t really have that much training at at and aren’t allowed to prescribe medications. CNMs mostly work in hospitals, but some with do home births, and CPMs can only do home births because they aren’t qualified to work in the hospital. CPMs are dangerous–the Colorado CPMs, who are required to release their death rates, lose 1/61 of the babies the deliver. Frankly, I don’t think they should be allowed–they don’t have the training to make birth safe at all.
The other problem that this article didn’t mention is that the homebirth movement isn’t really about choice–it is about demedicalization of childbirth, and it criticizes women who want a medicalized childbirth. Frankly, if I were to get pregnant now, I’d be discussing a maternal request c-section with my OB, and even if I decided on vaginal, I’d want a epidural placed right away. Those choices aren’t supported at all by the leaders of the homebirth movement, even though both are miles safer than a homebirth.
There is a lot of misinformation being passed back and forth among these comments. Hopefully, we can correct it.
1. Most of what homebirth advocates think they know is factually false. That’s because professional homebirth advocates and homebirth midwives routinely fabricate claims, misrepresent existing research, and ignore research they don’t like.
2. With the exception of 1 or 2 Canadian studies, there are NO studies that show that homebirth is safe, and all the existing statistics, state, national or international show homebirth increases the risk of perinatal or neonatal death, often dramatically.
3. Most midwives in the US are CNMs (certified nurse midwives); however, most homebirth midwives are NOT CNMs. They created a credential (the CPM, any confusion with CNM is intentional) and they awarded it to themselves. CPMs have less education and training than ANY other midwives in the first world. They have so little education and training that they are not eligible for licensure in the UK, the Netherlands, Australia or anywhere else.
4. The latest data from the CDC shows that PLANNED homebirth with a non-nurse midwife has a mortality rate 600% higher than comparable risk hospital birth.
5. This finding of a dramatically increased risk of perinatal or neonatal death is confirmed by state statistics in Colorado, Oregon, North Carolina and California.
6. The Midwives Alliance of North America (MANA), the organization that represents homebirth midwives is hiding their OWN death rates. They collected safety data on 24,000 planned homebirths attended by their members. They’ve released the C-section rate, the transfer rate, and the intervention rates, but they refuse to release the death rate.
7. Homebirth in the UK has double the risk of adverse outcomes than comparable risk hospital birth. The Netherlands is often touted as an example of the safety of homebirth, but the fact is that the Netherlands has one of the worst perinatal mortality rates in W. Europe. Moreover, low risk birth with a Dutch midwife (home or hospital) has a HIGHER mortality rate than high risk birth with a Dutch obstetrician.
8. Homebirth advocates like to compare international infant mortality rates without recognizing that infant mortality is a measure of pediatric care, not obstetric care. According to the World Health Organization, the correct measure is perinatal mortality and according to the WHO, the US has one of the lowest perinatal mortality rates in the world.
I realize that most of these facts are news to homebirth advocates, but that’s because homebirth celebrities and homebirth midwives routinely repeat misinformation and fabricate claims. Therefore, it is impossible to become educated on homebirth by reading websites or books by homebirth advocates. The only way to learn the truth is through the scientific literature and state and national statistics.
Every woman has a right to choose homebirth, but she can’t make an informed choice if all she knows is what other homebirth advocates tell her. Homebirth midwives in the US are undereducated, undertrained and considered unqualified by all other countries in the first world. They have embarked on a campaign to confuse women about the two different kinds of midwives and to hide their own death rates. All too many babies have died preventable deaths as a result.
@Elizabeth, Congratulations! Smell your baby’s head for me! (tries to maintain proper decorum)
This is interesting but unfortunately results are a while away:
Oh dear, link fail.
http://www.caesareanstudy.net/
A c-section might be more dangerous than successful vaginal birth at home or in the hospital, but you aren’t guaranteed a success. At least in a hospital the providers can perform an emergency c-section if necessary and have the drugs and blood supplies on hand to help if you start hemorrhaging. It’s very hard to find stats on homebirth mortality for either mothers or babies, but what data we have makes it look really bad. For example, Colorado homebirth midwives latest perinatal mortality rates were 16.4/1000–higher than the 6.3/1000 of Colorado as a whole, which also incudes babies born to high-risk mother and premature infants that shouldn’t and probably aren’t being born at home (http://skepticalob.blogspot.com/2012/06/no-wonder-colorado-homebirth-midwives.html). I’m guessing their maternal mortality rates would be fairly high as well, but they only delivered around 900 infants, so that isn’t enough to show an increase in maternal mortality which is overall fairly low.
In contrast, according to wikipedia, a c-section is harder to recover from and has a bit higher maternal mortality (though it is hard to tell with all the confounders), but is generally safe and in many cases absolutely necessary. Epidurals are even safer. Frankly, I find the demonization of pain relief during labor disgusting–labor hurts, often really, really badly. Go without it if you want, but don’t demonize those who chose it.
My sister probably would have died at birth if it wasn’t for an emergency c-section–her heartrate scared the OB, and when they got her out the cord was wrapped around her neck. CPMs don’t have the equipment or training to reliably detect fetal heart rates in time to transfer, much less actually do anything for a baby in distress.
The reason I brought up pain is because the wikipedia article on c-sections quoted the head of the royal college of midwives blaming rising c-section rates on women’s lack of pain tolerance (wikipedia: http://en.wikipedia.org/wiki/Caesarean_section. Citation: http://www.guardian.co.uk/society/2008/oct/26/health-women). I’m thinking it might have more to do with c-sections becoming in general safer and therefore an option for even more remote risks. Also, so what if women don’t like pain? That’s what the epidural is for.
Okay, look. Being a woman, or a pregnant woman, or a mother, doesn’t inherently make you stupider than any other randomly selected person in the world. It also does not make you smarter. Getting pregnant doesn’t often require a lot of thought or understanding of biology and the modern medical field. I drive a car and about all I know is I put poison in it and it goes vroom-vroom. My ability to drive doesn’t mean I know shit about cars.
I don’t think “Women know best” and that slogan makes me cringe. A better one is, “Well, it’s not going to kill you, is it, nosy-pants?” So if people want to give birth in their homes or get elective c-sections, I’m not going to make it illegal or make them miserable about it, but I’m also not going to act like I think they made the right decision and never raise a brow. I see people make fucked-up ignorant choices all the time. And I want to talk about the choices people make, and why they make them, and make sure that when people make choices that might be stupid or fucked-up or just really, really bad for them, they at least know what they’re doing.
All that said, even though I’m not on board with you at this moment, I think it’s always a good idea to have a voice in the crowd asking us if we’re talking about choices or just being jerks. So, like, keep being awesome and stuff. I like your comments a lot.
Really? “The home birth folks,” huh? This is not a monolith. Would you simplify every person who chooses an abortion into “the abortion folks”? Every person who has a child into “those children folks”?
There is a minority of home birth advocates who are particularly vocal–and sometimes even combative. But, for the most part, women choose home births for a variety of reasons that have to do with their personal views, their individual circumstances, and the lives they’re living–just like every other decision. Setting them up as a stereotype doesn’t account for that reality at all.
When I was born in 81, I was a breach birth and had fluid in my lungs. My mom, a nurse, had commented once that a few years earlier and I may not have made it, and about twenty years earlier she wouldn’t have either.
A home birth even today would have been extremely dangerous.
My niece’s birth was in 05, and my sister was lucky enough to have a hospital nearby that also had a birthing center staffed by midwives who were directly affiliated with the hospital. They wouldn’t let her give birth in the center, which is a big house across a small lot from the hospital, because of weight and a family history of birthing difficulties, so she gave birth in the hospital. This turned out to be a good choice as she needed some intervention, but the midwife was there for the entire process, along with nurses and a obgyn.
Some hospitals will not allow midwives or even dwala’s in the delivery room, and push for medical intervention.
But there is a happy medium.
LOL, hair splitting.
In the UK home births are very well supported by the NHS midwives. You have to have a low-risk pregnancy, a home visit and a routine delivery otherwise you’ll be transferred to a hospital. There are obviously fewer intervention options and slightly more risks in the event of serious complications, but there is always a medical professional with you and an ambulance on standby to transfer you if you need it. My first child was supposed to be born at home (as I was, and my mother, and my grandmother) but because of my waters breaking early I had to go to hospital. I absolutely hated it, it was impossible to relax or sleep there, and filled with the general public, some of whom were scary and violent. If I have another child I’ll definately have them at home if I can. Not because I don’t believe in medicine, but because I can have perfectly good medical care in my own home, in peace and quiet and safety.
My mom is an Ob-gyn who had my sister at home and who delivered countless babies at home before going to medical school. I think, from my experiences, the disempowerment of woman by callous health professionals can sometimes create knee jerk situations where women turn to callous practitioners of “natural” methods. I’m very pro-midwife, as I’ve been raised to be, but I’ve been to some shit ones, just as I’ve been to some shit doctors. I guess having been raised by a women’s health care professional, I’m very interested in seeing rigor from any health practitioner. I’m not going to give anyone carte blanch without asking a lot of questions. And I think it’s very dangerous to overinvest in philosophies- i.e. “natural” or “degree-approved-” and ignore the specifics of any situation.
Also, most hospitals now have both birthing centers and midwives.
The Janssen study goes further than just showing supported homebirth to be “safe” or “as safe” – it clearly showed that in a hospital birth both baby and mother were more likely to be injured. And it was a true, well-performed, well-matched, similar-risk intention-to-treat analysis, which can be a bit hard to come across in this area. I wrote about it at the time. Perineal tearing, postpartum haemorrhage, birth trauma (skull and clavicle fractures, brain haemorrhage, nerve injuries), neonatal asphyxia, meconium aspiration were all lower at home. Less surprisingly, planned homebirth also reduced the risk of assisted delivery, C section, and episiotomy.
One very interesting thing about this study is that women with one previous C section and outpatient induction of labour were included, as were those with breech position discovered after the onset of labour; risk factors that would cause US and Australian obstetricians to catastrophise and doomsay.
A subsequent study, Hutton, again showed very similar rates of perinatal death, with greater risks for women in hospital – in fact “All measures of serious maternal morbidity were lower in the planned home birth group as were rates for all interventions including cesarean section “.
Lastly, putting some women’s objections down to “awful hospital culture” and “patronizing doctors” is a serious denial of the horrendous violence done to some women. Why ignore the voices – which I am sure you have heard – of women being held down while screaming “no”, having their vaginas probed or cut or other procedures performed on them without consent? There are really good reasons why traumatised women are turning to non-hospital births (not that this is the only reason out there!), and ignoring that violence and those mothers’ voices, in this conversation, is dismissive and rude.
Violence against women is unacceptable no matter what degree you have and what colour your labcoat, no means no whether or not you’re in labour at the time, and Feminism needs to sit the fuck down and listen to women who are crying out ‘THIS VIOLENCE AGAINST US NEEDS TO STOP’.
I’m not trying to split hairs. I just don’t think that we can lump all women who choose a home birth in with the small, vocal minority that insists that natural methods are always superior to medical intervention or that all medicine is bad. Most of the women who choose or consider home births are doing so for complex, individual reasons based on informed decisions, not just hopping on a bandwagon. I think we would (and do) get upset when we lump all women who make other decisions (such as to have an abortion or to have children or whatever) into one monolith and ascribe them stereotypical descriptors. I’m just pointing out that it’s no different to do that to women who choose home birth.
Today Jill was like: Here’s something I know nothing about and have done extremely limited amounts of research on! I’m gonna write about it in an inflammatory fashion.
Even I know enough about the topic to know that Jill is talking out of her ass today. My favorite part is the weird dichotomy she draws between “medical” hospital birth, and “natural” home birth, as if home birth doesn’t involve any medical professionals or modern medicine.
Here is, I think, the key paragraph in the original article – and why I think the whole post takes the wrong focus:
The US has absolutely appalling maternal mortality rates (here’s some data – the Netherlands rate of maternal mortality is less than half the US rate). As a system, particularly given the resources that goes onto it, the way childbirth happens in the US is a disaster.
There are lots of reasons for this – obviously income inequality and the problems with the health system are two of them, but that’s not all that’s going on. I really recommend Jessica Mitford’s The American Way of Birth – it’s a bit old now – but it outlines the structural problems with the American birthing system. Basically it’s not structurally set up to try and minimise unnecessary intervention. Which means a lot of unnecessary intervention takes place – which comes with a high risk. This is not a separate problem from highly under-trained and unsupervised people calling themselves midwives and lying to women about risks (and this is something Jessica Mitford outlines really well) – the lack of proper qualification and certification for midwives is an outcome of the messed up US birthing system as a whole.
In places with a better birthing system as a whole – home birth is a lot safer (see this article to get back to the Netherlands http://www.ncbi.nlm.nih.gov/pubmed/19624439).
Finally the title of this post is just straight out untrue. According to the statistics in the article linked to there are 29,650 home births in the US in 2009 – in that year there were 4130665 births in the US. Home births made up 0.7% of births in the US – that’s well below any thresh-hold where ‘popular’ is an accurate adjective. This isn’t incidental – home births are much more dangerous in a system that isn’t set up for them.
As EG says – the whole set-up of home birth vs. hospital is problematic. There are better ways of imagining a birthing system (and a lot to be said for birthing units attached to hospitals as a good way of providing low-intervention for low-risk women with backup (which is basically the ideal practice) – particularly in a system where everyone has access to health care. Although for women who live near a hospital a home birth can provide exactly the same thing). But I think it’s really dangerous to look at one part of an isolated system and say “this is a problem” without looking at the whole. It gives us wrong disagnoses and wrong solutions and sets up two things as opposites when they’re actually the two sides of the same coin. The risky nature of home-births in the US is part of the same system as the over-intervention/loss of women’s autonomy in hospitals – it’s not the opposite to it.
There is nothing feminist about taking unnecessary risks with you and your baby’s life, health and wellbeing. Ignoring that childbirth is inhernetly dangerous is to dismiss the bravery and sacrifice of mothers and women now and throughout history. Children were and are born at home all over the world, and they and their mothers often suffer injuries and death that are totally preventable if they have access to medical care. Have your baby at home if you want, but know that if you are bleeding out or if your baby is deprived of oxygen, then being “ten minutes away” from a hospital won’t mean shit. If you want to risk sacrificing you or your baby to some crazy idea of feeling comfortable, have at it, but I don’t see why it is feminist to be foolish. Read the “Hurt by Homebirth” blog and you will see story after story of people who went with homebirth because it somehow felt more empowering or more comfortable, only to lose their children. Before anyone says that babies die in hospitals too, I will admit that they do, but they rarely die of preventable, treatable problems during labor like they do in homebirths. That’s like not wearing your seatbelt because if the accident is bad enough, it will kill you anyway.
Elena, I have to point out that what many people on this post are saying is that this is not a feminist issue either way. Yes, there’s nothing feminist about risks – but no, there’s nothing ANTI-feminist either.
Some of them do, and you just eat when they aren’t in the room. Avoids conflict for everyone.
Actually, while catastrophic hemorrage is always possible (if rare) standard postpartum hemorrage is easily resolved with a bag of pit, fundal massage and immediate hospital transfer. Happened to my stepmother, by the time she reached the hospital she was fine anyway.
Yes. My understanding is that a responsible CNM will, when attending a homebirth, bring with her a variety of emergency resuscitation supplies such as oxygen and suchlike. And it is indeed possible for a CNM to monitor the baby’s heartrate during a home birth. There are portable devices for just that purpose.
Beautifully put, Maia. Thank you.
I’m having my birth at a hospital with a Certified Nurse Midwife. I am lucky enough to live in a big city (and 4 blocks from the hospital). I considered a home birth, since I am so close to the hospital, but ultimately was unable (unwilling?) to find a midwifery practice I felt comfortable enough with. My first choice was unavailable.
I agree with those who have pointed out that there is a difference between the issue of midwife quality and the issue of home birth risks. Obviously if you have a fly-by-night, unqualified midwife, you are going to have risks with your home birth. But qualified midwives are trained to recognize problems/complications before they become crises and then take the appropriate steps, up to and including hospital transfer, to handle them. They are trained in infant resuscitation, equipped to handle hemorrhaging and will not push a woman away from choosing to go the hospital route if she changes her mind for whatever reason.
I also disagree that there is a lack of information out there on the risks and benefits of home birth. I’m not sure where that assertion comes from. And to the extent that there IS a lack of information, I agree with whoever pointed out that this post takes the opposite approach to lack of information from the previous post about drinking during pregnancy and the dearth of information on the effects of alcohol on the fetus.
I am pro-choice, we should all be able to make choices about our own bodies; but with the growing popularity of home births and the loud voices of the ‘natural birth’ movement, I fear my own bodily choices may be constrained in the future by such people. Just by reading online parent blogs I notice the vitriol and judgement directed at women who choose schedule c-sections over vaginal delivery. I am all for women choosing home births if they want (their body, their choice) so I would expect the same when it is my turn.
I am nowhere near procreating yet, but when I have kids I would prefer a schedule c-section in a private hospital (I’m in Australia) with care provided by doctors, I do NOT want to be attended by midwives as I do not intend to go through labour. I don’t see birth and mothering as a competition; if you think pushing a kid through your cooch makes you ‘win’ at mothering and womanhood, that’s fine by me. You can declare yourself as having a Golden Vagina because you’ve been ‘woman enough’ to go through the ‘experience’ of labour if you want, I really couldn’t care as long as you don’t attempt to push your views on me. For me, all I would want is a healthy child delivered as quickly, painlessly and efficiently as possible, with my family being able to be there at a specified date (they are spread out across the world so this would require pre-planning) . I don’t care at all about the birthing experience (I would rather be under general anaesthetic) and have no desire to go through labour to ‘prove’ my womanhood or anything like that. I don’t care for pain or stretching/suffering injury to my nether regions or having my baby injured through a traumatic birth, all I would want is a healthy child. I guess my views are tempered by the fact that I myself am a product of a planned c-section and it never did me or my brother (another c-section) or my mother any harm (we are all tertiary educated and productive citizens). I am also very petite, non-white and south asian; women and babies still die in childbirth in my country of origin due to a lack of medical care or suffer extensive injuries/trauma and I know of women in my family in past generations dying in such ‘home births.’ Being able to choose a medicalised birth in a hospital is very much a privileged choice and one that is preferred there, but of course not all women are able to access it. Basically in the absence of medical care, dying in childbirth is ‘natural’…as natural as vaginal birth.
Lastly I am a control freak and paranoid, I to be able to plan and want access to every medical intervention if needed. I’m petite and slim (and my partner is a tall white guy), so I’d guess that during pregnancy I would need a c-section anyway due to the size of the baby. Coming from a family of doctors, I guess I implicitly trust the medical establishment and the extensive training of doctors, more so than that of midwives and their ‘natural birth’ propaganda.
At the end of a the day I want a scheduled c-section attended by ob/gyns (and no midwives), and if I am able to pay for it through private insurance (so no arguments from the natural birth people about my choice being an undue burden on the Australian taxpayer through the public system), why shouldn’t I?
I would fully defend the choice of others to be able to deliver ‘naturally’, avoid ‘medicalised birth’, get home birth or what not, as long as they are able to pay for for it, so why can’t they defend my ability to make my own choice over my body?
With the growing influence of the midwife lobby (led by people like Hannah Dahlen) I fear that maybe in the future I won’t be able to make my own decision over my own body (by choosing an elective c-section), as they seem to want to reduce the c-section rate even if it is chosen by the woman herself. I fear the day midwives take over control over the majority of Australian births at the expense of experienced, extensively trained doctors.
Well, if I had said that, I wouldn’t be “on board” with me, either.
I also never said that pregnant women are any “smarter.”
Women who have been pregnant and given birth or are waiting to give birth might actually be more informed than women who haven’t, however.
It’s the paternalistic “Have you thought about THIS?” attitude that makes me roll my eyes. “Popular but dangerous!” (ooooh, preggies! Without this article, you might think giving birth is all kittens and puppies and rainbows and dessert!)
How in the world is it paternalistic? It’s an investigative piece on an increasingly popular birthing choice. No one has come close to suggesting that without this article, women would think that giving birth is puppies and rainbows. But um, this is how investigative journalism works — journalists investigate things. On the front page of the NYTimes today there’s a piece about the uptick of murder rates in certain Chicago neighborhoods. Is that paternalistic? OMG poor Chicagoans, without this article you might think that your neighborhoods are all kittens and puppies and rainbows! How DARE the New York Times point to some rapidly shifting statistics!
Well, I went out of my way to choose a hospital that had a birthing center (the other choice was one that was known for lots of C-sections). It was a much more female environment and I was hoping to go med-less. I even had a doula! What could go wrong?
FRIDAY 3 am: I phone the hospital: my water has broken.
Hospital: it’s okay, go back to sleep and call us back in the morning.
Me: but I was told I was strep-B positive and should come in right away to get on meds?
Hospital: well, we’re full right now. Go back to bed.
I call my doula and tell her what they said. She sticks to her previous info, that the WHO says you really have up to 24 hours to go in. Racing to the hospital doesn’t make things better and will only annoy them if they are swamped.
SATURDAY AFTERNOON: I finally get admitted. Dilated only to 4 cm, contractions have stopped. I’m shivering uncontrollably (started in the waiting room). They demand to know why I didn’t come in right away. After a very painful cervical check, which triggers me (I won’t go into that), I am told I need to let go of any negative feelings, fears, or ambivalence I might have toward the baby.
Now I will have to have pitocin (they say it like I’ve been naughty). They wrap me in heated blankets (can’t stop shivering) and start a very gradual pitocin dose. Doula arrives, gives hubby a break.
SATURDAY EVENING: About the 3rd doctor I’ve seen comes by, frowny. We have to get this kid out. We’ll try to avoid C-section by giving you a ton of pitocin. And thus begins the nightmare. Doula tries to help but the contractions are so strong I think each one will kill me, and they are about 2 minutes apart (30 seconds rest before the next one starts). None of the walking, rocking, or other movements help. I tolerate it as long as I can before asking for an epidural.
The baby monitor keeps going out and they keep scurrying in to adjust it. The baby’s heart rate keeps slowing down during contractions.
MIDNIGHT: the epidural guy finally comes, but won’t give me anything until he has read me a long legal thingy, which I can only listen to in 30-second intervals. He won’t let my husband answer any questions for me. I have to wait for an interval to sign it. I can’t hold still for the needle and he gets angry at me.
The epidural finally kicks in and I am sad because I am going to have to be on my back during labor. My doula says “Wow, I’ve never seen anyone go that long under pitocin without an epidural!” I want to cry. If she knew I’d need it, why didn’t she say so much earlier?
They tell me to get a little sleep and rest. They attach a fetal monitor to the baby’s head. I can hardly sleep knowing the baby’s heart keeps decelerating.
SUNDAY PREDAWN: labor and delivery at last! I don’t think it actually took that long. My doula is finally useful, helping to steady me while I push. The baby’s head crowns; my husband moves in to cut the cord, sees it is half severed already (apparently when they pulled out the fetal monitor, it sliced through?). They tell him to back off and he does. They whisk the baby out of the room without any announcement of dead/alive or boy/girl. Husband follows in a panic. Reports later to me that baby’s color was not good and she needed some intervention.
SUNDAY DAWN: the female doctor who delivered the baby comes into the room without a greeting, arguing with another doctor. She doesn’t want to wait for the placenta. He goes away and she takes up a position at my feet. What follows is a horrific, grim, and silent tugging as she pulls the placenta out. I don’t know where my doula or husband are–still with the baby I think, which surely is more important than me? I grit my teeth and weep until it’s over, and after.
SUNDAY MORNING: I’ve been in and out of sleep, but still no sign or news of the baby. A very kind male nurse comes and cleans me up, shows me the placenta on request. Hubby brings baby at last.
We wound up staying until Wednesday because they had to put baby and me on antibiotics, which made us both sick…because breastfeeding was delayed, they started feeding her formula, so breastfeeding got a very rocky start…the nurse who “instructed” me on breastfeeding before I left took the baby’s head and slammed it onto my breast and held it there: “You just have to SLAM-DUNK her head on there and keep it there.” I knew that couldn’t be right but just didn’t have the will to argue anymore.
CONCLUSION: water broke at 3 am Friday, baby born 5:25 am Sunday, and I have a feeling we were both lucky to survive. The one and only thing that went right was: no perineal tears! Yay team!
Never again, my friends!!!
QFT!
This is exactly why I haven’t been discussing the actual medical risks of home birth vs hospital birth; I don’t have any experience. What I do have is knowledge of systemic medical abuse and loss of autonomy, and that’s what I’ve been speaking to.
I’m speaking strictly from lived experience when the research is absent or hard to find. Now, if I could talk the more trollish of the commenters to do that….
@Lou – Huh? Nobody here said that a woman who elects a c-section isn’t ‘woman enough’? Nobody here said you should not have a c-section if you want one. I’ve never understood the whole “women who want an intervention-free birth are out to ‘prove’ something” mentality. I agree with you: it’s not a competition.
And to your point about lack of access to medical care being a leading cause of maternal death — yes. Agreed. Electing to have a home birth in the context of having access to medical care and a competent, well-prepared midwife is very different from being compelled to have a home birth with whatever limited resources are available because there is no other option.
Yes. My understanding is that a responsible CNM will, when attending a homebirth, bring with her a variety of emergency resuscitation supplies such as oxygen and suchlike.
I’m sure that’s true, but I’m not sure how helpful that is when — for example — the baby hasn’t been born yet, the umbilical cord is wrapped around his neck, and his heart rate goes down to almost nothing. All of which happened to my son, and I wonder if he would have made it even if we’d been 10 minutes from a hospital, and even if a fetal monitor had been used. Even as it was, we were told that he might have suffered enough oxygen deprivation to be brain-damaged, and we would have to wait and see. (I think we got lucky.)
The stories at the “Hurt by Home Birth” website are very, very difficult to read. But any of them could easily have been about my son, if he hadn’t been born in a hospital.
In a birthing center that’s part of a hospital? No problem; that’s an entirely different story.
(This is all a hypothetical discussion; there was no chance in a million years that my ex — or I, had I been in my ex’s position [maybe in my next lifetime!] — would ever have seriously considered a home birth, Neurotic Jews that we both were and are, I’m sure we would have both been so convinced, every second, that something awful was about to happen (as it did), that any psychological benefits of being at home would have been far outweighed.)
And they might not be – it varies quite a lot within these groups.
I think a part of the problem is the idea that we must focus exclusively on minimising risk. All living is risk and we all must judge what is an acceptable risk level. This is true even when it is a question of life and death or we would not be driving in traffic.
Home births may be more dangerous than hospital births, but that would still only be one part in the argument about which form is “best”.
I agree that nobody here has said anything negative about women who have c-sections.
According to the Jezebel article yesterday on this very same subject, The Business of Being Born, Ricki Lake’s documentary about home birth — which someone mentioned on this thread as a source for information about home birth — “insinuates that home birth is more empowering and that women who receive medical intervention or C-sections do not bond as well with their babies,”
Does anyone know if it’s true that she insinuates or suggests this?
If so — ugh. ,
Personally, of all the options I’ve seen, I’d go for that. More control, more resources and fewer fucking asshole doctors.
I watched and enjoyed much of The Business of Being Born, but I do think that there is an element of judgment for women who opt for medical interventions. To me, it seemed like the message was that medical options should only come after all non-medical options have been exhausted, and I don’t think that’s fair or productive. I definitely see how that message could be insulting.
As someone mentioned earlier in these comments, the part that frustrates me so much in this discussion is the idea that there are two “sides” in this debate when, really, virtually every woman giving birth wants the same thing: a healthy baby in a safe environment. The difference is in the way that those women understand safety, risk, and health, and I have never met any real-life woman who was making those decisions lightly, regardless of how different those ultimate decisions may have been.
I hate the rhetoric that people who want low-intervention births = anti-science kooks.
I’m getting my PhD in a science. That means I know exactly how many arrogant and stupid people have advanced degrees. I’ve been in plenty of classes with assholes who went to medical school. (Not to say, of course, that all people who are doctors or have advanced degrees are arrogant assholes.)
I’m a fat woman. I have been screwed over by the medical industry so many times, I should earn a medal for it.
I really don’t want to be in such a vulnerable position while at the mercy of doctors and nurses who I don’t know and who are likely pressed for time and and probably fatphobic, like the majority of healthcare professionals. Fuck that.
I would love to give birth in a birthing center that’s attached to a hospital, but there aren’t that many of them. And many of them restrict certain options, like water birth, to women over a certain BMI, even if the pregnancy seems low risk.
Unless the kid is being sneezed out of your nose, all birth is natural. The whole ” I want a natural birth” irks me because there’s really no such thing as an unnatural birth. Some women aren’t birthing cyborgs out of their ears, so the division to me is ridiculous. Natural or not. It’s all natural, even if you’re in a hospital surrounded by Beyonce’s obgyn guards.
“I have never met any real-life woman who was making those decisions lightly, regardless of how different those ultimate decisions may have been.”
Exactly. And that’s why, to me, this article feels a bit patronizing.
“I’m a fan of allowing women to make birthing choices for themselves…but choices should be informed, and there just isn’t a lot of great info out there on giving birth at home.” This says to me: ladies who have painstakingly researched and agonized over your decision over how to birth your babies, your choices aren’t actually informed. And based on what? A Daily Beast article that points to one study that seems to contradict another study as to the safety of home births, and some anecdotal evidence on women who had bad home birth experiences.
By the way, someone asked when it became common for women to give birth in hospitals. I tried googling the issue, but didn’t come up with much in the few minutes I spent, although I saw one statement that it didn’t become common in the USA until the 1930′s.
I think it was earlier, at least in major cities like New York and Chicago. I’ve seen lots of birth certificates from those cities from the period between the 1880′s and about 1930, and one starts to see a lot of hospital births by the mid 1910′s, and certainly in the 1920′s. And not just in wealthy families, either. My father was born in 1920 in Harlem Hospital,* and his family, while no longer as mired in poverty as it had been 15 or 20 years earlier, was barely what would have been considered “middle class.”
My mother, on the other hand, who was born in Berlin in 1923, was born at home, in an apartment at Prenzlauer Berg 6.
* At the time, Harlem was basically a mixed Jewish and African-American neighborhood, and Harlem Hospital was famous for being just about the only hospital in the city in which there was
– “in which there was integration in both the patients and the medical staff.”
Wait…why are we assuming that women have actually had the opportunity to “painstakingly research” this question or have access to that information? I mean…my best friend just found out she’s finally pregnant (yay!) and she is struggling to figure out what she wants to do. She is finding it extraordinarily hard to get what she considers to be unbiased information. I think she’d feel a lot better if there was more research and if medical professionals (on both sides) were less invested in their perspective and more interested in the well-being of women who are seeking their assistance.
I completely agree; that’s one of the reasons why a home birth would never be for me. I am Team Birthing Center (for me) all the way. What a terrifying experience you and your ex had, Donna. I’m so glad all the help you needed was on hand.
I don’t know if it’s true in that documentary in particular, but I’ve met enough women who have felt shamed by “natural”/home-birth advocates for wanting and getting medical interventions that it does seem to be a less-pleasant feature of the more zealous parts of the movement. And it’s completely unacceptable. If the goal is empowering women during a stressful, painful, and powerful experience and providing the best possible care for them and their babies, then those kinds of invidious distinctions need to stop immediately.
I agree. This is definitely the vibe I got off the post as well.
The point of the Daily Beast article is that even if you painstakingly research the issue, there’s a lot of bad information out there, and generally a dearth of information. Pointing that out doesn’t imply that women are stupid or that many women’s choices aren’t as informed as might be possible given the availability of information. But why in the world is it a bad thing to point out that there just isn’t enough information, and that’s hurting women?
Don’t you know, Jill? Mothers and pregnant women just know more than any other demographic. It’s so paternalistic to come from the assumption that they’re exactly as ill-informed on important issues as the rest of the planet.
I’m not assuming that all women have access to the information necessary, but I am agreeing with BalancingJane that most women who have had to make a decision about how and where to give birth make that decision with seriousness, regardless of how they come out. She said, and I agree:
The tone of the post implies that these women, who are making the best decisions they can make for themselves based on the information available to them, are making uninformed decisions. Your friend is a perfect example. She is putting a lot of thought and effort into what she decides to do. Of course it’s hard to find unbiased information, and of course there are slanted perspectives on both sides. That doesn’t mean that someone who is planning their birth and chooses home birth is inherently underinformed.
I could probably write a novel with all of the things I would like to say on this topic, but I’ll try to be brief. Essentially, in this and all medical decisions, we need more information. We need more medical professionals who take the right to informed consent very seriously, patients who are more aware of their rights when it comes to informed consent and refusal of procedures, and we need statistics that are as accurate and clear as they can be. For example, home birth statistics should always specify that it does or does not include unplanned/emergency home births and/or patients with medical contraindications for home births. This information should be given without bias one way or the other allowing the patient to make a sound decision based on medical facts versus a particular spin on things. Alas, this is not the world we live in. Therefore, I applaud the medical professionals and hospitals who do hold their standards that high. I’ve found a few and been so very grateful that I have.
You think it’s unreasonable to think that people who have given birth or are going to give birth in the near future might not take more of an interest and therefore do more research into issues surrounding childbirth than people who have not and aren’t going to? That contradicts everything I’ve ever observed of how people work, but OK.
@je
Ok, nobody here (on feministe) said that a woman who elects to have a c-section isn’t ‘woman enough’ but that seems to be a prevailing attitude online in parenting blogs and even in society; like a woman who doesn’t want to vaginally birth is scared to ‘trust her body and what it can do…women have been doing this for millenia, it’s what our bodies were designed for!!’ And when women don’t or can’t go through natural birth (e.g. they might need epidurals, emergency c-sections), they are thought of as not being as ‘strong’ or ‘woman enough’ as those who delivered drug-free vaginally. Even high profile women are not immune to this, Kate Winslett LIED about her birth because she was made to feel like a failure precisely because of these sentiments in society (http://www.dailymail.co.uk/tvshowbiz/article-300032/Why-Kate-lied-Mias-birth.html).
As for famous women who scheduled c-sections,
I can’t think of anyone who gave extensive interviews about their decision to do so unlike the many (like Miranda Kerr) who wax lyrical about their natural birth and home births in numerous interviews. Fact is women who choose scheduled c-sections (like Victoria Beckham) are denigrated as being ‘too posh to push’, and lacking in the motherly stakes somehow (‘oh they can’t bond with their baby properly, they’re superficial, vain etc.’). Birth and motherhood has become some stupid competition where natural birth advocates compete to have the GREATEST VAGINA OF ALL (‘oh I squeezed out a massive baby, completely drug free!!’), and make look down on women who choose differently. You know what, I’m really not interested, I really couldn’t give a shit how you birth so please spare c-section women the judgement.
What’s even worse is when those natural birth advocates imply that anyone opting for a schedule c-section is not informed enough or even worse been brainwashed by the BIG BAD DOCTOR into getting a c-section because obviously no normal woman would ever make the informed choice to get one- ‘poor dear, the evil medicalised industry has gotten to her, she doesn’t really know what she wants!!’ Oh gimme a break, it all just reeks of paternalism to me- let women make their own decisions about their bodies!!! (I do recognise not all pro-natural birth people are judgemental but a significant proportion seems to be).
In an Australian context, natural birth advocates do seem to want to restrict the birth choices of all women- they and the powerful Midwife lobby are trying to convince the government to take steps to bring down the rate of medically unnecessary c-sections (e.g. by restricting access to elective c-sections through the public health system even if the mother herself does not want to go through vaginal birth). They continually bleat about the c-section rate in private hospitals being too high and how women should not be having medically unnecessary c-sections for low risk pregnancies (even if this is the informed choice of the woman herself and she is able to pay for it). It’s basically become a turf war in Australia between midwives and their interests and doctors, so yes I fear that the growing influence of these natural birth advocates will someday restrict the reproductive choices of women who prefer to have elective c-sections.
They’re (we’re) the people who tend to have more at stake in these discussions. I think it’s easier to express opinions on this situation if you’ve never had to seriously ponder the question as to where it’s better for you to give birth. And to realize that if something goes wrong, in any setting, it’s your life on the line and the child’s. Especially since women are expected to be these “perfect mother” types, who can foresee and avoid any danger.
For what it’s worth, most of the women I know who opted for home births did it with their second or third child, after experiencing some appalling treatment at the hospital. A lot of pregnant women are already stretched to their limits physically and psychologically, and when you come up against an asshole doctor in that situation, you can wind up scarred for life. And by “asshole” I don’t just mean, “Well, this person was terribly rude and forgot to knock on the hospital room door,” you know?
OK, I think we’re running into major cultural context differences here, because US midwives and/or homebirth advocates have nothing even approaching a powerless lobby, let alone a powerful one, and the prevailing social attitude I have run across is one that assumes that all the interventions suggested are the best things to do and that women who want otherwise are laughable.
I guess I’m not seeing that tone. I think some people are very well informed and they feel like the suggestion that there isn’t sufficient access to information is undermining their agency. But they are taking for granted that other women have the same access that they have or have the time to gain that expertise. Asking for increased availability of quality research isn’t saying that women are stupid or that all women are uninformed about their birth choices…its asking for more information so that more women can make the best decision for them.
Actually, homebirth and natural advocates have a variety of well funded lobbying groups. These include:
The Childbirth Connection
Lamaze International
Coalitiion for Improving Maternity Services
Baby Friendly Hospital Initiative
The Big Push for Midwives
The Midwives Alliance of North America
They employ professional lobbyists and spend tens of thousands of dollars on marketing. And that doesn’t count the individual “Friends of Midwives” groups operating in each state.
100% of the income of homebirth midwives comes from homebirth. They have everything to lose if people start looking seriously at the appalling death rates of planned homebirths collected by the CDC, the state of Colorado, and other states.
Why do you think the Midwives Alliance of North America is hiding the death rates of the 24,000 homebirths in their database? The KNOW homebirth has an unacceptable rate of neonatal death. They just don’t want American women to find out.
You think it’s unreasonable to think that people who have given birth or are going to give birth in the near future might not take more of an interest and therefore do more research into issues surrounding childbirth[?]
I couldn’t possibly have been the only prospective biological father ever who took as much of an interest and did as much research as they would have if they’d been the one giving birth, could I? (And to forestall any assumptions anyone might make — not you, obviously — I don’t mean in some kind of creepy, appropriative, pregnancy-envy kind of way. It’s just that I didn’t see why I shouldn’t try to know as much about it as my then-spouse who was the prospective biological mother. He was my baby too, after all! I can still close my eyes and remember exactly what his heartbeat sounded like through the stethoscope we bought, all those years ago.)
This isn’t an area that I know a lot about, but if what Amy Tuteur is saying is correct, then home births do have significantly higher risks than births in hospitals or birthing centers (at least as they are currently being done in the U.S. — the fact that CNMs or birthing centers attached to hospitals have better outcomes may bear on whether those options should be expanded or CNMs should be able to perform more home births, but isn’t relevant to whether right now home births are higher risk). And if she’s wrong, then there’s a whole lot of misinformation out there about home births being more dangerous. But unless I missed it, no one has addressed her post because they’re more interested in arguing about whether Jill thinks mothers are stupid.
It doesn’t matter how smart mothers are if the information they need is either unavailable or is being muddied by bad information from people with a vested interest in either side of the issue. Every time I read a post that yells at Jill for thinking expectant mothers need more information about the risks of home birth, I cringe a little and think about the parents in the article Jill linked to — parents who weighed the home birth vs. hospital birth options, and talked to midwives, and decided to go with the home birth route and then realized, when things went catastrophically wrong, that they didn’t understand the risks. The fact that some people lost babies in a home birth that might have been saved in hospital doesn’t necessarily mean that home births are more dangerous or that parents lack information about the risks. But the real people in the article who went through that situation are saying that they didn’t know enough about the risks. I’m not inclined to tell them that they’re wrong or that they must be uniquely stupid because everyone else has got all the information they need.
And yes, there is a difference between “bad midwife” and “dangerous home birth” — but if the former is causing a lot of the latter, and if it’s difficult for people to figure out which are the good and bad midwives, then the two are linked in a pretty important way. Even earlier in this thread, some people were saying that midwives were trained medical professionals, when in reality the vast majority of midwives performing home births are CPMs and do not have medical training. That’s the kind of misinformation that makes it difficult for expectant parents to evaluate the risks of home birth.
Donna L @ 102
I believe that refers to what Michael Odent (french OB and unmedicated birth advocate) was saying in The Business of Being Born about how c-sections and epidurals interfere with oxytocin production in the mother’s body during labour. This is supposedly what makes it easier to bond with a newborn right after a birth. I have seen mothers who had medicated or surgical births get offended by this, and I think this is understandable. I had a c-section (hospital birth in Canada, with midwives until care was transferred to the OB) and it took a good couple of weeks for me to bond with my son. I know other people who have given birth via c-section have different experiences and feel bonded immediately and vice versa for people who have had unmedicated births. So who knows? I suppose my point is that my experience meshes with what he is saying about bonding.
Reading this comment thread is interesting – midwives are well-integrated into the hospitals here in Toronto and you can have a home or hospital birth attended by midwives, or a hospital birth attended by an OB. This is all covered under our provincial health plan. I was screened out of a home birth because of a minor complication so laboured in a hospital with only my support people and midwives in the room until care was transferred to the OB. Both my midwives were in the operating room. It seems to me that this integration with the medical system is key.
Lauradhel, I don’t ultimately disagree with you, but I will point out that the lack of a lab coat doesn’t mean you won’t be treated in a violent fashion. I’ve heard terrible stories about midwives, too.
I keep seeing this over and over again with regards to this article. The article is about *home births*, but many people quietly change the subject to birthing centers, which are *much* easier to defend than home births. That’s not what’s up for discussion. No one criticized birth centers or midwives.
In that case, they’re not very effective, given that “the actual rate of home birth in the United States has remained remarkably low (0.65%) over the past twenty years” and how heavily regulated midwives are, and how skyrocketing insurance rates have shut down freestanding midwifery centers. And “tens of thousands of dollars”? Don’t make me laugh. That’s a financial drop in the bucket when it comes to marketing and/or lobbying.
That’s…a nice tautology you’ve got going on there. Homebirth midwives earn their livings by attending homebirths? That’s…shocking. 100% of the income of hospital midwives comes from attending hospital births. How many US midwives are exclusively homebirth midwives, is the real question. I’m not coming up with any hard numbers, but given that most midwives attend hospital births, I’m gonna guess not a whole lot.
@19: Your presumption that parenthood is synonymous with shunning medical care for women and children is preposterous. Most parents do just fine with modern medicine.
I’m sorry, Donna; I should have said “parents-to-be.” What I mean was “people who have a vested personal interest in making the decision.”
That’s the problem, Amanda, which is why I brought it up–and not quietly, so I don’t know where that’s coming from. Jill’s piece frames the choice as one between home births and hospital births, and that’s a lousy dichotomy that does not address why people are choosing home birth, particularly after already having given birth in a hospital, presents women with a false choice, and pits people against each other instead of advocating for a happy medium. Quite frankly, if hospital births are such lousy experiences that they’re losing women who have already done them, then hospitals should be taking a good, hard look at their practices.
I don’t think it’s a bad thing at all! There can always be MORE information, which leads to better informed choices, and that’s great. I totally agree that there can and should be more research done on a variety of issues surrounding maternal & fetal health, including issues relating to home birth.
I did not read the Daily Beast article to be saying that there is a lack of information on the safety of home birth. It seemed to be saying that there are conflicting studies, and some advocates, both for and against home birth, are “slicing and dicing” the data to support their positions. Like the alcohol issue discussed earlier (and so, so many other issues that arise during pregnancy), it’s another situation where expectant parents are left to parse through unclear and often politicized information and draw their own conclusions. (The article’s other main point seemed to be that many women are choosing home birth because it’s trendy or a fad; i.e. they are uninformed because they are simply following a trend without informing themselves of risks – a different issue.)
Your post in response to the Daily Beast article was a completely valid rumination on these issues, but at the end of the day, I disagree with your conclusion that
because it seems to imply that given the supposed lack of quality information, women are better off avoiding home birth. In other words, it comes across as prescriptive, when in reality there is no right or wrong answer for every expectant family working with the information that there is right now.
And for all the talk about how not all women have the privilege of access to what information there is, the reality is that every single person who finds her or himself planning the birth of a new life is forced to work with what information is available and ultimately act on that choice (rather than simply discuss it in the abstract). Given that, it seems unfair to assume that “home birth folks” are cavalierly choosing to stake their child’s life on a political stance, rather than give them the benefit of the doubt that they’ve informed themselves to the best of their ability and drawn a different conclusion about the risks and benefits than another person might draw.
You know what one of the premier marketing techniques of the homebirth and natural childbirth advocacy movements is? Convincing women that believing the mistruths, half truths and outright lies that they are selling make you “educated.”"
This tactic has been copied directly from the anti-vax movement. When the anti-vax folks tell you they are “educated” about vaccines, they don’t mean that they have read the immunology literature, the virology literature or the public health and epidemiology literature (all of which support the safety and efficacy of vaccines); they mean they have read a bunch of websites and publications written for lay people, that ignore the bulk of the scientific literature and cherry pick non-representative, poorly done studies that supposedly “prove” that vaccines are a giant conspiracy of Big Pharma and Big Government.
Similarly, the homebirth and natural childbirth advocates who claim to be “educated” about homebirth haven’t read the obsteric literature, haven’t reviewed the state and national statistics, and have no idea of the scientific basis for the interventions they criticize. Those who are “educated” about homebirth have read a bunch of websites and publications written for lay people, usually written by other lay people, and have, and learned about the giant conspiracy between Big Medicine and Big Government that exists only to ruin your birth experience.
Just a quick example from a comment right above mine. The commentor writes about Michel Odent “(French OB and unmedicated birth advocate)”" “about how c-sections and epidurals interfere with oxytocin production in the mother’s body.”
1. Michel Odent is a general surgeon, not an obstetrician.
2. He was chief of surgery in a tiny French hospital that had four maternity beds. That is his OB “training.”
3. There is no evidence, none, zip, zero, nada, that c-sections or epidurals interfere with bonding by supressing oxytocin production or in any other way. He just made it up.
The real problem with homebirth advocacy is that much of what homebirth advocates think they “know” is flat out false. You cannot get “educated” by reading birth stories, web sites and publications for lay people. There is only one path to education and that is the scientific literature and professional training. That applies to vaccination and that applies equally to childbirth.
@Jane 124
Yes that is incredibly offensive, the idea that those who ‘birth naturally’ are able to ‘bond’ better with their babies. Are those who have epidurals or c-sections lacking in maternal bonding with their offspring? Are mothers who adopt or have babies via surrogate unable to bond as well with their babies? It almost implies that they’re not ‘real mothers’ unlike women who merely pass the baby through their vagina.
This idea of bonding seems so subjective, how do these natural birth advocates measure it? And so what if in some cases, ‘bonding’ takes some time, bonding with your kids and parenting is a lifelong process, so I wish natural birth advocates would stop conflating the ‘birth experience’ with motherhood. This focus on the perfect birth experience over the parenting process seems pretty shortsighted, almost like those bridezillas who focus on the perfect wedding day/experience over the marriage that follows.
Birth centers are an excellent compromise, but would be even better if they were just about making mothers comfortable and didn’t have all this cultural baggage about exercising discomfort with modernity by depriving women and children specifically of the benefits of modern medicine. I can’t be the only person who has noticed that the word “medicalizing” only gets tossed around when we’re talking about the health of women and children, am I? You’ll notice that adult men have no social pressure to prove their natural bona fides by rejecting disease prevention or pain medications.
What I find strange about the anti-hospital narrative is that going to the hospital sucks for EVERYONE. I just had minor outpatient surgery and the whole experience was mildly traumatizing despite being nearly as smooth as it gets. But it’s only with childbirth—something that is exclusively coded female though transmen can experience it, too—that the horror show that is hospital care causes people to believe that eliminating medical intervention and pain relief is the answer.
Now part of that is because being pregnant isn’t a disease, and so it’s easier to consider shifting it away from a medical framework than something like, say, surgery. And I don’t disagree, actually. I think we should look for ways to make childbirth more relaxing, because it’s supposed to be a joyful occasion and all that. But unfortunately the strategies that address that seem to always come along with a dose of fetishizing “natural” womanhood. And that has a whiff of patriarchy all over it.
It’s worth noting that when pain relief in childbirth was first practiced in the West, many people objected to it on religious grounds. They argued that childbirth pain was the punishment for Eve’s sin, and women should be forced to endure it as a reminder of how their femaleness made them inherently sinful. I can’t help but think of that when I hear platitudes about the evils of pain relief during childbirth now. We expect women—and children—to pay the price for perceived sins of modernity.
Actually, I think the “evils of medicalization,” such as it is, is seen all over the place, not just surrounding women. I’ve heard similar rhetoric in regards to mental health and modern pharmacology, specifically in relation to various forms of talk or cognitive behavioral therapies. I’ve heard it quite a bit in regards to fitness and preventative care, compared, again, to pharmacology, like diabetes and cholesterol medication. In each of those cases, it’s about finding “natural” solutions rather than “modern” ones. And none of that’s particularly gendered. When talking about pregnancy and childbirth, it’s all pretty gendered, obviously, but that’s not the only place that rhetoric appears.
I’ll add my experience to those saying elective c-sections are often criticized. That will be my choice (future) and I’d say 90 percent of the time someone hears my decision they have quite a bit to say–usually along the lines of assuming I am really just scared of childbirth and “it’s just what women do, they’ve been doing it for years why be afraid?”, or “don’t you know it’s actually safer to have a vaginal birth?” as if I’m an idiot or a child. I don’t like the idea of childbirth at all. I simply don’t–I want to be knocked out and not a part of it, same as I would want to be for major surgery–and in certain feminist circles that seems to make me a monster of sorts.
Yes that is incredibly offensive, the idea that those who ‘birth naturally’ are able to ‘bond’ better with their babies. Are those who have epidurals or c-sections lacking in maternal bonding with their offspring? Are mothers who adopt or have babies via surrogate unable to bond as well with their babies? It almost implies that they’re not ‘real mothers’ unlike women who merely pass the baby through their vagina.
Thank you. It’s repulsive. And, although I hate to sound like such a broken record, I don’t fit within any of your examples, and I bonded with my son the moment I saw him and first held him, immediately after he was born. Oxytocin, Shmoxytocin.
From a big picture standpoint, I have to wonder how sustainable a highly medicalized system of birth is. High intervention births require more resources than do lower intervention ones, which would be one thing if those resources were infinite, but they aren’t. For this reason, I’m glad there’s a movement out there to teach and learn a less medicalized system of birth.
I don’t think that’s entirely a result of birthing center ideology, though. A lot of it has to do with medical constraints surrounding the use of anesthesia–the banning of eating and drinking, for example, which would cause me a huge amount of pain and discomfort, is about what anesthesiologists are willing to work with. A woman with an epidural needs a hospital bed with stirrups because her ability to support her weight on her legs is compromised. If hospitals were willing to review their policies on what must accompany pain control, and if they found on review that those policies were unnecessarily stringent, then birthing centers would be able to use medical anesthesia.
And I’m completely on board with your comment, except for the “merely.” Giving birth is a big fucking deal.
Well, and the reason for that rhetoric is that modern medicine has been used as a tool to disempower large groups of people. It’s not just because people are fools–though some of it is that.
@ DonnaL–
Hells yeah, BoBB did that. There’s an ominous voiceover where they declare that chimps who do not birth vaginally abandon their babies, OMG.
I was a c-section baby, and my mother bonded just fine, thankyouverymuch. Asshats.
Agree that women need more choice, and that there ARE some dangers to home birth as it exists today. I looked for a home birth midwife for awhile—every single one set off my quackometer. Sorry, but if you believe in homeopathy, I’m not entrusting my vagina or my baby to your care. CPM is a junk credential, IMO.
Anecdata, but this experience of mine crystallizes what I see as the problem:
In hospital, 5 mins after delivery. I had wanted a low intervention birth, and largely got it. Everyone was lovely, FWIW, no Evil Doctors. When it was time for some interventions everyone was nice and respectful. Anyway, the nurse is handing me my son and blurts out, “Um, so why are you here, anyway??”
“Excuse me?”
“I mean, why are you here. You didn’t want an epidural or anything. Why did you come to the hospital?”
I eyed her for a minute and then finally returned–
“CHOP NICU. Best in the country.”
“Oh. OK.”
You should be able to decline certain non-necessary interventions and still birth in a hospital without people wondering why the hell you’re even bothering to be there, for Pete’s sake.
chava – sounds like you had your birth at the same place I plan to have mine :) I hope to have a similarly positive experience.
:-)
On the other side of the equation, I will never *quite* forgive my doula for asking the CNM if she thought the reason I had been stalled at 9 for 7 HOURS was “a mental block.” I really hate that rhetoric. I do recall the midwife giving her the sideeye and a curt, “No.”
The article, and this post, seems to miss the point. The fact that more and more women are looking into other options such as midwifery and home-birth is often a direct result of abusive experiences in the hospital. Instead of casting these women as ignorant or anti-medicine, we should be rallying around them to demand a higher standard of informed consent and patient-centered care during labor and delivery. I haven’t yet had children, but the idea of being forbidden to walk, stretch, eat or drink during labor is terrifying – not to mention forced episiotomy and being bullied into accepting pitocin and/or an epidural. Those are options that fall well within my right to choose or refuse, whatever my reasons.
The fact that I already have an un-diagnosed chronic pain condition that affects my neck (spine?), plus chronic tension headaches and migraines, obviously makes me wary of an epidural. If I birth in a hospital, the chances of this concern being brushed off and ridiculed are pretty high.
I only hope that I’m able to find a decent birth-center affiliated with a hospital that is accepting of doulas and midwives, as some of you have mentioned. If not, I may indeed be one of those women who stays home, as long as my pregnancy is considered ‘low-risk’. I have nothing but contempt for the anti-vax movement, and I have not seen these people active in the home-birth movement at all. I was very surprised to see the conflation between the two…
Exactly. There’s a time and a place for high intervention hospital childbirth. And a time and place for low intervention home birth. And everything in between.
Yes, there are risks associated with home births. There are risks associated with hospital births too. I was also a c-section baby, and my mother couldn’t hold me for a week because of an infection picked up in hospital (and yes, we bonded just fine, regardless). Plenty of mothers don’t get infections like that in the hospital, but plenty of mothers have births at home without their child dying too.
Not too long ago, childbirth meant twilight sleep and being strapped to a bed, without agency. The interest in home births is a reaction to some hospital birth experiences, and, done intelligently, does nothing but expand the options for women.
There is no cookie cutter solution. There is no risk-free solution. There needs to be more (good) information available to prospective mothers. But neither option is as evil or conniving as people like Dr Amy paint them to be, either.
Your observations of how people work are not definitive reality. Even if parents have done a ton of reading on the internet about homebirth and hospital birth, there is literally zero quality control enacted on that information. Taking in reams of misinformation is worse than having no information at all, and that happens all the time. And it’s not just about childbirth, lest you think I’m picking unfairly on the pregnant set.
By that logic, we should just assume that all parents of a child with autism have done a lot more reading up on its causes than us mere single people and we should just shut up about how wrong Jenny McCarthy and the anti-vax squad are, because Gawd knows we wouldn’t want to be patronizing and hurt parents’ feelings. After all, the stakes are so much higher when it’s your baby on the line, so obviously no parents have been credulous enough to start dangerous and useless chelation therapy in droves, and no children have died during resurgent pertussis outbreaks.
For fuck’s sake, we’re really protesting any attempt to introduce new information to the public because it implies we didn’t automatically trust them to know better? Wth? Since when has the truth been our enemy?
There is such an enormous difference between having outpatient surgery for kidney stones or whatever and giving birth, I can’t believe it’s even necessary to spell it out. The reality that a fetus is involved in childbirth and a fear of malpractice suits makes many doctors much more inclined to hit the panic button and opt for even unnecessary interventions.
Childbirth also tends to be far more intrusive than your average outpatient surgery. Unless it’s a gynecological procedure, your vagina is off limits. Nothing ups the ante for a lot of people who want that part of their body tampered with as little as possible than having a constant stream of medical professionals intrusively getting to know your most private parts even better than you may already.
Finally, there’s nothing wrong with wanting or not wanting an epidural. I went without one for my 2nd and 3rd births because I hated the experience I had with the first one. The reality is that an epidural generally leaves you paralyzed and unable to leave your hospital bed for the duration of the labor and potentially for several hours after the birth. The introduction of the epidural then necessitates the use of a urinary catheter, as you are unable to get up and use the loo as the need arises. And when pushing time comes you may very well not be able to control your legs or even feel the need to push.
I’ve done both, and I would go the no epidural route again in a heartbeat. Most of those who opt to go without the epidural also do so because they hope to maintain greater control over their own bodies during the birthing process.
I take your point; however I do think there is something worthwhile is listening to the stories of people who have actually had the life experience in question. Standard race and feminism 101–listen to the lived experience of the group in question before you start spouting off your own opinion.
@Lou 132
To clarify, as a mother who had both a c-section and an epidural, I don’t believe that my bond with my son is inferior in any way to a mother who had an unmedicated, vaginal birth. Or that anyone’s bond with their child, whatever way they came to be a parent to that child, is inferior. I was explaining where and by whom that idea was expressed in the Business of Being Born.
Although I can understand people taking issue with that (and I’m not sure whether I stand on it), I’m not personally offended by the possibility that my surgical birth affected our bonding process – for me it took a while to get to the point where I felt a mother-child bond. Whether it was because of the way my birth happened or because of something else, it took a while.
Quoted for truthiness.
I could write a novel about the horrible experiences I’ve had during two of my hospital births. I’m far from alone in that reality. The fact that so many are still treated so poorly in hospitals during the childbirthing experience is a feminist issue. Every day, people have their bodily autonomy and their human dignity violated in both very subtle and very horrible ways while giving birth. We shouldn’t just be telling them to shush and listen to their doctor, or to just be happy they have a healthy baby.
Not enough info? Seriously? Yes, if you listen to the hospital sponsored studies, of course they’ll manipulate the data to suggest homebirth is “more dangerous” and “risky”. Because birth makes a good deal of money for hospitals. Doctors take advantage of women being in a vulnerable state, and no matter your birth plan, it often doesn’t take much for an unwanted induction, “just a little” pitocin, or “you’re not progressing, we need to do a C-section”.
After having my first 2 months premature after a failed attempt to stop labor, and the (unwanted but nurse-insisted) epidural not work for my 2nd, I insisted on having my 3rd peacefully at home without unwanted cervical “checks” and nurses telling me to count and push. I did my research and found an incredible midwife with years of experience delivering hundreds of babies. I don’t have a single regret. There were no risks- my midwife is fully trained and had the same equipment you’d find in a standard delivery room. And I live close enough to the hospital for a transfer to take about the same amount of time as wheeling from the hospital’s birth center to the OR.
So tell me, how was I taking any risks? Oh wait.. if I had stayed with my OB, who spent an average of 40 seconds with me per appointment (yes I timed it), he would’ve missed many of the warning signs of something serious. My midwife appointments, however, were 45 MINUTES long, and thoroughly covered everything. She noticed minor edema and told me what to look for, talked about my diet and sleeping habits, and made sure I was both physically and mentally well along with explaining everything to me. In other words, provided superior patient care.
‘Listen’ doesn’t mean ‘defer.’ It is important to listen critically. Lived experience is famously unreliable when we’re discussing things like the safety of medical procedures. I do a lot of listening, but I also pay attention to reality – and the reality is that everyone is vulnerable to misinformation, even parents.
I just want to agree with what some others have said regarding the doctor in the BoBB documentary talking about lack of bonding with a c-section. He even says something along the lines of “can the world survive without love?” Frankly, this is one of the reasons I was terrified of having to have a c-section when I was pregnant.
But I did have a c-section, and the first time I set eyes on my son I loved him more than I’d ever loved anyone, so fuck that noise.
In BoBB’s defense, though, one of the filmmakers gets pregnant while they are making the documentary, and ends up with a c-section, and says at the end that she does not feel it interfered with bonding, so they do offer a differing opinion.
This isn’t really about parents as much as people whose bodies go through childbirth, eh? So the condesension is a wee bit misplaced. No one sugested that parents have magic knowledge sauce, just that when you’ve popped out a kid (in WHATEVER way) you have some experience that someone who hasn’t done it lacks.
But agreed, you can’t base medical policy/best practice off of anecdata entirely. You CAN change things like medical culture. I don’t expect doctors to actually feel empathetic, for example–I DO expect them to bloody well fake it.
I think people should be aware that “Amy Tuteur, MD” is widely known as “Dr. Amy” and flits around the internet criticizing homebirth wherever she can, often using very cherry picked or discredited studies to back up her claims. A simple google search will yield plenty of results.
Personally, I am all for informed birthing choices. Every decision you make regarding childbirth carries with it its own set of risks and benefits. Women who choose homebirth may be going on bad information, but more often, they are going with a very specific set of risks that they feel are more acceptable to them than the set of risks they would be undergoing at a hospital. And yes, there are risks to hospital birth too. And plenty of doctors and nurses are willing to minimize the risks that come with many types of intervention, while overhyping the risks of normal variations of childbirth, despite evidence to the contrary, because it is more convenient or they are hamstrung by insurance. Just see the debate on whether or not women are “allowed” to VBAC or forced into a repeat c-section despite their objections, or the debate on non-medically necessary inductions, for perfect examples of this type of scenario.
Homebirth should be a valid option for women, so long as they are aware of the risks, and qualified providers should be allowed to practice, which would remove many of the risks of “underground” providers that currently exist in the US.
Nicely put.
It’s actually because of the limited options for pain relief that I’m hesitant to give birth in a hospital. I don’t do well with most medical treatments for pain. I can’t imagine that an epidural would make me happy. I actually see it making me incredibly panicky. Having options like laboring in water or massage, or tools for getting into yoga poses seems much more useful for pain management to me, based on my experiences with my own body. I certainly don’t begrudge any woman pain medication for going through labor. But, at least in my experience, doctors and nurses are quick to give pain meds and often aren’t familiar with non-pharmaceutical methods of pain management. Because, heaven forbid, I might want to remain lucid and able to move my limbs during childbirth, even if I’m in pain.
It would be awesome if conventional doctors were more willing to look at less conventional methods for treatment, especially for things like pain management. But I won’t hold my breath. Though my rheumatologist has a nutritionist on staff who was also trained at a school for “natural medicine”.
Jill- it would be helpful if you were to understand that you really are dissing the experiences of those (even the non-homebirthers) of us who had horrible, unnecessary birth experiences BECAUSE the data on hospital birthing practices is also not kept out there. Doctors are not required to tell you what their C-section and epidural rate is. Doctors are out there telling people there is ‘no such thing as an unnecessary induction or c-section’ (because ‘there’s no way to know it would have worked out’).
Despite all the data and studies I looked at (I had a so-called high-risk pregnancy: i.e., fat, forty and Gestational Diabetes), it turned out I was misled by my providers, messed with, and generally harassed– and experienced the classic early induction>induction fail>c-section routine which is widely documented in the ob literature.
That’s beyond patronizing, ok?
And then there’s the ‘but your baby is ok, so you should’t care’ routine.
Wanting to have control over your uterus and having one’s doctors use evidence-based medicine is feminism, whether there’s a fetus you want to keep, or a fetus you don’t want to keep. Being screwed around by the medical establishment because They Know What’s Best For You (actually, their actuaries know what’s best for their malpractice insurance firm– there are actual actuarial studies on whether rushing to c-section is better or not) is oppression, whether you wanted to keep the contents of your uterus or not.
How in the world am I “dissing” mothers who had horrible birth experiences? I think I was pretty clear in the post that hospital births can be awful and doctors can be assholes and there are a ton of good reasons why women want to avoid hospital births and the attendant lack of control.
I do find it distressing that homebirth midwives say the exact same things about OB/GYN doctors that Amy Tuteur is saying about them. In a perfect world, they would all be willing to work together to improve outcome.
Both tend to say that the other side wants to hide the facts from you because if their “business” was found NOT to be the safer/better option, they would have less patients and make less money. I roll my eyes upon hearing that, whether it’s coming from an M.D. or a midwife.
IIRC, certified nurse midwives are not ‘allowed’ in some states to even attend home births without risking their license. This is appalling. I think that’s where the CPM vs. CNM came from, yes? While I personally wouldn’t choose a CPM, I do have some sympathy for them…
Is it also fair, then, to compare YOU, Amy, to the anti-vax crowd? I mean, since you’re similarly casting the side you oppose as “Big Rich Midwives who exist only to endanger your baby and rake in the CA$H while only PRETENDING to desire a better birthing experience for women!”? Why should I give you the benefit of the doubt and assume you have my best interests in mind? You seem to think no midwife actually cares about their patient, that they only care about money. Why should I not assume the same for you?
I’ve seen you pop up where ever home birth is discussed on the web, and very adamantly insist that home birth is all bad, bad BAD and all DEAD BBZ and anyone believing the Other Side (midwives) is an uneducated fool.
Hey, Amy? If your constant appearance in these discussions is truly coming from a well meaning place of concern for mothers and babies, you might consider being less abrasive and hateful toward midwives and those who seek their services. Your venom is showing. And seriously, you ESPECIALLY might want to consider NOT equating home birth advocates or home-birth-minded women like myself with the anti-vax movement. You catch more flies with honey, and all that.
THIS, so much this. It is absolutely abhorrent that birthing choices – whether it’s an elected cesarean or a ‘water birth’ – are so viciously attacked by both sides. It’s downright depressing. I want women to have just as much “Choice” when it comes to childbirth. Choice shouldn’t be limited to “Abortion or adoption?”
Why am I so scared of giving birth? I shouldn’t have to be. But I maintain that I have every reason to be. Handing control of my body over to strangers IS scary. The ability to make my own decisions for how I want to experience childbirth shouldn’t be some revolutionary ideal.
The reality is that an epidural generally leaves you paralyzed and unable to leave your hospital bed for the duration of the labor and potentially for several hours after the birth.
Because my ex had to have an emergency C-section before they even got around to administering an epidural, I didn’t entirely understand the effect it has until I had one myself in 2009 for the surgery I had that year. My legs were 100% paralyzed for three days afterwards, and it was one of the strangest sensations I’ve ever had. (Maybe I had a very high dose; I have no idea.)
Ina May’s Guide to Childbirth is an excellent example of using the experiences of home birth to inform (rather than oppose) medical culture. I noticed that the Daily Beast article barely mentions Ina May, and doesn’t credit her as a valid contributor to the plethora of information that DOES exist on home birth and IS recognized by the medical establishment. Instead, The Farm is just casually mentioned as some hippy counterculture practicing home births before home birthing went “mainstream”.
@Amy Tuteur
I’m not trying to shame C-section moms (and am disgusted by those who do) but off the top of my head I can think of this study that links immediate bonding and C-section births. I’m not a science person though, so it could be unsound in some way I’m not aware of.
I wanted an epidural, but my entire labor lasted 3 hours (and that was from admittance to the time her head popped out) so I wasn’t able to get one. They did, however, give me whatever pain killer you get and it made me hallucinate in between contractions though I have no memory of it. (my mother said I sat up and said ” Try 36″ then went back to sleep. No idea.) I do recall being pissed when the nurse told me it would help relax me in between contractions. In between them I was fine. DURING the contractions was the issue.
I also remember the doctor whistling during labor (annoying), then nurses telling me to breathe (I told them to fuck off. It hurt less when I held my breath) and the dr. and my mother looking up at me shocked when I said ” If you can see it’s eyebrows, you can get it the hell OUT” after I listened to them argue over it being girl eyebrows or boy eyebrows.
The Dr. also told me not to scream. I was too busy at the moment to give a shit, but my mother told him to put his balls on the table and if he didn’t scream when she smashed them with a hammer then he could tell me not to scream.
They gave me my last allowable pain injection about 30 minutes before she was out, so I was higher than a kite for about 3 hours. I walked to my recovery room. Didn’t really mind that part.
My best friend had an epidural and read a book until it was time to push.
I would have preferred her experience.
I notice that people keep avoiding the actual point of the original article: homebirth increases the risk of perinatal and neonatal death.
Between The Daily Beast, Jezebel, and this website, there have been nearly a thousand comments, and not one has refute the statistics at the heart of the article:
The latest CDC data shows that planned homebirth with a non-nurse midwife has a mortality rate 600% higher than comparable risk hospital birth.
Planned homebirth with a licensed midwife in Colorado has a perinatal mortality rate more than double that of the state as a whole (including premature babies, complications of pregnancy and pre-existing medical conditions).
No one has refuted these figures because they are true. In other words, contrary to the claims of homebirth advocates, homebirth increases the risk of death.
The only people who appear to be unaware of the data are homebirth advocates themselves. The comments I have made here are an attempt to explain WHY homebirth advocates don’t have accurate information. It’s because they believe the propaganda that they have read and have avoided accurate scientific information.
Whether homebirth is feminist or not; whether some women are traumatized by their hospital births or not; whether technology is good or bad does not change the basic fact: homebirth increases the risk of death.
As far as I can tell, the only thing that homebirth advocates intend to do about this is to ignore it and change the subject. Hardly anyone seems to ask themselves how they could claim to be educated about homebirth and not know this basic reality.
So let me ask homebirth advocates: are you planning to do anything about this increased risk of death besides ignoring it?
From my experience, it is generally neither the modernity nor the medicine involved in the Modern Medical Industrial Complex to which advocates of home birth (and anti-vaccine advocates) object… but the industrialization.
Ooh, that’s weird. After my c-section I could walk within the day. Not that I wanted to.
On reflection, it was two days, Still a long time. And my legs were encased in those weird electric leg sleeves that wheezed away the entire time, so I wouldn’t develop blood clots. But it really is an incredibly strange feeling to send signals to your legs to move and get no response at all. Not that I didn’t have other things to concern me, but still.
And there’s no denying the much higher risks with CPMs. However, since you’ve dug up the higher rates with CPMs, can you tell us the rates with CNMs?
I’m sure there’s a higher mortality rate in bad hospitals than in good hospitals too. Doesn’t mean all hospitals are inherent death traps.
The CDC data shows that planned homebirth with a CNM has double the neonatal mortality rate of comparable risk hospital birth.
Donna – they give you something stronger for surgery than they do for labour. But like Lauren, even after my C-section I was up and walking around within 12 hours (unlike Lauren I was thrilled to be out of bed). I think either you had a very high dose or your body is very sensitive to the medication.
With the epidural they gave me in labour, I wasn’t stuck flat on my back. I could sit up and squat with support (there was a birthing bar on my bed). Getting up and walking around would probably have been beyond me, but before the epidural even sitting and squatting were beyond me because the pain had reduced me to the fetal position, so the epidural was an improvement mobility-wise.
I absolutely think nobody should ever be pressured into pain medication they don’t want. And people should be made aware of the risks of epidurals as well as being taught non-medical ways of coping with the pain. But when I see things like this: “not being in the same room as epidural medicine (it’s right behind you in big cabinets, just waiting for you to say “ow”*)” as an argument for why home birth/birthing centre birth is better, it makes me angry. (From the article IrishUp linked way up at the top of the thread). It’s more of the same – women should have fewer options because we can’t trust them to decide for themselves what’s good for them.
Wow, a lot to catch up on after a night’s sleep! @ Wordspinner 75, I wasn’t commenting on epidurals. I know they are safe, but they are not relevant to the mortality issue. On that topic though, and responding to lolagirl and other who had epidurals and didn’t like them, I concur.
I had an epidural with my first delivery. We had transferred to the hospital because the midwife was concerned about the foetus. The foetus was actually fine but I was in pain and figured, since I was at hospital why not have an epidural. I was ok but not pleasant. My legs shook the whole time. It also mean I had to then wait two more hours until I could push once it wore off. Brilliant, what’s the point then? And after that my edema took 6 weeks to go away and I only found out later that was because of the epidural. I think that if I hadn’t been in the hospital I would have managed without it and been happier overall.
With my second birth it all happened very quickly, by the time I got to the centre the contractions were 1 min apart. Very painful, but no epidural. It was much easier to get around afterwards and the edema was gone in 3 days.
That’s just my personal experience of course, lots of women who had loved their epidurals had recommended them.
DonnaL, I’m not a doctor but I suspect you had a much higher dose. We get lower doses in labour so that we can still control enough to push.
Just an FYI, folks: Amy Tuteur is a well known troll in these kinds of discussions. She used to have a really vitriolic blog over at Salon and was famous for her venom that she directed at any and everyone who DARED to disagree with the Great Amy Tuteur, MD. You can’t have a factual, reasonable discussion with her on this topic.
I think Amanda Marcotte’s point about how birthing centers and CNMs aren’t the issue is fair enough; I’ll point out that the reason everyone brings up birthing centers attached to hospitals, or awesome CNM practices like the ones that delivered my kids, is because those are so bloody hard to find. In many places, you get a choice between an overly medicalized hospital birth that has a 33% chance (or maybe even more) of resulting in a c-section (which, because VBACs are hard to get most OBGYNs to agree to, will typically result in future births by c-section), or looking into whatever alternative practitioners you can find.
It’s not like childbirth exists in two flavors of Extremely Risky versus No Risk At All; like most other things in life, risk lies along a continuum, and laboring women need access to whatever level of medical assistance is considered standard for whatever level of risk (or lack thereof) they’re experiencing, in the care of practitioners who actually engage in practices designed to promote truly informed consent.
So…small to slightly less small, in other words. What about morbidity rates?
My question is, why exactly is this okay? I’ve had two outpatient surgeries, and both of them were unnecessarily traumatizing–emphasis on unnecessarily. The first time, the anesthesiologist gave me valium even as I was explicitly saying “NO, I DON’T WANT THIS” over and over again. He laughed at me as he did it. The second time, after I woke up, the recovery room nurses kept my husband out of the room and refused to tell me why, despite a written hospital policy that family members could visit as soon as patients were awake. Patronizing behavior and bullying are rampant in hospitals, especially, I think, towards women.
As has been stated many times in many places, the idea usually isn’t eliminating intervention for the sake of eliminating intervention. The idea is eliminating unnecessary intervention that can lead to more intervention and often causes harm. I think everyone on this thread would shake their heads at the use of forced general anesthesia, forcep deliveries, and episiotomies that was standard fifty or sixty years ago–and yet, when people complain about being forced into unnecessary interventions now, we roll our eyes and call them anti-medicine. Why do we think we have it all figured out now, when we’ve messed up so royally before?
Yes, the natural birth movement can be just as dogmatic as anti-natural birth people like Amy Tuteur (who, and I know someone already said this but it bears repeating, does routinely show up on threads like these to spout rhetoric and controversial data as if it were basic fact). And yes, the data on homebirth is inconclusive (although that’s a far cry from what the article and OP are claiming–that homebirth is without a doubt too dangerous to ever be worthwhile). But it baffles me that people treat the status quo as the only viable solution, rather than looking at why women want to avoid hospitals in the first place.
For the record: I’m 7 months pregnant and am working with the CNMs at the UCLA medical center. Homebirth and birthing centers weren’t an option because of insurance, but this is a great compromise, despite the higher cost: a hospital setting (that my insurance will pay for) with highly trained professionals, who just happen to respect birth plans, only use interventions when necessary, and have a c-section rate one third of the national average.
When I go through CDC Wonder, looking at low risk, full term births, I find the following mortality rates:
In hospital:
CNM: 0.175%
MD: 0.247%
Total: 0.242%
At home:
CNM: 0.215%
Other midwife: 0.292%
Total: 0.289%
So, CNM-attended home births actually have lower mortality rates than MD-attended hospital births, according to this CDC data. The overall risk is higher for home births, and the average risk is worse. But a “good” home birth isn’t really riskier than an average hospital birth.
Heck, if you limit the data to 2nd children and beyond, the average mortality rates for home births (0.256%) are actually marginally lower than the average mortality rates in the hospital (0.26%).
In other words, home birth can be riskier, yes, but obviously there are ways to mitigate that risk significantly.
(And while I don’t have a medical degree, my degrees in mathematics allow me some competence in examining statistics.)
You need to look at neonatal mortality for white women (race is a risk factor and almost all homebirth mothers are white), ages 20-45 (very young age and older age are risk factors), at term, with single babies, weiging at least 2500 gm..
You will find neonatal mortality rates of:
CNM 0.34/1000 (0.034%)
MD 0.57/1000 (0.057%)
non-CNM 2.63/1000 (0.262%)
The death rate for non CNM-midwives is 7.7X higher than comparable risk hospital birth.
That actually undercounts the difference because all the high risk patients are in the MD group and all the homebirth transfers (including deaths) that should have been in the homebirth group are counted in the hospital group.
Okay, I’ve limited the data to white mothers between the ages of 20 and 44 (inclusive), giving birth at 37-41 weeks, to single babies, 2.5kg-8.165kg in mass. The following are the percentage of deaths per 100 births, grouped by birth place and attendent.
In hospital:
CNM: 0.13%
MD: 0.17%
Other midwife: 0.15%
Average: 0.17%
At home:
CNM: 0.17%
MD: 0.61%
Other midwife: 0.29%
Average: 0.27%
And, yes, I’m sure the MD attended births included a lot of high risk ones, upping their rates. But without data describing how much that skews it, you can’t really make a statistical argument about it.
So, still certified nurse-midwifes, at a hospital or at home, are a pretty low risk choice, relatively.
Oh, and that’s the 2007 data.
I included births of 42 weeks and beyond.
Did you use deaths from birth to 27 days of life?
The query form does not return the data as percent. What were your actual results?
this discussion has gone the way just about all discussions of home-birth have that i’ve seen here. lots of heat, not much light.
my experience: one vaginal birth, performed in a hospital, with an epidural, very quick, complication-free, my only complaint is that i wanted more epidural during the pushing phase and the doctor wouldn’t allow it, saying that it would interfere with my ability to push. except that it didn’t, i was pushing just fine in between contractions despite feeling numb. that’s yoga training for you.
the issue i keep hearing brought up by home-birth advocates is that MDs are so scared of lawsuits that they “hit the panic button” (as one person stated) and go with interventions that may not be necessary. well, my husband is an MD, though he works in the ER and is not an OB/GYN. and yes, he is scared silly of malpractice lawsuits, having been the subject of several frivolous ones already. (they’re called machine-gun lawsuits: when a bad outcome occurs, every single medical professional in the hospital who had contact with the patient gets listed as a defendant, in the hopes that something will stick.) so, yeah, the risk is real.
my husband doesn’t want to lose everything he’s worked for his entire life taking a chance that someone else wants because their idea of a bad outcome is different than his idea of a bad outcome. as in bad outcome = c-section rather than preferred vaginal birth vs bad outcome = dead baby. and before there’s a pushback against my invoking the spector of a dead baby, it does happen.
i know a woman in our community who was pregnant with twins(!), whose midwife told her that she could do a homebirth, no problem. in what world is a multiple-birth not considered a high-risk birth? but whatever, the woman decided to go for it. and only one twin survived the birth.
this story absolutely enraged my husband. he thinks that the midwife who advised a home birth, and proceeded to undertake the medical care of this high-risk birth, should lose her license to practice. at the very least. and i see his point. an outcome like that in a hospital setting would result in lawsuits galore. and the midwife skated.
i do see this as a problem. of course, i acknowledge that this anecdata does not mean that home births are not safe. what i am saying is that the lack of accountability that the homebirth midwife profession is held too, compared to the hospital medical community lives with, constitutes a problem.
so what practicable solution is proposed by homebirth advocates? does anyone have any thoughts?
I posted a previous link to a Context and Variation discussion of the study cited in the article of the OP. Here is another C&V discussion that delves nicely into the nuances of “why” homebirths, the difficulties in comparing outcomes across diverse settings (home, birthing centers, hospitals) , and a bunch of the issues that have come up in this thread.
http://blogs.scientificamerican.com/context-and-variation/2011/08/24/why-do-those-who-advocate-home-birth-feel-the-way-they-do/
Here is another blog post on the CDC numbers. he CDC posts XLS files of data that are publicly available to allow individualized examination of their figures. I don’t necessarily agree with everything the blogger writes, but I think it’s a useful illustration of how the CDC data can be massaged to show whatever point of view you’d like to show. This author is fairly transparent about how she applied the filters to the raw CDC data. You may disagree with the criteria, but at least you can ascertain what they are.
http://www.homebirth.net.au/2008/06/homebirth-vs-hospital-statistics-to-die.html
Here is another great post on the topic with interesting discussion:
http://confutata.com/2009/07/29/midwives-mortality-rates/
@trishka. I thought really early on I raised the question of whether it is a problem with home births or a problem with the midwives who conduct them. In NZ we have a straightforward system that licences midwives and holds them to the same standards as other health professionals.
By the way, in NZ we do not have liability for medical professionals as you cannot sue for personal injury. However, we still have the same intervention issue in our hospitals. So, I don’t think it’s just about nervous doctors. There’s a lot more medicalisation stuff going on there.
I included all deaths within the study parameters.
And the query returns deaths normalized per 1,000 births. By magically dividing by 10, you get deaths per 100 births. Those are my actual results.
Not to get sarcastic, but for someone who’s repeatedly (and in many venues) criticized home birth advocates for not understanding “Science,” you really should recognize “actual results,” simply converted from deaths/1000 births to deaths/100 births.
I’m curious as to whether there are any studies on the long-term health of babies born in hospital vs. home birth babies. Such a study would be hard to control for variables, of course- but it would be interesting.
What do you mean by “all deaths in the study parameters”? The query form allows you to choose deaths in increments ranging from less than 1 hour up to 364 days. Which increment(s) did you use?
I used all deaths in the study parameters. That means all the deaths, regardless of cause or time period. You can use all infant ages at time of death, from under an hour to 364 days.
If you used all the time increments, you calculated infant mortality, which is in large part a measure of pediatric care, including as it does deaths up to one year of age.
I am referring to neonatal mortality, a measure of obstetric care, which is deaths from birth to 27 days.
Run the query again with the correct parameters and see what you get.
Why is this? It seems to be a pattern overall with these naturalistic types of movements.
The actual benefits of home birth: less stress on the mother, less babies being sent off to SCUBU and coming back with nineteen holes and a diagnosis of “it was just a gurgle” (this was the incident that caused my mother to switch to home birthing).
The less stress benefit is the important one, obviously.
In the US do you spend much of active labour without medical attendants in the room? The OB only popped his head in a couple times for me, but there was a nurse there the whole time, so I wouldn’t have been able to get away with eating on the sly. Although now that I think of it I’m not 100% sure food was banned – I’m assuming it was because I wasn’t offered any, but I didn’t want any anyway so I didn’t actually ask. I was allowed water until it became apparent I would almost certainly need a C-section, then the nurse wouldn’t let me have any more. It seems extremely cruel to routinely deny water in labour – pushing is hard work and made me very thirsty.
You know, the more I think about it, the more I disagree that it’s only women who are supposed to suck it up and endure pain; the US is absolutely phobic about pain meds, so much so that there’s a significant problem with not giving terminally ill patients sufficient pain relief, presumably to avoid turning them into addicts or something. When my stepfather was recovering from heart surgery he’d had the previous day, and the pain meds they were giving him were having almost no effect even after they’d been upped to the maximum dosage, the doctor, prior to just changing to a pain med that worked for him, tried to give him a long talk about how “some discomfort and pain” was “unavoidable.” The US really undermedicates pain in lots of circumstances, which makes it all the more noticeable that pharmacological pain relief during labor is standard.
Okay, same parameters as last time, but limiting infant age at death to 27 weeks at the latest.
In hospital:
CNM: 0.033%
MD: 0.056%
Other midwife: 0.075%
Average: 0.054%
At home:
CNM: 0.08%
MD: 0.338% (Likely the result of emergency home births, not planned)
Other midwife: 0.225%
Average: 0.176%
Certified nurse midwives, at the hospital or at home, are still a relatively low risk proposition. Even compared to in hospital doctor deliveries, there’s only a 43% increase with at-home CNM deliveries. Yes, higher risk, but given the very low risks overall, really not that significant.
CNMs in the hospital represent the correct comparison because they care for only lower risk patients. You can’t use MDs as the comparison because all the high risk patients are in their cohort.
Your numbers show that low risk hospital births have a neonatal mortality rate of 0.33/ 1000 whereas non CNM midwives at home have a mortality rate of 2.25/1000. Therefore planned homebirths with a non-CNM midwife have a neonatal death rate 6.8X higher than comparable risk hospital birth … almost exactly the statistics I presented.
So we are back to where we were in the beginning. Homebirth dramatically increases the risk of neonatal death. That’s what the CDC statistics show and that is what the statistics from the states that have been collecting them show. Women deserve to know this and professional homebirth advocates should not be pretending that homebirth is as safe as hospital hospital birth.
That’s what Michelle Goldberg was trying to say and she is absolutely right.
Also a troll who likes to go by the moniker “Dr. Amy” even though she hasn’t actually practiced medicine in something like 20 years.
I dunno. I don’t think its *only* women who are supposed to suck it up. But I think this also breaks down along class/race/ability status vectors. There is a lot more pressure on certain types (white/wealthy/able) of women to do whatever is necessary (including not seeking intervention) to protect the fetus. It fits in with the motherhood as sacrifice meme.
The reason that birth centers get talked about along with home birth is that for free standing birth centers there is not much difference between giving birth at the birth center and giving birth at home. My CNMs had all the same equipment at the birth center as they bring to your home (or require you to obtain by 37 weeks). They are the same providers with the same training and the same equipment. So why are my 2 birth center births “totally different” than if I’d been at home? Personally, I preferred not being at home. But I don’t think the risks I incurred were significantly less because I went to the birth center.
Also, the fact is that you cannot get serious pain meds outside of the hospital. So if you don’t want to be in the hospital, you have to forgo pain meds. It’s not necessarily a philosophical objection to pain meds as much as a decision to forgo them based on other priorities.
I think posts like the OP just strike me as typical of people who don’t know anyone who’s actually made these choices and assume whoevers loudest on the Internet is representative of some imagined group. Are there people who are into home birth for religious reasons? Yes. But I doubt they read Feministe. The cross over between the readership of this blog and home birthers is a totally different set of people. But some big Internet feminists don’t seem to get that.
I wish there was an app to block everything Amy Tuteur has ever said on the internet.
Almost the stats, but, oddly, just a little lower.
Also, I don’t think you can compare hospital CNMs with at home other midwives. The vast majority of hospital births are MDs, not CNM, low-risk or no.
And, there are good at home births and bad at home births. Obviously, CNMs are good at home births, with low mortality rates (though, yes, a little higher than at the hospital).
Which then raises the question, why are CPMs the ones so widely legalized, while CNMs, the better choice, so restricted?
gomi, thanks for responding to the statistics with something more than calling her a troll or expressing a desire that the information be blocked. it’s a tough set of statistics to parse, that is for sure, because of the discrepancy in risk factors going in.
i’m curious, for my own edification, to learn how the scenario i described above would be classified. it started out as a homebirth with a midwife – don’t know her credentials – and ended up with the baby dying in the hospital under the care of an MD. (umbilical cord wrapped around the neck = not enough oxygen). would that get classified under the in-hospital MD mortality stat?
hardly seems fair, does it? if that is indeed the case. am curious how they set that out. if they look at only situations of mortality where a hospital does not come into play, then of course the homebirth rate is going to look pretty good. because how many laboring mothers stay home if they can help it when it truly turns life or death for them or their baby? that’s the whole “a hospital is only 10min away” rationale. (if that’s not how the stats are gathered, ignore this paragraph and chalk it up to my ignorance; am happy to learn otherwise if someone knows the answer)
The trade off on that is things like how CNMs will do a risk assessment on their patients and push high risk mothers into the hospital to begin with. They’re medical professionals, same as any L&D nurse or doctor in a hospital, and act accordingly.
The current structure has forced the worst possible outcomes in home births. And then people compare the best of hospital births with the resulting worst of home births, and demonize home births with that biased outcome.
Bad things can happen in home births, like an umbilical cord around the neck. Bad things can happen in hospital births too. Like doctors refusing to deal with breech births and jumping to c-sections, which automatically increase the risks with those inherent in any surgical operation.
What needs to be done is finding ways to make all these birthing options better. Like someone said earlier, we need to be using this debate to improve patient focused care, rather than throwing vitriol at home birth mothers with carefully chosen and poorly compared statistics.
I like socks. Mine are argyle. Add some googly eyes, and they look just like you!
More white people have the luxury of being able to choose. Also- lots of white people appropriate the snot out of bits and pieces of other cultures, twist it and turn it into some godawful earth mother crap. The same people who tend to do the ” oh look we bought a farm, isn’t it quaint, we shall grow our own food just like real farmers” only without having to work from dawn til dusk for barely enough to scrape by and without all the stress and worry that comes from being a real farmer. They make up for that though with a ton of snotty attitude.
White Privilege takes some truly weird forms.
If it started out as a homebirth, but the mother was transferred, and the baby died in the hospital, it would be classified (in these statistics) as an MD hospital death.
The CDC statistics that show a 7X higher neonatal mortality rate at homebirth are not the only ones. The Colorado statistics show a much higher rate of neonatal death at homebirth as do statistics from other states. The Birthplace Study in the UK showed a higher rate of adverse outcomes at homebirth. All the data out of Australia shows a higher rate of neonatal death.
There is simply no question that homebirth increases the risk of perinatal and neonatal death. So why don’t homebirth advocates know this information? Why is it being hidden from them? Where are the homebirth advocates demanding that the Midwives Alliance of North America (MANA), the group that represents homebirth midwives, release the death rates of the 24,000 homebirths in their database? You don’t hear a peep from them because they don’t want to know that homebirth is dangerous.
As far as legality is concerned, CNMs are legal in all 50 states. It is CPMs that are not legal in many states. CNMs are professionals, just like doctors, and practice under professional restrictions, including the need for liability insurance. CPMs are hobbyists who do what they please, ignoring laws, ignoring regulations and ignoring science.
The CPM is credential was made up by Ina May Gaskin and colleagues to award to themselves. Gaskin, the grandmother of American homebirth midwifery has blood on her hands, and not just the blood of one of her own children who died at homebirth. She boasts fabulous statistics, but they are not true. The only scientific paper published about Gaskin and the Farm (Durand, 1992) is a bait and switch. The death rate at The Farm was high, so they compared it to a survey of HIGH risk hospital births to make it look good by comparison. Since then, Gaskin has refused to publish her outcomes.
As I’ve said many times, every woman has a right to give birth at home, but if she doesn’t know the truth about homebirth (and no homebirth advocate is going to tell her the truth), she cannot make an informed decision.
Heh.
Frankly, I think *all* birth options in the US are problematic. A couple of folks have related their horrific experiences, and I really feel for you.
Here’s my antedata: after being nagged by family and especially friends about my pregnancy, I went to the library and did some research, and concluded within 15 minutes that home birth was for me. Further research confirmed the initial decision, because I wanted to be in charge and I didn’t want an unnecessary c-section.
I had the sort of midwife people decry — anti-vax, into homeopathy, hippy dippy. She still had me pee on a stick every week, had a doctor order blood work, was strict on diet, exercise and vaginal conditioning. She had me set up a backup plan with a nearby hospital. She even accused me of being a bit `lazy’ like one other poster complained about. Until she discovered the baby’s head was transverse, then I was superwoman.
I was intermittently in labor for almost two weeks. Can you imagine *any* hospital letting a birth go on that long?
Me either.
While all this was going on, she had my spouse and me track my temperature and fetal heart tones, especially after my water broke. She and her apprentices brought oxygen, so it’s not just CNMs who’ve moved with the times! She couldn’t turn the baby’s head, (because illegal, not because she didn’t know how) so we all went to the hospital, but that was *my* decision. Even with the baby’s head crowning, they still talked about c-sections! As it was, I got to deliver vaginally, but had an unwanted episiotomy. So much for the perineal stretching.
They gave the baby sugar water, even though it was clearly labeled breast feed. The doctor didn’t know how to deal with the shoulder dystocia. They tried to blackmail me into staying longer with fears of the baby dying. I said in that case, it would probably die anyway, and I would rather she died at home. *That* shut them up. But, according to my midwife, I had a good hospital experience. Again, I am so sorry for everyone who’s had bad ones. I can’t imagine, truly, how horrific those experiences could be. Oh, and for those without insurance, all my prenatal care, classes, multiple visits, post birth checkups, etc was about $1600. Hospital, 10 minutes turning head with a car part from the local auto parts store, less than 24 hour stay, $5000.
(And yes, the kid who is now an adult, is fine.)
Now here’s the interesting part of my story. My sister, who has basically similar health, socioeconomic background, age at first birth, etc, decided to go the nurse-midwife route in a birth center attached to a hospital. Answer to all the problems, so much better than home birth, right?
Well, not so much, in her case. Like me her first was a failure-to-progress, with a hand up by the head, instead of being transverse. They pricked her, pitted her, and did the suction cup thing, but had to reach in behind the pubic bone, and it was *far* more painful. I was there as her birth coach. I have the feeling that if they’d left her alone she would have also done the weird go into labor at night, stop during the day.
But she never had the option.
There was good information about home birth 20 years ago when I did it,(1) and good lay midwives, though you had to interview them just as they did you. Mine `risked out’ anyone she thought ought to go to a hospital. I know a lot of people who like the compromise of the CNM and birthing centers. But there’s still going to be that percentage who wants to have their babies at home, and for whom it really is the best choice.
I’m extremely grateful I went with homebirth, because I think the `home court’ advantage, psychologically, was a huge factor in my outcomes. My sister was happy with the birth center. My sister-in-law was recently grateful for her c-section after her baby’s heart tones started slowing down. Frankly the idea of a scheduled c-section gives me hives, but I presume the scheduled c-section folks get hives at the thought of doing home birth.
It would be awfully nice if home birth/mom-patient’s wishes-birth plan were more integrated into US medicine. As it stands now, they’re not. Home birth is sorta legal in my state, or was, but it’s certainly not supported, let alone insured. I was lucky to have the cash to pay for it.
Finally, I’ve been in the hospital both for emergencies and routine procedures, and I’m sorry, I just don’t think the comparison is a good one.
(1)Assuming access to a decent library, that is. I lived in a poor urban area, which did not have adequate resources, but luckily for me, I was able to get books thru my parents’ suburban, and much better funded, library. It’s a bit easier now, if one can cadge some internet access.
The fear of lawsuits is absolutely a rational one. As an aside, I actually spent a few years of my early associate years defending medical malpractice suits, often it was doctors being sued unfairly, but I’ve also seen doctors who panicked and let all standards of evidence based medicine go out the window in the process. Of course doctors are human, mistakes happen, and judgment calls get made that turn out to be wrong in hindsight.
The problem is that it doesn’t have to be a choice between extremes. Additional personal anecdote: my 2nd and 3rd deliveries were VBACs. During the 2nd delivery, I literally had the anesthesiology attending literally yell at me, while I was in active labor, and tell me that I was foolish and selfish for having a VBAC delivery. He also threw the dead baby spector in my face and insisted that I resign the hospital’s standard VBAC waiver form that I had already filled out prior to my delivery at my OB’s office, after extensive and well informed discussions with said doctor.
The delivery went smoothly and without complications, in under 5 hours, btw. The bullying that I experienced, and let’s not pretend it wasn’t bullying was completely ott and ridiculous, not to mention insulting and completely beyond the normal measures of human decency.
This is far from standard practice at all hospitals. I was encouraged to use a bouncy ball, walk the halls, and use the tub if I felt like it. I was allowed to eat and drink up until the point I had the epidural, which was basically two hours before I gave birth. They dose the epidurals much lower nowadays, so you aren’t totally numb and creeped out. Also, it’s no longer standard practice to do an episiotomy because studies show it doesn’t work.
As for bullying, everyone was very respectful of my desire to wait it out and see if labor would start on its own after my water broke, but after 10 hours I got tired and decided to just get it over with using pitocin. One doctor was moderately obnoxious but the others were kind and actually had numbers on relative risks of infection with or without inducing labor. By contrast, I’ve had friends whose midwives refused to respect their desire for an epidural in the moment, because of some ideological allegiance to the notion of natural birth. So jerky care providers who don’t’ respect your autonomy can come in all stripes.
As for pushing epidurals, my experience was that everyone respected your choice, but precisely because of the legal requirements (signing papers, etc.) and time lag associated with an epidural, they want to have an idea who is going to have one. Making women in the throes of labor sign papers is really annoying (as one of the commenters above noted), and they don’t want you to be screaming for one when it’s too late to do it. This is not bullying women–in fact, they probably see tons of women who don’t intend to take any pain medication only to change their minds during labor, so they just want to make sure the future-you is taken care of without compromising the wishes of the current you. An inherently tricky balance.
As an aside, the epidural was AMAZING. I felt no pain and was able to nap through the most intense two hours of labor, but still felt enough to push perfectly. It also made it easier for the doctors to do the c-section without knocking me out when I got a small placental abruption. Being well-rested for the trauma of the actual delivery was key–I would have lost my shit otherwise.
Also, the woman who put an end to me pushing was a certified nurse midwife. She took one look at the heart rate monitor and said “that’s it, it’s over,” and thirty seconds later I was wheeled into the OR. I’m so glad she was there or my baby would have had long lasting brain damage or died. But it just goes to show that nurse midwives can be just as pro-intervention in certain circumstances.
Further statistics, if you use the same restrictions as my last stats comment, and narrow it to just 2nd and subsequent births, you get even better at home numbers for the CNMs.
In hospital:
CNM: 0.03%
MD: 0.055%
At home:
CNM: 0.048%
Other midwives: 0.18%
So, after the first birth, at home births with a certified nurse midwife are actually marginally less risk than an in-hospital delivery with a doctor. And only 60% riskier than an in-hospital CNM delivery.
Overall, less than 1 in every 2000 at home births, for a second or later child, in the given demographic*, with a CNM, is fatal. Compared to slightly more than 1 in every 2000 in hospital births with a doctor, for the same demographic. Little different.
* That demographic is: White mothers between 20 and 44 years of age, delivering a full term weighing 5.5lbs or more, and the rate of death for those infants within the first month.
Kungfulola, you just made my night that I’ve spent prepping lectures in between reading here so much brighter with this. Thank you :)
look, i don’t have a dog in this hunt, per se. when it was time for me to make my choice of where to have birth, i chose the hospital, for a variety of reasons. at the same time, i come from the demographic where homebirths are held in higher esteem than hospital births, so i have loads of friends who have given birth at home, and done so successfully. the noted exception being the one i described above.
however, from all this it does appear like there is not enough information to reach a clear conclusion one way or another on the relative risk factors for home births vs. hospital births. in order to accurately compare the two, it is important that all factors be controlled for, and it doesn’t appear that they have been. given the numbers that are being presented on perinatal mortality, it seems like no matter what we do we are going to compare either apples to oranges, or oranges to apples, providing results that both sides use to their advantage.
and this? is not a good thing, as jill brought up in the first post. it doesn’t seem possible to me for anyone to make a truly informed decision on whether or not to have a homebirth, based on perinatal mortality statistics alone. of course there are other factors at play, many other factors. but that one, for me, is definitely the biggest. all things aside, we all want a healthy baby at the end of it. so what are we to do?
and lastly, except for hearing that NZ has it covered (which is a good thing! don’t change, NZ!), nobody has addressed the issue of the lack of malpractice accountability associated with homebirth midwives. the situation with the woman i know whose baby ended up dead wasn’t just a case of “bad things happening”, like the umbilical cord being wrapped around his neck. it was a case of a midwife recommending a homebirth to a woman pregnant with twins. it was a high-risk birth to begin with.
should this be considered malpractice? if so, what is to be done? the suggestions of doing a better job of integrating the homebirth style with the medicalized style makes a lot of sense – hence the hurrahs for birthing centers. (my own hospital experience was more like a birthing center, with a hot tub & similar amenities for me to make the most of the experience). but that’s not going to happen overnight, and what to do in the meantime?
is it reasonable to suggest that it would be good for women choosing homebirths to know if they lack any legal recourse if the midwife they hire royally screws the pooch in some way? it seems to me that would be good information to have – though most women i know who have chosen homebirth don’t look at it like that at all. i respect their decisions, don’t get me wrong. but the point of view seems to be “i have no reason to expect anything will go wrong, and if it does the hospital is 10 min away.” the thought of “what if this midwife that i have hired and placed my trust in is actually incompetent?” isn’t in the thought process.
The justification for many people who choose home birth is avoiding unwanted intervention. It sounds like I’m in the minority, but I said no to several things while I was in labor with each of my children. The nurses were irritated with me and there was some grumbling, but nobody made me do anything I didn’t want to do. They did seem to understand that an intervention without my consent goes by another name, “battery.”
Why is it that so many women lack the confidence or appropriate sense of entitlement to simply say no?
Jill– arguments like this:
“Complaining about the medicalization of childbirth strikes me as akin to complaining about the medicalization of cancer. ”
Is dissing the experiences of people who had their ‘medicalized’ childbirth turned — unnecessarily — into a nightmare. It’s saying that ‘untreated’ childbirth is deadly. Not just sometimes, but most of the time. And throwing in that fallacy to discussions of childbirth basically disses anyone who has a problem with medically-managed childbirth at all.
I’m going with Gomi for the win.
I’d like to emphasize something matulun said way up thread that I think hasn’t gotten much consideration: It is perfectly reasonable and rational to take other factors other than risk of death into account when making a decision (whether that’s a decision to drive a car rather than walk, or a decision to have a homebirth rather than a hospital birth). For some reason, factors such as comfort and convenience are seen as perfectly reasonable reasons for choosing to drive a car, even though the data clearly point to walking as being far safer, but suddenly when it’s a woman giving birth’s comfort and desire to remain in control of her body, the only factor she should consider is risk of neonatal death (and not even risk to her own health, mental and physical, let alone factors such as preferences and desires).
Even if we’re having trouble pinning down the exact statistics for homebirth vs hospital birth neonatal deaths, everyone in this thread is agreeing that the numbers are in the 1 or 2 in 1000 range. In contrast, I believe the c-section rate for births that start out as homebirths is about 5% while the average hospital rate (obviously this varies by hospital and regionally) is about 30% in the US. I realize that those risk groups are not equal, but it’s clear that the risk of ending up with major surgery is much higher in a hospital birth. It is perfectly rational for a woman to not desire major abdominal surgery (and note that this is not a commentary on women who want elective c-sections, just that it is also perfectly reasonable not to want one) and to be willing to trade off a large decrease in the risk of that surgery for a very small increase in the chance of neonatal death (if that increase really does exist, which we’re unclear on, at least for low-risk births attended by a CNM).
I would dispute the statement that good information about home birth isn’t widely available. I gave birth to my son, 16 years ago, in a hospital, and to my daughter, 13 years ago, at home, and there was a plethora of information about home birth out there — and that was before everything in the universe was on the Internet. Perhaps the difference today is that there is SO MUCH information out there that it’s actually harder for people to sift through. But it’s really not difficult to learn the difference between a CNM and a CPM, or to find which kind of midwife you’re talking to.
I would also dispute the characterization of planned home birth as “popular.” It’s still chosen by a small minority of families.
Because I’m (thankfully) past my childbearing years, I haven’t kept up with the statistics on home birth vs. hospital birth and I’m not in a position to evaluate the studies. The eternal question, of course, is whether the risk of serious harm or death caused by the lack of high-tech equipment in the home outweighs the risk of serious harm or death caused by poor hospital practices. In some ways, hospital practices have improved tremendously over my lifetime — my mother was unconscious when I was born, and I was hauled out of her with forceps. But then I think about that 35% C-section rate. My own midwife once said to me that she’d be perfectly happy to work in a hospital birthing center, rather than in clients’ homes, if there were such a place that actually respected the midwifery model of care. Unfortunately, in most areas, there isn’t.
As for midwives who discourage their clients from getting ultrasounds on flimsy grounds, or who do high-risk deliveries at home, there isn’t enough contempt in the world for them. There’s no logical reason why we can’t combine the best of the medical model with the best of the midwifery model. Sadly, the culture is nowhere close to allowing that.
LuckyLady -
A LOT of the time, your “No” in L&D is outright ignored or you are bullied into doing whatever it is you first objected to. And many women are not in a position to shop around for an OB/L&D team who will help them with and adhere to their birth plan.
Check out “My OB Said What?” for some accounts.
Isn’t this Feminist 101? Women in the U.S. are still often raised and socialized to not argue, to make nice, and to respect and defer to authority figures.
I personally found the birthing experience to be a deeply vulnerable time for me emotionally. What I needed to get through it was to be left in peace as much as possible, and to not be approached in an aggressive or rough manner. It was exhausting, distracting and disheartening to have to stand my ground and say no. And I’m not suggesting that all medical staff stand back and just let a birthing patient go, but I am insisting that they keep their patient’s dignity in mind and not forget that it isn’t just any old random day for the patient like it may be for that doctor.
I think this again goes back to the dichotomizing of the rhetoric surrounding birth. If everyone were (as we sometimes like to pretend in these debates) strictly home birth(“natural”) vs. hospital birth(“medical”), then maybe you could just say no. But since most people don’t fall into either of those extremes, we need to be able to listen to medical professionals that we trust so that we know when we need to move from our wanted birth plan to our needed birth plan.
The point of being in a hospital if you want a med-free birth is in case something goes wrong, but if the medical staff is trying to convince you that something IS going wrong from the moment you walk through the door (and that was certainly my experience– “don’t stand up out of the bed, the cord might sweep into the birth canal” “you need internal monitors at all times in case the baby’s heart stops” “you can’t get in the shower because once your water breaks the shower can infect you” “don’t eat anything because if you need a c-section you’ll choke on your own vomit and die” and this was with a completely normally progressing birth with no complications), it makes it really hard to figure out what’s just fear-mongering and what is a legitimate cause for concern that should alter your plans. Not to mention, giving birth puts you in a rather vulnerable position where you are physically weakened and emotionally drained.
What’s even more disturbing is that most of this isn’t evidence based medicine in practice. Standing, walking and remaining upright can and often does help labor progress and self-regulate. Internal fetal monitoring is invasive, contraindicated for GBH+ patients because of the increased risk of introducing infection, and is supposed to be reserved for suspected fetal distress. Warm water showers can help alleviate pain for laboring patients, and unless that patient has a monitor lead coming out of the vagina the risk of infection being introduced is practically nonexistent. Patients undergoing a lengthy labor often need some food and water to maintain their energy level and prevent exhaustion.
I notice that Amy T never did bother to reply to my question about morbidity. Mortality/morbidity rates are sometimes trade-offs in medical care–and there is a serious ethical question as to whether it is better to prevent one death vs. a large number of iatrogenic co-morbidities.
Yeah, there were chunks of time where the nurse wasn’t around. I think this is routine. Besides, only one nurse spouted off the (antiquated, by the way) idea that I shouldn’t have anything to eat or drink. The medical student attending actually kept bringing me juice, sweet kid.
It generally is still considered routine to forbid food or drink while laboring, because of fear a patient may vomit/aspirate in case a c-section becomes necessary.
I had all food and water withheld from me for 16 hours when I preterm labor during my last pregnancy, and that was just last year. One of the nurses finally snuck me some ice chips while the attending and resident were out of the room for a while because I was dying of thirst.
This was at a major university hospital too, not some little regional center.
I disagree with the implication that all people who choose homebirth do so because it is more ‘natural’ or ‘hippy’, or because we don’t appreciate modern medicine. For me in the UK (where I feel extremely lucky to have the NHS) the midwife who helped me plan my homebirth was the same (hospital employed) midwife who would have planned my hospital birth if I had wanted one. There was no mention of homeopathy or other snake oils, and candles and incense were absolutely forbidden because of the presence of pressurised containers of oxygen. I didn’t decide on a home birth because I hated hospitals but because it was a convenient way of receiving the professional medical care I needed in a safe and stress-free environment. You accept the risk that you don’t have instant access to a fully staffed operating theatre, and accepting the risk is an entirely different thing to ignoring it!
As it was, my bad experience in hospital came from being placed into birthing stirrups while drugged up beyond my ability to consent (because pushing uphill is so much better!), and then after the birth having myself and my baby threatened by the violent husband of another patient. If you are lucky enough not to need a doctor or operating theatre, and if the standard of midwife care is identical to that of the hospital (as it is in the UK) then homebirth is simply choosing where you have your baby, and has nothing to do with Granola.
ACOG most recent recommendations:
“Oral Intake During Labor
ABSTRACT: There is insufficient evidence to address the safety of any particular fasting period for solids in obstetric patients. Expert opinion supports that patients undergoing either elective cesarean delivery or elective postpartum tubal ligation should undergo a fasting period of 6–8 hours. Adherence to a predetermined fasting period before nonelective surgical procedures (ie, cesarean delivery) is not possible. Therefore, solid foods should be avoided in laboring patients.
Over the past 60 years, the incidence of maternal death because of aspiration has decreased dramatically. Contributing to this decrease have been hospital policies and strategies to reduce maternal gastric volume and increase gastric pH and improvements in obstetric anesthesia practice. This has led to questions about the utility of very restrictive oral intake policies in laboring patients and calls to liberalize these policies in low-risk patients.
There is insufficient evidence to draw conclusions about the relationship between fasting times for clear liquids and the risk of emesis or reflux or both or pulmonary aspiration during labor. Although there is some disagreement, most experts agree that oral intake of clear liquids during labor does not increase maternal complications.
The oral intake of modest amounts of clear liquids may be allowed for patients with uncomplicated labor. The patient without complications undergoing elective cesarean delivery may have modest amounts of clear liquids up to 2 hours before induction of anesthesia. Examples of clear liquids include, but are not limited to, water, fruit juices without pulp, carbonated beverages, clear tea, black coffee, and sports drinks. Particulate containing fluids should be avoided. Patients with risk factors for aspiration (eg, morbid obesity, diabetes, and difficult airway), or patients at increased risk for operative delivery may require further restrictions of oral intake, determined on a case-by-case basis.
There is insufficient evidence to address the safety of any particular fasting period for solids in obstetric patients. Expert opinion supports that patients undergoing either elective cesarean delivery or elective postpartum tubal ligation should undergo a fasting period of 6–8 hours. Adherence to a predetermined fasting period before nonelective surgical procedures (ie, cesarean delivery) is not possible. Therefore, solid foods should be avoided in laboring patients.”
***************************
Personally experience: I was weak and shaky from having slept no more than an hour or two at a stretch for ~3wks, when I came in for a scheduled induction @43wk. My OB and CNM ok’d lunch and snacks while we waited for me to dilate enough to go to the delivery suite, on the basis that risks from fatigue and low blood sugar outweighed risks of aspiration in an otherwise low risk delivery situation. YMMV.
My gut feeling is that forbidding food and water in case of a C-section becomes a self-fulfilling prophecy, because it seems like not letting you drink or eat for hours of physical exertion would mess up your body to the point where labor wouldn’t go right and a C-section would become necessary. But I am not a doctor and haven’t done research on this. I’d be really curious to know if I’m right – if there’s a study showing whether it makes a difference whether you are allowed to eat and drink during labor. Seems like the studies quoted above basically say no one has good evidence either way.
Also, how likely is it that having eaten will cause serious problems if they do do a C-section? I honestly don’t know. If its really that serious of a risk, maybe they’re right. But I’m suspicious.
I’m terrified of the idea of being told I can’t have water or food, and being put in the position of having to decide between letting myself be weakened by not drinking, or potentially getting in trouble with the hospital. I’ve read stories where women’s babies were taken away because they “endangered” them by refusing to follow the doctor’s advice during labor. Realistically its unlikely I’d be in any real trouble since they probably only get away with that with marginalized groups, but still, its a scary thought that that can happen to anyone. And I hate getting scolded or feeling like I’m doing something wrong, but both options here seem wrong.
FWIW, I could drink any clear fluids (juices, gatorade, water) that I wanted during labor. I wasn’t allowed to eat, but I really didn’t feel like eating anyway.
I still think that the policy needs revisiting and that it should be a conversation about risks and benefits between doctor/midwife and patient.
chava- Yeah, the morbidity question is an excellent one, and I’d be very interested in an answer to that- on how well long-term hospital birthed babies do vs. those born at home. Anecdote time: my sister had her first child at a hospital. And while her delivery was uneventful, the baby developed aspiration pneumonia and needed an extra week in the hospital; a couple of years later, he was struck with some pretty severe allergies and asthma. Did the pneumonia make him susceptible to his later breathing issues? I have no clue as to how preventable the pneumonia was, either. But I can definitely see how there can be connection between how your born and later in life health.
Overheard at the hospital today: “Delivery suite is bedlam, it’s so manic, some of the midwives are in tears”.
If it’s that bad for the staff, it’s probably not great for the mothers or babies either. Another reason why some women may prefer homebirths.
Safiya- In addition to being profoundly unpleasant, that doesn’t sound like a particularly safe environment in which to give birth, either.
Olympia – Precisely. Yet in “austerity Britain”, it’s all about cuts to public funding. Maternity services have never got the funding they deserve and it’s going to get worse.
This is a feminist and social justice issue for so many reasons. Hence my impatience with the way women’s dissatisfaction with birth services is being painted.
Ding, ding, ding!
Dehydation is a very real issue for laboring patients, and putting an IV in place to try and deal with it is still not the optimal solution (guess what, an IV can and will also hamper movement during the laboring process.) In general, the scaremongering of just in case you need a c-section can feel like a self fulfilling prophecy for pregnant patients. And in flies in the face of actual statistics regarding how frequently sections become a necessary outcome, especially for low risk patients.
Oh, and that preterm labor experience I had at 30 weeks never even turned into a birthing situation. Labor was halted and I went on to have an uncomplicated VBAC2 delivery at 38 weeks. So all of that time spent NPO was for nothing, except to make me thirsty, weak and exhausted.
Treebeard – you can find out from your doctor or midwife before hand whether you’ll be allowed to have fluids at the hospital where you’ll be delivering. I think it’s becoming more common to allow at least water.
The risk is that with general anesthetic, stomach contents can travel up the throat and into the lungs. But the thing is – most C-sections are done with local anesthetic (epidural). General anesthetic is only required if the epidural doesn’t work, if there is no time to place one, or if there’s some reason the patient can’t have an epidural. So I think the risk would be pretty small – especially when there is already an epidural placed and working. Also, clear fluids are less of a risk because they clear the stomach faster than solid foods.
There have been scientific studies on the effect of oral food and hydration during labor and they show that it has NO impact on labor. So there’s no demonstrable benefit and a small, but very real risk of death from aspiration pneumonitis.
Talk about missing the forest for the trees. I’m talking about babies dying and you’re talking about feeling hungry.
Babies are dying at a much higher rate at homebirth and not only are homebirth advocates ignoring that fact (which was demonstrated by one of your own actually crunching the numbers), but no one seems even remotely concerned that this is happening or that women are not being told the truth about the risks.
How can anyone claim to be educated about homebirth when they don’t know that it increases the risk of perinatal and neonatal death?
For the record, I’m not a “home birth advocate.” I think home births can be a viable option, but only if done intelligently. But apparently, to an extremist, that’s being an “advocate.”
I can’t speak for others, Dr Amy, but I was already aware of the statistics. I’ve looked at the various numbers before, including the ones that show second births with a medical professional are comparable to hospital births (which, by the way, is the situation in which my wife and I opted for a home birth for our second kid). Just because people don’t lockstep behind you doesn’t mean they’re uninformed. Just that they interpret the data, and consider the risks, differently than you do.
THINK OF THE CHILDREN!
Seriously, Amy. No-one has denied that Oregon-style homebirth with a CPM is dubious at best, in terms of safety. Try not to denigrate being denied food and water for (potentially) days as “being hungry.”
Still, the doubled! risk! you describe for a proper cnm attended homebirth is a jump from a small risk…to a slightly less small risk, potentially with lower morbidity.
I have migraines w/aura. Taking oral contraceptives doubles my stroke risk….from a tiny number….to another tiny number. My gyn and neuro docs thought it acceptable.
For normal births in New Zealand the advice is to drink fluids and eat light easily digestible foods if you feel like it.
It seems like putting the cart before the horse – if you come from the standpoint that the c-section is likely then you will recommend fasting. That means a risk of dehydration, ketosis etc and there you have your cascade of interventions.
It seems that if you expect a normal birth you are more likely to achieve it.
Safiya- I believe more austerity measures are coming, for all countries. I don’t think it’s all about politics- the resources that help run hospitals (among other facilities) are simply not renewable, or renewable enough. This is something that discourages me about those who discourage/wish to ban home birth- they aren’t willing to admit that the things that give hospitals an advantage, so far as birth goes, are dependent upon resources that can’t be counted on long-term. It’s not hard for me to imagine a future in which the hospitals that are in business are shakily staffed and supplied with insufficient amounts of the drugs and surgical supplies we’ve gotten used to using during birth. Would this place be a safer place to give birth than the home? And yet it would be the only place you could give birth, according to some.
The vast majority of homebirths are attended by non-CNM midwives with a much higher death rate.
Regardless of whether it is double or 7 times higher the fact remains that none of the homebirth advocates commenting here were aware of it. Why not? Because professional homebirth advocates are not giving accurate information and without accurate information, you cannot be “educated.”
It’s your right to decide that exposing your baby to double the risk of death or even 7 times the risk of death is an acceptable risk to you. That’s entirely different, however, from declaring that homebirth is “as safe or safer than hospital birth.”
Michelle Goldberg’s piece was on the mark. She wrote about the fact that women who choose homebirth don’t understand the risks and that women who lose babies as a result are outraged that they were not informed of the increased risk of death.
The idea that telling the truth is somehow “anti-feminist” is mind boggling to me. Are women incapable of understanding the truth? Are they incapable of making decisions based on the truth?
What is feminist about lying to women in order to pretend to be a midwife and make money without bothering to get a degree? I realize that this is part of the homebirth propaganda, but really, isn’t that obvious and can’t homebirth advocates see through it?
In case anyone’s interested this report just came out in New Zealand. Crunching the numbers isn’t my strength but maybe someone else might like to? It’s the Sixth Annual Report of the Perinatal and Maternal Mortality Review Committee.
http://www.hqsc.govt.nz/assets/PMMRC/Publications/PMMRC-6th-Report-2010-Lkd.pdf
Well, you know, apparently, saying “Women who choose home birth are not anti-science idiots who care little for the lives of their babies, but are basing their decisions about what kinds of risks they’re willing to run on a number of factors” makes you some kind of nutty home-birthing advocate, or something.
You were already aware of the statistics? Then why did you write in your first comment that homebirth is “perfectly safe.”
You’ve just seen for yourself that homebirth with a CNM has double the risk of neonatal death compared to comparable risk hospital birth.
“Second births … are comparable to hospital births.”
Not in the US, they’re not.
You appear to be referring to The Birthplace Study, but the study, performed by a branch of the government that is trying to save money by promoting homebirth, has far more stringent elibility criteria than homebirth in the UK actually does, let alone homebirth in the US, which has no eligibility criteria at all.
It’s true that the absolute risk of death at homebirth with a CNM is low, but then the absolute risk of death for a baby not strapped into a carseat is even lower, but most people would never consider not strapping a baby to be acceptable simply because the absolute risk is low.
Even though the absolute risk is low, consider that half the babies who died at a CNM attended homebirth would have been saved in the hospital. Is a “birth experience” really worth that risk?
treebeard, I know that other people have emergency surgery after having eaten a meal – maybe even a really BIG meal, and doctors don’t just let them die. Friend of mine, an OR nurse, said the no eating/drinking during labor is just in case an EMERGENCY c-section is performed, and the woman has to be anesthetized fully. Because there’s less chance of her aspirating into her mask. As my friend said, “Anesthesiologists know how to compensate for people who have eaten before emergency surgery. That’s part of their education, y’know.”
As far as eating, by the time labor is going strong, you likely would not feel like eating, anyway. But sips of water really tasted good going down. By transition, I puked a lot anyway, but water comes up with a lot less discomfort than stomach bile.
For the record, I was already aware that the absolute risk was slightly higher as well. Wouldn’t call myself a “homebirth advocate.” To be fair, I have the advantage of being married to an MD/PhD with the PhD in statistics. So we relied mainly on the actual studies and some of the meta-analysis rather than the news media/propaganda.
Regardless, Amy–can you knock off the scare quotes you use around “educated”? It’s that kind of condescension–you can’t possibly know squat without an MD–that turns people off to your *valid* points about the issues with unsafe home birth.
Well, that wasn’t an absolute statement. But I guess you preferred to edit it down to maintain your “advocate” strawman.
Uh, no, I’m referring to the CDC data, as I made quite clear. Yet again, like your “actual results” question, you seem unable to deal with data from your own source that doesn’t agree with your bias.
In our estimation, given statistical data, our local OB/GYN, our local conditions, prior birth experience, the CNM we’ve found, etc… yes.
Sorry that makes us only “educated.”
Exactly. Also, this:
is almost indistinguishable from anti-choice propaganda. I think it’s a good illustration of how all these reproductive issues are intimately connected. Some people actually do seem to believe–or are incapable of figuring out that they sound like they believe–that women are worth less than shit, and there’s no limit to the things you should do to a woman to get a live baby out of her. And I think this attitude is absolutely connected with the US’s maternal mortality rate. This trend of dismissing women’s fears of becoming a helpless object as ignorance or selfishness or new-age nonsense or what have you is deeply discouraging.
No, actually, you’re technically talking about a complication that could potentially befall the mother, not the (dead) baby.
If anyone is confusing trees and forests, it’s you, Dr. Tuteur.
But go ahead, flog us all with the dead baby card. It makes you feel more righteous, and that’s all that really matters. And screw laboring patients, they’re all just a bunch of whiners and complainers anyway.
Also, let me tell you, those studies can kiss my ass, because I know how my body responds to being hungry and tired. I know very well that if I go more than four hours without eating I become tired, cranky, and unhappy, and that if I go on without eating, I become nauseated, dizzy, light-headed, exhausted, weak, and physically unbalanced. This affects my ability to walk across the room without bumping into objects and walls. Don’t tell me it won’t affect my labor.
Hey EG, don’t worry your pretty head about that, just let the nice doctors get that baby out for you./snark
+1 to that. I have exactly the same response to fasting.
EG–well, it probably won’t if you’re immobilized, numbed, and semi-conscious, which seems to be the model Tuteur is fighting for.
Christ. Minimizing the effect of a laboring woman not eating, saying it’s just a minor discomfort instead of something that could very well affect the whole birth process- and if you do eat, well, the baby! No mention of what aspiration could do to the person who’s actually aspirating- what the fuck is that? I’d call that very much not seeing the forest for the trees.
Right.
What’s even more maddening is that the potential for aspiration only presents when a patient is undergoing a c-section, and the pneumonia will not make itself known until post-delivery. So we’re not even talking about a complication that will cause the patient to crash on the table. Furthermore, none of these complications have anything to do with the fetus/baby, nor will they harm or cause the death of that fetus/baby.
Talk about basic logical fail.
I usually have that response to fasting, too, and when I was pregnant I ate constantly…but during labor I felt zero desire to eat. It’s really one of those things where you have no idea how you’ll react until you’re experiencing it.
Gomi,
As you know from crunching the numbers, the CDC data does not show that homebirth with a CNM for a second child (or any subsequent child) is as safe as comparable risk hospital birth. The death rate at home is over 60% higher.
If you and your wife want to take that risk, go right ahead, but please don’t pretend that homebirth is as safe as hospital birth or “perfectly safe,” because it isn’t.
And as long as women are unaware of the additional risk, they are not “educated” about homebirth.
Interestingly, the women who are truly educated about childbirth, women obstetricians, pediatricians and anesthesiologists among others, are not claiming that homebirth is safe and are not choosing it for themselves. The idea that women can “educate” themselves by reading the fabrications of lay people like Ina May Gaskin (who lost one of her own children at homebirth) or Henci Goer who has no training in midwifery, obstetrics or statistics, is simply ludicrous.
Homebirth, like natural childbirth, is an affectation of Western, white women who are relatively well off. Homebirth is a fringe practice; 99+% of American women aren’t willing to take the additional risk.
Sounds bad, doesn’t it? Of course, that “60% higher” is less than one extra death for every 10,000 births.
Well, we “educated” ourselves through government statistics and consultation with a doctor, along with other materials. Or maybe it’s that people are only “educated,” with scare quotes, when they don’t reach the conclusion you want them to?
Lolagirl- I was trying to think up a scenario in which eating during labor was more dangerous to the baby than to the woman, or even dangerous at all to the baby, but logic wouldn’t cooperate. :) Dr. Teuter comes across as dangerously one track. She really hurts her case.
Obviously the danger is to the mother. Who else would aspirate the food in the mother’s stomach. Certainly not the baby.
Obviously, which is why you were so full of consternation for the poor dying babies.
I know, I’m beating a dead horse at this point.
Just admit it, you threw out the spector of dying babies in your passionate attempt to shut down or at least derail the debate. Mentioning dying and dead babies is supposed to act as some sort of trump card and stop everyone in their tracks. The same sort tactic gets used all the time for patients in L&D wards all over the the U.S. to get them to do things that have nothing to do with evidence based medicine or preventing dead babies.
Personally, I can’t imagine why anybody would be at all wary of a hospital birth after hearing from Dr. Amy. Why, the promise of being seen and attended to by somebody with such a wealth of respect for my concerns and experiences would be a positive inducement. After reading her posts, I feel really secure that doctors in L&D wards will treat me like a thoughtful human being and respect my agency; why, I can’t see any reason to think that they would be condescending, arrogant, self-righteous assholes in the slightest.
I’m not even really an advocate for homebirthing, I’ve never had one myself, but I definitely understand what motivates so many of the people who do opt for them. Dr. Amy does absolutely nothing for own cause save but turning people off with her over the top, alarmist, and borderline dishonest use of dead baby rhetoric as a cudgel to silence her opponents. Condescending to and insulting others, not the way to win an honest debate.
From what I’ve read, there was a time when Dr Amy did try to honestly debate (real) home birth advocates. But, at some point, she stopped, closed her ears and resorted to tracking down every discussion of home birth around the web (why she showed up here), to bludgeon people with selective numbers and fear rhetoric.
This. High blood sugar that I’m managing and which has stayed level (and below diabetes level) pretty much all my life, but I couldn’t go half as long as the average labour without eating, without getting weak and, oh, wait! Potentially endangering the baby! Jesus.
I’ve witnessed Dr. Amy trolling the internets for close to 10 years now, and in that time she’s always been ott and shrill in pushing her point. It’s not just homebirthing that she goes after either, unmedicated birth is another one of her hobby horses, and she uses the exact same tactics in attacking anyone she views as an opponent. It’s like she’s the Rush Limbaugh of Ob/Gyns.
What a horrifying image, Lolagirl.
dr. amy’s inflammatory & counterproductive rhetoric aside, i do think this discussion serves as an interesting examination of how we evaluate risk.
for example, gobi wrote:
i realize that childbirth is one of the most inherently intimate, personal and emotionally fraught experiences we go through; i know, i’ve been through it.
looking at situations that are less loaded, let’s examine, for example, airplane travel.
in 1990, 39 airline travelers out of 500,000,000 died in crashes. that is a mortality rate of .00078 deaths out of every 10,000 (to translate it to the terms that gobi used).
now, if the news came out that FlyByTheSeatofYourPants Airlines had a flight safety record that resulted in 60% more deaths than the industry average, would you by a ticket on that airline? what if they offered the equivalent of a first class travel experience for a fraction of the cost that other airlines charged? after all that is 1/1000 of 1 additional death for every 10,000 travelers. there’s no right or wrong answer; just framing it this way to offer perspective.
my guess is that the FAA would shut that airline down and/or the court of public opinion would drive them to change their ways. would that be justified? it’s hard to say, but that’s one metric we could use as a comparison.
NOTE: I AM NOT SAYING HOMEBIRTHS SHOULD BE MADE ILLEGAL. i’m saying let’s look at other activities and the risks we willingly take (or or not willing to take) and compare numbers.
EG posted this:
okay, for the sake of argument, let’s work with 1% as the standard pre-modern medicine mortality rate inherent in childbirth that we, the human species, have been living with for several hundred thousand years. of course, there’s no way of knowing what our hunter/gatherer ancestors actually experienced as a mortality rate, but it’s not unreasonable to assume that they had any more success than pre-industrial europe.
what if one airplane out of 100 fell out of the sky and crashed? would we consider air travel to be safe? what if a certain automobile make and model had a problem where 1 out of every 100 cars manufactured experienced brake failure at highway speeds?
would we consider that safe? absolutely not! a 1% failure rate, when it comes to issues of mortality, is absolutely considered unacceptable for the population at large. obviously, people choose to climb mt. everest, knowing the mortality rate is 25%, but nobody considers that to be a safe activity. and that’s the thing about childbirth – and this isn’t about homebirth vs. medicalized birth – but the process of human childbirth, is statistically very unsafe, by any measure.
which is brings me to the real point of this post, and what is a pet peeve of mine: when child-birth proponents make the statement that ‘women’s bodies are perfectly designed for childbirth’. now, i don’t believe anyone has said that here on this thread, but: i have heard it so many times from women i know in the off-line real world. then again, i live in oregon, which is the home of the famed “oregon-style homebirths” decried upthread, so draw your own conclusions.
human beings are not perfectly designed for childbirth. first of all, we are not designed for anything, we evolved same as every other organism on earth. and just like all organisms, we are well adapted for some activities and not well adapted for others. and childbirth is actually one activity for which we are extremely poorly adapted – arguably the worst of any mammal on earth. the determining factors are first, our ability walk upright, and second, our ridiculously large frontal lobes (which fortunately allow us to do things like develop medicalized childbirth which raises the survival rate).
the shorter version is: our pelvises are too small and our heads are too big. we have managed to survive childbirth enough times, under those parameters, to be able to perpetuate the species. we’ve even adapted to those physical constraints by bearing our young only partially matured – relative to other primates. but our mortality rate is still off the charts compared to not just other mammals but other primates. (from what i read in the national geographic, if that is considered a valid source)
this doesn’t mean that homebirth isn’t safe for low-risk pregnancies, especially second or later births. but it does mean (IMHO) that any woman who bases her decision to have a homebirth on the premise that “our bodies are perfectly designed for childbirth” – and i know plenty of women who are – is not making an informed decision.
it doesn’t change any statistic in the world, and many women may choose homebirth based on the premise of “our pelvises are too small and our heads are too big for this to be relatively safe.” but it really bothers me how many women i know who don’t. and the accuracy fundamental premise under which we approach the decision – is this process inherently statistically safe or not – is crucial.
It’s Gomi, by the way. Japanese for “junk,” rather than Gobi, the desert.
Anyway, let’s compare it to automobile fatalities, because we all tend to drive a lot more than we fly.
In the US, we usually have around 21 to 22 yearly fatalities, for every 100,000 registered drivers.
Statistically, for every 100,000 hospital births of a second or later child with a CNM, there are 30 infant deaths, within the narrow demographic used above. That’s more than there are car fatalities. With a doctor, there are 55 deaths. With a CNM in a home birth, there are 48 deaths.
And those fatality numbers are worse, across the board, with first child, as well.
By those numbers, we just shouldn’t have children in the first place, as they’re all more likely to die at birth than we are likely to die while driving in any given year.
Yes, 48 deaths are higher than 30 deaths (though lower than 55). But they’re all riskier than driving.
You’re right, though. How we perceive risk is an important part of this debate. The metrics we use to determine risk, and the qualities we use to balance it, are central to the home birth discussion. Regardless of Dr Amy’s vitriol, plenty of people look at these basic statistics and interpret them differently. It’s not as simple as “ZOMG, DED BABIEZ!”
No, most homebirth advocates have never seen these statistics. They’ve never seen the CDC statistics that show homebirth with a non-CNM has a neonatal mortality rate 600% higher than comparable risk hospital birth. They’ve certainly never seen the 2010 Colorado homebirth statistics because the midwives there tried to hide them (in violation of Colorado law) and we had to file a Colorado Open Records Request to get them.
Moreover, no one knows how many of the 24,000 babies in the MANA database died at the hands of CPMs, because MANA refuses to release that number.
The entire point of Michelle Goldberg’s piece is that homebirth is far more dangerous than women realize, because professional homebirth advocates hide the truth.
In all 266 previous comments, no one has had the courage to admit that they had no idea that these are the real mortality statistics. Indeed, almost everyone but Gomi refuses to even acknowledge that homebirth does increase the rate of neonatal death.
My point, which is entirely unrebutted by the numerous ad hominems flung at me, is that if you don’t know these numbers, you aren’t educated. All the efforts to change the subject and talk about everything else merely confirms the fundamental lack of knowledge of homebirth advocates.
There are so many flat out falsehoods in this thread that it would be impossible to address them all, but I can say with a great deal of assurance that almost everything the commentors here think they “know” about childbirth is factually false.
It’s a conceit of the homebirth movement that adherents are educated. They’re not; they’re simply indoctrinated with falsehoods that they repeat over an over to each other in the echo chamber that is the homebirth blogosphere until they think they are true.
The greatest canard, which, of course, has been cheerfully repeated here is that modern obstetrics is not based on scientific evidence. The claim is ludicrous on its face and the fact that so many homebirth advocates repeat it is merely confirmation that they are not “educated” about the scientific evidence.
We are supposed to believe that obstetricians (with 8 years of higher education, extensive study of science and statistics, and four additional years of hands on experience caring for pregnant women), the people who actually DO the research that represents the corpus of scientific evidence, are ignoring their own findings while homebirth midwives (generally high school graduates with no background in college science or statistics, let alone advanced study of these subjects, and limited experience of caring for pregnant women), the people who NEVER do scientific research, are assiduously scouring the scientific literature, reading the main obstetric journals each month, and changing their practice based on the latest scientific evidence.
See what I mean? Ludicrous on it’s face.
Do yourselves a favor and read the scientific evidence. If you have trouble interpreting it, get help. Don’t take the word of lay people like Henci Goer and Ina May Gaskin. Your baby’s life may depend on it.
And you’ve refused to acknowledge that you cherry-pick very specific and narrow sets of statistics to make it appear as absolutely bad as possible, followed by fear rhetoric and insults to peoples’ intelligence.
You portray a home birth as something akin to drinking Drano, when the relative comparison of the absolute risk (if you have trouble interpreting that, get help) is statistically quite narrow.
…and yet, you act as if it were an epidemic. In any case, WOC and poor women are in fact MORE likely to not get needed or desired interventions (c-sec included), pain meds, etc.
Then what on earth are you so steamed up about? Clearly your work is done.
No, my statistics are not cherry picked. The are THE statistics. You crunched the CDC numbers yourself and found what I found. Feel free to look at the statistics from Colorado or California. Feel free to count the number of homebirth deaths and complaints in the states that keep records of homebirth. At this very moment, fully 28% of Oregon homebirth midwives are under investigation for homebirth disasters. Feel free to check it out and correct me if I am wrong.
The fact that you’ve been unable to offer any other statistics merely confirms that these are the statistics, and no amount of shouting “cherry-picking” changes that.
Listen, I am happy to agree that if complete information about the relative risks of home births is not available to pregnant parents then that’s wrong and needs to be rectified. However, throwing around “stats” like 60% riskier is only useful if the context is given. As Gomi said, the over all risk is still small. Otherwise, you’re just scaremongering. How about this analogy. I am using a BC pill that also treats high androgen symptoms since I want to control my acne. It has double the risk of blot clots as the standard 4th gen BC pill. I chose to take it nonetheless since the overall risk is still tiny and I prefer not to have to deal with cysts, scarring etc from the acne. I have weighed up the risks and other factors and made my choice.
By the way, RANZCOG also says home births are three times riskier. This info is freely available in NZ. Yet a small number of NZ parents still chose to birth at home. Why? Because the overall risk is still tiny and so they weigh up a myriad of factors and reach their decision.
Y’know, as much as you throw around claims of authority to try and silence your critics, I don’t think you really understand large set statistics or how to analyze multi-factor data sets.
Sticking your fingers in your ears and yelling “ninny ninny poo poo” doesn’t really prove anything.
You narrowed your set of data to pull a very specific outcome of statistics. And then you picked very specific groupings of those statistics for comparison to find the greater difference. That you don’t realize how you’re using that data set, and how it isn’t a simple proof, reveals a lot about your “education” on these things.
(Such condescension sucks, don’t it?)
Plenty of doctors do things that are neither standard of care nor evidence based medicine, in large part because they want to know that they went above and beyond should a lawsuit arise. Sometimes they even opt to do things that may up certain risk factors hoping that it will balance out by again engaging in cya medicine. The earlier example I gave of the use of internal fetal monitoring in GBH+ patients is just one example. Even with IV antibiotics, there is still an increased risk of postpartum uterine infection from the internal monitoring.
How do I possibly know what I’m talking about? Because I’ve seen first hand doctors lose malpractice suits for just these sorts of scenarios.
But of course medical school and residency is like an impregnable shield for all doctors so that they never, ever make mistakes, or miss problems, or operate from a defensive standpoint.
I’m not worried about being hungry or thirsty, I’m worried about having the fuel and energy to do all that physical labor efficiently so the baby gets pushed out on time and safely. I assume if you’re only in labor for an hour or two it doesn’t really matter, but some labors go more than a day, and it seems insane to be dehydrated during all that work. I also imagine no one wants to eat a steak dinner during this. We’re probably mostly talking about water, juice, and maybe some sort of smoothie tops.
I mean, yes, if aspiration is really going to kill me, I’d like to avoid that. But I am suspicious of that logic. I don’t go around fasting whenever I take a road trip because I might be in a car accident and might end up in emergency surgery. Doctors have to be able to deal with emergency surgery under all sorts of circumstances and I doubt they just give up on people who have eaten that day.
That’s pretty much my attitude. People eat. Do your damn job anyway, anesthesiologists.
The aspiration thing is a myth. Medical professionals currently in the field, as opposed to internet trolls, are rejecting it, c.f. http://www.webmd.com/baby/news/20100120/eating-drinking-may-be-ok-during-labor (for the interviews–and follow along to the actual research if you’re so inclined).
Like much of the other “medical advice”, this boils down to “I’m the doctor, dammit! Make things easy for me or else!”
Interestingly, the mortality rate for births outside a hospital attended by an MD are 15 times higher than those outside a hospital attended by a CNM. Guess we better lock all the doctors inside, they’re killing everyone when we let them out!
Ah, statistics applied with no knowledge of the context.
Construing the data on neonatal mortality so narrowly, and ignoring morbidity and maternal outcomes, also smacks of propaganda. It reminds of suburbanites who crow about how cities are so dangerous because of crime stats, but ignore that if you look at *all* risk factors and control for socioeconomic factors, it’s much safer to live in the city than the ‘burbs (largely because you have to do way more driving in the ‘burbs, and you’re orders of magnitude more likely to be killed or maimed in a car wreck than by a mugger or rapist in the big bad city). I know which risk I’ll take!
@trishka (#265) – The stats per airline are readily available. You could have looked them up and found that deaths vary among airlines by *much* more than 60%. In some cases probably because of poor practices and unqualified crew, in others simple because… it’s statistics. There will be anomalies, and distributions that look meaningful but aren’t due simply to chance.
E.g., http://www.airsafe.com/airline.htm
brian, thanks; i didn’t dig that deep into the numbers, obviously.
Interestingly, most birth outside a hospital attended by an MD are in ambulances and cars pulling into the parking lot with emergency cases. They are NOT planned homebirths of comparable risk women, which is the only valid comparison.
It’s not enough to look at statistics. You have to know what they actually mean.
Absolutely classic example of an “educated” homebirth advocate commenting on Andrew Sullivan’s follow up ttoday to Michelle’s piece:
“I found a lay midwife who has attended more than 700 births and never lost a mother and lost only 3 babies. (Find an OB with a similar record and I’ll be shocked.)”
Considering that the CDC statistics (as presented by Gomi above) is 0.3/1000, this midwife has a mortality rate more than 10X higher than expected!
This woman is publicly boasting about her grossly incompetent and dangerous midwife and doesn’t have a clue.
Way to prove Michelle’s central point. Homebirth is far more dangerous than people realize and homebirth advocates have no idea of the real risks.
Whooooosh, over your head. That was exactly the point. You, ma’am, clearly don’t know what they mean, as Gomi has demonstrated thoroughly enough that nobody else really needs to bother.
@dramy
Wow, that’s rich. You might be right; on the other hand, your post immediately after the one quoted says:
and you have no idea of a single aspect of the risk profile of this woman’s clients. Intellectual honesty, your strong suit it is not.
I might be right?
Oh, you think all the dead babies were from high risk clients that the midwife had no business caring for? That’s your defense of the homebirth midwife’s competence?
I’m saying that you can’t pretend to be rigorous one minute, and abandon that rigor for invective the next. It’s dishonest. Yes, you may be right. It’s also entirely possible (we simply have no idea) that this midwife took on some cases she “shouldn’t” have and ended up with no worse outcome than a hospital would have. Maybe two of the three were anencephalic, and all the hospital would have done is butcher the mother to boot. You. Have. No. Idea. That, is the point. We can “what-if” all day but that’s not science.
You can keep trying to shoot the messenger, but that doesn’t change the truth of the message:
Homebirth increases the risk of neonatal death (often dramatically) and homebirth advocates are entirely unaware of it.
If anything, the endless ad hominems and logical fallacies presented in these comments emphasize the point even more strongly than the data. The very homebirth advocates who claim to be “educated” are anything but.
It’s not ad-hom for a person much more qualified than you to point out that your use of statistics is sloppy and disingenuous, and hence your “facts” are nothing of the kind.
Face it, “Dr.” Amy. You weren’t aware of the ongoing work re: food and drink during labor, you weren’t aware of (or choose to ignore) well-designed, contemporary studies looking into home birth in favor of old, questionable ones, you exhibit extreme confirmation bias in your choice of data to evangelize… etc.
Those are the facts. Now here’s the ad-hom. You were trained in the wake of the strap-them-down, knock them out, and shoot them up with thalidomide era, and, like most of us humans, you have a lot of trouble unlearning everything that grounds your worldview as new facts come to light. There’s no shame in that–there is shame in chasing people around the internet pushing 40-year-old discredited pseudo-science (i.e., OB-Gyn practices through most of the 20th century) on them. Might as well rock some phrenology or homeopathy while you’re at it–you are, in fact, exactly that which you hate.
I’m more than happy to have undecided women read this comment thread and decide for themselves who has presented relevant data and who is “evidence resistant.”
In fact, as I’ve said above, I encourage women to read the scientific literature for themselves, and not take the word of other homebirth advocates for what it shows.
Those who make the effort may be very surprised that they don’t need Ina May Gaskin and Henci Goer to “explain” what it shows; they can figure out for themselves that it shows the opposite of what Gaskin and Goer and others like them say it does.
American homebirth is based on pseudoscience and like all pseudoscience it is forced to invoke vast conspiracy theories to explaiin why everyone with real training rejects it.
When patients are pondering a medical issue, they often ask doctors, “What would you recommend if this were your mother, or your sister, oor you?” That’s because they believe that doctors would recommend whatever is best to a loved one, regardless of financial benefit or penalties to themselves.
The same thing applies to childbirth. The women who are really educated about obstetrics, science and statistics are women obstetricians, pediatricians, neonatologists and anesthesiologists. Theey aren’t choosing homebirth and they aren’t telling their loved ones that it is safe. In fact, they utterly reject the claims of homebirth advocates and natural childbirth advocates.
I’ll leave it to individuals to determine what is safer: what those who aree really educated say is safer, or what a bunch of lay people who read Ina May Gaskin and Henci Goer is safer.
Well, at least you’ve dropped the “listen to authorities because you can’t figure it out yourself” angle. That’s progress.
And those doctors that give home birth a green light? Oh, they’re probably only “educated” too, right?
People need to go to the primary sources, and ask medical professionals, I entirely agree. However, I wouldn’t phrase it with so much veiled condescension and obvious bias. There are options for birth, and women should make informed choices about them (and demand the information if it’s not around), regardless of your bullying.
Unsurprisingly, when it becomes clear that your facts aren’t up to date, you have nothing to fall back on but an appeal to authority. The same authorities that still preach debunked pseudo-science like routine cervical exams (which rarely harm, but don’t accomplish anything either), the same authorities that still tell women they’ll die if they eat during childbirth, the same authorities that somehow manage to kill way more babies and mothers than anywhere else in the first world (and more than a lot of places in the third). Some authorities. It’s not a conspiracy–plenty of doctors are fine. The U.S. just happens to have a crap system that encourages crap “treatment” that doesn’t pass muster elsewhere, as others have mentioned.
And the problem is that that’s a bullshit question. The doctor might recommend whatever is best to a loved one, or the doctor might be a neurotic worrier and recommend safety measures that are unnecessary, or the doctor might have seen too many horror stories to be able to contemplate the stats objectively, or the doctor might not be aware of all the issues in the pregnant woman’s life that she is trying to manage.
Isn’t there a reason that it’s a breach of professional ethics to treat one’s own loved ones except in an emergency?
Gomi- Best of luck with the impending arrival!
Dr. Teuter- You do realize how hard you are to take seriously, right? Inferring that eating during labor leads to babies! dying! and than expecting people to just ignore what you said, all the while keeping your condescension completely intact. You need to stop hurting your case.
You do realize that I am not trying to persuade you. After all, I cannot reason people out of a position they did not reason themselves into.
I am writing for the much larger group of women who read and don’t comment; women who may be attracted to homebirth. They’ve been intrigued by the propaganda spouted by people like Ricki Lake, but they want to know the scientific facts.
As I said above, I’m quite comfortable with the persuasiveness of the data and scientific evidence I have offered in this thread, and pretty confident that not many people are going to be impressed or convinced of anything by the endless ad hominems flung at me.
That’s a handy defense when people in this thread have repeatedly shown themselves unpersuaded. Just accuse the unconvinced of being irrational, and claim you weren’t trying to convince them when you posted argument after argument.
I think the data is quite informative and vitally so, just maybe not as inherently persuasive as you think. Also, I’m sure those readers are going to be impressed and convinced by your repeated insults to their intelligence.
my problem is that it doesn’t appear to me that the data is persuasive either way. it appears inconclusive as to what the actual increase risk in perinatal death from homebirth really is.
in order to have an accurate assessment of that, we would first of all need to have all of the perinatal deaths that occurred in hospitals under an MD’s care that started out as planned homebirths get credited to the homebirth with a midwife number. second, we would need all of the perinatal deaths that occurred in hospitals under an MD’s care that were high risk to begin with taken out of the numbers.
then see how the rate of perinatal births between planned homebirths attended by midwives and low-risk hospital births attended by MDs and/or midwives.
and it may well be that the increase in risk is still from a miniscule number to a slightly larger miniscule number, and that many women (and their partners) may feel comfortable with that risk. but until those numbers have been determined, there’s still something of a question mark about the data.
which, if i’m not mistaken, was the point of the OP.
Amy, that’s just about the most entertaining trolling you’ve done yet! You do realize how complete your public humiliation as a complete incompetent at statistics, critical thinking, and general credibility is, don’t you? Anyone who’s reading here for an intelligent interpretation of the available stats is not going to be the LEAST little bit impressed with your arrogance, silly scare quotes, and general failure to apply logic.
On the other hand, Gomi’s and Brian’s parsing of the data actually adheres to the scientific method. Maybe you should spend a little of your time actually getting familiar with that rather foundational principle of science instead of making an utter fool of yourself in the presence of folks who actually know how to apply it.
Dr. Teuter- When I see people putting out false connections, peppering their speech with manipulative words, it makes it difficult for me to take anything they say seriously. So, seriously. Being *educated* doesn’t mean you know enough.
82 posts until Lauredhel turned up!
I find a lot of the pro-homebirth crowd ableist, as there is a strong “you should want to do childbirth without pain relief” element. As someone with a chronic pain condition, I need hospital and the medicalisation it provides. I am sick of being shamed for admitting, yes, actually I do want pain relief.
Ah, I’m really sorry Lauredhel. I let my own issues cloud my judgment. I’m very sorry for what I said. It was untrue and selfish. I hope you don’t let my nasty comment get to you.
Apologies
Trishka–not only that, but we’d need to sort through all the confounding factors behind the raw numbers. For instance, using 28 days as the cutoff for perinatal death provides a lot of time for additional confounding factors. For instance, I think it’s safe to say that home birth is usually part of a larger attachment parenting philosophy; that is, home birth moms are more likely to practice attachment parenting. Attachment parenting involves co-sleeping, which is correlated with a higher risk of SIDS. If someone has a home birth and their baby dies of SIDS, is that death blamed on the birth itself–even though a completely separate (although ideologically related) practice caused it?
I have no idea. That’s why just throwing numbers around doesn’t do anyone any good–unless your *only* goal is to scare people into agreeing with you. If reliable raw numbers, produced in an intellectually honest way, suggest that home birth correlates with a statistically significantly higher perinatal mortality rate (something that I’m not convinced of at all after reading Tuteur’s comments on this thread), then it seems to me that the sensible thing to do is to sit down and figure out what’s going on, and how practitioners can work with women to retain the benefits of home birth while eliminating the risk. That’s my understanding of how research works: you work to understand the numbers, rather than shouting, “SHUT IT DOWN! SHUT IT ALL DOWN!”
And I’m not even getting into the very real, very well documented maternal mortality rate at US hospitals, which is through the roof and definitely can’t be blamed on those hippy-dippy granola munchin’ midwives.
CynicalFatty: Do I know you? Is there some reason you wished to snark at me in the first place?
I’m not “pro-homebirth”, I’m pro-choice, and I see homebirth availability activism as part of the spectrum of pro-choice activism. If you think that people should be literally forced into hospitals (because that’s what it comes to, when push comes to shove) just because there’s a fetus inside a contracting uterus, that’s not a feminist position.
Ableism? Because I fight for the recognition of post-birth PTSD? Because I think birthing centres and homebirth midwifery shouldn’t so heavily controlled that they are made to “risk out” people with disabilities (also people who are deemed too young, too old, too fat, too thin, too etc)?
I think supported homebirth availability and the non-criminalisation of people who participate in it is incredibly important from a feminist point of view. “Fetal homicide/endangerment” shit is everywhere. We’re looking at homes treated as crime scenes, people forced into surgery against their will, people reported to child protection services.
Never, ever, ever have I argued that pregnant people should be denied access to hospitals or to pain relief. I argue for supported choices and full information. That’s it.
I wish I had discovered this conversation earlier, because I have a lot to say. I have been a childbirth educator and breastfeeding counselor. I have four daughters. . One was delivered by an OB who I hardly ever saw at New York Hospital in 1973. In 1975 barely made it to Roosevelt Hospital in NYC for a nurse midwife to catch the baby who was born after a labor under 2 hours and 2 pushes. (That’s my Liz; it had nothing to do with me)
We considered a birthing center, but it was about an hour away. In 1978 my third baby, 10 lbs. 4 oz. was born at home, caught by a superb nurse-midwife who stayed for the whole labor. She had admitting privileges at Lenox Hill Hospital and I had one appt. with her backup OB. In 1982 my fourth was born at home when we lived in Maine. She was caught by a wonderful family physician.
New York Hospital was horrible. I hardly saw my OB. The staff jeered at my commitment to drug free childbirth. I was told to come in when my water’s broke, and I wasn’t truly in labor. They gave me pitocin, actually telling me it was chic lets. When the labor got much harder, they rejoiced in my pain. They reneged on their promise of rooming in. So did Roosevelt.
OBs have waged war on nurse-midwives. In 1975 Roosevelt innovated care by nurse midwives. I am not sure they still have it.
My parents, aunts, and uncles were born at home. My English husband was born at home. There was a very active home birth movement in the late 70s and 80s. Of course OBs want women to deliver in hospitals where 33% of them will have C sections.
Almost all the parents who practice co-sleeping in both my generation and my daughters’ generation lie to their disapproving pediatricians about it (even therapists do), so all the data is about people naive enough not to lie.
Wow, I understand now that a home birth with a truely low risk woman (not a first time mom- someone with previous low risk easy deliveries, no twins, no breech, no GBS, no GDM, no post dates, no IUGR, no low fluid, no AMA, etc), with a CNM!, with a great transfer plan and OB backup has a slighter than higher risk of neonate death than a hospital birth. If someone fits that description and wants to try homebirth, Godspeed. But most homebirth midwifes in USA are CPM and DEM that readily take on high risk clients with breech, twins, etc. they use garlic for GBS. Homebirth in America IS what homebirth in America DOES. We cannot compare homebirth in America with NZ, UK, or the Netherlands, because they use CNM only. So Gomi is right when he argues that with a CNM at home in a low risk patient the risk is there but small. And Dr. Amy is right in that most of homebirths in America at at a higher risk as they are actually practiced. I hear all the time that homebirth is as safe or safer than hospital birth from homebirth advocates. I guess the evidence and this blog discussion has actually denounced that quote. Even with CNM, there is slighter higher risk, and as it is practiced in America, much much higher risk. The CPM and DEM hate to transfer because they lose they client which is 100 % of their income. I understand MANA won’t release their 24,000 homebirth death rates, if they were good, I’m sure they would be out there. Colorado tried to hide their 2010 death rates, but they got released from a court order. And they are bad. I browsed Oregonmidwifeinfo.com and see so many CPMs and DEMs that have poor outcomes but still practice. People attempting homebirth should be aware of these stats. Then make your own choice.
Thank-you for writing about this important issue. I could not agree with you more. I was considering a homebirth after a close friend of mine started planning one, and fortunately I did more research. In retrospect it’s hard to even respond directly to the proponents of homebirth because nearly everything that they say about it – and hospital birth – is false in some way. I guess the best way to summarize what I found is that the practitioners, their teachers, and the founders of the homebirth movement are all way undereducated when it comes to biology/chemistry/anatomy/physiology/medicine. Mix in a big dose of suspicion of doctors and hospitals that for some reason they think anyone with an MD is some kind of a sociopath (??). They muddle badly through the science and their rationales are full of half-truths and confusion. As a Biology major in a past life (lol), I understand how not knowing their subject material might cause them to not even realize how much they don’t know. What scares me, though, is that babies are dying as a direct result of their misinformation and paranoia.
I found the skepticalob.blogspot.com to be a huge source of information. Of course, they are paranoid about her too (a former OB started the site), but what can I say – her references are actually legit, and the entire OBGYN community stands behind her. But the sheer volume of misinformation that the homebirth community puts out can be a bit overwhelming. Some of it is obviously stupid (putting garlic in your vagina to cure Hep B infection, or not getting an ultrasound so you won’t hurt the baby), but a lot of it sounds okay on the surface (less interventions are better for you and your baby). In the latter case, they seem to have completely missed the whole point of why doctors use interventions in the first place…i.e., pitocin, which Ricky Lake portrayed as the devil, speeds up labor. It turns out that long labors or delayed labors (being in labor too long or not going into labor until past your due date) over time increasing the percentage chance that the baby will die. But they never ever talk about that, it’s only about the side effects of the intervention. I’m not even sure if they know why the doctors use the interventions! But that gets back to their education, or lack thereof, and suddenly it all makes sense why they don’t “get” it. They also way overexaggerate the number, prevalence, and significance of side effects of interventions. And that’s just ONE issue that they completely mishandle from an intellectual point of view :(
@EG – I am so tired of this doctors-caused-more deaths-than-midwives-through-puerperal-fever crap that surfaces whenever this subject comes up. Yes, there was a spike when doctors and laying-in wards at hospitals became more popular just because doctors saw more patients than midwives. But midwives also spread germs by not washing their hands and caused their fair share of puerperal fever too. You may be interested to know that it was in fact a midwife who delivered Mary Wollstonecraft – not a doctor.
From Wikipedia: “In Internet slang, a troll is someone who posts inflammatory, or off-topic messages in an online community.” Here’s a perfect example of the misinformation of the homebirth community. Where Dr. Amy comments, she is called a “troll.” Read the definition. Her posts are most certainly not off-topic or inflammatory. They are timely, medically-sound, and informative. But I guess that if you don’t want to hear it, she’s a “troll.” Hmmmm.
Threatened by the information much?
I am also starting to lose a bit of hope. If you have no scientific/medical background, do you think it is possible that you did not fully understand what and why the doctors were doing during your birth? When they explained to you why they were giving you Pitocin or recommending a C-section, and knowing that you have no scientific/medical background, why did you automatically assume that they were lying to you? How many times have I heard, “my doctor was playing the dead baby card when he [recommended X intervention]“? If you have no scientific/medical training, why would you assume that he is lying as opposed to – gee, you have no scientific/medical training?
Perhaps one huge issue is that birth is extremely personal; it’s often out of our control; it’s extremely emotional; the mother we are about to become requires that we adopt a certain amount of self-confidence to “be in charge” to a little person. So perhaps it can be very frustrating when a medical professional doesn’t take as much time as we want them to; tells us to do something that we don’t want to do; treats us condescendingly. A bit of perspective would help. Yes, there are two sides to every story, but one of those sides is extremely well informed and the other is not. OBGYNs are incredibly intelligent, educated, trained people. Starting with excellent undergraduate GPAs and extensive biology/chemistry/anatomy/physiology/physics, high MCAT scores, usually along with extracurricular activities, character references, they then manage to do well in medical school, do their internship, and then have to be accepted into the residency that will be their specialty (not everyone who wants to be an OBGYN gets to specialize in this and become one)….more exams, more supervision, ongoing education, etc. Everything they do existing in close contact with a robust scientific research field using double-blind studies with placebo group and peer review to analyze the best known outcomes for the moment, and constantly advancing their knowledge.
Compare this to the average midwife (certified nurse midwives doing homebirths is uncommon in the US) in America. No college education required. One year of coursework taught by other midwives (easily leading to the blind leading the blind), followed by 2-3 years of internship (“assisting” other homebirths). Ina May Gaskin and Henci Goer, big founder/writers in the movement, don’t even have a single drop of scientific or medical training, and neither one was ever trained as a midwife. Is it any surprise that they don’t know how to analyze the safety statistics of midwifery?
We don’t expect that we can build a rocket ship from scratch without adequate training, why not? There actually is something that people learn in school. If you don’t have the education (scientific or medical background) to analyze good research and make logical sense of it, consider turning to a reputable source such as your doctor to sort it out. Do not turn to random people online who also have no education.
And Ina May’s “reputation” for hippie commune midwife is, um, exactly who she is, minus having any midwifery training. Google search and read a few websites for her biography. The woman did NOT turn to homebirth because she had some insight/inside knowledge about how hospital interventions are bad and should be avoided. She quite simply joined a cult in her early 20s in which authority and the outside was distrusted, grabbed a book on how indiginous women gave birth, and started “assisting” women in giving birth at the cult “Farm.” And she has gotten no formal training since that point; lots of babies have died including her own in the process. Yet she is constantly quoted by midwives as being some sort of expert. If anything that proves how low some people’s bar for an “expert” really is. Truth really is stranger than fiction.
“Certified Professional Midwives
May or may not have a high school diploma
May or may not have attended college
May or may not have attended a MEAC accredited midwifery education program
May have taken a non accredited midwifery correspondence course or attended a non accredited school.
May have only apprenticed under a single midwife
Only required to attend 20 births as an assistant
Only required to attend 20 births in the role of primary midwife before receiving license.
Required to take the NARM exam
Lay/Traditional Midwife
No educational requirements
No license requirements
No certification requirements
No oversight”
Source: http://makemidwiferysafernow.blogspot.com/
This isn’t true – you don’t need to be a nurse to train to be a mid-wife in New Zealand. Midwifery is a stand-alone 4 year qualification – and midwives are licensed by a professional body, much the same way as doctors, lawyers, teachers and nurses are. I think it’s foolish to look at the system in the US and say “midwives need to be trained as nurses”. The US obviously needs a system of properly training and licensing midwives – but that doesn’t mean every midwife needs nursing training.
But also I find the point you are making really frustrating. Because I think all sorts of people, in all sorts of ways have said ‘the structure around home births in the US make home-births higher risk.’
And I think that the feminist response to this should be looking to change the structure around childbirth in the US so homebirth is as safe as it is in other countries. When it comes to our bodies, and sexual and reproductive rights, isn’t feminisms basic motto ‘trust women’ (and all pregnant people)? As lauredhel says, this is about being pro-choice
I also hate the 33% cesarean rate in hospitals. This is the total cesarean rate ( repeat and primary cesareans, elective cesareans, extreme prematurity cesareans, multiple births cesareans)! If a major referral hospital takes on many many high risk patients, their total/overall cesarean rate will be high. In order to compare apples and apples, you need each hospitals primary (attempting labor for a vaginal birth) cesarean rate. Most doctors and hospitals primary cesarean rate is between 14-20%. This is another scare tactic/fear mongering statement the homebirth crowd perpetuates in all their literature.
Also homebirth midwifes in America (CPM and DEM) cannot give an epidural, so they are bad. They cannot do forceps, vacuum, or cesarean, so they are bad or unnecessary. Even science they don’t understand like Rhogam and GBBS, they have unproven treatments. Some don’t even recommend rhogam if you’re Rh -! They use garlic or hibiclens for GBBS. They don’t test for GDM or recommend ultrasounds. Why? Because they don’t believe this is necessary or because if their client risk out for high risk they lose the money they otherwise could get now that they transferred the patient. MD and CNM do primary care annual visits in their offices. OB do procedures, GYN surgery, mEnopause etc. the OB and CNM make money in many ways. There is no turf war for these 1%ers. OB fire non compliant patients every month from their office. Why would they ever be fighting or begging for new noncompliant patients. Why take on that legal risk. But homebirth midwifes spread fear mongering about doctors and hospitals to clients. When in reality they fear losing clients to them.
American homebirth can be overhauled. First abolish CPM, LM, and DEM. make one CNM degree with uniform consistent training. ( how many different forms of OB are there? Answer one. Why so many types of homebirth midwife? The lay public believe a midwife is a midwife. Hell, the government representatives think a midwife is a midwife. Oregon is now being sued for their criteria of licensing CPM and DEM in a homebirth death, because the midwife had no malpractice insurance. License all CNM homebirth midwifes, they need malpractice insurance for accountability. Share hospital priveleges and review boards that could suspend them or put them on a summary suspension until a root cause analysis can be done for any sentinal event. Doctors do this and have accountability, so should homebirth midwifes.
I agree with Captain Obvious that an overall of the current home birth system should be done, to improve the numerous flaws in it. Fixing those flaws would go a long way in making it a better birthing option than it is now.
At the same time, I think there’s a lot that could be done to improve the system of hospital births we have right now too. Improving patient-centric care, but perhaps more importantly, recognizing on a broader scale that the mother, as well as the child, are the patients. Improving the experience for both, while maintaining (or bettering) the level of medical care would also go a long way in making it a better birthing option than it is now. There’s a reason that many women, whether you want to consider them “educated” or not, choose home births over hospital births.
Like I said before, there’s a time for hospital births and a time for home births (and birthing centers, etc in between). Improving all of those options, across the board, would help improve the experience of women in childbirth that seems sadly lacking in this country.
@Maia, only until a few months ago did CPM finally put a high school degree as a prerequisite. Probably due to the increased awareness published by Dr Amy and other licensing boards. How embarrassing is that. Some women hired and paid thousands of dollars to a birth junkie they thought was a government approved expert and they didn’t even have a high school diploma.
Why don’t women say no? I ask myself this all the time because it seems like women of the 70s were more comfortable with saying no.
I am going to trot out a theory that will have everyone mad at me. Confidence that one can disobey, challenge, resist and still be loved is probably developed in toddlerhood. If the young toddler is raised by someone who will love her all her life–parents, grandparents, aunts, uncles, close family friends,–much disobedience is tolerated, even indulged.
But a poorly paid nanny or day care worker, responsible for more children, living a very stressful life, cannot be so indulgent. We are now putting enormous pressure on a second generation of children to adjust to long hours of out-of-home care. Infants in day care can spent 10 hours in a setting that cannot by it very nature be centered on their individual needs.
My brother with 6 kids and I with 4 kids, all of whom have turned out splendidly , are convinced our children would have been diagnosed and medicated. I believe the incredible rise in so-called child mental illness is the result of forcing our children to adapt to an excessively regimented world almost from birth.
Superb day care for infants and toddlers is possible, but it is incredibly expensive. Teachers should be college graduates with a master’s degree in infancy and toddlerhood. If you need to pay the teacher at least 40,000 with full benefits and the teacher,child ratio is one to two or one to three, how can anyone but the most affluent afford it?
On site care at work, subsidized by the company, seems the best approach large companies could take. Mothers would find it much easier to take breaks and lunches nursing their babies than pumping. A hungry baby is so much more efficient than any pump.
I have gotten off the topic, but not really. We have a society where babies and toddlers are compelled to adjust to our inhumane world. They are much better at obedience than children raised by their parents are.
First of all, I don’t believe I said it. I believe that what I said was that maternal death rates in pre-industrial Europe were 1% per birth, and the research I’ve read gives the credit for such a low rate to skilled midwifery. I’ll provide the citations when I get home, if you like, but as I’m out of town right now, I can’t. I think it’s from an article called “Did the Mothers Really Die” by R. Schofield, but it may also be by I. Loudon. I don’t remember for sure. I don’t know what the maternal death-rate was for doctor-attended births in the 19th century, because I haven’t read research on it.
I then said that comparing contemporary home birth to pre-modern birth with respect to safety was completely inappropriate for a number of reasons, including rickets and puerpal fever. Since those two things are no longer major concerns today in the US, what with the germ theory of disease being largely accepted, it’s not a relevant comparison.
No doubt. But midwives were also a lot less likely to be spending their free time messing around with decaying corpses.
As for “fair share”–is that why it was called “The Doctor’s Plague?” Or why even doctors were noticing that women giving birth at home had a much lower incidence of death from childbirth fever than women in maternity wards? I also like how “Hospitals throughout Europe and America consistently reported death rates between 20% to 25% of all women giving birth, punctuated by intermittent epidemics with up to 100% fatalities of women giving birth in childbirth wards[15]” and “From the 1600s through the mid to late 1800s, the majority of childbed fever cases were caused by the doctors themselves” somehow become “there was a spike when doctors and laying-in wards at hospitals became more popular just because doctors saw more patients than midwives.”
Almost 200 years with 20%-100% maternal mortality rate is a hell of a spike, I’d say.
I am indeed interested in knowing almost anything about Wollstonecraft. Thank you.
Homebirth advocate share some of the favorite “arguments” of other pseudosciences. One of these is described by Dr. Richard Dawkins in his recent review of a book about creationism, perhaps the premier pseudoscience in contemporary America:
“Two rival theories, A and B, are set up. Theory A explains loads of facts and is supported by mountains of evidence. Theory B has no supporting evidence, nor is any attempt made to find any. Now a single little fact is discovered, which A allegedly can’t explain. Without even asking whether B can explain it, the default conclusion is fallaciously drawn: B must be correct.Incidentally, further research usually reveals that A can explain the phenomenon after all …”
Homebirth advocates have their own variation:
Two rival approaches, modern obstetrics and homebirth are set up. Modern obstetrics explains loads of facts, is supported by mountains of evidence, and has dramatically reduced both neonatal and maternal mortality rates. Homebirth has virtually no supporting evidence, nor is any attempt made to find any, and is not responsible for any discoveries, devices or procedures that have saved any lives. Now an error in the history of modern obstetrics is discovered. Without even asking whether homebirth advocates understood the error at the time or whether they discovered the solution, the default conclusion is fallaciously drawn: homebirth must be correct.
Take Semmelweis for example. For some strange reason, homebirth advocates think that the story of Semmelweis and puerperal sepsis tells us something about homebirth. The error is that prior to the discovery of the germ theory of disease, doctors spread infections by proceding from autopsies to live patients without washing their hands.
Did homebirth midwives know about hand washing? No.
Did homebirth midwives understand the germ theory of disease. No.
Did homebirth midwives perhaps discover the germ theory of disease and correct the error of the doctors? No.
How did homebirth midwives learn about the germ theory of disease and the importance of handwashing? Doctors told them.
Incidentally, further investigation reveals that this was not an error of modern obstetrics at all. Modern obstetrics did not come into being until after the discovery of the germ theory of disease and after the introduction of anesthesia. So the fact that doctors in the mid 19th century did not wash their hands tells us nothing about anything.
Pointing out a spurious error or even a real error of modern obstetrics tells us nothing about whether the premises of homebirth advocacy are true. Moreover, it tells us nothing about whether homebirth is as safe as contemporary hospital birth. It is yet another form of faulty argument used to support homebirth.
You think 1% is a low death rate? I have seen estimates of the “natural” death rate (ie death rate when the woman has no health service access or skilled help at all) at around 1.5% (eg wiki. The United States national average today is at 0.08%.
1% death rate would be fairly close to the death rate without any intervention at all, and it eludes me how this statistics would show “skilled midwifery”.
That would certainly have been a high spike. Perhaps high enough that the human race would have had trouble surviving. Obviously that was not the general death rate.
Even when considering only hospital births the statistics were better than that. Compare for example Semmelweiss’ statistics collected at Vienna hospital.
You are correct in that the situation in pre-germ-theory hospitals was extremely bad but I am not sure who would dispute that.
Also, there are still a number of comments here, using oddly the same references and style as Dr Amy though they go by different names, who address the entire concept of home births based on one type of midwife. Yes, CNMs are rare for home births, but they do perform them.
Just as there are bad hospitals and bad OBs (regardless of the numerous appeals to blind obedience of authority), there are bad midwives. The proportion might be higher, but that doesn’t negate the fact that, like good hospitals and doctors, there are good midwives.
Rather than make the same bias fallacy as you disparage among “home birth advocates,” you should probably recognize and acknowledge that good examples should be promoted as the potential of the practice.
Home birth isn’t always elective. My county hospital does not deliver babies. We have a (reported) unemployment rate well over 12%, a 13% Hispanic population, many undocumented, and a huge uninsured population. Many rural areas of America have one or more of these challenges. Undocumented lay midwives are out there delivering babies, and we have no way of knowing just what their infant mortality rate might be. Teen and impoverished mothers may not even have a midwife helping them, just their mother or another friend. This bodes ill for infants who can be infected with their mothers’ herpes, or worse. If a hospital closed their ICU, the state probably would close that hospital, but misogyny gives their neglect of mothers and babies a free pass.
Are these maternal mortality figures for home vs hospital adjusted for the higher death rates (27/1000 vs 9/1000) of Caesarians vs vaginal births? If so, the home birth mortality rate would be even higher.
Certain physicians will attend home births if requested, even though they can be investigated and risk their licensure for this.
The problem with flailing about, yelling that ONCE UPON A TIME, MANY MOTHERS AND BABIES DIED IN CHILDBIRTH! GET TO HOSPITAL NOW!” is not that doctors were culpable for higher death rates at a given point in time. Rather, many of the common causes of death in childbirth are/were easily fixed through proper hygiene, nutrition, and fairly low-tech techniques (sutures, fundal massage, oxygen, IV fluids/pit, etc).
Most of these can be taken care of at home. Of course, things will go wrong from time to time. But comparing a well attended (say NZ) homebirth with hospital backup to one in the Middle Ages…yeah, not so much.
Another pseudoscience claim about obstetrics is that deaths are a thing of the past, and that death rates were reduced dramatically through nutrition and basic hygiene. It’s simply made up.
Neonatal and maternal death rates are low ONLY where the interventions of modern obstetrics exist and are used liberally. Most of the leading causes of neonatal and maternal mortality have nothing to do with nutrition or hygiene. These include prematurity, congenital anomalies, hemorrhage, eclampsia and pre-existing maternal medical conditions. Indeed, one of the current most common causes of maternal mortality in the US is peripartum cardiomyopathy. Most US maternal deaths are due to lack of obstetric care, not too much care.
Childbirth is INHERENTLY dangerous. In the absence of modern obstetrics, childbirth would be nearly as dangerous as it was in the Middle Ages. That is reflected by the fact that most babies and women who die of childbirth related death in the US in 2012 die from being deprived of state of the art obstetric care, not, as homebirth advocates like to fantasize, because of too much of it.
Here is an interesting report about the abismal care in the Netherlands. Homebirthers always pull the “homebirth in the Netherlands” card. Do you really understand what homebirth and hospital birth is like in the Netherlands? Dutch feminists are demanding analgesia for labor. Midwifes miss classify 25% of their patients that actually have high risks… Again, home birth IS what homebirth DOES. How you picture your homebirth in your head isn’t how it happens in life majority of the time. For you out there that had it, congrats. Don’t brag and recommend it to the masses. It is too risky.
http://www.ranzcog.edu.au/publications/oandg-magazine/doc_view/762-16-trouble-in-paradise.html
Interesting how you put the emphasis on issues with midwifery while leaving out the points made regarding shortcomings in obstetrics care that were also noted in that article.
If that article is to be believed, the Netherlands and the U.S. have a lot of the same problems. Doctors and midwives sniping and being distrustful and disrespectful of one another, shortcomings with the on-call systems in hospitals leaving patients without care, patients presenting towards the end of their pregnancies without much prenatal care, the list goes on.
Errrm, are you really going to claim that malnutrition and lack of sterile technique didn’t kill a lot of mothers and babies? I don’t disagree that the things you list are significant obstetric problems, but death rates are/were cut dramatically with an understanding of sterile technique and sufficient nutrition.
The problem with the leading cases of death you list is that they (I believe) are taken from countries that already do things like, say, cut the umbilical cord with a sterile blade.
(As far as I know, the leading causes of maternal mortality worldwide are infection, hemorrhage, pre-eclampsia/eclampsia, and unsafe abortion. I don’t know what percentage of those deaths are represented by infection, but I imagine it’s fairly high. )
In fact, according to Loudon in On Maternal and Infant Mortality 1900-1960:
“In most Western countries infant mortality declined more or less steadily from the late nineteenth century (Sweden and the Netherlands) or the early twentieth (Britain). Most of the decline took place in post-neonatal mortality and is generally attributed to improvements in standards of living in general and nutrition in particular. Neonatal rates declined less steeply, and if neonatal deaths were split into early and late, the early neonatal death rates fell more slowly than the late. As a result of these different gradients, the proportion of the neonatal component of infant mortality, and of the early neonatal component of neonatal mortality, steadily increased.
So, instead of decreasing in response to public health measures, neonatal mortality became an ever larger component of infant mortality as post-neonatal deaths rates from infectious disease began to fall.”
Now let’s look at maternal mortality. In the early 1920′s the maternal mortality rate in the US was 680/100,000. The rate was similar in England and Wales. The most common causes of maternal death (England and Wales) in the early decades of the 1900′s were puerperal sepsis 33%, eclampsia with seizures 18% and hemorrhage 7.5%.
Sepsis does have an infectious cause, so if public health measures were responsible for its decline, we should see a slow and steady drop as public health measures spread throughout the country. That’s not what we find, however. Maternal mortality does not begin to fall until the late 1930′s when both antibiotics and blood banking were introduced. There is no evidence that public health measures had any impact on the maternal mortality rate.
In summary: the primary causes of neonatal mortality have never been infectious and public health measures did not contribute very much (if anything) to the decline of neonatal mortality. The decline in neonatal mortality must be attributed to better neonatology and obstetrical care. Maternal mortality does include a large component of infection, but this did not respond to public health measures and was only controlled by antibiotics. Dramatic declines in maternal mortality from eclampsia and hemorrhage are attributed to obstetrical management and the advent of blood banking.
So, a full 1/3 are attributed to sepsis. Interesting. I find it strange that public health measures (I assume you’re referring to handwashing, sterile instruments, etc) did not decrease that dramatically. The study you cite only looks at 1900-1960, though–after some of those measures had already been introduced.
However, given the difficulty we have even today with getting hospital staff to practice good handwashing between patients and the resultant central line infections, MERSA infections, etc….I should not be so surprised.
Browsing Dr Amy’s site, she already addressed a three times the rate of neonatal death at homebirth than hospital birth in NZ! Imagine that.
http://skepticalob.blogspot.com/2011/11/nz-study-tries-to-bury-increased.html?m=0
Dr Amy’s biggest issue with that NZ study seems to be that the authors didn’t divide their analysis into two simple groups: home birth and hospital birth. So, when the authors presented numbers consistent with everything else in their paper, they were apparently being dishonest and “hiding” things. Just because they weren’t presenting the data the way she wanted it presented.
She could have criticized their analysis and used their numbers to make her own argument. But instead, she made up a conspiracy of lies on the authors’ behalf, because they must be lying if they aren’t waving her particular flag. Same thing she’s done in this comment thread, and elsewhere on the web, as I understand it.
Gomi, I had a go at reading the paper. Dr Amy was only interested in that one part of it as I understand. I am a bit confused about what they said though. Why didn’t they include neonatal deaths from intended primary and secondary hospitals?
Oh, Jill. I have been reading your site for 5+ years, and this post is a shame. Please educate yourself on birth politics before writing things you know little about. Home birth will always happen (There are SO many parallels between abortion and birth rights!), and I would hope any feminist would not only support women who choose it (no matter what their opinions on vaccines), but work to make it safer. Many women turn to home birth bc the current maternity system in hospitals is so bad…only 9% of women VBAC (vaginal birth after cesarean), even though it is as safe as a repeat c-section – and is safer when comparing VBAC to 3+ c-sections. Please do your research before jumping on the “everything medicalized is safer!” bandwagon. The book “Pushed” is a great place to start.
So, neither the author nor the editor here took any time to do any research on either homebirth or the outrageous maternal mortality rates in hospitals, I assume? Nobody noted that homebirth midwives carry supplies for emergencies and that studies show maternal mortality AND maternal morbidity are LOWER at HOME with qualified care. Nobody noted that infant outcomes are the same in both settings. Nobody noted that there are very intelligent, educated, scientific women like myself who give birth at home AFTER having been traumatized by birthing in the hospital. There are no statistics here, no research – just that same old ignorant party line that “women used to DIE in childbirth before medicine!” Newsflash – women STILL die using this modern medicine, often BECAUSE of it, and that is a very, very real tragedy.
There’s not a single study that shows that maternal mortality is lower at homebirth. In order to do that, a study would have to include several hundred thousand homebirths and there is no study like that.
The Feminist Breeder just makes stuff up to suit herself, and this is classic example.
Yeah, because *they aren’t.* I’m not against home birth at all, but the available data shows a small increase in risk. Whether or not to bear that is a personal choice, but let’s not deny it entirely.
I agree. The data doesn’t support the FeministBreeder’s position any more than it supports Dr Amy’s. Reality is often different from fundamental extremist fantasy.
If that were true, none of the studies on infant mortality at homebirth would be valid either. You need a large, representative sample, yes, but several hundred thousand (although a statistician’s wet dream)…no. You’d have an awesome confidence interval, though.
I’m not sure Dr Army just realized she argued against her own claims on infant mortality. This is why you need to be more than “educated” about statistics, if you’re going to argue them.
Wrong again.
Statistical power depends on the frequency of the event that you are studying. Since maternal mortality is measured per 100,000 you need at least several hundred thousands of homebirths for a sample size. In contrast, neonatal mortality is measured per 1000. So the sample size need only be in the thousands, not the hundreds of thousands.
Amy…argh. Just go take some stats classes, ok? Or maybe Gomi has the time to explain it to you.
Sonya, yes, a bit of perspective would help. There’s more of a problem here than confused, ignorant women assuming that doctors are lying to them because they’re too ill-informed to understand what’s really going on. There’s more of a problem here than medical professionals simply being “condescending.”
Medical professionals of all types have been known to take their degrees as license to do whatever they think is best, regardless of what their patients are actually going through. They don’t leave their prejudices or biases at the door. They don’t shed the patriarchy when they pick up a stethoscope. Telling people to trust their doctor and his education/experience and ignore their own experiences (their understanding of their own bodies) to go along with whatever the doctor thinks is right isn’t a foolproof plan.
There’s a reason why someone above mentioned “post-birth PTSD.” Please do more reading about the ways some women have been traumatized by medical professionals.
This.
Furthermore, Sonya’s comment comes alarmingly close to throwing all modern notions of informed consent out the window.
Every treating physician has an affirmative, legal duty to explain a patient’s condition to them, explain all of the treatment options available to that patient, and finally leave the final call of what treatment that patient will or will not accept to receive up to that patient. Telling a patient to just leave it up to the doctor and assume s/he knows best is not only offensive from the standpoint of respecting that patient’s bodily autonomy it also ignores their legal rights as patients.
To tell a laboring patient that they should ignore their right to make their own medical decisions because, what about the baybees! treads far too close to the sort of rhetoric that the anti-choice crowd uses as its stock in trade. Just because a fetus resides there does not mean that we should have to check our rights to our bodily autonomy at the door.
Lou, I wish you the best, but I think you may have been misinformed about the pain of c-section recovery. It’s major surgery, and recovery is considerably longer and more painful than with a normal vaginal birth.