"I don't agree with home birth"

I've encountered several statements similar to this one over the last week:

"While I do not agree with home birth..."

A few things come to mind when I hear this statement.

1) How can you "disagree" that home birth was right for me or anyone else?  Do you know my medical history?  Do you know my midwives' level of experience and the quality of their outcomes?  Do you know your own care provider's?  How many home birth studies have you examined? ....

Check out the rest of this post over at my new website!

Dolphins and Birth Plans

While I was in California a few weeks ago, we hit the beach. Almost as soon as we got there, we saw something swimming several yards out in the water. At first I didn't know what it was and sort of screamed (thinking shark), "There's an animal!" Once it became clear it was a pod of dolphins, I had to smile to myself, reminiscing.

I used to be mildly (or... very) obsessed with dolphins as an adolescent. I had dolphin figurines, dolphin stuffed animals, dolphin posters, dolphin videos, dolphin stationary, dolphin everything. I did book reports about them, dreamed of swimming with them, toyed with becoming a marine biologist because of them, etc.

I was reminded of that adolescent dolphin fascination again this morning.

Years ago, my sister saw Marsden Wagner's Creating Your Birth Plan at Overstock.com for cheap and, knowing my passion for all things birth-related, she told me about it. I had never heard of the book itself, but I knew simply because it had Marsden Wagner's name on it that it was a book worth having. So I ordered it, and it has basically been collecting dust on my bookshelf ever since.

About 2 weeks ago we got word that my sister-in-law is pregnant after years of infertility. I'm ecstatic for them. And, naturally, I'm feeling protective of her and wanting to do all I can to ensure that she has the best birth experience possible. So I was perusing the birth books on my shelves about a week ago, contemplating which one(s) I should lend to her first, and I pulled out Creating Your Birth Plan, thinking it might be a good one to start with (especially since it has an M.D. in the by-line). As I flipped through the book, however, I realized that I'd probably better read it before I lend it out to anyone, just so I know what I'm sharing with people.

(I lent her Penny Simkin's Pregnancy, Childbirth, and the Newborn and The Birth Partner instead. Her husband's currently in physical therapy school, so it seemed fitting to start them off with the words of a fellow PT.)

So I've been skimming through Creating Your Birth Plan off and on over the past week or so. This morning I lingered on p. 176 where Dr. Wagner shares some fascinating details about dolphin birthing. Here's an excerpt:

At its physical and emotional best, support for women in labor has always reminded me of dolphin birth. When a dolphin gives birth to a calf, several female dolphins swim in a circle close to the laboring mother. Slightly farther away, another larger group of all the remaining females in the pod circle around the laboring dolphin. Then, even farther away, all the male dolphins in the pod circle around her. The entire collective comes together to protect the laboring dolphin and her emerging calf from intrusion and harm. A woman giving birth to a baby thrives when she's at the center of a circle of love.

This prompted me to do a google search and discovered that there are actually places where women give birth in the water "assisted" by dolphins.

A Russian male midwife, Igor Charkovsky, says this about the practice: "Dolphins have an affinity with the baby in the womb and are automatically attracted to pregnant women. They sense when a woman is about to give birth and gather round. They give both the mother and child a sense of protection and safety" (source).

I've been mulling over the topic of birth partners in preparation for writing something for the book, so this dolphin stuff feels relevant. And it has reminded me, yet again, how crucial it is for women to have supportive people around them as they give birth. The people we invite or allow to be with us can make or break our birth experiences. I recently encountered a 2005 study indicating that there is a strong correlation between patient satisfaction with care provider and lower cesarean rates. And Penny Simkin's research has demonstrated that the women with the highest long-term levels of satisfaction with their birth experiences were the women who had positive memories of the way they were treated by their care providers. Which brings me back to birth plans.

I think writing a birth plan is a helpful exercise. But I think most women do it too late in the game. A birth plan will do little to help you if the care provider and place of birth you have chosen have a practice style totally incompatible with it. In my opinion, the time to write your birth plan is before you ever choose a doctor or midwife (which is why I toyed with giving my sister-in-law Marsden Wagner's book now). I can't stress enough how important it is to choose the right provider--someone who will support and respect your birth preferences and shares your personal philosophy of birthing. You'll know you've found the right provider when you know you don't need to give them a copy of your birth plan when they arrive to catch your baby. Birth plans, at their best, aren't for labor day, they're for doctor/midwife interviews. Unfortunately, most women don't approach the doctor/midwife selection process this way. Hence, there are far too many battles in the labor room where peace and joy should prevail and far too many cruel jokes among doctors and nurses about "those women" with birth plans. Alas.

Given how protective I feel of my pregnant and laboring loved ones, I suppose it's no surprise I grew up with such an affinity for dolphins. I wish I could circle protectively around them throughout their pregnancies and births as the dolphins do. Maybe if I ever start an official doula business, I'll have a dolphin logo? That would be cool.

Obstetric trade union threatened by homebirth

[An opinion piece I recently sent to a local newspaper]

With Ricki Lake’s new film, “The Business of Being Born,” giving homebirth a high-profile legitimacy, the American College of Obstetricians and Gynecologists had to do something. As if their monopoly on maternity care in the U.S. wasn’t extensive enough, they felt a need to, once again, stake out their turf. On February 6, the ACOG issued a press release outlining their strong opposition to homebirth. They claim to be concerned for the well being of women and infants. Given the state of maternity care in this country, I find the ACOG’s supposed concern highly questionable.

The ACOG press release criticized mothers who choose homebirth for placing “the process of giving birth over the goal of having a healthy baby.” Women choosing homebirth are often accused in this way. How could they put their own comfort before the health of their baby? The problem with that accusation is that it should really be turned the other way. How can obstetricians put their comfort before the health of the baby?

Many prevalent hospital birth interventions including labor induction for non-medical reasons, elective cesarean section, continuous electronic fetal monitoring, routine use of IVs, early amniotomy (artificial breaking of water), episiotomy, and withholding of food and liquids have not been shown to improve outcomes and, in many cases, lead to other harmful complications for both infants and mothers (click here for more info). These interventions are warranted in rare cases, but they are being used excessively. When many of the most common birth interventions used by obstetricians in hospitals cause unnecessary harm, it is hard to believe that the ACOG’s concern for the well being of mothers and infants is at all genuine. Interestingly enough, most of these interventions reduce the amount of time doctors must spend attending a laboring mother and protect them from possible malpractice lawsuits. It is obstetricians that are putting babies and mothers at unnecessary risk for their own ease and comfort, not homebirth mothers.

The ACOG press release also erroneously claims that there are no scientifically rigorous studies demonstrating the safety of homebirth. There are, in fact, many reputable studies demonstrating that a midwife-attended homebirth is just as safe as a hospital birth for healthy women with normal pregnancies, and with much lower intervention and c-section rates. The most recent and largest of these studies was published in the British Medical Journal in 2005 (“Outcomes of planned home births with certified professional midwives: large prospective study in North America.” Kenneth C Johnson and Betty-Anne Daviss).

The United States is unique among developed nations in its obstetric-heavy maternity care system. The developed nations with the best birth outcomes, the lowest c-section rates, and the lowest rates of maternal and infant death have the majority of women attended by midwives and a significant portion of them giving birth at home. The United States trails behind 27 other developed countries in terms of maternal death and 35 other countries in terms of neonatal deaths.

Homebirth is not “trendy” as the ACOG would have you believe. Women have been giving birth in their homes for thousands of years. Being induced early or opting for an elective c-section are the truly dangerous trends. Women who choose homebirth do so after much research and soul-searching. They deserve our admiration and respect for their courageous choice to avoid the complications stemming from medical intervention and follow their birthing instincts. It is these informed women who will stem the tide of obstetric abuse. As Marsden Wagner, Director of Women’s and Children’s Health for the World Health Organization for 15 years, pointed out, “In every country where I have seen real progress in maternity care, it was women's groups working together with midwives that made the difference.”

The OBs Fight Back

Yesterday, the American College of Obstetricians and Gynecologists issued this press release reiterating their strong opposition to home birth and non-nurse midwives. This is, no doubt, in response to Ricki Lake's film and the Big Push for Midwives press conference. It's no surprise that OBs would feel threatened by the growing publicity and support for homebirth. Let's remind ourselves, however, what Marsden Wagner had to say about this group called the American College of Obstetricians and Gynecologists:

To understand the absolute monopoly ACOG has established in American maternity care, it is helpful to look more closely at this organization. The American College of Obstetricians and Gynecologists is not a "college" in the usual sense: it is not an institution of higher learning. Nor is it a scientific body. With few exceptions, its members and leaders are not scientists but medical practitioners, and there is nothing in ACOG's mission statement about science. The ultimate proof that ACOG is not a scientific body? Too many of its policies and recommendations are not based on real science. . . .

In truth, ACOG is a "professional organization," which amounts to a trade union. Like every trade union, ACOG has two goals--to promote the interests of its members and to promote a better product, in this case, the well-being of women. But if there is a conflict between these two goals, the interests of its members come first. . . .

American maternity care, then, is under the control of tribal obstetrics. A small group, most of them men, are controlling birth in such a way as to preserve their own power and wealth while robbing women and families of control over one of the most important events in their lives. . . .

Power without wisdom is tyranny. There are plenty of intelligent obstetricians who have lots of knowledge, but intelligence and knowledge do not guarantee wisdom. I have known wise individual American obstetricians, but I see no evidence of wisdom in organized obstetrics in the United States. The maternity care we have in what we like to believe is our free country is obstetric tyranny.

(From Marsden Wagner's, Born in the USA: How a Broken Maternity System must Be Fixed to Put Women and Children First, p. 33, 35-36.)

For a look at the facts about homebirth, here's a nice overview from iVillage by Henci Goer.

Let's get angry and organized.

"We Americans are consumed with the need to believe that we are number one. But here's a wrenching fact: forty-one countries have better infant mortality rates than the United States does. In 2002, our infant mortality rate went up, not down, and if the United States had an infant mortality rate as good as Cuba's, we would save an additional 2,212 American babies a year. And mothers? Women are 70 percent more likely to die in childbirth in America than in Europe, and the rate of women dying in childbirth in America has been going up every year for more than twenty years. . . .

"Just as those who never make mistakes can never learn from them, so too those who must always be number one can never learn from others. . . .

"[S]omething happens in the countries at the bottom of the chart. It varies from country to country, but whatever it is, when things get really bad and women's reproductive freedom is abused severely enough, some precipitating factor or series of events finally brings women's attention to the power doctors hold over their reproductive lives. This leads to women's disillusionment, anger, and resentment and a call to action. . . .

"[Midwives] join with the angry women (often forming coalitions that also include scientists, journalists, some politicians, and some doctors and nurses) to start the long, difficult process of regaining women's autonomy in childbirth and reproduction, moving the country up . . . .

"It seems there is at least one thing more powerful than the medical establishment: women, when they are angry and get organized" (Marsden Wagner, Born in the USA, p. 212, 214-215).

Hmmm... Interesting...

"After working as a practicing physician for several years, I became a perinatologist and perinatal scientist, as well as a full-time faculty member at the Schools of Medicine and Public Health at UCLA. Then I became a director of maternal and child health for the California State Health Department. In that capacity, I learned that in the rural town of Madera, California, doctors had decided that they no longer wanted to attend births at the Madera County hospital. They complained that it took too much of their time and didn't pay enough. So in 1968, two out-of-state midwives were recruited by the county to fill the gap. After two years of midwifery practice at the hospital, the rate of babies dying around the time of birth in the Madera County hospital was cut in half. Alarmed that their style of maternity care was being made to look bad, the doctors in the town agreed that they would once again attend births in the hospital if the two midwives were fired. The hospital fired the midwives, the doctors returned, and soon the rate of babies dying around birth rose to its earlier levels" (Marsden Wagner, Born in the USA, p.99, emphasis added).

ACOG and "obstetric tyranny"

Have I mentioned how much I love Marsden Wagner? I have to share this:

To understand the absolute monopoly ACOG [American College of Obstetricians and Gynecologists] has established in American maternity care, it is helpful to look more closely at this organization. The American College of Obstetricians and Gynecologists is not a "college" in the usual sense: it is not an institution of higher learning. Nor is it a scientific body. With few exceptions, its members and leaders are not scientists but medical practitioners, and there is nothing in ACOG's mission statement about science. The ultimate proof that ACOG is not a scientific body? Too many of its policies and recommendations are not based on real science. . . .

In truth, ACOG is a "professional organization," which amounts to a trade union. Like every trade union, ACOG has two goals--to promote the interests of its members and to promote a better product, in this case, the well-being of women. But if there is a conflict between these two goals, the interests of its members come first. . . .

American maternity care, then, is under the control of tribal obstetrics. A small group, most of them men, are controlling birth in such a way as to preserve their own power and wealth while robbing women and families of control over one of the most important events in their lives. . . .

Power without wisdom is tyranny. There are plenty of intelligent obstetricians who have lots of knowledge, but intelligence and knowledge do not guarantee wisdom. I have known wise individual American obstetricians, but I see no evidence of wisdom in organized obstetrics in the United States. The maternity care we have in what we like to believe is our free country is obstetric tyranny.

(From Marsden Wagner's, Born in the USA: How a Broken Maternity System must Be Fixed to Put Women and Children First, p. 33, 35-36.)

Recent attacks on midwives...

A bill was proposed earlier this year by members of the Utah state senate, Margaret Dayton in particular, which would have severely restricted the number of women who could choose a licensed midwife as a maternity care provider. They claimed they were simply trying to define what "normal birth" was and clarify a law that was passed in 2005 which gave midwives the ability to become legally licensed to practice in Utah, but their definition of "normal" somehow only included a very small percentage of women. Nearly all of the women involved with the Utah Friends of Midwives, many of whom have successfully given birth at home multiple times with excellent outcomes, would have been required to be referred to a physician under this bill.

The state division of professional lisencing and Utah's midwives had already spent two years clarifying their rules for licensure defining when they must refer their clients to physicians, etc. These things were already taken care of by the proper groups. This recent bill was simply trying to do what had already been done, but doing it in a much more restrictive way. And, it is interesting to note, that the bill was created by a woman who spent many years as a labor and delivery nurse, married to an obstetrician. It was also written by the Utah Medical Association whose membership includes many obstetricians. We can only assume this had a lot more to do with a "turf war" than concern for safety.

I wrote the following on a Utah State Senate comment website:

I am a mother of two--both hospital births. I am not a midwife nor do I have any relatives who are midwives. But I am a concerned person who finds it highly unsettling to see the rights of Utah's women so trampled upon. Whatever happened to the limited government and freedom the Founding Fathers fought so long and hard to ensure? . . .

I am concerned that Senator Dayton and those responsible for this bill have so little faith in mothers. I am concerned that they do not respect women enough to expect that they can make responsible decisions for themselves and their babies. Even if you disagree about the safety of homebirth, it is not your place to infringe upon mother's rights and require that they do what you may think is best. You say you are not restricting women's rights to choose, but the ramifications of this bill will do exactly that.

Thousands of unnecessary c-sections and other questionable medical interventions occur every day in hospitals in this country--putting mothers and babies at increased risk. So do not tell me that you are doing this out of concern for safety. If the medical community was really concerned about safety, hospitals would completely revamp their policies and most obstetricians would completely revamp their practices. We aren't so behind in the world's infant and maternal mortality rates because we've been making the safety of mothers and babies a priority. We certainly haven't made it a priority.

The issue here is not whether hospital or home is the safer place of birth. And I don't believe that is why the bill was initially created. The issue here is will we uphold freedom and have respect for the women and mothers of Utah, or will we trample upon their freedoms by essentially legislating their place of birth because we feel that they are incapable of acting responsibly?

Fortunately, this bill did not pass in the recent legislative sesssion, but supposedly Senator Dayton is "reworking" the bill for a comeback. Thank goodness for the outraged response of Utah's midwives, the Utah Friends of Midwives, and other concerned Utahns.

I'd like to quote Marsden Wagner's account, testifying in behalf of midwives in California who were trying to pass a midwifery bill:

I recently testified before a state legislative committee in California on pending midwifery legislation. Among other things I said in my statement that midwives are perfectly capable and that planned home birth is a healthy option for many women. I finished by suggesting that if anyone said otherwise to the committee, they should ask, "Where are your data?"

Thirty minutes later, a representative from the California Medical Association stood before the same committee and said that midwives are less safe than doctors for low-risk pregnant women and that home birth is not safe. Lo and behold! One of the legislators on the committee immediately asked, "And does the California Medical Association have any data to support your statements?" Not surprisingly, it did not (there are none). Instead, the spokesperson retreated to the familiar position: Trust us, we're the California Medical Association. That legislator took note, and the midwifery legislation was eventually passed. Slowly but surely, times are changing (see Marsden Wagner's Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First, p. 35).

Thank goodness for freedom and concrete scientific evidence.