Here is a BBC story on the latest study by the British Journal of Obstetrics and Gynocology that shows that homebirth is just as safe at home with midwives or hospital for low-risk women at the start of their labor.
Andrew Goldman chronicles his wife’s journey of choosing a care provider. Her autoimmune condition labels her high-risk, but his wife is eager to have the empowering birth she saw in the documentary. They interview Cara, but ultimately choose an obstetric hospital birth after his wife’s rheumatologist threatens to terminate her.
I found the second half pretty unbalanced. Goldman seems to have personally decided that the homebirth experience is inherently risky (because his wife may not have been low-risk), which it is proven not to be, and focuses on two of Cara’s complicated births out of her 700 births. The Business of Being Born showed a competent care provider, encouraging a hospital transfer, during her only birth in the documentary
I also found the lack of information about homebirth as being far more mainstream in countries like the UK, Australia, and the Netherlands where doctors and midwives all have a very open and collaborative system to be unfortunate. There is no cult of homebirth. It is a necessary new direction to curb national healthcare costs and maintain, and even improve, health standards.
It is critical to continue educating about how poorly our ghastly American maternity system stacks up to every other country in the developed world while acknowledging how different our system is. Our racial disparity of birth outcomes are indefensible. Moving to have more CNMs care for more women in hospitals or birth centers dramatically lowers c-section rates and improves birth and maternal health outcome regardless of race, education level, citizen status, and income.
I think the unfortunate thing here is that when members of the media cover birth (or marriage and death), it is difficult for them to separate from their personal experiences, and in this case, the American experience of a hospitalized birth where an OB “saved a baby in danger” from the very care model they perform. This system is perfect for perpetuating how dangerous and risky birth is and to show proven solutions to our problems in a negative light. Taken straight out of a despotic political model, it keeps the masses from waking up and overthrowing their leaders.
I can’t help but add this great comment from the New York Mag website provided by a client of Cara’s:
My name is Leigh Pennebaker and I was interviewed for this story. Throughout the interview I thought it was obvious that Goldman had an agenda that sought to establish me and other people who have home births as hippie-dippy flakes. Here are two of the questions that he asked me:
Are you a vegetarian?
Do you only buy organic food?
I don’t know how these questions relate to the stated topic of our conversation, home birth/Cara Muhlhahn. One of the most upsetting points in the interview was after I went to great lengths to tell Goldman about my personal experience with home birth, which gets into my family history and the fact that mother had a home birth. She had me (her first child) in a hospital with all the technological bells and whistles of the day — she was strapped down and hooked up to all the monitors, I was pulled out with forceps, she was immediately separated from me, and hours later when a nurse returned with a baby…it was not me! The experience was traumatic for both of us and it began the journey that led my mom to do her research and stay at home with a midwife by the time her third child was born. The home birth proved to be a far more positive and healthy experience.
Goldman seemed to be listening, but when I reached the end of the story, he simply asked, “would you say that your parents were hippies?”
As a reader of New York magazine for nearly two decades, I appreciate their witty and sensationalist style. They could have offered a piece with far greater press impact to their readership by framing homebirth as the safe and increasingly popular choice for New York women, “Homebirth: Coming to a Coop Near You.”
I just returned from a wedding of a physician friend. I discussed the midwifery bill with one of his medical school friends, now a GI in Manhattan. I never talk childbirth with my physician friends to keep things peaceful, and I never really talk childbirth with doctors during appointments, so my experience with talking about childbirth with physicians is none.
I described the Massachusetts midwifery bill’s goals in relation to nurse-midwives alone, as I didn’t feel bringing CPMs into the conversation was prudent without knowing his experiences more. This physician continued to spew one fallacy after another about midwives, their training, maternal and neonatal mortality rates in the US, the rate of c-sections, and elective c-sections, the benefits of vaginal birth to mom and baby, the risk of c-sections and their rates of infections.
As he started boasting the ease and low risks of c-sections with “a really good doctor” I moved the conversation to his own GI field and of the disadvantage c-sectioned babies have from bypassing the vaginal canal and missing out on their first intended exposure of the mother’s bacterial flora to the infant’s system. Surely a GI would like to see infants start out with the best gut health at the beginning of their lives.
To my astonishment, he was even misinformed on this topic and kept trying to claim that vaginal birth provided no additional benefit to a baby’s gut flora. Then he started lying. He claimed he was very familiar with a study that showed that if you placed a vaginally birthed baby in a sterile environment immediately after birth that the baby develops no bacterial flora over an extended period of time.
Since this was a social event, and I wanted to appear polite, I merely said, “I am very interested to see that study.” He then claimed he had worked with this study in other presentations of his. An hour later I realized how gullible I was, wanting to assume the best in people. Let’s all realize that no study exists that starves a newborn baby to prove it won’t develop flora. In fact, there are studies that show that the gut of a vaginally birthed infant immediately shows similar bacterial flora in its fecal matter to the mother’s.
I hear stereotypes of how uneducated physicians really are in so many areas that interest those following natural parenting, like breastfeeding, nutrition, vaccine efficacy, or the training and abilities of midwives. I had always hoped these were exaggerations. This encounter only made me sad to see how much education will be necessary to implement the scale of change we need to turn our maternity system around.
For those like myself who prefer to follow evidenced based medicine, it is a shame how fringe and uneducated we are made to feel by many allopathic doctors when we often have had the time and energy to cover topics with much more thorough research than they have. They should be asking parents for more information about the published studies that we have read rather than fabricating studies that don’t exist to attempt to belittle our knowledge.
The 2007 data on births in Massachusetts is available. It is a really interesting read to look at c-section rates for each hospital.
Here are some highlights:
• In 2007, for the first time since 1998, the cesarean delivery rate did not increase significantly from the previous year. The rate in 2007 was 33.7%, compared with the 2006 rate of 33.4%.
• The percentage of mothers who had their prenatal care paid by public programs continues to increase. Between 2006 and 2007, it increased by 4%, from 34.2% in 2006 to 35.5% in 2007. For white mothers, it increased by 7% (24.4% vs. 22.9%).
• Disparities in birth outcomes by race, ethnicity, education, and community persist.
• Homebirths increased from 337 to 373 from 2006 to 2007, which is a 10% increase, but home births totaled .5% of all 2007 births.
The latest article on the Big Push for Midwives campaign confirmed our anecdotal experience:
Midwife-attended home births increased by 27 percent between 1996 and 2006. Home-birth advocates believe the numbers will rise as more states amend their laws to accommodate the practice, which they contend is at least as safe as hospital births for healthy women with low-risk pregnancies.
I have women on airplanes telling me they plan to homebirth now. Once the 2007 and 2008 numbers are in, I imagine those homebirth increases will be dramatic compared to the previous years.
If we are to address the healthcare system in this country, we cannot ignore the third of all total spending that is spent on maternity care. We spend more than any other country without any health outcomes to show for it. Eventually, physicians’ special interest groups lose to reforming legislation that promotes safer and more efficient models of integrated midwifery care at home and in hospitals like programs in countries like the United Kingdom and Australia.
Hopefully our own state legislature will pass the midwifery bill this session because women are going to be birthing at home regardless of what they do, so we may as well make it as safe as possible by creating a midwifery board with the expertise to support and regulate this critical profession.
Please read our section on the bill and take action!!!!!!
We have a February 4 deadline.
20/20 aired a segment on Orgasmic Birth that many of us have been waiting to see since the spring. The segment was fairly even-handed and Debra Pascali-Bonari should feel very proud to what her film has contributed to the larger conversation about birth and the mother’s mental state.
After additional segments that could have been called “Wacky Things Women Do” it featured serial surrogate mothers who have birthed more than one dozen babies, women nursing their children past the age of five, women who spend thousands of dollars on newborn dolls and stroll them outside, and finally the most outlandish segment on homebirth.
While interviewing the woman who authored the book Unassisted Childbirth, they began to weave clips from the Business of Being Born with new footage of Elizabeth Vargas interviewing film creators Ricki Lake and Abby Epstein, not clearly explaining that homebirth is usually overseen by some sort of midwife.
I kept waiting for the voice over to explain the choice of homebirth with an attending midwife as a more popular choice, but midwives were never discuss in detail. The producers intentionally blurred the distinction between homebirth with certified midwives and unassisted birth. They had to to make the homebirth segment seem more fitting with with the other “Wacky Things Women Do.”
It is pretty offensive for mothers who researched the safest birth options with the least intervention with midwives to be compared to the sincerely sad, childless women spending thousands of dollars on newborn dolls to get strangers to talk to them.
From director Debra Pascali-Bonari:
Please help us share our good news…
Orgasmic Birth will be a featured segment on ABC-TV’s “20/20″
this Friday December 12, at 10 PM Eastern Time
Visit the ABC website to read more about Orgasmic Birth and share
your comments on the film.
Joyous, sensuous and revolutionary, Orgasmic Birth brings the ultimate
challenge to our cultural myths by inviting viewers to see the
emotional, spiritual, and physical heights attainable through
birth. Witness the passion as birth is revealed as an integral
part of woman’s sexuality and a neglected human right. With
commentary by Christiane Northrup, MD, and midwives Ina May
Gaskin, Elizabeth Davis and other experts in the field . . . and
stunning moments of women in the ecstatic release of childbirth.
OK, all of you awesome MFOM members, I know you know how to call state legislators. It’s time to call Washington now. This is important, especially given the unknown future of the North Shore Birth Center.
American Association of Birth Centers
We are writing to ask you to contact your Federal Representatives and Senators–it is now or never to mandate the Birth Center facility fee in Medicaid!
Our Goal – 50 calls this week!
As you know, we are working hard to mandate the birth center facility fee in Medicaid. The Texas case against Center for Medicaid Services (when they said they would stop paying the federal match for birth centers) is just one battle. The only permanent solution for us in the Medicaid program and with other insurers is to pass legislation making birth centers an official mandated provider.
The Texas case will not solve this problem! It is clear that even if we win, CMS will write new rules that will effectively shut down birth centers all over. Now, we need legislation to stop them. We may already have missed our chance to tag our issue on to the next major piece of legislation–the Economic Stimulus package. But we still have a chance with the Children’s Health Bill (S-CHIP), but ONLY if Congress hears from you and your consumers.
Each and every one of you must take action to put birth centers on the Congressional radar. The birth center community must take the lead on this–Congress won’t take any action for us unless it hears from its constituents. AABC’s lobbyinst Karen Fennell is busy making Congressional visits, but they are saying they have not heard from you–so it must not be important . . .
Right now, Rep. Susan Davis (CA) will sponsor the bill and Rep. Lois Capps (CA) will co-sponsors, but we need many more–including Republicans so it has bi-partisan support.
Call your Federal Representatives and Senators.
Find out who they are.
If you have any trouble making contact, call Karen Fennell–she will help. Use the linked flyer (“Pregnant Women’s Access to Care Threatened“) as a reference for help with talking points and:
1. Tell them you are a (midwife or student midwife, staff person or client) that cares that birth centers provide access for Medicaid women. Other birth centers have already closed due to lack of facility reimbursement.
2. On the House side, ask Democrats to co-sponsor our bill which would add Birth Centers to Medicaid covered services. (Our bill does not have a number yet). Ask House Republicans to be a sponsor or lead. On the Senate side, we need leads and sponsors in both parties.
3. Please notify Karen of your calls. Provide her with the representative’s name, the staff person’s name, and any questions or information she should be aware of. Karen’s contact info: tel: 301-830-3910 – email: firstname.lastname@example.org. Please also cc me on these emails:
email@example.com (tel: 423-253-4455).
This is urgent if we want to sustain birth centers in the United States. Please call today. Remember, this is your survival we are working for–we need 50 calls this week!
Please pass this on to your Friends of the Birth Center groups and ask them to call too.
Jill Alliman, CNM, MSN
American Association of Birth Centers