Tuesday, May 23, 2006

Do homebirth advocacy websites inform or misinform?

The Farm Study has been extensively discussed here and most of us agree that it shows an unacceptably high neonatal mortality rate and that the conclusions of the paper are in no way justified by the results.

So why is it that every major homebirth advocacy website cites this paper and often quotes the abstract in support for the safety of homebirth? The paper has been thoroughly discredited and I have not seen a homebirth advocate offer an effective defense of its methods or conclusions when directly confronted with the results.

How can the average woman trust the information on a homebirth website when some of the most basic information it provides isn't even true?

14 Old Comments:

I guess you are going to need to read some actual information and not just the web--
as for the Farm I don't really think that they do "low risk" births or help only low risk women.
Women from all over the country go to the Farm to give birth- because they have special circumstances that do not allow them to birth in the places they live already--
also I would guess you would be surprised at what the set up is there-
one midwife in particular who had a neonatal death who was included in the BMJ article was also a midwife who does fairly high risk births-

By Anonymous Anonymous, at 1:10 PM  

Amy, I run a "natural mothering" website that promotes natural childbirth. It is the position of my website that the Midwives Model of Care and the choice of homebirth are reasonable and safe. I think most readers will understand that my website is opinion and experience driven. I provide links to websites that I believe are reputable, such as The Coalition for Improving Maternity Services. I think my readers are very well informed and will do the research for themselves. The medical community does more than an adequate job of promoting your point of view, so I don't think you need to be worried that women choosing homebirth haven't heard both sides. Women have brains, you know! And you don't need a medical degree to figure things out.

By Blogger Mama Liberty, at 5:35 PM  

Danielle,

If you go for a C-section (preferably when you aren't needing one emergently) they'll tell you things.

They'll tell you the risks, as far as they know them.

They'll tell you the benefits, as far as they know them.

They'll tell you WHY they believe the benefits outweigh the risks.

They'll give you a consent form to sign which makes extroardinarily sure you know the risks and have accepted them.

in fact, a good doctor will do this for EVERY procedure.

Do you do the same? Are you seriously assuming that your patients "will do the research for themselves"?

That is NOT informed consent. Your job as a health care provider (if you want to be an ethical one) is to ENSURE that your patients are informed, not to ASSUME that they are informed.

This means, for example, that if you have had various people point out flaws in studies, you are OBLIGED to discuss them, or to seek further explanation, before basing your recommendations on those studies.

Your current practice may be safe. It may be healthy. But it sure as hell doesn't sound like "informed" consent.

What is REAL informed consent? Well, it would include explaining to a mother that certain anomalies or situations, occurring at home, will likely mean her baby (or she) will die. You would explain that they can't always be detected through tests. You would accurately represent your skill in treating the theoretically 'treatable' ones at home. You would be cautious if she seemed not to understand that: if she didn't touch wine because a single glass might have a 0.01 change of FAS, does she really understand what a difference of 1/1000 deaths means? You would show her the statistics for women of her type. You would point her here, as well as midwifery sites.

THAT's informed.

By Blogger sailorman, at 6:44 PM  

Thanks Sailorman,
That is exactly the kind of informed consent I get from my midwife.

By Anonymous Anonymous, at 7:10 PM  

Sailorman, I AM NOT A MIDWIFE! I am a mother who wants to have her babies at home and have the OBs leave me the heck alone unless I there is an emergency! Then, they can do whatever they want to me!

I am informed. My peers who have births at home are informed. Almost all of them have bachelors or advanced degrees. They do FAR more research and weighing of the risks/benefits than do OB attended hospital birthing mothers (for the most part).

And for the record, my OB did NOT adequately inform me of the risks of c-section as you outlined in your post.

Danielle

By Blogger Mama Liberty, at 7:15 PM  

Yup, my midwife has given good, honest advice. I check with other midwives online, I have my own midwifery textbooks etc etc etc..... I like to be as informed as possible.... And if something does go wrong, at least I have the textboks to help out PMSL...

By Anonymous Anonymous, at 7:18 PM  

"in fact, a good doctor will do this for EVERY procedure.

Do you do the same? Are you seriously assuming that your patients "will do the research for themselves"?

That is NOT informed consent. Your job as a health care provider (if you want to be an ethical one) is to ENSURE that your patients are informed, not to ASSUME that they are informed. "

I have never gotten better informed consent from a health care provider than what the midwives I have seen have provided-- on nearly all things including even touching me they ask if they can touch me and say or often describe what the procedure they are proposing to do in detail and what they expect to learn from the procedure and how could that change my care-- for many details they offer books and detailed articles usually providing differing opinions , risk benifit and long term risks ---
this goes for many routine procedures like eye ointment for infants- vitamin K- metabolic screening- things that may seem routine and you sign a blanket consent form for when you enter the hospital-- certainly when I had my children in the hospital no one even told me what they were doing to my baby they just did it within moments of their births-- now I know why things are done and it is my decision -- and I may also decide to get the more bigger metabolic screening that is available rather than just what ever ones the state I live in has decided to worry about- many parents get the state screening and think well the stuff that is wrong with my kid can't be metabolic because we had the screening and nothing came back-- I don't know maybe there are midwives who do not offer an education along with treatment- but I haven't met them yet.

By Anonymous Anonymous, at 7:40 PM  

If everyone is giving informed consent to homebirth, why is it that all the information in the homebirth papers is news to them? No one appeared to know the true risks until Sailorman and I pointed them out.

And, I'm still looking for the homebirth advocacy website that discusses the truth about safety. Since homebirth advocacy websites and books are filled with misinformation, and since homebirth mothers appear to get their information from these websites and books, how can they be informed?

By Blogger Amy Tuteur, MD, at 8:09 PM  

could you direct, (or tell me here, again) me to where you discuss how the farm study has unacceptablely high infant mortality rate?

thank you

By Anonymous Anonymous, at 9:29 PM  

"the truth about safety". Amy, the fact of the matter is, you are one of those dogmatic midwifery types you don't like, excpet you are on the opposite side of the spectrum.

YOu refuse to accept that midwives and homebirth midwives DO their research. Can cite studies up and down just like you. They are stupid, they aren't ignorant. But in your mind they have to be because anything that is out side of the model of care you deem safe is dangerous and reckless.

It's obvious from you posts you know very little about how homebirth midwives practice. Funny, since you are so against it, yet you don't even know what you are against.

Once you stop being so dogmatic maybe you will be able to see the truth about safety.

Sadly, I don't think you would ever accept the fact that homebirth can be safe for certain women. There are studies that support this (see the post in the other thread listing them). Because you think you know for a fact that most births can't be trusted to turn out well without the interventions of modern medicine and OBS.

I personally don't like dogmatic types on either side of the spectrum, technocratic medical model or midwifery model. Each has its place, neither is always right.

By Anonymous Anonymous, at 9:38 PM  

"They'll tell you the risks, as far as they know them.
They'll tell you the benefits, as far as they know them.
They'll tell you WHY they believe the benefits outweigh the risks.
They'll give you a consent form to sign which makes extroardinarily sure you know the risks and have accepted them.
in fact, a good doctor will do this for EVERY procedure."

Yeah, and how many good doctors are left out there? Virtually every single couple I've taught, every single hosptial birth I've been at and every single birth story I've been told has included a lack of informed consent. A good many OBs are not informing, they are lying - or they are not informed themselves. Maybe it's just my area and the OBs here. But reading about other stories, I really feel like this is more common than the medical world would like to admit.

And the phrase, "as far as they know them" really says something. Should we have to depend on what is stored up in the head of one doctor to make sure we have informed consent? But then they get upset when you mention something you read or ask the tough questions that make them go back and get answers.

Speaking about informed consent, do OBs routinely inform their patients that the package insert for Cytotec says it shouldn't be used for induction of labor? Do they inform them that their routine induction carries a higher risk of c-section? Do they tell them that the only reason they need continuous EFM is to save the hospital money? Around here, unfortunately, no they don't.

By Anonymous Christine, at 9:33 AM  

Anonymous said...

could you direct, (or tell me here, again) me to where you discuss how the farm study has unacceptablely high infant mortality rate?

You might try my blog, Statistics for Believers #1 through 3.

You could also search for the comments at Neonatal Doc (Dr Amy discussed it at length there), and for her earlier comments here.

By Blogger sailorman, at 9:42 AM  

My midwives have always been informative. No they may not have directed me to various studies, just like the Obs never directed me studies on induction etc.

Midwives 'offer' me induction with the pro's and cons, Obs have told me that 'unless you have an induction you will kill your baby, now when shall I book you in?'.

Give me a midwife any day.

By Blogger Heartwrench, at 12:25 PM  

Heartwrench:

"My midwives have always been informative. No they may not have directed me to various studies, just like the Obs never directed me studies on induction etc."

I don't know about the midwives who care for you. However, if a homebirth midwife told you that homebirth is as safe or safer than hospital birth, she told you something that isn't true. If you are not getting valid information, then you can't give informed consent. This is persistent problem with homebirth advocacy websites and books.

By Blogger Amy Tuteur, MD, at 2:17 PM