Ladies, the physicians of America have issued their decree: they don't want you having your babies at home with midwives.
We can't imagine why not. Study upon study have shown that planning a home birth with a trained midwife is a great choice if you want to avoid unnecessary medical intervention. Midwives are experts in supporting the physiological birth process: monitoring you and your baby during labor, helping you into positions that help labor progress, protecting your pelvic parts from damage while you push, and "catching" the baby from the position that's most effective and comfortable for you -- hands and knees, squatting, even standing -- not the position most comfortable for her.
When healthy women are supported this way, 95% give birth vaginally, with hardly any intervention.
And yet, the American Medical Association doesn't see the point. Yesterday at its annual meeting it adopted a policy written by the American College of Obstetricians and Gynecologists against "home deliveries" and in support of legislation "that helps ensure safe deliveries and healthy babies by acknowledging that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital" or accredited birth center.
"There ought to be a law!" cry the doctors.
The trouble is, they have no evidence to back up their safety claims. In fact, the largest and most rigorous study of home birth internationally to date found that among 5,000 healthy, "low-risk" women, babies were born just as safely at home under a midwife's care as in the hospital. And not only that, the study, like many before it, found that the women actually fared better at home, with far fewer interventions like labor induction, cesarean section, and episiotomy (taking scissors to the vagina, a practice that according to the research should be obsolete but is still performed on one-third of women who give birth vaginally).
Which is why the American Public Health Association and the American College of Nurse Midwives support women choosing home birth. The British OB/GYNs have read the research, too, and have this to say: "There is no reason why home birth should not be offered to women at low risk of complications... it may confer considerable benefits for them and their families. There is ample evidence showing that labouring at home increases a woman's likelihood of a birth that is both satisfying and safe..."
The other trouble with the American MDs is that they seem to have lost all respect for women's civil rights, indeed for the U.S. Constitution -- the right to privacy, to bodily integrity, and the right of every adult to determine her own health care. The "father knows best" legislation they are promoting could indeed be used to criminally prosecute women who choose home birth, say, by equating it with child abuse.
Research evidence be damned, the doctors want to mandate you to go to the hospital. They don't want you to have a choice.
We think they're spooked. The cesarean rate is rising, celebrities are publicizing their home births (the initial wording of the AMA resolution actually took aim at Ricki for publicizing her home birth on the Today Show!), people are reading Pushed and watching The Business of Being Born, and there's a nationwide legislative "push" to license certified professional midwives in all states (The AMA is against that, too, by the way).
The docs are on the defensive.
After all, birth is big business -- it's in fact the most common reason for a woman to be admitted to the hospital. And if more women start giving birth outside of it, who will get paid? Not doctors and not hospitals.
"The AMA supports a woman's right to make an informed decision regarding her delivery and to choose her health care provider," the group said in a statement. But if it really supported women's choices it wouldn't adopt a policy condemning home birth and midwives.
Because if U.S. women are to have real birth choices, everybody needs to be working together to provide them, not waging turf wars at their expense.
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A video to share:
http://www.youtube.com/watch?v=2pN58kf3Ims
Let's keep home birth legal -- for the sake of the RIGHTS of all women. Visit http://www.ipetitions.com/petition/birthathome/ to sign the petition.
So were supposed to believe a study that is funded by the AMA? A bunch of self-centered greedy control freaks that for the most part see dollar signs as the "bottom line" instead of a woman's right of choice? Heres a suggestion for a new study to be done in two parts, and it should prove my point well.
First, compare the amount of money that Doctors and Hospitals have over billed and milked from the insurance companies, as compared to midwives doing home births.
Secondly, compare the amounts of unneeded as well as questionably safe drugs that Doctors and Hospitals have literally "pushed" onto and into their patients because of "kickbacks and perks" from pharmaceutical companies; as compared to midwives.
Its all a dollar game with you people, and has nothing at all to respecting patients rights, or providing them with the care and passion they deserve.
You are so down on MANA, that one would almost think your misdirected anger is because you failed to pass your own midwifery exams.
Food for thought Amy. If you check your lineage and family tree, I'm sure you'll find many babies were delivered by midwives, without which you might not be here now. Think about it.
Consider some significant results of this study: "Outcomes of planned home births with certified professional midwives: large prospective study in North America."
Kenneth C Johnson, senior epidemiologist, Betty-Anne Daviss, project manager. BMJ 2005;330:1416 (18 June).
- Medical intervention rates of planned home births were dramatically lower than of planned hospital births, including: episiotomy rate of 2.1% (33.0% in hospital), cesarean section rate of 3.7% (19.0% in hospital), forceps rate of 1.0% (2.2% in hospital), induction rate of 9.6% (21% in hospital), and electronic fetal monitoring rate of 9.6% (84.3% in hospital).
You can view the full article and references on the British Medical Journal website at the following link: http://www.bmj.com/cgi/content/full/330/7505/1416?ehom
If you are someone who needs to see statistics, compare the above numbers, and think twice before you say home birth is not as "safe" as hospital birth.
The bottom line on this matter is that EVERY WOMAN HAS THE RIGHT TO CHOOSE WHERE SHE GIVES BIRTH.
Consider the key result of this study:
See the intervention rates in the hospital group mentioned above? The neonatal death rate of the homebirth group is almost TRIPLE the death rate in THAT hospital group. That information is deliberately omitted from the BMJ study. Instead the authors pulled a bait-and-switch and compared homebirth DEATH rates to a bunch of out of date studies extending back to 1969.
See the authors' description of themselves? The authors deliberately omitted the rest of their professional descriptions. Johnson is the former Director of Research of MANA, the homebirth midwife trade organization, and Daviss (his wife) is a homebirth midwife?
Consider also that the study was done in collaboration with MANA and was funded by a homebirth advocacy foundation.
Bottom line: a study performed by the homebirth industry and funded by the homebirth industry was forced to resort to deception to suppress the fact that the study ACTUALLY showed that homebirth has an increased rate of neonatal death.
Amy, people are not as stupid as you think. Stop trying to insult them.
Everyone should read the study for themselves. The only neonatal deaths were from things like fatal birth defects, or SIDS afterwards; NOT ONE was from provider error! You sure can't say that about hospitals. And how many less mothers and babies were damaged by unnecessary interventions? Obviously that doesn't matter to you, Amy.
And feel free to honestly compare the stats from any year, any hospital in the US to the CPM record. It still proves that low-risk homebirth with a trained midwife is just as safe as low-risk birth in a US hospital. Twist and spin all you want, the facts stand.
Post by "Dr. John". A very intelligent commentary on the subject, well worth reading:
http://womenshealthnews.wordpress.com/2008/06/19/thoughts-on-the-ama-homebirth-ban-ricki-lake-and-midwifery/#comment-21549
My wife and I thought we would never consider a homebirth, but the more we learnt about hospital births and OB/GYN practices in this country, the more concerned we became and the more time we spent researching the alternatives. The bottom line has to be safety for mother and child - nothing else really matters - and this was the reason we eventually chose a homebirth for our daughter.
The people commenting above that homebirth is not safe for low-risk pregnancies need to go and do some of that research themselves. Your comments are ill-informed and insulting. How come the medical establishment of so many countries endorses homebirth (e.g. http://www.rcog.org.uk/index.asp?PageID=2023) if it is not as safe as or safer than hospital birth ? How come the UK OB/GYN association statement on homebirths cites 43 research references, when the American one has none ? If ACOG and AMA had any actual evidence for their position, wouldn't they share it ? My conclusion was that they cite no evidence because they have none. Their use of emotive language in their statements just reinforces that conclusion. (And just to address the claim that midwives have poorer qualifications here then in those other countries, if that was what this was about, then wouldn't the AMA just say that ? Call for tougher licensing requirements for homebirth midwives ? But that is not what they are doing at all, so I doubt that is what this is about.)
The state of maternity care in the U.S. is appalling. The U.S. is ranked 22nd in the world for neonatal mortality-just slightly in front of Slovenia. Developed nations where midwifery is the standard of care have a much lower maternal/neonatal morbity and mortality rate than standard OB care in the U.S. Better births mean better lives.
Want to fight this?
http://www.ipetitions.com/petition/birthathome/
As a future CNM is it really wonderful to read all of this fantastic support of midwifery and women's choice in childbirth. I applaud Ricki, Abby and Jennifer and hope they continue to fight the smear campaign against them.
Here's the Midwives Alliance of North America Position Statement on Homebirth:
The Midwives' Alliance of North America holds the position that home birth is a safe option for many women.
Statistics have demonstrated that, for the majority of women, home birth with the presence of a skilled attendant is a reasonable and safe option. Home birth has a positive effect on the reduction of unnecessary medical intervention and the application of technology. Birth at home allows for unique conditions which ensure individualized care, facilitate the birth process, support the health of women and their babies, contribute to family life and optimize birth outcomes.
In keeping with its position, MANA:
* supports the right of women to choose home birth and of midwives to work in the home birth setting;
* encourages access and referral to physicians and hospital care when transfer from home to hospital becomes necessary; and
* encourages organizations that work with governmental agencies to provide the support required to make birth at home an option for all women who so choose.
The Midwives Alliance of North America is the largest organization of homebirth midwives in the US and Mexico. The Midwives Alliance embraces midwives from all backgrounds.
Then why are they hiding their OWN safety statistics?
MANA has been collecting detailed safety statistics on all homebirths with a CNM since 2001. They have PUBLICLY offered these statistics to those who can demonstrate that they will use them for the "advancement of midwifery". Even then, the procedure is complicated:
Researchers must provide:
"a. A statement that the decision has been made by the group
b. A list of participating members ...
4) The DOR will then send a contract which contains two parts:
a. The agreement between the association and the Midwives Alliance for the account
b. A Non-disclosure Agreement which prohibits inappropriate use of the data...
The data made available from the Midwives Alliance Statistics Project ... puts the control of the data in the hands of the midwives."
In contrast, national safety data for is posted on the CDC website and anyone can view it.
MANA has taken extraordinary steps to suppress this data. It does not take a rocket scientist to suspect that this data shows that homebirth with a DEM has a much higher rate of neonatal mortality than hospital birth. In fact, it almost certainly shows homebirth with a DEM has a much higher risk of neonatal death than the high rate that other studies have shown.
Homebirth with a DEM is unsafe. MANA's own data shows it. In response, MANA has taken extraordinary steps to make sure that women cannot find out that homebirth increases the risk of neonatal death.
You remind me of the recent study that was splashed all over the headlines, and even made into a CMEU on MedScape. "St. John's Wort Proven Ineffective for ADHD". I actually read the study, and was appalled. They formulated the herb to be at a very low dose (not homeopathically potentized, just too low to be effective), but never tested it until after the trial, when it was found to be almost totally inactivated - far less than the low dose that they had intended. The active ingredient was only 0.13% when the herb normally contains about 5%. How could they prove anything from giving an inactivated ingredient to a handful of kids? The conclusion of the study should have been worded properly to reflect the inconclusive reality of the findings based on no active substance having actually been tested. They also found no side effects, but did the headlines read "St. John's Wort Proven Safe"? Hmmm, no - it didn't.
Unethical types can always twist things to imply a lie, only you don't even imply lies, you just declare them outright. MANA could sue you for your comments.
Amy, you are fooling NO ONE.
You claim that these stats show something terrible, but you haven't seen them. You have a crystal ball?
The reality is, you know very well that the stats will show the same thing they have always shown - that low-risk homebirth with a trained midwife is just as safe as low-risk birth in a hospital in the US.
You and ACOG are still in contortions over the last batch of stats from MANA (complied and publicly released for all the world to see), and that's why you have been taking such an aggressive stand of offensive defense, because those stats exposed you anti-midwife types for the nefarious witch-hunters that you are. It is exactly your kind for whom the phrase "inappropriate use of the data" was included, because you take pieces of information out of context to support your lies. Why should MANA or anyone else facilitate that? Your own AMA should investigate you (if you are even a member,) for implying that you have a license to be dispensing what unsuspecting women take as medical "advice" online, and for tarnishing the reputations of real OB's by allowing women to believe that you actually are a practicing doctor. How many babies have you delivered, Amy? When was the last one?
The sad thing is, the intelligent folks see through you. It's the more gullible ones that you successfully prey upon.
Hey, all! I have had 3 babies by home-birth with midwives attending and everything this article says is true! Midwives take way better care of you before, during, and after birth. My babies were born in an atmosphere of peace and quiet. I was in my own bed and did not have to go somewhere and then come home when I least felt like it. My husband and children were in attendance. I was well-prepared, thanks to the midwives and my own conscientious reading. From each birth, I healed quickly and perfectly. No scissors to my vagina, or drugs to make labor go faster (and harder). More people should try it. Thumb your nose at the medical establishment, protecting their paychecks at your expense!
The ultimate irony of the campaign to promote homebirth and license direct entry midwives may be to bring about the demise of direct entry midwifery.
DEMs have successfully tried to confuse American women on two critical points:
1. Homebirth is KNOWN to increase the neonatal death rate
2. American DEMs are grossly undereducated and undertrained compared to ANY other midwives in the industrialized world.
The government has begun collecting statistics on homebirth with a DEM. The first large data set already shows that homebirth with a DEM triples the rate of neonatal death compared to low risk hospital birth. This is consistent with all the existing scientific evidence. Homebirth advocates will no longer be able to pretend to themselves or others that homebirth is safe.
MANA, the trade union for DEMs, has confused people about the education and training of DEMs. Their certification ("CPM") closely resembles CNM (certified nurse midwife). Homebirth advocates routinely cite midwifery in European countries like the Netherlands, without explaining that the American DEMs would never be considered qualified in the Netherlands. Dutch midwives, like ALL other midwives in the industrialized world are hospital trained. American DEMs have no hospital training and receive degrees from correspondence courses.
Homebirth advocates are shrilly and falsely decrying the AMA's attempt to "outlaw" homebirth when the AMA is simply asking for acknowledgement of the facts. Homebirth is not as safe as hospital birth and American DEMs do not meet the standards for midwives anywhere else in the industrialized world.
Whether or not you care about birth, support home birth or think home birth is outright ridiculous; you must at least recognize that this is chipping away at women"s rights. Are women not capable of making their own decisions?
In no way is it acceptable for the AMA to demand that I seek medical attention for any condition; or to tell me what is the right choice in my treatment. This paternalistic view of women is part of the reason why more and more are turning to home birth in the first place. This decree speaks volumes to how women are stripped of their autonomy, voice and power to make healthcare decisions for themselves and their families as soon as they walk through the hospital doors in labor.
I cannot help but take this personally. This is an assault on my individualism, my rights, and my freedom of choice. What"s next? Will the AMA rally to pass legislation stating that all Jehovah"s witnesses must accept blood transfusions because THEY think it"s best? Will they inform me of what kind of birth control I must use? How many children I can have? Create legislation that forces me to visit a hospital every time I sneeze?
This is down right insulting to my intelligence and reproductive freedom.
Wow Amy,
You are determined to have the last word, aren't you?
Your statements are extremely biased for the AMA worldview. You refuse to consider any kind of study and statistics which supports home birth in countries that fully accept it.
The AMA is a mercenary entity which forces their viewpoint (not always succesfully) on everyone. They lost bigtime on chiropractic and osteopaths, which are two of the longest battles they fought, yet have full acceptance today.
I conjecture that though you have considerable book learning, you have no wisdom.
In spite of your MD, I do not think you are qualified to to pontificate on this subject.
There are no studies and statistics that show that homebirth is as safe as hospital birth. There are studies that claim to show that homebirth is as safe as hospital birth, but they compare homebirth to hospital birth of high risk women or hospital birth in decades past. You do not have to take my word for it. Read the papers that claim to show homebirth is as safe as hospital birth. You will see what I mean. None of them compare homebirth to low risk hospital birth in the same year.
"home birth in countries that fully accept it."
Homebirth in countries like the Netherlands and the UK is very different than homebirth in the US. The midwives who attend homebirths in Europe are hospital midwives who usually practice in the hospital but occasionally attend births at home. They have a university education, are trained to a very high standard and have extensive experience in diagnosing and treating complications. In contrast, American DEMs do not have college degrees, are trained in proprietary midwifery schools accredited by MEAC, the sister organization of MANA, and their education is often nothing more than a correspondence course and an apprenticeship with a DEM in their area. They have absolutely no training or experience in diagnosing or managing complications.
It is disingenuous at best for homebirth advocates to point to European midwifery when American homebirth midwives would be considered grossly undereducated, undertrained, and ineligible for licensure in Europe.
The AMA and ACOG"s claims to have irrefutable evidence of the superiority and increased safety of hospital birth and techno-birth are factually inaccurate.
Studies in Evidence Based Medicine have revealed Obstetrics has one of the lowest percentage rates of concrete facts to substantiate its claims. They rate among the lowest of any specialty.
Credible contrary opinions from MDs, PhDs and midwives indicate other opinions are available. Famed American midwife Ina May Gaskin has an international reputation. Sarah Buckley MD likewise has researched and proven without a doubt contrary opinions need to be thoughtful parts of an on-going conversation. Why does Ina May"s birth center in Tennessee have the best birth outcomes on the planet?
We need a medical establishment that is open to asking questions and looking at alternatives for the sake of their patients not for the sake of maintaining authority. We could combine the best of both world"natural and smart.
Most importantly if you listen to what women want such as the national surveys: Listening to Mothers I and Listening to Mothers II.
Time to look deeper. Sorry AMA and ACOG. You are out of step with the future. I"ve seen the green movement transform from sentimental joke to pressing reality in my life time. Our respect for the intelligence of nature in how we conduct birth will be next. Babies are the living fabric of the humanity of the future. Beating them up on their way into life is counter-productive to us all.
The AMA and ACOG perceive a threat from homebirth practitioners, when they should rather accept the challenge to provide high-risk services to those 10-15% of women and babies who are "risked out" by LMs/CPMs and require hospital delivery.
Hiring a surgeon to catch your baby is like hiring a pediatrician to babysit for your toddler. It's not necessary, and it's a shameful waste of our precious healthcare resources.
Amy, you might benefit by studying how systems like England, the Netherlands, New Zealand, and Japan manage to provide a generous range of services for their birthing women, AND have better birth outcomes than the good ol' US of A.
One month ago I participated in the home birth of my grandson. This was the 2nd home birth for my daughter with her two midwives, her husband, her father and me. It was a beautiful experience for all of us and safe, safer I would say than my daughter-in-laws hospital birth that ended with a c-section. The doctors had put her in a bed and strapped her to monitoring machines so she couldn't walk around. At the home birth my daughter was walking around as I recorded the inteval between her contractions and the duration. When contractions got too strong to talk through she got into a spa where about 30 minutes later her son was born. The midwives checked for the cord to be sure it was clear and then instructed Dad how to pass the baby up to Mom. We had a healthy, 8lb, 6oz boy from a healthy and happy Mom - she was never strapped to a bed and was allowed to nurse her baby soon after Dad cut the cord. My daughter was attended to by two wonderful midwives who we all had complete trust in. None of the literature that we have read proves that hospitals are safer than home deliveries. My daughter did her research and decided on a home birth. The AMA has no right to take that choice away from her and other women!
Here's is what the leading women's rights organization in America has to say:
WHEREAS, The National Organization for Women has long supported reproductive freedom as a
priority issue; and
WHEREAS, NOW believes that women should have compete authority over their reproductive lives; and
WHEREAS, reproductive freedom not only includes the ability to decide whether or when to bear children, but also the right to devise a birth plan with a medical provider of their choice in either a hospital or an alternative setting such as a freestanding birth center or private residence; and
WHEREAS, women have historically given birth with midwives; and
WHEREAS, the practice of midwifery has many benefits including lower costs, lower rates of premature births, higher rates of breastfeeding; and greater satisfaction with the birthing experience, and has been endorsed by The World Health Organization; and
WHEREAS, midwifery has a lower incidence of medical interventions during the birthing process, including routine episiotomies and cesarean sections; and
WHEREAS, women's access to midwifery and traditional birthing practices are many times limited by restrictive laws and non-coverage by private insurance companies and state-subsidized funding;
THEREFORE, BE IT RESLOVED that The National Organization for Women's policy statements, brochures and fact sheets on reproductive freedom shall include references to birthing choices, safe childbearing practices, midwifery; and
BE IT FINALLY RESOLVED that NOW work in cooperation with state and national midwifery organizations to increase women's limited access to midwifery and community awareness of childbirth, pregnancy and early parenting choices.
I am a health care consumer, and I demand the choice of home birth with a trained attendant.
Obstetricians and hospitals do not provide the kind of care and support that I believe I need during pregnancy and childbirth. OBs practice defensively--in such a way as to protect patients from the most dire outcomes while causing the vast majority of women and babies unnecessary stress, pain and morbidity. In my opinion, it is a practice with diminishing returns.
Certified Professional Midwives have skills for managing labor and birth that OB's lack, and practice proactively, in such a way as to optimize health outcomes, so that the vast majority (90%) of their clients achieve spontaneous birth at home, and babies are treated gently according to the wishes of the parents. CPMs, because they are trained outside the medical model of care, respect the physiology of birth and know how to wait and how to encourage progress without the use of drugs or instruments. CPMs achieve optimal results without a statistically significant rise in perinatal mortality, especially in situations where they are well-supported by the medical community.
So why is ACOG and the AMA trying to outlaw homebirth with midwives? MONEY! They will lose a lot of it if women were primarily using midwives, whether in or out of a hospital. CNMs shouldn't be working under an OB, either, they should be autonomous. ACOG is scared and this is how they are trying to stop the progression of laws being passed accross the country to legalize out-of-hospital midwifery.
I've had 3 cesareans (2 emergency, 1 planned/coerced) and I believe midwives should be the primary caregivers for low-risk women and that ALL women should have the choice to choose a midwife. My last birth was a planned homebirth. Due to my intuition and my midwife, we decided to transfer to the hospital after 2 hours of pushing at home. I was bedridden without pain meds for another 2 hours before another c-section was done. It was discovered only DURING the cesarean that my uterus had ruptured, but my baby lost no oxygen. She did have to spend the first 5 hours of her life in the NICU due to breathing difficulty due to the c-section. I believe if I'd had midwifery care and knew my options, all of my cesareans could have been avoided. I want my daughters to have the choice of where and with whom they give birth. It is absolute ludicrousy that ACOG and the AMA want to take away our choices...My body, My baby, My birth!
Thank you for this post and for sharing your story -- a story which is common for many women who undergo cesarean sections. So many cesareans could be avoided if it weren't for the repeated unecessary interventions that hospital procedures impose on low-risk laboring women. Midwives statistically have much lower intervention rates, and therefore fewer cesarean sections. We need to remember the importance of FREEDOM OF CHOICE in all aspects of life, especially birth. Children who are born in a natural environment and left to be with their mothers immediately following birth, will have a better future overall.
Support our right to CHOOSE where and how we give birth!
Posted June 18, 2008 | 02:26 PM (EST)