Tuesday, June 06, 2006

Hostility toward midwives

This is from Laura Shanley, an advocate of unassisted homebirth. I am struck by the fact that this is almost exactly the language used by homebirth advocates to disparage doctors. Is this an accurate portrayal of midwives? How would you explain to her why hiring a midwife is safer than unassisted homebirth?

"However, I will say this to anyone who is considering hiring a midwife. If a midwife tells you that she understands your body better than you do, run from her. Yes, she may have a general understanding of how "a woman's body" functions in birth. But she doesn't know how your body functions, any more than she knows what turns you on sexually. Birth is indeed a sexual experience, and what works for one woman may not work for another. Every body is different, every woman is unique, and for that matter, every birth is unique. As the woman who will be giving birth, you are in the best position to know what works best for you. Just as you know what sexual positions you prefer, you will know what birthing positions you prefer, as well. Your body will tell you - if you listen.

If a midwife tells you that she is indispensable to the birthing process, run from her. Contrary to popular opinion, birth is not inherently dangerous. Infant and maternal mortality rates are high in third world countries not because the births are often unassisted. They are high due to poor living conditions and lack of food. Throughout history, healthy, well-nourished women have successfully given birth without medical assistance.

It amazes me that the same women who berate obstetricians for portraying birth as a dangerous ordeal, do the exact same thing when confronted with a woman who is considering having an unassisted birth. "Trust yourself," the Wise Women say, "but not to the point of giving birth without me!"

Midwives are not the saviors of birth (as I've heard several of them say). They are not the exclusive holders of the "sacred knowledge." They are not the "Goddesses of Birth" - unless they are the ones giving birth. Every woman is her own birth savior. Every woman has the sacred knowledge. Every woman is wise if she allows herself to be.

Are there good midwives? Yes, and occasionally I hear from them. But for a midwife to be "good" she must encourage women to believe in their own abilities as much as possible - even if that means that she may not be called for the birth. A good midwife knows when to hold your hand - and when to let it go. If she doesn't know, tell her. Or better yet, learn to depend on your own abilities. Dare to believe you know how to give birth. Strive to become your own Birth Goddess because that, in fact, is what you are."

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62 Old Comments:

Is this an accurate portrayal of midwives?

I'm sure it is an accurate portrayal of some midwives just as you've seen an accurate portrayal of some obstetricians in previous replies to entries you've made.

How would you explain to her why hiring a midwife is safer than unassisted homebirth?

How could we possibly and why would we try? I don't try because I respect their choice.

I can't wait to read more of your critique on the unassisted birth movement and also look forward to reading their opinions. I'm off to make popcorn.

By Anonymous clever ID, at 11:53 PM  

I'd love to try unassisted childbirth... in a hospital.

I read of one person who went up into the mountains to do this, and she gave birth outside. She is a writer, and she wrote of a beautiful experience. She spoke of feeling like a goddess, etc. Makes you want to give birth once a month or something.

These things are kind of borderline as far as choice respecting goes. The problem is that she is risking not only herself, but a non-consensual baby. The baby will never complain because she will be raised in a system that normalizes this. She will express gratitude and think that she is happy because of this and feel bad for the poor kids that got birthed in the hospitals.

I'm angry at this mother. I'm angry at all mothers like this. Feeling like a Goddess is more important than safety to them. Luckily, it all worked out well. We probably wouldn't have heard about it otherwise.

A right? Maybe. Where do you draw the line between acceptable risk and medical neglect? If her child had died because she purposefully gave birth 2 hours away from any medical resources, could she have been convicted of neglect?

And if she was convicted in such a case, doesn't it follow that even though the baby was fine, she is still guilty of negligence? She is well educated and knew the risks. She just didn't believe they applied to her. Is there any case resembling this at all?

There are laws about keeping kids in carseats. Most of the time, if they aren't restrained, nothing happens. One might say they are happier and more free than the kids kept in seat belts. I know I've gone through a struggle with every child and a certain stage. But the laws are there for a reason.

Just because you are I haven't seen a child injured because they weren't in a carseat doesn't mean they don't get injured. Even with seat belt laws, a lot of kids are getting hurt because they aren't properly restrained.

What would happen if this unassisted childbirth and homebirth in general became more widely practiced? I think we'd have more statistics to prove to us what common sense already tells us: that giving birth in the hospital is safer for mother and baby.

By Anonymous Amka, at 1:57 AM  

what about c-sections on demand amka? or mothers who drink or mothers who work as drivers, or who are hookers or who become pregnant and work as dental assistants? Women who have a quiver full or women who abort for potential anomalies... where do you draw the line in deciding what are personal rights?
what about Jehova's witnesses or Christian Scientists- do you have a right to force treatment no more than we would have the right to force death on a patient we consider brain dead-- in a Catholic family.
well the unassisted births do have a neonatal mortality numbers- read the Pang study thru-- they talk about the fact that Birth Certificates do not distinguish between attended/intended homebirths and intended unattended or even accidental births that happen at home--- but from other studies they reference number of deaths are quite high.

By Anonymous Anonymous, at 2:26 AM  

what about c-sections on demand amka? or mothers who drink or mothers who work as drivers, or who are hookers or who become pregnant and work as dental assistants? Women who have a quiver full or women who abort for potential anomalies... where do you draw the line in deciding what are personal rights?
what about Jehova's witnesses or Christian Scientists- do you have a right to force treatment no more than we would have the right to force death on a patient we consider brain dead-- in a Catholic family.
well the unassisted births do have a neonatal mortality numbers- read the Pang study thru-- they talk about the fact that Birth Certificates do not distinguish between attended/intended homebirths and intended unattended or even accidental births that happen at home--- but from other studies they reference number of deaths are quite high.

By Anonymous Anonymous, at 2:27 AM  

Anyone who starts ranting about goddess crap and birth being a sexual experience ought to be put in a looney bin.

Unfortunately, you can't do that.

And you really gotta wonder how they're raising these kids and what they'll be unleashing on the world in eighteen years...more over-indulged, selfish, dumbass morons we'll all have to deal with, I suppose...

By Anonymous jdiac, at 5:49 AM  

The writer describes midwives in exactly the same language as many homebirth advocates describe obstetricians. The writer clearly thinks that DEMs are very similar to the doctors that they criticize.

I am wondering if you think that DEMs are guilty of the same arrogance and superiority that you accuse doctors of demonstrating? If not, why not?

Furthermore, if you think that the appropriate response to the writer is to ignore her, why shouldn't doctors do the same to DEMs? In other words, DEMs can do whatever they want, but no one is going to make it legal just because some people would like to see it that way.

By Blogger Amy Tuteur, MD, at 7:02 AM  

Personally, I don't see how I could reconcile being firmly prochoice and faulting the choice of a mother who elects an unassisted birth.

But this woman who recommends things like this does seem to be completely out of her gourd.

By Blogger sailorman, at 8:57 AM  

terIs this an accurate portrayal of midwives?
I've had two (Dr. attended) hospital births and two (planned)unassisted homebirths so my personal experiences with midwives is pretty much non-existant. On message boards, I have seen some midwives appear to have themselves on a pedestal with the exact attitude that Laura Shanley describes. I've also seen some other midwives have a humble attitude towards birth, and they only want to be part of the journey to a woman's birthing autonomy. That I respect.
How would you explain to her why hiring a midwife is safer than unassisted homebirth? I couldn't because I believe an unassisted birth is safer. If a mom is not mentally prepared for an unassisted birth for whatever reason and I don't recommend people going into labor in complete fear (because that can hinder the birth process), I would suggest to try to find a humble midwive or make an informed choice of what would make mom most comfortable, even if I don't think it's the safer choice.
Amka: I'm angry at this mother. I'm angry at all mothers like this. Feeling like a Goddess is more important than safety to them. Luckily, it all worked out well. We probably wouldn't have heard about it otherwise.
It's not luck, and you see technically unassisted birth stories in the news all of the time, although they are usually of the unplanned precipitous birth variety. And yet 9 times out of 10 with those stories all is well (though there is always a Dr. quote at the end about how "lucky" mom and baby were).
Feeling like a Goddess is not of utmost importance to me, safety is, and that's why after a couple of years of steady research I knew unassisted birth was correct for me.
My first son was born in a hospital and nearly died after all of the iatrogenic complications put into play. The birth attendants didn't save him, but the two different NICU units sure worked hard to fix the damage though. (partial pnuemothorax, pulmonary hypotension, 3 wk NICU stay.
I was more aware of how hosptial practices can be a danger to birth when I had my second, and the whole labor was full of annoyances and them battling me to get me to be a "good girl", while I struggled to cling to the birth that I wanted. It was impossible, and when I had my healthy son in arms, I turned to someone and said
"I could have done this at home!" The following 36 hours post partum was terrible, I left the hospital depressed and swore I would never walk back in.

My biggest baby was born at home after a twelve hour labor and a two minute long pushing stage. It didn't get any safer than that. Then I had my smallest baby 22 months later, born in the caul (amnio sac intact until birth) and just as healthy.

As for hearing about unassisted deaths, for lack of a better term, the few I have heard of were from congenital abormalities, where nothing could have been done regardless of the setting, or one where the mom used too much intervention on herself prior and during labor and had a fair amount of fear and distrust in herself, and the others I see on the news, when a scared teenager gives birth to a live baby and then abandons it or commits infanticide and hides it, the latter of which doesn't compare to a fully informed mother making a concious choice.

By Blogger Jesse, at 9:05 AM  

when it comes down to it, a woman will give birth best wherever she feels safest.

For some women that is a hospital.

For some women that is at home.

For some women that is with a birth team.

For some women that means being alone.

Birth is a natural process--we gave birth for thousands of years without hospitals.
I am _so_ grateful that we have them now--that we have these medical advancements for when they are needed, but I feel they are being over used and are causing more complications and placing more women and infants at risk.

Of course if more women were educated about their bodies...
if more women were more familiar with the birthing process...
if our society really believed in *informed* consent....

then, I think more women would feel comfortable respecting other women's birthing decisions

and more women would feel like they could give birth wherever/however they feel safe

and we would have far less birth complications.

By Blogger Lauren, at 9:27 AM  

What would happen if this unassisted childbirth and homebirth in general became more widely practiced?

LOL, the "panic" in your story is really amusing. If 1% of women are risking their lives in ATTENDED home births it's not as if there is some danger to this becoming at all the "mainstream" thing to do.

ps: I know the story you're referring to and it would be lovely of you to invite her to the "debate" and "defend" her choice to you instead of ranting about it.

By Anonymous clever ID, at 10:04 AM  

Amy's question:
How would you explain to her why hiring a midwife is safer than unassisted homebirth?

I wouldn't try to explain this to Laura. For Laura, it isn't safer to have extra people there. She's made her educated decision and her right is to do so.

I agree that DEMs can show much the same attitude as CNMs or OBs can. Some OBs look much like DEMs, I know two of them. There are always exceptions, I think we can all agree on that.

amika asks where we should draw the line between choice and law. That's a good question. Our current laws (generally speaking) restrict parent choice AFTER a baby is born, and leaves a woman's choice alone before birth. I think there is a movement to try to draw the line further and further inward. But that's difficult to do.

When a woman is pregnant, when do her rights to her own body take a backseat to the fetus? The law has upheld that no person can be forced into a medical procedure for the benifit of another. I believe that is a correct and proper law.

However there are a number of cases where c-sections have been court ordered, on medical advice. Several of the c-sections were able to be preformed, and I know of a couple cases where the woman wasn't available. In one recient case, the woman went to another hospital and gave birth vaginally to the large baby the first hosptial said would die had she attempted it. Mother and baby were fine.

Changing the laws is a slow process, and maybe someday amika's wish will have come true.

Or, maybe my wish will come true. 'Keep your laws off my body'

By Anonymous Cherrie, at 10:14 AM  

"what about c-sections on demand amka? or mothers who drink or mothers who work as drivers, or who are hookers or who become pregnant and work as dental assistants? Women who have a quiver full or women who abort for potential anomalies... where do you draw the line in deciding what are personal rights?"

Clearly, legalities of certain situations are complicated at best. They must encompass personal beliefs and moralities, and that is a thing difficult to impossible for us mortals to judge. We've decided it best, in most circumstances, not to try. And we certainly don't stick our noses in where outcomes are good.

My own personal line is: What are the motivations of the mother?

The mother who had her baby in the mountains wanted power. Not world dominating power, to be sure, but power none-the-less. It was a natural high she was after.

That isn't a good enough motivation.

The Christian Scientist, irrational as I believe her to be, believes that medical intervention is against the commandment of God. It is a matter of sin for her.

That is a good enough motivation for me.

Some women honestly believe it is safer in the home. I may disagree with them, but...

That is a good enough motivation for me.

When it comes down to it, the question to ask yourself is "Do I want to do this for selfish reasons?" Is it a pretty birth that I'm after and I'm trying to rationalize it? Or am I scared of hospitals, doctors, and why? Will that fear be so detrimental that it may cause complications?

Jesse said:

"It's not luck, and you see technically unassisted birth stories in the news all of the time, although they are usually of the unplanned precipitous birth variety. And yet 9 times out of 10 with those stories all is well (though there is always a Dr. quote at the end about how "lucky" mom and baby were)."

The doctors are right about that. 9 times out of 10 aren't good odds when it comes to life and death. Those aren't odds I'm going to play when it comes to my baby's life and health.

By Anonymous Amka, at 11:18 AM  

As for the topic on hand:

It seems clear that unassisted childbirths fair even worse than DEM assisted childbirth at home.

Amy is right: how do we educate these women? They may be in their rights, but their choices are irrational - whether it is power, fear of technology, or fear of authority that motivates.

How do we counter basic assumptions that lead to erroneous conclusions?

By Anonymous Amka, at 11:19 AM  

Jesse,

are you saying that you gave birth to a baby who required three weeks in the NICU, and you wish you had done so at home? What sort of iatrogenic complications are you talking about? Did the hospital cause the hypotension? Did they cause the pneumothorax?

Usually when I hear "infant who required three weeks of intensive nursing care in a hospital" I think "this baby would have been in trouble at home" but of course I'm often wrong.

By Blogger sailorman, at 11:22 AM  

i guess im one of those stupid irrational power seeking women who prefers birth at home.
recently i gave birth to two 34 weekers in the mountains while camping. one has problems, nothing that could have been prevented if i had birthed in the hospital. she is now in NICU. i kept her home several days before taking her in. i monitered them closely.
ihave reasons for being where i was when i was. and i knew when i left that mountain i would do so with me babies having been born.
if they had been born in the hospital they would have been taken from me immediately, been poked and prodded, had iv's and feeding tubes stuck in them when it wasnt neccessary. instead they had several days together in the loving care of their family before being thrown into a sterile degrading environment, taken from arms that love them and put in a plastic box.
when i first considered unassisted birth with my 3rd child i made the concious decision to accept whatever is to happen. to take responsibility for my body and my actions. after all, it ultimately is my responsibility, not anyone elses.
i often get told "you're a nurse you should know better." i reply, i am a nurse thats why i know better. it wasnt a power trip, it wasnt for the high, it was for the safety and peace of my babies.

By Anonymous Anonymous, at 12:23 PM  

Is the 12:23 anonymous a troll?

By Anonymous Joanna, at 1:03 PM  

what's a troll?

NOT anon 12:23

By Anonymous Anonymous, at 1:12 PM  

Cherrie:

"I wouldn't try to explain this to Laura. For Laura, it isn't safer to have extra people there. She's made her educated decision and her right is to do so."

Well, how would you explain the need for a DEM to a woman who is contemplating unassisted birth, is researching her options and wants your opinion?

By Blogger Amy Tuteur, MD, at 7:42 PM  

I would tell her my unassisted story- and my midwife attended story and my 2 hospital birth stories-- I would say that although my child was unharmed that I really understand the usefulness of skilled attendant at a birth- someone the mother is comfortable with who can be responsible for taking heart tones -- and someone who would be around incase something did happen that I or the baby would need help--I would say that skilled midwife stats are not the stats of all homebirths- and that the Pang study is skewed to higher mortality rates because of unassisted homebirths, and show the Pang study as well info from the midwives in Washington state and info from the Unpublished Washington health department study( also there are some other state midwifery organizations that keep up with their stats and compare them to the health department records) If they just kept better records about birth attendants so much more could be known -Show the other studies that show religious who stay at home- maternal deaths-- along with infant deaths.

By Anonymous Anonymous, at 10:10 PM  

Ok lets see when you take parental rights away- who is then responsible? we already have an over taxed welfare- foster child system- it is not our place to take over all people's beliefs and choices-- and who would decide this-- if she felt like a goddess- that is a religious belief just as much as Christian Science it just because you find a belief in "god" more acceptable to your way of thinking does not mean she does not have a right to her beliefs- and the seemingly different cultural values --
I almost think that many of us who give birth at home do have different cultural values--
and different folks have stated with very judgmental air- well they have done xyz with their babies and we could just suck it up and god for bid that a kid might get formula or something--- do you really want people around you giving you imput about your desires or goals in parenting and birthing and they have attitudes just like the ones demonstrated here.
Amy would you in any way like to be coerced or forced into giving birth at home without pain meds or a care provider you trusted or equipment around that you have faith in and trust ? How about the rest of you would you like your feelings about parenting or birth openly or subtly undermined or disrespected? you may think that you attitude about any of the choice a woman makes are her own but how do you support those differences? When my children were born and were babies I worked at having a support system- but I did not have one automatically --
I have watched several of you gals report with great distain about women who make choices different than the ones you would make- and how their choices in some way felt like challenges to you- and guess what we know that too- you can't hide your attitude and you can't hide your bias against a choice we might have- like exclusive breastfeeding-read your ped doc stories- they know the nurses condescend in the nursery and that babies get bottles when they shouldn't- and they feel that they can't change it yet we are suppose to put up with every bit of energy a group exerts against us.
things that can add perspective - in having come in contact with a particular rehab doctor - the first thing he said to us-- some how you have been given the message that you are at fault for what has happened- let me tell you straight off you are not at fault here... He had hit the nail on the the
the truth is that the over all attitude of the nurses and docs before that with a couple exceptions was urked intolerance and they were very dismissive- even when I had caught in 1 months time 10 - medicine dispensing mistakes and prevented them from happening and that was in the time I was around to catch the mistakes... what about the times I wasn't there!!!!!!
-------

By Anonymous Anonymous, at 11:17 PM  

"I would say that although my child was unharmed that I really understand the usefulness of skilled attendant at a birth ..."

In other words, you would discuss the data. Just like doctors do when discussing the safety of homebirth and the competence of DEMs.

By Blogger Amy Tuteur, MD, at 11:20 PM  

"Amy would you in any way like to be coerced or forced into giving birth at home without pain meds or a care provider you trusted or equipment around that you have faith in and trust?"

No one would have to force me if they showed me data that it was safer for my baby.

That's not the point, though. The point is that making healthcare decisions is one thing. Insisting that the government sanction your healthcare decision is something else.

You may decide that you want to go to an alternative medical practitioner for your cancer treatment. However, if that person is not a licensed doctor, but prescribes medication anyway, he has violated the law and may be prosecuted for it.

The government is not required to endorse a particular group's opinion about who is or is not qualified to deliver a baby, or whether or not it is safe to do so at home.

By Blogger Amy Tuteur, MD, at 11:29 PM  

For some other woman who asked me my opinion on unassisted birth....

I'd suggest a reading list to her, with books such as Holistic Midwifery 1 & 2, Obstetric Myths vs Research Realitys, and Guide to Effective care in Pregnancy and Childbirth. I'd tell her to learn the risk/benifit balance for complications and their treatments (both medical management and midwifery management) And decide what treatments she would choose for herself and her baby in event of any of these complications of pregnancy/labor/birth. If she felt her choices could be fulfilled at home, by her husband or herself, And if she felt entirely comfortable taking the responsibility, then an unassisted childbirth may be right for her.

By Anonymous Cherrie, at 11:33 PM  

But when skilled midwifery attendance can reduce infant mortality from some reports say 75/1000- to nearly the same as hospital births what are you trying to prove- with a law that prevents better care, and certainly better stats for maternal mortality. there is nothing altruistic or reasonable about that decision--

------ just read over the stats on live birth with the place of birth being reported as residence in the US 2003- and it is .5% of all births and this would include accidental home births and unattended as well.
Table 38--
out of 23, 221 live births that residence was listed as place of birth

total doctor attended- 1,813; MDs 1,613; DOs 200
total midwife attended-13,403 CNM 3,272;
other midwife 10,131

attendant listed as other- 1,137 unspecified 115
as you can see there are some missing -6753 ?
-------------------------------------------
there are racial break down of births as well- and after reading over the stats I am wondering if smaller populations skew stats...

By Anonymous Anonymous, at 2:24 AM  

"The government is not required to endorse a particular group's opinion about who is or is not qualified to deliver a baby, or whether or not it is safe to do so at home."

I'm sorry, but I have yet to hear the story of the male OB who delivered a baby. MOTHERS deliver babies. No one else. You people can look down your noses at mothers who choose unassisted childbirth all you please to, and call it a power trip. But, what is a man's motivation for walking into a hospital room with a woman he has never met, not ask her permission or introduce himself, and shove his hand into her vagina? POWER! He's a glorified rapist, and so are the women who do it. How many of you have survived a birth rape? I have had 3. I can tell you from experience that the only 3 days in my life that I felt like the day I was raped were the days my kids were born. It was the exact same feeling. Me screaming 'NO' and 'STOP' and 'OUCH' while a man I barely knew ignored my pleas and repeatedly invaded my body while I was in my most vulnerable state. Is that how a mother should feel when she brings forth life? Is that the emotion that should greet a new baby? My fourth child was born at home, unassisted. I delivered him, my husband caught him. We spent the 44 weeks leading up to his birth studying every aspect of birth. Learning what to do with every possible scenario. No one stuck their hand in my body. No one gave me medications that could harm my baby. When my son was born, there WAS high emotion, but it was overwhelming joy. No one touched him except myself and my husband. He was with me for days. Never taken away from what he knew as home. You can say all day long that I was 'overindulging' my child, but perhaps you were underindulged. You can't overlove or overcomfort a child. It's not possible.

By Anonymous Anonymous, at 4:19 AM  

"And if she felt entirely comfortable taking the responsibility, then an unassisted childbirth may be right for her."

Really? What if it isn't "right" for the baby? Or are you saying that you believe every mother has the right to put the life of her baby at risk?

By Blogger Amy Tuteur, MD, at 6:59 AM  

Is this an accurate portrayal of midwives?

Dunno.

But I saw the "portrayal" of unassisted birth advocates she posted on her professional sites and I'd say that's, um, pretty accurate, LOL!

Geez, what a crackhead this woman is.

By Anonymous jdiac, at 8:51 AM  

"Really? What if it isn't "right" for the baby? Or are you saying that you believe every mother has the right to put the life of her baby at risk?"

Well, doesn't she? She has the right to abort, the right for some really unnecisary tests that may increase risks of fetal death, she has the right to choose elective c-section (which has been shown to increase fetal problems), the right to choose elective induction, the right to choose to vaccinate or not, the right to choose to give her child formula.... all these things are things that may harm or kill her child. So, even a if you feel the stats show that homebirth isn't as safe, shouldn't that still be HER choice? And for those of us who don't read the stats the same way as you.... well, of course it should be the mother's call!

By Anonymous Anonymous, at 10:23 AM  

**I wrote this yesterday but blogger was down**

Sailorman: are you saying that you gave birth to a baby who required three weeks in the NICU, and you wish you had done so at home? What sort of iatrogenic complications are you talking about? Did the hospital cause the hypotension? Did they cause the pneumothorax?

I'll start by saying that I had a healthy pregnancy, carried to 42 wks (yes I was a day away from induction, oye, and I had NSTs every other day, and a sono to check fluid levels towards the end, but all I heard was "textbook pregnancy")

Yes, I believe that if I had allowed myself to rest during prodromal labor (about 24 hrs time frame there) I would not have been so exausted by the end of active labor (lasting 12 hrs at the hosptial) and I would have had a pretty standard birth at home.

They wanted me on the monitor at all times and that had me pretty much strapped into bed the entire night. Four hrs after arriving I let go of my "natural childbirth" dream and asked for something to take the edge off. 3 or 4 hours after the nubain my water bag broke, Dr noted mec, and AROMed the rest of sac, if that makes any sense. Soon I had an IFM, O2, pushing while sitting on my tailbone, and so tired I literally fell asleep between pushes.

I saw the mec they were getting out later that day, and it was old, brown mucousy and have since heard of many homebirthed babies getting the "gunk" out of their lungs on their own. It was not the thick black tar that everyone fears. Because of that and heart decel during pushes (which is normal so long as they go back up after contrax) the peds team was waiting in the wings for the birth.

One of the most critical interventions came into play when they immediately clamped his cord, which is standard procedure at any birth. Here is one of the more in depth websites on cord clamping: http://www.cordclamp.com/ ; a page relevant to our case is here: http://www.cordclamp.com/Iatrogenic%20Resuscitationxx.htm

As you can guess my baby was whisked to the peds table to be worked on (initial apgar score was 7 I believe). If there was "bad meconium" he may have aspirated some upon the early cord clamp, or his lung may have been punctured by rescussitation - I'll never know for sure. The upper part of his right lung was affected. He still has a little white scar from the catheter inserted into his chest.

I was told at the time "his body is still trying to 'breath' the way it did in the womb" - blood gases grew worse and worse despite an oxygen tent and then a canula, until he was put on a ventilator - several hours after that at about 36 hrs he was transported to a level 4 NICU and put on an oscillating respirator for several days. He downgraded back to a regular respirator for a day or so and then spent the rest of the time recovering.

Usually when I hear "infant who required three weeks of intensive nursing care in a hospital" I think "this baby would have been in trouble at home" but of course I'm often wrong.
I would expect that :D Is it out of the realm of possibility that trouble can occur at home? Of course not. But at home, typically, a baby's cord is left alone so that if there is indeed a problem, at least baby is still getting 02, for a time, while an attendant or parent tries to get baby going. I wish that immediate cord clamping-then-cutting was not the standard procedure in most American hospitals (as I understand it to be). A baby could be 'worked on' on or near the mother.

I tried to keep my explanation brief and to the point, sorry if it was a bit long!

By Blogger Jesse, at 10:40 AM  

'Really? What if it isn't "right" for the baby? Or are you saying that you believe every mother has the right to put the life of her baby at risk?'

Yup. Absolutly. A woman has the right to make any choice she wishes with her own body. Our laws uphold this (mostly, there has been a recient movement away) Until the baby is a separate entity, Mother has the rights. At that point, CPS is designed to step in where abuse or neglect is suspected.

By Anonymous Cherrie, at 10:42 AM  

It would be a heated debate for sure, but it seems like you're asking me when a mother's rights over her own body should be removed.

I say never. There is never a time a women should have her bodily rights removed.

A woman may make choices I consider terrible, horrible. And some people will make those choices. But I must allow those people to make their choices, to protect the choice for everyone.

Don't you agree?

By Anonymous Anonymous, at 10:50 AM  

"How many of you have survived a birth rape? I have had 3."

I have commented elsewhere that I do not believe that there is any such thing. It is an abuse of language to use the word "rape", a cheap attempt to shock and draw attention to one's self, and a vicious accusation that has not basis in reality.

By Blogger Amy Tuteur, MD, at 9:28 PM  

"But when skilled midwifery attendance can reduce infant mortality from some reports say 75/1000- to nearly the same as hospital births what are you trying to prove"

However, the hospital neonatality rate for low risk women is LOWER than the rates for any midwife group studied thusfat. If you believe otherwise, you need to offer some PROOF.

By Blogger Amy Tuteur, MD, at 9:31 PM  

"Well, doesn't she? She has the right to abort,..."

I am not talking about legal rights. I am talking about whether the mother's decision to risk her baby's life at a homebirth is BENEFICIAL for the baby. I am responding to the comment that homebirth may be "right" (meaning correct), for some women.

We can have a separate discussion about whether parents have a legal right to put their child's health at risk, but of course, once you've gotten to that point, you've conceded the fact that homebirth puts a baby's life at risk.

By Blogger Amy Tuteur, MD, at 9:36 PM  

Jesse,

Your story illustrates complications of postdates, not any unnecessary interventions on the part of healthcare personnel. Based on what you have written, it sounds like your baby was at very high risk of dying if it was born at home.

If you'd like to discuss the known risks of postdates pregnancy and meconium and how they correspond to exactly what you experienced, we can do so.

By Blogger Amy Tuteur, MD, at 9:41 PM  

'We can have a separate discussion about whether parents have a legal right to put their child's health at risk, but of course, once you've gotten to that point, you've conceded the fact that homebirth puts a baby's life at risk.'

Amy on this section we are supposed to be talking about UNASSISTED birth. Not homebirth with a midwife, or natural birth, you keep confusing those terms, and they are not the same.

I do believe that unassisted birth carries a higher rate of neonatal death than a midwife attended homebirth. However there is no hard evidence to support this belief, simply because there are not enough people having UCs.


You said:
I am not talking about legal rights. I am talking about whether the mother's decision to risk her baby's life at a homebirth is BENEFICIAL for the baby. I am responding to the comment that homebirth may be "right" (meaning correct), for some women.

(again confusing terms)I said that an UNASSISTED birth may be 'right' for the hypothetical woman in question. I did NOT say that the choice would be benificial for the baby. You did not ask me that. You asked me if I feel every mother has the right to put her baby at risk. If you read my post again you'll find that I said after studying and learning about birth, if her choices surrounding all the 'what if's' were things she and her husband could do at home alone, then an unassisted birth may be right for her.

I absolutly believe that a mother has a right to put her baby at risk if she chooses to do so. I believe that we should protect that right, even if people take advantage of it and do things we don't think they should.

Again, I am not conceding any points, as I believe unassisted is probably less safe for both mother and baby than a midwife or OB attended birth.

By Anonymous Cherrie, at 10:47 PM  

now you keep saying the term low risk and every one of the studies I have seen do not consistently have "low risk " women-- so you keep wanting to compare apples and oranges-- Even in Janssens group of "low risk" we have drugs and tobacco ... do you put women who do drugs and smoke into your low risk category?

as for if you think that you would respond to a woman the same way I would -- no because first of all I would talk about my own UC--and I know I wrote that in my list of things to do... secondly at any point I may end up not saying any of the things I listed because I am interactive with the person that I am seeing at the time-- what I do say - when in doubt call an ambulance--
........and pray that you don't get dr amy....

By Anonymous Anonymous, at 2:25 AM  

"now you keep saying the term low risk and every one of the studies I have seen do not consistently have "low risk " women"

I doesn't matter what is in each group as long as the groups have the same risk level. So a study may have tobacco use in the homebirth group, but it also has it in the hospital group (where it is usually higher).

By Blogger Amy Tuteur, MD, at 6:36 AM  

Dr. Amy: If you'd like to discuss the known risks of postdates pregnancy and meconium and how they correspond to exactly what you experienced, we can do so.

I've already heard all about all of these known risks. It's not as if I started thinking about homebirth on a whim, especially after an experience like my first birth. I'm sure it's been brought up before on this homebirth debate, many homebirthers, and especially unassisted birthers are looking to avoid standard interventions which are not necessary and which can snowball to more drastic interventions: "The domino effect" if you will. Unassisted birthers typically feel that midwives can be too interventive as well, and are choosing to have no outside distractions get in the way of a normal physiological process, the hormonal flow, and the woman's own intutition.

FWIW, I'm not a Christian scientist, not even Christian, and don't belong to any sort of organized anything, lol.

I thought I'd throw my comments out there as someone who's had two hospital births (Dr. attended) and never had a desire for a midwife after that.

I have a question: If a baby is past 40 wks (in an assumed healthy pregnancy) and thought to be at higher risks, why isn't early cord clamping thought to be dangerous to the baby, especially if already thought to be showing signs of distress?

Thank you for the opportunity for dialogue.

By Blogger Jesse, at 8:04 AM  

Jesse:

"why isn't early cord clamping thought to be dangerous to the baby"

What evidence is there that cord clamping is dangerous for the baby? What would be the physiologic reason for cord clamping to be dangerous?

By Blogger Amy Tuteur, MD, at 8:27 AM  

www.cordclamp.com

By Anonymous Anonymous, at 11:06 AM  

"I am not talking about legal rights. I am talking about whether the mother's decision to risk her baby's life at a homebirth is BENEFICIAL for the baby. I am responding to the comment that homebirth may be "right" (meaning correct), for some women."

Ah, but you asked if the woman had the right to decide on something that may not be right for the baby, so that would be discussing her legal rights.

I am not conceeding on anything as far as homebirth safety goes. I also feel a woman has the right to choose an epidural or narcotics during birth and I feel those may not be right for the baby.

By Anonymous Anonymous, at 11:06 AM  

""How many of you have survived a birth rape? I have had 3."

I have commented elsewhere that I do not believe that there is any such thing. It is an abuse of language to use the word "rape", a cheap attempt to shock and draw attention to one's self, and a vicious accusation that has not basis in reality."

So I guess that means you have never been through those two things. Here's a definiton of the word rape:
Definition:
1. force somebody to have sex: to force somebody to have sexual intercourse
2. violate something: to treat something in a violent, destructive, or abusive way
This definion IS an acurate one of many hospital births. I have been raped. I know what I felt walking away from it. I also know what I felt walking away from my births, and it was the same exact feeling. So, rather than calling my words a cheap shot at getting attention, why don't you address the power trip that these doctors get on that makes them do this to women, and why you think it should be illegal for women to have an alternitive over feeling this way?

By Anonymous Anonymous, at 12:41 PM  

This is a particularly disturbing thread. I would no more try to talk a woman out of an unassisted birth than I would talk a woman out of an elective c-section. I don't agree with either decision, but that is not my place to interfere or persuade her in decision making if she hasn't asked for my opinion. I always assume that a woman making such a personal decision has more information about her own circumstances than do I.

It is very scary to think that so many people think it is ok for the state to be involved in decisions about such a personal event. Birth is more than a physiological process. Birth involves the physical, psychological, spiritual, sexual and sometimes religious dimensions of a woman's being. Next thing you know, we'll be requiring proctologists to sign off on the brand of toilet paper chosen by hemorrhoid sufferers. If a person believes an alternate brand of toilet paper would be best for his situation, he will be forced to design, conduct and present research to validate his dissenting opinion. Toilet paper will become so expensive that Medicaid will have to start covering it. I wonder why this debate makes me think about hemorrhoids.

Seriously, it is ridiculous to insinuate some sort of neglect on the part of a mother making a decision about the circumstances in which she will expel a baby from her uterus. I guess squeezing a baby through your birth canal is a form of assault? Because willful aggression or blatant neglect, such as letting your two year old play in th middl of the interstate, is the only circumstance in which the state should interfere in the parent/child relationship. We make decisions and allow our children to participate in things far more dangerous than the act of being born.

By Blogger Mama Liberty, at 1:02 PM  

From the Janssen study-
Table 1

sociodemographic and pregnancy-related characteristics

use of illicit drugs home birth- 26 --- hospital 7
use of alcohol home birth 16---- hospital 9
use of tobacco home birth 136 --- hospital 121
---------------
I would say that the Farm in the past would have had an increased level of illicit drugs

By Anonymous Anonymous, at 2:16 PM  

What evidence is there that cord clamping is dangerous for the baby?

I'm assuming you mean early cord clamping and are not trying to bait someone. But you really mean this question? Man, Amy, you sure are retired. Most OBs and perinatologists I know have practiced delayed cord clamping since the study released in March. It was BIG NEWS in the peds field.

Pediatrics. 2006 Apr;117(4):1235-42.

Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized, controlled trial.

Mercer JS, Vohr BR, McGrath MM, Padbury JF, Wallach M, Oh W.

OBJECTIVE: This study compared the effects of immediate (ICC) and delayed (DCC) cord clamping on very low birth weight (VLBW) infants on 2 primary variables: bronchopulmonary dysplasia (BPD) and suspected necrotizing enterocolitis (SNEC). Other outcome variables were late-onset sepsis (LOS) and intraventricular hemorrhage (IVH). STUDY DESIGN: This was a randomized, controlled unmasked trial in which women in labor with singleton fetuses <32 weeks' gestation were randomly assigned to ICC (cord clamped at 5-10 seconds) or DCC (30-45 seconds) groups. Women were excluded for the following reasons: their obstetrician refused to participate, major congenital anomalies, multiple gestations, intent to withhold care, severe maternal illnesses, placenta abruption or previa, or rapid delivery after admission. RESULTS: Seventy-two mother/infant pairs were randomized. Infants in the ICC and DCC groups weighed 1151 and 1175 g, and mean gestational ages were 28.2 and 28.3 weeks, respectively. Analyses revealed no difference in maternal and infant demographic, clinical, and safety variables. There were no differences in the incidence of our primary outcomes (BPD and suspected NEC). However, significant differences were found between the ICC and DCC groups in the rates of IVH and LOS. Two of the 23 male infants in the DCC group had IVH versus 8 of the 19 in the ICC group. No cases of sepsis occurred in the 23 boys in the DCC group, whereas 6 of the 19 boys in the ICC group had confirmed sepsis. There was a trend toward higher initial hematocrit in the infants in the DCC group. CONCLUSIONS: Delayed cord clamping seems to protect VLBW infants from IVH and LOS, especially for male infants.

PMID: 16585320

Pediatrics. 2006 Apr;117(4):e779-86. Epub 2006 Mar 27.

The effect of timing of cord clamping on neonatal venous hematocrit values and clinical outcome at term: a randomized, controlled trial.

Ceriani Cernadas JM, Carroli G, Pellegrini L, Otano L, Ferreira M, Ricci C, Casas O, Giordano D, Lardizabal J.

BACKGROUND: The umbilical cord is usually clamped immediately after birth. There is no sound evidence to support this approach, which might deprive the newborn of some benefits such as an increase in iron storage. OBJECTIVES: We sought to determine the effect of timing of cord clamping on neonatal venous hematocrit and clinical outcome in term newborns and maternal postpartum hemorrhage. METHODS: This was a randomized, controlled trial performed in 2 obstetrical units in Argentina on neonates born at term without complications to mothers with uneventful pregnancies. After written parental consents were obtained, newborns were randomly assigned to cord clamping within the first 15 seconds (group 1), at 1 minute (group 2), or at 3 minutes (group 3) after birth. The infants' venous hematocrit value was measured 6 hours after birth. RESULTS: Two hundred seventy-six newborns were recruited. Mean venous hematocrit values at 6 hours of life were 53.5% (group 1), 57.0% (group 2), and 59.4% (group 3). Statistical analyses were performed, and results were equivalent among groups because the hematocrit increase in neonates with late clamping was within the prespecified physiologic range. The prevalence of hematocrit at <45% (anemia) was significantly lower in groups 2 and 3 than in group 1. The prevalence of hematocrit at >65% was similar in groups 1 and 2 (4.4% and 5.9%, respectively) but significantly higher in group 3 (14.1%) versus group 1 (4.4%). There were no significant differences in other neonatal outcomes and in maternal postpartum hemorrhage. CONCLUSIONS: Delayed cord clamping at birth increases neonatal mean venous hematocrit within a physiologic range. Neither significant differences nor harmful effects were observed among groups. Furthermore, this intervention seems to reduce the rate of neonatal anemia. This practice has been shown to be safe and should be implemented to increase neonatal iron storage at birth.

PMID: 16567393

By Anonymous maribeth, cnm, at 5:41 PM  

Mrs. Amy, why are you deleting the comments rather than replying to them. How can it be a debate if you won't let others speak?

By Anonymous Anonymous, at 5:55 PM  

"I have commented elsewhere that I do not believe that there is any such thing. It is an abuse of language to use the word "rape", a cheap attempt to shock and draw attention to one's self, and a vicious accusation that has not basis in reality."

I was going to remain an interested reader until I read this callous comment.

I managed to save my virginity for my husband, although I was violated by a boyfriend in highschool. All along I have held onto the belief that many are told to have when they've been violated...that is that it wasn't my fault.... So now that I've become pregnant, suddenly I'm supposed to lay down, and spread my legs for the doctor to poke around in there. I am sure that (especially with my family practitioner) it's not a case of sexual gratification for all doctors...but that doesn't mean that I don't leave there feeling violated... and society tells me that I'm supposed to do this...because after all, a healthy baby is all that matters. Never mind that there are risks with giving birth in a hospital and vaginal exams are part of that risk, because the chances of infection DO increase with them.
I am told (either consciously or subconsciously) that I am weak, that my body useless, that my intuition is nothing... that I am at fault for my violation... I really have "no choice" but to accept the violation that is imposed upon me by the medical model of birth.
Even midwives have certain interventions they're required by law to do... whether they're right for the mother or not. That's not fair for midwives, but it is a reality.

Anyways, my point. My point was this: You can say that it's not "rape" and that the women who use the word in this way are attention seekers and are trivializing "actual rape" but you're going one worse... you're trivializing the way that these women are made to feel. The way that I've been made to feel and the reason I've left the doctor's office shaking from my own acceptance of the violation that is automatically imposed upon me because i'm pregnant.
Laura promotes education...not fearmongering. I think that most unassisted birthers that you meet and talk to would be the first to say that education is the crucial point...and if your education leads you to the hospital, a midwife, or doing it yourself...then that's the right choice. But don't get all high and mighty, I know best...because honestly, you may know best for you, or for the "standard"...but you don't know what each person has gone through, and you don't know why they come to the conclusions they do.
The old adage rings true... don't judge a book by its cover.

By Anonymous nicole baker, ucer, at 6:26 PM  

"why are you deleting the comments rather than replying to them. How can it be a debate if you won't let others speak?"

I am not deleting any comments. Blogger had a worldwide failure over the last 2 days and lost some posts, including mine.

By Blogger Amy Tuteur, MD, at 6:42 PM  

"What evidence is there that cord clamping is dangerous for the baby?"

I did not proof read what I wrote. I meant what evidence is there that cord clamping was dangerous for your baby?

This is yet another intriguing point, though. The woman's baby nearly dies of postdates and meconium aspiration and is saved by the hospital staff, and not only is the mother not appreciative, she doesn't really seem to understand what happened, and her big concern is that the cord was clamped earlier than she would have liked.

Personally, I did whatever my patients asked me to do regarding the cord UNLESS there was a need for immediate resucitation of the baby, in which case I handed the baby immediately to the neonatologist who was standing next to me.

By Blogger Amy Tuteur, MD, at 6:46 PM  

"You can say that it's not "rape" and that the women who use the word in this way are attention seekers and are trivializing "actual rape" but you're going one worse... you're trivializing the way that these women are made to feel."

I certainly stand by everything I said.

I am not trivializing the fact that some women have strong feelings. However, I do not believe that having strong feelings about something entitles someone to hurl vicious, unsubstantiated accusations at innocent people.

There is a very big difference between "feeling" something and having that something be true.

By Blogger Amy Tuteur, MD, at 6:50 PM  

ONCE AGAIN, read the definition of a rape. Hospital birth falls under the second definition of it. Let me offer another perspective. I'm a 16 year old boy and I'm out walking in the woods. Suddenly I am attacked by an older man (let's assume he's a well-educated man.... say, a doctor) who forces me onto the ground and shoves a stick up my rear. He does this for a few minutes while I scream NO. After he leaves me, I go to the police. The counselor they appoint is undoubtedly going to call it a rape and tell me that this was not about sex, but about power.

Now, I'm a woman. I am in the hospital about to give birth. I am expecting a serene atmosphere to birth my baby in. As I begin to transition, in walks a doctor who I don't know. Before even telling me that my doctor is not on call tonight, he reaches out a gloved hand and shoves it deep into my vagina for a minute. Any woman who has had this done while in such pain knows how much worse it makes it. I cry out, but he doesn't stop. What he's doing is not about sex either, but IT IS ABOUT POWER.

Now, what was the difference between the two men? They were both doctors. They both ignored my cries. They both hurt me. They both shoved an unwelcome object into my sacred places. What was the difference?

By Anonymous Anonymous, at 8:17 PM  

"read the definition of a rape. Hospital birth falls under the second definition of it."

I'm sorry, but I strongly disagree.

What if people started saying homebirth is child abuse? After all, one of the definitions of child abuse is deliberately denying your child appropriate medical care. Since the data show that hospital birth is safer, why shouldn't we say that women who deliver at home are child abusers?

How would you feel if people publicly proclaimed you to be a child abuser? I suspect that you might become a bit more concerned about precision in language.

By Blogger Amy Tuteur, MD, at 8:35 PM  

ONCE AGAIN..... respond to the scenario. What is the difference between the two men?

By Anonymous Anonymous, at 8:44 PM  

"What is the difference between the two men?"

If you can't see why that is an absurd example, I cannot possibly explain it to you.

There is no such thing as "birth rape". Period.

By Blogger Amy Tuteur, MD, at 8:51 PM  

I have to argue that rape is anything put forcibly into the anogenital region against ones will, and I have seen it happen in hospital several times.

Unfortunately, I have to admit that I've DONE it. I have clearly explained the manual removal of a placenta, gotten a full informed consent, told a woman that she will want me to stop doing it and I will stop (and we will go to the hospital) if she tells me to, unless she gives me permission to do what I need to do regardless of what she says in that 60 seconds. She has said yes I understand, do it no matter what if you can. I did it, she cried no, and I finished it, per her instructions. It still felt terrible and violative to me, though she told me yes, yes, good job, I did not want the hospital, thank you.

However, what I've witnessed has been nothing like that. I have known these women for years, they trust me. I have seen residents walk in and put fingers inside a sleeping woman they've never met before.

I think it is incredibly callous of you Amy to deny such claims. I could understand if you admitted a lack of knowlege about it, a denial with a willingness to learn more. But not even that, it's plain old ridiculous. What exactly are you defending?

By Anonymous maribeth, CNM, at 11:38 PM  

""What is the difference between the two men?"

If you can't see why that is an absurd example, I cannot possibly explain it to you.

There is no such thing as "birth rape". Period."

So, you refuse to answer me? I think it is a perfect example, and obviously I am not the only one who feels this way. So, why is it that rather than try to educate me, you want to use belittling terms and try to bully me into your way of thinking (belittling is bullying, so that's exactly what you are doing)? Gee! Imagine that.... a doctor who doesn't care about what a woman thinks or feels, and would rather bully than educate...... I'm shocked!

By Anonymous Anonymous, at 2:28 AM  

Maribeth, I have to say that it sounds like you do what you do as well as it can be done. I thank you for being so loving to your clients.

By Anonymous Anonymous, at 2:29 AM  

Thank you, anon.

By Anonymous maribeth, CNM, at 4:13 PM  

many people DO try to say that unassisted birth is the equivalent to child abuse... what they fail to realize is that most UCer's don't deny their child necessary medical care... they are protecting their child from unnecessary (in a "normal" birth) medical "care" (or in some cases "abuse")
I don't deny that obstetricians save lives... in fact, that is what they are intended to do... but the problem that many homebirthers have is that they CAN (not always, but sometimes) cause the very problems that we need saving from. I would never try to say that an OB shouldn't be used when needed... our OBs SHOULD be heros...but if they're forced to do routine deliveries of a normal birth, when they're trained to deal with things that aren't "normal" about birth.. that's where there's a problem.
Personally I do wish that I had been able to find a midwife that I could feel comfortable with and trust enough to give birth around, and that I could afford. But my options were taken from me by a society that moved birth to the hospital, denied the last couple generations in my family the birth wisdom that has been handed down throughout the years... and leaves me either to "fend for myself", feeling alone, or subjecting myself to "rape" and "violation" at the hands of an OB. And you are ignoring the use of language by denying that hospital birth fits the second definition of rape...which is ironic as that's what you accuse us of doing.

By Anonymous nicole baker, ucer, at 4:27 PM  

This is yet another intriguing point, though. The woman's baby nearly dies of postdates and meconium aspiration and is saved by the hospital staff, and not only is the mother not appreciative, she doesn't really seem to understand what happened, and her big concern is that the cord was clamped earlier than she would have liked.
Today I celebrated my first baby's seventh birthday, feeling a lot of gratitude to the staff who helped save his life, particularly the NICU staff. I don't feel the need to assign blame, really, the people in that room were there doing what they were trained to do. Was I angry, later on, yes. But I felt ultimately that I didn't know and many women don't know that overmanagement of the labor that came from a healthy pregnancy is a bad idea. In other words, my birth, my responsibility.

By Blogger Jesse, at 7:12 PM  

who knows maybe the birth rapist have bad stats as well- so then really no one is safe in their hands-- just talking to someone with more than 10,000 hospital births and not one neonatal death-- now someone else is making up the balance-- no matter what you do you the person who barely passed the test is practicing somewhere......

By Anonymous Anonymous, at 10:01 PM