Docs to Women: Pay No Attention to Ricki Lake's Home Birth

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.

Comments

[kriski42]

As more and more women are having primary c-sections, sometimes coerced, even more repeat c-sections will occur because hospitals and obstetricians across the country are banning VBACs (vaginal birth after cesarean), with rupture cited as the main concern. Complications, such as cord prolapse and placental abruption, can and do arise in normal births, and the rates of these other complications are higher or similar to the rate of rupture. Some of these complications are iatrogenic (caused by the doctor’s actions). Cesarean can be a lifesaving event and I am glad that it is a safe option when necessary, but banning VBACs is a violation of our rights since we can not be forced to consent to any medical procedure. Yet, some women HAVE been forced to have a cesarean by court orders obtained by obstetricians.

According to Dr. Marsden Wagner (Perinatologist and former Chief of Women and Children’s Health for the World Health Organization, author of Born in the USA), midwives should be the primary caregivers for low-risk pregnant women and birth should be at home or in a birth center to minimize germ exposure from the sick people in hospitals. In countries with lower mortality rates, midwives are the primary caregivers for low-risk pregnant women. Jennifer Block, author of the recently published book, Pushed, also found through her investigations and interviews that there is, indeed, a maternity crisis in America because of the lack of access to midwives.

[kriski42]

The problem is that most women believe we are receiving the best care possible, when in actuality, we are not. Out of all industrialized nations, the US ranks 41st in the rates of maternal and infant mortality. In the US the cesarean section rate in 2005 was 30.2%; 1 in 3 women are having MAJOR abdominal surgery in order for their babies to be born. Some hospitals’ rates are even as high as 50% or more. The WHO (World Health Organization) states that the optimum c-section rate would be 10-15%; any higher or lower means more maternal and infant deaths. Besides c-sections, interventions such as routine use of I.V.s, CEFM (continuous electronic fetal monitoring), epidural, routine episiotomy, induction (with Pitocin, cervidil, Cytotec, amniotomy, etc.), directed pushing, and time limits on labor and pushing stages have been proven NOT to decrease maternal/infant mortality and do increase the risk for c-section. In fact, maternal/infant mortality rates are on the rise. Most women are not given truly informed consent for these usually unnecessary procedures. They do not know how these interventions can affect them, their labor, and their babies.

[enjoybirth]

Most births are safe and can be done at home. There are circumstances in which a birth becomes high risk and the mom should have the baby in the hospital. Mom's intuitions are very strong, if we let them trust their bodies and babies they will know what to do.

Part of the problem with so many women with Obstetricians today, they are filling them with fear. At 20 weeks they start saying, your baby is getting SO big. They start setting moms up for interventions during birth from this early. These interventions so often lead to problems during birth.

Women should have the choice of care providers and birth locations. I don't think all women should have birth at home, nor do I think they should all have birth at hospitals. I think that a woman will know what the best choice for her and her baby are. I know a few women who planned homebirths and then at the last minute, their intuition led them to the hospital and that was the best choice for them. I know plenty of moms who planned homebirths, felt good about it through the birth and had wonderful birth experiences.

Let's trust women to make choices for their bodies and births!

[sfmidwife]

The AMA and ACOG are in their final death throws of this turf war against midwives and homebirth. In their own internal memo, they lamented about being on the defensive and losing the fight to Big Push wins for legalized midwifery in the Midwest. This is their attempt at taking the offensive. I think they had no idea how quickly would catch on or that we were even watching. Well, we are, and we will prevail on this one. They can waste their money trying to cook up "model legislation" to limits women's right to choose, but, guess what, that ain't the way of America. Women have autonomy over their own bodies. ACOG can't decide, the AMA can't decide, even midwives can't decide for a woman. Women get to choose. Dare I say, duh?

[dmmSF]

I think that ACOG thought that squashing 1% of the birthing demographic would be easy-peasy. What they didn't realize is:
whether you desire a homebirth or not, every American believes in choice.
Dare I say, don't tread on me?

[MLBathome]

BEHIND CLOSED DOORS, ACOG ACKNOWLEDGES SAFETY ARGUMENT CANNOT BE WON

Not only is the AMA unable to produce references to back up the claims that homebirth is unsafe, but ACOG'S 2007 State Legislative Update/Year In Review on midwifery directly acknowledges that the safety argument cannot be won.

Verbatim from the report:
"For example, in Missouri, 'lay' midwife bills get introduced year after year. These bills have been stopped – up to now – mainly by deft political manuvering and hardball tactics employed by the State Medical Society, NOT BY ANY PERSUASIVE TESTIMONY ABOUT COMPARATIVE SAFETY OR QUALITY OF CARE." (Emphasis mine)

As of 6/18/2008, the full report is available at http://www.acog.org/departments/stateleg/MidwiferyYearinReview2007.pdf

Not only does ACOG acknowledge it cannot win the safety argument, but pleads guilty to the Missouri State Medical Association's use of "political maneuvering" and "hardball tactics" every decent citizen abhors.

As a fellow midwifery advocate says, "Given the experiences of the tireless advocates at the [Missouri State] Capitol, the admission of using 'hardball' tactics is interesting, because that's certainly how it FELT, but it was denied by opponents of the legislation."

As a mother, I am appalled that physician groups would have the arrogance to attempt to mandate where I birth. Either they are truly ignorant of the research, or this is nothing more than a turf war. Either way, mothers and babies lose.

[hotmamamidwife]

Pregnancy is not a disease and birth is not a medical event. There is a growing body of research showing excellent outcomes for planned homebirths indicating that home is as healthy and safe a place to give birth as a hospital or birth center for most women and babies. Homebirth is not the goal—the true aim is to have a safe, empowering birth while minimizing unnecessary interventions or complications. If transfer to a hospital is indicated the tools and techniques of obstetrics are welcomed and utilized.

No one should make you feel like you have to choose between having a healthy baby and having a meaningful birth experience – both are possible. Are there risks to choosing a midwife-attended homebirth? Yes. As with anything in life there are always risks. But there are risks involved with a hospital birth, a birth center birth, an unassisted homebirth, or a planned C-section too. Women give birth best where they feel safe. It is up to each mother and family to decide what setting with its related risks and benefits is the right for their pregnancy and birth.

Is a planned homebirth for everyone? Of course not, but in reality neither is a planned hospital birth. Even if you are sure that homebirth is not for you, I encourage you to support others that make that choice and recognize that the choice should be available to women who desire it!

[pianoblond]

After experiencing a wonderful pregnancy and a homebirth that went off without a hitch just 10 weeks ago, my husband and I decided that, truly, if you aren't comfortable having a homebirth, then you shouldn't have one, because just your anxiety could cause unnecessary problems. However, the freedom to have a homebirth SHOULD NOT be taken away from those who are comfortable having one. Due to my experience and the research I have done, I would be absolutely terrified to have a hospital birth, therefore I should not have one unless there are serious complications.

[diamond67]

If this bothers you as much as it does me, you should send a note to the AMA: http://webapps.ama-assn.org/contactus/contactus-submit.do

Here's what I wrote:

The AMA should lay off midwives and home birth. Your recent take on the issue is so out of touch with actual health that any doctor who supports such rubbish should be considered in violation of the Hippocratic oath.

I don't think that I, or the general public, should trust anything that comes from the AMA. I'm truly disappointed.

[lwfky]

As a pediatrician, I get queasy just seeing this blog. The last home birth baby who presented to me was in septic shock at 4 hours of age. Please, investigate before you decide that you want to risk your child's life .

[debbiemidwife]

Without any other information about the health of mother, health of baby, labor and birth in this situation there is no way of making any scientic conclusions about why the baby you attended was septic. To conclude that the homebirth alone was the cause of this is conjecture.

I have witnessed in the hospital a perfectly health mother and baby develop chorioamnitis after far too many unnecessary vaginal exams. That baby was septic shortly after birth too.

[SarahZim]

As someone who has studied science you should well be aware of what is called the 'availability heuristic' or sampling bias. Just because you saw a baby born at home that was septic, doesn't mean that there haven't been thousands and thousand more in your time of practice that you have never seen. As for sampling bias, you are a pediatrician, you only see sick babies!!! Furthermore, this is why midwives should be licensed, to ensure that those overseeing home births have the training to know when to send the mom to the hospital.

[quetlin]

I find your reaction extremely snotty, Talk about, "I am the Doctor and you aren't!" You have been brinwashed, young man.

As a three time perfectly safe home birth mother, two of them before midwives were allowed, I have a lot I can argue you with you about.

I obtained an English text book for Midwives called Midwifery" a standard text in Englnd where home births are supported- About 700 pages long and I read it thoroughly. I learned a lot. I also used the Policeman's Emergency Birth Manual which has a matter of fact description of techniques for a cop to use, including tips on a breech birth. I also shared it with friends who attended my home birth, which was painless. Yes, painless with La Maze- as long as I kept my breathing in sync.

The American hospital infant mortality rates on the list compared to other countries was that we are not even in the top 10 %, in fact we rank 42nd as analyzed by the CIA. That is actually the SECOND WORST mortality rate in the deleveloped world! I have references in the other article on Rickie Lane. http://www.huffingtonpost.com/2008/06/17/ricki-lake-in-dispute-wit_n_107710.html

But at least you should recognize your bias! The AMA is a one track train that is always trying to make things that people without health insurance can try, illegal.

[klmebane]

a painless birth? you're trying to tell me that squeezing something the size of a watermelon out of a hole the size of a lemon didn't hurt? man, i took lamaze, but when those contractions hit i couldn't breath. i'm sure it worked for you, just keep in mind it isn't the same for everyone. there is also a certain amount of "amnesia" that hits when you get to transition. you don't forget the whole thing, but you don't remember exactly how much it hurt, or so some of my friends who have had natural births tell me. i knew i wanted an epidural from the time i was like 11 years old. and the baby was in distress so i ended up with a cesarian. which worked for me, cuz i had no desire to have a vaginal birth in the first place.

[quetlin]

You need to take a more open-minded view of this.

The American health care system has the second highest infant mortality in the developed world and the infant mortality ranked is 42nd from the best in the world. We Americans are way down the list from Singapore Hong Kong and Sweden which are the three top ranked countries. The CIA did a report on this.

I had three safe home births chronicled in the other article on this subject. http://www.huffingtonpost.com/2008/06/17/ricki-lake-in-dispute-wit_n_107710.html

I did investigate thoroughly. I had an English midwifery text book and read it all. I also found the Policeman's Emergency childbirth manual very simple adn helpful.

[NorthwestMidwife]

lwfky -

Very scientific anecdote. The last hospital birth I saw was a total disaster. So was the one before that, and far too large a percentage of the 100 before that. What's your point?

I chose homebirth for my own babies in part to lower their risk. My house didn't contain any deadly antibiotic­-resistant disease organisms.

[ranchobob]

how much do they mae a year in c-sections whihc have become virtually s.o.p?

[IdahoGrrl]

I had a homebirth with very experienced midwives & felt it was incredibly safe.

I can't believe the vast difference in opinion between the major medical bodies in the UK & the US. Isn't this science?!

[TerrapinCB]

No, this is business as usual.

It's all about the $$$$$$$$$$$$$

[Dannydel]

When will you ladies learn? Doctors know more about you than you, otherwise, why would they be so rich? Right wing conservative christian wingnuts certainly know more about your body than you do, which might be suspect, as they only do the sex thing once a month, after praying, with the lights off, or when they use a hooker, or have sex with a male prostitute, or molest an altar boy. So when someone like Ricki Lake tries to give advice on childbirth, you can see why the pundits roll their eyes and feel the need to jump in and save you ladies from yourselves. Yuh?

[LeftHandedMama]

In this particular case, you're going after the wrong people. Conservative Christians are very big on the homebirth movement - especially the homeschooling, full quiver types. The people going after home birth here are the ACOG and the AMA - let's save the ire for them who deserve it. When the right-wing is to blame for something, I'll be the first one blaming them with you, ok?

You might end up being surprised who ends up supporting this vile legislation and who doesn't.

[NatalieJean]

My water broke at 1am. No contractions for hours, and when they started they were slow and sporadic. All day we waited for labor to get going. Finally, around 5pm, things picked up! 2am the next day was when we welcomed our son into the world.
Had I birthed in a hospital, I likely would've been told I needed labor boosting drugs, and probably would've been at risk for an unneeded c-section due to length of labor. But nothing was wrong! I was just a first time mother who needed a little extra time. Fortunately, my midwife had that time and patience.

Doctors need to support midwives, and save their energies for the women who NEED that level of high tech care! Doctors need to work so women are HAPPY about their labors and births, and know that they weren't subjected to unneeded or harmful interventions!

Risks... unless you're in a large hospital, it WILL take time to get you into the OR or get specialists there. My closest hospital takes 45 minutes to get a surgical team in place in the middle of the night. If a homebirth midwife has a good relationship with a doctor, calls ahead and transports to a major hospital, her patient can get care she needs sooner.

Doctors need to accept that women are going to homebirth, and cultivate good relationships with midwives so they can care for those women who have a need for them, either during pregnancy or birth.

[DeafMom]

Outlawing homebirth isn't the answer-- there will always be Moms who will give birth at home unassisted or with DEMs. Instead, what is needed is actually more support for homebirth and procedures in place that enable cooperation between home and hospital.

I want my kids to choose how and where they bring their kids into the world -- I sure hope they don't have to get on a plane and birth overseas if they choose homebirth. The AMA is moving birth in America in that direction.

[AmyTuteurMD]

Why are homebirth midwives hiding their safety statistics?

MANA (the Midwives Alliance of North America), the homebirth midwife trade union, has been collecting detailed safety statistics from its midwives since 2001. MANA has publically offered these safety statistics to those who can prove they will use them for the "advancement of midwifery". Even then, recipients must sign a legal non-disclosure agreement promising not to reveal any of the data to anyone else.

MANA will NOT release the safety statistics to the public. Those statistics almost certainly confirm the new US statistics that show that homebirth with a direct entry midwife (DEM) has a death rate DOUBLE or TRIPLE that of hospital birth with an MD or a certified nurse midwife.

American women deserve to know what MANA is hiding.

[LateDave]

Amy,

You have been repeating your statistics for two days that the risks with a hospital-based medical-model "delivery", which you state are on the order of one death per three thousand or so birth attempts, are better than "DEM" outcomes, which you say are around one death per one thousand birth attempts. I assume these are very wide data gatherings, with no exclusions on either side. This rate of bad outcomes is small, so any anomalies have a big effect. You also leave out nonfatal bad outcomes, and don't indicate if both maternal and child mortality are included.

Citing statistics to justify a position is always risky in view of the ease with which critical factors can be fiddled to skew the results. More instructive may be Kat's or Rose's argument that ACOG and AMA are flagrantly pushing aside FDA and WHO, and that the US statistics (yours *are* for the US alone, right?) really suck compared to the rest of the developed world. The biggest factors may be insurance and drugs, with doctors being misled into unwise patterns of behavior. Mostly. In that context, the overall birth model for Americans is so screwed up that it is unreasonable to draw *any* conclusion based on *any* information and claim that one is being rational, not emotional.

[AmyTuteurMD]

" WHO, and that the US statistics (yours *are* for the US alone, right?) really suck compared to the rest of the developed world."

One of the biggest problems of homebirth advocacy is that most of what homebirth advocates think they "know" is actually false.

The US perinatal mortality statistics are excellent. According to the World Health Organization 2006 report on perinatal mortality, the US has a LOWER rate of perinatal death than Denmark, the UK and the Netherlands!

[LateDave]

Amy,

I know what a certified nurse-midwife (CNM) is; that's what we had for all of ours starting in 1980, and what our daughter had for our first grandchild. All were formally trained, experienced, registered nurses specializing in birth attendance. All had doctor backup and were minutes from a hospital should intervention have been needed. All were one-on-one nonstop throughout the perinatal period. What is a "direct entry midwife"?

[NorthwestMidwife]

Hi Dave, I'll try to answer your question as simply as possible.

DEM's vary by state, and they may or may not be CPM's. Certified Professional Midwife is a national credential. They are called "direct-entry" because instead of being nurses and then adding a midwifery certification, they go directly into midwifery and take a longer training program. Some take the same exam as their nurse counterparts, and are called Certified Midwives.

Here in my state, a DEM is a licensed midwife who completed an approved program of 3+ years of ob/gyn training, including mountains of coursework and rigorous clinical preceptorships. There are both academic and training prerequisites before applying for these programs, which I satisfied by obtaining a biology/pre-med degree with a 4.0 GPA, plus professional lactation consultant, childbirth educator training, and labor assistance training, all from the national certification associations. We must have at least 100 supervised births documented before we can sit for our exams, which are both the national exam and a tougher state exam.

Personally, I trained under a variety of providers, including an outstanding OB/GYN, and did deliveries in 3 hospitals, and thousands of patient exams. Next year I start my doctorate research. I do home births.

So now you have a picture of a mere "direct-entry" midwife. 'Course, we don know nuthin 'bout birthin no babies! :-)

[quetlin]

Golly Amy, are you psychic? Or are you revealing info that you agreed to keep confidential?

It is clear to anyone doing even internet research, that home birth is safer and less stressful on the baby than hospital birth.

The US is a lousy forty -second from the best according the the CIA statistics. Our rate is the second worst among developed countries three time higher at 6.4% than Sweden, Hong Kong and Singapor who rank the highest in birth safety in the 2-3% range.

You are speaking from brainwashed AMA approach. You have not really investigated from an unbiased viewpoint.

[klmebane]

i don't know that a home birth is always safer for a baby. in a complication free pregnancy (which i believe is the only way you can use a midwife, but correct me if i'm wrong) that works usually. i had a complication free pregnancy, but the baby was in distress when i was in labor and had to be taken by emergency c section. of course, i picked a hospital cuz i wanted an epidural.