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Midwifery Controversy
Should a woman be able to use a midwife to delivery her baby if she has previously had a caesarian section or if she is delivering a twin or breech baby? A group of Portland midwives plan to sue to keep that right.
Here's what happened: according to the Oregonian, Heather Hermans was using a midwife for the delivery of her first child, but during labor she began to experience breathing troubles. That, combined with the fact that the baby was breech, led the midwife to call an ambulance and have Herman transported to Oregon Health & Science University. Once there, an OBGYN delivered the baby successfully by caeserian section but then filed a complaint against the midwife saying she had violated professional standards by even attempting the breech birth.
As a result, The Oregon Health Licensing Agency began investigating the actions of midwives, specifically at the Andaluz Waterbirth Center in Portland. Now the midwives are planning to sue OHSU and the Oregon Health Licensing Agency. They say their practices comply with professional standards and the investigations are a form of harassment.
Have you delivered a baby with a midwife? Should they be able to delivery babies who are breech? What about twins? Should they be able to deliver babies for women who have already had a c-section (a practice commonly known as a VBAC — Vaginal Birth After Caesarian)? As a parent (or parent-to-be), a doctor, a nurse, or a midwife yourself, what's your experience with midwifery in what some people consider "high risk" situations?
GUESTS:
- Heather Hermans: Andaluz Waterbirth Center patient
- Jennifer Gallardo: Midwife with Andaluz Waterbirth Center
- Roy Haber: Attorney for midwives
- Dr. James Cross: Retired Obstetrician and past president of the Oregon Medical Association
- Laura Erickson: Owner and director of the Alma Midwifery Birth Center
Tagged as: births · health · midwives · ohsu
Photo credit: Christy Scherrer / Creative Commons
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For all the joy of a birth, it is a process that can go tragically wrong in moments. Any birth is one minute away from being to converted to an emergency abdominal operation. Mistakes are costly and the implications last a lifetime. Neonatal anoxia can happen in 2-3 minutes and if they survive, brain damage and cerebral palsy complications will last from the cradle to the grave. Only three generations ago, birth complications were the leading cause of death in women. In our litigious society, unhappy parents have been know to sue the obstetrician many decades later because their offspring did not have the chops to get into Harvard--probably from birth anoxia?
In complicated pregnancies, experience and knowledge must be of the highest caliber because misjudgement has long term results that will never be patched over with an "I'm Sorry." Multigestations, placenta complications, positional malpresentations, maternal health issues, and perinatal infections(ie AIDs) may best be handled in conjunction with specialist doctors.
I am afraid it would take some well publicized mistakes and life changing tragedies to realize that for some things in life, expertise is warranted, for instance: flying a passenger jumbo jet, brain surgery or being Governor of Oregon--I'll forgive you if you put whole cream instead of nonfat soy in my Mochachino.
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Thank you for being specific! Far, far too often when discussing midwifery care is there not a distinction made between a complicated pregnancy and a high risk pregnancy. Simply being obese labels a woman as high risk and not enough people understand what it means to have risk factors as opposed to having actual complications. While I appreciate your thoughtful comment, don't forget that what is considered a complication and what is considered a variation of normal is still up for debate. Breech and twins being the best examples in this case. Breech babies are frequently born with the skilled hands of midwives and do not see the resulting complications that come from attempted vaginal delivers by OBs who are no longer trained to perform breech delivery. Also, it is not made clear how many of those tragic complications arise because of interventive practices in hospitals. How does one distinguish between a complication that could not have been avoided and one that was caused by trying to avoid it? This is part of why more women are not even bothering with hospitals anymore.
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Jacob, your post illustrates exactly the views of most of America, that birth is extremely dangerous (it's not) and also that homebirth and birth center midwives don't have the "experience and knowledge" necessary to safeguard a birth.
We assume that hospitals are necessarily safer for birth than home. But "adverse events" happen in hospitals quite frequently. They just aren't reported in the media. I know it sounds crazy because we just never hear about it, but it's true. It's hospitals that use Cytotec/misoprostol "off-label" to induce labor, causing hyperstimulation of the uterus in some women with tragic effects for the mother or the baby (oxygen deprivation or death for the baby, uterine rupture, or massive hemorrhaging for the mother). It is hospitals that overuse the life-saving cesarean surgery. When the surgery is not necessary, it can do more harm than good, contributing to maternal death by post-surgery infection, fatal blood clots or placenta accreta in a later pregnancy.
Far from a dangerous undertaking, birth at home is very safe. At least 90% of planned homebirths are successfully completed at home. Most things that can go wrong in a birth go wrong slowly, with plenty of time for an experienced midwife to use her professional judgement to transfer to a hospital with tools and surgical capabilities when necessary. A transport to the hospital from home is not a demonstration that homebirth is not safe, it's proof that midwives know when to transfer care to a specialist.
I have had two homebirths. My first went beautifully, except that I bled excessively after the placenta was born. My experienced midwife was able to stop the bleeding and stabilize me without any outside intervention, though she wouldn't have hesitated to call an ambulance if my bleeding hadn't slowed. I chose the same midwife for my second birth, which also went beautifully, except that my son was a bit slow to breathe. Still, not a problem for my well equipped midwives! They know how to stimulate a just-born baby and carry oxygen, which we used to help my son breathe and "pink up."
As I said in my previous post. Birth has some risks, whether in the hospital or at home. No one can guarantee you a perfect birth or a healthy baby. Since there are no absolutes about what care is best, it really ought to be up to the parents to make informed decisions.
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Even in the hospital a cesarean section cannot be accomplished 4 minutes after disaster strikes. Get real for a minute! In hospital it is set up for 30 to 45 minutes from decision to incision. A well organized home birth with accessible back up can manage the risk by instituting emergency procedures, and notifying the team in the hospital to be ready. This is why OHSU's response to the appropriate transfer of this mother was so out of line. Get away from the tv version of birth emergencies and look at the reality. Homebirth is a legal right for women in the UK and their results are excellent. A mother and family who actually understand the risk inherent in giving birth can be trusted to make the decisions that are right for them, even if they choose the riskier hospital birth!
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If you read my post lower down on the list, you will see that hospital protocol is to have moms from emergency in their hospital room to operating table in 20 minutes, a protocol which is ideal but not always possible if the operating rooms are all in use. 20 minutes jacob, which means that even in the hospital, some emergencies are unavoidable, and not all babies make it. However, what we can do is avoid unnecessarily adding to the threat of those potential circumstances by doing things like leaving the bag of waters in tact so we don't CAUSE a hypoxic emergency for the baby. Midwives are experts in vaginal birth. If you are looking for expertise in birth, I can't think of better suited professionals.
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I am a practicing ob/gyn who firmly believes in the choice of home birth. Birth outside of a hospital is a safe option but not for every woman. Unfortunately, I think the two "sides" (home birth vs hospital) have misconceptions about the other "side" that results in extremely poor communication and poor understanding of the motivations, outcomes and rationales.
Having seen both positive and negative results of home births, I can say in my experience, it is appropriate for low risk patients. When problems arise, they seem to come from home birth attempts which I would not consider safe - diabetic patients under poor control, obese patients, breech, twins, preeclampsia. Also, problems seem to happen when the patients or midwives fail to recognize the seriousness of the situation and push for home birth. While not all home birth attempts are successful (ie need delivery in hospital setting), it seems that if the above issues are present chances of successful home delivery are less and the potential complications are greater. Again, based on my experience, the baby seems to bear the brunt of the risk (infection, blood sugar problems, delay in resuscitation).
I had read through the comments on another discussion about home birth and one of the comments implied that the delay to emergent surgery (ie C-section) was just as long in the hospital as it is at home. This is just not true. I have done a C-section (from decision to baby out) in less than 10 minutes from a patient arriving to the doors of L&D. It is rare that it needs to be done but emergencies by their very nature are unpredictable. The standard should be under 30 min but in a true emergency, it is usually much faster.
It seems that patients who approach birthing with a plan (whether it be home delivery or hospital; low intervention or epidural and induction) but the realization that birthing, (like life) often doesn't follow a plan, have the best experience and best outcomes (healthy baby & Mom).
I don't think either side presents the information in an unbiased way. Both sides "believe" that they are doing what is best for the patient. Each side seems to think that the other side is in it for the wrong reasons (money, control, power). Each side accuses the other of withholding the real information. I am not sure how this will be resolved but I think that if we keep in mind that our goals probably very similar, that will go a long way.
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It will be resolved when birthing choices are laid in the hands of the women giving birth. If both sides believe they are doing what is best, then it is only left to the choice of women which one they agree with. That is the whole point of Andaluz fighting to cease the harrassment by OHSU so they may continue to do what they are legally allowed to do without unwarranted road blocks and birthing mothers continue to have the option to go to them should they decide that is what is best for them. Choice is the solution and it is what women all over the US fight for on a daily basis.
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I commented this earlier above but I have seen hospitals receive transports with full operating rooms, or refuse to prep the OR when we call saying we are coming with an emergency, both of which substancially delay emergency treatment. Thankfully, none of those emergencies have ended in damage or death to baby or mom. I agree it is more likely to get to OR sooner from within the hospital, but not guaranteed. If you have a true emergency and full OR, there is not much that can be done to speed up the operation. There are also times when even 10 minutes is fast enough.
I would like to add that midwives are trained and highly skilled in neonatal resuscitation, and what you are describing is not delayed resuscitation but delayed intubation, which again, is along the same lines as the cesarean, where it is more likely to be quick in a hospital but not guaranteed. Usually resuscitation alone is enough, and when intubation is done unnecessarily, it can be very harmful to a newborn.
The one thing I discuss in my own comment further down is that there are very real risks to babies in the hospital, including resistant infection strains, a lifetime of gut flora imbalance and digestion problems from not passing through the vagina, delayed breastfeeding, immune reduction from seperation stress in the immediate hours and sometimes days postpartum, etc. All of these, but especially the first and last are real and common and can be life threatening or altering. The last one because it intensifies the first. Not to mention, starting out life without a mom is also a risk to the baby, so the doubled risk for maternal mortality is important to the baby.
I agree with so much of what you said and personally am so tired of the endless arguing. We all want the same thing, but have different ideas about how best to achieve that end. In an ideal world, I would be allowed hospital privilages with my clients with twins and breeches, so they could have low interventive vaginal births AND access to emergency equiptment. I think we're a long way off from that as we stand now in the U.S., but if we use evidence rather than culture to start making our future decisions around childbirth, we will get there. In the meantime, families are left to decide which set of risks they think are the least.
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Why does midwifery so often turn into an ideological statement? Midwifery is a matter-of-fact, age-old occupation, that has been turned into a divisive advocacy. What is the war exactly? Who are the enemies? The benefits of midwifery are largely ethereal, about personal preference, and are often at base ‘spiritual’ in nature---which is perfectly fine, but it is not perfectly fine to overstate them and turn something personal and banal into some unknown cause. When people advocate midwifery they are generally not doing so from a medical perspective, they are not proposing direct medical advantages---they are generally suggesting it is a better experience, that women will feel ‘empowered’ by it, and often go so far as to suggest that childbirth is ‘sacred.’
The crux of the benefits of midwifery seem to surround the idea that childbirth should be ‘natural.’ Which is (of course) a loose, relative term. What is meant by natural? Really the whole concept of a midwife itself is unnatural, and is not particularly any more natural then a doctor. But the focus is meant to apply to the process of labor and birth itself, with the midwife overseeing this 'natural' process, and often what is 'natural' about the process is largely superficial and subjective. The hospital is apparently not deemed a natural place to have a baby, but some done up Victorian in a muted palate with a hot tub, is alleged to be closer to what nature, at some-point, must have fated as ‘natural.’ It would be possible to go so far as to argue, and perhaps with credibility, that midwifery in the modern world is unnatural, because we cannot separate ourselves from nature, and our evolution has naturally resulted in modern birthing practices, such as the use of hospitals. On the other hand, you can understand the desire to not give birth in a hospital, because childbirth is not an illness. And even if you don’t find birth to be sacred, it is still generally something that is celebrated, so parents understandably want the experience to be special and to feel comfortable and well cared for during the process. >>>
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It's funny, I do believe that homebirth and birth center midwifery has direct medical advantages over hospital birth in the low-risk, healthy pregnancy. We usually assume that hospital birth is risk free, but there are situations in which mothers or babies have actually perished as a direct result of commonly used hospital interventions that would never be used in a home birth.
Cytotec/misoprostol is a great example. It is a drug approved by the FDA to treat people with ulcers. For ulcer patients it is taken orally. Misoprostol, however, contains synthetic prostaglandins which can ripen the cervix and induce labor. OBs figured out that if you placed this very inexpensive pill onto a woman's cervix you could soften it enough to induce with Pitocin or could start labor using misoprostol alone. This works beautifully in many cases, but for some women (or perhaps it has to do with how close she is to labor anyway) the use of this drug caused hyperstimulation of the uterus with catastrophic effects for the mother or baby. The uterus would contract uncontrollably causing a rupture of the uterus, lack of oxygen to the baby and after the birth of the baby the uterus can be so fatigued that it fails to clamp down on the blood vessels after the placenta is born causing massive hemorrhaging causing the death of the mother or necessitating a blood transfusion. This cause of maternal or newborn death is entirely preventable, and is a risk of giving birth in the hospital.
I have known women who were given misoprostol to start labor who were not informed of the risks. They were lucky to be in the majority of women who react positively to the drug, but they were not given a choice whether they wanted to take on those risk (for instance to avoid another set of risks, such as risks of continuing the pregnancy with preeclampsia or risks of cesarean delivery.)
Everyone asks the question: Is home birth safe? No one is asking the question: Is hospital birth safe?
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Haha! I'm asking the question is hospital birth safe, and so are many others. It is not inherently safe, and many interventions cause harm and are carried out without necessity. Thank you for saying so, but I disagree that people aren't asking about it. The World Health Organization certainly is, along with many other global organizations who have said the U.S. is on the verge of a humanitarian crisis if they do not address their hospital standards of care for women in childbirth. This is the primary reason I'm sure that ACOG changed their stance on VBAC this year.
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<<< The questions proposed by this show, remind me of a previous TOL show regarding faith healing. I suspect many of the same people who were against the rights of the faith healers, are for the rights of the midwives in this lawsuit. In this case, they will probably be willing to gamble with the risk of the health of the mother and child, because of their view that the mother (or parents) should be allowed to give birth under their own terms, and, perhaps they see midwifery as some preferred ideological lifestyle choice, much in the same way that the faith healers claim a right to free practice of their own ideology. This is just replacing a religious ideology with a secular ideology.
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This is not a good analogy. Giving birth without the use of drugs is a choice that is beneficial to mothers and infants, a fact proven over and over again. Over 90% of women in the hospital receive drugs and/or anesthesia during their labor. This is not natural and it interferes with the body's natural process causing a cascade of issues and interventions. It is not an ideologic choice, it is a logical choice to have a natural birth. The WHO and other countries around the world are taking advantage of these scientific facts and that is why they have better maternal and fetal outcomes. Midwives have very extensive and specialized training and are certified by a rigorous set of examinations. Their practices is all science right down to emotional support they provided.
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thoughtfullgirl,
It is a birth without drugs up until the point things go wrong, then it becomes just as ‘unnatural’ as any other birth. There is nothing logical about it, because it is not based on any specific evidence. The research I have seen says that using midwifery in low risk cases is equal medically, it is not better---so what could the choice be based on but ideology. Ideology that says ‘natural’ is better. Even if the case could be made that midwives were generally preferable, there is no evidence to say this is based on the ‘naturalness’ of their approach. It could simply be do to specialization and experience.
It is a good analogy if you apply it to risk, (which is what this show should have focused on) because the risk of using a midwife in a higher risk pregnancy is increased, so the gamble that something could go wrong is greater. So, should parents be allowed to risk the lives of their children because of ideology? I personally think they should, in both cases. There is no evidence to say faith healing works nor is there evidence to say midwifery works especially in high risk cases---in both cases the risk is really increased. I agree faith healing is more of a stretch and a degree further, additionally it is withholding all care, but I think the concepts are similar, it is just about relative degrees---and, who gets to decide where to draw the line. And, whether it is acceptable to take on added risks because of personal preferences that are ancillary to the actual medical care. The same can be applied to vaccinations, and many parents’ rather recent desire to avoid them despite the evidence. I suspect statistics would prove that many people who advocate midwifery are also against inoculations, because it is an ideology that motivates them. Certainly, anecdotally I have encountered this.
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The research says it's equal in life/death outcomes, but also mentions that women at home have less interventions which can have life altering consequences to both mom and baby. Consequences like bladder incision which is happens more often than you think during cesarean. Also associated with cesarean is doubled maternal mortality due to post-surgical infection, blood loss, and blood clots. Risks also include perineal damage and standard episiotomy, hypoxic events leading to cesarean caused by drug managed labors and breaking of waters, instrument deliveries which are necessary because a mother is lying flat on her back during delivery, the "lithotomy position". Even augmentation of labor is more likely in a hospital simply because a mother is in an unfamiliar environment where her primal brain will respond with stress rather than an increase in labor stimulating hormones.
Just being in a hospital with nothing else done to "manage labor" is more likely to lead to infection for mom and baby because it's a hosptial, where people with infections go.
It is clear that interventions compound risks and morbitity, even if mortality is equal in the comparison group. Vaginal birth is not risk free in any event, but the numbers of complications from medicated versus unmedicated births, including and especially the likelihood of cesarean are much higher.
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I am an about-to-be liscenced midwife in the Portland area who has been fortunate enough to work with amazing women in many different settings. Midwives are dedicated, educated specialists in normal birth who practice under the Midwives Model of Care, as described by MANA:
The Midwives Model of Care™ is based on the fact that pregnancy and birth are normal life events. The Midwives Model of Care includes:
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monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle
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providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
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minimizing technological interventions and
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identifying and referring women who require obstetrical attention
We have a defined scope of practice, regulated by the state. It excludes women who are truly high-risk (pre-eclampsia or AIDS, eg) from attempting an out-of-hospital birth. I cannot fathom a midwife who does not want the best outcome for her client (healthy mother, healthy baby). It is in our scope of practice to attend the births of twins, breeches and VBAC's if the pregnancy is otherwise normal. (The conservative ACOG themselves just released a statement endorsing relaxing access to VBAC's)
We are liscenced by the state to carry certain medications, certified in Neonatal Resuscitation Protocols, and have passed an extensive certification process. One of the main differences between a midwife caring for a normal, healthy mama and an OB is the time we spend with our clients and the relationship we are able to build. I have personally been involved in a number of beautiful births that took place in a hospital setting, and I'm sure there are many OB's who wish they had the time to practice like we do.
Communication between the OB world and the midwives is key. I have been fortunate enough to work with a practice that has had good reception for almost all of our transports. This has not been by accident, but by the dedication of our midwives making the effort to attend meetings with the OB's at our primary transport hospital, and their effort in return, attending meetings at our facility. This river of knowledge and trust is vital to preserving birth choice in Oregon.
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I chose a home/waterbirth for my breech twins 2.5 years ago. I researched and researched and talked to many Dr's, OB/GYN's, and midwives. I did not like what I was told by the Dr's and OB/GYN's. I also didn't like the fact that I had 5 minutes to ask the miriad of questions that I had for my first pregnancy when I was seeing the Dr's and OB/GYN's. Where as I had a free meet and greet appointment and all further appointments were an hour long, constant 24/7 access to my midwives.
What ultimtely decided the fate between a homebirth and a hospital birth was when a perinatologist told me I would labor in an Operating Room, have to have an epidural, and would be placed in a bed not allowed to walk and move as needed. To be told that I couldn't be in a suite within the L&D wing really was a blow to me. It was a statement that my labor was no longer something natural but something to be feared.
I am glad that I followed what my research showed as it very likely saved my daughters life. She was born as a footling posterior breech. If I had been in the hospital for her birth I would have had a c-birth she would have been brain damaged or dead due to how she would have been held during the extraction. She was born with a ping pong dent in her head on the vein that takes the oxygen into the brain. Due to the location of the dent if there was any pressure on it she would have been brain damaged or dead.
The choice of where and how you deliver your child is one worthy of thinking and reasearching. Homebirth is not for everyone. I had to do a lot of soul searching especially when realizing that I could lose one of my twins if the worst happened.
I honestly wish the US would adopt a program similar to what the Netherlands has. Every pregnant woman has access to a midwife and only sees an OB/GYN if there is a risk factor that requires special handling and care. I wish a woman wouldn't be told or have to endure what I was told could happen if I birthed in a hospital. I do not believe that twins, breeches, and vbac's are not automatic reasons to shove a woman into an Operating Room as soon as she walks in.
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To add to the previous comment (and speaking as a midwife also working in the Portland area): midwives also employ informed choice as part of the foundation of our practice. Every step of the care we provide is explained with the purpose of educating our clients as consumers to be able to make the best choice available to them. While we are trained to recognize high risk situations, and to refer those clients for care to an obstetrician, or perinatologist, we are also trained to care for women who fall into the "complicated" category. But this care cannot be provided without full disclosure of both the potential risks and benefits of choosing to labor and birth outside of the hospital.
When a woman is pregnant with twins, or a persistent breech, or is desiring to have a VBAC, she falls into the "complicated" category. In an otherwise healthy pregnancy of the sort described above, clients are provided with written informed choice documents and are then provided with ample time to ask questions and do independent research, before making a decision as to how they choose to continue their care. The decision to birth outside of the hospital therefore lies ultimately with the client herself, and whatever her choice may be, she will be supported by her midwife.
Having also attended many prenatals and births in hospital settings, I cannot recall a time when I saw a woman or her partner allowed the time to process, research, and ask questions about the variety of procedures that will be a part of her routine care. I am worried that the majority of Americans have been so left out of the decision making process in regards to their health care. In truth we are all consumers who are being served by professionals, and we should feel free to ask questions, make choices, and seek other providers should we deem appropriate.
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Although I fell well within the "normal" category during my pregnancy, labor became potentially "difficult" at our midwives' birthing center. My experience throughout was positive, but I later learned I would have been a candidate for an (unnecessary) cesearean in a hospital setting.
Uneven dilation and baby turning posterior, both common in labor, combined, resulting in six hours of active pushing. The midwives regularly monitored fetal heartbeat and other medical signs to ensure that neither baby or I were in any danger. Since we were not, they gave us the space and time to progress naturally, supporting us with a variety of very helpful practices for pain management and positions. My experience of labor was of confidence and encouragement and I was never demoralized or alarmed by being taken out of the laboring zone with unneccesary technical accounts. My husband was updated calmly outside the room once at his request. After baby was born completely healthy (in water), we had round the clock gentle asistance for 2 days with nursing, delicious food, diapering, and getting up to go to the toilet . After a blissful week, the midwives and I discussed the birth in more objective terms, and I learned baby had circled 180 degrees (a rare "long arc") and that had I been in a hospital, I most likely would not have been permited to push for six hours and would have been told I needed a c-section, a decision that would have been made on the basis of a clock rather than my or my baby's actual medical condition.
The way a woman feels about her birthing story is not merely a sentimental or extraneous matter - it greatly impacts her health and her abilities to care for her newborn. I am grateful for the unconditional love and support that surrounded me, and for the natural hormonal processes that were not interrupted by medical interventions or drugs.
I can't sing the praises of midwives highly enough for their inexhaustible breadth and depth of knowledge of the processes of pregnancy, birth and postpartum. The level of professional and empathetic care I received not only empowered me to think and advocate for myself as a patient, but should be the standard of all health care, not only prenatal care, for all people.
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I am 36 weeks pregnant with twins. I'm planning a homebirth VBAC with a team of midwives and I am not worried in the least.
During my first laboring experience, I was transported from a birth center to the hospital for non-progression. My midwives recognized a need for transport in plenty of time. During my c-section, the doctor performing the surgery cut my bladder and had enough time to stitch that up before finishing the cesarean. Nobody would ever think of reporting the surgeon to a licensing board for violating professional standards. People accept that complications occur in surgery. I don't understand how a midwife paying attention to her client, and getting her to the hospital in time for a positive outcome, can be seen as violating any professional standard.
With my current pregnancy, I have had regular midwife visits intersperced with regular ultrasounds, and have seen the difference in care. Every ultrasound has had a different group of people pushing me through the appointment, getting things done as quickly and efficiently as possible. At every appointment, the doctors have the same comment: I have nothing to say, everything looks good. Because of that, I don't see myself as high risk. When I look at the risk of a repeat cesarean versus the risks of VBAC, breech & twin birth, I choose not to have an unnecessary operation.
Every midwife appointment has lasted 1-1 1/2 hours. Nothing is rushed and I am allowed ample time to ask questions and talk about any concerns I may be having. My midwives ask about my personal life to make sure that my stress level is low. We have a personal relationship that breeds trust, which has to be present to have the most optimal birthing experience. I trust my midwives to know if/when it is time to go to the hospital.
I believe that midwives want to support women looking for a birth that does not include drugs and unnecessary interventions. They are not going to put women or babies at risk. They are not forcing anyone to enter into a birth that they are not prepared for. Most women seeking natural homebirth are trying to take back the birth experience. We are women who have done our research and know the risks of our decisions. The hospital is there for women who DO need medical attention.
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I gave birth about 15 months ago. During my pregnancy, I started with the doctor's office I had been going to with everything else. Once I got transfered to thier prenatal care group, I no longer felt listen to, my normal doctor visits use to be about a half hour and the doctor I went to I felt listened to me. The prenatal group I would sit in the office waiting, and then the nurse would come in take all the measurements and didn't talk to me or ask if I had any questions, then the doctor would come in and tell me that it was nice I was loosing weight but that I should just plan for a C-Section. I am a larger woman and they told me that even though I didn't test for gestaional diabeties the first time, they were going to have to test me every month or so for it.
So I looked into other options, in part is because one of the things I always wanted to do was to give birth to my child naturally. I felt if they were already telling me that I was going to have to have a c-section, well I felt I was going to be pressured into it.
I found the Andaluz birth center with the help of my doula and I fell inlove with the care and consideration I was treated with. Each meeting was over an hour long, they answered my questions and asked what I wanted. And worked with me to get what I wanted.
part one
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I had a very easy pregnancy, and when things came to the delievery and my daughter didn't want to come out, I had to be transfered to Legacy Emmanual. My midwife, came with and I believe that if it weren't for her, my daughter wouldn't be here today. Once I arrived and they had me strapped to all the monitors - it was found my daughter was having late decels and then the doctor told me that I was going to have to have a C-section, and I was half tempted to walk out there and then, I was ready to have an unassisted birth rather than a c-section. My midwife talked with the doctor and came back in and sat down with me, held my hand and told me that in her over 30 years of delievering babies she has only every told 4 women that they did indeed need a c-section and I was the fourth.
The doctor just announced it and left the room so I could prepare myself, there was no compassion or consideration for my feelings. I fully believe that if it weren't for my midwife, my daughter wouldn't have been here, and if it weren't for the medical people doing their job I wouldn't have my daughter.
Talking with both my midwife, and the medical staff, the medically neccessary c-section wasn't something that could have been forseen. It wasn't because of my weight, or anything else. It is one of those rare things where the signal to start labor, just didn't happen and she stayed in too long. And had I refused to plan to go in for a csection - and done a natural child birth with a hospital, I may not have gone in until after it was too late, it was due to the diligence and caring of the midwife that got me in and got me to have a c-section.
Emmanual Legacy was amazing with the transfer and they way they treated me and my daughter. Andaluz was absolutely amazing with the continued care I got with them even though I had to have a C-section. I was very lucky.
However my old doctor office, had thier say with the fact that it would have never come to that with them as they would have had me in for an induction and or a c-section before it became critical. And that was the last time I went back to that office for anything.
I will always return to the caring professionals at Andaluz.
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The midwife did what she was supposed to do and transferred the birth to OHSU. If OHSU doctors had treated her appropriately everyone would have been happy with the outcome. If OHSU would return to teaching doctors how to avoid unnecessareans perhaps more low-risk mothers would choose to deliver with them. Until the proverbial freeze-over then mothers deserve the safety of low-tech natural birth at home or in Birthing Centers with midwives. If you can't trust a doctor to assist with a VBAC in the hospital then a mother, to be safer, needs to be out of the hospital. And let's not forget how hard it is to get a water labor or water birth in L&D!! At home I have my tub.
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Thank you for starting this discussion. I have two children. My first child's birth was a home birth attended by a midwife in Nevada. My second child's birth was a hospital birth in OR attended by a midwife. In Nevada my home birth was covered 100% by our insurance. After moving to Oregon our new insurance would not cover a direct entry midwife. We were financially forced to choose a midwife attended birth in the hospital.
Midwives understand the process of birth better than an OB/GYN. They are trained to recognize complications that would put mother and child in danger.
Midwives should be able to attend births for breech babies, twins and VBACs. Most women will accept the risk in order to have the birth they feel they deserve.
Delivering both of my children with my own power, will and ability left me feeling like I could take on the world.
Thank you!
Kristin (Bend)
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My youngest daughter Skyler turned 1 this month. She was born at home. My wife & I decided to got with a midwife after seeing our first birth involved little to no help from the hospital. In fact they told my wife to "hold the baby in" until the doctor got there...
I LOVED it! I would not change a thing in the world and our midwife was the greatest professional and passionate member of our team - dare I say family - that morning that Skyler came into our lives.
Thank you Midwives for all that you do! We support you!
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I had my daughter at home 27 years ago with a midwife, I have also been attendance at two other home births with midwives. The birth of my daughter at home was smooth and peaceful. No machines, no bright lights. I was able to walk around, take a shower and really follow the instincts of my body.
Someone above mentioned the need for trained professionals, that is what midwives are. I would argue that they are even more qualified to birth babies as that is all they do. Midwives are typically able to turn a breech baby something that is rarely attempted in a hospital. Professional midwives also have connections to hospitals in case anything does go wrong.
And in hospitals things go wrong, often. Are there any studies that show a comparison between midwife births and hospital births in terms of problems? Throughout Europe midwives and homebirths are commonplace. Hospitals are for sickness and medical problems the birth of most children is neither.
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Two certified professional midwives provided my care during my pregnancy, birth and postpartum period last year. My son was born at home on December 11 after a long but calm and healthy 42 hour labor.
The midwives' care through all of it was excellent — it was thorough, holistic and empowering. All the prenatal visits were at my own home, and each lasted at least an hour, during which time my husband and I talked at length with our midwives. The focus was on me as a future mother, and yes that included medical care (checking baby's heartbeat, testing my urine, taking my blood pressure), but it also included checking up on me emotionally, educating me about healthy choices during pregnancy, and talking with my husband about his role in the birth.
The postpartum visits were equally wonderful. I didn't have to leave my home for a week, because the midwives visited us there and were able to provide gentle, attentive one-on-one help with breastfeeding and baby care. Everything about the experience was conducive to my husband and I bonding with our new baby.
And, of course, the birth itself was MAGIC. Being at home, surrounded by loving women and my husband. Gentle hands. Christmas music playing on the iPod. Christmas lights on the tree. Birthing my son in my own bedroom and cuddling him on my own bed. Taking a shower in my own shower afterward. Eating my own food. I strongly believe that the familiarity, love, and warmth of the experience played a significant role in my long labor staying healthy and straightforward. In a hospital, I'm sure I would have had more difficulty staying calm after hours and hours of labor, and certainly there would been medical interventions to "speed things up" -- which clearly weren't necessary.
There is NO QUESTION that I will choose midwives again for any future pregnancies and births. I felt extremely empowered during the entire experience, and since baby and I were healthy throughout, it made no sense to be in a medical environment at any point.
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But, I should add: would I choose homebirth in a complicated birth scenario (twins, breech, VBAC)? Not sure.
Honeslty, I'd at least want to have the opportunity to try to have my baby (or babies) vaginally, and there is evidence that this is POSSIBLE to do this safely if the care provider is trained well. However, the vast majority of hopsital care providers will NOT permit vaginal births in these cases, and OBs are no longer being trained to do anything but c-section in such scenarios. Given that, I feel that hospital providers are in a sense forcing women who want vaginal births to go outside the hospital. We can't ignore the c-section epidemic in this conversation. It's a big reason why women are choosing out-of-hospital birth for any kind of pregnancy and birth situation.
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Yes, out of hospital birth is safe, but every study you read about the subject will alway add the caveat that that it is safe for a select group of women. These studies, done all over the world, specify that breech, twins and VBACs do not fall under the low risk group, and are not considered to be safe for out of hospital birth.
Midwives who practice in hospital settings can safely care for women who have these three factors, while providing the safety net in the case of the rare but potentially disastrous complications.
In your interview, you should ask the representative of AndaLuz how many bad outcomes they have had in the last 5 years, (neonatal deaths, and close calls for mothers) related to caring for women who are seeking out of hospital birth and who have the three factors listed above. Also make sure you include their homebirth practice. If she denies any such problems, then her veracity should be seriously questioned.
Full disclosure: I am a CNM at OHSU. I was also an out of hospital midiwfe for over 20 years. I did not care for women with twins, VBACS or breech presentations because of the documented increase in risks of poor outcomes for these conditions. Honestly, we have seen the results of these practices in the transfers that come through our doors, and have mourned with the parents who have lost thier babies as a result. Yes, birth is nromal, and most of the time the results are wonderful and ideal, but there should be a threshold for the types of risks a provider is willing to accept for the safety of mothers and babies.
This is not a witch hunt. This whole issue is an attempt to prevent the disasters we have seen as a result lack of respect for the potential risks involved for certain conditions.
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Before the show starts, as a CNM I would like to remind the interviewers that this controversy is about home vs hospital birth, not about midwifery per se. Most Oregon births attended by midwives occur in hospitals, and many Portland-area hospitals have large and active midwifery services. For example, the majority of biths at Kaiser hospitals are attended by midwives. Midwives andprofessional midwifery organizations support home birth, but many CNMs have never observed, let alone attended, a home birth and are more comfortable working in a hospital.
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My daughter was born at Andaluz and I would go back again in a heartbeat. At the time, I was young, low income and on food stamps and the Oregon Health Plan, which paid for the amazing care I received at Andaluz. Giving birth in an atmosphere of respect and empowerment was an incredible turning point for me after feeling ambivalent about the pregnancy. Trusting my own body and working with it to bring my daughter into the world changed my entire perspective about myself and allowed me to embrace my own intuition and make healthy choices for me and my daughter. Today my family is healthy, and I am a very different person and in a very different place in life because of the love and support of a midwife.
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I love this comment, Ann, and have heard this so many times as a midwife: This birth changed everything about how I see myself and my own strength. That's a comment that comes when women are well-supported by a capable midwife who understand that the woman does NOT need to be rescued from her labor - only loved and cared for and watched over.
All too often in the hospital, the staff not only searches for complications (and often creates them when they didn't previously exist), but they seem to think that women in normal labor are suffering needlessly and deserve to be rescued with anesthesia and surgery, short-circuiting the normal hormonal cascade of childbirth and creating increased dependence on the medical system instead of learning to rely on one's own inner strength.
Women are strong and capable - able to make good decisions with good information and able to give birth normally outside of the hospital in most cases.
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48 hours of labor vs 6 hours of labor; 15 minute office visits vs. 1 1/2 hour office visits; a pool of doctors, none dedicated to one mother vs. two midwives both dedicated to each mother. A few of the stark contrasts between my hospital experience and my home birth with a direct-entry midwife. Birth is a normal process that has been medicalized to the point of separating the mother from basic functions of her body. There are no guarantees in the hospital nor at home that everything will turn out perfectly. We should remember this when throwing around the word "dangerous" when we talk about homebirth. I read the literature around birth (hospital and home) extensively before making the choice to go with a home birth; the midwives I worked with in Corvallis educated me further. I hope that more and more women are able to become mothers in the gentle way I welcomed my second child into the world. It was truly a joyful experience and we both thrived as a result!
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I'm so glad that you are talking about this as well! I agree with our first commenter that birth outside of a hospita,l and birth in general, is not nearly as dangerous as people imagine. That said ALL of the good-quality studies on the risks/benefits of out of hospital birth include only women experiencing low risk pregnancies- excluding breech presentation, twins, and VBAC. I am totally in support of a woman being able to make her own decisions about where and how to birth, but I am only in support of this if the woman has received evidence-based and thoughtful counseling about the risks and benfits of all her options. Certain homebirth and birth center practices in Portland cite the research on homebirth's safety on their websites and trumpet these studies to support their practices but fail to clarify to the women they care for that these studies only include low risk pregnancies. It would be far more honest to share with women that we have little good data regarding the risks and benefits of birthing out of hospital with breech, twins, or VBAC. The American College of Nurse Midwives has a statement on homebirth that I agree with: http://www.midwife.org/siteFiles/position/homeBirth.pdf
I think the key to this discussion lies in the question regarding what the line is between low risk and high risk pregnancies and labors. Midwives around the world agree that twins, breech, and VBAC present higher risk situations. I am very concerned that some midwives in our community seem to be pushing to minimize these risks. And in the controversy over this subject, this lawsuit as an example, we all fail to move toward the Scandinavian model: the 90% of healthy low risk women birthing out of hospital and the 10% of ill or higher risk women birthing in hospital. Portland can achieve this model but only if we can all move beyond the current argument.
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Funny Bumper Sticker:
Midwives Help People Out
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Too True!
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Haha! I have this bumper sticker. I love it.
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I birthed both of my children at home with a midwife. During my prenatal visits, which lasted at least an hour, my midwife, a trained professional, checked my blood pressure, the baby's heart rate, the position of the baby, etc. She also listened to any concerns that I might have about the birth. If any concerns arose between visits, I could call and talk directly to her.
During the birth, she checked dilation when necessary (a lot with Baby #1, not at all with Baby #2), and checked the baby's heartrate with the Doppler. She was there with me the whole time, providing support, medical advice, and experience.
Her services also included 6 weeks of post partum check-ups. When we had a concern about our newborn, she drove out to our house at 11 pm to check on our daughter.
I had average, low-risk pregnancies. But if I had been in the situation of a VBAC, twins, or breech birth, I think I would have felt more comfortable in a hospital with midwives, attempting a vaginal birth. However, many hospitals have the policy that these pregnancies mean an automatic C-section, which is not always warranted.
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I emplore these people posting to step back from blaming and listen. Listen to women, listen to evidence.
Home birth is safe. In the UK and Netherlands where home birth is much more common than the US midwives deliver babies at home every day. They follow specific standards that don't include delivery of VBAC, breech or multiples at home. those women deliver with midwives at the hospital. Netherlands has a neonatal loss rate of .3 per 1000. The majority of these are losses that would be unavoidable, congenital defects or still birth.
In Oregon the intrapartum loss rate for out of hospital birth is 5 in 600 homebirths thus far in 2010. These are babies alive going into labor that do not survive labor. This should be a very very rare event. In my 10 years of being a midwife, I have not experienced it and in the almost 30 years of practice of my group we have not experienced it.
Compare .3 per 1000 to 5 in 600. Something has to change! Informed choice must be documented and transparent. Informing and providing risk assessment must be ongoing through labor. I believe that every woman does need and deserve a midwife, but some really do need a doctor in addition to their midwife. A professional midwife should be eithically bound to present that care which is safest for mother and baby without bias or propaganda. An informed midwife and mother can find good care within a hospital system should they seek it early enough.
There are many things that need to change about in hospital birth. It exists within a broken medical system. There are many committed and exquisit providers in the hospital too. They are bringing vaginal breech back, providing VBAC with >85% success. There are midwives in every Portland hospital providing VBAC.
Out of hospital birth exists in Oregon like no other developed region in the world. The scope of practice for out of hospital midwives has been stretched to the point that women are not protected should they choose a midwife who may be confident and loving but not prudent. There is no professional accountability. The result has been an intrapartum loss rate that is unacceptable. This is why something must change. A diologue is underway. Unfortunately a lawsuit will bring this diologue to a halting stop.
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I think it's important to point out, many women wouldn't mind doing "riskier" deliveries in a hospital, if hospital policy allowed it. However, they don't. They have policies that force you to go else where or submit to a c-section. Hospitals are the issue. If my midwife could deliver me in a comfortable setting within a hospital so I was RIGHT THERE just in case, then I'd do it. But they can't. They can make it some what more comfortable, but nurse midwives have to conform to hospital policy, which means no breech attemps or twins. And the majority of hosptials in Oregon have a strict no VBAC policy.
Women aren't trying to endanger, midwives would likely love to have the same freedoms in a hospital setting, but they can't. It would be nice if we could adopt ALL of their policies.
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eck555,
Will you share your source of Oregon 2010 homebirth statistics?
"In Oregon the intrapartum loss rate for out of hospital birth is 5 in 600 homebirths thus far in 2010."
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Is this by chance the same source that includes miscarriages at any stage of care that was also used to initially fuel the discussion with the Oregon Congressional Committee that was later withdrawn from discussion because of the combination of all the losses made the statistics irrelevant?
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Most births can go smoothly without a lot of intervention. Some births would go horribly wrong for the mother and baby without intervention. There is a place for home births, birth centers AND hospitals. The most important thing is appropriate care. Any provider must recognize where a home birth is no longer appropriate and to transfer the laboring woman to a more medical setting.
Listening to the speaker on the radio complain about her doctor, it sounds like she should have found a different provider but that it wasn't so much about doctors vs midwives as about a bad practitioner. I used midwives for my first birth and a doctor for my second (twin) pregnancy. Both were extremely warm and caring AND provided appropriate care.
It is annoying to hear people suggest that ALL midwives provide better care than ALL doctors or that home birth is always better than hospital experience. My physicians for my twin pregnancy respected my desire to have a low-intervention birth and helped me have a safe vaginal birth despite my risk factors. Without their care my birth could have gone horribly wrong and ended in an emergency cesarean. I will be forever appreciative for their love and support and wonderful medical care.
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Norarachel,
Thank you so much for your post! Would you mind sharing the name of your physician who allowed you to have a vaginal birth with your twins? Did you birth both vaginally or just Twin A?
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I had a joyful and safe home birth last year and I am also a doula and childbirth educator. I fully support Andaluz and homebirth midwifery in general as a safe and beneficial option for women who feel that is the option they desire. Women have the right to choose their own birthplace. As for breech and twins, there is a good reason why homebirth midwives in Oregon are allowed to assist these births - because they are prepared for these types of births and because women's bodies are capable in most situations of birthing babies in a variety of presentations. I wish for a world (or at least a city) where homebirth and hospital birth can coexist harmoniously, with respect and collaboration between providers.
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Hi,
I'm a NICU nurse. I am extremely invested in this conversation because I have seen several horrible outcomes for babies that resulted from poorly managed home births. In these cases, babies died or suffered severe neurological complications.
Please proceed with caution. The birth experence is not as important as the babies life...
Jim
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And I'll bet you've NEVER seen horrible outcomes from hospital births, either vaginal or C/S... right?
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This is the same silliness I hear all the time. The NICU is filled, FILLED with babies nearly all of whom come right out of a hospital birth into your wing. No matter what you think, and out of hospital birth with a skilled, trained midwife is still safer than a hospital birth where nurses manage labor in a fear based, interventionist way. And that is a fact. Only high risk women benefit from a planned hospital birth.
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I'd like to find out how much the guest on your show had to pay for her attempted birth at the birthing center and then at OHSU.
From what I understand, many who attempt birth at a birthing center and then have to go to the hospital end up getting hit twice with medical bills - they have to pay both the birthing center (even though the baby didn't end up being born there) and the hospital.
This puts an undue burden on families. If there is a strong possibility that the baby will have to be delivered at the hospital anyway, birthing centers should be clear with patients about this. They should also be upfront about the cost of this.
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Hello Beth,
The prenatal care and home care during labor that I received from my midwife were what I paid to Andaluz - Approximately 1/2 of what I would have paid had a medical emergency not occurred.The deductibles for the hospital procedures, etc. were indeed above and beyond that. As with many services, there are these nifty payment plans one may use in the event that things do not happen as planned. And I consider a payment plan for a valuable service an acceptable cost. My payment to Andaluz was not a medical bill.
My medical bills from OHSU were for medical services performed during our stay at OHSU.I sought a birth center knowing full well and taking into account that my insurance provided only full birth coverage minus deductible for an in-network preferred provider.
So, I received precisely the services I purchased: Prenatal & Labor Care from Andaluz, Medical Care for myself and my son from OHSU.
Heather Hermans -
Andaluz is upfront about the costs including the what you would pay if you had to transfer during labor. I had my daughter there 1.5 years ago and remember the form.
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For the 90% of moms who don't have to transport, the cost is much lower than a standard vaginal hospital birth.
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A week ago today, at 8:05am at home, I gave birth to our first child with the assistance of two midwives and a student. It was the most memorable experience in my life.
As a nursing student spending many clinical hours in a hospital, I met few people who agreed with my decision to have a home birth. Sometimes, they would try to scare me by telling me everything that goes wrong in labor. Other times, they would tell me that I was being selfish and not doing what was best for my child. I would come home from school in tears. Research and studying however told me that my body and my baby's body was healthy and prepared for a home birth.
My home birth was beautiful. Right after the delivery of our son, I told my midwife that it was an experience that I would never change and would definitely do again. Being at home after the birth and not in a hospital environment was almost as amazing as the birth itself.
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As a nursing instructor, I know what you went through being a nursing student and finding such a lack of supprt for homebirth. It's incredibly difficult to teach normal birth in hospitals where normal birth almost doesn't exist anymore - the doctors, nurses, and then the students all become obsessive about the notion that the hospital is the only safe place for birth while continually distorting the normal process of birth so that complications are rampant.
I'm delighted that all went well for you. Consider becoming an OB nurse or midwife and share what you know with women who need both your clinical skills and your personal testament.
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I just had my 10 lb 2 oz VBAC baby at home with Andaluz Waterbirth Center midwives. I interviewed and called numerous midwives and doctors in hospital practices and was unable to find anyone to help me with a VBAC because my first child was not yet one year when I got pregnant. My only options were to have a cesarean or have an out of hospital birth. I researched the risks and chose a home birth with experienced midwives. I plan on having a large family and had I chosen a repeat cesarean this would have increased the risks of death and injury to me and my baby in future pregnancies.
I am a plaintiff in this class action lawsuit. This lawsuit is important to me because I want to protect VBAC birth and I want my midwives to not be harassed by the medical community and the state of Oregon so they will be able to continue giving me great care at my next VBAC birth.
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Whatever happened to a women's choice? Yes, the health of the baby is important but so is the birth experience for the mother. I had a baby 3 month ago and, we ultimately decided to have our child at Providence St. Vincent because it made my husband most comfortable. But we used a midwife and it was the most amazing experience. My husband was adamant that we go to a hospital "in case something went wrong" but I think he'd be okay with a homebirth now after the experience we had with the midwife in the hospital.
In my mind, a midwife focuses on letting the mother have a good birth experience and delivering a healthy baby. An OB is only focused on the later (s/he is only there for the final few minutes of labor and tends to be very quick to jump to a C-section)
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I had both of my sons at home.
I think the most important thing is for parents to have access to unbiased information so that they can have a safe birth WHEREVER they choose.
Home birth isn't for everyone. But for those who choose it, they deserve respect, gentle care, and compassion in the event of a hospital transfer.
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As a CNM with many years of experience in out-of-hospital birth and hospital birth, I have two comments:
1. Women should have the opportunity to make informed choices in their birth site.
2. In countries with well-documented safety in out-of-hospital births-- i.e. statistically decreased rates of cesarean section/less significant perineal trauma/ AND lower fetal morbidity and mortality-- there ARE strict guidelines for conditions that are NOT allowed to birth at home. Malpresentation (such as breech babies), previous uterine incision (such as women who have had cesarean sections), and multiple gestations (twins, etc) are birthed in hospital, no exceptions. The use of these countries' statistics to argue for home birth for breech, TOL-AC, and multiples is very misleading.
Again, I support women in their choices 100%. I sincerely hope that women ARE well-informed about risks and benefits of those choices. Hospitals have an obligation to provide women with reasonable, compassionate, and EVIDENCE-BASED care--including normalized birth for trial of labor after cesarean, twins, and breech babies.
Thank you,
Happy Barnes, CNM
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WHat GOOD evidence shows that breech birth IS high risk and that c-section is the ONLY appropriate way to manage it. It is THE ONLY current option because we have NO doctors that have experience in breech birth. So those of us who have breech and may have wanted to birth in a more secure place would only be cut. The current evidence includes pre-mature labor, which is of course high risk. I would love more evidence.
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Happy, I appreciate what you are saying, but what woman is "allowed" to have a VBAC in this country in a hospital? Very few. They are discouraged, misinformed and badgered into additional c-sections. Up until 10 years ago there were doctors at OHSU who would do a vaginal breech or twins. They are retired or no longer providing those services. It is not a fair comparison. Out of hospital midwives are not renegades. They are careful practitioners who have demonstrated a willingness to transfer care when situations are not optimal.
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I agree and further down discuss that the ideal situation would be to take my twins, breeches, and VBACs to the hospital to have low interventive vaginal births unless emergency care was needed. However, the current birth climate, especially around these particular circumstances, does not allow moms the choice of having the safest birth in the hospital. Therefore, they must weigh the risks and benefits, and there are substancial risks to giving birth by cesarean just as much as there are increased risks to giving birth farther away from the OR in these circumstances. The point is there's absolutely no way for us as care providers to decide for women what risks they prefer.
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As a 31-year-old, extremely healthy (and low-risk) pregnant woman, I went into premature labor and had a prolapsed cord at barely 24 weeks gestation. We drove to Providence, and my OB GYN had me transferred to Emanuel immediately after she assessed the situation. I had a radical emergency c-section. Without it, my son would have died. In spite of being born weighing only 1 lb, 6 oz., he's doing great. He's nearly 14 years old now.
For my next two pregnancies, I saw a highly gifted perinatologist (high-risk OB) at Emanuel, Dr. Andy Merrill. He treated me with such loving care...it was similar to being cared for by a midwife, but with the high-tech experience. (I had to have c-sections with my other pregnancies b/c I had a radical c-section with my first.)
I support the choice of midwifery, but my recommendation would be to use a midwife who practices in a hospital. I agree with the NICU nurse who commented earlier. I have seen way too many babies who had tragic beginnings and ends because of birth problems. Yes, it happens rarely...but would you want to be in that rare percentage of cases?
Before my son was born prematurely, I was planning on a low-impact, natural birth. The chance of having a 24-weeker is about 1 percent. But I was in that 1 percent. Women who choose home births or midwifery experiences outside of the hospital need to be fully aware of those risks.
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No mid-wife or parent would consider delivering a baby at 24 weeks, it's just stupid. Homebirth gives parents options about where they want their child to be born - it doesn't make them lose their sense of responsibility for their child.
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I did not mean to imply a midwife would attempt to deliver a baby at 24 weeks. My point was that I was an extremely low-risk mom, and this shouldn't have happened to me. Even when moms are low risk, bad things can happen.
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OrganicMama,
Your story actually underscores the safety of choosing to give birth outside of the hospital, even when complications arise: in the same way your OBGyn transferred you to Emanuel when she discovered you were in premature labor with a prolapsed cord so too would a homebirth midwife have done that. In your story, you had time to get to Providence, see your OB, switch to Emanuel, and have a healthy baby. The only difference if you had a midwife would have been that she would probably have met you at home, discovered the same things, and taken you to the same place. The outcome would have been exactly the same-- midwives are trained to recognize complications just as OBs are, and as you saw with your own story even with a serious emergency, there was time to make an appropriate plan and get--a very appropriate-- surgery.
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I had two wonderful BREECH births. I had the fortune of being a client of both Alma and Andaluz. Laura at Alma was with me for both at first. I made the decision to have a planned C-section at the hospital with my 1st first birth due to several factors. One of the reasons was that my baby was footling breech. I made this decision after much careful research and consulting with my very competent midwife. After my second pregnancy turned out to be breech as well, Laura was able to turn my care over to Andaluz. This time I had beautiful, frank breech birth at home that was very swift and easy. I am so grateful to have had the opportunity to have 2 great birth experiences that I made the decision to have where I felt comfortable at the time of my children's birth. Women should have the opportunity to make informed decisions that are not based on fear. I feel that doctors make most of their decisions based on fear and unfortunately; much of our society has a very fearful and scary view of birthing. I am saddened that many doctors no longer have the experience to deliver breech babies and so the fear seems much greater. I and others should not be forced to have their bodies cut open because of fear. It is NOT acceptable for these rights to be taken away.
Zoe F
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Comments from mothers and family with direct experience with midwives are so important for educating the public on midwifery care. Thank you for sharing.
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Going crazy not being able to call in. I hope the public reads posts and not just listens on the radio.
The mechanism of reporting practices under question is proper. If a midwife or doctor in the hospital delivers a baby that needs resuscitation or if a mother has an infection, hemorrhage or some other unexpected outcome that case goes to review. The purpose of the review is not expressly punitive. It is meant to look at the practice of those involved to see if the outcome could have been avoided.
Every licensed provider is duty bound by their license to report cases or practices that are of concern to the licensing body. OHSU was simply doing this. It is the role of the midwifery board and Oregon Health Licensing Agency (OHLA) to review the case. If their standard has been met and the practice was not outside of the midwife's scope then the board is not obligated to do more.
Of concern is that the scope out of hospital midwives is so broad that even when outcomes are repeatedly poor there has been no breach of practice. OHLA has decided to investigate not just Andaluz but all cases. Andaluz has not been targeted. They just happen to be the practice with the most reports filed. Hmmm.
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That is because other well respected midwives are being harrased out of being able to deliver breech and twins at home or a birthing center. Andaluz also has the MOST experience with breech births. Which is exactly why I chose them and so do MANY others. I'd like to see the evidence of the statement "when outcomes are repeatedly poor." All evidence has been that low risk, low intervention births with midwives are better than hospital births.
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Andaluz, a birth center with several midwives, sees a higher volume of clients than an individual homebirth midwife. Therefore, they have a higher incidence of reports statistically speaking.
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I would like to add that some people have higher risk in birth where ever they give birth. The hospitals have as many or more as the homebirth midwives. Hospitals do insanely risky behavior on a daily basis as standard practice, like breaking water when a women is 4 or 5 cm dilated. There are probably way more cord problems from this alone, leading to emergency cesareans than occur naturally. This happens in aiding induction in women who are "postdates" who are nowhere near ready for labor! But because the practice is impatience for liability purposes, unripe babies are forced out of unripe mamas at tremendous risk to them. Do a survey of your NICU babies and see how many of them had some sort of heart rate event after rupturing membranes or increasing pitocin. I think it's pretty unbelievable to consider the risks of birthing at home without considering the very real and common risks of birthing in the hospital. This even applies to special circumstance births, like twins, breeches, and VBACs.
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I am a former certified nurse-midwife with over 20 years of experience delivering babies in both hospitals and at home. It has become clear that hospital-based health-care professionals are usually extremely biased against homebirth and steadfastly maintain that it is dangerous, even for healthy low-risk women (despite good evidence to the contrary). Part of the problem is that hospitals only see the transfers that home-based midwives bring in for obstetrical care due to complications that have arisen, a very skewed sample, and don't see the other 90% of normal, joyful births that do happen safely in the home setting.
In a decade of delivering babies at home, I never once had a complication in which the health of the baby or mother suffered because of loss of time due to transport. My complication rate and C/S rate were extremely low, as is common with out-of-hospital births that occur with well-trained professionals and well-screened women who have been given extensive information to make informed consent.
Very very rarely, there might be a major complication in which loss of time in transfer is potentially harmful, but there are far more complications that occur to normal, healthy women as a result of attempting to do normal birth inside a hospital. If is almost impossible to get a normal unmedicated birth inside of the hospital due to the incredible fear of malpractice lawsuits, over-monitoring, preventing maternal mobility, refusing women to eat and drink, overuse of uterine stimulants, inability to support women through labor without extensive use of anesthesias, and very low thresholds for deciding to do C-sections, which carry a much higher risk of both maternal and neonatal morbidity and mortality (but earns the hospital and physician a lot more money).
Women deserve the chance to make their own decisions about how they give birth to their babies as long as the information is being provided by licensed professionals acting within the lawh
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Thank for your well-stated comment. You have obviously seen birth both in the hospital and out, and you have a first hand view of the medical establishments perspective.
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I am a twin, and both of my other siblings were breech births and we were all born in a hospital without cesareans in the 60's and 70's. Doesn't it feel like hospitals/doctors aren't allowing mothers to give their bodies a chance to deliver vaginally because of insurance liabilities anymore?
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I work for a surgeon. All medicine boils down to people making informed decisions based on current medical evidence, then weighing the risks vs the benefits in their decision-making. Unfortunately, too few people recognize that there will always be trade-offs.
Heather had the right to choose to have a risky delivery at home, but she also must recognize, as must her midwife, that those risky choices come with consequences. They apparently don't want to take responsibility for the risky choice they made, instead blaming their problems on the staff at OHSU who were left to rescue them from their choices. Had they not had the option to go to OHSU or another hospital and been left with a brain damaged or dead child, I wonder what discussion we would be having now?
Do midwives carry $200,000 worth of malpractice insurance? I doubt it, because there likely is an expectation that a midwife would recommend a risky delivery start at the hospital, hence the investigation for unprofessional conduct.
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Why is Heather's choice considered risky? She did not have a poor outcome, she had a healthy baby born in the hospital. I'm not sure what you mean by blaming staff for risky choices. The story is that she chose to have a creech birth at home. The midwife transported appropriately to the hospital. Mom and baby were fine.
The consequence was that OHSU filed a complaint, based on their belief that breech births shouldn't be out-of-hospital (or vaginal at all), and when the licensing board investigated they dropped the case immediately-- recognizing that nothing had been done wrong.
We are lucky that we can transport to the hospital when complications occur-- but that is not just a bonus, it is part of the decision-making to choose out-of-hospital birth. Many midwives would stop practicing if that wasn't an option. There is no one who thinks that every birth is safe or apprpriate out-of-hospital, but 90% of them are.
Midwives in Oregon don't carry malpractice insurance because it's unavailable or prohibitively expensive--in most cases, more than the midwives' yearly salary. Clients who choose midwives know this and accept their part in their decision-making for their care. Like it or not, choosing to give birth at all is accepting a level of risk, and choosing to be in the hospital doesn't eliminate that. Just look at the statistics, and the fact that the US infant mortality rate is one of the highest in the industrialized world, and that has nothing to do with home birth, andit has everything to do with the high c-section rate.
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As an educated mother capable of weighing the risks of my decisions to myself and my child, I chose a home waterbirth for my frank breech baby. My list of pros outweighed my list of cons.
I consider the customer service I received at OHSU to be what I have come to expect from the medical world. I do not blame OHSU that my child was breech, or that we experienced distress in labor, or that we saw a necessity to transport for an emergency C-Section, or that an emergency C-Section occurred.
Naturally, the location of and distance to OHSU were great considerations of mine when choosing a homebirth! Had I been allowed to do the logical thing: attempt a frank breech delivery in their hospital, my first healthcare provider would not have lost my business.
What I find displeasing is the fact that the complaint issued against my midwife included: falsified data about my medical records, incorrect data about my medical records, inaccurately recorded comments made by me, invented comments made by my child's father, incorrect reading and interpretation of my medical chart, incorrect assumptions and statements on my level of awareness and consent to homebirth for breech positioning.
I am furious that OHSU staff members took it upon themselves to file complaint "on my behalf" comprised of inaccurate, incomplete, and invented data. This behavior from any professional is appalling. I have to conclude that the staff members were too overworked and exhausted to do proper fact and record checking, and therefore in need of a leave of absence. And the fact that these people 'rescued me' (as they were paid to do) and provided my and my child's care is downright disturbing. Particularly since no one came to me for any input persuant to the complaint.The nature of the complaint is the only thing I would not have expected from medical professionals.
Heather Hermans
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Most of the differences listed on this page between a midwifery assisted birth outside the hospital and a birth in the hospital seem to be about customer service and aesthetics. Which are certainly valuable things in there own right. And, it is fine to value those things and make choices based on them, but it is not fine to malign the medical establishment, and create some kind of unnecessary war between doctors and midwives, especially when that war is not based on evidence or science, but really some new-age-like spirituality.
If baby stops breathing you are going to run to the hospital, because, obviously hospitals save lives, they are functional places that specialize in this. If I get sick I would love to stay home and have the hospital brought to me, it would be quite a luxury. But for most illnesses this isn’t practical because of cost, but for birthing this is practical because, well it isn’t an illness, and it generally is a straightforward process that doesn’t require a lot of medical equipment and a technically advanced level of care, so birthing at home can be functional, because sometimes it isn’t complex. People in poverty all over the world have babies at home. This isn’t a new concept, it is really the old norm.
What is bothersome about American midwifery is not that it occurs, but that it is turned into a kind of culture, and is almost sold as having some moral component that goes above and beyond its merit. From your show, it sounds like midwives are already on the defensive and at war with the medical establishment, so I think their response to the OHSU case is overblown, sounds a bit outrageous, and borders on a conspiracy theory. The overstated midwifery advocacy ends up undermining the good work that midwives often do.
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It sould be the families right to choose what way their child is to be born.
I had two at home and had the best experience. I would definatly do it again.
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Response to James Cross: We had a full plan for birth with options for every eventuality and a goal of having a safe and happy birth (vaginal or caesarian) so our baby was first in our mind, as I'm sure all parent's minds are. We did hours and hours of research to determine the best path and midwifery was it. Short story; we ended up transporting (non-emergency) because our baby, though strong and healthy, was a little sideways and not coming out right. We had a great experience at the hospital and our midwife was there supporting us.
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Thank you for addressing a very real and personal issue for many women in the US. I am somebody who has had a stillborn child at 7 months of pregnancy. I had a wonderful midwife the entire time who gave me and my child great care. Unfortunately, my child lost his heartbeat and I was devistated. Meanwhile, I was still carrying him inside of me. My midwife spoke with me about ALL of my options including inducing labor, which I opted for. This very loving Midwife came with me to the hospital, stayed the entire time I was there, held my hand and explained every step of the process (which the Doctor and Nurses at Emaunual seemed to be too busy and stressed to have much time for).In short, I feel that there is a definate difference in level of compassion and nurturing between Doctors and Midwives. Also, I beleive that many Doctors have a great fear of being sued and therefore will not take chances with VBAC's and breech births because of this fear.
-Jennifer Johnson
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Perhaps if hospital based staff were willing and trained to labor with women rather than manage birth than their would be a greater sense of trust of a hospital setting for mother's of twin, vbac and breech babies.
For an MD to tell a mother that she has no choice in her birth plan, that she must have a scheduled c section, makes her a patient being acted upon and not an active participant in the decision making process.
It is frightenening to put so much faith in professionals whom some have never seen a truly natural birth to decide whether or not you as a birthing mother are progressing "normally".
If MD's could worry more about the whole health of motherbaby than their insurance premiums we may have a maternal health system that served motherbaby patients with the care they truly deserve.
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The retired OBGYN is ill informed when he made the statement, "Women are making a sefish decision when deciding to birth at home." I chose to have my child at home primarily for the health of my child and not just for my own experience. When a women is pregnant her health is the predominant factor when determing the health of her child.
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I agree that parents have the right to chose to give birth at home, but it is unreasonable to expect that no one raise questions when it goes wrong. If the staff at OHSU were concerned about what happened, then they had the duty to ask that it be investigated. The midwives accused OHSU and the HLA of "bullying" them... so they threatened to file a lawsuit in order to get them to stop asking questions. Who is bullying who?
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I think the issue was that the birth didn't go wrong (in the sense that the mother got poor care) it went wrong in the sense that births are unpredictable and can take a turn for the worse. She got perfect care from her midwife, who carefully monitored her and her baby and transferred her to a hospital in a timely manner when it was evident that hospital care was needed.
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I am 36 weeks pregnant and will deliver with the midwives at OHSU. Everything is normal with my pregnancy. I love the way the midwives treat me as a healthy person going through a natural process. I am not treated like a sick person. I expect that my labor and birth will be the same. I will be allowed to give birth naturally, by myself, without assistance unless it is needed.
We wanted to work with the OHSU midwives so that if assistance or intervention is needed, we would already be at the hospital. However, I highly respect woman who choose to give birth at home. For most of us, birth is a completely natural process. Doctors are trained to deal with complications and danger, it is no wonder that they look for and expect to find it. It is critial, however, that we understand that birth is a natural process that most often occurs without a need for intervention. We need to trust women to deliver their own babies better than anyone else can. We must trust those trained to work with them to do this too.
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I feel that the retired OB/GYN comments about women being "selfish" and unthinking about their unborn children, are very sexist. I'm SHOCKED that in this day and age, we as a culture still tolerate these attitudes. Women LOVE their babies, but they are NOT baby making machines!!!
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I agree. Even though I would be concerned about taking the risk of going with a midwifery organization (see my comment below), I felt that this comment was misguided and unfair. I know that women who choose home births and midwifes want the best for their babies and their families. But I do believe that they have to be aware of the risks they are taking. Even low-risk births can go awry.
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I come from a long line of women who have had their babies at home. My Mother was born in 1933, she was delivered by her Grandmother and she was a month premature. She was a very healthy, strong child. I had both of my daughters with a mid-wife at a birthing center in 1977 and 1978. I am proud that both of my daughters have chosen to use mid-wives for the birth of their children. Hospitals are for emergencies and for sickness - birthing children is definately not a sickness and many times not an emergency. The mid-wives I have been honored to know have always been caring, intelligent, mindful professionals. Let's give them our support and provide Mothers and Fathers with options for the birth of their children.
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I decided to go with a Midwife and have a home birth as a VBAC. I chose to have a "backup" OBGYN (hard to find one that would do this). I went to appointments with each one and was shocked at the difference in care. At the hospital, I rarely saw my doctor and mostly saw the nurse. There were hardly any discussions about how I was truly feeling, eating and what I was doing and so forth. I really was only encouraged to share if I had something big go wrong. I was immediately considered high-risk and considred for another c-section. I read numerous books on midwifery (especially Spiritual Midwifery) and found that in general the midwife succesful birth (healthy baby/mom - natural birth) statistics were far better than the doctors/hospitals. My appointments with my Midwife were anywhere from 30 - 60 minutes long (versus 30 min wait and 10 min appointment with doctor). At each appointment, she did a more thorough check up on me and the baby, went over nutrition, my feelings - fears- concerns, and gave me information about what was going on and what I could expect at each point in my pregnancy. This alone, is worth going with a midwife. She came to my home or I went to her office in her home for my appointments. I was very comfortable throughout my entire pregnancy. Rating the care: Midwife 10 Hospital 1 - they are truly at each end of the spectrum. During the birth I was able to labor longer and in the comfort of my own home. She was by my side the entire 40+ hours (she also had another midwife there to help). Her care and expertice were impeccable. My baby was healthy and strong during the entire time.Some midwives carry pain medication, others don't. As mine didn't, I requested a preemptive transport to the hospital for med help. My Midwife stayed with me the entire time (during an after the nursing staff gave me pian meds). I had a vaginal birth with no complications. My Midwife still helped deliver (my obgyn showed up for the delivery) and I went home asap and was taken care of by her and all my aftercare was with her. My experience was safe, comfortable, well supported, and I was generally cared for (taken care of and loved). The bond with one's midwife is so much stronger and so often life long. It is truly a loving, baby-centered community.
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Two and a half weeks ago, my husband and I delivered our first child at Andaluz. I had a low-risk pregnancy and felt very comfortable with the midwives. My labor and delivery were more eventful then anticipated (70 hours of contractions, military asynclitic position of our son (his head was tilted back and to the side), he became stuck on the lip of my cervix for an extended period of time, and after birth had difficulty breathing on his own for several minutes and required oxygen). However, throughout the entire process, the midwives and staff took great care of our entire family, monitored our child extremely closely, kept us informed of all our options and gave us the choice to continue laboring at the birth center of be transported (non-emergency) to a hospital. I never felt that I or our child were in danger and my mom (who was an OB nurse for 13 years and encouraged me to look into midwives for our birth) commented that she felt that I received more monitoring and care than I ever would have gotten in a hospital setting. Our son is a healthy, thriving baby and we are so thankful we had him at Andaluz. Had we been laboring at a hospital, even under hospital midwives' care, hospital policies would have dictated a mandatory c-section for "failure to progress" long before we had our son. Instead, we were able to have a vaginal birth, which we felt was best and healthiest for both our baby and myself.
As a veterinarian, I am dependent upon the state licensing board to practice my profession and am thankful that they are diligent about investigating complaints and ensuring that those they license are practicing according to the law. However, the midwives in this situation were practicing according to state law - it is legal for them to perform home births of breech and multiple babies. They closely monitored the mother and transported her to the hospital when they felt the situation was beyond their capabilities. I would not understand if I were to be investigated for doing something that was completely legal by my state's professional standards. Other veterinarians I know may not practice medicine in the same fashion as I feel it should be practiced, but if they are abiding by state law, I believe it is up to them and their clients to choose how they work, even if it is different from how I would do things.
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Women have the right to choose where birth is best for them and there babies. Its about choice. I choose for my first birth to be in the hospital. I had wanted a natural birth. But the docs and nurses don't have the time or energy to be with a women throughout the whole process helping her deal with what’s happening to her body. Epidurals are used 70 percent of the time in labor. This started a very common chain of events. Epidural to cope with the pain... led to a drop in my blood pressure...led to a drop in babies heart rate...led to emergency pushing situation...yelling to prep OR...yelling to call the pediatrician...heart rate dropping...PUSH...led to using a vacuume...led to 3rd degree episiotomy/tearing...baby born within seconds of c-section...baby born with a 3 APGAR...resuscitated in front of us and whisked away to the NICU...left with a broken tailbone from force of pulling the baby out to fast with the vacuume. Horrible, horrible birth but so common in the hospital. As the doctor stitched me up she looked me in the eyes and said, "There must have been something wrong with your pelvis, the baby just couldn't get out, and I will never deliver you vaginally again, If I see you again, you will have a c-section" Well, you know what- you won't see me again! I know why all that happened and I know I can have a better experience.
Two years later pregnant with my second child I knew I would not have him in the hospital, I knew my body was capable of this given the right support. I knew it would be healthier for my baby. I started my care with Alma and it was a whole other world from OB care. They have time for you, get to know you and your family, listen to your fears, massage you--tell me what OB has ever sat and given you a massage?!? My son was born after 8 hours of labor, 1 1/2 hours of hard pushing. Never thought about pain meds, because I had the support to get me through this. Baby was perfect, healthy, 9 APGAR.
Safe, healthy babies are being born everyday out of the hospital in Oregon and all over the world. For me and my baby it was safer outside of the hospital. I knew that inside me. That said, I knew and trusted my midwife to make the call about transfer at anytime. The hospitals and Midwives should be working together- not against each other.
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Melea,
Thanks for sharing your story. I had my first two children in the hospital and asked for an epidural the moment I checked in at the front desk. I knew that I “couldn’t” do it without an epidural. Now I am pregnant with my third child and after watching the documentary “The Business of Being Born” and doing a lot of reading about childbirth, I have completely changed my opinion about my ability as a childbearing woman. I had started with an OBGYN, but then promptly switched to a midwife at Alma after visiting Alma’s Childbirth Center. The birthing rooms at Alma are peaceful and my midwife team is warm, nurturing, and capable. I am so excited to have a natural childbirth without drugs. My daughter is going to have a completely different birth experience than my boys did. I am excited for my children to see that women can give birth without drugs and hospitals. Midwives have been delivering babies forever and they have a vast amount of experience.
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Ruth,
Would you e-mail me, I work with some of the midwives at Alma as a doula, I'd love to talk to you more. Melea.Bauer@gmail.com
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Midwives provide informed choice to their clients for all aspects of their midwifery care. Mothers are thoroughly informed of the consequences, of both their actions or lack of action, on their baby and themselves, in an unbiased manner, with evidence-based information. This can be a great distinction between obstetric care and midwifery care. OBGYNs have all their clients sign a consent form, but not all OBGYNs discuss all the options that are avaialble to their "patients", including all the possible consequences of their actions.
When I was pregnant, at my monthly prenatal visits my midwife, we spent at least an hour going over my health and my babies health. We thoroughly discussed all the decisions I had to make for myself and my baby (and I intentionally say we, because in midwifery care I am ultimately responsible for making these decisions and not just the midwife). My midwife knew what was normal for me and my baby, and therefor she was able to recognize if something out of normal was occuring. This was one of the primary reasons I chose to have my baby with a midwife. I did not believe that an obstetrician that I saw once a month for 10 minutes could know what was normal for me and my baby. Therefore how could the OBGYN recognize what was abnormal for us?
These are just two distinguishing factors that set midwifery care apart form obstetric care. If OBGYNs could adjust their practice to reflect just these two aspects of midwifery care, their quality of care would be substantially better, and therefore increase the positive the birth outcomes for their clients.
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I'm currently 16 weeks pregnant with my 3rd child. I had two hospital births that were in turns tramatic and depressing. Things were done to me without consent, no one listened to me, I was told not to make noises when I pushed, and was otherwise bullied.
This pregnancy I started seeing a nurse midwife in a doctors office. We discussed the births I'd had, the birth I want, and my personal risk factos. At the end of that discussion my nurse midwife recommended I transfer to a birthing center because she couldn't give me the birth I desired in the hospital. Not wouldn't. COULDN'T. I think that my nurse midwife refered me out speaks volumes!
The biggest issue I hear time and time again from other moms is the issue of OB's being c-section happy and hospital policy not allowing for the birth they want. You MUST follow this predetermined schedule or you get "help" whether you want it or not.
A very good friend of mine is also pregnant with her third child. Her first, she had to have a c-section because her baby was breech. Her second, she was at a hospital that would allow VBAC and she was able to successfully deliver. This time, she's in a new area where she'll be faced with driving an hour and a half to a hospital that will allow VBAC because no one in her area will. That shouldn't be the case. A woman shouldn't have to go so far in labor to avoid being cut open because it's policy.
THAT is why women chose to birth out of hospitals. It's not some hippy-dippy incense and scarf reason, it's because that's how where we HAVE to go to avoid unnessecary interventions and have a healthier delivery.
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My first baby was born via cesarean, and my second was born at home. Here were my birth priorities:
1. healthy mom, healthy baby
2. vaginal birth
3. home birth
Now that that is out of the way.. :) While recovering from a c-section, I am most definitely NOT healthy. Not mentally, and definitely not physically. It is not healthy for the baby, either. There is an increase in respiratory distress, both at birth and in the future. The neonatal mortality rate is HIGHER in cesarean born babies. Not to mention the risk for future pregnancies. unexplained miscarriage/stillbirth, and increased risk of placenta complications. These risks go up with every surgery.
I name those c-section risks only to describe how important it is to me to avoid one. I KNOW I can have a VBAC in a Portland hospital, I know there are supportive Midwives and OBs. But the fact is, my home birth midwife has a significantly higher VBAC success rate than any hospital. I deserve to be given the best chance. the RISK that I am NOT WILLING to assume, is the risk of unnecessary surgery.
It is ridiculous to prevent VBAC moms from birthing out of the hospital. The risk of rupture w/o induction/augmentation is SO incredibly low. And when rupture does occur, the neonatal mortality rate is ALSO low, even when it occurs out of the hospital. There often IS time to make it to the hospital. Sometimes not. I fully understand that. I am very, informed of what can go wrong in a VBAC, including how often it actually happens. I choose to birth at home. I am an informed consumer, and I DEMAND my right to choose where and with whom I birth.
I moved to Oregon 2 years ago *specifically* because of the birth choices. My husband telecommutes, and we can live anywhere. We chose Portland so that we could have the best possible birth for our 2nd child. Do not take away those choices.
-VBAC mom, who just might have twins or a breech baby some day
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I am a mother of three (2 born in the hospital, one born at home) and childbirth educator in Portland, and what stands out for me in this discussion is the need for informed choice and personal responsibility for the choices we make.
When I decided on the birth place for my babies, it was I who made the call (with help and support from my husband). Though influenced by books, community and culture, no one forced me to have my baby in the hospital or at home. I did what I believed was right for me, and take therefore full responsibility for the consequences of my action, for better or worse (including the epidural, vacuum extraction and severe tearing during my first birth). If women don't take this responsibility, i.e. fully commit to and own their choices, it is only natural that they would blame others for unwanted outcomes.
Women need to educate themselves, and they need to have the right to choose where to give birth. They need to ask questions, look around, meet practioners, read and research. They also need to look within, do thorough soul-searching and self-inquiry to find out what is right and true for them, and then they need to embrace the autonomy of their decision, 100%. That's a lot of work, and it's not easy either, but the only lasting way, in my experience, to put an end to accusing other's of failing them.
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I was disappointed that the show didn't really touch on the heart of the lawsuit(s) - where is the line between regulation and "harrassment"?
"Direct-entry" midwives fought to be regulated just a few years ago, so insurance companies would pay them. Now they object to the state agency & advisory board investigating complaints and setting standards.
You really can't have it both ways. The issue here is not whether home birth is wonderful blah blah - obviously midwives have been delivering babies as long as humans have roamed the planet.
If they don't want to be regulated, they should change the law - which they caused. Then they can go back to receiving gifts of linen or a couple chickens or ...
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I gathered from the show that the reason these midwives are calling these complaints harassment is because they were practicing within their scope of practice, abiding by Oregon law and midwifery regulations. No one wants it 'both ways', midwives are not asking to be unregulated.
Also, these regulations were in place long before 'a few years ago'.
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If they are not violating laws or practice standards, they should be glad to give their records to someone investigating a complaint. That's what professionals do.
As I consumer, if I make a complaint about a licensed professional, I expect more than that person assuring me "it's OK" - the agency has a legal responsibility to respond to the complaint.
And when you're my age, 17 years is "a few" ... my kids were born in hospitals and it was just fine. Someone needs to say that, there are only millions of us.
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Note: it is not the consumer filing complaints against the midwives it is OHSU. Actually one of the patients cases there is a complaint about is having her next baby with the same midwife.
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They didn't have a problem handing over records for legitimate issues, but the information not being given is that the requests for records weren't even complete. They were requesting information on midwives and patients they didn't even have the names for. That's what happens when baseless complaints are made. They throw out accusations of problems without even having complete information on the issue. It was, in fact, a fishing expedition and was meant to be a hassle. Thus that is why it is called harrassment and that is why OHLA immediately withdrew their investigations after their records requests were denied. They had nothing to back it up, no ground to force Andaluz to present records.
http://geoffrie.wordpress.com/2010/07/23/andaluz-waterbirth-center-files-class-action-lawsuit-against-ohsu-ohla/
"In April and May 2010, the OHLA sent out five subpoenas to midwives from Andaluz Waterbirth Center demanding medical records to investigate “complaints”, though it was unclear that legitimate complaints were actually made, as OHLA didn’t even know the name of some of the birthing mothers or other details, such as who the midwife was (note that the birthing mothers were angry about complaints being filed about them against their midwives). Andaluz lawyer, Roy Haber, notified OHLA that the birthing files would not be provided because the OHLA did not have any “cause” to believe that the complaints had any merit. After receiving the letter refusing the records, the OHLA withdrew all of the investigations. A sixth case against an Andaluz midwife was also dropped after Haber demanded a list of witnesses."
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Hello- I hope that someone at OPB will pass this along to Heather, who shared her birth story this morning.
Heather twice used the analogy of being treated like a "teen mommy who made an oopsy". The first time I cringed and thought, oh I hope she regrets that when she gets off the air, thinking that it must be tough to communicate well, off the cuff, as a radio guest for the first time. When she repeated this phrase a second time I became angry and took time away from my job to phone in, unsuccessfully.
As she seems to have integrated this as some kind of clever comparison, I would like her to know that it is vastly offensive and that she should consider that she will not necessarily know when she is talking to someone who had a child in her teen years. If I were at the pool with my 10 year old, for instance, you would not know that my older daughter is a sophmore at Reed who will be able to buy beer legally in 6 months
When the Reedie was born I made the informed decision to have a home birth after several months of hospital based prenatal care. I looked up a naturopath in the yellow pages, interviewed with her, and convinced my family and the father that it was a good idea. I went to childbirth classes like any responsible mother-to-be. I was never made to feel like I was incapable of making these choices or carrying them out until the second repeat of the phrase "teen mommy who made an oopsy" today.
I offer this with no hard feelings, only to keep Heather and others she talks to about her experience from awkward feelings in the future.
Thank you for the conversation. Go midwives!
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Go you!
I can understand both Heather's point and yours. I hope that she didn't mean that teen mom's should be treated with disrespect, but they often are. She felt that she was not being treated as the intelligent human that she was. Everyone deserves that regardless of their age!
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Edki,
I am truly sorry if that my comment caused upset for you! Yes, it was offensive. And in this society, when someone looks at a youthful face on a pregnant woman who is not wearing a ring, yes, we are often treated with disrespect.Even now, people look at my son and I ask if I'm babysitting when they see no ring. Or they ask how old he is, then how old I am. Or they ask if he has a daddy, etc. So, when I stated that I was treated in that fashion, that is precisely what I meant: I was treated with extreme disrespect.
From my ob/gyn showing up late to my appointments, to not remembering me or our previous discussions, to scheduling me while on-call, to throwing pills at me, to assuming that I did no research into my pregnancy options, to providing inadequate dumbed-down answers to my questions.I have a deep respect and admiration for any woman who educates herself and takes responsibility for herself and her family; and this particularly includes teen mothers. I wouldn't be here otherwise. :)
Heather Hermans
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Thanks for the reply Heather. I assumed that your comment was meant in the way you describe, but it was still hard to hear. Like I said, just wanted you to know how it could be hard on someone sensitive to the subject. Best of luck in the future.
Scarlettkatrin, thanks for the support!
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I gave birth to twins in December and I am so grateful that I had the right to choose midwife care over a traditional OB. When I discovered I was pregnant with twins, I started talking to numerous mothers of twins on discussion boards and the common factor I saw with all of them was the idea that two babies are too much to carry and that they will come early or be induced between 34-36 weeks. Over and over I saw babies with birth weights in the 3-4 pound range, spending weeks in the NICU and having difficulty with breathing, nursing, thriving etc. This caused great concern for me!
I went with Andaluz to have my twins because I wanted not only full-term babies, but someone that would work closely with me on preventative care. With an hour or more for each appointment and after hour contact information, I was able to keep them posted on any issues and we went through several issues throughout the pregnancy. I was anemic and was immediately given a couple forms of iron to take as well as a high iron diet. Problem under control. I was hit with a horrible flu, again my midwives were in my home caring for me and ensuring I became healthy again, and closely monitored the babies to be sure they were doing well. I work non-stop running my own businesses. During several weeks I didn't gain any weight, my midwives encouraged me to seek help, gave me numerous ideas for meal planning and snacking to gain weight and was kept under close supervision to ensure that not only I gained weight but the babies did too.
6 days before my due date I went into labor. Within 15 minutes, I realized I was not only in labor but delivery was imminent and no matter what I may have wanted for my birth, I was going to deliver at home. We called our midwives and they were all at my home within 15 minutes, just before pushing began. Having been prepared for a homebirth, I was lucky to have everything I needed and was also emotionally prepared for the location of the birth of my babies. Both came out within 10 minutes of each other. It was uncomplicated, I had very minimal bloodloss even with two placentas and the babies were nursing right away. My babies weighed 5 lbs 3 oz and 5 lbs 10 oz in comparison to my first child who weighed 6 lbs 3 oz, we were extremely pleased with their size and the fact that we carried them an extra day longer than my first child.
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I'm a new parent, and had my little girl in a homebirth one month ago with a wonderful midwife, and never felt at any time that my safety or the baby's safety was in jeopardy. The care offered to me was excellent, and I feel that having the same practitioner care for you during the pregnancy and birth was a huge advantage over a hospital birth, where there are doctors and nurses you may have never met before.
There is no reason that women should lose the right to have a midwife in her birth, and they are more than capable of caring for a woman with a VBAC or with twins.
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I agree! Thank you for posting! We need more home birth advocates to be vocal and let women know they don't have to suffer with the docs in the hospital. This is the United States- women should have the best care in ALL states, not just Oregon....
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I have attended mostly hospital births (as a doula). I have seen beautiful hospital births. I have worked with wonderful nurses, OB's, and CNM's in many of the hospitals in the Portland Metro area. A large number of my past clients have ended up having c-sections and unnecessary interventions. A significant number of my clients have been induced for low-risk situations. I have had clients who have sought a VBAC through hospitals with no success.
If hospitals offered more opportunities for vaginal deliveries with breeches, twins, and VBACS, I bet more people would go there. But the truth is the majority of hospital folk won't risk it due to liability. Health care shouldn't be fear based around liability. This is where mamas are thinking about what's best for themselves and their babies. Many interventions occur due to liability. Example: every baby who is born at the hospital receives Erythromycin in their eyes, fairly quickly after the birth. Erythromycin is used preventively to treat infection caused by Gonorrhea and Chlamydia.
I find it a rare that informed consent is fully given to my clients in hospital care. I think informed consent is one of the most important aspects of medical care in general. People need unbiased facts on risks, benefits, and alternatives on any type of health care they seek. They need to understand the information, do their own research, ask questions and take responsibility for their choices.
I fully support families giving birth where ever they choose. I appreciate that hospitals are there when needed. I value their knowledge and expertise in complex situations. I hope that CPM's, CNM's, and OB's together can find a way to support the well being of mamas and babies while also supporting a persons right to choose freely. Unfortunate outcomes happen in birth where ever it occurs. I'm proud to be serving women in out of hospital births and won't give up on educating and supporting people to take responsibility for their own health care choices.
Apprentice Midwife
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I agree with you wholeheartedly. For my first birth I was going with an OB in our local hospital here in Oregon, and in the 8th month I switched to a midwife and a home birth. I was told NO to all of my requests for a gentle birth without any drugs or eye drops given to the baby, and none given to me. I also asked my OB if he would "allow" food and water, pacing, a shower for pain, a birthing stool or ball....no, no, no. Then I asked if he would be the one delivering my baby, since I'd only seen him from the beginning of the pregnancy, and he said, "Well, it will be whatever doctor is on call when you go into labor." How sad. Not quality care at all! I even asked if a nurse could stay with me and coach me through the birth, and he said no, they are too busy. So I began to look for other options, and I found a wonderful doula who introduced me to a midwife who was very experienced, and my son was born at home, with no destructive interventions or drugs, a 5 hour labor, and a few minutes of pushing- turns out I was "allowed" to have everything my friends in the Netherlands get as a "basic right", and it was, in this instance, a complete reversal of the "more expensive is better" line of thinking. I thought my OB should have been given 4 thousand, and the midwife at my home birth 18 thousand.
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It's more than irritating to read some of these comments. Bad, dangerous, hospital; good, saintly midwives!
Heather did not have anything positive to say about OHSU, but these professionals, who did not have the luxury of knowing anything about her, saved her baby's life, and probably hers as well. Not enough warm fuzzies in a hospital? Maybe just having a healthy baby in your arms should be enough.
Kat
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I think you might be missing the point, Kat. All of us who enoy having the choice to have babies at home know that hospitals are VERY necessary. I have no illusions about fairy-dust making everything okay for every birth at home - that would be foolishness. Moms and babies would die without modern hospitals, physicians, and the ability to do safe C-sections.
The point is that institutional obstetrics, a system run by hospitals who need to make a profit and doctors trained to be surgeons, often isn't the most conducive environment for pregnant women who are low-risk and desire the chance to allow their bodies to do what they are designed to do. In order to make money, they system is often set up so that prenatal visits are short, waits are long, and women often feel like cattle being herded through the shoot with little ability to make individual choices about their care. The delivering physician (and sometimes CNM) in the hospital may be present for less than 30 minutes out of an entire labor and postpartum. This is simply vastly different from what is offered by midwives in an out-of-hospital setting.
There are clearly many, many women (a vast majority, in fact) who believe that they are getting their needs met with care from an obstetrician and delivery in a hospital, and that's fine. Heather has different expectations and needs - allow her and the others who have posted on this list the ability to make the choice to seek out the kind of care and type of provider who meets their needs as well as to express WHY they hold the preferences that they do.
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Healthy babies are number one it is certain. What OHSU did was designed to make it difficult for midwives to access higher risk care thereby threatening the health and safety of other babies. Shortsighted to be sure. Have your baby where you feel safest, but be sure to educate yourself as the Obstetricians at OHSU and elsewhere see themselves as a surgical specialty first, when most of the mothers they cut could have had both a vaginal delivery and a healthy baby.
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I like your comment gbr- thank you for the calm, thoughtful post on a topic where I tend to get pretty heated. :) I have been so grateful to have professional quality midwives deliver my two sons, and now my third out of the hospital! I feel horrible when I get phone calls from women in other states asking how they too can have the experience I had, and I have to tell them, I'm sorry, your state does not allow midwives like Oregon does. I wish every woman had the options for birth like I did.
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I had my daughter at Andaluz and would do it again in less than a heartbeat. Birthing is not a medical process unless there are complications. Then OB/GYNs are appropriate.
Andaluz fully informed me of the risks and what would happen if something did not go normally, I knew there was a chance we would have to transfer to a hospital, but I also wanted to give myself and my child a chance to have a normal, drug free entrance into the world in a very peaceful, homelike setting.
I highly suggest this documentary to anyone wanting to compare the differences between midwife assisted homebirth and hospital birth with statics and studies to back up as well as interviews by OB/GYNs and midwives http://www.thebusinessofbeingborn.com/ it is very informative.
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As someone who works in a hospital, I know there will always be people who will avoid a hospital/clinical setting at all costs, for anything from a vaccination to cancer treatment to labor & delivery. From everything that I have seen, the doctors/NPs/CNMs/RNs out there genuinely want happy and healthy parents and babies. Many practitioners would gladly allow women to attempt "riskier births" if the insurance companies would allow it AND if they believed that the parents were really willing to accept the risks. (Parents will often demand what makes sense to THEM, but when things go south, they expect the doctors to step in and work miracles.) And it's not just the health insurance companies that are dictating care, it's also the companies that provide malpractice/liability coverage to practitioners. Practitioners get frustrated when parents vehemently reject the prenatal care that they can provide, accusing them of not caring about women or babies, and then show up at the hospital in need of critical care because the home setting could not provide a safe delivery and healthy baby. And then they blame the "cold" and "uncaring" hospital and doctor for ruining their experience and talk about suing for damages, even though they now have a healthy baby. (No wonder malpractice premiums are mind-boggling high in this day and age.) As many posters here have said, there is common ground and a lot of good people ultimately want the same things. Doesn't every parent, when they look down at that perfect little face, want to know that they and their care providers did the best they could?
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I don't mean to be rude here, but honestly, I believe that the care providers don't do the best they can at hospitals, and midwives are being kicked out all over the country because they CAN provide a better birth, both at home, in a free-standing birth center, and in the hospital. Doctors and nurses are afraid to take a stand and tell the truth, and many times, they actually cause the problems parents ask them to prevent in their gentle birth plans. A "riskier" birth is being induced, lying flat on the back, many antibiotics and drugs pumped into an already stressed immune system, demanding pushing when the mother is clearly not there yet, denial of basics like water and food, and, to add insult to injury, no nurses and doctors STAYING in the room with the laboring mother....all this for thousands more dollars than a midwife charges to actually stay by your side and coach you through a wonderful, life-changing experience in a gentle way.
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I've had three births. The first two were in a planned hospital setting with an OBGYN. The third in a birth center with midwives.
My first daughter broke her collar bone when coming out of the birth canal, due to lead pushing rather than letting me push when I was ready. No one at the hospital caught that my daughter's collar bone was broken, and it wasn't discovered until her two week check up.
My second daughter was induced and consequently had dropped blood pressure. Lucky I have very quick labors and I didn't need a c-section.
Out of fear that my first two birth experiences might be repeated, and my third child hurt in the hospital, I chose to birth at a birthing center. My third birth was at Alma Midwifery. It was a most enjoyable, and least traumatic for the baby, of all my births. I also had less healing to do.
The interventions that result from a hospital setting caused damage to my daughters that could have been avoided if I was allowed to birth naturally as I did with my third daughter.
The concept that woman choose to have out of hospital births for "selfish" reasons is absurd. It's an absolute oxymoron.
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Northwest Passages: Crystal Williams. Poet Crystal Williams on race and relationships. ... Northwest Passages: Cynthia Rylant and Nikki McClure ...Naruto Shippuden
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They SHOULD sue. I'm so tired of doctors and hospitals trying to take away women's rights. If women have the right to abort a baby, they should have the right to give birth in a SAFE environment- far from the hospital rules and procedures that have made the United States 41 out of 41 countries in terms of safety for the mother and baby during childbirth. That means 40 other countries are better able to keep us both alive during a very dangerous time. I think if we had more midwives and freestanding birth centers in this country we could take those dismal numbers up, and probably join the top 10 nations. OBGYNs are clearly not able to provide quality gentle births.
My first was a home birth, my second was with the same midwife at their newly built birth center, and my third, due in November, will be with the same midwife at the same place! I am so happy to be able to have peaceful, wonderful births....at our hospital I would have been subject to the no food/no water rules, the mandatory hep-lock, the no water births, use of showers, or births on a stool, the bright lights, the obtrusive nurses and beeping machines, and in general, a lack of calm, professional care. I believe these midwives in Oregon are FAR more qualified and knowledgeable than the doctors, and OBGYNs are afraid of them for that- harassment is the correct word, as they are trying to take away our rights to have a beautiful birth.
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I think the part of the midwifery discussion that was missed largely (with the exception of Jennifer's comment on cesarean risks to moms) was the risk of hospital birth, even with more complicated pregnancies. Babies are at greater risk for infection due to hospital exposure, some infections which are resistant to treatment and can cause brain/body damage and death to baby (and mom!). They are also susceptible to injury during cesarean or vaginal delivery, and a whole slew of medical interventions which can potentially damage babies like augmentation of labor with pitocin which squeezes the baby harder than a normal contraction would, increases risk for uterine rupture in both VBAC and moms with no previous cesarean. They practice breaking of water, which is routine in hospitals, and extremely dangerous to the baby. It may be the leading cause of emergency cesarean in the hospital. Also the use of delivery instruments like vaccumes and foreceps can pose huge risks to babies of brain and body damage, or even death.
Also the doubled risk of maternal death in a cesarean versus a vaginal delivery seems to directly correlate to a risk to the baby, which is starting it's life without it's mother. I don't agree that a selfish mother protects her life along with her baby's during a delivery.
Also I know that hospital protocol is to be able to get a mother from emergent situation to operating table in 20 minutes from WITHIN the hospital. If a hospital is notified of an incoming emergency transport, it is highly possible to get a mom from home to the operating table within 20-25 minutes from as far away as 15 minutes by car when she is riding in an ambulance AND the hospital believes the midwife and starts prepping the operating room. If the hospital is dismissive and biased, they have the potential of slowing down the emergent treatment and are adding to the risk to the baby and the mother.
We are not weighing the risks and benefits of a dangerous home birth versus a safe cesarean for these moms, we are weighing risks and benefits of each possible way of giving birth, all of which carry very real risks. Mom's do have the right to decide which they think will provide the best outcome for themselves AND their baby, given the risks and benefits of each possible cenario.
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It's funny you should mention this as I had one footling breech c-section and one frank breech at home. I just recently recalled that they nicked his butt during deliver with my 1st. He's had 2 infections of MRSA. Now I also work at a hospital so I could certainly bring it home but at least one for sure was a spontaneous blister with NO open wound. The other one may have been too but it was on his foot and he is barefoot frequently. Who knows. It's worth thinking out. There are yucky bugs in the hospital.
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In an earlier post, a CNM cited some statistics that I would like to address. Comparing .3 per 1000 neonatal loss rate (Netherland stats) to 5 in 600 intrapartum loss rate is comparing apples to oranges. Fetal intrapartum loss (babies alive going into labor that do not survive labor) does not equal neonatal loss rate.
Neonatal mortality refers to the death of a live-born baby, specifically from birth through the first 28 days.
Fetal deaths are those that occur after 20 wks gestation in which the fetus dies in utero or upon delivery, never taking a breath. They are classified as "early" (20-27 wks gestation) or "late" (28+ wks gestation). Fetal deaths include stillbirths of babies that die in utero before labor or before the birth, as well as babies that go into labor alive, but die during labor. Fetal death can also be divided into death prior to labor, antenatal (antepartum) death, and death during labor, intranatal (intrapartum) death.
US National average neonatal deaths is 4.5 per 1,000 births. US national average fetal death rates are 7.3 per 1,000 births. These are the latest I was able to find, but if you have more current ones or a better source for US national statistics, I'd love to have them.
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Also, can you share where you got your statistics for Oregon out of hospital births for 2010? Did this include anomalies? I happen to know that in at least one of the baby deaths in the out of hospital community the baby had anomalies where he/she would not have survived no matter where born. Also, any 2010 statistics/data you have is anectodal, and not scientifically valid, as 2008 Oregon vital statistics records haven't even been released yet and won't be for several more months; 2007 is the latest date for which perinatal outcomes have been published.
I am also wondering if your midwifery group counts in your statistics baby's that you transfer out of your care in labor. For example, if something in the labor happens that makes the mom higher risk and you transfer her to the care of the physicians, but her baby dies, do you count this in your statistics for neonatal or fetal deaths? I ask because out of hospital midwives do.
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I had two VBACs with wonderful midwives in Portland. The whole experience was wonderful and I can never praise them enough for the wonderful way my family and I were treated by the entire staff there. I was never made to feel like a burden, unlike my first birth at a hospital in Oregon or my misciarrage at a hospital in Idaho. I like to be able to birth with people I have known my entire pregnacy or in the case of my second VBAC I had known many of them since my first VBAC.
Woman should have the right to get informed of their choices the pros and cons of any decision they make and then make that decision for themselves and their families.
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Comments are now closed.
I'm so glad that you are talking about this. Birth outside of a hospital is not nearly as dangerous as people think. By all good-quality studies, out-of-hospital birth is as safe as in-hospital birth with the added benefit of fewer cesareans and other risky interventions. Even twins and breech babies can be birthed safely as long as the practitioner has the skills for these special situations. Truly, there is no risk-free way to give birth. There will always be some risks. Women and their families need to be given unbiased information about the risks and benefits of all their options and they should be able to choose for themselves how to give birth.