…the latest Hathor comic is making me feel sick.
Search This Classical Life:
categories:
in the middle of:
read in 2016:
Paterson, The Great Gilly Hopkins
Sloan, Ajax Penumbra 1969
Mandel, Station Eleven
Elliot, Shadow of the Almighty
Shakespeare, As You Like It
Bolz-Weber, Accidental Saintsarchives:
Nothing comes up on Google news, or a LexisNexis search.
yeah, i didnt find anything either
It’s going on in Spokane. Because the couple was being “cooperative” things were going well with CPS and their lawyer advised not to take it to the media. Email me if you want a link.
Spokane, WA? Or somewhere else?
Spokane, WA
hmm, thats awful. i know homebirth is very legal in washington. their medicaid PAYS for it! maybe it was a UC?
It was a UC. I personally would never intentially have a UC, but I still don’t think that’s cause for CPS to be involved…
Pardon my ignorance, but what’s a UC?
UC = Unassisted Childbirth.
::wow!!::
That’s a little bit crazy.
Hmmmm. Perhaps I’m the liberal medical establishment person here, but what possesses people to try childbirth unassisted when we know so much that can go wrong, and we have the technology and skill to make sure badness doesn’t happen? After all, are we really thinking of the best interest of mom and the child if we intentionally completely ignore useful and potentially life-saving interventions?
There are people all over the world that would LOVE to have the option of giving birth in a hospital where all sorts of expert personnel and technology are available to help in case something goes wrong fast (and it can).
Seriously!
I am afraid that I am in the same thinking as Phil. I have a personal friend who, after a normal pregnancy and labor with her first child, had a uterine rupture. They ended up losing the baby (who was otherwise healthy)and almost losing Mom because of the massive internal bleeding. If she had been at home or having a UC she certainly would have not made it.
I think that homebirths are fine when attended by qualified assistants, and the parents are aware of the risks to both mom and child. But only if it is a low-risk pregnancy with no delivery complications expected. I think if you choose to have a non-hospital birth when there is a high risk of delivery complications or with pre-term delivery then you are really setting yourself up for a problem. I think most moms who are pro homebirth and UC are also pro-life. Why would you set yourself up for a tragic ending to a complicated pregnancy or delivery you have been warned will be difficult?
AND- what is this with people who do their own prenatal care? How is a layperson able to test for gestational diabetes, strep B, fetal heart tones, placenta previa and other diagnostic tests that have greatly increased the survival rate of both Mom and child?
I realize that 1) I am a wimp and want all the medical help at beck and call when I think there is even a possibility I might need it. I also have a background working in the hospital and am not the least bit uncomfortable in that setting, so it was definitely right for us. and 2) This is a very personal, and controversial topic that has been argued vehemently for years. Hope I have not offended!
As I have said before, I would never UC, but there is a whole movement of UC and books to read, etc. to help women and those who attend to them (husbands, friends and relatives) know how to make wise choices and when to seek medical help. http://www.unassistedchildbirth.com/
There is a difference between knowledgably choosing to have a baby at home without an attendant and molesting or beating children. It is not illegal to have a baby at home unattended – it happens accidentally! CPS just seems to be consistently missing real abuse and spending too much time attacking families — http://www.savejacksonbortz.com/ for a good example of one child who was taken from his home for THREE MONTHS without just cause. Things like extended breastfeeding and cosleeping have given neighbors cause to call CPS and CPS cause to take children away from their parents.
“…we have the technology and skill to make sure badness doesn’t happen?”
Not necessarily. I personally think that homebirths are generally safer. A lot of medical intervention at hospitals can actually cause a mother in labor failure to progress or cause fetal distress in the child.
UC is a totally different situation, and like Kristen, I’d never personally purposely have one. I think that at least two people that are knowledgeable should be there to assist. But just because someone had an UC doesn’t warrant a call to CPS. I hate that organization.
Kristen, I’d be interested in reading the story.
I take it the agreement not to breastfeed was a joke. That really baffled me :-S
From a recent study in The British Medical Journal (I think it was published in the fall.)
“It was found that the intrapartum and neonatal mortality rate for homebirths was on par with what other studies have shown for hospital births, while the rate for medical inverventions was much lower for the homebirth group as compared to the hospital birth group. In other words, for low risk women, homebirth is just as safe as hospital birth, and hospital birth is just as safe as homebirth, from a statistical standpoint. Of the 5418 women, 655 (12.1%) were transferred to the hospital, mostly for epidural medication (4.7%) or cesarean delivery (3.7%), indicating medical intervention rates astoundingly lower than the national average (19% in 2000 for low risk women). The intrapartum and neonatal mortality rate was calculated at 1.7 deaths for every 1000 planned home births, after breech and twin deliveries were excluded (since they don’t qualify as low risk). This is consistent with the findings of other studies of planned home births and low risk hospital births. No maternal deaths occurred.”
You can find this study on the website: http://www.bmj.com
I agree that in the case of a low-risk pregnancy, homebirthing is as safe, or possibly even safer, than a hospital birth. I think it’s an important and reasonable option for women to have.
In 2004, the last year for which statistics are available, the cesarean rate in the U.S. was 29.1% of all births. TWENTY-NINE PERCENT!
If you factor out the repeat cesareans (and women planning to have more than ne or two children should be aware that every successive cesarean increases the risk of “badness”), a first-time mother going to the hospital to have her baby has a one in five chance of having a surgical birth.
If she stays home, her chance of a cesarean is less than one in thirty.
According to a July 2003 ACOG press release, which summarizes findings of a recent study, “a cesarean delivery significantly increased a woman’s risk of experiencing a pregnancy-related death (35.9 deaths per 100,000 deliveries with a live-birth outcome) compared to a woman who delivered vaginally (9.2 deaths per 100,000).”
ICAN, the International Cesarean Awareness Network, writes that while they “recognize that when a cesarean is necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved” — the risks are significant. “Potential risks to babies include: low birth weight; prematurity; respiratory problems; and lacerations. Potential risks to women include: hemorrhage; infection; hysterectomy; surgical mistakes; re-hospitalization; dangerous placental abnormalities in future pregnancies; increased percentage of maternal death. ”
That “increased percentage of maternal death” is almost 4 times greater with surgical than vaginal birth, according to this study.
In many places, women with previous cesarean sections are being denied the opportunity to even attempt a subsequent vaginal birth in the hospital. In many places, homebirth midwives (where they are legal) cannot legally attend a VBAC at home. Is the mother who births unattended in this situation being negligent, or is she protecting her baby, her future children, and herself? Should she really go to the hospital, where “we have the technology and skill to make sure badness doesn’t happen?”
Lenise,
Not a joke — apparently she was on some sort of anti-depressants and they made her sign a statement saying she would not breastfeed. Most ADs are compatible with bfing, even some for bi-polar disorders, etc., so… that’s kinda infuriating.
Wow. I can’t believe they made her sign a statement saying she wouldn’t breastfeed due to anti-depressants. That’s ridiculous.
We had an unplanned unassisted homebirth with our second. (Unassisted part was unplanned; homebirth was planned.) My labor was an hour and a half, and the midwives got stuck in rush hour traffic. They arrived five minutes after our daughter was born. It was perfect. But, I agree with some above posters–I would not plan an unassisted homebirth. And not because I’m not knowledgeable about birth–I’m a childbirth educator–but because I believe someone experienced & trained who is not *in labor* or about to become a father should be there to make objective decisions. It’s just smart.
That said, I understand why people have educated unassisted homebirths.
I realize I didn’t address the UC question in my first post….I wouldn’t have UC either. But I understand why one would.
And from what I understand, the World Health Organization recommends midwife-attended homebirths as the safest way to birth (in developed countries.)
I think I’m still the most “liberal” one here. the only man, too. where’s my wife when I need her? :)
One thing at a time. First off, the BMJ article (can I have a citation so I can read the whole thing?) about homebirthing. It should be noted that midwives and the like in the UK are significantly different from their counterparts in the US, especially when you factor in state-to-state variation. Therefore, I’m not sure that study is even applicable to the populations you have in the US. Additionally, with the NHS, there are different levels of prenatal care provided compared to here in the US. I’m sure there are other confounding factors. That said, for educated, involved, known low-risk situations, help in some form physically present (be it the NMW or some other medical person), homebirthing may be just jim-dandy spectacular. However, I don’t know how many NMW’s feel comfortable handling dystocia or massive hemorrhage by themselves.
Factors affecting c-section rates in the US are varied and multiple. More existing c-sections mean more repeats, depending on various factors. Deliveries in training hospitals probably mean lower threshold for c-sections. Elective c-sections are also much more common now for many reasons. Almost all ob-gyn residents at my school elected to have scheduled c-sections, or at least talked about how they would have scheduled c-sections. Also, consider who is most likely to choose homebirthing – educated, involved, decently well off financially, white. Not exactly a high risk group. That may self-select for less risky pregnancies. After all, they’re probably not doing cocaine during their pregnancy. Additionally, the litiginous nature of our society makes OBs more likely to be “safe, rather than sorry.” If things start looking bad, they’re more likely to pull the trigger and go to the OR. CYA medicine.
Also, I’m just wondering why a 30% rate is startling. Should it be less? Why? What if mothers in the US are shown to be engaging in riskier behaviors, necessitating the increase (which I assume it has) in C-sections? I don’t know if that actually IS the fact, but I do know that we are seeing more high-risk births from IVF, advanced maternal age, etc. as women choose to have children later, or really going for the high-tech stuff to bear them.
Surgery is always dangerous, no matter what it is. Emergent surgery, (which is what a non-scheduled c-section is) that much more so.
And if she attempts a VBAC at home and ruptures? What then?
So the problem with psych drugs (and in fact, most drugs) and breastfeeding is that the data is either non-existent or weak. It’s hard to do randomized double-blinded trials in things like this ethically. From uptodate, a well-respected clinical resource:
“The American Academy of Pediatrics (AAP) committee on drugs provides information on several hundred commonly prescribed medications, as well as other agents, that may pass into breast milk… This information is often cited in drug databases (including the drug information database in UpToDate). However, there are few to no large or randomized trials in this area. Most recommendations about the safety or possible harm from breastfeeding while taking medication are expert committee opinion based on case reports and laboratory studies. Nevertheless, the data presented below shows that the exposure of most infants to antidepressants and antipsychotics via human milk is clinically insignificant, with some exceptions.”
Re: the WHO recs. I don’t know if you realize this, but the WHO makes lots of recs, most of which aren’t followed the world over. It’s a nice organization, but it has little to no enforcement power, unfortunately. Additionally, midwifery, as mentioned above, varies significantly just from state to state in the US, and I’m sure even more so between countries. I’d be interested to see what they really mean when they recommend that – exactly what training and how much training should the midwife have, and how close ought the pregnant mother be to a hospital?
Just a not-so-quick note-I have had a homebirth without a DEM, CNM or CPM in attendance, also quite by accident, and I certainly would not call it “unassisted.” I had loads of help from other women who had homebirthed, and my husband. A DEM arrived about an hour after the baby was born, and all was well. This is not, as many think, “lucky.” It is the normal course of events and as natural as can be. It was a beautiful birth.
Phil, my OB/GYN, who I see regularly for shadow care (I think it is prudent for me to have a good relationship with an OB on the seriously off chance that I will need a section or to transport for some other reason) ASSURES me that there is NO situation he can actually fix in hospital that a confident experienced direct entry midwife can not handle for the 15 minutes it would take me to transport. In other words, he can not make sure nothing bad happens. Women and babies do still die in hospitals.
Part of the difficulty in this discussion is that a big group of what are essentially surgeons (ob’s)are the ones making the definitions. The women, who for centuries have attended birth, honed their skills and practiced (with success) their craft, are treated as though they know nothing and are a danger to women. I am amazed at the knowledge and experiences that my DEM brings to homebirth. She knows stuff my OB doesn’t need to know because he practices in an institution.
I do not cede, for example, that a woman who is above 35 is a high-risk for complications because of her “advanced maternal age.” I do not cede that all placental ruptures end in death for either mom or baby. I do not cede that a baby who is over 42 weeks in the womb can not be born naturally. I do not cede that a child who needs some assistance breathing at birth needs to be whisked away from its mother and hooked up to machines. The “protocols” found in hospital births are used because the medical establishment does not know any other way, not because there is no other way.
Phil,
the BMJ study was actually done in North America:
http://bmj.bmjjournals.com/cgi/content/abstract/330/7505/1416
“I am amazed at the knowledge and experiences that my DEM brings to homebirth. She knows stuff my OB doesn’t need to know because he practices in an institution.”
We found this too. I’m amazed how little those in the medical establishment know about childbirthing compared to midwives.
When Rachel was 42 weeks, our OB’s assistant said Rachel would not be able to have v-birth and that Rachel’s placenta was dying and all sorts of other misinformed opinions…all things that were proved wrong after Kyrie’s birth. She really got us a bit flustered. She said this stuff while looking at an ultrasound.
Fortunately we had a midwife to tell us why these things were true, and she could say those things with confidence because she had spent time with Rachel and knew her body.
Wonder how soon it will be before we start being warned of the dangers of going out without a cell phone? “While strong, healthy people may certainly choose to drive on America’s highways without a cell phone, they should be aware that having a cell phone allows instant contact with 911 if anything should go wrong…”
;-)
“I believe someone experienced & trained who is not *in labor* or about to become a father should be there to make objective decisions. It’s just smart.”
That’s my belief, too. That said, it seems the midwives have faded into the background more and more, with each successive birth. (I’ve had two in-hospital, two in-home births, all attended by midwives, each with “complications” that were within normal and handled skillfully by the midwife.)
I think it is insane to take a baby away from a family because of an UC, and certifiable that they required a do-not-breastfeed pledge for the mother to get her child back.
One cool thing that really surprised me at the birth center I hope to use someday, The Birth and Women’s Center in Dallas, was that the OB/GYN practice they partner with for pregnancy issues outside their sphere, (called the Women to Women Clinic near Baylor Hospital,) had SEVERAL female OB’s at the practice who CHOSE to give birth at the BIRTH CENTER with a…..MIDWIFE! And not just for one birth, but multiple times did these doctors choose the midwife at that birth center. I found that fascinating, and perhaps a bit telling. Not quite a homebirth, I realize, but amazing just the same.
And Phil, I am not a expert on the WHO, but I certainly don’t think it’s some sort of all-powerful organization. I am not surprised it doesn’t “enforce” its recs–they’re recommendations, after all. I just found the recs interesting–after all, it’s the “World Health Organization.” :)
I’ll deal with the paper in a separate post after I have some time to sit down and read it thoroughly.
“Phil, my OB/GYN, who I see regularly for shadow care (I think it is prudent for me to have a good relationship with an OB on the seriously off chance that I will need a section or to transport for some other reason) ASSURES me that there is NO situation he can actually fix in hospital that a confident experienced direct entry midwife can not handle for the 15 minutes it would take me to transport. In other words, he can not make sure nothing bad happens. Women and babies do still die in hospitals.”
Yes. if you’re blessed enough to live 15 minutes from a hospital. and in 15 minutes, lots can still happen. I have seen it happen in front of me, in the hospital. Thankfully, none of them were truly bad outcomes. Many of them were complicated. Meaning blood loss and other things. Many of the complications may have been cut off by the decision to section. we may never know because a decision was made to not watch it develop. And while I’m not trying to make anyone out to be a liar, I bet I can come up with some stuff that could kill in 15 minutes depending on what sort of things you’re willing to let me assume (like no prenatal care). And while we are talking about statistically improbable things, the point is that pregnancy and childbirth are natural processes with plenty of risks.
I have no doubt there are things that midwives know better than OBs. Experience and repeated exposure to things does that for people. That’s one of the reasons people DIDN’T want a cap on resident work hours.
“I do not cede, for example, that a woman who is above 35 is a high-risk for complications because of her “advanced maternal age.†I do not cede that all placental ruptures end in death for either mom or baby. I do not cede that a baby who is over 42 weeks in the womb can not be born naturally. I do not cede that a child who needs some assistance breathing at birth needs to be whisked away from its mother and hooked up to machines. The “protocols†found in hospital births are used because the medical establishment does not know any other way, not because there is no other way.”
All definitions are arbitrary. A certain time period is picked because the statistical analysis shows the curve pick up at that point. You’re right, the line could have been moved one way or the other. I’m not sure what you mean by “placental rupture.” I’m sure there are 42 weekers born entirely normally. I’m also sure that the risks of a 43 weeker are very different from that of a 40 weeker. I am also certain that 42-43 weekers that were otherwise healthy can, and are, stillborn. There are known increases in risks with increasing age and gestation past 40 weeks. The curves may not pick up a lot at our modern medical “boundary”, but they do. Beyond that boundary, I promise, the likelihood of an uncomplicated healthy pregnancy and delivery drops very quickly.
How else do you suggest we assist breathing without at least bag-venting a child? would you rather the pediatrician do mouth to mouth right there on an infant with a fraction of his lung capacity? Perhaps your complaints are more logistical than anything else. The footprints of the machines needed to provide artificial ventilation are not small and often cannot be brought into a delivery room. That’s all there is to it. So the baby must go to it if that intervention is needed.
Protocols are (usually) established based on the understanding of risks and the current technology for reducing risk and addressing problems. That does not mean interventions are not without their own problems, but merely that those risks are considered worth the benefit that they provide, on a large-scale analysis. Of course, statistics say nothing about the specific outcome of any individual situation with a specific child.
The Birth and Women’s Center in Dallas is less than 2 blocks from Baylor University Medical Center. That’s very close to VERY good medical care. That is a good thing, a VERY good thing.
We’ve been over this before. I am not against midwifery. I am not against home births. I am not against so-called “natural childbirthing” methods. I am against conservative Christianity holding it up to be some magical experience that is somehow without real risks or tradeoffs. As I said above, there are many women for whom a home birth with a midwife will work just fine. There are times when a midwife will be woefully inadequate. I pray that none of you will have to personally experience such a situation. I also trust that most of you are decently educated and understand the risks and benefits of such an arrangement.
However, it was not such a long time ago, (and midwives were still being used then), that infant mortality and maternal mortality were dreadfully high. The point is that the mere use of midwifery does not in and of itself make the process of childbirth necessarily any better. It was not such a long time ago when it didn’t matter if you had a midwife or not. And there was also not such a long time ago that a home birth attended by a midwife WAS worse than a hospital birth – there was a time when they weren’t trained very well, or did not know much about modern germ theory. There are many places in the world where that is still true, and we have seen the results of such things. It’s not pretty. And that applies way beyond childbirth, reaching into general medical care and attitudes towards health in populations with less education or other confounding factors.
Many of the things many of you are advocating are not bad things, and they are actually quite useful and good in certain situations (low-risk mommies, or moderate risk who live close to a good hospital). However, they are not necessarily tranferrable across all situations in the US, and definitely not across cultural and national boundaries.
The comments section of the BMJ article is very interesting, in that it plays out some of these issues as various people respond differently.
One of my favorite things to pick on the WHO about is their definition of health:
“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.”
That all sounds well and good, but seriously, who’s going to pay so that everyone can have their “right” to complete mental and social well-being? and who decides what that is exactly? and so on.
I mean, they do lots of great stuff, no doubt, but they’re also kinda useless at times. As I said, seriously, how do they expect to actually do some of these things when they have no power? How do they expect to actually put midwives on the ground, or ensure that they’re well-trained, and so on?
I’m personally happy that midwives are well-trained in the US, such that if you do use one, people can have confidence that there is some level of training a CNM or someone else actually has and has been shown to reach a minimum level of competency.
As for UC, well, I don’t think I want to deal with that one. I can think of many situations where you just need a 3rd party to do stuff, and dad cannot be that person.
I think my post, followed by your post, Phil, is an amusing display of the very difficulty I am talking about. I am speaking midwife/homebirth-ese and you are talking hospital/doctor-ese. And the two have some vocabulary in common, which makes it all the more confusing, but we are not speaking the same language.
Your “how else would you suggest we assist breathing” could be answered by about 5 different suggestions from my midwife, who knows other ways than taking a child from its mother to help it breathe. In fact, at 36 weeks, she comes to the house to do an entire run-through of all the things she can do at a homebirth to get a child to breath (and yes, a last resort is using a bag, but the kid is still with mommy, a circumstance I believe helps the child deal with and recover from any trouble they may be having more easily than if they are handled by strangers). Your assumption that a pediatrician is the one performing these maneuvers is another example of how we just don’t see things the same way. What about mommy talking to and rubbing the little child, while Daddy prays for his family and the midwife works her protocols? She is certified by the same people and takes the same classes as all the L&D nurses who would be performing that work in a hospital. I really do not see the problem at all.
I did not say there’s nothing that can kill in 15 minutes. Neither did my OB. But there is nothing that HE CAN FIX. In other words, death in 15 minutes can happen in hospital as well as at home. Of course this depends upon my earlier qualification of an experienced knowledgable DEM being in attendance. Of course outcomes are different when you assume things like no pre-natal care and drug abuse and all kinds of irresponsible behavior.
I meant, of course, abruption. When a placenta ruptures, I believe that’s what it is called. I could be wrong, I frequently am.
Another part of the problem with this “discussion” is that I don’t really see much of the medical establishment dealing with newborns as…people. As dear children, connected to the covenant community and beloved in the image of God. My decision to homebirth has a lot to do with this paradigm we have as a family. So when I read a medical, scientific, outcomes based argument I think it is severely lacking when it comes to dealing with the child as a human being. We’ve decided to live responsibly within this paradigm. Although I find Sora’s medical scientific outcomes based argument regarding the dangers of c-section rather compelling.
With all due respect, and I don’t know what training your OB has, but there are things that can kill in 15 minutes at home, but can be rectified at the hospital by a qualified OB.
Yes, there are a number of options you can take, which they use in the hospital as well – stimulation by any number of individuals is an option, long before the child is bag-vented. But you can’t wait for 15 minutes before you bag a kid. Or even 5. We are finding more and more data to show that early intervention is better for the child. But since that doesn’t fit your paradigm, it must not be useful data. Only the stuff that supports your paradigm is valid, right?
As for the abruption, I didn’t know if you were talking about the abruption or a uterine rupture, which we had mentioned earlier in the context of a VBAC. Abruptions are a sort of rupture, I suppose – the placenta just comes off the uterine wall, and sometimes it’s intact when it does that, sometimes it shears off and chunks are left attached to the uterine wall. Either situation (uterine rupture or placental abruption) are medical emergencies, as the former can kill mom, and the latter can kill both mom and child.
I agree that there has been significant depersonalization of medicine and that there are a number of ways that affects the process of pregnancy and childbirth. However, no one can ask the scientific method to deal with “the child as a human being.” It doesn’t claim to do so and can’t claim such a thing. However, medicine can, and ought to, in the application of scientifica data to individual situations. The data we have about risks and the like are fundamentally about populations, and can say nothing about an individual situation. So it can’t have any say in any issues surrounding the covenant community or anything else of that matter. However, to discount scientific data because of that is a mistake, IMHO, because there’s a lot of “impersonal” research out there that has led to real life applications that you, your family, and I all benefit from greatly.
For example, if your option were a midwife NOT trained in sterile technique homebirth vs. a doctor who was, what would you choose? Now I know that’s a false dichotomy and that doesn’t happen, but the point is that impersonal scientific research is what led to the discovery and implementation of things like sterile technique, so that if you do have a laceration while giving birth, you get sewn up with clean suture and don’t seed infection, whether at home or in the hospital.
Additionally, impersonal studies have objectively shown that the relative rates of complications ARE higher as you get older. We just happened to decide to draw a line at 35, even though the rate actually increases prior to that, just not enough to invest the resources to call all of them “high-risk.” But the application of that knowledge is what makes medicine “personal” or “impersonal.” Application of the knowledge and tools is what makes a doctor a physician vs. a glorified technician.
Finally, I want to reiterate that I am not against wisely considered midwife attended homebirth. I am against any insinuation that any other option is less spiritual or less in line with what God wants for the family in pregnancy and childbirth. I would never recommend midwife attended homebirth in a number of situations, in and out of the US, because they would not be safe for mom or the child, and that is out of love and concern for the family, not to cover my rear end from being sued.
And I am not against wisely considered OB attended hospital birth. I am against any insinuation that other options are riskier or less in line with being responsible parents before God. I would not recommend OB attended hospital birth in a number of situations, because they are not as safe for certain mothers and children.
My paradigm includes dealing with medical evidence as a tool, not a final standard. It is an important piece of the puzzle, but not to be considered the last authority. Statistics play a role. It would be foolish to ignore the many great things we know because of advances in western medicine. I just don’t agree with all the conclusions. This disagreement is not based on anything arbitrary, but on evidence to the contrary from the model of midwifery care.
Perhaps you misunderstood my scenario re: bag venting. We don’t have to wait to get to the hospital to do this procedure. The midwife has a tool with her to accomplish this if needed. We just prefer it done (as with a number of things involved in birth) in a way that includes honoring and considering the many things that are going on.
For example, (and this may be TMI) in my last homebirth, there was a laceration. My midwife is completely competent to handle suturing and is trained to do such. However, we decided after considering all the factors,(severity of tear, past history of lacerations, general health of the mother) to leave the laceration without stitches, keeping it clean and sterile as possible. The body healed itself beautifully, as the midwife knew it would. This is just one example of how things can be done a little differently with a perfectly good outcome (in fact better than the previous hospital outcome I experienced) when a little more personal paradigm is used. That’s all.
I am not against OB-attended births, either, Phil. :) There are situations where I think I would praise God for an OB….Incidentally, I agree with the first part of the WHO’s health definition–in terms of real health being more than just the absence of disease. But then, I’m into integrative medicine. But heavens, let’s not get into that, ‘kay? ;)
I’m growing weary of debating across a chasm of philosophical differences, however. Obviously no consensus will be reached here. So, I’m out. God Bless, everyone!
I am no OB and no midwife, but I bet the times that a midwife is superior to an OB are few and far between from a strict outcomes perspective. I would like to hear of an example where an OB is clearly more dangerous than a midwife. If the outcomes are equal, then sure, choose whichever you want.
If medical evidence is a tool, why do you only selectively use it?
“So when I read a medical, scientific, outcomes based argument I think it is severely lacking when it comes to dealing with the child as a human being. We’ve decided to live responsibly within this paradigm. Although I find Sora’s medical scientific outcomes based argument regarding the dangers of c-section rather compelling.”
Why is “medical, scientific, outcomes based argument” lacking in dealing with a child as a human being when that other article (medical, scientic, outcomes based) not guilty of the same? by virtue of it supporting your paradigm? Show me the body of evidence “to the contrary from the model of midwifery care.”
I agree that you have options when waiting for a child to breathe spontaneously. Many interventions other than bag venting are possible, ranging from nothing, to stimulation, and so on. However, if a child isn’t breathing fairly soon, that’s a bad thing. A very bad thing. Minutes can make a huge difference, obviously.
I’m very happy that your laceration healed well without sutures. Not all do. Depending on the severity, not suturing a laceration can have NUMEROUS complications, ranging from vaginal/uterine prolapse to rectovaginal fistulas to infection and sepsis. I’m glad yours was not severe, and I’m glad it worked out. However, I would not go around recommending not suturing lacerations. In fact, I don’t see anything wrong with suturing even a minimal lac to be safe, since the complications are profound.
I’m into integrative medicine, and if you ever asked me, I would be more than happy to explain my philosophy of medicine. My problem is that no one has ever defined anything. By the WHO’s definition, we could basically spend every last resource we have on this planet, and still not ever get anywhere. Pragmatically, we must set more realistic definitions, and set levels to aim for that are reachable within reasonable use of our resources.
Additionally, I think it is folly to hold up certain practices as superior to modern medicine when it is because of modern medicine that certain practices are possible. As I briefly mentioned above, there was a time not so long ago that childbirth had nearly a 50% mortality rate for moms due to unhygienic conditions. The only reason that midwives and OBs are able to reduce such morbidity and mortality is directly related to modern science’s discovery and applicationg of germ theory. That’s one of the key reasons that homebirthing IS a safe alternative for low-risk women in the US – we know how to keep things relatively clean/sterile when it needs to be, reducing the risk of things like chorioamnionitis during protracted labor.
A lot of this boils down to who you are and the specific blessings of being in a very safe developed country. You are educated women with a strong desire to understand what is going on with your pregnancy, your child, and your family. I believe you would have the wisdom to call an OB ASAP if things went bad. However, I have been exposed to more than a couple people who are so dedicated to the “natural childbirth” movement that their actions border on child abuse/neglect because of the risks they are willing to take to preserve this “blessing/honor/paradigm” of a more “spiritual” (for lack of a better word) way to do so.
Yup, I’m done talkin’. It isn’t that I don’t have more to say (LOL) but the water is wide and I can’t cross o’er.
Ok. I lied. One more thing. On the laceration thing? I suffered a tremendously botched suturing job in the hospital and had some of those complications you mentioned as a direct result of an irresponsible Attending allowing a newbie to stitch up my 3rd degree tear and then not seeing me to fix it after it was obvious that I was not recovering properly. This hospital is known throughout our city for its GREAT perinatal staff and as a great place for a high risk birth. Well, I had a low-risk birth, which they turned into a high-risk postpartum. They would not take responsibility and would not fix the problem. I was in recovery after that birth for 14 weeks. I believe in this situation, the OB was more dangerous to me than any qualified homebirth midwife would have been. And, in fact, the next laceration healed just fine without the intervention. In a homebirth situation, the MW comes to your home to do postpartum care at least 6 times in 6 weeks. If I had had that sort of care after my botched hospital birth, (and yes, I know, nobody died, but that’s not the only thing I care about) the problem could have been caught and dealt with a lot sooner.
Done.
I’m sorry to hear about that mess, and I’m sorry you had a rotten experience at that hospital with that OB. For what it’s worth, I think that OB handled that situation in entirely the wrong way. I’m very happy that things didn’t turn out worse.
Anything done wrongly/poorly is going to be bad, no matter who they are, how much experience they’ve had, what training they’ve had (or didn’t have). Midwives will miss things and OBs will miss things, and midwives and OBs with both make mistakes. The question is whether or not they are people of character and humility, and whether or not they will handle themselves properly afterwards. I would hope that both midwives and OBs would have such people.
The relative luxury of some of the things we used to consider integral to good medicine (such as the follow-up visits and treating patients with dignity and respect) are, for many reasons, not valued and encouraged in modern medicine. I, too, wish that OBs could/would do like midwives, and come and check on their patients. I wish many things about medicine, including a return to the original covenantal nature of the profession, which I believe both of us long for.
The modern scientific establishment need not be unresponsive and disrespectful of its patients, but unfortunately, that is where we are. I fully admit the shortcomings of medicine, and I apologize for that. That is also why I nearly dropped out of medical school more times than I can count (my wife and friends will vouch for that).
I fully agree that mere avoidance of death is not the only part of an outcome. There are many non-quantifiable things that go into the physician-patient relationship that are entirely qualitative, and have intrinsic value beyond reimbursement or outcomes studies.
Finally, I would like to make the distinction between the OB being responsible, and therefore dangerous, in a strictly medical science sense vs. that of the OB as a professional. Had the attending done the suturing him/herself, I’m sure it would have been great. Because he chose to let someone else do it, it was, in my mind, more of a moral and character failure that he did not take responsibility for checking on what someone under his supervision did. I am not trying to remove any guilt from him – he was entirely wrong. However, it wasn’t because of modern medical science that you had a bad outcome – it was because what should have fixed everything was done badly to begin with, and not followed up on properly.
The problem is not medical science or even improper application of our knowledge, as both the OBs and midwives are going to be guilty of such things. The problem is fundamentally in the human beings, their character and moral failings. The medical establishments weaknesses with respect to treating people (parents and their new children) with dignity and respect are moral failings, not scientific ones.
It is naive to suppose that one’s science is not affected by one’s moral and character failings.
The application of said science has moral and character failings. However, I don’t see how the actual data, while possibly biased, incomplete, and selective depending on how it is accumulated, has moral character itself.
The way the science is affected morally still has to do with the person and how the person uses scientific methods, data, and so forth.
What a meandering conversation. I first read this when I was 42 weeks pregnant and still planning a homebirth. It was a bit odd to read, I wondered what Phil would think of me. ;) (Wondered but was not concerned, btw. :))
I recently gave birth to my beautiful daughter at 42 weeks 5 days at my MW’s home. (she had a jacuzzi tub!) Based on my last pregnancy I expected to go long, still it was hard doing so in this day and age when women start being induced earlier and earlier. I allowed myself to be pressured into an induced laborwith my first daughter by my doctor after he consulted with another dr (my dr was willing to let me go longer until he spoke to his colleague). Thank God the induction went “OK” though cytotec was used against my better judgement and my dd was fine… however, when they examined my placenta they said it looked like a “39 week placenta.” So though by *their* calendar I was two weeks past my EDD, my baby was not yet due really.
Knowing this information, as the 42 week mark approached, my MW just monitored me carefully and had me do frequent kick counts, stay hydrated, etc. When my labor began after days of on/off contractions, it was very quick and easy.
Still, I’m not in the UC camp myself, though I support the right to have an UC. I personally appreciate the support of a MW and doula, and was glad that my MW was there given that I got a second-degree tear that I would not have been able to discern if I had given birth alone (it “approximated” perfectly.) I think that for normal births that a MW in a home or birth-center setting provides superior care. But I do think there is a place for hospital births- there are high-risk pregnancies and conditions that are best served in a hospital setting for sure. So I’m glad that here in the US we have a system where the best of both worlds is available, though I’d like to see more awareness of the work that MW’s do. :)