Tension between doctors and homebirth midwives

This isn't news to anyone, but when a planned homebirth turns into a hospital transfer, there can be tension, if not conflict, between the midwife (passing over her client) and the doctor (taking the client on).

What's interesting about this article is how frankly and objectively it is being addressed in a community in Oregon.

What started out as a research project about higher than expected prematurity and low birth weight rates revealed a "deep mistrust" between doctors and midwives. The Oregon State researcher, who also happens to be a practicing midwife, has found a local obstetrician willing to work with her to draft guidelines for midwives and doctors who find themselves suddenly working together.

The main purpose is, of course, not a perfect medical world where doctors are respectful of all homebirth practitioners, but a world where *some* are willing to work together, so there is data to support the fact that homebirth is safe, and that smooth hospital transfers are crucial.

Good for them, I say.

Birth regulations in Australia

In Homebirths May Have to Be Secret, the possible effects of proposed laws about practicing midwifery are discussed. My understanding (and I may be totally wrong) is that medicine in Australia loosely resembles the UK's socialized system. The proposed changes to midwives include requiring them to carry "professional indemnity" insurance. Is that the same as "liability" or "malpractice?" The thing is, no insurance carrier is prepared to offer such insurance to midwives, making them ineligible to practice legally.

Many people, including parents, midwives and some obstetricians, are calling for change that would leave homebirth legal, if not improve the situation.

The way it stands now, midwives are legal, but don't get reimbursement for their services, so parents pay out of pocket, whereas hospital birth is covered by the government insurance.

One mother, who is pregnant and planning a homebirth, put it this way: "It's ridiculous to effectively make homebirth illegal, when other countries like Britain have publicly funded homebirth programs," Ms McLean said.

Indeed it is.

Talk about VBAC

I've been AWOL for a while, sorry! But all this talk about VBAC got my attention. Have you heard about the Time magazine article on repeat cesareans? The author, Pamela Paul, posted an essay on the Huffington Post the day after her Time article was published, to tell us some of the back story. They are both great discussions of the difficulty finding a doctor and hospital that will genuinely support a mother's choice for VBAC. Go, read them!

Also of interest is the ICAN hospital survey. Volunteers called virtually every hospital in the US to find out which ones allow VBACs, which ones ban them, and which ones say they allow, but no doctors will attend them ("de facto ban"). Logan Regional Hospital is listed as having a de facto ban, but there are at least 6 hospitals along the Wasatch front that allow VBACs.

I found of particular interest one of the comments left at the Huffington Post story, calling the right to VBAC a civil rights issue. Interesting point of view. Is it really about safety or money or are those handy excuses to deny a human right?

Thanks to Rixa for keeping current on all these things!

~s~

New Yorker article on breast milk

Unique and interesting take on the history and politics of wet-nursing and pumping breastmilk. Lengthy, but informative. The article asserts (I think) that breast is good, but *at* breast is best.

I've often thought that formula isn't necessarily a bad thing. It can be mighty helpful, and even on occasion, life-saving. But things are such that formula is way over-used, completely beyond its helpfulness. The author speaks of non-breast-feeding of mother's milk the same way.

And just to be crystal clear - I respect every individual mother's choices: formula, breast or both; pump and bottle! Formula is inferior to breastmilk, yet helpful on occasion. Could it be argued that pumping is helpful on occasion, yet inferior to mother-baby togetherness?

My favorite line: When did “women’s rights” turn into “the right to work”?

Are them fight'n words for any of you? :)

Read the whole thing here.

~s~

p.s. still polishing that essay

Finances and Birth-place Decisions

The Salt Lake Trib recently had an article on homebirth. Hooray! An actual positive article where the option of homebirth wasn't "balanced" with some statistic-less scare quote by a UMA authority.

The main gist of the article was that finances is a major consideration in the birth-place decision. The article interviewed three couples: 2 who planned and achieved homebirths, and one who planned a birth-center birth and ended up having a cesarean. All three considered the cost of hospital birth while making their decisions.

If you are so inclined, you might drop the author and/or editor a line expressing appreciation for publishing an article on homebirth that wasn't sensationalized, and portrayed homebirth as a rational decision.

~s~

"High-risk" homebirth in England

This is just another short story that illustrates how different the "official" line about homebirth is in the UK. This woman had a c-section her first birth, and planned to have a homebirth the second time around. That's not so shocking - that happens in the US, too. What's interesting is that they used the same health care system both times around. When she went into labor with her planned homebirth, she "called the labour ward," and a midwife came 'round.

In the mother's words:

"All it needed was time, good support, a relaxed environment and a lot of maternal effort! I've experienced both ends of the scales. Last time I made a complaint about my midwife, this time I couldn't praise them enough. Good supportive midwives are the key to a good birthing outcome."

Wow.

~s~

Giving Birth to Peace in the Middle East

I have read several articles about birth from Israel, and maybe it's coincidence, but there's a simple respect, almost reverence, that comes through. This story is about a group of Israeli and Palestinian midwives who have been meeting to share information and support each other in the role of "wise woman."

Says Sera Bonds, the midwife who started this group, "We managed to avoid politics in the beginning, as we felt it was more important to get to know each other as midwives, as women, as wives, and as mothers. The two days were full of laughter, learning, and open hearts as these women boldly demonstrated through their participation their commitment to partnership, peace and professional development. It was an honor to bear witness to the trust and humility expressed during the meeting."

I like this thought best: "By working towards non-violent birth," said another participant, "we are working to create a non-violent world."

~s~

Birth Summit

Connie, of the Childbirth Today from Birthsource blog, asked herself a month ago, "What if all of the leaders of childbirth organizations came together for a summit meeting to talk about the state of birth in the US?" Well, I get the impression she is involved (bless her heart), but it's going to happen. In Chicago on November 8, "Nurses, physicians, midwives, childbirth educators, doulas and lactation consultants will be meeting ... to set the evidence-based record straight regarding midwifery care and childbirth in hospital settings in the US." (link) BirthSource and Birth Facts appear to be associated with this event. I'll try to keep you posted!

Motherbaby International Film Festival

So there's a traveling film festival, which features many short films (7-30 minutes) and several feature-length, including Orgasmic Birth. You can read a list of descriptions here. (I had trouble with the site being slow, so give it another chance if it doesn't come right up.)

I'd love to see a few of them, like "Luna:" This luscious birth video is narrative free. It is set to an amazing and beautiful blues rendition of “Silent Night.” In playful hours before the birth, the camera chases Luna’s toddling sister, Sol, through the house and into the bathtub. When Luna arrives, amniotic fluid and bag still intact, we feel refreshed, invigorated, playful and so glad that all of this was ‘captured’ on film.

Or "A Cow Trough???:" A cow trough is turned into a sumptuous birthing spa with the creative genius of a mother and her toddler. Set to music and humorously edited by Matt and Frank Ferrel, you will never look at a cow trough in the same way again.


I first learned of the MBIFF because it is going on the same weekend as the MANA Midwives Alliance conference.

~s~

"Birthing From Within" class in Wyoming

So, just over the mountains (OK, a few mountains), in Cody, WY, a gal is teaching childbirth classes from Birthing From Within. These classes are different in that they have you address your fears, thus paving the way for confidence. You can read reviews for the book here. Wouldn't this be great for our area? Do you think they'd be popular?

~s~

CNM who does homebirths

I found this news story interesting because it's not just another superficial, short piece about homebirth (OK, it's a little superficial), but it's about a Certified Nurse Midwife who not only chose to leave the hospital environment to do homebirths, but that she's allowed to. Not many states allow CNMs to attend homebirths. Read about Angelina Nixon here.

Homebirth in the news

On a whim, I did a google news search on homebirth. Of course, most of it was a result of the AMA's recent resolution regarding place of birth, and Riki Lake's film The Business of Being Born. Overall, though, the tone of each news story was fair and positive. How nice is that?

South Dakota has had a new law that allows certified nurse midwives (CNMs) to attend home births. I'm not sure what the ramifications are to that, whether other professional or unlicensed midwives have the right to attend homebirths or not.

On a news-gathering website called Finding Dulcinea there is a page on recent news and opinions on the AMA and homebirth.

I was pleasantly surprised to see a short column on the Mayo Clinic's site by a CNM that advocates a parent's right to choose birth place and attendant.

There were also stories about homebirth in Arkansas and North Carolina.

My favorite line from the whole batch:

“Babies should be born where they are conceived,” said Prentice, who has delivered more than a 2,000 babies.

~S~

The Herald Journal has graciously given permission to post the article on homebirth here. We are waiting word on whether we can post the photographs.

Stay at home birth

By Jen Beasley

Published:

Tuesday, October 30, 2007 1:39 AM CDT

A time-tested method of childbirth is again gaining popularity

At the Frome residence west of Smithfield, there are four small children who know exactly where babies come from.

Babies come from the living room. Via their mother, Beate.

Beate Frome has given birth to all of her children in her own house with the help of a midwife and without the help of drugs. All of her children ages 3 to 8 have experienced the birth of their siblings save the youngest, who will get the chance any day now, as Frome’s fifth child is currently due any time.

Frome reads a book to her children nightly about home birth to help prepare them for the experience, and said participating in the birth of their siblings has helped her adjust to new arrivals.

“They’ve never been jealous,” Frome said. “I believe it’s because it’s not like I’m going to a department store and bringing a baby back. You know, they don’t know where the baby comes from when you go to the hospital. This way they can see it’s a lot of work to bring the baby here.”

Frome is just one of a number of Cache Valley women who have chosen to do the work of labor and childbirth at home. At a recent home birth workshop held by the Association for Wise Childbearing, an organization that encourages choice and education about a wide range of pregnancy and childbirth topics, women who had previously birthed a baby at home or wanted to, as well as some fathers, gathered to learn more and share their stories.

Chris Miller, Frome’s midwife, said it is common for families that choose home birth to do so after attending such workshops, because as they become educated they discover that home birth is as safe or safer than hospital birth in low-risk pregnancies.

A study of planned home births in North America published in 2000 in the British Medical Journal concluded that planned home births with certified professional midwives in the United States had “similar rates of intrapartum and neonatal mortality to those of low risk hospital births,” and rates of medical intervention, such as epidural, episiotomy, forceps, vacuum extraction and Caesarian sections for planned home births were lower than for low risk hospital births.

Frome said she has always felt safe in her at-home labors, and has benefited from the more personal relationship she has with Miller than she would have with a doctor, who would not have as much time to spend on pre-natal care.

“We’ve gotten to know each other, and I think she can sense if there’s something wrong,” Frome said.

Frome said when Miller comes to a birth, she brings so much equipment — oxygen, emergency kits, etc. — “it looks like she’s moving in.” But all of her home births have gone smoothly, and the emergency equipment has gone unused in the Frome house.

Miller said it’s no surprise that Frome’s, or any other home births have gone smoothly. With 35 years of experience, Miller said she can still count on her fingers the number of times something has gone wrong in a birth. In such cases, a woman can be transferred to the hospital, but Miller said it is rare.

“It’s a work that a woman was made to do, and usually she does it beautifully,” Miller said.

Frome is from Germany, and said in Europe home birth is considered normal and often covered by insurance. Miller said in America only some insurance companies cover the cost of a midwife for home birth, but said paying out-of-pocket for a midwife is still relatively inexpensive, about $2,000 for everything from pre-natal care visits to the birth itself, as well as all equipment and post-partum care. Miller said many midwives will allow payment plans, and often clients choose home birth because they don’t have insurance.

For Kim Borchert, it was doctors’ insurance, and not her own, that led her into the realm of home birth. Borchert had her first child by Caesarian section, which effectively meant that she would be forced to have all the rest the same way, as malpractice rates have discouraged most doctors from performing VBAC, or vaginal birth after Caesarian. Borchert said she had looked into having her second child at a birth center in Salt Lake City, but when they wouldn’t do VBAC either, “I was either a Caesarian section or home birth.”

Borchert said her sister had a baby at home, and that’s what she decided to do as well.

“It was the most amazing experience ever. And I had a 9 pound, 3 ounce baby,” Borchert said. “I think that a lot of people think it’s really dangerous, and I think that a lot of people think that hippies do it without a lot of thought for their children. There’s a lot of misconceptions about home birth.”

Borchert said one of the best benefits of home birth is the birth high that comes afterwards when adrenaline and endorphins take over, instead of the grog of anesthesia. Borchert has birthed naturally as well as under anesthesia when she had her Caesarian section, and said natural is the way to go.

“You’re just going a mile a minute and you’re so excited and you’re wide awake and it doesn’t matter if it’s the middle of the night. It’s just a rush,” Borchert said.

As for the pain, Frome said it’s all about attitude.

“I picture it as surfing, you’re sitting on top of the waves. And as soon as you start to complain you start to go under.”

Frome’s husband Kurt said because he’s never seen his wife give birth any other way, he’s relatively comfortable with home birth and has gained added respect for his wife in the process.

“I think it’s amazing to watch what she does. I can see her inner strength when she does it, and that’s the amazing thing,” he said.

Kurt Frome has also had the opportunity to catch the babies when they’re born, an experience he calls a “highlight.”

“That’s one of the things I love about home birth,” Beate Frome said. “He’s totally involved from the beginning to the end.”

Borchert said she would recommend home birth to anybody.

“You have to trust your body and trust your midwife and know that you can do it,” Borchert said. She said she also recommends that women explore all the alternatives and seek out information about options for childbirth.

“Become educated about all your options, because there’s a lot of different options out there for childbirth that I don’t think most women know about.”

————

The next meeting of the Association for Wise Childbearing will be held Nov. 6 from 6 to 7 p.m. at the Whittier Community Center, 290 N. 400 E. The AWC seeks to support and educate parents through a wide range of pregnancy, childbirth, post-partum and baby nurturing workshops. For more information, email wisechildbearing@yahoo.com or call Director Jennetta Billhimer at (435)563-8484.

Great Publicity for Homebirth

AWC invited the local newspaper to our meeting on homebirth with a midwife, and the paper wrote a terrific article. Read it here.