March 2008

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Hi Dr. Amy ~I’m curious as to what really is going on that has you so afraid of allowing women to have the birth of their choice. No matter what I, as a safe birth advocate and you as a safe birth advocate ~ yes, we both want birth to be safe ~ believe is actually the safest, the fact is that in America we were meant to have our rights to do what we choose to do with our bodies, ourselves, protected.

Pregnancy is simply one piece of healthcare and care involves nothing less than what is given to all others in all other health care fields regardless of gravity of the situation. I want to know why you feel a need to TELL women not to birth at home. I don’t TELL women not to birth in hospitals. I do what they ask of me: share what I know, point them to resources and let them choose for themselves.

Women who have been my birth clients have chosen from among hospital with OBs, hospital with MW/OB, free standing birth center with MW, homebirth with CPMs and Traditional Birth Attendants, homebirth with CNMs and unassisted childbirth. They made their own choices and collectively they represent a c/s rate right around 10% (the WHO guideline recommendations) and of the almost 90% vaginal birth rate a little over 80% of those were without drugs ~ pain medication ~ and only a few with augmentation.

The reasons for cesareans were breech and less than textbook labor patterns. I don’t believe everyone is either at your end of the “birth is not safe” spectrum or at my end of the “birth is safe” spectrum” rather I believe the greater majority is somewhere in the middle. Certainly statistics show that less than 10% of births take place at home. I wonder that such a small group with healthy birth outcomes would take up so much of your time.

I wish that you devoted the same amount of energy to asking careproviders to give all the facts about every procedure and protecting the right to make our own health care decisions. What exactly is it about homebirth that is so dangerous? I know I can pinpoint the abuse of oxytocin, the abuse of medical privileges in prescribing drugs off label and the untold risks of cesareans, such as putting your future children’s lives at risk, for specifics about medicalized birth that is dangerous.

I’m not alone in that aspect. There are doctors out there who agree these practices bear scrutiny and are unethical. They question America’s maternity health care system in whole. I really am very interested to know exactly what aspects of homebirth are dangerous in your opinion and why you feel a need to use fear to quell an individual’s right to explore and educate themselves, invade a person’s home, privacy, body and right to choose for themselves. I notice that most of what is posted between you and others on the internet is lost in rants.

I don’t need the stats. I can find stats myself and I fully understand anyone can interpret stats however they’d like. I’m interested in hearing what YOU KNOW about birth, your experience with birth.

As a matter of interest, in my case it wasn’t homebirth advocates who advised me to VBAC spontaneously, without medications and especially with my premature son.  My skilled homebirth midwives advised me to birth in a hospital with the underlying medical conditions I had.  It wasn’t the homebirth advocates that encouraged me to VBAC telling me I could do it and I would be fine.   It was two different obstetricians in two different hospitals.  It was obstetricians who weren’t just trained in VBAC and complications of birth, they were SKILLED.

Winter is still here in Connecticut. I drove to Capitol Avenue to formally hear the opinion of the Connecticut Medical Examining Board regarding midwifery, specifically Direct Entry and Certified Practicing Midwives. It began with the lot of us being told the doors were being opened for us to to come in but we need to keep the noisemakers, meaning the children, out. Dennis O’Neill, MD, Chairman of the Board explained the acoustics were so poor in the Conference Room they could barely hear each other let alone the audience who might speak.
At this point in time we know only that the charges stemmed from a transport case, a transport that was timely and resulted in a positive outcome.
It has been reported by members in the midwifery community that the case was not the result of poor care, a complaint from the parents, nor was there a maternal or fetal death. Although I never caught the actual root of this case I did meet Donna Vedam who had been through this procedure before and realized her case was why we found ourselves here again. In her case, parents who were more than overjoyed with their birth experience wrote their insurance company asking them to consider covering homebirth in the future and wrote how homebirth saved money, reduced the use of interventions, and improved birth outcomes. Someone somewhere in the insurance company read the letter and thought this must be illegal! They forwarded the letter to the State to look into and Donna was accused of practicing medicine. That charge was dismissed as it was determined that she was practicing midwifery and midwifery is not medicine.
Since that precedence already exists, the Board has to step up the charge and go for practicing nurse midwifery without a license. It is a step toward regulating midwifery in Connecticut — and make no mistake about it — a step towards eliminating the “problem” of midwives enticing women away from OB income, and opening the window to the proven dangers of many routine interventions.
In less than four minutes total the issue was brought up and voted on. Dr. O’Neill relayed that the case was dragged out over 21 months with only 8 actual days of hearing, after which there was no explanation as to why it took this long to finally bring the motion to a vote. Dr. O’Neill simply said “it eventually lay around held up in some office somewhere …(until now).” As for this writer, what the summation hints to me is that the testimony presented during those 8 days took a lot of time and energy for the medical community to understand.
A doctor raised his hand to move to uphold, another seconded, and then all of the Board Members unanimously declared to uphold the decision.
Neither the motion nor the decision were ever actually stated, but it was to cease and desist, don’t do it again — “it” being practicing medicine without a license. What this hints to me, the writer, is that formally stating the decision would require an explanation supporting the decision and no one was prepared to do so, either as a subversive tactic for the day (we were actually thrown out, prevented from taking a peaceful group photo in the lobby), or as an ongoing tactic of “because we can.”
What is important for all women to know is that the board isn’t made up of consumers or consumer advocates. If it were, it would have members such as homebirthers Jennifer Wisner, Tammy Gallo, Tara McElfresh, Lisa Breton, Aja McCarty, and Bruce and Randy Neely who were here with their homebirthing daughter, Kendra Smith. They might have included a gentle birth La Leche League leader like Rebecca Cronon.
I think the Board’s worst fear, though, is that a member of their own community, someone like Susan Parker, RN, CEN might have been on the Board. As a hospital-based nurse, Susan has seen “the worst of the worst including witnessing a maternal death just six months before” she herself gavebirth. The experience left her even more determined to birth at home.
Which hospital you ask? Avoiding that hospital in particular won’t keep you any safer in birth. Maternal deaths in hospitals are everywhere like Hawaii, California, and New Jersey, as well as many other states and the truth behind the stories aren’t being told. Consider this, embolism is one of the leading causes of maternal death. Risk of embolism increases with surgical procedures and the cesarean rate is climbing steadily!
We are not arguing that no one ever needs to birth in a hospital nor that everyone needs to birth at home. The point is that we have medics who do not know normal, natural childbirth, but they are making unfounded decisions about a non-medical event. This, while they are forgetting to investigate their own at the least, and turn a blind eye to their own at worst.
The midwives’ next step is an appeal or to argue for the right to argue the decision. 
I may not have been alive in 1692 but what transpired over the past few years and culminated in today’s five minutes in Hartford, Connecticut, could only have been done better were the Board Members in period costume.

There is a view that a baby is conceived and the mother is a maternal environment.  I suppose there must be a science to birth or else the medical model wouldn’t exist and be beneficial to the healthy mother who finds herself in the rare medical situation. No matter your comfort or fear of birth there is a truism: that our existence is meant to be, conscious birth.  We have an awareness that as our bodies decay our bones, those that carried our babies, may do so but very slowly.  These bones are solid with the memories of the blood, oxygen, nutrients that the frame supported.  These bones cradled life and remember the weight of a uterus heavy with child and light in love for the child; An appreciation that each of us is “here” and very much “present”.  That appreciation opens us to understanding the influence of those who share our child’s birth with us.   Every person who acknowledges our pregnancy can influence the birth, from birth fright to joyful birth. We spend time letting go of the negative when we run across someone angry who chooses to vent or release near us.  We know it’s not healthy.  It is unconscionable that our society does not promote this same attitude to mothers.  The longer we spend time on stress over birth the less likely we are to give ourselves permission to be radiant carrying life within us, smug in our selves as birthing bodies that have been wise with this knowledge for centuries.

If your Care Provider says something that Scares you… ASK Questions, DO Research and Make INFORMED Choices!

A 5th baby, born spontaneously at 42+ weeks in a hospital with supportive staff.

Recently The New York Times wrote about doulas and the article left a negative impression about doulas, and tossed in a criticizing lactation consultant comment as an aside. To take the view that the New York Times article does–as an across-the-board view that doulas are problems–is an error. The paper presented a complaint rather than pursuing a couple of viable angles: the many expectations that mothers and partners have of labor support today, and the licensure of female support at birth such as midwives, birth educators in the role of birth support, monitrices (someone who has been trained to provide some clinical assessment in labor usually while mother is at home) and doulas.

There are now many birth support and whole birth health care options for women to learn about, choose from and advocate for change. Midwives, independent childbirth educators, doulas, birth centers, homebirth and breastfeeding are now more commonplace subjects to bring up when planning birth. Women today are realizing that they need to avoid interventions such as induction which carries a higher risk for cesarean or just arriving at the hospital too early; and there are options available to support their refusal to fall in line with industrialized birth. In response, hospitals are trying to offer more and more amenities but many parents recognize that in spite of measures by hospitals to draw them in by offering a luxury tub or more comfortable birth room furniture, hospital birth is still hospital birth. Seeing the smoke and mirrors, women who still choose to birth in a hospital may seek additional independent female support in birth which has been shown to be a positive influence on outcomes. However the benefits of the additional birth support is very clear in the birth community and we hope the media will take the time to do more in-depth articles on the anthropology of women in birth, culturally and traditionally.

It is confusing for the public to read contradictory articles posted by the same journalism venue such as this one from CNN that says doulas advocate for you and then CNN also posted this article stating “doulas are not supposed to offer a medical opinion….strictly to motivate the mother.” What remains the focus for women is that we still need to think independently, make our own choices and employ those who support our choices from birth care to birth itself. Women have many different reasons for hiring a doula besides strictly whether or not to ask them to advocate. Doulas can make fathers and siblings comfortable with birth and help them enjoy birth too! There are obstetricians, midwives and labor and delivery nurses who have witnessed doulas as an extra pair of caring hands so that all participating in the birth remain fresh and positive during a labor and birth–especially an intense birth. Doulas help military moms birthing without their partners. Doulas are sometimes even interpreters! This is a day that many never imagined: birth support, midwives, homebirth, unassisted birth, informed birth, etc. are all in the headlines!

In many states women’s choices are being restricted and the birth community continues to work together for the greater benefit of society at large ~ improving mother and baby outcomes ~ and for the mothers and babies where you live!