Your Home Birth is Not a Feminist Statement

Yesterday reader Becca alerted me to an article in Ms. Magazine from the author of the twitter feed Feminist Hulk.  Feminist Hulk is a bit of a feminist icon around the Twitterz, smashing patriarchy 140 characters at a time.  What seems to have attracted Becca is the fact that Feminist Hulk had a home birth.  Becca asked:

@drisis is it wrong that I now wanna have a home birth if I’m every crazy enough to do it again?

After reading the article in which Feminist Hulk says:

While I value the ways that obstetrical science has made birth safer for women with high-risk pregnancies, mine was a low-risk pregnancy and I was compelled by the many studies that show the midwifery model of care is as safe as hospital birth, often with fewer interventions and post-birth complications. Unfortunately, though Certified Nurse-Midwives legally practice in all 50 states, I gave birth in one of the handful of states which still does not license Certified Professional Midwives. I am active in attempts to push midwifery licensure through our state legislature. I still chose home birth, though, and am so lucky to have labored in an environment that made me feel relaxed and safe, with a birth team that gave me tons of love and support. And for anyone who asks, “What if something goes wrong?” all I have to say is, “Something did go wrong.” I suffered a postpartum hemorrhage and lost about a quart of blood. My birth team responded with speed and skill to stop the bleeding (and they would have transferred me to a hospital without hesitation if they encountered a complication that required additional resources). I owe them my life, and I have nothing but faith in the quality of their care.

Home birth as a way to find a loving supportive environment and fight the enslavement of the patriarchy is absolute, utter nonsense.   It’s one of the only medical scenarios I can think of where women place health and welfare in jeopardy in order to feel “in control” and avoid intervention. 

Amy Tuteur  wrote a great piece in 2009 at Science Based Medicine on the increased neonatal mortality rate associated with home birth.  According to 2004 data from the CDC, comparing midwife-assisted births, infants born at home were 3x more likely to die than infants born in a hospital setting.  Similar data were discussed in 2010 by Harriet Hall.  A meta-analysis of studies of planned home births versus planned hospital births reveals that infants born at home, with a midwife in attendance, are 2x more likely to die than infants born in hospital with an MD or midwife in attendance.  That is fascinating given that it is typically the “lowest risk” women who are advised that they may be good candidates for home birth.   Let me say it even more clearly…

 Infants born to the lowest risk women at home are 2x more likely to die than a cohort of infants delivered in hospital, which includes some of the highest risk pregnancies.

Apparently these interventions some women try to avoid have some benefit.  Even more interesting, up to 37% of home births result in emergency transport to a hospital.  But what is the overall neonatal mortality risk?  The overall risk of neonatal death is 0.3%, or 3 in 1000 live births.  That risk increases to 0.6%, or 6 in 1000 live births, if you deliver at home.  As a comparison, the risk of developing cervical cancer, which we are all screened for annually ad speculum, is only 8.1 in 100,000.  An increased neonatal mortality of 0.3% represents 12,948 dead babies (based on this).  My mind is boggled.

If you can look at those data and still decide that you’re still sufficiently dedicated to your own empowerment to choose home birth, then I say “You go get ‘em, Gloria Steinem!”  But, you should know that I’m going to judge you.  Choosing to deliver at home because it makes you feel empowerful isn’t a feminist act.  It’s a selfish one.  It’s no different from the attitudes of the anti-vaccine mothers who choose delayed vaccination schedules, or no vaccines at all, because it makes them feel safe and in control of their children’s well-being.   You might feel empowered, but the data tell us that you are hurting your children with your choices.   I can think of no other women’s health area – Pap screening, breast cancer treatment, HPV vaccination,  in which forgoing a treatment shown to improve health outcomes would be flown on a feminist banner. 

Only the choices that affect our children.  Because we are powerful women and we know what’s good for us and our children. (snark?)

If feminists care about empowering women during child birth, they should do so in an evidence-based manner.  The data demonstrate that the safest place to deliver is  in a medical environment.  We should be continuing to ask how can we make women feel empowered in an environment that offers the best chance of survival for their offspring.  This home birth talk is shenanigans.

And if you still insist on a home birth, you should have to do it as it was truly intended to be done…

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155 responses to “Your Home Birth is Not a Feminist Statement

  1. Fascinating essay- none of my peers are having children yet, so most of what I know about births comes from feminist blogs comparing ‘natural births’ to the scheduled and sterilized environment of a hospital (think Betty on Mad Men). I’ve never seen the other side presented so clearly and forcefully. One minor quibble- I think you’re off by a couple of decimal places with your percentages. Using your numbers, there would be 400 million live US births a year!

  2. isisthescientist

    FUCK! You totes got me. I was really in to typing zeros. At least I didn’t give us 120 million dead babies.

    Still a lot of dead babies.

  3. By “clearly and forcefully” I take it you mean “with actual data”? Yeah, the homebirther blogs are kinda weak on data..

  4. isisthescientist

    Maybe I should have made it 1.2 billion dead babies. I say go big or go home.

  5. This is SUCH a great post – agree 100%. Thank you!

  6. There is an excellent chapter called “The Score” by Atul Gawande in his book “Better” about the development of the Apgar score and the standardization of childbirth. He openly acknowledges that sometimes interventions are overused, but the data clearly show that “almost nothing else in medicine has saved lives on the scale that obstetrics has” (p. 189).

  7. I’m an American who recently gave birth in the Netherlands. There, about 30% of women have a home-birth. (I didn’t, I went to a birthing center.) The whole system is set up to permit this. After care, midwife visits, etc. It seems that there is no increased death risk in the NL as shown by the study summarized here: http://www.washingtonmidwives.org/netherlands-study.shtml

    Now, I don’t think that would work in the US, it’s just not in the culture. But, you should know that home birth can work, safely, if the system is designed for it.

  8. I gave birth in a birthing suite in a hospital, after choosing very carefully my midwife. In advance I made it clear what I wanted: no IVs, no drugs unless I asked, no shaving. I felt plenty empowered, thank you very much. In the birthing suite I could walk around, cry or yell or laugh, sit/squat/stand, listen to music, face this way or that, whatever I wanted. After a very quick check the baby stayed with me constantly afterward. My midwife and the attending obstetrical nurses listened to me and offered tons of support. And at the same time I feel sure that had something gone wrong they would have done what was best for me and for the baby, and I would have been fine with that. (And this is fifteen years ago, by the way.) The important part is the people you work with, not the place.

  9. “It seems that there is no increased death risk in the NL as shown by the study summarized here.”

    No, that’s not true.

    That study shows that homebirth with a Dutch midwife has the same mortality rate as hospital birth with a Dutch midwife. That sounds great until you learn that another study, “Perinatal mortality and severe morbidity in low and high risk term pregnancies in the Netherlands: prospective cohort study,” also in the British Medical Journal shows that the perinatal mortality rate for LOW risk women cared for by Dutch midwives is HIGHER than the perinatal mortality rate for HIGH risk women cared for by Dutch obstetricians!

    Moreover, the Netherlands, the country with the highest homebirth rate in the industrialized world has one of the highest perinatal mortality rates in Western Europe and a high rate of maternal mortality. Both statistics are deeply concerning to the Dutch government.

  10. isisthescientist

    Holy crap!! Amy Tuteur just showed up on my blog?? YAY!!!

  11. And she’s right about the study. I live in the Netherlands and it’s indeed an issue here (although there hasn’t been much news about it lately because of stuff like Europe going bankrupt etc.).

    There has been a movement towards “home-like” environments attached to hospitals, to convince women away from home births.

    Full disclosure: I was born at home (to the satisfaction of all parties involved) and I will need to pound myself in the head with statistics for a non-trivial amount of time to get that norm out. But if it comes up, I’ll have a couple of months to manage it.

  12. I was drawn by the title of your post because I strongly agree that homebirth has little to do with feminism as we understand it. Homebirth and natural childbirth have been hijacked by biological essentialism and feminist anti-rationalism.

    The biological essentialists are characterized by a belief that women are defined by their biology. The anti-rationalists are essentialists with a twist. In their view, empiricism and rational thought are the preserves of men, and that women have “different ways of knowing.”

    The essentialists and the anti-rationalists share quite a few characteristics. Almost exclusively Western, white women of privileged classes, they believe that they speak for all women because all women have the same needs and desires. They simply assume that they represent non-Western women and women of color. They are sociologists and anthropologists. Curiously, they have little or no practical knowledge of childbirth or modern obstetrics, but don’t view that lack of knowledge to as a problem.

    You can recognize them by what they say. The biological essentialists are fond of catch phrases like “trust birth” and “pregnancy is not a disease.” They insist that obstetrics has “pathologized” childbirth and they can display a shocking and callous fatalism by dismissing deaths with the dictum that “babies die, that’s just the way it is” or “some babies are not meant to live.”

    The anti-rationalists are distinguished, not surprisingly, by their anti-rationalism. They dismiss science as a male form of “authoritative knowledge” on the understanding that there are “other ways of knowing” like “intuition.” Many are post modernists who believe that reality is radically subjective, that rationality is unnecessary and that “including the non-rational is sensible midwifery”

    The grandmother of anti-rationalism among childbirth advocates is Ina May Gaskin, and MANA (the Midwives Alliance of North America), which is her creation, is the primary organizational exponent of anti-rationalism in childbirth. Also included under the anti-rationalist umbrella are the “freebirthers” and the Quiverful movement that rejects rationalism in favor of religious belief.

    As far as I (and most women) are concerned biological essentialism and feminist anti-rationalism are two radical theories that have come and gone. Women are not determined by their biology and women differ in their needs and desires even if they share common biology.

    Anti-rationalism is the preserve of educated social theorists and uneducated laypeople. It is a doctrine of sour grapes. Rationalism does not support their opinions and rather than changing their opinions, they prefer to reject rationality itself. Anti-rationalism cannot account for the fact that some women not only believe in science, but they are scientists.

  13. DrLizzyMoore

    Only in America are we so fucking spoiled that it suddenly makes sense to endanger our newborns (AND ourselves, FFS!) and throw vaccines in the garbage. Don’t get me wrong, the OB’s that induce on a Thursday so that they can make their golf game on Saturday really piss me off–but guess what Women, you have a choice not to go to those assholes too. It doesn’t mean that the only logical back-up plan is a kiddie pool in your kitchen!

  14. Amen, Isis. As the pediatric resident at some low-risk deliveries that went bad, I had no trouble giving birth in the hospital. My OB talked me into a smaller community hospital for the first delivery because it would be more welcoming. My next baby came in a major medical center. I had no trouble feeling empowered either place.

  15. My first was in a hospital- might as well have been in a bush for all the technology that got involved, and my second (this Friday!) will be as scheduled and choreographed as a Russian ballet due to complications. Just the luck of the draw, but in no way do I feel less of a woman for having to do it this way. If anything it demonstrates that I’m not an asshat for thinking that some tea and positive thinking is going to fix everything. The homebirthers would have you think that I’m not actually giving birth, or that if I’d done things differently that none of this would happen. (Trust me, they’ve told me so).
    How’s that for feminism?

  16. I’m so glad that there are SOME places around the interwebs that talk sense about this issue. I especially love it when it’s a blog I already follow. Bravo Isis!!!

  17. DrLizzyMoore makes me wonder about the correlation between homebirther orientation and antivaccaloon beliefs.

  18. So BikeMonkey, I might have been a coincidence but most of the avid homebirthers that I knew where also anti-vaxers.

  19. Dr. Isis, I’m glad you’ve shared your thoughts here, and I admit that the Netherland study results are troubling. I will definitely be reading more about this. I would ask though, that we not conflate those who think avoiding medical interventions in birth is good with those who are anti-vaxxers. I think Dr. Tuteur’s further conflation with those of us who think avoiding interventions is a good thing with those who are biological essentialists or not rational is also not that useful.

    Here’s what I guess I am trying to sort through, and this is something I covered in a blog post on the topic last year, when the issue last heated up (http://professorkateclancy.blogspot.com/2010/09/repost-which-is-more-safe-home-birth-or.html). The percentages we are talking about, in terms of maternal and infant mortality at both hospital and home births, are incredibly, incredibly low. Even if you agree with the increased risk at home births (which some people have contested, because the meta-analysis cited recently used some studies of homebirths that weren’t actually staffed by midwives), the chance for an individual to have complications is hardly appreciably raised. I guess what I’m trying to get at here is that the numbers tell us something from a public health perspective, and they should certainly inform an individual’s perspective, but as one of a million things a pregnant woman must consider.

    Not all pregnant women avoid soft cheese, or heat up their cold cuts before eating them, or have someone else clean out their cat’s litterbox… even though all of these things could slightly increase their risk of complications as well. But they do these things because life is about trade-offs. For some women who worry they have weakened immune systems, I imagine they would obsessively avoid foods that could lead to their getting ill. For other women who are severely depressed, I imagine they would take the risk of taking antidepressants.

    To me, these decisions are context-dependent. I study women’s reproductive physiology from an evolutionary context for a living, and from my perspective, feel avoiding interventions when possible leads to better outcomes. But that’s not the same thing as being a homebirther, and it is, in fact, evidence-based.

    Anyway, apologies the comment is so long.

  20. Maybe this is a simplification, but I think the whole “natural birth” idea ignores the fact that we’ve removed a lot of natural selection that used to act (through mortality) at childbirth. In other words, a lot of us were born under circumstances where we or our mothers would not normally have survived. Expecting all mothers to have complication-free home births just because that used to be normal seems a bit like expecting everyone to be able to run a marathon without injuries just because humans evolved as distance runners at some point in our past.

  21. YES! YES! YES!
    I bought in to some of the crunchy stuff for a while (never out-of-hospital birth however) and had 2 unmedicated hospital births. Home birth is dangerous, homebirth midwives are appallingly uneducated, you can have a “natural” birth in the hospital and “natural” birth is overrated anyway. I felt like I was dying and it sucked. I recommend drugs.

  22. I recently started following Dr Tuteur on Twitter. A few days ago she posted this: “Mother of dead baby asks: Why does there have to be so much fear around childbirth?” http://t.co/XQZ9mwT

    She swears it’s not satire. Sadly, I believe her.

  23. YES!!!! These are my thoughts EXACTLY about home birth. Now, I’m many years away from having children, but I lived with a girl who was a midwifery student so I got to learn quite a bit about it from her. Now, we’re Canadian and I believe that training, certification and regulation of the midwifery profession are somewhat different here- but even then, certain programs are known for being militantly feminist and offering “natural medicine” based curriculum ,whereas others offer balanced curriculum founded in science. I do like the idea of a midwife as an assistant and advocate in the hospital setting, as well as for the post-natal services they provide (at-home breastfeeding assistance, etc), since my personal feeling is that far too many women are being urged into having C-sections unnecessarily. But still, demanding to give birth at home just screams “first world entitlement”! Seriously, have you looked at infant/mother mortality rates in third world countries where EVERYONE gives birth at home??? WHY WOULD YOU CHOOSE THAT?!?! I’m really tired of the “modern medicine and hospitals are evil” trope that’s so overplayed in North America (and that includes “vaccines are evil”.)

  24. Great post Isis. I was just discussing this with some facebook friends. What is the big deal about where and how your baby is born? I had a wonderful scheduled c-section and I sure don’t feel any less a woman/person than if I’d had a home birth.

    It’s insane that any woman should be judged as “less than” if she chooses the wise, evidence-based method of birth?

  25. Not to mention the mess… I’ve given birth to two healthy beautiful children (11 months and 4.5 years). I delivered both in a hospital. What a mess! I was glad to not have that mess in my home.

    By the way, I delivered both children without medication. I was fortunate – both deliveries were the best experiences of my life. Perhaps I have a high tolerance for pain. Anyway, the medical staff on both occasions were very respectful.

    Once it was determined that it was safe for us to go home, I left taking my bundles of joy with me, and leaving all that mess behind. :)

    Dr. Isis – I hope your next delivery is safe and beautiful.

  26. I don’t have any kids (yet), but I can’t imagine wanting to give birth at home. I once told my mother about a classmate of mine who was born at home and my mom’s comment was “Why would you want to do that, then you have to clean it all up yourself!” so even if everything goes perfectly, someone still has to try and clean all of those bodily fluids out of your house, which is (presumably) not made of the same, easy-to-clean surfaces as a medical center.

  27. “guess what Women, you have a choice not to go to those assholes too. “
    O Rly? This is reflective of deep ignorance of the realities of different women’s situations. I had health insurance when I gave birth (“good” health insurance by most reports). I did not have any choice as to what institution to give birth in, nor did I have any input whatsoever on what care providers would be there once I was in labor.

    What is feminist is fighting for women to ALL be able to give birth an environments that make them “feel relaxed and safe, with a birth team that gave me tons of love and support”. That was the part of the article that got my attention.
    It is feminist to listen to why some women are choosing homebirths and not assume that the negative things that happen during some hospital births don’t matter because they happen to women, and giving birth is supposed to suck anyway (god said so, right?).

    It’s also feminist to try to get the hospitals to change so they can provide that for all women, which is (for the record) my preferred solution.

    Anyone who feels that homebirth is safer than hospital birth is, to put it politely, misinformed.

    Anyone who feels that homebirth is sufficiently safe for her own threshold of “safety”, and in some way advantageous, is entitled to her decision and its consequences.
    Anyone who feels that homebirth is in/sufficiently safe for other’s thresholds of safety, is, to put it politely, a buttinsky.
    Feminism is not about safety, it is about agency and choice. Choice means nothing if there is not the potential to make the “wrong” choice.

  28. I guess telling women where they are allowed to birth is an empowering feminist action, too?

  29. Sorry, turns out I had more to say…

    Choosing what you want to do with your body is your right as a woman. That’s a feminist action when there is a system in place (medical, cultural) that presumes to tell you that you do not or should not be allowed to have that choice.

    It would be a feminist action to face the fact that many woman desire and seek home births for a variety of reasons (home birth is rarely about statistical safety issues – and, as an aside, I just worked with a department director for two hospitals who deals with the problem of hospital infections like MRSA and C. Dif. and his first priority for his wife’s birth was HOME BIRTH because in light of hospital acquired infection, home birth is the safest place to birth a baby for low risk pregnancies) and to take action to continuously improve health outcomes for home birth.

    It is not a feminist action to publicly berate a woman for putting her unborn/newborn at (presumed) risk due to home birth.

    A woman is more than a vessel. Didn’t we already resolve that issue about 30 years ago?!

  30. Anyone who feels that homebirth is in/sufficiently safe for other’s thresholds of safety, is, to put it politely, a buttinsky.

    and is the entire notion of CPS being patriarchal, antifeminist and a buttinsky? if not, we’re talking threshold not principle.

    At some point the child has independent rights that must come into consideration. I am a fairly staunch supporter of abortion being the decision of the mother into a fairly late stage. And I am a big believer in the slippery slope argument that you can’t give this right wing wackaloons a micron on this issue.

    But FFS, the day of birth is one place I’m full willing to let the slippery slope in support of right wing wackaloonery start.

  31. Christ. This sort of person leaves me shaking with anger.

    http://skepticalob.blogspot.com/2011/08/mother-of-dead-baby-asks-why-does-there.html

  32. isisthescientist

    It is absolutely a woman’s right to choose what to do with her body, but given the scientific data at hand, we should consider home birth to be no different than any other risky behavior. The only difference is that the risk is born by someone else.

  33. I’d also like to say that your “natural” birth is not a feminist statement. Having a baby hurts like hell, and opting for epidural anesthesia does not mean embracing the patriarchy.

  34. Leanne, is it feminist to try to force all low risk women to birth at home? To force women to forgo c-sections or inductions regardless of the cost of life? To remove a woman’s pain relief options? To make all women nurse their offspring? To make mothers who want to formula feed obtain prescriptions from their doctors?

    These are ALL things advocated by self-proclaimed feminists within the birthing community. It is not feminism to determine that women are only good for pushing a kid out and nursing it. It’s also not feminist to blame a woman for her baby dying (BTDT).

    Dr Isis, this was an awesome post!! Thank you. I think many women need to read it.

  35. In her essay entitled In Praise Of Women’s Bodies (found in Outrageous Acts and Everyday Rebellions) Gloria Steinem has a very moving passage on mothers by c section and their scars, and how the scar has more meaning than any other scar, because life came from that scar. Very profound words.

  36. My missing rib has a lot of meaning WendyLou. Very profound.

  37. Pingback: Homebirth vs. Hospital Birth | The Pen is Mightier Than the Pipette

  38. Isis, this post is fabulous. It is absolutely the case that choosing home birth is not a feminist statement.

    It is also the case that it may be feminist to continue to ensure that women have the power to elect to have a home birth.

    However, the biggest concern is not about the choice. It’s about what is there when you make the choice. If you choose to have an unassisted birth, then you are completely responsible for everything that happens, including any choice to withhold medical care for an injured child once it is born. Women should know that.

    Women should also be able to depend on their care providers, if they choose to have an attendant, is capable of a basic standard of care and will also be truthful with them about the risks and benefits of the various aspects of the care they provide. We have these requirements of obstetricians and nurses–even if some people’s ideological belief contradicts the scientific assessment of risks. But the terrifying reality is that many US states DON’T have these requirements of out of hospital care providers, even when they license them. Even more terrifying is that this movement celebrates and often strongly recommends flouting the law and seeking midwifery care when it is specifically illegal in a state–not by leaving the state, but by choosing a criminal to attend your birth.

  39. Isis, this is a fantastic, fantastic post!!! Forgoing skilled medical care to give birth in a fetid pool on your livingroom floor and calling it the height of feminism has always baffled me. Warning women of the dangers of homebirth is hardly advocating suppressing that option for women. I am absolutely for the right of women to choose homebirth. I am not for the right to call yourself a midwife and advertise yourself as such with minimal , if any, real education and training. Part of the reason for the rate of poor outcomes may be location, but much of it – in the US at least – is the people attending as care providers.

  40. I think that Becca and Leanne make good points. Additionally, while the pro-home birth faction needs to admit that in a lot of cases the evidence weighs against them, the anti-home birth faction should admit that evidence weighs against it, too. For example, that same study you quote above indicates that home birth is more beneficial to the mother in a lot of senses: “Planned home births were associated with fewer maternal interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative delivery. These women were less likely to experience lacerations, hemorrhage, and infections.”

    (I don’t think it’s “selfish” to not want to be coerced into maternal interventions which are sometimes not necessary. What comparative studies have been done to measure the effects of maternal interventions that lead to infections and such, relative to the risk that children face? I’m curious what the mortality/serious injury rate is among women who’ve had home birth vs. not.)

    Moreover, it’s not fair to be dismissive of the pro-home birth movement’s distrust of obstetrics, given its history of treatment towards mothers (twilight births being the most sensationalist example). Nor of women who are afraid of “not being heard” while giving birth. While many commenters above have recounted their good experiences in the hospital, they should also keep in mind that perhaps they were much more likely to “be heard” because they themselves are scientists/in the medical profession and could better speak the language of the doctors or are more likely to be listened to because of their level of “literacy” in the sciences.

  41. Of COURSE there’s less pain relief and monitoring used. You can’t do those at home. But that’s not exactly a GOOD thing. Monitoring is how you know when the baby is having trouble instead of proceeding in ignorance and hoping for the best. Episiotomy is also something that most midwives simply do not do, but based on ideology. Routine episiotomy has been demonstrated unhelpful and has left the standard of care. It is difficult to find a doctor who does them routinely (but easy to find people spreading myths about such doctors).

    And the evidence on hemorrhage is clear… the best way to prevent it is active management of the third stage of labor, something that’s anathema to most home birthers.

    A note on infection, by the way. MRSA is not solely hospital acquired, and hospital acquired MRSA generally only impacts those with a reason behind their infection such as compromised immunity. That said, MRSA is ubiquitous, and the infections acquired outside the hospital are harder to treat and more likely to be deadly. And as a person with insulin resistance, like diabetics, I suffer from C. diff. infections from time to time. And it is always easily dispatched. Sometimes it isn’t, but, again, that tends to reflect the state of health of the person suffering from the infection. That’s not to blame the patient, but most pregnant women who would be eligible to birth at home would not fall into this category.

    Of course, that’s the biggest problem with the home birth movement… they don’t really want to restrict home birth to those who are good, low risk candidates. They push HBAC, home breech (which the evidence suggests c secction is safest for the baby), oppose treatment for GBS infection, oppose testing for GBS and GD, and are even starting to support home birth for placental previa! It’s beyond the pale. For a lovely example, see http://www.unhinderedliving.com or http://birthwithoutfearblog.com.

    And that doesn’t even begin to address the push for chiropractic, acupuncture, homeopathy, and the use of unregulated herbs by this movement. Right, and the whole licensing and regulating of midwives issue.

  42. MNMommyJosie

    I think this is where that “own your birth” thing comes from with homebirthers, though. While they expect everyone to do it, not everyone has the time, resources, or ability to educate themselves properly. So when a baby DOES die, they fly in on their brooms to remind you that YOU made the choice to trust someone and not do your own research, YOU are responsible.

    What pisses me off is that these women expect responsibility on one life event, but do they follow through on everything else? Your life could be consumed with going to school to learn how to sell houses, underwrite your own mortgage, do your own basement installation, search for an secure your own insurance (health, house, car…), birth your own babies, fix your own furnace, fix your own car (and don’t let your husband do it! OWN your car, ladies!)…. I could go on forever. Where does the line crossing into unreasonable lie? I find my time is better spent researching for a little while to find out who really knows what they are doing and can do whatever task I need rather than researching it all myself and making very well formed decisions. Maybe that’s just me. Maybe I have too much else going on. I don’t know. And maybe they are right – maybe you do need to own your outcome if you birth at home, and honestly – I don’t want to.

    Loved the blog. Loved the citations. :-)

  43. Anon, your inclusion of fetal HR monitoring is bothersome. why is that band such a downer on the “experience” exactly?

  44. Actually, BikeMonkey, my understanding is that the lead to a lot of false positives. I had infrequent rather than continuous monitoring, and even that was intensely painful, because every time anyone touched my belly it brought on a contraction (even if I’d just had one).

  45. @BikeMonkey, I quoted the study without removing any content. Of course, external fetal heart rate monitoring is not terrible for the mother (though it does restrict her ability to move freely while in labor). Internal fetal heart monitoring, while rarer, is fairly invasive.

  46. Pingback: Home Birther Logic. or “Logic” actually | DrugMonkey

  47. @ anon: “Moreover, it’s not fair to be dismissive of the pro-home birth movement’s distrust of obstetrics, given its history of treatment towards mothers (twilight births being the most sensationalist example)”

    Um…I think you have your facts wrong. Early feminists fought hard for Twilight Birth. They desperately wanted pain relief during labour, while many male doctors and the medical establishment opposed it, some on religious grounds. Two female American journalists went to great lengths to uncover the secret of Twilight Sleep, traveling to Germany to find out the secret from the doctors who pioneered it. I don’t see how early obstetricians giving women exactly what they wanted is evidence of their poor treatment of mothers.

  48. You know what’s also fucken natural? Smallpox. That’s what.

  49. Leanne, is it feminist to try to force all low risk women to birth at home? To force women to forgo c-sections or inductions regardless of the cost of life? To remove a woman’s pain relief options? To make all women nurse their offspring? To make mothers who want to formula feed obtain prescriptions from their doctors?

    These are ALL things advocated by self-proclaimed feminists within the birthing community.

    I agree with Isis’ assertion that homebirths aren’t necessarily safer than hospital births, but I’m calling bullshit on this statement about feminist women in “the birthing community” trying to force all women into crunchy lockstep. It’s a ludicrous remark.

  50. I agree with Isis’ assertion that homebirths aren’t necessarily safer than hospital births, but I’m calling bullshit on this statement about feminist women in “the birthing community” trying to force all women into crunchy lockstep. It’s a ludicrous remark.

    Unfortunately it isn’t. In the UK, all low risk women birth with midwives and, because of funding issues, they are attempting to push more and more women into home births. Interestingly, they are the only country in Europe with an increasing perinatal mortality rate. This push is heralded by the natural birth movement in the US as a fabulous thing. And, while the most visible aspect of this movement, termed The Big Push, is licensure of Certified Professional Midwives, a largely unregulated and miserably underqualified certification with hideously uneven training at the various institutions that produce these providers, this is but the first step to overhauling our entire maternity care system to look much more like the UK where women who want pain relief often can’t get it, where women can’t see an OB unless there’s a serious complication, and where babies are dying at an increasing rate and preeclampsia and other serious risks to women are missed. And in the UK they actually have qualified midwives similar, generally, to our CNMs who are licensed to practice in all states and have a high minimum standard of training. Of course, they call these women “medwives” in a slur over their increased education which usually shows them that, yes, pregnancy and birth are dangerous and without intervention there is a lot of wastage–something anyone with a basic understanding of evolution understands.

    See the quote from their site:

    The Big Push about me page:
    Those who Push for Midwives are envisioning a new model of U.S. maternity care built on expanding access to out-of-hospital maternity care and CPMs, who provide affordable, quality, community-based care that is proven to reduce costly and preventable interventions as well as the rate of low-birth weight and premature births.

    It sounds nice. But it doesn’t really stand up to the weight of evidence. If they cared about quality care, they’d put forth the effort and take out the loans and go to nursing school. Something more and more women previously interested in the CPM certification are doing.

  51. The medical case against home birth is very strong.
    The political case against hospital birth is… well, it’s summarized pretty concisely here.

  52. possible to be feminist and scientific and still not totally agree

    So yes, I agree that there is much in the home birth movement that smells of ant-rational anti-scientific ideologies. But I am a trained and working scientist who clearly felt dismissed and “not heard” at the hospital during her labor. At no point in my pregnancy have I felt respected by my doctor, who being a woman of childbearing age, I had hoped, would be more sympathetic if not respectful. And as becca mentions, it is not always possible for us to choose our providers, I was assigned this doctor through my insurance, and apparently she was the best one around. If this is the best around then I can see how some women may be totally turned off by what is available via the medical establishment.

    I would not risk a home birth myself, but I think that it is totally unfair to dismiss all the home birthers as selfish, reckless and, let’s admit it, stupid women.

    Oh, and birth does not have to be the worst pain in your life. I did have a relatively smooth labor and delivery, and I know I was lucky, but whatever I felt could be classified as severe discomfort, not really incapacitating pain,. And in low risk scenarios like mine, I am fully convinced that a little brainwashing goes a long way into redefining the experience coming onto you as a painful or an empowering one.

  53. @possible to be feminist and scientific and still not totally agree:
    “Oh, and birth does not have to be the worst pain in your life. I did have a relatively smooth labor and delivery, and I know I was lucky, but whatever I felt could be classified as severe discomfort, not really incapacitating pain,. And in low risk scenarios like mine, I am fully convinced that a little brainwashing goes a long way into redefining the experience coming onto you as a painful or an empowering one.”

    So because you, personally, had an easy birth, you are extrapolating that all women everywhere, regardless of their different pelvis sizes, uterus shapes, individual anatomy, length of labour, baby size and / or position, would not feel birth was painful, merely severely discomforting.

    This is based on anecdata and a sample size of one? And you call yourself a scientist?

  54. Meant to say “…would not feel birth was painful, merely severely discomforting, *with a little brainwashing?*”

  55. possible to be feminist and scientific and still not totally agree

    Note that I said “does not have to be”. And for such a claim, a sample of one is sufficient. Obviously I know others may not have this kind of experience. I said I was low-risk AND lucky, and simply assumed that that caveat would suffice but apparently not…

    And yes, I was talking about self-brainwashing, which is done by many to convince ourselves of far more dangerous “facts”.

  56. oklahomamidwife

    CONCLUSION: One third of the recommendations put forth by the College in its practice bulletins are based on good and consistent scientific evidence.( Meaning 2/3 are NOT BASED ON GOOD AND CONSISTENT SCIENTIFIC EVIDENCE!!!!!!!!!!!!

    cientific Evidence Underlying the American College of Obstetricians and Gynecologists’ Practice Bulletins

    Wright, Jason D. MD; Pawar, Neha MD; Gonzalez, Julie S. R. MD; Lewin, Sharyn N. MD; Burke, William M. MD; Simpson, Lynn L. MD; Charles, Abigail S. MS; D’Alton, Mary E. MD; Herzog, Thomas J. MD

    Published Ahead-of-PrintAbstractOBJECTIVE: Clinical guidelines are an important source of guidance for clinicians. Few studies have examined the quality of scientific data underlying evidence-based guidelines. We examined the quality of evidence that underlies the recommendations made by the American College of Obstetricians and Gynecologists (the College).

    METHODS: The current practice bulletins of the College were examined. Each bulletin makes multiple recommendations. Each recommendation is categorized based on the quality and quantity of evidence that underlies the recommendation into one of three levels of evidence: A (good and consistent evidence), B (limited or inconsistent evidence), or C (consensus and opinion). We analyzed the distribution of levels of evidence for obstetrics and gynecology recommendations.

    RESULTS: A total of 84 practice bulletins that offered 717 individual recommendations were identified. Forty-eight (57.1%) of the guidelines were obstetric and 36 (42.9%) were gynecologic. When all recommendations were considered, 215 (30.0%) provided level A evidence, 270 (37.7%) level B, and 232 (32.4%) level C. Among obstetric recommendations, 93 (25.5%) were level A, 145 (39.7%) level B, and 117 (34.8%) level C. For the gynecologic recommendations, 122 (34.7%) were level A, 125 (35.5%) level B, and 105 (29.8%) level C. The gynecology recommendations were more likely to be of level A evidence than the obstetrics recommendations (P=.049).

    CONCLUSION: One third of the recommendations put forth by the College in its practice bulletins are based on good and consistent scientific evidence.

    LEVEL OF EVIDENCE: III

    (C) 2011 The American College of Obstetricians and Gynecologists

  57. “and is the entire notion of CPS being patriarchal, antifeminist and a buttinsky? if not, we’re talking threshold not principle. “
    Pretty much.
    I mean, the buttinsky aspect of CPS is well-recognized. It’s pretty much by design.
    And if you think the way CPS functions *isn’t* influenced by the kyriarchy you just aren’t paying any actual attention. In a patriarchy, ALL institutional power tends to function in a patrirarchal, antifeminist way. That’s why it’s a patriarchy. CPS is institutional power, same as the courts.

    Full disclosure- my family would be dramatically different were it not for the actions of CPS. Whether this taints my ability to see what they do in a rational light, I cannot say.

  58. (rx for formula)

    http://www.abc.net.au/worldtoday/content/2010/s3019953.htm

    (states should encourage homebirth to save money)

    http://www.indianamidwiferytaskforce.org/html/homebirth_facts_.html

    (epidurals prevent bonding)

    http://www.newscientist.com/article/mg17022916.400-convenient-births.html

    They are ludicrous ideas, but it is not a ludicrous remark. Unfortunately in attempting to make hospital birth care more individualized and respectful, the pendulum has swung rather far in the other direction. Even the APHA has been persuaded by pseudo scientist data twisters (like Daviss and Citizens for Midwifery lobbyists) that encouraging home birth is cost effective and reimbursing uneducated people who call themselves midwives (despite having no formal medical training) is a good policy idea.

    Respectful, individualized, evidence based care IS possible in the hospital setting (many hospitals are amazing at it!) or accredited birth center. Humane care is a feminist issue! But telling mums they are terrible parents for subjecting their babies to hospital interventions is the antithesis of feminism. Women can birth anywhere they like, bodily autonomy for all, but people who manipulate and coerce women into believing homebirth is safer and a better parenting choice need to be called out.

    (there are like a million more websites spouting this crap, but these are the three I found in 3 seconds on google)

  59. oklahoma midwife,

    You seem deeply concerned that only 1/3 of the ACOG guidelines meet the Level A criteria. How do you feel about the fact that NONE of the practices exclusive to homebirth midwifery (like breech homebirth, refusing antibiotics for group B strep, herbs) meet the criteria for Level A guidelines?

    Oh, and did you notice that the paper you just cited is graded Level III for evidence, the lowest possible grade?

  60. Compound fracture is totally natural, CPP.

  61. yes I homebirth

    This article is so opposite what homebirth is about to me or any of my many friends who have homebirthed with certified midwives. Half of us had terrible hospital birthing experiences and knew that birth could be different. The other half just felt that a homebirth better fit what they wanted their birth experience to be like.
    I have now had one hospital birth and one homebirth- night and day difference. It was like giving birth on different planets.
    Hospital Birth: Induced with 2 rounds of cervidil and then pitcoin, labored over 50 hours, epidural that would never take, tore during pushing with my little 7lb’er, had a lethargic baby that wouldn’t nurse and was jaundiced for over a week.
    Home Birth: Labored 8 hours TOTAL. Had a 9.1lb baby and didn’t tear at all. Had a very alert and pink baby that nursed right away and had no jaundice.

    I believe that no matter where you birth you have the possibility of facing something perilous happening to you or your baby. I am ANTI feminist or a non-feminist if you will. It’s not about feminism to me. It’s about wanting the best experience and outcome for myself and the baby. My hospital birth sucked for me and sucked even more for my little lethargic, drugged, and exhausted baby. I didn’t want to do that again. I couldn’t sleep at night during my 2nd pregnancy thinking about history repeating itself.
    There’s a lot of big words in the comments on this blog and people feeling high and mighty that they would NEVER be a stupid, crunchy, homebirther and all that feminist crap. But can you think for just a second that maybe you are missing the point? Maybe these mothers really do want a peaceful experience with an alert and healthy baby. Not one that is given hep B as soon as it’s born with eye crap smeared on in case the mother has an STD (even though they test you 2x at least during pregnancy), and where the baby is whisked away to be cleaned (ewww, that gosh darn icky vernix!) before it can even have a chance to try and breast crawl (google it) and bond with mommy and daddy.
    Are there good hospitals doing things well? Yes. Are there a lot of hospitals making birth strictly surgical and hurting the mother and baby in the process? Definitely.

    I just find this article very abrasive and soap-boxy and missing the point. To ME, a hospital birth is more feminist. It’s like, ” I am woman, here me roar! I don’t need to feel any pain or get up and move around and let my stupid body do what it needs. I don’t need to bond with my baby or touch a baby that hasn’t been bathed yet. I am a modern woman! Induce me because I’m just so sick of being pregnant and please put me in a room with a tv and good food. And when I start feeling pain I need drugs!!!! Because I am a woman and I can do whatever the hell I want no matter the cervidil or pitocin or cytotec or epidural might harm me or my baby.”

  62. Your second baby was easier than your first? Yup, must’ve been the homebirth. Can’t think of aaaaany other ‘splaination on that one…

  63. While promoting home birth has been bandied about by many entities as a cost saving measure, I am pretty sure you will find that no government is at all interested in forcing all low risk women to birth out of hospital. I’ve never even heard fringey people say that. Whoever mentioned the NHS in England farked up the info there: due to budget restraints, FEWER home births are possible because there are fewer midwives available to attend them. It’s a problem because there is demand that is currently outstripping the ability to provide service.

    I’m really surprised at the level of discourse on here. Feminism is about choice and all I see is a whole lot of people deciding they can choose best for women they don’t even know.

  64. “But can you think for just a second that maybe you are missing the point? Maybe these mothers really do want a peaceful experience with an alert and healthy baby.”

    Well, of course. Isn’t this what everyone wants, whether in the hospital or at home? The point is that despite what the home birth advocates would have you believe, giving birth at home isn’t some guarantee that you’ll achieve this goal, and in fact, home birth brings substantial risks for the baby that go way beyond the mother just not having her ideal birthing experience.

  65. DrLizzyMoore

    @becca
    Some of my comments yesterday were ignorant. I have lived in several different cities under various health insurance plans and always had choice-that said, I only gave birth in one place, so I have an n=1 of personal experience. What concerns me most is that homebirth is seen as the only viable option to modern medicine. Maybe the happy bridge is birthing centers, BUT women are kidding themselves if they think that all of these don’t have agendas. We should all be lobbying for more transparency, better education and licensure for midwives and always have the goal (which I know you share, so please don’t take what I’m about to say as patronizing) of delivering babies safely and have mom and baby safe at the end of the day.

    Also my assertion that homebirthers are linked to the anti-vax movement is both ignornant and misleading. I am sure that there are many women who embrace homebirthing whom would never not consider vaccinating their children.

    There I feel clean and purged.

  66. moto_librarian

    Natural childbirth websites frequently employ scare tactics about hospitals and hospital birth. It’s like I’ve stepped back in time when I read “facts” over there. If I read nothing but NCB blather, I would think that episiotomies and shaving were still commonplace, that I would be confined to my bed and bullied into an epidural, and that the doctors would rush to give me a c-section so they could go play golf. I sometimes wonder if the authors of these sites have been on an obstetric ward any time in recent history. Because the truth is that women have a lot more options in hospitals than they used to. Many hospitals have whirlpool tubs for labor, exercise balls, use intermittent fetal monitoring so mom can move around as she wishes during labor, etc.

    There is also rampant confusion over the different types of midwives practicing in the United States. Certified nurse midwives are the only type of midwife that has the same rigorous qualifications as those practicing in Europe and Canada. Certified professional midwives are a pale imitation. While some of them do go to great lengths to improve their education, the minimum requirements are shockingly poor. You can be the primary midwife for as few as 25 births and become a CPM. Depending on what state you are in, a CPM may or may not be able to give life-saving medications (like pitocin to stop a postpartum hemmorhage). Few of them have seen enough births to catch early warning signs of an obstetric emergency, which then can cause them to transfer a patient too late. When a midwife does commit malpractice, it’s virtually impossible to get any kind of legal justice. Most don’t carry malpractice, so there is no money for the families of dead or damaged children, and they rarely serve jail time. The state review boards for CPMs are typically packed with their cronies, who fail to mete out any real punishments, nor do they cull bad midwives from their ranks. If youn wind up with a bad outcome, you’re blamed, either for “not trusting birth enough” or for choosing a bad provider (not that you can tell if a provider is bad, because that date is incredibly difficult to find.)

    I would personally never choose a homebirth, but I believe that women should have the right to homebirth with a skilled provider. If we want to make homebirth relatively safe, though, this is what must happen: the CPM must be abolished (only CNMs should be licensed); all homebirth midwives must carry malpractice insurance; only low-risk women should have homebirths (there are plenty of stories of homebirths of twins, breech babies, VBACs, and of women who have pre-eclampsia, gestational diabetes, etc.); pre-registration at a hospital and clear guidelines for transfer. Women and their babies deserve competent, skilled providers. Anything less is the very antithesis of feminism.

  67. @yes I homebirth: See your post is a perfect example of why the home birthing crowd drives me nuts, even though I fully support a woman’s right to birth where ever and however she likes. What I don’t support is all the pseudosceince and bizarre claims that come with it (not to mention the ever so subtle sense of smug self-righteousness.)

    Did it ever occur to you that your baby was drowsy because it had endured 50 hours of labour??? It had nothing to do with the cervidil, the pitocin, or the epidural. And the fact that your 2nd baby’s birth was easier could have had nothing to do with being at home, and everything to do with the fact that it second labours are usually shorter and easier than first births, as well as the fact that every birth is different, even for the same woman, depending on a variety of factors, based not only on the size of the baby but also its position.

    If you’re going to have a home birth, knock yourself out. But don’t go all over the internet claiming hospital birth or interventions are dangerous for babies based on nothing more than personal anecdote and perhaps some non-scientific Ina May Gaskin tract you read.

  68. See, *I* know that it’s silly to suggest that a home birth with two dedicated midwives for each woman will be less expensive for the NHS, but the RCOG doesn’t seem to. There are still campaigns to increase the rate of home births. But, of course, their main interest is putting all low risk women in out of hospital midwife led centers. Which is certainly fine in theory. But while complications are more likely to occur in high risk women as individuals, as a group, most complications happen in the low risk population. And we’re still pretty bad at predicting which women will face life threatening complications.

  69. Pingback: Commentary and repost: improving the birth experience « The Tightrope

  70. Thanks Isis, this is great! I check in periodically, and comment rarely, but love what you do. I hope you follow Dr. Amy at her own blog, where there is more dangers out there than noted in your post.

  71. Pingback: There Is Nothing Feminist About Homebirths « Clarissa's Blog

  72. Divine Miss S

    Great post. And oh look – a new blog for my reader! :) As a PhD student with 2 small children hoping to make a career in academia, I will be looking forward to your posts.

  73. Pingback: Child Protection | DrugMonkey

  74. Indeed, someone new to read! I’m growing so tired of anti-scientific, anti-academic feminists. I adore women AND education, tyvm!
    My great-grandmother and great-great-grandmother had babies at home in a loving, supportive environment, surrounded by their families and experienced midwives and women, during the early 1900s when yes there was sanitation and reasonable amounts of food available to them. THEY DIED. Me and my son are alive because of hospital interventions. Some of these crazy-talking people will get all up in my face and tell me that none of those were necessary and I was lied to. None of these people have medical degrees – they read it in some book or some blog somewhere that what was done to me wasn’t needed and we weren’t really dying. Do me and my child really have to be dead on some altar to “feminism” somewhere to make these jerks happy?

  75. After a birth at home, who does all the horrible messy cleaning up?

    d.

  76. @d., the midwife and/or her assistant typically cleans things up. Birth usually isn’t as messy as one imagines.

  77. I completely agree that home birth is not ideal and that women should be given complete and accurate information as to why it places their children at risk, but I feel that too often those who oppose home birth fail to understand the motivations at play behind a desire to birth at home. As much as I appreciated the Skeptical OB at first, I’ve grown tired of Dr. Tuteur’s constant haranguing about why stupid stupid midwives and home-birth advocates just don’t want to look at all her science and logic and cease being so stupid.

    As a low income and often uninsured person who has had very little control over my choice of health care professionals – I’ve had terrifying experiences involving irresponsible and unprofessional doctors and medical workers, and have at times been unable to complete necessary treatments or therapies due to prohibitive costs. I do not think my experience is terribly unique – and I can see that for people without reliable access to quality health care just how easy it is to feel empowered by alternative therapies with poor or nonexistent scientific support. I actually try to keep up to date with studies on herbal remedies relating to my condition -not because I think I should be using herbal remedies- but because I’m fearful that I won’t have enough money some day to pay for important medications and when that happens, I want to at least have a crappy piece of bark containing vaguely similar chemicals – knowing full well that it might just be a placebo so that I can feel less helpless.

    Healthcare in the United States is difficult to access for many people and those who can access it sometimes have to make do with bad doctors because they lack available choices. Until this issue is addressed, no matter how much the well-educated tell people in this position otherwise, flaky and alternative routes of treatment are going to seem appealing.

  78. A,

    Actually, births usually are very messy. Where do you get this idea? Could you elaborate?

  79. Flaky and alternative routes of treatment are appealing to some because it is what they read on the internet, and think they understand. Medicine to them is scary precisely because they don’t understand, like a cancer patient’s husband who is angry that chemotherapy can kill healthy cells, and promptly claims pharma companies evil. Education about things medical tends to debunk most of those said treatments. It’s just that most people don’t choose to be educated about things medical.

    What you may not know is that a lot of teaching hospitals see patients pro-bono. Just as law schools have pro-bono community law clinics, Prestigious hospitals have community clinics or doctors that see patients pro-bono, donate clinic hours, etc. etc. Medical establishment is one of the most donating and selfless communities that I have been a part of. Don’t demonize doctors and turn against them when we are doing as much as we humanly can to provide the best care.

    So, Blu3vib3,
    What are you doing to address the underlying issue, i.e. that healthcare in US is difficult to access for many? Are you politically active for the right candidates? Where do you think money to support the cost and liability of CPM based birthing centers are going to come from? Are you saving for that too? If people who don’t have insurance have home births, and then have to rush to ER to treat a complication, who’s going to foot the bill? You think all people are going to be grateful to the doctor who treats home birth complications in ER? What if patient smells money and sues them? In this climate of sue every pharma / medical establishment for a nickle, do you think it’s understandable doctors don’t want to shoulder the liability of having to treat a home birth patient in an emergency setting?

    Oh, no, we do understand the motivation of home birthers. If that’s what you think. It’s the reaction that comes from it, undermining the medical establishment by grossly exaggerating their figures (essentially lies), not disclosing their data when called on their lies, demonizing doctors in return, etc. etc. that precisely enrages us. Pick the right fights. Picking fights with science, data, and centuries of medical knowledge, and then resorting to demonizing doctors no matter how noble your intentions and motivations are, puts you on an ultimately untenable position.

  80. Yes, I remember three births being very messy, and messy for days afterwards with oozing from every orifice – both by me and the baby.

    d.

  81. A few thoughts from someone who has never had a child but has experience in the birth field. 37% of home births do not “result in emergency transport to a hospital.” The vast majority of hospital transports are because the mother is tired, has been in labor for a long time with minimal progress and/or desires pain relief. These are cases in which the baby is NOT experiencing distress of any kind. The number of actual “emergency” transports is very small. I know that some advocates of home birth demonize doctors and downplay medical risks, but it’s obvious that many physicians do the same to the other side. I know more than a few Labor and Delivery R.N.s who, after working in hospital L&D for years, chose to have their babies at home with CNMs or LM/CPMs. They know a lot about birth from all sides and I trust that they have made this choice for a reason. It is the states that refuse to allow home birth that contribute to safety risks for babies born at home. In the state in which I live, the majority of homebirth midwives are scrupulously trained professionals with years of experience dealing with a spectrum of birth issues that many obstetricians haven’t even dealt with. They are experts in normal birth, and because they must be trained and licensed, most of them are extremely competent. Are there incompetent midwives out there? Sure. There are incompetent physicians, too, but no one is trying to ban the practice of medicine.

  82. moto_librarian

    “In the state in which I live, the majority of homebirth midwives are scrupulously trained professionals with years of experience dealing with a spectrum of birth issues that many obstetricians haven’t even dealt with. They are experts in normal birth, and because they must be trained and licensed, most of them are extremely competent.”

    Well, you obviously don’t live in Oregon, Lyn, where anybody can set up shop and call herself a midwife. A couple of weeks ago, a couple of “midwives” let a mother labor for eight days at home (2 days after her water had broken), despite the mother’s pleas to go to the hospital. They took away her cell phone, and banned her friends from coming into the house to check on her. Oh, and did I mention that there were signs of meconium when the mother’s water broke? When the baby was finally born, he wasn’t breathing, and the two “midwives” argued over who should perform CPR. The baby is dead.

    If this were a lone story of incompetence, maybe I could agree with you, but there have been too many recent stories about incompetent midwives. Any idiot can catch a baby when a birth is normal – it’s when things become abnormal that you’d better hope that your midwife knows what to do.

  83. Do me and my child really have to be dead on some altar to “feminism” somewhere to make these jerks happy?

    Good grief. Where are all these strawfeminists who are willing to let mothers and children die on ANY altar?

    I maintain that the number of “feminists” who really believe that medical science is less effective than folk remedies has been greatly exaggerated, and it’s frankly a bit of a misogynistic meme to blame “feminism” or “midwives” for homebirth issues.

  84. I don’t seek to demonize doctors. I seek to condemn *bad* doctors and an oftentimes bad system. I don’t see why I have to be politically active (although I am) to voice my opinion that the problematic state of US health care helps fuel people who turn to ineffective therapies. I do not think it is the sole cause and I do not think that a push towards universal health care with an emphasis on preventative medicine (which I support, although I know its unlikely to happen) would eliminate the problem, but I think that looking at ways to better understand the context of peoples decisions is important.

    As easy as it is to characterize all people who make ill-informed choices as immoral, stupid, greedy or otherwise inferior to those with scientifically-backed knowledge, such otherizing behavior sits poorly with me, and I think does little to help people to understand why their beliefs are incorrect.

  85. Ok, I realise that the first comment pointed out your problem with numbers, but I think it would be helpful to everyone if you were also a little more rigorous in your citations; there is little point in citing a meta-study which only reviewed papers in the English language when you are seeking to draw sweeping conclusions which you contend are relevant to all advanced societies. Improbable as it may seem to you, there are doctors who write their research papers in other languages; for example, the Norwegian data does not support your claims. Of course, on all health indicators Norwegians fare much better than people in the US, but that is a problem with the US healthcare system; it is not evidence that home births are intrinsically more dangerous than hospital births.

    It would also be helpful if you explained to your readers the difference between perinatal and neonatal mortality; there is a very big difference, which is another reason why the paper you cited has been the subject of so much controversy.

    Science is about getting the facts right; if you can’t do that then it’s not hugely surprising that women are going to ask whether there really is a scientific basis to your claims…

  86. Just by coincidence, there was this report in my morning newspaper here in Australia.

    http://news.smh.com.au/breaking-news-national/same-midwife-at-two-fatal-home-births-20110826-1jdq1.html

    NOW, I know this is not a representative sample, being only 2 cases, and it is one that has been brought to court which indicates that there are many, many safe home births. But it does illustrate some of the dangers.

    By the way, there is a registration system for independent midwives here but I have no idea of the details, and at least for a time, insurance was a problem for them.

    d.

  87. I don’t get why we’re talking about home birth and midwives at the same time. I was born at home with a doctor and a midwife. But maybe the 80s were just wacky that way.

  88. Please take care when discussing midwives. All “midwives” are not created equal. Certified Nurse Midwives in my opinion are the only professionals. Everyone else is a lay midwife, with the exception of a handful of Certified Midwives who are not nurses but have completed their training in an a college or university. And just because someone has done a study and come up with statistics doesn’t mean it gets at the truth. Home birth studies are not ever randomized controlled trials. The most recent meta analysis form data from the US has included unplanned home births as well as planned home births, which completely skewed the data.
    The recent Dutch study indicated a problem with how patients were selected and triaged for care, not where the care was provided.
    The bottom line is that we need to have an honest discussion about birth and how we make it safe for all and at the same time meet the emotional and psychological needs of the birthing families. Too many health care workers do an inadequate job of patient focused care, which leaves many frustrated and angry and seeking alternatives. Health care in the US should be better given what we pay for it.

  89. Isis the Scientist

    Alright, I was actually reading this comment with a serious face until I read this:

    And just because someone has done a study and come up with statistics doesn’t mean it gets at the truth.

  90. Anyone considering homebirth or who knows someone considering homebirth or who is reading this and had the worst happen needs to see this: http://hurtbyhomebirth.blogspot.com/

    Please pass it along.

  91. Well, I’m still grimly trying to stick to the science here; the authors of the paper on the Netherlands published in the BMJ which has been cited as further proof that homebirths are a really, really bad idea specifically state in their letter to the editor of the BMJ:

    “We regret if, against our intention, the idea has developed that we suggest that home delivery is the cause of the higher perinatal mortality rate among low-risk women. This is explicitly not what we want to imply.”

    http://www.bmj.com/content/341/bmj.c5639.full/reply#bmj_el_249291

    Again it would help if you had actually read the paper in question, together with all the associated correspondence; it’s all open access so there really is no excuse for failing to read it. You are supposed to be educating your readers about how science works, which brings us back to the boring but essential task of getting the facts right…

  92. Janis, you are right: just because someone has done a study and come up with statistics doesn’t mean it gets at the truth.

    Isis, yes the statement seems ludicrous at first, but here is an example in support of it: Andrew Wakefield.

    Knowledge is power. Critical thinking is…critical. Being critical of studies is part of what peer review is all about. Women making these decisions need the best, most honest resources available to them.

    Several people left links to articles regarding the dangers of homebirth…. That’s why I posted the link to http://hurtbyhomebirth.blogspot.com/ and am posting it again. It is one thing to hear a journalist’s story versus reading the women’s story in their own words, seeing their family and their pain when things go horribly wrong….

    Janis, unfortunately at least one of these stories supports what you say – a bad midwife influenced a family’s decision to birth at home and the baby died.

    Here is a quote about http://hurtbyhomebirth.blogspot.com/ : “Hurt by Homebirth has been created as a safe place where women can tell the stories of the babies who died or who were left injured by homebirth.

    This is not a debate board, but we will try to provide sources to research papers and other accurate information on the death toll of homebirth, as well as newspaper accounts of homebirth tragedies.

    If you have a story to submit, you can send it to DrAmy5 at aol dot com. Please include a picture or pictures if you can. Babies who have been hurt by homebirth should be seen, literally, so everyone can understand that each death represents an unimaginable tragedy for the babies who never had a chance to live, and for the families who will mourn them forever.

    The babies who have died at homebirth will be hidden no more. ”

    Eyes wide open, folks.

  93. Hurt by Homebirth is a powerful site. I also recommend 10Centimeters.com, especially this recent entry.

    http://www.10centimeters.com/friday-fallacy-babies-die-in-the-hospital-too/

    Babies outside the hospital die at nearly 3 times the rate of in-hospital babies of complications of the placenta, cord, and membranes. That’s things like placental abruption, nuchal cords, true knots, and so on.
    They die of respiratory issues (birth asphyxia, neonatal aspiration, hypoxia…) at four times the rate.
    Infection causes death at nearly twice the rate outside of the hospital.
    But the most shocking number of all is the number for complications of labor and delivery. It is nearly eleven times –ELEVEN TIMES!!! — as high for babies born outside the hospital. This is the category that contains breech birth and other malpresentations. These babies aren’t dying from congenital abnormalities; they’re dying preventable deaths.

  94. Unfortunately the person under the name of Heather writing at 10Centimeters.com has not read the research either; her claims there about the Netherlands study could only be made by someone who has not bothered to read the paper and the ensuing discussion.

    I would, however, highlight her attempts at statistical analysis as an almost perfect demonstration of just how badly non-statisticians go astray when they attempt to do things they are not trained to do; Microsoft has a lot to answer for in general, but sticking some statistical functions in Excel has been an almost perfect example of the law of unintended consequences. The Web is knee-deep in people who do not know the first law of statistics: Consult a Statistician.

    I do recognise the deeply emotional nature of the issue, but real science requires one to think, not feel…

  95. “Well, I’m still grimly trying to stick to the science here; the authors of the paper on the Netherlands published in the BMJ which has been cited as further proof that homebirths are a really, really bad idea specifically state in their letter to the editor of the BMJ:

    “We regret if, against our intention, the idea has developed that we suggest that home delivery is the cause of the higher perinatal mortality rate among low-risk women. This is explicitly not what we want to imply.”

    Right, the problem with birth in The Netherlands is not necessarily homebirth, but midwives, whether they deliver at home or at the hospital. That’s why the study commonly cited by homebirth advocates in support of homebirth safety (Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births) doesn’t demonstrate that homebirth is safe. Both groups have an unacceptably high mortality rate. And the study Perinatal mortality and severe morbidity in low and high risk term pregnancies in the Netherlands: prospective cohort study (BMJ 2010;341) shows that low risk birth with a Dutch midwife has a HIGHER mortality rate than high risk birth with a Dutch obstetrician.

    By the way, if you want to examine someone playing fast and loose with statistical analysis, you should read the paper most commonly cited in support of homebirth safety (Outcomes of planned home births with certified professional midwives: large prospective study in North America, Johnson and Daviss, BMJ 330 : 1416) which is a statistical bait and switch. If you read the paper carefully, you will see that the authors compared medical intervention rates for the planned home births in 2000 with data from birth certificates for all 3 360 868 singleton, vertex births at 37 weeks or more gestation in the United States in 2000, as reported by the National Center for Health Statistics.

    But when it came to compare mortality rates, the authors compared homebirth in 2000 … with a bunch of out of date papers extending back to 1969. Why didn’t they compare homebirth in 2000 with low risk hospital birth in 2000? Because that would have shown that homebirth had a mortality rate nearly triple that of low risk hospital birth in the same year.

  96. Amy said:

    “Right, the problem with birth in The Netherlands is not necessarily homebirth, but midwives, whether they deliver at home or at the hospital.”

    Do you have any evidence to support that statement? Bearing in mind, of course, that at no time have the researchers themselves suggested that to be the case.

    Incidentally, I am surprised that you did not take the opportunity to comment on the paper in the BMJ, given that you are attaching such importance to what you claim to be its findings. We all know that peer review is not perfect, but it’s the best we’ve got; science needs scientists to engage directly with other scientists. You appear to pass on that in favour of arguing on non peer reviewed websites. If you are not prepared to tackle other scientists head on then you are undermining the scientific process itself; that really isn’t what we need.

    There were serious structural problems with the study, noted in the discussion, and there is an ongoing audit process to try to discover the facts about the care of pregnant women and infants in the Netherlands. Evidence based health care is in everyone’s best interests.

    I note your observations about the 2005 Johnson and Daviss paper; oddly enough, no-one commenting on the paper so far apparently shares your view. I am also surprised that you have failed to make these claims in the proper forum which is the BMJ itself; the most recent comments on the paper are February 2011 and it is always open to you to comment there. You would, of course, have to tackle the scientists you are criticising head on but this is what the scientific process is all about. For example, the egregious errors in a letter on the paper last year, purporting to find, inter alia, high rates of mortality, were summarily disposed of, and the author of that letter has not attempted to defend her claims following that.

    If you really believe your claims then, in my view, you are gravely at fault for failing to pursue them with your fellow scientists; if you can rebut Johnson and Daviss then why have you not done so? Six years in which mothers and babies may have been put at risk because you are not prepared to engage in the normal scientific process is not calculated to convince anyone that you are saying something which is worth listening to. Nor is it likely to convince your fellow scientists that you have any worthwhile arguments to make…

  97. “Do you have any evidence to support that statement? Bearing in mind, of course, that at no time have the researchers themselves suggested that to be the case.”

    They didn’t? What does this mean?

    “In summary, the Dutch obstetric care system is based on the assumptions that pregnant women and women in labour can be divided into a low risk group and a high risk group, that the first group of women can be supervised by a midwife (primary care) and the second group by an obstetrician (secondary care) … We found that the perinatal death rate of normal term infants was higher in the low risk group than in the high risk group, so the Dutch system of risk selection in relation to perinatal death at term is not as effective as was once thought… A critical evaluation of the obstetric care system in the Netherlands is thus urgently needed.”

    “You would, of course, have to tackle the scientists you are criticising head on but this is what the scientific process is all about.”

    They’ve already publicly acknowledged that my criticism is correct on their website, Understanding Birth Better:

    “Thus a crude comparison of the comparable rates for non-Hispanic white >37 week babies in hospital in the year 2000 would be about 0.91 neonatal deaths/1000 live births …”

    That was the number they should have used, NOT the rate from a bunch of out of date studies.

    By the way, the paper does not disclose that Johnson was the former Director of Research for MANA (the Midwives Alliance of North America, the organization that represents homebirth midwives) and that he undertook this study in conjunction with MANA. It does disclose that the study was funded by a homebirth advocacy foundation. In other words, it is hardly a study done by uninterested observers.

  98. Pingback: There is no alternative to prevention « White Coat Underground

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  100. So Isis, the scientist tell me what you think of the studies that say abortion causes breast cancer and depression. Or perhaps you like the studies that say vaccines cause autism. All flawed studies, all erroneous conclusions, all with statistics. All lies. There are no, and never will be adequate studies of home birth. Outside of outlawing the practice, we need to educate women, above all listen to them, avoid passing judgement and do what is possible to make birth safe, where ever it happens.
    After working in women’s health for many years I can site case after case of women dying from epidurals and from laboring too long, babies with broken necks from vacuums, dying from pneumonia, birth asphyxia and on and on. These were all hospital attended births and mos tattended by MDs. I would never participate in a home birth or advocate for it. But I would hope that we can all be honest about birth and the state of the health care system in the US. We can do better.

  101. MrPopularSentiment

    The hospital where I gave birth was absolutely fantastic. I had a midwife and a planned hospital birth. My incredibly low risk birth started going south, so the midwife called the OB for a consultation. For the next bazillion hours (subjectively speaking, but still a seriously long time), the OB checked in periodically to talk to the midwife about how I was doing. Eventually, a respiratory specialist was brought in and she just waited in a corner until my son was born so that she could tend to him right away.

    So I got the best of both worlds. I got to have a quiet birth with the midwife I’d been getting to know for the better part of the last year, but I had a real doctor making sure that everything was going okay. I called the shots. When things went wrong, my midwife explained to me what was going on (explanations were pretty easy since we’d talked about most of it during our appointments), and I made the decisions. Even when the OB became concerned about my son’s heart rate, she just explained to me that she only felt comfortable waiting another ten minutes and that I’d have to make the caesarian-or-not decision then, so I should start thinking about whether I was okay with the possibility or not. It was still left entirely in my hands.

    Everything seemed to go wrong and my labour was the WORST FREAKIN’ EXPERIENCE EVER, but all the issues were biological/medical. It was empowering, it was respectful, and it was as safe as labour gets.

    A homebirth, on the other hand, is not about doing things my way. Homebirths are about ideology and dogma. If something goes wrong in a homebirth, you don’t have the chance to change your mind. I was able to put off a c-section and give my son a chance to come out on his own *because* I was in a hospital – meaning that the amount of time I could safely delay the decision was longer. After all, I would only had to travel down the hall. That’s empowering. Closing off your choices for ideology, that’s the very opposite of empowerment.

  102. Habibi L'amour

    I’m anti-vaccination because the bastards made me sick and didn’t work, so don’t judge me, I’m not a “loon”, I learnt from my experiences.

  103. If you avoid a certain vaccine for you because you had a reaction, then you’re not a loon.

    If you avoid all vaccines out of principle or think that because you had a reaction then no one should use them, you are still a loon.

  104. There is one thing to be said for home births in the 70s and 80s–hospitals responded to the criticisms of the birth experience there by changing. The fact that we have those comfortable and homey birthing rooms now is in large part a response to losing customers in what is one of the money makers in hospitals–childbirth.

  105. Wow. These comments are really interesting and thank you to all the different perspectives. There are, however, some topics that are getting more attention than others.

    First, it’s necessary to point out how much hate or rather, animosity is being thrown at “home birthers” or “feminists” without any real acknowledgment that the women opting for home births may be smart women who are not necessarily getting ready to shove granola down your thrown and make you have birth around a fire while chanting. I’m being hyperbolic but come on! I am considering home birth and to be honest, I’m not even pregnant yet. I have been reading, reading, reading for the good part of a year now about EVERYTHING. Home birth, hospital birth, maternal deaths, infant deaths, pain relief, healthy habits for pregnancy etc. Do not insult me by insinuating that just because I don’t think home birth is a the devil, that I can’t possibly have a good head on my shoulders. I’ve tried to read both sides and I know that I have the luxury/chance to be living in Ontario, Canada where there is a very professional Midwife Association that is focused on making sure that every midwife working in this province is trained, accountable and responsible.

    Second, everyone has been pretty eager to dissect the above comments but I am stunned to see that Liz’s comment didn’t get more of a response. Where are are the anti-home birthers when she says that the majority of transfers ARE NOT EMERGENCIES? A woman who chooses a home birth can change her mind and go to a hospital and get an epidural if she wants. If you are going to criticize the crunchy crowd for fear-mongering about hospitals, be fair about the fact that portraying every transfer to be an absolute disaster emergency is the same difference.
    And if your midwife is “militant”, which I’m sure there are some just as there are some pretty narrow-minded doctors, birth is not the time to find this out. It is our responsibility to question our health care provider with very specific concerns.

    Third, yes just because a study has statistics, doesn’t mean the whole truth is there. This is scientific method 101. A study is only as good as its sample. If I reference a study that tells me the majority of prisoners in U.S. institutions are Black and do no more research of course I could jump to the conclusion that Blacks are more violent or predisposed to crime. Could I reference only that study and ignore the study that tells me that crime is linked to socio-economic factors? Or how about the study that tells me that juries are harder on Blacks? Or the studies that show that laws regarding crack (which is unfortunately often considered the drug of the poor) have more severe sentences associated with them than laws regarding cocaine (the more expensive, ahem, White drug)?
    In a system, where the woman is low-risk as well as educated about her choices and risks and there is support from a trained midwife and an emergency plan if needed, the midwifery model and yes, even home birth is just as safe as a hospital, doctor-led model. Maybe my stance is skewed because I’m looking at the Ontario system. I understand that not everyone has a system like that in place. Maybe our efforts should be about ensuring that everyone has a right to that level of care.

    Fourth, why has no one addressed the issues of the risks of many of the interventions at the hospital? Everyone woman can decide if she wants an epidural, pitocin or even an elective c-section but these procedures have become so routine that I don’t think their risks are full flushed out. In a lot of the pro-hospital birth research I’ve done, those risks are often down-played. They’ve become givens in “modern” birthing experiences. But seriously, think about it. Pregnant mothers think twice about so many things, from aspirin to lunch meat. But many don’t bother to think about the idea of taking drugs so strong that they numb you from the waist down? I get that by this point, the baby is already fully developed but it’s still attached to you and your blood stream. A c-section is an incredibly invasive operation but because it’s done by a doctor in a hospital, it’s less reaction-inspiring than the idea of someone wanting to birth at home. There is a connection between hospital births and invasive procedures. Shouldn’t we be honest about that? Shouldn’t we be honest about how far away we’ve gotten from really thinking about birth as a necessarily reflective time for a mother and her child? I’m not trying to make it flaky but honestly, the birth itself needs to be treated with respect. It’s not getting your teeth cleaned or your appendix removed. You are having your baby.

  106. MrPopularSentiment

    Hi MF,

    You’ve raised some really good points and, though I’m sure your comment wasn’t aimed at me, I’d like to respond.

    “I am considering home birth and to be honest, I’m not even pregnant yet.”
    I realize that you’ve been doing a lot of reading, and that’s fantastic! Obviously, to give birth in your home or in the hospital is entirely your choice, but I do want to offer you my perspective as someone who has recently gone through the process – No matter how much you read, you do not know how your body will react to labour until you are actually in the situation. Because of this, my sincere recommendation is for you to give birth in a hospital. It’s important not to close off your options (and, believe me, when the pain gets bad enough, you may have a hard time waiting for the anaesthesiologist to get to your room, let alone getting yourself to the hospital first). The way I see it, you should plan for the worst and hope for the best – especially with something as variable and dangerous as childbirth.

    “I’ve tried to read both sides and I know that I have the luxury/chance to be living in Ontario, Canada where there is a very professional Midwife Association that is focused on making sure that every midwife working in this province is trained, accountable and responsible.”
    I also live in Ontario. If you do decide to go for a homebirth, this is by far the best place in North America to do it.

    But speaking as someone who had quite a few complications during my labour, midwives are only trained to deal with a narrow range of complications. They are absolutely fantastic as long as everything is going well, but the first thing my midwife did when the human waste started to hit the ventilation system was call in the OB on duty (and, later, the hospital respiratory specialist to see my son as soon as he was born).

    I have faith in the training of midwives in Ontario and I have no doubt that she would do whatever she could to keep you and your hypothetical future-baby safe, but when you’re introducing the factor of time to get to the hospital (especially if you’re giving birth during winter or rush hour), it strikes me as just adding an unnecessary element of danger.

    The wonderful thing about midwives in Ontario is that they are all associated with hospitals, with whom they have a very good working relationship. Giving birth in a hospital with a midwife is nowhere near the same thing as just giving birth in a hospital (which I would agree has some drastic flaws). You really do have all the conveniences of home, but that’s combined with the safety net of the hospital.

    Obviously, you’ll want to visit your hospital before you go into labour so you can see what it’s like. You can always change your mind if you don’t like what you see, but I would heartily encourage you to take that visit and give it a chance.
    “A woman who chooses a home birth can change her mind and go to a hospital and get an epidural if she wants.”
    Sometimes. Sometimes not. I know two people who decided to give birth at home, and both decided towards the end that they wanted epidurals. In both cases, it was too late and they had to just “tough it out.” You generally try to last as long as you can, as did I. When you give birth in a hospital, that often doesn’t matter and you can still get the pain relief. But when you have to factor in travel time to a hospital, that isn’t always the case.

    That, I think, is a very good argument in favour of a hospital birth. Granted, we’re all built differently and I’ve known some women who’ve given birth without pain relief and done pretty well with it. Personally, I thought it was by far the single worst thing that had ever happened to me, pain-wise. Even worse than that time a dentist accidentally started drilling before the numbing had kicked in.

    “And if your midwife is “militant”, which I’m sure there are some just as there are some pretty narrow-minded doctors, birth is not the time to find this out.”
    This is actually why, if you live in Ontario, I would encourage you to consider a midwife-assisted birth. The way the system works is that you are assigned two midwives (a primary and a secondary, just in case the primary is off-duty or assisting someone else when you go into labour). You get to know your midwives throughout the pregnancy, so you can be as prepared as possible for whatever personality quirks she may have when the time comes. With an OB, on the other hand, you get the doctor on call and she may or may not be the one you’ve been seeing. To me, that’s a huge downside.

    “It is our responsibility to question our health care provider with very specific concerns.”
    Living in Ontario, you’re in luck here too. Ontario OBs, midwives, and family doctors (depending on which you choose) are given a checklist of things to go over with their patients, so you’ll be covering most of the birth angles (including the things that can go wrong). Incidentally, there’s also a pediatric checklist once your baby is born. This system is wonderful because it allows the really good doctors to go above and beyond, but pretty much assures a minimum standard of quality.

    “In a system, where the woman is low-risk as well as educated about her choices and risks and there is support from a trained midwife and an emergency plan if needed, the midwifery model and yes, even home birth is just as safe as a hospital, doctor-led model.”
    Anyways, I know I said this before, but I think it bears repeating – Childbirth is highly variable and inherently risky. None of us knew until he was out of me that my son was going to weigh almost 11lbs. None of us knew that I was going to suddenly stop progressing after 18 hours of active labour. None of us knew that my son’s heartrate was going to suddenly drop for no discernible reason. I didn’t, couldn’t possibly, know what labour was going to feel like for me.

    Living in Ontario, you have the singularly fantastic advantage of being able to choose a midwife assisted birth in the hospital. I say to you as someone with nothing to gain from your choice and no ideological beliefs either way, but merely as a woman who has been through this recently – Take advantage of the choice you have. Do it your own way, on your own terms, with a midwife if you so choose, but do it in a hospital where they can help you should something go wrong.

    “Maybe our efforts should be about ensuring that everyone has a right to that level of care.”
    Fully agreed. Part of that is the reason I posted here in the first place – I’m hoping that if more people know about what a truly good pregnancy/labour system looks like, they may demand change in their own areas.

    “Shouldn’t we be honest about how far away we’ve gotten from really thinking about birth as a necessarily reflective time for a mother and her child? I’m not trying to make it flaky but honestly, the birth itself needs to be treated with respect. It’s not getting your teeth cleaned or your appendix removed. You are having your baby.”
    Why? What makes it different from any other medical issue? If you get a splinter and your body fails to expel it, you need help to have it removed. If you’re full term and your body fails to expel your baby, you need help. The fact that this particular splinter is the most precious and wonderful thing in my life is a stronger argument for getting help – so that I can assure that he’s extracted carefully and quickly, and in a way that does him the least harm!

    I absolutely agree with you that all medical intervention should be questioned. Don’t take an aspirin unless you really need it, don’t go to the hospital unless you really need to, yadda yadda. And I do agree with you that people are often too quick to go for medical “quick fixes” rather than focusing on prevention.

    But that doesn’t mean that there is anything wrong with epidurals or c-sections or pitocin. When you need them, you need them, and the fact that this is labour as opposed to dental surgery doesn’t change that. But the worst thing you can do for yourself and for your baby is to go into labour seeing medical intervention as a “failure.” Winning, in the chaos and pain of labour, is coming out alive with a health baby. What you have to do in the unique circumstances of your labour to make that happen is irrelevant in the long term. Just keep your options open and get out alive.

  107. The best thing I ever did was to invest in pre-natal classes with a childbirth organisation that employed a trained physiotherapist, skilled in the techniques of psychoprophylaxis. (I also attended the free hospital pre-natal tours and classes). It just taught us (in the group) all the various options, and talked about things that might go wrong – or not – and how to cope, and what to do if you want to say ‘yes’ or ‘no’ to pain relief, and described the different types of relief, their names, and their side effects.

    It also gave me a chance to talk to the other women in the group, as it gave time for each to tell their own stories – several had given birth before, one had had a baby who had died.

    My husband was involved too, and in the end he was my best physical supporter during the first birth, where the back of the baby’s head was against my back and created a classic ‘backache labour’ where pain relief would have been ineffective anyway, even if I had used it. He knew, however, how to massage my back and that was wonderful.

    The second best thing I ever did was to elect to be in a ward afterwards where there were a few other women. Again, some had had babies before, and their practical advice was better than that of the nurses in some instances, and they were right there and didn’t have to be called by pressing a button. Several times their comfort saved me from panic and tears, which I’m sure I would have succumbed to if I had been in a private room.

    In the end, I have had three completely different birth experiences; in two cases they thought there was a problem – luckily, in neither case was this the actuality. For my second, I only just ‘made it’ to the hospital, but I was glad I did because at first they thought there was a prolapsed cord. A closer exam showed it wasn’t, it was the baby’s head already crowned. But I was glad I was in a hospital where everybody knew how to work things out, and there were facilities there for an immediate Caesar if it HAD been a prolapsed cord.

    My advice is – get as much pre-natal information and ‘training’ as possible, and consider that your own preferred ‘method’ may not work in your particular circumstances when the birth actually happens. I suggest, from my own experiences, if you are pregnant, that you inform yourself of alternative emotional and physical strategies, just in case; and talk to other women who have had babies in different situations.

    As mentioned by other correspondents here, NOTHING prepares you for the force of your own body during childbirth, nor your own reactions to it. And that is apart from the fact of ‘something going wrong’. Even one birth does not prepare you for the next birth.

    d.

  108. … Oh, and the one that was born quickly was early, small, slightly jaundiced and very sleepy – yet there had been a very short labour and absolutely no medications (no time for them). So her condition could in no way have been attributed to whether she was born in a hospital or …. as nearly happned… in the car on the way to the hospital.

    d.

  109. I was told that homebirth was all about empowering women. What they neglected to mention was that the women it empowers? Are the midwives.

    http://oregonmidwifereviews.blogspot.com/2011/08/alma-midwifery-experience-i-am-alma-you.html

  110. We’ve created a system of chaos around birth in the US. I’ve been a labor nurse, a CNM and am now a PhD student looking at stigma and the role that plays in creating less-safe care, both in the context of abortion and home birth. We don’t have a structure in place to safely support home birth in the US; the transfer system is fragmented at best and the overwhelming stigma attached to home birth (and other birth choices, including declining cesarean or induction) affects the practice decisions of providers. The receiving providers never see the home births that go well; they see the “train wrecks”, as they openly call them. The studies that look at home birth mortality in countries with structures to support home birth, including appropriate transfer and backup, do not show a significant mortality difference. Even the Pang study in Washington State, which does have good support for home birth and licenses non-nurse midwives, was supportive of its safety.

    Birth safety cannot be divorced from the culture and system in which it exists. One of my (many) issues with Dr Amy is that she refuses to see the role that system plays in obstetrical safety, and she acts as though there is an absolute single safest way to receive care. Health care is complex. Dr Amy is simplistic. This isn’t about pitting one study against another, and there are very valid criticisms of the design of the most recent meta-analyses.

    Oh, and PS: If you don’t have a history of abnormal paps and you’re still being screened annually, your provider isn’t practicing according to the recommendations of the USPHSTF and the ACS. You might want to consider how research-based most OB practice isn’t.

  111. You might want to consider how research-based most OB practice isn’t.

    So the solution is to make it even less research-based?

  112. MrPopularSentiment

    @smallprimates – I’d have to do some digging, but even Dr. Amy has come out in support of the midwifery/homebirth system in Ontario. She still didn’t like the idea of homebirth, but she admitted that it was a reasonable choice in this province.

    She can get a bit “crusader” on the topic (although, frankly, I think that anyone would if they spent the amount of time she does listening to stories of babies and mothers dying completely needless deaths), but she does admit when the “other side” gets something right.

  113. High and mighty classist load of BS you’ve got here if I may say. To begin with, while a woman is pregnant it is still more about her body than it is about the baby. If you’re going to be a feminist, you should acknowledge a woman’s choice to be treated as she wishes to be treated in the environment in which she feels comfortable because she is a human being in her own right and not simply a martyr to childbirth and motherhood. Yes, sometimes newborns die. With low risk pregnancies, however, it’s a very rare sort of risk.

    The United States has the highest infant and maternal mortality rate of all first world countries and this is due in no small part to our malpractice fear-heightened overuse of c-sections and our infection-filled hospital environments. While it may be marginally safer to use a hospital than to birth at home I could just as easily judge *you* for choosing to have your children in America. You irresponsible mother, you! You ought have gotten on a plane to Sweden and had a better than marginal difference in survival.

    In fact Sweden is where I gave birth to my first child, without anesthesia, and attended only by midwives. Midwives are the default care providers in hospital births in Sweden and acupuncture is the default pain relief methodology. In Sweden and Norway the government is beginning to encourage home births actually for low risk pregnancies as the trauma level for mothers is significantly reduced and births tend to be easier as well as cheaper for everyone in general.

    Home birth and detached birth center births (not actually different in practice) are a popular choice for self-employed women and women who otherwise have limited or nonexistent maternity insurance. For my second child, born in America, I was able to receive prenatal care and give birth in a birthing center which was literally 100 yards from a hospital emergency room under the care of an experienced midwife for a grand whopping total of $3,500 cash out of pocket. A hospital birth would have run me $15,000 to $40,000 depending on whether a c-section was necessary. My births were painless.

    So go ahead and judge me, I don’t give a fuck. I *will* judge *you* for choosing to give birth in this backward country and call it feminist to treat a woman like a baby vessel.

  114. I have a PhD in biology and gave birth to my first child in a hospital. I also attended a Lamaze class and had a clear idea of what I wanted for my birth: no induction; no epidural; ability to move around the room OR change positions on the bed; delayed cutting of the cord.
    And then I was induced at 41 weeks (my doctor, it turned out, did not allow patients to over 41 weeks). I also was not allowed to move AT ALL once in bed. Even though everything was fine. No prolapse. It was pure hell. I can tolerate pain well, and I’ve done so in the past. But the level of pain I had was un freakin’ believable. I failed to progress at 7cm and was stuck there for 4 hours. After that, I was told that I had to get an epidural in order to reduce my stress level. I did, but the epidural decreased the pain in one half of my body. All of this with an ever-changing cast of nurses (3 in total).
    When it was time to push, more nurses showed up. With good intensions, I am sure. And one of those kindly, probably well-trained nurses kept getting in my face saying that I was not pushing hard, that I was not working hard enough. After 22 hours of labor, semi-epidural and other things not worth mentioning, I so wanted to pick up my right, incredible heavy, knocked out foot and kick that b**** in the face.
    In the end, my baby was kiwi-d out. She was pink, active, and perfect. how would I sum up my hospital birth in the US? great, because the baby is fine. My personal experience as the one who labored? Not good at all. The most appalling part was inability to move during labor; inability to wait, say, for 2-3 more days past my 41 week. I would not have wanted to go longer than that myself, yet somehow the very mandatory induction was off-putting. I do wonder if I would have had less pain if I went in labour on my own and progressed fine if allowed to move around a bit. I’ll never know. One thing I am certain of: my brush with the health system during pregnancy, labor and delivery was not an encouraging one. I had a very little choice of providers even though I was insured and paid a lot for an insurance with maternity coverage. Maybe there are better hospitals and nurses out there, but I am yet to see one.

  115. MrPopularSentiment

    @AGR – The longer you wait after your due date, the more dangerous it is for the baby. I had a midwife and she warned me when I hit 40 weeks that she wouldn’t let me go past 41.5.

    I’m surprised that you weren’t allowed to move around in bed. That’s not cool at all if there was no medical reason for it. If you were given pitocin, they may have needed fetal monitoring, but they could have worked around your movements (heck, even after I had my epidural, I continued to move and try different positions – like you, the epidural only worked on half my body and I wasn’t more than just a little shaky, so I was allowed to move as long as I did so slowly and my husband held me at all times). I hope that you wrote a letter to your hospital about it.

    The level of pain may have had something to do with the induction if you had pitocin, but then again it might not. I was in active labour for 23 hours and I wasn’t given pitocin until about 19 hours in – after about 4 hours of the most excruciating pain I’ve ever felt in my life. So yeah, childbirth hurts *a lot*, but I don’t think that this is something we can really blame on hospitals.

    The nurse who was in your face was acting unprofessionally, but again I wouldn’t assume that this is a hospital thing. The pushing phase of my labour was attended by my midwife and her student. My midwife was great, but her student was in my face the whole time trying to push me into a particular position (sort of a fetal position, but lying on your back). I already felt like I couldn’t breathe, and her forcing my chin to my chest made me feel like I was drowning. I kept saying “no, no, no,” which was about the best that I could do, but she kept forcing me until my husband physically pushed her away from me. That your nurse did this was unprofessional, but it was not a hospital issue.

    I’m sorry that your birth didn’t go as you would have liked, but it looks like most of the issues you had were unavoidable and not due to the hospital itself. That’s not to say that hospitals can’t (or shouldn’t) be made better. The hospital I laboured in, the Montford in Ottawa, ON, has a newly renovated maternity ward and they really went all out. From the non-biological end of things, my experience couldn’t have been better and I wouldn’t hesitate to hold it up as the model all maternity wards should aspire to. But at the same time, we can’t really blame hospitals for us experiencing pain in childbirth…

  116. @MrPopularSentiment:
    ACOG considers expectant management acceptable for post-dates pregnancies (which, by the way, are pregnancies at 42 completed weeks, not 40, particularly for primips). Since even ACOG accepts watchful waiting as an option for post-dates pregnancy, given their reflexive fear of litigation and distrust of physiology, you might want to consider that the research does not support significantly increased mortality until 42 weeks LMP.

    @drugmonkey: No, the point is to improve the evidence base and support evidence-based care. Most care delivered is done because it’s always been done, or because it’s community standard of care, or because of the belief that the only cesarean you’ll be sued for is the one you don’t do. Obstetrics has its own myths and superstitions, and if you really don’t think so, you haven’t spent much time on a labor unit. The point is that we make decisions with a paucity of data on those decisions and the best of intentions. Midwifery isn’t de facto any more or less evidence-based than obstetrics. There simply has not been enough high-quality research done, and the research that has been done doesn’t support many obstetrical myths (like eating and drinking in labor, to choose a current ACOG position change, or a routine IV, or delivery by 24 hours with SROM in the absence of clinical signs of infection). We do things to women because we can, not because we know with any reasonable certainty that they will help her (CEFM comes to mind), and those things then become part of the mythology of OB.

  117. “No, the point is to improve the evidence base and support evidence-based care.”

    Homebirth advocates love mantras. They spread through the community, are quoted over and over, and become received wisdom as though by saying something enough times it might make it true. Classic homebirth mantras include “pain is caused by fear” and “animals need privacy to birth successfully; so do humans.”

    Mantras change with time and in response to cultural values. In an age in which science is greatly respected, the most popular mantra is “obstetricians ignore the scientific evidence.” What could sound more impressive that shouting from every hilltop that obstetricians ignore the scientific evidence, while homebirth advocates are slaves to scientific rigor? The fact that the claim is a lie is beside the point.

    Are we supposed to believe that obstetricians (with 8 years of higher education, extensive study of science and statistics, and four additional years of hands on experience caring for pregnant women), the people who actually DO the research that represents the corpus of scientific evidence, are ignoring their own findings? Are we supposed to believe that homebirth midwives (generally high school graduates with no background in college science or statistics, let alone advanced study of these subjects, and limited experience of caring for pregnant women), the people who NEVER do scientific research, are assiduously scouring the scientific literature, reading the main obstetric journals each month, and changing their practice based on the latest scientific evidence?

    And what does the scientific evidence on childbirth really show? There is virtually no support for ANY of the central tenets of homebirth advocacy. Let’s start with a favorite claim that “lots of scientific papers show that homebirth is safe.” When it comes to homebirth in the US, ZERO scientific papers show that homebirth is safe. Indeed EVERY paper written on the subject shows that homebirth increases the risk of neonatal or perinatal death, even the Johnson and Daviss BMJ paper that claims to show otherwise. National statistics on homebirth collected by the CDC from 2003-2005 (the only years published thus far) show that homebirth with a non-CNM midwife triples the rate of neonatal death, and homebirth with a CNM doubles the rate of neonatal death.

    Consider other, easily verifiable claims:

    Proper position speeds labor? No, no evidence for that.

    Eating in labor gives women “strength” and improves outcomes? No, no evidence for that.

    Babies won’t breathe if delivered under water because of the diving reflex? The diving reflex works in cold water, not warm water.

    Epidurals are dangerous? No, no evidence for that, either.

    Indeed, I am hard pressed to come up with even a single homebirth tenet that is based on scientific evidence. Oh, wait. I can think of one: breastfeeding is beneficial for your baby. But even that scientific evidence is misrepresented by homebirth advocates, since the benefits are actually quite small.

    The bottom line is that the claim that “obstetricians ignore the scientific evidence” is a lie.

  118. … surely breastfeeding has absolutely nothing to do with home-birthing or not.

  119. I have no particular stake in the homebirth debate at this juncture, through for full disclosure, I’d planned a birth-center delivery for my first birth, then switched to the hospital when the birth center lost its back-up OB.
    I must admit that this post and many of the following comments horrified me. I think it is clear that the miserable state of maternity care in the United States is a feminist issue. I think it is also clear that the position of “I did my research and wrote a birth plan and had an empowering hospital birth so you can, too” is incredibly privileged and also incredibly myopic. Surely you can see that some women are not in a position to make the same choices and some who would like to are ignored?
    What would the author of the post propose? That homebirthing women be thrown in jail? That they shut up about their experience and accept your disdain? Or is the whole problem that a subset of the 1% of births that occur out of hospital are chosen by women who self-identify as feminist?
    Feminism is the radical idea that women should have the power to make decisions about their own bodies and their own lives — that doesn’t get chucked to the side as soon as a woman becomes pregnant and it sure as hell shouldn’t be chucked aside as soon as she makes a choice different from the one you would have made for her.

  120. Pingback: Book review: Get Me Out | Books & Publishing News

  121. When people talk about wanting to give birth at home I always want to tell them, “if you’d been my mom, I would have died.” It’s an odd feeling, knowing that it’s unnatural that you’re alive. I never think of it until somebody starts talking about what nature “intends.”

  122. @AB – Realising that this is purely anecdotal, but I don’t know anyone who has lost a child in labour. But among homebirth advocates, so many of them seem to have lost babies. That tells me something.

  123. smallprimates

    Dr. Tuteur:

    As always, you miss the point. There isn’t any evidence that eating and drinking in labor is harmful, for example, so why ban it? Why turn birthing women into “patients”?

    The point isn’t to do things because we can. The point is to “first, do no harm”. Right? Or did you become a different kind of doctor from that?

  124. smallprimates, “no evidence that eating and drinking in labor is harmful?”

    You’ve never heard of aspiration pneumonia?

  125. Yes, I have.

    Regrettably, at least from your perspective, there are no scientific papers supporting the claim that eating or drinking during labour gives rise to aspiration pneumonia.

    Admittedly Isis the Scientist seems to have a distinctly tenuous grasp on the scientific process- I am still waiting for her or Amy et al to answer my challenge by making their claims in a scientific journal where they can be rebutted by peer review, rather than clinging to the safe territory of blogdom- but I suppose that is all one can expect from people who have yet to learn that the plural of anecdote is anecdotes.

    However, for the benefit of those who are unaware that the research that Isis is relying on has been rebutted, I will quote from the BMJ, where deputy editor Tony Delamothe had immediately spotted the gaping hole in what purported to be a meta-analysis, and asked why the authors of the American meta-analysis shifted focus from perinatal mortality to neonatal mortality “despite having relevant data for these calculations on only 9% of their total sample.”

    As Daviss and Johnson pointed out:

    “The answer to this question is the key in undoing the original conclusions of the meta-analysis. The researchers included the very large Dutch study in their meta-analysis of perinatal mortality, and found no difference in outcomes between planned home and planned hospital births. When the authors isolated the neonatal risk from the perinatal risk, they chose to include only studies that looked at combined early (0-7 days) and late (8-28 days) neonatal mortality (deaths in the first 28 days). Conveniently, that allowed them to leave out the Dutch study because it reported only on early (0-7 day) neonatal mortality. However, across perinatal/neonatal studies in high resource countries, 2/3 to 4/5 of neonatal deaths consistently occur in the first 7 days.(4)

    The Dutch study represents over 90% of the home births in all the studies summarized in the meta-analysis and there is no reason to expect that the rate of later neonatal mortality would carry any difference in safety had it simply been reported or requested. Thus, setting up the methodology in this way and then running shamelessly with conclusions that focus on less than 10% of the data, to suggest a twofold higher rate of death with home births compared to hospital, is a form of cultural myopia most politely described as academic oversight. ”

    Of course, if you want to put your life into the hands of people who are prepared to exclude 91% of the data in order to arrive at the answers they want then you are perfectly free to do so. You are not free to misrepresent the data itself…

  126. My feminism will be intersectional or it will be bullshit.

    And this here is some bullshit. Do we now get to pile on those women because they didn’t make the “right” (RIIGHT FOR ME OF COURSE!!) choice about THEIR OWN FUCKING BODIES?

    I’m agog, I’m aghast.

  127. You are not the only one agog and aghast; I am deeply offended by the mishmash of pseudo science and patronising claptrap being peddled by people with a direct financial interest in frightening women.

    The place to debate scientific papers is in science journals; I have waited months to see if Amy et al had the guts to do so. They haven’t.

    In the meantime women are being scared sick by someone who claims to be a post-doctoral researcher but who strangely has not yet learned that the plural of anecdote is anecdotes. I appreciate that we all bewail the dumbing down of science, but on this side of the pond even lab techs know that one…

  128. My births were primitive, instinctive events that would have been wonderful to experience in my familiar-smelling, comfortable home. But in lieu of Star Trek transporter technology able to beam me to a surgical room, alas, I had to follow the science. But someday…..

  129. Firstly, I am deeply offended to read the comment that homebirth midwives are uneducated. Clearly, the writer of that comment has no idea the process a midwife must go through to be able to work with women at home. One would say THAT comment was uneducated.

    A systemmatic review of RCT (the “gold standard” of research) by O, Olsen & D, Jewell (1998) concluded that there is no evidence to favour either a planner home brith OR hospital birth for low risk women. The same study also stated that a “planned hospital birth may even increase unnecessary interventions and complications without any benefit for low-risk women”.

    Single studies, especially those of low research value, can be span to say whatever you want them to. So beware where you get your figures from.

    And strage, with all this “research” about the dangers of a planned home birth (please note, a lot of home birth studies include date from FREE BIRTHS which is like comparing apples and oranges) the WHO has released a statement that all low-risk women should be offered a home birth. What an evil organisation this WHO must be.

  130. Amy’s conclusions are directly in opposition to what the CDC states about the safety of birthing outside of a hospital:

    “After controlling for a wide variety of social and medical risk factors, the risk of experiencing an infant death was 19 percent lower for births attended by certified nurse midwives than for births attended by physicians. The risk of neonatal mortality (an infant death occurring in the first 28 days of life) was 33 percent lower, and the risk of delivering a low birthweight infant was 31 percent lower.”

    http://www.cdc.gov/nchs/pressroom/98news/midwife.htm

    When you look at ACTUAL facts and statistics, a woman who has a planned home birth is actually SAFER than if she were to have a planned hospital birth, with all the interventions that get pushed on her. She’s more likely to have a safe vaginal birth than a risky ceserean if she delivers at home.

  131. Trailrider, you’re jumping to all sorts of conclusions. And they’re all wrong.

    Certified Nurse Midwives usually work in hospital based birth centers. They also work exclusively with low risk patients. They are governed by ruling bodies that include physicians, so they are held responsible for cavalier behavior, minimizing it. So, those numbers? Representative of hospital births with plenty of “intervention” and only the lowest risk patients. Yep. All a good indication that their mortality rates should be much lower.

  132. FeministOfADifferentKind

    How is it a feminist issue to have a choice to abort, but not a choice for a place of birth?

  133. This article makes massive assumptions & does not effectively talk about ‘risk’ in my opinion. There is risk no matter what you do or where you go.
    Blindly assuming a hospital effectively manages risk (with all their wonderful technology) & assuming ‘all hospitals & all providers’ provide evidence based care is naive. I love hospitals & I love any providers.
    All hospitals & providers are not created equal.
    I could drive a Hummer and be at ‘greater risk’ simply by the way I use/drive it —as compared to someone who drives a smaller honda accord.
    Hospitals are noting more than people operating under a set of protocols developed by people.
    As amazing as hospitals are….they have their own set of risks. That’s why there is no wrong place to birth. Your values are important. What is risky for one mom, is not for another.
    Do you really think a hospital with a c-section rate of 40% is ‘less risky’ than a low risk planned homebirth with a skilled provider?

    Maybe for you & maybe not for someone else.

    The other super important point this article leaves out….the mind body connection. It’s huge, it matters, the mind clearly affects outcomes. Look at ANY major event in your own life.

  134. I had a homebirth and everything went great. How DARE any of you who speak out against another woman’s choice to homebirth think you’ve the right to dictate where/when/how she gives birth. I wasn’t SELFISH when I chose having a home birth after doing the RESEARCH! I decided that I was a HUMAN BEING and NOT a fucking science project. I gave birth to my baby to PROTECT her. You don’t want a homebirth, that’s your choice. But DON’T tell other women how to birth their babies. As for “Dr. Amy” shut the fuck up, bitch! You don’t even practice anymore. It’s the “doctors” like you that had me running for the door and to the safety of my home.

  135. HAHAHHAHAHAHHHHAAA!!!!!!!!

  136. Hahahaha! I am so glad that I’m still subscribed to this post.

  137. The problem is, as i see it, that not everyone does their research adequately before making these decisions. See this case study from Oz.

    d.

    http://www.smh.com.au/nsw/babys-death-due-to-rash-mother-says-irate-coroner-20120628-215a2.html

  138. Jamie, that was uncalled for. A debate is NEVER won by personal attacks. That aside, it was your choice and you did what you thought was best after doing the research. That’s great.

    What I saw people complaining about was people who don’t do the research and just go from a place of ‘it’s more natural’. (Which clearly doesn’t apply to you) That argument doesn’t work. I mean:

    Would they feed their child Belladonna? (Deadly Nightshade)
    How about leaving them to die if their appendix ruptures?
    How about weaning them at two, three years old?
    Not intervening during an asthma attack (letting kid die)?
    Guess what? They’re all natural.

    You (general you) know what else is natural? High Infant/Child Mortality Rates.

    See why that would be a bad argument?

    Vaccine schedules are based on the expected maturity of the baby’s system at that time. Delayed-schedule therefore has its benefits for premature babies.

    Unless your doctor specifically absolutely contradicts it (no offence but they are the ones who have been to medical school), I can’t see any reason why you would forego vaccines altogether. I can see using dead-shot rather than live-mist in cases such as asthma. No vaccines at all? Erm…what?

    I hated having to call you out on that personal attack, Jamie. While I don’t agree with you, you’ve clearly thought this through and aside from that, I consider you a worthy opponent.

  139. whatpalebluedot

    Would they feed their child Belladonna? (Deadly Nightshade)

    Actually, yes.

    http://www.hylands.com/products/teethinggel.php

    When it was recalled for having detectable levels of Belladonna, it was hunted down by crunchaloon after crunchaloon.

  140. Don’t write about things you have not researched thoroughly. Many doctors say home birth IS safe. Much research points out that THERE ARE TO MANY INTERVENTIONS in child birth. This is a personal decision, made by many educated people, thanks for helping make the public even more stupid with this article.

  141. Isis the Scientist

    My favorite part of this post is that it will continue to attract wackaloons forever. It’s like the giving tree of wacakloonery.

  142. This entire essay is a scare tactic without any scientific basis what so ever. You have completely missed the point of, whom you call the “Feminist Hulk”, is saying. It has NOTHING to do with feminism. It has to do with what she felt happy and comfortable with and how it is illegal to have a midwife at home birth in some states. Hospitals are filled with sickness, disease, and infections. Here, laying in a sheet and bed someone died in the day before, and have someone scream at you to “PUSH!!!” while you sit in the most uncomfortable, unnatural position ever created to give birth, just because it is easier for the doctor to pull your baby out. Giving birth is hard enough, contractions are uncomfortable and the easiest way to get through the pain is to walk around and move your hips. But this is not an option in a hospital.
    The figures you use are way off base and you fail to quote any viable statistics. I could not disagree more with this horrible essay.
    Woman gave birth at home naturally since the beginning of time!!! All other countries (aside from the United States of America) all have at home births and have fewer child and mother mortality rates than that of the US.
    You are an idiot who seriously needs to check your facts against more than ONE government ran website. This is pure propaganda. You should feel ashamed of yourself.

  143. Isis the Scientist

    You got me. I do feel ashame by my use of “scarce tactics”. And data. I am really ashamed that I used data.

  144. I appreciate and understand your comments. Canada fully funds home birth with a registered midwife because it is safe as proven by the research. Here as well as In many other countries we have fabulous Homebirth outcomes attended by midwives who work both in the hospital and the community. Unfortunately much of the data you cite is seriously flawed by including unplanned out of hospital births or births attended by unskilled professionals without guidelines or emergency equipment on hand. I encourage you to read some of the more recent research on planned home birth attended by registered and accredited midwives. One of the more comprehensive studies can be found in full form here http://www.cmaj.ca/content/181/6-7/377.full.pdf as well a very well written clear handbook of what home birth entails http://www.midwiferygroup.ca/downloads/labour/Home-Birth-Handbook-for-Clients.pdf
    Unfortunately of the industrialized countries the us has very poor maternal and neonatal morbidity and mortality rates as compared to countries that have predominantly midwifery run obstetrical services and offer home birth. Please make this an informed discussion not one purely emotional or experience-based.

  145. @ Daina …. not so much that the data is flawed by “including unplanned out of hospital births or births attended by unskilled professionals without guidelines or emergency equipment on hand.” – that is really irrelevant. What happens is that REAL PEOPLE GIVE BIRTH IN THEIR HOMES, ATTENDED ONLY BY UNSKILLED ‘PROFESSIONALS’ AND NO EMERGENCY EQUIPMENT. That is the tragedy. Whatever cases one likes to include or not include in any ‘study’, the tragedies KEEP HAPPENING.

    If there are services available where emergency equipment and trained professionals are available, then women need to be educated about it. As you point out, it isn’t available everywhere and we don’t all live in Canada where, as has been pointed out by several correspondents, there is support for this option. I think it is the other cases (the ones you would not include in a ‘study’) that Isis and some others of us are concerned about. I reiterate; they may not belong in an academic study, but the tragedies keep happening.

  146. Isis there is allot of data out there to choose from. You used data that supported your claim. Very easy to do in medical research. I dare you to look up some data about hospital interventions and the death rate of birth in the United States.

  147. One thing that is undermining feminism today is how women judge each other over how they choose to deal with birth and parenthood. Regardless of statistics and personal preference, calling women ‘selfish’ for choosing to deliver in a surrounding in which they feel comfortable is terribly unfeminist. Have you missed that word: ‘selfish’, being brandished in arguments ranging from ‘why women shouldn’t work when they have kids’ to ‘if you choose not to have kids there must be something wrong with you’, oh and not to mention abortion? Surely this is one of those topics where it is entirely possible to have an open discussion and find a middle ground, getting out the ‘selfish’ argument is totally missing the point.

  148. Isis the Scientist

    It is glorious to me that the occcasional wackaloon still finds these posts.

    On Thu, Nov 8, 2012 at 3:42 PM, On Becoming a Domestic and Laboratory

  149. If they only knew

    Did the person who wrote this ever attend a home birth or have a home birth? Sounds like a bunch of talk coming from a person with no experience on the matter but rather an ignorant opinion unfounded in true experience. FYI The neonatal death rate in America has not improved in over 20 years with the our advancements in technology but the maternal death rate has risen… by 25% actually since 1995. But I’m sure that has nothing to do with the over use of artificial inductions by drugs that are not even approved by the FDA or surgical births being done to 1 in every 3 women in this country right? A woman is 4 times more likely to die in a surgical birth than a vaginal birth and birthing in the care of a modern day hospital. In some hospitals the c-section rate is up to 80%! A woman’s chance of death is largely increased just by setting foot in such a place. Midwifery today is more evidenced based than obstetrics ever has been. It is as safe, if not safer to birth out of a hospital setting with trained professionals. Here is a large study that shows “planned” out of hospital births and there outcomes vs. hospital birth. http://www.apha.org/membergroups/newsletters/sectionnewsletters/matern/fall05/2142.htm
    In my experience and opinion after attending a few hundred births, both at home and in hospitals, I know home birth is safe and that birth does not have a chance to unfold the way it is intended to in a hospital setting. I have also seen, with my own eyes, hospital care providers create the emergency with their alarmist interventions that are fear based and lawsuit dodging in nature. I believe hospitals are a great place for the high-risk mother and fetus/neonate. But these are rare situation. OBs are specialists in high-risk birth and surgery, why would you see this kind of provider when you can see a midwife who is a specialist in normal birth, which most OBs are not even familiar with or ever have witnessed? Also, where did you get the 37% emergency transfer rate? The midwives I work for have a transfer rate of about 10% with the most common transport being exhaustion. People who make assumptions off of study’s or statistics without the experience to back it up just spread ignorance.

  150. non-conformist

    YES! Let’s have our baby’s in hospitals! Our babies will come out drugged just like we are, barely being able to cry. I know I always dreamed of giving birth in a robe that someone died in yesterday. Let’s bring our children into the world in a place that is riddled with infectious disease, and have them taken away to be poked and prodded their first moments in life instead of feeling the warm embrace of their mothers. I had my first child in the hospital. As soon as I pushed her out, they took her from me, and gave her all sorts of shots without even asking. I was held against my will in the hospital for 2 days, and woken up every half hour to make sure I was still breathing ( which, after not getting sleep 24 hours prior to labor, kind of sucked)…. You want to talk about the neonatal mortality rate in third world countries, think about the lack of sanitation. That couldn’t possibly be the cause, now could it? Did you know that over 99% of births in the US occur in hospitals, yet our neonatal mortality rate is actually higher than the Netherlands, where home birth is much more prominent- http://data.worldbank.org/indicator/SH.DYN.NMRT (I believe the article stated other WRONG figures; I doubt the UN would lie to promote hospital zombie births). So, we want to have our babies in a familiar environment, wearing our own clothing, eating our own food instead of the bland- I don’t even think I can really call it food- stuff they provide us to shove down our gullet. Home birth is not selfish. Home birth is natural and beautiful… Why do women’s rights have to end when she decides whether or not to keep the baby? Why dont you all mind your own freaking business? I doubt any of you picket at abortion clinics, so why are you taking a stand against home birth? Birthing your child at home should be just as acceptable choice as having an abortion.

  151. Also, Isis, I love how when someone brings up a valid point that contradicts your thoughts on the subject, they are immediately labeled a “wackaloon.” Why don’t you respond to their comments with an intelligent, fact-based response, instead of attacking them and their beliefs personally? Or, do you not have intelligent, fact-based response? Just some food for thought.

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  153. There is no accountability for home birth midwives. Please sign and share this petition for federal oversight of midwifery if you think this is a problem.

    https://petitions.whitehouse.gov/petition/review-direct-entry-midwife-credential-safety-and-accountability/hF2dcL6g

  154. Pingback: Why do those who advocate home birth feel the way they do? | Kathryn B. H. Clancy, PhD

  155. I’m confused. I totally support the information in your post regarding midwifery and in complete opposition to the misinformation that midwives spread.

    But I don’t see anywhere where Feminist Hulk said that homebirth was a pro-feminist thing. Am I just missing it?

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