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The Delivery Debate

Why deciding how and where to have a baby is more confusing than ever.

By Barbara Kantrowitz and Pat Wingert | Newsweek Web Exclusive
Feb 20, 2008 | Updated: 12:59  p.m. ET Feb 20, 2008

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  • Posted By: pbr90 @ 04/17/2008 9:52:45 PM

    Comment: Amidst the trend to rate everything from toothpaste to colleges, Americans might wonder why we didn't think of rating the birth experience of the millions of women who give birth in hospitals around the nation, and visit a diverse assortment of obstetricians, etc.

    Certainly, most postpartum mothers are all too willing to share horror stories along with those deemed spectacular in the department of easy births.

    This might be a sign of the times today where easy access and communications can help to remind the medical community that there is more to success than profitable hospital rates. New infants and mothers are rarely concerned with price, but terribly concerned with comfort and safety.

    Since birthing is such a common experience for women, women are uniquely situated to identify where and with whom they are most likely to get the best hospital, midwife center experience. It's surprising that Newsweek hasn't already taken up the charge for rating our childbirth centers. It could be enlightening for all families.

  • Posted By: pbr90 @ 04/17/2008 9:52:22 PM

    Comment: Amidst the trend to rate everything from toothpaste to colleges, Americans might wonder why we didn't think of rating the birth experience of the millions of women who give birth in hospitals around the nation, and visit a diverse assortment of obstetricians, etc.

    Certainly, most postpartum mothers are all too willing to share horror stories along with those deemed spectacular in the department of easy births.

    This might be a sign of the times today where easy access and communications can help to remind the medical community that there is more to success than profitable hospital rates. New infants and mothers are rarely concerned with price, but terribly concerned with comfort and safety.

    Since birthing is such a common experience for women, women are uniquely situated to identify where and with whom they are most likely to get the best hospital, midwife center experience. It's surprising that Newsweek hasn't already taken up the charge for rating our childbirth centers. It could be enlightening for all families.

  • Posted By: Klradakovich @ 04/04/2008 4:11:37 PM

    Comment: All I needed to hear when close to my second child's due date was "her shoulders are measuring large" and there is a risk of breaking them during a vaginal birth. Since my first child was 9 and 1/2 pounds, and I did not suffer from gestentional diabetes and he was on time, my fear of a larger more complicated birth arose. If a c-section promises more safety, I don't understand the comments surrounding the unnecessary surgeries. I was sure to read everything possible about childbirth when making my decision. Instead of choosing one of the leading women's hospitals in the U.S. - I chose a smaller more intimate hospital, where each baby and patient seemed special. I was not the least bit impressed by the treatment of my friends at the large hospital, they were not happy, and I often wondered why they returned. Women need to be in charge of their own bodies and birthing processes. We cannot rely on others to provide us with "all" the information. There will always be the socio-economic disadvantages of others, who are not provided the best healthcare options - but this is an overall problem to the disadvantaged when it comes to woman, child, and overall healthcare. Let's also not forget - the fear of many physicians - being sued when birth complications occur and the high price of malpractice insurance - when they see a potential childbirth problem - perhaps it's more fear than greed when recommending a c-section. I had a horrible time recooperating from the section - but I was happy my daughter was happy and healthy.

  • Posted By: multirn @ 03/31/2008 7:07:27 PM

    Comment: You do not mention family practice physicians as an option. In smaller communities, and in some bigger hospitals, a family practitioner can be your OB provider. They deliver thousands of babies and can also provide continuity of care for you and your baby by continuing to be you and your family's physician for many years down the road.
    As for vbac's, I am a L&D nurse who is very disturbed by all the unnecessary intervention we insist upon in OB. I am not totally against repeat C-sections, but it provides plenty of risk itself. C-sections under normal circumstances are far riskier for the mother (damage to other organs, more blood loss, risks of anesthesia, etc), not to mention if she wants to have more children later on. Each c section adds more scar tissue which can lead to multiple complications. There are risks to the baby as well. They are far more likely to have breathing problems and require oxygen therapy after delivery. The mother and child miss out on precious bonding and nursing time because the mother is in surgery and then recovery during the initial 2 hrs of the baby's life. The recovery time is so much longer, and the mother will need narcotics for pain control after delivery which can affect breast feeding and bonding as well. There are so many reasons for vbac, not just for the "experience" of vaginal birth. It can be a healthier choice.
    Of course, a ruptured uterus can be catastrophic, there is no doubt. But 99% if the time, a vbac is perfectly safe. You should not be induced, and should be monitored closely during labor and delivery if you choose this. And the reason for the prior c-section needs to be taken into account. One reason for the huge c-section rate increase is due to the fact that insurance companies no longer require a trial of labor after c-section, and some may frown on vbac. MD's are afraid of lawsuits so many prefer not to do vbacs.
    But women need to be aware of the pros and cons of both sides so that they can make and informed choice on what to do with their bodies and their babies. They should not be forced into a decision either way.

  • Posted By: pinksupermodel87 @ 03/31/2008 6:27:47 PM

    Comment: uyjjjjjjjjjjjjjjjjjjjjjjjj

  • Posted By: bad media @ 03/31/2008 6:05:49 PM

    Comment: I personally agree with not taking any unnecessary risks when it is not only your own life but that of the baby. I have never been able to understand women insisting on a Vback after a cesarian. Why take such an unnecessary risk? Because you feel you may have missed something? I was pleased that my OB told me the second time around that he would not allow a Vback as it is an unnecessary risk to myself and my unborn child.

  • Posted By: inmyopinion08 @ 03/31/2008 5:41:05 PM

    Comment: Why do we put our children in carseats? Is it because we believe ourselves to be dangerous drivers... or because we believe that if we go out on the road we will be in an accident? No, it is because we want our children to be safe in the EVENT of an emergency. Motherhood is the most unselfish act a human can accomplish... I personally believe it is a selfish thing to put your child at risk to have the experience that YOU desire (such as spurning life-saving medical care that saves lives on a daily basis). Chances are, you and the baby will be safe... but chances are, if you go to the grocery store you will not be involved in a fatal accident- so, again, why do we put our children in carseats?

  • Posted By: Jaidendawn @ 03/04/2008 8:47:59 PM

    Comment: In September I delivered a happy, healthy 9 lb boy in the front room of my home, nine years after the hospital birth of my first son. It was intensely intimate and ultimately low-stress. My second pregnancy mirrored my first - no complications or even blips, and both of my babies arrived exactly on their due date. Why then the need for the intensive intervention taken with my first? Despite objections, my waters were manually broken, pitocin was administered in IV upon admittance after I'd only been in labor 30 minutes. I was monitored the whole time and not allowed to leave my bed. After having my son in a hospital at the tender age of 20 and having no one listen to any of my concerns, this was the only place I would choose to have my baby. I am lucky to have uncomplicated pregnancies/births. I realize that anything can go wrong, and made an emergency plan. My midwife was certified as a nurse and had attended over 1500 births. My doula was a registered EMT. What could a doctor have done that these women could not? My entire pregnancy - all the tests, check ups and birth cost $5,000, not a penny of which was covered by health insurance. Some how a $20,000, possibly unnecessary cesarean is better, more educated, more justified? This is foolish. Human beings are not sardines. Every birth is different, just as every child and parent. Each should be evaluated on an individual basis. My freedom to birth as I choose is very important to me. This freedom should never be withheld from any woman.

  • Posted By: Amy TuteurMD @ 02/27/2008 9:51:01 PM

    Comment: "Why is it that the US has such dismal infant mortality rates? "

    Why is it that homebirth advocates always mention infant mortality when infant mortality is the wrong statistic. Infant mortality is deaths from birth to 1 year of age. The correct statistic to evaluate obstetric care is perinatal mortality, death from 28 weeks of pregnancy to 28 days of life. According to the World Health Organization 2006 report on perinatal mortality, the US has one of the lowest perinatal mortality rates in the world, lower than Denmark, the UK and the Netherlands.

    • Posted By: Kiersten @ 03/03/2008 14:08:22

      Comment: You are right in one respect Amy. Perinatal mortality is the correct statistic to evaluate obstetric care. However, I believe you have cited your statistics incorrectly. The WHO 2006 report on perinatal mortality (which analyzes data from 2000) has a regional breakdown which shows Western Europe with a perinatal mortality rate of 6% and Northern America (Canada and USA) with a 7% perinatal mortality rate. Western Europe also comes in ahead of Northern America with lower rates of early neonatal (0-6 days after birth) and neonatal (0-28 days after birth) mortality.

      The WHO updated this report in 2007: "Neonatal and Perinatal Mortality--Country, Regional and Global estimates 2004." This time they did do a country by country breakdown, and among 13 comparable developed countries (Canada and most of Western Europe) the United States ranks 11th in overall perinatal, stillbirth, and neonatal mortality at 4.5%. Yes, the UK and Ireland do slightly worse, the Netherlands does slightly better at 4.25% but Denmark does considerably better at 3.25%. Canada is at 3.75% and they require that midwifery practices include homebirth services. The United States is dead last in terms of early neonatal deaths at 4%; the other 12 countries are between 1 and 3%.

      These rates are certainly the lowest in the world, with a range from 2.25% (Iceland) to 5.5% (Ireland). Considering that the USA comes in 11th in perinatal mortality and 13th in early-neonatal mortality (which also has a bearing on obstetrics) it could serve us to take a look at why.

      The 13 countries in order of rank are: Iceland, Norway, Belgium, Sweden, Denmark, Switzerland, Canada, France, Germany, Netherlands, USA, United Kingdom, and Ireland.

      All of these countries (other than the US) have nationalized health care systems, and one of the leading factors in reducing perinatal and neonatal death is ensuring the health of the mother, including her health at time of conception, throughout pregnancy, and having a skilled attendant during childbirth. These countries also have a larger percentage of midwife attended births and many have integrated home birth into their health system rather than ostracizing or marginalizing it.

      By trying to make home birth illegal, or refusing to license and regulate Certified Professional Midwives we create a break in our health care system which does indeed create a level of danger for a home birth situation. If CPM's are licensed, regulated, and granted admitting privileges at hospitals at hospitals with emergency and neonatal intensive care units than the risks of home births will virtually vanish.

      CPM's are trained in neonatal resuscitation, and in newborn stabilization and care, they're also trained in ways to stop or at least slow maternal hemorrhage--when they are licensed, regulated, and integrated into the health care and hospital system then a transfer to hospital in the very rare emergency can be smooth and life-saving.

      • Posted By: bobpine2@yahoo.com @ 03/05/2008 14:19:35

        Comment: (continued ??? neonate resus -- from last)
        Even worse, research shows that incredible inexperience will mean they will have a high death rate. But, I???m sure they will claim the baby was stillborn, 18 weeks, whatever to cover it up.

        ???Ten percent of all newborns require resuscitation at birth. The Neonatal Resuscitation Program establishes the authoritative technique of newborn resuscitation. Errors continue to occur that are related to the use of ****unskilled resuscitators****???

        (From the article _Pitfalls in Neonatal Resuscitation_

        Found at:
        http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B75HV-4FPWX39-8&_user=949101&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000049115&_version=1&_urlVersion=0&_userid=949101&md5=5f59a6517e5521f5e9b76856c85127c4)

        FYI Intubation is darned hard and intubation of an infant is one of the most difficult procedures in medicine. There is difficulty and delay for those who do it all day every day. How do you think a non-medical person who had done it once on a doll would do?

        ???Fifteen infants were successfully intubated on each of the first and second attempts, 10 on the third attempt, and 10 required more than 3 attempts???

        (From the article _Duration of Intubation Attempts During Neonatal Resuscitations_

        http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WKR-4CSCVC5-16&_user=949101&_origUdi=B75HV-4FPWX39-8&_fmt=high&_coverDate=07%2F31%2F2004&_rdoc=1&_orig=article&_acct=C000049115&_version=1&_urlVersion=0&_userid=949101&md5=630ddce28b787fc73bc86f88406c0ca8)

        This is what I mean by the façade of medical back-up and expertise (medical or non). These women are taking advantage of pregnant moms by pretending they can provide care they can???t. They get away with it because, in most cases, the birth is normal anyway.

        If your baby is in trouble, they will fumble around with equipment that they have never used before on a human while your baby is deprived of oxygen. They will become brain damaged or die. Their ???training??? is no more than you got a merit badge for in the Girl Scouts. It???s about the same as the Red Cross first aid class. These ???midwives??? are selling snake oil -- at our expense.
        Enter Your Comment

      • Posted By: bobpine2@yahoo.com @ 03/05/2008 14:19:12

        Comment: <<CPM's are trained in neonatal resuscitation>>

        That???s great. A midwife can save any DOLL you give birth to that has a problem. You don???t bother to mention that ???training??? still means they have never successfully done one on a live human. You want hide from pregnant women how little skill (and effectiveness) your word ???training??? means.

        ???Neonatal resuscitation is a mandatory skill for healthcare professionals involved in maternity suites. For ethical reasons, it is ***impossible to teach and practice airway management skills on neonates****, and manikins are used for this purpose???

        (From the article _Training for Neonatal Resusitation with the Laryngeal Mask Airway: A Comparison of the LMA-ProSeal and the LMA-Classic in an Airway Management Manikin_

        Found at:

        http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WKR-4CSCVC5-16&_user=949101&_origUdi=B75HV-4FPWX39-8&_fmt=high&_coverDate=07%2F31%2F2004&_rdoc=1&_orig=article&_acct=C000049115&_version=1&_urlVersion=0&_userid=949101&md5=630ddce28b787fc73bc86f88406c0ca8)

        (continued ???neonate resus- next screen)

      • Posted By: bobpine2@yahoo.com @ 03/05/2008 11:42:34

        Comment: More on international comparisons of perinatal mortality.
        http://links.jstor.org/sici?sici=0025-7079(199801)36%3A1%3C54%3ATPMRAA%3E2.0.CO%3B2-7

        The Perinatal Mortality Rate as an Indicator of Quality of Care in International Comparisons
        Jan H. Richardus, Wilco C. Graafmans, S. Pauline Verloove-Vanhorick, Johan P. Mackenbach
        Medical Care, Vol. 36, No. 1 (Jan., 1998), pp. 54-66
        This article consists of 13 page(s).
        Abstract
        The perinatal mortality rate is used as an indicator of the quality of antenatal and perinatal care, yet uncritical application of this indicator in international comparisons can be misleading. The perinatal mortality rate depends on a number of factors and important determinants that need to be assessed separately before reaching conclusions about quality-of-care issues. This article provides a conceptual model of the construction of the perinatal mortality rate. It illustrates the relationship between quality of antenatal and perinatal care and risk factors for perinatal mortality and how these lead to the perinatal mortality rate. It also indicates how differences in registration procedures and practices influence the final mortality figures published by individual countries. For international comparison, the first step is to apply common definitions. The rate can vary by 50% depending on the definition used. Also, sources of registration bias need to be examined, because they differ considerably by country. Underregistration is known to be as high as 20% of perinatal deaths. The next step is to correct perinatal mortality figures according to differences in known risk factors. The perinatal mortality rate then can serve as a reasonable indicator for the quality of antenatal and perinatal care. In western countries, perinatal mortality could be reduced by as much as 25% with improved standards of care. Policies and practices in individual countries concerning ethical issues related to termination of pregnancy and care of newborn infants with (very) poor prognosis need to be taken into account as well. They are not related to quality of care, but do have a relatively large impact on the perinatal mortality rate

      • Posted By: bobpine2@yahoo.com @ 03/05/2008 11:17:27

        Comment: <<The WHO 2006 report on perinatal mortality (which analyzes data from 2000) has a regional breakdown which shows Western Europe with a perinatal mortality rate of 6% and Northern America (Canada and USA) with a 7% perinatal mortality rate. Western Europe also comes in ahead of Northern America with lower rates of early neonatal (0-6 days after birth) and neonatal (0-28 days after birth) mortality.>>


        Apparently, you cut class when the flaws with this position were revealed, previously. Or perhaps, you want to ???lower perinatal mortality??? they way most midwives do ??? the baby dies? Run out the room and don???t count them as yours. Lie and say the baby was much earlier gesational age than s/he was ??? a miscarriage really.

        For your information and edification, saving babies born at less than 28 weeks is a good thing, even if it fails sometimes and raises the mortality rate for trying. Europe and other western countries are light years behind the US in saving early preemies. Our miracle babies are their miscarriages. Killing early preemies and not counting them is NOT a good way to lower your perinatal death rate either.

        Killing and pretending like they didn???t matter is sick and callous.

        http://en.wikipedia.org/wiki/Perinatal_mortality


        ???Thus the WHO ???s definition "Deaths occurring during late pregnancy (at 22 completed weeks gestation and over), during childbirth and up to seven completed days of life" is not universally accepted.??? (the US counts down to 20 weeks and 500 grams)

        ???In some definitions of the PNM early fetal mortality (week 20-27 gestation) is not included, and the PNM may only include late fetal death and neonatal death.???

        ???Comparisons between different rates may be hampered by varying definitions, registration bias, and differences in the underlying risks of the populations.???


        And by the way, what is the honest to god, no BS, no cover up perinatal death rate with these lay birth attendants?

    • Posted By: jondaley @ 03/03/2008 09:04:33

      Comment: Don't forget that Amy isn't really a doctor (licensed or otherwise), and that MD doesn't stand for what you think it does. Or if she is, she hasn't ever replied to a comment that stated she wasn't. Maybe this will be the first time.

      Somehow, she thinks that putting herself out as a doctor is better than those she accuses of putting themselves out as midwives.

    • Posted By: bobpine2@yahoo.com @ 02/28/2008 10:58:38

      Comment: DISCLAIMER: The fact that I am agreeing here does NOT mean I don't think Amy is a crackpot.

      But, she's right. Knowing so little so you kill the babies in utero/intrapartum is NOT a good way to reduce your neonatal death rate. You guys are very sick, self-centered, and callous individuals.

      http://en.wikipedia.org/wiki/Perinatal_death

      And within this article it reveals a bigger problem with your conclsion

      "Comparisons between different rates may be hampered by varying definitions, registration bias, and differences in the underlying risks of the populations."




      http://en.wikipedia.org/wiki/Perinatal_death

  • Posted By: kathryn raynes @ 02/27/2008 8:56:21 PM

    Comment: Why is it that the US has such dismal infant mortality rates? We rank 180 out of 221 countries according to the CIA's World Fact Book. (https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html). Gee, could it be that obstriticians are not on the right track in the US. The more they try to fix the problem of pregnancy and birth the worse things get for mothers and babies. Why are we not outraged by the inadequecy of our medical model of birth?!!! Why not look at another alternative? And, CPMs are NOT Traditional Birth Attendants and are highly trained in normal birth. How much training in normal birth does a doc get? How many unmedicated births do docs get to see in their training. Lets stop blaming homebirth midwives for the mistakes of the medical community. Normal birth is NOT a medical event!!!

    • Posted By: bobpine2@yahoo.com @ 02/28/2008 11:09:21

      Comment: Your comments are unsubstantied and/or defy common sense.

      <<And, CPMs are NOT Traditional Birth Attendants and are highly trained in normal birth.>>

      This is laughable. If it is a normal birth, there isn't that much to know or do. How can someone be "highly trained" in something normal and common!!!

      No one has answered, after numerous requests, what do these women know or do that is so special? Or like some OBs are you acting like the average pregnant women is incompentent to make her own decisions? W e have nine months but we are so bad that we can't learn it too? But this housewife, who was earning extra money selling Mary Kay before, knows so much know.

      <<How much training in normal birth does a doc get? How many unmedicated births do docs get to see in their training.>>

      Why does anybody need extensive training in something so simple and straightforward??

      You guys (gals really) keep talking out of both sides of your mouths.

      If you are safe enough to do it at home, why aren't you safe enough to do it by yourself?

      The reality is your "lay midwife" model offers so little as to be the same freebirthing. Many many low risk women can do this successfully --- without you.

      What's the difference between freebirthing and certified midwives? About $800.

      • Posted By: acupx4all @ 03/22/2008 11:24:52

        Comment: You know, you make absolutely no sense whatsoever. You should get down off your high horse and open your eyes. *Somehow*, humans have managed to survive for a VERY LONG TIME, most of wich we didn't have this technology that we are so enraptured with. CPMs are trained to deliver a high standard of CARE for the laboring woman- which means physical and emotional support, knowledge of the many different ways labor can progress, and the confidence and assurance to help women to know that, barring any emergencies, she is capable of birthing her baby WITHOUT intervention. MD's have little training in this, and even less actual experience. OBs RARELY, if ever, get to see a natural, non-intervention birth. Even when they do, there is still often an unacceptable amount of intervention that they don't even acknowledge- continuous fetal monitoring, IV drips, PITOCIN. I feel far safer putting my trust in a well-educated, sensitive, caring person who has literally tens of thousands of hours of experience in helping laboring moms than some OB who has basically no comparable experience.

      • Posted By: jondaley @ 03/03/2008 09:02:41

        Comment: What's the difference between a lay-midwife and an unattended birth in my case? The experience of over 2000 births. (By my averaging, that adds up to somewhere around 20 to 30 thousand hours of experience with women and babies, not counting post-natal visits too). The doctors I have talked to don't have anywhere near that much experience.



        • Posted By: bobpine2@yahoo.com @ 03/05/2008 10:51:56

          Comment: <<What's the difference between a lay-midwife and an unattended birth in my case? The experience of over 2000 births.>>

          I think you have a couple extra zeros in there. It's 20, 2-0, TWENTY. Can't you get that by watching The Learning Channel? If they even do 20, as there's admonishments on their website not to claim births one didn't really observe, which suggests there has been a problem. (I had to look it up since everyone evaded the issue when asked).

          And I ask AGAIN, what do they "learn" by watching a bunch of normal births? What does this lead this supposed midwife to be able to DO that is different that makes a difference in the future?

          If a baby pops out normally, they do that whether or not a lay midwife is watching. Saying breathe, pus,turn is something a doula or a dad can do and doesn't make much difference either.

  • Posted By: Happy Homebirther @ 02/27/2008 5:54:31 PM

    Comment: In my opinion, deciding which risks to take in childbirth is up to each individual family. If family A chooses to have an elective cesarean, fine. If family B chooses to have a homebirth, fine. Each decision has both benefits and risks. Research, statistics, and safety do not account for the RIGHT of each family to make a decision based on their personal belief system. It is not up to the doctor, the government, or any type of advocate to make up someone else's mind.
    There is an extremely large volume of information available on this subject to anyone who takes the time to look at it. Ultimately, each family will decide based upon their own values, interpretation of the facts, and most likely from friends' and family members' experiences. They will then have to take responsibility for the outcome of said decision. Responsibility is the keyword here. Each person is responsible for him/herself. Not the doctor, the Midwife, or anyone else. We each have to make our own decisions. Unfortunately, the majority of Americans do not accept responsibility for their own healthcare, but instead take whatever advice is given and then lay blame wherever they can when a negative outcome occurs.
    In choosing my pregnancy care provider, I relied on my instincts, interviews with numerous personnel, personal experiences, beliefs, and values, as well as extensive reading and researching. I chose the person who best fit with my wishes and weighed the benefits and risks of each prenatal decision. I acknowledged that each decision had an effect on both my child and myself, whether good or bad. I understood that I was the only one responsible for making these decisions and therefore, should the outcome be adverse, I could only look to myself for blame. I did not expect my provider to make any decision for me, as it was not her body and her child. Her opinion on my decisions was just that, an opinion. I familiarized myself with the normal birth process, as well as deviations from normal. In short, I took responsibility for the birth I chose, as we all should.

    • Posted By: bobpine2@yahoo.com @ 02/28/2008 10:12:21

      Comment: A group of wannabes don't have a right to demand of the rest of society agree that their amateuristic ambitions are a profession worthy of licensing.

      As a society we have decided to license many, many functions because we realize we can't possibly master everything and would be inefficient. We license professions ONLY when those people are mastering a large amount of highly specialized skills and knowledge that is outside the average person's. We regulate them so that the public can relie on their claims of special compentencies.

      This midwife group is trying to hijack licensing and force the state and their communities to inappropriately declare them as profession having special knowledge and skills. They don't. As you rightly point out, information is everywhere. They don't know anything that a very interested and inquisitive pregnant mom can't look up. They don't know how to do anything a husband or a sister can't learn how to do.

      The reason they want licensing -- MONEY. Licensing would artificially inflate the public's perception of their know-how and skills. If these women want to believe they have something special to offer, that's fine. But, they need to stop denying their communities RIGHTS not to agree with them.

  • Posted By: bobpine2@yahoo.com @ 02/27/2008 2:49:30 PM

    Comment: Clearly, Bacteria don't respect women's choices,, are trying to undermine midwives, and monopolizing birth.

    1: Health Policy Plan. 2000 Dec;15(4):394-9. Links
    Training traditional birth attendants in clean delivery does not prevent postpartum infection.Goodburn EA, Chowdhury M, Gazi R, Marshall T, Graham W.
    Centre for Sexual and Reproductive Health, John Snow Inc., London, UK.

    OBJECTIVE: To compare the maternal outcome, in terms of postpartum infection, of deliveries conducted by trained traditional birth attendants (TBAs) with those conducted by untrained birth attendants. METHODS: The study took place in a rural area of Bangladesh where a local NGO (BRAC) had previously undertaken TBA training. Demographic surveillance in the study site allowed the systematic identification of pregnant women. Pregnant women were recruited continuously over a period of 18 months. Data on the delivery circumstances were collected shortly after delivery while data on postpartum morbidity were collected prospectively at 2 and 6 weeks. All women with complete records who had delivered at home with a non-formal birth attendant (800) were included in the analysis. The intervention investigated was TBA training in hygienic delivery comprising the 'three cleans' (hand-washing with soap, clean cord care, clean surface). The key outcome measure was maternal postpartum genital tract infection diagnosed by a symptom complex of any two out of three symptoms: foul discharge, fever, lower abdominal pain. RESULTS: Trained TBAs were significantly more likely to practice hygienic delivery than untrained TBAs (45.0 vs. 19.3%, p < 0.0001). However, no significant difference in levels of postpartum infection was found when deliveries by trained TBAs and untrained TBAs were compared. The practice of hygienic delivery itself also had no significant effect on postpartum infection. Logistic regression models confirmed that TBA training and hygienic delivery had no independent effect on postpartum outcome. Other factors, such as pre-existing infection, long labour and insertion of hands into the vagina were found to be highly significant. CONCLUSIONS: Trained TBAs are more likely to practice hygienic delivery than those that are untrained. However, hygienic delivery practices do not prevent postpartum infection in this community. Training TBAs to wash their hands is not an effective strategy to prevent maternal postpartum infection. More rigorous evaluation is needed, not only of TBA training programmes as a whole, but also of the effectiveness of the individual components of the training.

    PMID: 11124242 [PubMed - indexed for MEDLINE]

  • Posted By: bobpine2@yahoo.com @ 02/27/2008 2:40:39 PM

    Comment: Take a look ahead at the step backwards you all are advocating. If it becomes widespread, this is what we will start to see. I am astounded by the indifference, if not outright callousness of this midwife lobbying group. Some women and babies have serious problems. But since you didn't you don't care.

    This is like a bunch of people driving down the freeway past a terrible car wreck. Since the vast majority doesn't need a doctor in their cars, they don't care that one guy bleeding out on the roadside desperately does.

    1: Bull World Health Organ. 2007 Oct;85(10):783-90. Links
    Are skilled birth attendants really skilled? A measurement method, some disturbing results and a potential way forward.Harvey SA, Blandón YC, McCaw-Binns A, Sandino I, Urbina L, Rodríguez C, Gómez I, Ayabaca P, Djibrina S; Nicaraguan Maternal and Neonatal Health Quality Improvement Group.
    Quality Assurance Project, University Research Co LLC, Bethesda, MD 20814, USA. sharvey@urc-chs.com

    OBJECTIVE: Delivery by a skilled birth attendant (SBA) serves as an indicator of progress towards reducing maternal mortality worldwide -- the fifth Millennium Development Goal. Though WHO tracks the proportion of women delivered by SBAs, ***we know little about their competence to manage common life-threatening obstetric complications.*** We assessed SBA competence in five high maternal mortality settings as a basis for initiating quality improvement. METHODS: The WHO Integrated Management of Pregnancy and Childbirth (IMPAC) guidelines served as our competency standard. Evaluation included a written knowledge test, partograph (used to record all observations of a woman in labour) case studies and assessment of procedures demonstrated on anatomical models at five skills stations. We tested a purposive sample of 166 SBAs in Benin, Ecuador, Jamaica and Rwanda (Phase I). These initial results were used to refine the instruments, which were then used to evaluate 1358 SBAs throughout Nicaragua (Phase II). FINDINGS: On average, Phase I participants were correct for 56% of the knowledge questions and 48% of the skills steps. Phase II participants were correct for 62% of the knowledge questions. Their average skills scores by area were: active management of the third stage of labour -- 46%; manual removal of placenta -- 52%; bimanual uterine compression -- 46%; immediate newborn care -- 71%; and neonatal resuscitation -- 55%. CONCLUSION: ***There is a wide gap between current evidence-based standards and provider competence to manage selected obstetric and neonatal complications.**** We discuss the significance of that gap, suggest approaches to close it and describe briefly current efforts to do so in Ecuador, Nicaragua and Niger.

  • Posted By: bobpine2@yahoo.com @ 02/27/2008 2:36:03 PM

    Comment: Take a look ahead at the step backwards you all are advocating. If it becomes widespread, this is what we will start to see. I am astounded by the indifference, if not outright callousness of this midwife lobbying group. Some women and babies have serious problems. But since you didn't you don't care.

    This is like a bunch of people driving down the freeway past a terrible car wreck. Since the vast majority doesn't need a doctor in their cars, they don't care that one guy bleeding out on the roadside desperately does.

    1: Bull World Health Organ. 2007 Oct;85(10):783-90. Links
    Are skilled birth attendants really skilled? A measurement method, some disturbing results and a potential way forward.Harvey SA, Blandón YC, McCaw-Binns A, Sandino I, Urbina L, Rodríguez C, Gómez I, Ayabaca P, Djibrina S; Nicaraguan Maternal and Neonatal Health Quality Improvement Group.
    Quality Assurance Project, University Research Co LLC, Bethesda, MD 20814, USA. sharvey@urc-chs.com

    OBJECTIVE: Delivery by a skilled birth attendant (SBA) serves as an indicator of progress towards reducing maternal mortality worldwide -- the fifth Millennium Development Goal. Though WHO tracks the proportion of women delivered by SBAs, ***we know little about their competence to manage common life-threatening obstetric complications.*** We assessed SBA competence in five high maternal mortality settings as a basis for initiating quality improvement. METHODS: The WHO Integrated Management of Pregnancy and Childbirth (IMPAC) guidelines served as our competency standard. Evaluation included a written knowledge test, partograph (used to record all observations of a woman in labour) case studies and assessment of procedures demonstrated on anatomical models at five skills stations. We tested a purposive sample of 166 SBAs in Benin, Ecuador, Jamaica and Rwanda (Phase I). These initial results were used to refine the instruments, which were then used to evaluate 1358 SBAs throughout Nicaragua (Phase II). FINDINGS: On average, Phase I participants were correct for 56% of the knowledge questions and 48% of the skills steps. Phase II participants were correct for 62% of the knowledge questions. Their average skills scores by area were: active management of the third stage of labour -- 46%; manual removal of placenta -- 52%; bimanual uterine compression -- 46%; immediate newborn care -- 71%; and neonatal resuscitation -- 55%. CONCLUSION: ***There is a wide gap between current evidence-based standards and provider competence to manage selected obstetric and neonatal complications.**** We discuss the significance of that gap, suggest approaches to close it and describe briefly current efforts to do so in Ecuador, Nicaragua and Niger.

  • Posted By: Fatherof10 @ 02/27/2008 11:54:47 AM

    Comment: The point for me is that we are supposed to live in a "free country" so why can my wife and I not be "free" to choose where and how we want to birth our children. Abortion activist talk about "It's a choice" so why can we not have a choice as to who attends us in childbirth. These are children we actually want, love, and desire. We live in Missouri and pray that our Legislature listens to us when we tell them this is what we want. Dr. Amy NEEDS to attend a home birth just to get a glimpse of what childbirth should really be like. We have chosen homebirh for the last 17 years not as a "trend" but as a way to protect the mother and child from all the unwanted indignities forced upon an unsuspecting participant who signs "consent for care" when one enters their doors.

    • Posted By: pap smear @ 02/28/2008 00:37:34

      Comment: We do live in a free country and you are free to have a homebirth.
      What is happening in Missouri is that you are asking the legislature to license CPMs, and you are not asking to "license" homebirth.

      CPMs are asking for a license to practice independantly and autonomously and to care for 2 patients simultanously. They are asking for this while only having 20 deliveries in their training. This is not adequate to recognize the many situations which are high risk and that they should not handle.

      We do live in a free country. you are free to have a homebirth.

      • Posted By: Fatherof10 @ 03/01/2008 09:54:26

        Comment: Yes, we know home birth is legal. It is just illegal to ask for trained help!! So our choice is to birth at home alone, without any knowledgeable help, or to subject the mother and child to the control of the medical "system" and all its indignities whether you want them or not.

  • Posted By: Fatherof10 @ 02/27/2008 11:39:28 AM

    Comment: The point for me is that we are supposed to live in a "free country" so why can my wife and I not be "free" to choose where and how we want to birth our children. Abortion activist talk about "It's a choice" so why can we not have a choice as to who attends us in childbirth. These are children we actually want, love, and desire. We live in Missouri and pray that our Legislature listens to us when we tell them this is what we want. Dr. Amy NEEDS to attend a home birth just to get a glimpse of what childbirth should really be like. We have chosen homebirh for the last 17 years not as a "trend" but as a way to protect the mother and child from all the unwanted indignities forced upon an unsuspecting participant who signs "consent for care" when one enters their doors.

  • Posted By: jpru @ 02/27/2008 11:34:56 AM

    Comment: I made the decision to have homebirths with both of my children with a Certified Professional Midwife because of the large amount of studies I easily found on reliable web sites and in unbiased books. There is also an overwhelming amount of information from European countries that support homebirth with a midwife whose training is equivalent to CPMs. My first birth would have definitely been an unnecessary C-section if I had been in a hopsital and my second baby would have spent weeks in the NICU if I had chosen hospital birth.

  • Posted By: jpru @ 02/27/2008 11:30:49 AM

    Comment: I made the decision to have homebirths with both of my children with a Certified Professional Midwife because of the large amount of studies I easily found on reliable web sites and in unbiased books. There is also an overwhelming amount of information from European countries that support homebirth with a midwife whose training is equivalent to CPMs. My first birth would have definitely been an unnecessary C-section if I had been in a hopsital and my second baby would have spent weeks in the NICU if I had chosen hospital birth.

  • Posted By: Beelinn @ 02/27/2008 11:03:44 AM

    Comment: I think it's plain where the motivation for slamming midwives comes from. It all starts with a woman receiving top-notch care from her midwife telling a friend who has had a bad experience from an OB that it doesn't have to be that way. All of a sudden the OB has one less client. If a woman who would prefer a midwife ends up high risk and has to be in an OB's care? All of a sudden that OB has a woman who knows that she wants the best of care, she doesn't want to be rushed out of prenatal appointments, and she doesn't want un-necessary stuff done on her. She questions everything of the OB's way of doing things. From my experience, OB's HATE that. OB's have their way and they expect their way to be respected an followed all in the name of safety. Women who question OB's must not care about their baby is what they say, so they scare you into compliance.
    Someone said in a post that the way is to fix the system, not get away from it. I agree, but I think this is the only way it will get done. If OB's no longer had the monopoly in the big money-maker of babies, they would be forced to change their way of doing things; like causing harm.

    • Posted By: bobpine2@yahoo.com @ 02/27/2008 13:43:11

      Comment: Yeah, OBs are just like midwives, when women dump them for unassisted birth.

      http://www.theglobeandmail.com/servlet/story/RTGAM.20070515.wxlunassisted15/BNStory/lifeFamily/home

      "After using a doula for her first child's home birth, Ms. Becker decided that the job of a good midwife is to "let the process happen," she says. So with George she decided to go solo."

      "When Ms. Boychuk declined the services of a registered midwife during her second pregnancy, the midwife - who questioned the safety of even an attended home birth after a cesarean - promptly called the Children's Aid Society."

  • Posted By: Amy TuteurMD @ 02/27/2008 7:01:51 AM

    Comment: "The 2000 BMJ data was collected by the authors of the study, Ken Johnson and Betty Anne Daviss. After collection, it took an expected five years for the data to be analyzed and published in a reputable journal."

    You don't seem to understand. The data is ALREADY available. It is just not available to the public. It is only available to midwifery organizations who can prove they will use it for "the advancement" of midwifery. Even then, the people who will see the data must sign a legal non-disclosure agreement preventing them from revealing the data to anyone else.

    Moreover, it did not take 5 years to analyze the data. According to the NARM (North American Registry of Midwives) Bulletin in January 2001, Johnson and Daviss were publicly presenting the data to other homebirth advocates and using it to lobby members of the American Public Health Association to pass a resolution supporting homebirth. That's LESS THAN A MONTH after full data collection was complete.

    Johnson and Daviss are not independent researchers, either. Johnson is the former Director of Research for the Midwives Alliance of North America (MANA), and Daviss, his wife, is a homebirth midwife. NARM was intimately involved in the creation of the study and enforced the participation of the midwives. The project was funded with money from a homebirth advocacy foundation.

    The same data has been collected in the same way every year since 2000. Not only has none of it been published, none of it is available to the public. It will only be released to persons who promise to use it for "the benefit of midwifery" and who sign a legal confidentiality requirement that prohibits them from sharing the data with anyone else. This strongly suggests that the existing data shows that homebirth is not as safe as hospital birth and that's why it must be suppressed.

  • Posted By: IVD @ 02/27/2008 12:19:33 AM

    Comment: from Amy Tudor: <<MANA is already collecting statistics on all CPMs and has been since 2000. The 2000 MANA data was the basis for the BMJ study. The data from 2001-2007, which is probably the largest existing database on homebirth, is being withheld from the public. >>

    The 2000 BMJ data was collected by the authors of the study, Ken Johnson and Betty Anne Daviss. After collection, it took an expected five years for the data to be analyzed and published in a reputable journal. The new MANA web-based data collection system began in 2004 collecting raw data from participating midwives (CPMs, CNMs, and non-credentialed midwives). To publish research using that data, professional researchers must submit proposals to the Institutional Review Board. Raw data is released to the participating midwives and to participating state groups (which is why some states may publish their results). Otherwise, raw data for analysis and publication is only released to qualified researchers who have applied through proper channels.
    Certified Professional Midwives have done an excellent job, evidenced both by the research cited in the British Medical Journal and also by the 22 state agencies that license CPMs in the US. Each year, more state legislatures recognize the benefits to their citizens of licensing Certified Professional Midwives to attend home births. Not only are outcomes equally as good for low-risk mothers whether birthing at home or in a hospital, but the lower rate of intervention in home births is safer for the mother and baby, and much more economical for those paying the tab. It is difficult to understand why any state legislature would continue to impose the higher risks of mandatory hospital birth on citizens who would prefer a natural, safer, home birth with a trained midwife.

  • Posted By: bobpine2@yahoo.com @ 02/26/2008 11:35:53 PM

    Comment: <<Maybe it's not so ironic that here we are, 35 years later, fighting for the right to give birth in our own homes with the provider of our choice, in spite of the fact that this is the option that has kept humanity going and growing for all but the last 80 years of its existence.>>

    S'Yeah.right. It kept us going...at a fraction of the planet's current population, because so many women and kids died. It kept us going... when, like my granma, women had over a dozen kids a piece so humans kept going even though we lost several of them. It kept us going....even though a lot of women didn't. Childbirth was to women what war was to men. Something that claimed a lot of young lives. And you didn't need abortion. Infanticide was quietly acceptable for any babies less than perfect. Simply unwanted ones could be abandoned at will.

    Doncha miss the Good Ol Days.

  • Posted By: goairforcefalcons @ 02/26/2008 8:01:06 PM

    Comment: Funny how a procedure with a 100% mortality rate got legalized in 1973. It was argued that abortions were happening illegally, and legalizing them would make them "safer." Maybe it's not so ironic that here we are, 35 years later, fighting for the right to give birth in our own homes with the provider of our choice, in spite of the fact that this is the option that has kept humanity going and growing for all but the last 80 years of its existence.

  • Posted By: goairforcefalcons @ 02/26/2008 7:54:50 PM

    Comment: Funny how a procedure with a 100% mortality rate got legalized in 1973. It was argued that abortions were happening illegally, and legalizing them would make them "safer." Maybe it's not so ironic that here we are, 35 years later, fighting for the right to give birth in our own homes with the provider of our choice, in spite of the fact that this is the option that has kept humanity going and growing for all but the last 80 years of its existence.

  • Posted By: kprown @ 02/26/2008 2:15:10 PM

    Comment: Russ is correct. The BMJ study published in 2000 includes only deliveries by CPMs, who had to participate as a condition of recertification under the North American Registry of Midwives. The MANA statistical project, which is ongoing, includes CNMs, CPMs and non-CPM midwives who deliver babies at home.

  • Posted By: Midhusband @ 02/26/2008 12:53:24 PM

    Comment: Thank you, Newsweek, for calling attention to this important issue.

    For women who choose to birth out of hospital, it is critical that they have trained midwives to attend them. The national standard for home birth midwives is the Certified Professional Midwife (CPM). The CPM credential is accredited by the same organizations that accredit the Certified Nurse Midwife credential. For many years, numerous states have been licensing and regulating CPMs.

    The key problems that need to be addressed in many states around the US are 1) maternal health, 2) access to maternity care and 3) cost of care. Advancing the Midwives Model of Care in all settings is a sensible step toward making improvements. Confining women to the hospital will not solve our problems, particularly as more and more hospitals are closing their maternity wards.

    In response to the previous technical discussion, the appropriate analysis basis reference for safety of planned home birth attended by a CPM is the CPM2000 study which confirms outcomes equivalent to hospital for healthy women experiencing normal pregnancies.

    Russ

    • Posted By: pap smear @ 02/28/2008 00:44:50

      Comment: Russ:
      You are confused as to what the BMJ study showed. It did not confirm equivalent outcomes to hospital for healthy women experiencing normal pregnancy. it did reveal that CPMs doing homebirth had 3 x the neonatal mortality that a normal Low risk population experienced. Johnson and Daviss even admitted on their web site that the did not correctly compare their CPM group.
      Good to see you again, Russ.

  • Posted By: Amy TuteurMD @ 02/26/2008 12:33:11 PM

    Comment: katie prown:

    "168 babies were delivered by CPMs, while 29 were delivered at home by CNMs, with zero deaths in either group."

    You need to provide a reference for that data. As far as I know, there is no published reference.

    Is this part of the dataset that MANA is offering to midwives, but refuses to release to the public? Where else could you possibly be getting unpublished CPM statistics? If so, we can presume that you are quoting the unpublished data for 2000 because the years 2001-2007 show unacceptably high levels of neonatal mortality. That's precisely why MANA is refusing to release their data. They are sitting on what is probably the largest database of homebirth with a CPM (approximately 30,000 births) and almost certainly shows definitively that homebirth with a CPM has an excess risk of neonatal death.

    Why aren't homebirth midwives and homebirth advocates honest with women about the risks?

  • Posted By: Leahtrabue @ 02/26/2008 12:27:27 PM

    Comment: I am so pleased to see an article about CPMs. It is a great idea to use the CPM as the national credentialing standard to provide women who are choosing homebirth with safe, qualified care providers. It's amazing as advanced as the US is that we are so far behind on safe, relevant and benevolent maternity care...

  • Posted By: kprown @ 02/26/2008 12:16:20 PM

    Comment: In the year 2000 in Wisconsin???again, the only year for which we have data to distinguish among CPMs, ???Other Midwives??? and ???Other??????168 babies were delivered by CPMs, while 29 were delivered at home by CNMs, with zero deaths in either group.

    373 babies were delivered at home by ???Other Midwives,??? a category that includes planned unassisted births as well as births managed by non-CPM midwives. There were 2 deaths in that group.

    264 babies were delivered at home by ???Other,??? a category that also includes planned and unplanned births with no attendant present, as well as births managed by non-CPM midwives. There were 3 deaths in that group.

    Yes, the numbers are small, small enough that we could reasonably expect to see no neonatal deaths in any of the categories. Nevertheless, of the 637 babies delivered at home by non-CPM midwives and lay people in the year 2000 in Wisconsin, there were 5 deaths.

    It???s precisely because I care about the safety of mothers and babies that I???ve been working to promote CPM licensure???as a volunteer, I might add. And for the record, I???m not a midwife myself.

    Regardless of what the medical lobby has to say about it, families in every state will continue to choose home birth, very often for religious, cultural or financial reasons (the majority of CPM patients in the year 2000 were on Medicaid or uninsured). These families deserve access to licensed and regulated providers whose education and training qualifies them as specialists in safe out-of-hospital maternity care.

    Without state licensure that requires out-of-hospital midwives to meet national credentialing standards and to follow national standards of care, anyone can claim to be a midwife, and families have to take it on faith that their midwife is appropriately educated and trained to deliver babies at home. I think most people would agree that mothers and babies deserve better than that.

  • Posted By: bobpine2@yahoo.com @ 02/25/2008 1:56:10 PM

    Comment: <<And in the year 2000 in Wisconsin, CPMs had a neonatal mortality rate of zero, while "Other Midwives" had a neonatal mortality rate of 11.83 per thousand.>>

    Do you know what people with perfect data are called in science? Fakers. No one has a death rate of zero. Either you don't have a large enough sample or people are not reporting things accurately as you allude to in the rest of the post.

    More importantly, it is perinatal death rates, not neonatal that are important in assessing birth options. Do you even know the difference without googling it? If lay midwives have problems, they probably won't be able to get the child out in time and it will be recorded as a stillbirth. Take a few more that are born live and but they don't have a a clue as to what to do, but just call them stillborn. Pretend the CPM wasn't there and deny involvement when there is a death. Poof. Away goes your neonatal death rate.

    The fact you could post these statements and think they actually support your position, to not realize you have holes you can drive a truck through speaks volumes about the complete and udder lack of scientific knowledge of you and your group.

    Again, the more you say, the more it seems like the only "option" is to improve things (read pocketbook) for your members at pregnant women's expense.

    Women and babies lives on the line.

    You don't seem to care one bit. It's not something for my grandma's farm neighbor women to do because it is more interesting than "Welcome to Wal-mart" and lets them buy more Longaberger. It's not something for bored urban/suburban housewives to do when the last kid is in school and there's too many bills.

    When pregnant women are disgusted by the hospital model, the thing to do is fix it. Not give them cheap imitation of what they are trying to get away from.

  • Posted By: bobpine2@yahoo.com @ 02/25/2008 1:31:50 PM

    Comment: Prown <<< paid to promote CPMs

    << The point is that the year 2000 is the only year in which it's possible to distinguish between CPMs and "Other Midwives," a category which does, in fact, include unassisted and unplanned home births, as well as deliveries by non-CPM midwives. >>

    That doesn't address the point. If you are mixing in accidental home deliveries with planned, you do nothing to show these lay people acting a midwife do better than having a friend or relative.

    It seems the only "opportunity" or "option" your group is promoting is the option to take advantage of women's dissatification with hospital maternity wards and rip-them off. I see money for nothing for your members. I see nothing but a false sense of medical back-up for pregnant moms.

    What kind of informed consent do these pregnant women get?

    • Posted By: The Mrs. @ 02/26/2008 12:33:52

      Comment: I don't look at hiring a CPM, the only professional trained in out-of-hospital birth, as "medical back-up." On the contrary, I hire an OB for that. I see my CPM for at least one hour a month in the comfort of my own for preventive care. This includes taking blood pressure, monitoring urine for sugars and proteins, palpation of the uterus, measuring fundal height, and other things a lot of OBs aren't even doing anymore they are so dependent on the Ultrasound technology. I see my OB whenever there's a problem. He knows my plans and fully backs me up if I need a hospital transfer. When I had a problem with blood sugar, my midwife caught it, we made an OB appointment, and he prescribed me a glucose monitor/test strips. The midwife was not unnecessary. She was a vital link to needed medical back-up. I have the best of all possible worlds. I have a wonderful CPM who treats my family and unborn child with respect and our individual personal needs are met. I have a supportive OB who helps me if something happens where I actually need medical attention. And I have my babies at home without augmentation, dangerous germs, uneccessary medical procedures, un-needed drug and IV use, and where my children are treated humanely, instead of as lab specimens, from the time they are conceived until the last postpartum visit at 6 weeks. CPMs have a different job, another calling, they are not a rip-off.

      Oh, and BTW, there is a very involed informed consent that a homebirth family signs, making sure we know just exactly what a CPM is. It states they are NOT medical personnel. Women are not foolish, we are not being taken advantage of. We know what we are doing and so do our midwives.

      • Posted By: bobpine2@yahoo.com @ 02/27/2008 12:51:07

        Comment: <<This includes taking blood pressure, monitoring urine for sugars and proteins, palpation of the uterus, measuring fundal height, and other things a lot of OBs aren't even doing anymore>>

        Freebirthers do all these things themselves. There's home blood pressure cuffs, you can do the urine strips yourself, a tape measure -- I'm sure you can handle that.

        Again, what do we need these people for????? They are the same as no one in particular. It has been pointed out that they often target poor women. Why take their limited money for doing things so simple?

        • Posted By: ChristyR @ 03/01/2008 22:19:47

          Comment: Bob, I'm assuming you are a man? If so, then you haven't experienced natural birth firsthand. You are therefore not aware of the altered state of consciousness that occurs in a labouring mother who is undisturbed. In this altered state, sometimes the mother needs advise/prompting to take measures to correct potential problems (i.e. a needed change of position). This is where an experienced birth attendant comes in. Most women give birth only a few times in their lives. Experienced midwives, on the other hand, witness/assist large numbers of births in their practices. While no two births are exactly the same, said trained midwife will have a well of experience to fall back on in situations that require a bit of 'help.' This homebirthing mama experienced two such 'complications' that were quickly and skillfully handled by my midwife. You're also not taking into account the degree of reassurance most women feel to have the support of an experienced person present at their birth. I'll happily pay for that again a second time around:)

          • Posted By: bobpine2@yahoo.com @ 03/05/2008 14:35:03

            Comment: No, I'm not a man, I'm a mom. I didn't need anyone to tell me to change positions. I personally didn't experience any altered state of consciousness.

            I had someone to help me change positions (if I so desired). I had someone to support me personally. These women are called Doulas. They don't pretend to be able to help you or the baby if something goes wrong. They are what these midwives are, but they are honest, don't risk your life, and don't charge you out the wazoo for what they do.

            You are vague about your own anecdote, but I can imagine what this midwife did that had any basis in fact that made a difference. What "complication" how did she know, what was done? How would you know if she had really done nothing except for show and the baby would have come out just fine without her alleged help? See above (or below given how this board works) my posts about their so-called neonatal resuscitation skills.

            These women are trying to snow us in to putting ours and our babies lives in their hand and fork over a lot of money for nothing.

  • Posted By: Amy TuteurMD @ 02/24/2008 6:00:22 PM

    Comment: katie prown:

    "And in the year 2000 in Wisconsin, CPMs had a neonatal mortality rate of zero, while "Other Midwives" had a neonatal mortality rate of 11.83 per thousand."

    Do you have a citation for that claim?I have never seen any published data that shows that CPMs in Wisconsin had a neonatal death rate of zero in 2000.

    "The fact is, the categories of "Other Midwife" and "Other" are absolutely meaningless,"

    Your backpedaling is not particularly compelling. It was YOU who claimed that we should look at the statistics for Wisconsin as confirmation that homebirth is safe, before you found at that the statistics for Wisconsin showed homebirth to have triple the neonatal death rate of hospital birth.

    Let's take a look at another state you touted: Utah. You don't seem to be familiar with the statistics from that state, either. Utah's statistics also show a higher rate of neonatal death. It is more than triple the expected rate of neonatal death for low risk women in the hospital.

    The state of Utah, as a condition of licensing direct entry midwives, has required that they submit their MANA statistics each year. Statistics collected over the first 18 months since the inception of licensing show a high rate of neonatal death. According to the 2007 report, there have been a total of 225 DEM attended labors and 1 neonatal deaths for a rate of 5/1000.

    Homebirth advocates are routinely dishonest about these bad outcomes. Holly Richardson, the midwife who wrote the Utah reports downplays the neonatal death. She actually asserts that the outcomes were "excellent" and that the " mortality rate for mothers was 0%, for babies 0.5% (1 baby)." A neonatal mortality rate of 5/1000 is not excellent, it is 5 times higher than expected!

    Homebirth advocates cannot be trusted on the issue of safety. You were wrong about Wisconsin, you were wrong about Utah and you are wrong about the safety of homebirth.


  • Posted By: kprown @ 02/24/2008 1:12:02 PM

    Comment: Re: Wisconsin. The point is that the year 2000 is the only year in which it's possible to distinguish between CPMs and "Other Midwives," a category which does, in fact, include unassisted and unplanned home births, as well as deliveries by non-CPM midwives.

    And in the year 2000 in Wisconsin, CPMs had a neonatal mortality rate of zero, while "Other Midwives" had a neonatal mortality rate of 11.83 per thousand.

    The fact is, the categories of "Other Midwife" and "Other" are absolutely meaningless, which is why the Bureau of Vital Statistics is revising them. Many parents who plan to have unassisted births check off "Other Midwife" out of fear of being accused of child endangerment. And plenty of non-CPM midwives, whose numbers have dwindled thanks to our new law, check "Other" out of fear of being arrested for practicing illegally.

    Apples and Oranges. Check back after we've had a few years of birth certificate data that accurately reflects each category of birth attendants responsible for managing out-of-hospital deliveries in Wisconsin.

  • Posted By: bobpine2@yahoo.com @ 02/23/2008 8:52:54 PM

    Comment: >>>Posted By: Amy TuteurMD @ 02/23/2008 4:23:58 PM
    >>Comment: bobpine2:

    >>"Why don't you address the huge rate of preventable maternal deaths in hospitals?"

    >>>Because there is no "huge rate" of preventable maternal deaths in hospitals. Moreover, the most common causes of >>>maternal death are pre-eclampsia and hemorrhage and neither can be successfully managed at home


    oh no, no, no. There's no problem.

    Even though ACOG admits it.
    http://www.acog.org/from_home/publications/press_releases/nr11-30-05-2.cfm
    http://www.medscape.com/viewarticle/520168_3

    Even though the CDC has had a goal of cutting the rate in half.
    http://www.csctulsa.org/images/CDC%20Strategies%20to%20Reduce%20Pregnancy%20Related%20Death%202001.pdf

    Even though the US ranks 41st in maternal mortality rates.
    http://www.msmagazine.com/news/uswirestory.asp?ID=10601


    Or maybe severe hypertension, hemorrhage and the like can't be managed FROM home either (by the doctor). And maybe primary care doctors (like your average OB/GYN) don't do all that much better at managing complex medical emergencies. Maybe both US midwifery and obstetrics are obsolete in the 21st century.

    Moms deserve better than either one.

  • Posted By: bobpine2@yahoo.com @ 02/23/2008 8:38:13 PM

    Comment: :

    "Why don't you address the huge rate of preventable maternal deaths in hospitals?"


    The infamous Amy-without-a-license countered:
    <<Because there is no "huge rate" of preventable maternal deaths in hospitals. Moreover, the most common causes of maternal death are pre-eclampsia and hemorrhage and neither can be successfully managed at home.>>

    No, no, no. There's no problem. Even though ACOG admits it. Even though the CDC has had a goal of cutting the rate in half. Even though the US ranks 41st in maternal mortality rates.

    Or maybe its because severe hypertension, hemorrhage and the like can't be managed FROM home (doctor or patient). And maybe primary care doctors (like your average OB) don't do so well at managing complex medical emergencies. Maybe because the current hospital model for obstetrics is obsolete in the 21st century.

    http://www.acog.org/from_home/publications/press_releases/nr11-30-05-2.cfm
    http://www.medscape.com/viewarticle/520168_3
    http://www.csctulsa.org/images/CDC%20Strategies%20to%20Reduce%20Pregnancy%20Related%20Death%202001.pdf
    http://www.msmagazine.com/news/uswirestory.asp?ID=10601

  • Posted By: bobpine2@yahoo.com @ 02/23/2008 2:53:33 PM

    Comment: Worse still is the lack of training and expertise in the very thing they are there for ??? medical emergencies in pregnancy. Direct entry midwives or CPM are no different than what my grandmother did. She called the farm lady up the road who had 10 kids. Nurse midwives know enough to be dangerous. Women get a false sense of security of medical rescue in an emergency.

    OB/Gyns are primary care doctors. If you have massive bleeding, severe hypertension, or surgery unpregnant, you will get immediate, specialized care from a doctor that deals with that crisis extensively and frequently. If you are a dying pregnant woman, it is amateur hour. An average OB sees ???death???s doorstep??? cases once in a Blue Moon. No where else in medicine are critically ill patients treated by primary care doctors. Life-threats in pregnancy are seen by docs with infrequent exposure to them and inadequate experience with their treatment.

    Women should not have to take risks to avoid unwanted intervention during normal birth.

    We shouldn't have to make choices between terrible alternatives. We need promote the Laborist model. That would be a new specialty where doctors are in house 24/7 in shifts. They are highly trained in only on labor and deliver. They are more practiced and therefore more effective (and most of all AVAILABLE) in emergencies of labor and delivery. A laborist would be LESS likely to do unnecessary interventions and sections because they are more familiar with variations of normal labor and not ordering things to cover their butts when practicing medicine over the phone. Laborist maternity wards would easily allow other birth attendants, natural childbirth and the like for uncomplicated births. But, it gives the skilled, readily accessible emergency back-up that the others promise, but do not (excuse the pun) deliver.

    Moms are People Too. Let's not choose between bad options. Let's demand good ones. Support Laborists as a new specialty and the standard

  • Posted By: bobpine2@yahoo.com @ 02/23/2008 2:52:58 PM

    Comment: The problem is that women have NO good options. Most births are full-term and normal. These are seen as little more than easy money for both doctors and midwives. These women could have unassisted home birth and do just as well. Should you actually need medical help, all groups fail miserably.

    Midwives (lay or nurse) often don't recognize problems and/or overestimate their ability to handle them. Then, there is the delay in getting to a hospital. But hospitals, nurses, and doctors also have similar problems.

    OBs claim that all pregnant women should labor in a hospital because of unforeseeable, sudden emergencies. Yet, in most community hospitals the Obs take call from home, so there???s a huge delay in an emergency there too! OBs manage most of the labor by pre-written protocols and by phone. That coupled with malpractice concerns leads to the massive amounts of unneeded and unwanted interventions that drive low-risk women out of hospital birth.

  • Posted By: Amy TuteurMD @ 02/23/2008 12:29:27 PM

    Comment: MD_mom:

    "Why are you so bent on trying eliminate viable birth options for women and their babies? "

    Is that a Freudian slip? Dead babies are not viable. Women deserve to know that homebirth increases the risk of neonatal death. What they choose to do with that information is up to them, but they cannot make an informed decision if they don't know the truth.

    I don't doubt that homebirth is more pleasant than hospital birth for some women. However, despite all the shortcomings of the hospital (real or fabricated by homebirth advocates), it is still safer than homebirth.

    • Posted By: bobpine2@yahoo.com @ 02/23/2008 14:44:37

      Comment: Dead mothers aren't "viable" either. Why don't you address the huge rate of preventable maternal deaths in hospitals.

      • Posted By: Amy TuteurMD @ 02/23/2008 16:23:58

        Comment: bobpine2:

        "Why don't you address the huge rate of preventable maternal deaths in hospitals?"

        Because there is no "huge rate" of preventable maternal deaths in hospitals. Moreover, the most common causes of maternal death are pre-eclampsia and hemorrhage and neither can be successfully managed at home.

  • Posted By: MD_mom @ 02/23/2008 11:23:30 AM

    Comment: Women deserve better than what we're getting in the hospital: higher rates of maternal mortality, high rates of c-sections, higher rates of preterm and near term babies due to inductions out of convenience (not medical necessity), increase in problems w/ future fertility and pregnancy/birth complications after c-section.

    Making sure we have choices in terms of care and birth environment - CPM (at home or in birth center), CNM (in birth center or in hospital), OB (in hospital) - is vital to making sure we can choose the best individualized care for ourselves and our babies. Clearly "Dr." Amy isn't into supporting a woman & her baby in getting the best, safest care -- she's into forcing ALL women into the obstetric machine, warts and all, regardless of its safety or efficacy.

  • Posted By: MD_mom @ 02/23/2008 11:11:34 AM

    Comment: Dr. Amy Tuteur, do you have nothing better to do with your time than to go around browbeating people with how you hate anything other than OB-attended, hospital-based birth? You don't even practice anymore. You're not even licensed. Why are you so bent on trying eliminate viable birth options for women and their babies? Are you really not able to see where current OB care falls short in so many ways, and I'm not talking about "a mom's experience" - I'm talking about the very real health and safety of the mom AND baby during the pregnancy, labor, birth, AND postpartum periods. You might not have a problem with the typical induce, augment, cut 'n gut, postpartum stress and feeding issues -- but a lot of us do. Women deserve better than what we're getting in the hospital - lower rates of maternal mortality, lower rates of neonatal mortality, lower rates of induction and sectioning. Period.

  • Posted By: kprown @ 02/22/2008 5:38:53 PM

    Comment: Comment: Reposted for better readability:

    Or maybe, not so much! i apologize for the translation problems that have added question marks where parentheses and commas were supposed to go.

  • Posted By: Amy TuteurMD @ 02/22/2008 5:38:35 PM

    Comment: Katie Prown:

    "The Wisconsin data cited here doesn't distinguish between Certified Professional Midwives and 'Other' Midwives, a category that also includes unassisted births, unplanned out-of-hospital births and births assisted by midwives who are not CPMs, Amish grandmothers and anyone who might want to claim to be a midwife."

    That is simply false, and I can't imagine why you keep repeating something that is factually false. The Wisconsin data divides attendants into doctors, CNMs, other midwives, and other non-midwives. The "other midwife" category does NOTincluded unassisted births and it does NOTinclude unplanned out of hospital births. Anyone who would like to check for themselves can do so at the WISH Query Infant Mortality Module(http://dhfs.wisconsin.gov/wish/measures/inf_mort/long_form.html), which is an interactive data query system.

    "However, because all Wisconsin CPMs participated in the BMJ 2000 study ..."

    The BMJ 2000 study (Johnson and Daviss, published in the BMJ 2005) is a nationwide study that CLAIMED to show that homebirth is as safe as hospital birth. However, it never compared the neonatal death rate for homebirth in 2000 with the neonatal death rate for low risk women in the hospital in 2000. When you do compare the two, you find that homebirth has an increased rate of neonatal death almost TRIPLE the hospital neonatal death rate, just like the Wisonsin statistics.

    "One benefit to CPM licensure is that it helps us to collect more accurate data on out-of-hospital births to distinguish between planned home births attended by trained professional midwives and all other out-of-hospital births in the state."

    That's not true, either. MANA is already collecting statistics on all CPMs and has been since 2000. The 2000 MANA data was the basis for the BMJ study. The data from 2001-2007, which is probably the largest existing database on homebirth, is being withheld from the public.

    "Another benefit of CPM licensure is that it requires anyone who works as a home birth midwife to undergo the education and training necessary to gain the skills required to provide safe and competent out-of-hospital maternity care"

    CPM education and training is grossly deficient in all respects. It is important