Home Made: Inside Baltimore's Home-Birth Underground

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Home Made
Inside Baltimore's Home-Birth Underground

Michelle Gienow

By Michelle Gienow | Posted 6/25/2008

Like any 8-day-old baby, Jimmy Gaffney spends most of his time either nursing or sleeping. Peacefully alternating between the two while cradled in his mother's arms in the family's sun-dappled Hamilton backyard, the robust newborn looks like a promotional photograph for parenthood. And yet, so far as the state and city of his birth are concerned, this baby does not officially exist.

He was born at home, in May, with only his mother and father, Alana and Matt Gaffney, in attendance (his two excited siblings, who had slept through most of the five-hour labor that culminated in his 4 a.m. birth, came in just as their father was placing the freshly born baby on his mother's chest). The family is in no rush to notify the authorities about Jimmy's birth; they have been taking it easy for the past week, sticking close to home and bonding with the new addition while Alana recovers. A call to register his birth with the Baltimore City Health Department will summon a visit from a home nurse, and the Gaffneys are not quite ready for outsiders, particularly bureaucrats asking a lot of questions about a process they regard as utterly natural--and completely private.

Although they have health insurance that would have paid for a hospital delivery, Alana and Matt managed Jimmy's birth entirely on their own; Alana even administered her own prenatal care. Neither is a doctor; she is trained as a nurse and Matt is a wildlife biologist, so there is a certain amount of medical/scientific experience between them, but it's hardly the job experience most people look for when hiring a birth attendant. In fact, 99 percent of women in the United States give birth in a hospital; the remaining one percent of births include all births outside the hospital, including accidental births (as in, say, the back seat of a taxi).

Thus it is impossible to say how many of the nation's annual 4 million births take place at home. Not all states track births outside of hospitals, and those that do typically classify intentional home births together with the kind attended by taxi drivers. Furthermore, in Maryland and other states where certified professional midwives cannot legally practice, many midwife-attended births end up being recorded as unassisted to keep the midwife off the bureaucratic radar.

Disenchanted with a medical system that treats birth as an emergency instead of an emergence, seeking an alternative to the tubes and wires and monitors of a high-tech birth, some women are stepping outside of the hospital to have their babies. And some say their numbers are growing.

But is home birth safe? No studies exist for unattended births like Jimmy Gaffney's, but there are dozens demonstrating that, in low-risk pregnancies, home births attended by a midwife are as safe for mother and baby as going to the hospital. The largest and most scientifically rigorous home-birth study to date, sponsored by the Canadian government, followed all 5,418 planned home births across the United States and Canada attended by Certified Practical Midwives in 2000. The authors concluded that babies are born as safely at home as they are in the hospital, and with vastly fewer interventions like cesarean section, the use of forceps, or episiotomy; other recent studies, including a 1995 study of 11,788 intentional home births under midwife care published in the Journal of Nurse Midwifery, have reached the same conclusion.

Despite evidence that it is safe, "I think some people shy away from home birth because of the responsibility," Alana Gaffney says. "If you're at home, attended or unattended, and something happens to the baby, it's your fault for not seeking appropriate medical care. But if you go to the hospital and something happens, you're guilt free. No one is going to say anything to you--it's just one of those things that happens."

The Gaffneys' decision to have an unassisted birth was not made lightly. The births of their first two children, Joseph, now 10, and Keira, now 3, took place in medical facilities; Joseph was born in a hospital, Keira in a birth center. "We are pretty mainstream," Alana says. "We own our home. We drive a minivan." But when she became pregnant with Jimmy, Alana knew she wanted to do things differently.

"The first two times there were a few issues with both my care and the baby's care," she says wryly. While in labor with Joseph, Alana says she was given pitocin (a synthetic hormone that speeds up contractions) without her knowledge or permission, and another drug caused her to hallucinate. During Keira's birth at a now-defunct birth center, each time Alana's labor plan diverged from birth-center policy the staff threatened to transfer her to the hospital for a cesarean section; even worse, immediately after Keira was born, they took action that potentially endangered the neonate. There was meconium stain--feces passed by the baby in utero, which happens in approximately 13 percent of births--when Keira was born, and, as Alana explains, "studies show that if the baby is alert and crying, suctioning in the presence of meconium will do more damage than good--it can cause pneumonia. I repeatedly told them not to do it, and even gave them the reference number of the article, but they just did it anyway. It was maddening."

So for Jimmy's birth the Gaffneys sought a setting where no one would be threatening them, giving medication without consent, or performing potentially harmful treatment on the baby: their own home. In deciding to do it themselves, they skipped right over the usual alternative to a hospital delivery: birth at home under the care of a midwife.

"We did initially consider using a midwife," Alana explains during a visit shortly before Jimmy's birth. "But if we were looking for something that was truly intervention-free, and we knew what we wanted and we knew how to do it, then we finally decided we should do it ourselves" A daunting proposition to some, perhaps, but not to Alana, who has attended births as a nurse. "I don't have any apprehension about the birth, or about labor," she says. "In 95 percent of births there is no special equipment but two hands to catch the baby. While there are things that could happen, it doesn't take a rocket scientist to deal with those things."

It's a decision that mystifies Evelyn Muhlhan, who has worked as a Certified Nurse Midwife for 22 years. "If you want to be left alone while you labor, that's fine, but have an attendant in the next room," she says. "For the most part, birth is normal and very few women will have problems, but when a problem does arise are you going to be equipped to handle that?"

A veteran of a recent unintentional unassisted birth, Brigitte Jacobson wishes that Muhlhan could have been in the same room when her son Noah was born in September 2007. Jacobson's plan for the home birth of her second child definitely included the presence of her midwife, but labor progressed more quickly than anticipated, and Brigitte began pushing Noah out before Muhlhan could get there. Although everything ended well, Noah's shoulder got stuck, and Jacobson, along with husband Mike and doula Bobbie Humphrey, spent a terrifying couple of minutes trying to dislodge the baby before he suffered oxygen deprivation. Noah's birth was one of the 5 percent where complications arise, but Jacobson is confident that her animal instincts saved the day: Although her helpers urged her to remain on her back, she says, "I just felt the overwhelming urge to stand up--when I finally did, he just fell out of me. Bobbie actually dove down and caught him!"

Despite the drama of Noah's birth, Jacobson says she has never regretted her decision to birth at home: "If I had encountered the same shoulder dystocia at the hospital, I may have ended up with an injured baby or a C-section."

The American College of Obstetricians and Gynecologists (ACOG) strongly opposes home birth--at its annual conference in 2006, the organization gave out bumper stickers reading home deliveries are for pizza. The official ACOG statement on home birth says in part, "Unless a woman is in a hospital . . . with physicians ready to intervene quickly if necessary, she puts herself and her baby's health and life at unnecessary risk."

Unlike the majority of his ACOG colleagues, Dr. Robert Atlas, chief of obstetrics and gynecology at Mercy Medical Center in downtown Baltimore, is not against home birth per se. "I think in the correct patient demographic, home birth is an acceptable alternative," he says. However, he explains, "the problem most obstetricians have with home birth is that [at the point] when we get involved, nothing is good, things have gone awry, so we have a bad taste in our mouths because of being placed in that situation."

On the other hand Dr. Victor Khouzami, chairman of obstetrics at the Greater Baltimore Medical Center in Towson, agrees wholeheartedly with ACOG's anti-home birth stance. And, although he confirms Alana Gaffney's contention that the incidence of complications in a normal, low-risk pregnancy is 5 percent or less, he looks at this statistic from the diametrically opposite view. "The incidence is low, yes, but the severity--the `what if'--well, in medicine we do a lot of testing to find that one in a thousand," Khouzami says. "And I don't think that anyone is willing to be that one in a thousand. It's fair to say that anyone doing a home birth is taking at least a 1-in-1,000 risk."

Advocates for home birth, however, argue that in always looking for that one in 1,000, that 1/10th of 1 percent, has resulted in hospitals treating every birth, even in low-risk mothers, as a potential emergency. Instead of trusting the human body to bring forth babies as they have for millennia, requiring mainly time and a supportive atmosphere, risk management has transformed birth into a heavily medicalized event where the laboring woman, bristling with IV tubes and multiple probes and monitors, must remain on her back in a hospital bed--which may be the worst possible position for effectively pushing out a baby.

Well, yes, says Khouzami. "If you are here long enough, we are going to do something to you. It's a matter of time. I will be the first one to admit that," he says. "The trade-off is that I am going to make sure that nothing happens to you or to the baby.

"So which risk do you want? You can't have it both ways."

Khouzami oversees Maryland's most prolific labor and delivery hospital ward: GBMC physicians and staff delivered nearly 5,000 babies in 2007. Almost half--42 percent--of those babies arrived via surgery.

The cesarean section is unquestionably one of modern medicine's greatest achievements. Still, it is major surgery and carries risks that for the mother include death, hemorrhage, infection, organ damage, uterine rupture, and threats to future fertility. Nor are babies necessarily better off: Studies show that the risk of post-cesarean infant death rate is double that of babies delivered vaginally. Long-term side effects include substantially elevated rates of asthma and severe food allergies in cesarean babies. (Researchers are beginning to understand that the cruise down the birth canal serves a biological purpose, squeezing amniotic fluid from the baby's lungs to facilitate breathing, and colonizing the baby's digestive tract with healthy bacteria that help protect against future food allergies.) Other neonatal risks include, according to ACOG's own research on cesareans performed in low-risk pregnancies, "increased fetal hemorrhage, asphyxia, birth trauma, electrolyte abnormalities, and use of mechanical ventilation, suggesting that high cesarean delivery rates themselves are not protective."

Overall, Maryland hospitals had an average C-section rate of 32.2 percent in 2006; nationwide the same-year average was 31.1 percent. In plain terms this means one in three of babies in our state is now born via surgery. (According to Atlas, Mercy's 2007 overall cesarean rate is 30 percent, though the cesarean rate for deliveries by its staff midwives is "5 to 10 percent at most.")

Both Maryland and U.S. cesarean rates are double the World Health Organization's recommended proportion (for developed countries) of 15 cesareans per 100 births. Beyond that number, a 2005 WHO survey reports, "the maternal injury and death consequent to major abdominal surgery begins to eclipse the lives and health saved."

There are, of course, births where a cesarean is medically necessary, and even the most ardent birth activist readily admits that properly administered C-sections have saved the lives of countless women and their babies. What is startling, however, is the rapidly increasing number of cesarean deliveries in the United States experienced by low-risk pregnant women who have uncomplicated labors. According to the National Center for Health Statistics, "Twenty-four percent of first births to low-risk women in 2003 were cesarean births, an increase of one-third since 1996."

"There's always a reason to cut," says Barbara Stratton, a former doula who now leads the Baltimore chapter of the International Cesarian Awareness Network ( ICAN). "Your labor's too early, your labor's too late. Your baby's too little, your baby's too big, you're too little, you're too big. You have too little amniotic fluid or you have too much amniotic fluid. They come up with reasons sometimes verging on the bizarre about why they have to section." And many women, she says, are not properly notified of the risks to their health, fertility, or life.

Mercy's Atlas says that obstetricians are in a tough position. "What we're held to now is the expectation that every patient who delivers a baby should have a perfect baby," he says. "Cesarean rates keep rising because obstetricians can't practice in a safe environment legally." Fetal monitoring during labor produces a paper trail and, Atlas explains, "any time you have a bad outcome you then go back and say, `It was here, this drop in the heart rate right here that caused the baby to suffer.' So most likely any time there's an abnormal fetal heart rate tracing they're going to do a cesarean section." In other words, when doctors perform a cesarean it is seen as doing everything they can--they get sued for the C-section they don't do.

Escalating cesarean rates have grabbed headlines in recent years, but one trend behind the trend--a corresponding jump in the artificial induction of labor--has garnered less attention. Induction occurs when, rather than waiting for labor to start on its own, medical personnel jump-start things by administering pitocin, a synthetic version of oxytocin, the "birth hormone" secreted by the body during naturally occurring labor. The Centers for Disease Control and Prevention report that in 2005 the rate of induction of labor was 22.3 percent, a number that has more than doubled since 1990.

"I can't tell you how many times people asked me during this pregnancy, `So when are you getting induced?'" Alana Gaffney says. "One woman even told me, `The last two weeks don't count.' Inductions and interventions have totally just become how we, as a society, picture giving birth."

"Don't. Be. Induced," Mercy's Atlas says emphatically. "Inductions themselves increase the rate of cesarean twofold."

Beyond creating contractions in an otherwise nonlaboring woman, pitocin is also used to speed up existing labor that is not progressing quickly. That goes against everything one Baltimore midwife believes in.

"Some women just take a long time to have their babies," says "Denise," a midwife who has practiced locally for years and who asked that her real name not be used to protect her from possible arrest. "Birth is a normal bodily process. It's not a medical event. When you treat it like one you're creating problems. Lots of times what I see with hospital births is them tinkering around the edges, cranking up this thing and that thing, to move everything along according to their outline of how a birth is supposed to go.

"They tweak the labor until there is a problem, and then they `rescue' the woman from that and say, `Aren't you glad you were here?'" Denise contends. "It happens all the time. And the woman feels sure that something terrible would have happened if they hadn't had their baby in that hospital. But the truth is if she hadn't gone, none of those problems would have arisen."

Nichole Kirby could be a poster child for the process of one intervention leading to a series of interventions resulting in an unwanted cesarean. The March 2006 birth of her first baby, Alana, at a local hospital, was artificially induced and turned into a grueling 30-hour marathon of suffering and fear. "I got the epidural and all progress stopped," she recalls. "I had at least eight or nine internal exams. I had doctors coming in in pairs of two to do exams. They didn't really talk to me or even introduce themselves. It felt incredibly violating--there were at least 15 different people in that 30-hour period poking around my genitals, and that's not cool."

Although the baby was not in distress, Kirby says, "They did the C-section as a policy decision--it was 24 hours after my water had broken. It was so traumatizing, I was crying and begging them not to give me a C-section. They just started tying me down to the table--I had no idea that it's part of surgery. I was terrified, and they didn't explain anything. I was hyperventilating and shaking so much they thought I was having a seizure." The surgery proceeded, and Alana was quickly born.

"I heard her crying and asked if I could see my baby, and they said I couldn't see her. So I tried to ask how she was doing, what color eyes does she have, what color hair, and nobody would even answer me. They were just busy doing what they were doing to my body, but it's like I wasn't there. I was so exhausted after 30 hours of not sleeping or eating and then the surgery that I just passed out and woke up half an hour later when they were done with my stitches." It was another hour before Kirby got to hold her baby, she says, "because even after I got to the recovery room I was shaking so badly from the epidural I couldn't control my muscles."

Ultimately, Kirby says, "It was a really, really horrible experience, but it's the standard way things are done, and what a lot of women are told is that this is what you have to go through to have a baby, and you just have to suck it up for the baby's sake."

Perhaps it is not a surprise that when Kirby became pregnant for the second time she was reluctant to return to a hospital. Initially, she says, she wanted a midwife-assisted home birth but was told "because of the [previous] cesarean, no nurse-midwife would deliver me at home." Ultimately, Kirby saw no other option except to do it herself: "I had a friend who was studying to be a midwife one day, and she had an unassisted birth herself, so I had her come and keep me company. I did a lot of reading and research to learn about possible complications, how to handle it if something went wrong."

But this time, in September 2007, at home instead of the hospital, everything went smoothly. "I had a 14-hour labor at home," she says. "I could move around, eat and drink. Lying in the tub with a hot towel over my stomach took away a good portion of the pain." Kirby's baby boy Robbie arrived without incident and, she says, this time the experience was exhilarating: "I wanted to do it again, right away!"

Is there any scenario where women can have it both ways--freedom to labor and birth in their own time and their own way, yet do so within the medical safety net?

"There are a lot of people who believe that all you need are midwives and high-risk obstetricians," Mercy's Atlas says. "The reality is, many midwives have been driven out of practice themselves because of the difficulty of being able to afford malpractice insurance. What's sad is that midwives, dollar for dollar, get paid less than obstetricians for doing more. They spend more time with their clients, they have better interactions with their clients, and they get paid less."

Local midwives and doulas have good things to say about Mercy's support of alternative birth choices. "I think that it has been helpful to our institution to have women come in who do want to do things differently, because it makes the team have to think differently," Atlas says. Mercy prides itself on its in-house midwifery practice, where women can move about--"We have multiple telemetry units, so you can walk around and still be on the monitor," Atlas notes--and eat during labor, as well as choose any position, including in a water tub, for pushing.

"We just had a woman deliver a 12-pound infant with a midwife, and she would never have delivered vaginally with an obstetrician," Atlas says. "The question is, did she get the correct care? Or was that too risky to have allowed that patient to have delivered vaginally? The fallacy is, `Ooh, doctors say we gotta get this baby out before it gets too big,' and there's no data suggesting that is of benefit." Atlas says, whenever possible, "labor should be natural. It is not a pathologic process but a natural process and should be treated that way."

In many other hospitals, however, all bets are off. "An issue with natural birth at the hospital is, if you ask most hospital staff what that means, they think it just means labor without an epidural or painkillers," Kirby says. "Natural birth is so much more than that. It is birth unfolding in its own time, without a deadline, without pitocin, without monitors, without IVs, without being stuck in a bed or deprived of food."

"Doctors will say that they support natural birth," local nurse-midwife Evelyn Muhlhan says. "I think they think they support natural birth, but when it comes down to it they really don't. In the majority of hospitals, the system is really set up to handle one kind of birth, and the pressure is on to get with the program."

Atlas, Kirby, and Muhlhan all agree that the best thing that women can do is educate themselves about birth, and then seek out a health-care provider that will support their birth plan. "Be an advocate," Atlas says. "Make it clear when you come through the door: This is how I'd like things to go."

Actually, it appears that the majority of women would like things to go as painlessly as possible. In the 1990s, birth centers became a popular alternative: home-birth comfort and freedom with a medical safety net. Recently, however, birthing centers have been going out of business at a brisk rate. Due partly to slim profit margins--"Vaginal deliveries are not a moneymaking enterprise," Barbara Stratton observes--and partly to ever-rising liability insurance, birth centers are losing out to hospitals that have wisely co-opted the birth-center ambiance (comfortable homey setting, complete with mood lighting, Wi-Fi, and iPod docks) while also providing epidurals.

Ahh, the epidural. Epidural pain relief is an anesthetic/narcotic cocktail administered continuously into the lower spine via catheter. Ideally, when administered at the right level at the right point during labor, the epidural dulls the pain of contractions while allowing the laboring mother enough sensation to be able to push the baby out when the time comes. When administered in the wrong amount or at the wrong point during labor, however, epidurals can slow or even stall contractions altogether, leading to pitocin or a C-section for "failure to progress." It can also leave a woman too numb to push, necesitating a vacuum extraction device to help the baby out through the birth canal.

GBMC's Khouzami reports that, among women birthing there, demand for epidurals is such that "we had to create a dedicated OB anesthesia department to make sure epidurals are given 24-7. . . . I would say the majority, certainly more than 90 percent, want an epidural."

"In our world today we are very comfortable," midwife Denise muses. "People just don't do anything that's hard anymore. We don't even have to suffer the heat or the cold anymore, we drive everywhere. You don't really get that challenge that helps you to grow, to mature--avoiding those challenges seems to be the order of the day. And I think that is translating to how we give birth in this society."

But birth in the sweaty, grimacing model--birth that puts the labor into labor--still holds attraction for some. "I got interested in home birth because when I talked to women who had done it, they all talked about how it was so incredible, a peak experience like nothing else," Brigitte Jacobson says. "I had never heard anyone talk about their hospital birth like that and I wanted that experience."

Having had it, she describes it as "incredible--like the best drug in the world, free and nonaddictive."

For those up to the challenge of a no-pain-relief birth, midwives Evelyn Muhlhan and Denise are at your service. For home birth in Baltimore they are the two to see--pretty much the only two.

In Maryland, only Certified Nurse Midwives (CNMs) like Muhlhan are allowed, under state law, to "attend births habitually or for hire." CNMs have nursing degrees with graduate-level training in delivering babies; due to burdensome regulations and skyrocketing liability insurance, nearly all of them work in hospitals or as part of a medical practice. As an independent practitioner, Muhlhan sees about 100 patients each year through her Catonsville practice, Alternative Birth Choices. She works with clients who want a hospital birth with her as their midwife, but she says the vast majority of her caseload is home-based.

A lay midwife, on the other hand, always works outside the medical system. "We learn from other midwives, we don't work in hospitals. It's mostly a lot of self study and apprenticeship," Denise says. "I call myself a lay midwife, but technically I do have a Certified Professional Midwife certification." Passing the CPM test is a way for independent practitioners to get professional recognition through the North American Registry of Midwives, and in some states a CPM can practice legally. Virginia recently started allowing CPMs to be licensed, but, Denise says, "I will be perfectly honest, I don't mind being illegal.

"The reason women come to us in the first place is that the licensed practitioners' hands are tied in many ways," she continues. "Hospitals are now discouraging VBACs [vaginal births after cesarian], not delivering breeches, and doing everything they can to give you that first C-section, and the midwives who work there are bound by hospital policy. It's very distressing. People come to me because they need to get outside the system to birth appropriately."

Denise sees about 120 patients a year: "Sometimes it's people who have had previous traumatic experiences in hospitals, but I do have a lot of religious women and women who are just very comfortable giving birth. I think I get a lot of religious ladies because they don't deify doctors as much as the rest of us might--they feel like they can trust a different kind of power to see that their birth goes well. I do get all different persuasions: Christian women, Orthodox Jewish women, Muslim ladies that come here in the whole burka business." Furthermore, she has seen "nurses who have home births, physicians, wives of physicians. They are intimately familiar with the medical model and realize that it is a better choice to birth at home.

"In my opinion the only reason to give birth in a hospital is to get pain medication," she says. "There's really nothing else they have to offer you. It's safer at home, or at least as safe, and some studies show it's significantly safer. People always say, `Well, what if something happens?' Nobody ever asks that same question about hospitals, because they assume that if you are at the hospital then they are going to take care of it. We have one of the highest infant mortality rates in the developed world, and it's not because of home births--how could it be, there are so few--it's because of hospital births."

With only 1 percent of births in this country taking place outside a hospital, that means when mothers and babies die in the United States, the vast majority are doing it hospitals. "Well, when 10 percent of my patients who come through my door have no prenatal care at all, that would give some of the answer," Mercy's Atlas explains. "Other industrialized countries give prenatal care. I think the fact that the US doesn't have universal health care is the main factor [in elevated maternal and fetal mortality and morbidity rates]."

Muhlhan and Denise each end up transporting less than 5 percent of their laboring home-birth patients to the hospital. They report cesarean rates of 3.5 percent, meaning that 95 out of 100 patients in their care will deliver at home and 97 percent will deliver vaginally.

Denise's low C-section rate is one reason Barbara Stratton chose Denise to deliver her second baby at home after a traumatic C-section with her first. The other reason was she had little choice: "I wanted a VBAC and I didn't trust that I would get it in the hospital."

As liability-leery hospitals increasingly limit or even ban post-cesarean vaginal deliveries, home births after cesarean are becoming increasingly common.

"It's not like I thought, Woo-hoo, I have a scar on my uterus, let's go give birth at home!" Stratton says. "I knew that risk of uterine rupture was there, and if you rupture in labor, the best place to be is not at home. But in my mind the risk of what they could do in the hospital to actually raise my risk of rupture, like artificially breaking my bag of waters, using induction or augmentation drugs, ending up with an unnecessary C-section, I felt that outweighed my risk of the very small chance of having a uterine rupture at home."

Mary Haber also chose Denise to deliver her second child, in April. "I am not radical" she says. "I really want to be safe. And I chose home birth with [Denise] because I knew she would transport the moment she suspected a problem. She is not going to take that risk for me, for the baby, or for herself." Haber had given birth to her daughter Ella in a birthing center; the closest one to Baltimore, it was still an hour away. "I loved the place and loved the midwives, but I did not love the drive," she says.

So for Haber's second birth, she sought options closer to home. "It just came down to I don't want to disappear from Ella's life for two days, or even 12 hours, and come back with a new person," she says. "It would be the biggest shock of her life, not being part of that experience. I didn't want her to be there so much as to have the choice to be there. And it turned out--this is the irony--that I was making such loud horrific noises that she didn't want to come anywhere near."

As soon as Caleb came out, however, Haber felt nothing but "pure bliss.

"When I tell you it was the perfect experience, that doesn't mean that it didn't hurt," Haber says. "There were moments I thought I might die, that's how bad it hurt. But birth is such a paradox, because it is simultaneously the most blissful and most painful experience.

"It still hurts like hell, no matter where you give birth."

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Jentle1

1 comments.

Member since 6/25/2008

Bravo on an article well done-- I read with great interest this piece which spells out the horrors (yes, horrors) of hospital birth, and which shines a nice bright light on gentle home birth. My first birth was in the hospital with an OB, and afterwards I felt violated, stripped of all my power, and lied to. Healing mentally and emotionally from that birth took a very long time, and no one even noticed how shell-shocked and damaged I was. I had the good fortune of hooking up with a midwife for all of my other births. My prenatal care was gentle, and thorough, and she helped me process the damage of my first birth while helping my heart and mind get ready for subsequent births. EACH prenatal appointment was an hour long, unhurried, with no one looking at a clock to hurry me out. I grew, and became empowered as a woman in ways I never had known were available to me. The births themselves were beautiful: supremely gentle, amazing, deeply peaceful, and so empowering. Until I began to work with my midwife, Nancy Giglio, I never knew life could have such a deep beauty-- Until you have the experience, you cannot imagine exactly what I'm referring to, but once you have it, life is never the same in the very best of ways. Nancy passes the wisdom of the ages on to her mamas, which, in turn, affects all aspects of their lives: they become better mothers, more confident women and citizens, have a bigger love to bring to their relationships, because they feel more deeply rooted and satisfied as people. Furthermore, nothing invasive happens at home-- when a woman is encouraged to listen to the messages her body is giving her, she moves into different positions, which allows her baby to find its best path out. Birth is a process our bodies were designed to do, so midwives allow that process to happen, not interfering, but always being watchful for pathology. If they see something is starting down a pathological path, that is when her mama is handed over to those trained to deal with pathology in birth-- the medical doctors. Midwives are trained to deal with normal, non-pathological birth; doctors are only trained to deal with the pathology of it. There is a place for both, and a need for both.

Posted 6.25.2008 12:00 PM

AmyTuteurMD

29 comments.

Member since 6/25/2008

"but there are dozens demonstrating that, in low-risk pregnancies, home births attended by a midwife are as safe for mother and baby as going to the hospital."

No, there are NO studies demonstrating that homebirth is safe. Indeed, all the existing scientific evidence shows that homebirth has an increased risk of neonatal death.

There are studies that CLAIM to show that homebirth is as safe as hospital birth, but they do so by comparing low risk homebirth with high risk hospital birth, or by comparing low risk homebirth to hospital birth 20 or 30 years before.

The US government has begun collecting statistics on homebirth. The first dataset (2003-3004) is available online at the CDC website. It shows that hospital birth (white women, 37+ weeks, 2500 + gm) with an MD (including high risk) has a neonatal death rate of 0.61/1000, hospital birth with a certified nurse midwife (low risk) has a neonatal death rate of 0.37/1000, and PLANNED homebirth with a homebirth midwife has a neonatal death rate of 1.15. In other words, homebirth has a neonatal death rate double to triple that of hospital birth. The MOST dangerous form of planned birth in the US is homebirth with a homebirth midwife. Women deserve to know this information.

Women also need to know that MANA (the Midwives Alliance of North America) has been collecting detailed safety statistics since 2001. They have publicly offered the statistics to those who can prove they will use them for the "advancement of midwifery". Even those people must sign a legal non-disclosure agreement prohibiting them from revealing any data to anyone. MANA is deliberately hiding this data from the public, because it almost certainly shows that homebirth has an increased rate of neonatal death compared to hospital birth.

The scientific evidence shows that homebirth leads to an increased risk of neonatal death, the US statistics show that homebirth leads to an increase in neonatal death, and MANA's own statistics are being hidden from the public. It is quite clear that homebirth increases the risk of neonatal death.

Posted 6.25.2008 3:53 PM

birdseye

1 comments.

Member since 6/25/2008

Although a more than 30% caesarean rate in the U.S. is a concerning statistic, what bothers me about the breathless anecdotes cited by this article and a number of books about birth is the effect they have on women who did give birth by caesarean because it was medically necessary to do so. These women are made to feel like they took an unfair shortcut, or that they are not "real" mothers because they couldn't push the baby out. What's the point of making them feel bad, when they are healthy, their babies are healthy, and a beautiful new life has begun?

I understand that giving birth in a hospital can be unnecessarily frightening and mechanized for a lot of women, and I agree that hospitals should improve the way that they handle births, allowing more time for labor, letting women try different positions, and generally facilitating a more natural birth. Women should keep up the pressure on hospitals to change their ways. Isn't there a reasonable compromise between totally mechanized birth at one extreme and a risky home birth with no prenatal care at the other?

I think hospitals are under an enormous amount of pressure, financial, legal, and logistical, to ensure that births have as few complications as possible, and, unfortunately, happen within a certain amount of time. This undoubtedly has a negative impact on the birth experience. These strains are caused in large part by our horribly broken health care system. The point made in this article about mortality and morbidity rates being affected by patients without health insurance who have received no prenatal care is a very important one. Until we fix our health care system and ensure that hospitals receive the funding, staffing, and expertise that they desperately need, birth will continue to be a nervewracking experience for all involved.

Personally, I'm glad that most OBs now have experience performing c-sections. If that option had been available to my mother in the 70's, my brother might have been OK. That's my breathless anecdote.

Posted 6.25.2008 4:58 PM

salvadordream

1 comments.

Member since 6/25/2008

I found this article to be well written and well presented. I used to work at Mercy. I knew they specialized in women's care, but because I didn't work in that department myself, I was unaware of the cheif OB's view. I'm pleasantly surprised to learn of his opinion. Most doctor's are not willing to state opinions that go against the AMA or other medical organizations.

I gave birth to three children and all three were very different. My first was a nightmare. At the time I thought it was just because it was in a military hospital in Germany, but I later found out that if I had been in a regular hospital it would have probably been a lot worse and ended up with a C-section. It all started when they broke my water when I wasn't even in labor yet (I was 10 days over due with my first child - not abnormal - and they felt the need to "hurry things along"). When that didn't induce things, they brought out the petocin, which eventually led to a whole host of problems. My second child was born at one of the most famous hosptials in Baltimore, but fame isn't equal with wonderful care. Labor started normally, and the baby was fine until the first internal exam which was so rough I started bleeding, my child went into fetal distress. They may have been planning a C-section, but my daughter was born before the epidural even took effect. My youngest was born in England, and I have to say that the pre-natal care there was so much better than in this country. You are seen by a midwife through your whole pregnancy unless a problem develops. You have a choice on giving birth in a hospital or a birthing center, and a midwife visits you at home after the baby is born at regular intervals for the first month. I was going to go the birthing center route. We had it all planned, until I developed a complication in my last trimester. I did wind up with a C-section with my last one, but they had given me the choice. She was breech and big, and I had high blood pressure, but they sitll felt they could deliver vaginally if I wanted to try. At the time I was young and had been through two nightmare births already, so I told them to give me a C-section.

I both laud and envy these women who went against the status quo and decided to have home births. I wish the option would have been there my first one. I think things would have gone a lot differently with my subsequent births.

I'm proud of you, Nichole. You grew up to be an extremely resourceful, intelligent and determined young lady.

Posted 6.25.2008 8:26 PM

nopain

2 comments.

Member since 6/25/2008

I enjoyed reading this article. I have two children, and their births were as different from each other as night and day. The first one was a nightmare 30 labor which included intervention after intervention trying to "get things going." By the time it was time to push, I was so worn out, tired, and starved I had no energy to push, plus there were six women around me yelling at me to push. What a horrible experience. No there wasn't much pain during the labor, but that balanced out with a lot of pain afterwards with my C-section.

With my second birth, I was too scared to go back to the hospital, and Evelyn Muhlhan attended my homebirth. Interesting all the talk about pain in natural births. I used a birthing hypnosis program called Hypnobabies, and I had virtually no pain at all. It's a self-study program using compact discs, and was so wonderful I had to write in today to share about it, since natural, or non-drug pain relief wasn't touched on at all. Great article.

Posted 6.25.2008 8:42 PM

apelilae

1 comments.

Member since 6/25/2008

Amy- I think you are way off in your incorrect assumptions and declarations. Given your personal history, I completely understand your extreme bias on this topic and I can respect that.

For others that may read this, I encourage you to make your own decision on this matter, and not just blindly follow OB/GYNs or midwives.

http://homebirthdebate.blogspot.com/2008/05/new-national-statistics-homebirth.html

http://www.gentlebirth.org/ronnie/homesafe.html

http://www.mothering.com/articles/pregnancy_birth/homebirth/under-fire.html

Posted 6.25.2008 10:31 PM

joymum

2 comments.

Member since 6/25/2008

Both of my children were born at home with capable experienced midwives in attendance. After educating myself for years before my first birth I could not imagine birth any other way. Giving birth at home was truly the best decision of my life. Not just for myself but for my children and our family as a whole.

Each year drugs, everyday objects and processes that are considered mainstream and accepted by society as a whole are recalled and abandoned when they are found to be less than effective or downright dangerous. Until American consumers say enough is enough the medical establishement will gladly let you pay big bucks for your birth (the largest source of hospital revenue) while making you and your baby guinea pigs in their relatively new (60 year old) unscientific experiement. Out of hospital birth has worked quite well for millions of years. We are anything but an endangered species. No doctor at GBMC or any other hospital can prove that almost half of the women (42% a revolting statistic) are unable to birth normally. Yes, there are a few for whom the procedure is medically necessary, a few. As for the rest, pregnancy is not a disease that can only be cured by the seven tissue layer surgical extraction of the often premature infant. It's a normal bodily function. We give our pets and farm animals more credit and dignity in birth than we give our fellow humans.

Posted 6.25.2008 11:12 PM

AmyTuteurMD

29 comments.

Member since 6/25/2008

"Out of hospital birth has worked quite well for millions of years"

No, it has not. That's just another fantasy made up by homebirth advocates. Childbirth is and has always been, in every time, place and culture, a leading cause of death of young women and the leading cause of death of infants.

Mothers and babies are at much higher risk of death and permanent disability UNLESS they are cared for by people practicing modern obstetrics. The ONLY places where perinatal and maternal mortality are low are places that practice modern obstetrics. That's because rates of perinatal and maternal mortality in "nature" are appallingly high. Any country where the majority of births are homebirth has third world levels of perinatal and maternal mortality.

It's just like the miscarriage rate. Approximately 1 in 5 pregnancies ends in miscarriage, because human reprodouction has a high wastage rate. Lots of genetic mistakes occur "naturally", lots of failures of implantation occur "naturally", lots of failures to develop properly occur "naturally". Similarly, although the natural neonatal and maternal death rates are much lower than the miscarriage rate, human childbirth has a high wastage rate, too. The natural neonatal mortality rate appears to be approximately 7% (7 out of 100 babies will die without modern obstetrics) and the natural maternal mortality rate appears to be approximately 1% (1 out of 100 women will die each time she becomes pregnant, without modern obstetrics).

One of the fundamental mistakes of homebirth advocates is to look at the current low neonatal and maternal mortality rates and assume that they have happened in spite of obstetricians and modern obstetrics. Nothing could be further than the truth. Neonatal and maternal mortality are low BECAUSE OF obstetricians and modern obstetrics.

Posted 6.25.2008 11:50 PM

SarahJeanne

4 comments.

Member since 6/26/2008

Please don't believe anything Amy Tuteur says. She makes a profit from encouraging women not to homebirth. How do you think she affords all of her advertising? Come on Amy, find something better to do. No one believes you anymore! You spew scewed statistics from botched studies like you are a robot. How many more women will be influenced by your ridiculousness? I've read your website, thanks to the myspace advertising you do- and I find it sick that you thoroughly encourage innocent women to be raped by the medical model. Maybe you should look into yourself for answers and realize that you are wrong. Do you sleep well at night, Amy Tuteur, MD?

Sarah

Posted 6.26.2008 12:45 AM

SarahJeanne

4 comments.

Member since 6/26/2008

"Any country where the majority of births are homebirth has third world levels of perinatal and maternal mortality."

LOL. That's because it's a third world country, not because of lack of OB care. You have to take into consideration water quality, disease factors, famine, etc. etc. before you start blaming it on just homebirth.

Posted 6.26.2008 12:53 AM

Helenkww

6 comments.

Member since 6/26/2008

It is appalling as a medical profession myself to hear the antiquated comments of the supposedly educated Doctors. Do you MD's really think it is ok to tell society that the US 30%+ c-section aka major abdominal surgery stats are acceptable? Shame on you and all of your profession for not making REAL natural births possible in the hospital. How many more sad stories do you need to hear to make changes. My friends who are Ob-Gyn's and practice natural birth tell me the hospital horror stories behind the inductions and unnecessary c-sections. Yes sometimes they are necessary but look at our stats compared to Europe. Are you not embarrassed to be part of the medical community in a "Industrialized super power" that has one of the highest mother and infant mortality rates in the industrialized world? If 95% of all births in the US are in a hospital then look in the mirror docs and say hello to the problem! You are birthing the majority of the babies in this country – please have the guts and integrity to make changes that will make you proud one day to say you were part of the solution not the problem.

Posted 6.26.2008 1:11 AM

dalena

23 comments.

Member since 6/26/2008

Amy writes:

The US has one of the highest neonatal and maternal mortality rates of the industrialized world. http://www.infoplease.com/ipa/A0004393.html

Compared to those countries where midwifery care and homebirth are the established practice, no US statistics show any reason to believe that hospital birth is a better birth option.

As someone coming from a country where midwifery and homebirth are norm, I find the statements of Amy Tuteur laughable to say the least.

I also have serious issues with Amy's credentials. I have not been able to verify that Amy is a M.D., much less an obstetrician. No license to practice medicine for Amy is to be found. Also, some of Amy’s domain names are held publicly, but who holds the registration on homebirthdebate.com is not, which is something that can be done at an additional fee. This raises the question of why she would conceal the domain backer, especially since she has not done this with the others. She has also gone to the trouble and expense of copyrighting homebirth debate, which denies others access to the term. As far as I am concerned, Amy may be fronting a disinformation campaign. Blogs have become a common tool for this sort of thing. It’s an interesting, if somewhat paranoid, thought. If she is, an obvious suspect comes to mind for which entity might be backing her. It is certainly one that has deliberately spread disinformation in the past.

Posted 6.26.2008 1:18 AM

Helenkww

6 comments.

Member since 6/26/2008

Thank you SaraJeanne for your words of wisdom. It is a good question "Do you sleep at night." not just for Amy Tuteur but for any Doctor that has a high c-section rate - shame on all of you for being art of a herd mentality and not being willing to have the integrity one would like to think should come with being a doctor and especially an Ob-Gyn to stand up and be part f change for good. My friends who do natural births and treat their patients with respect have the lowest liability fees I have heard of for you Ob-gyn's. Could it be because allowing a woman's body to birth at it's own speed and natural birth overall is safer? Oh sorry no double blind studies yet to support that idea. Sorry to be so rude but arrogant doctors are one of my giant pet peeves.

Posted 6.26.2008 1:18 AM

AmyTuteurMD

29 comments.

Member since 6/25/2008

"The US has one of the highest neonatal and maternal mortality rates of the industrialized world."

No, it doesn't. That's yet another claim made up by homebirth advocates.

First of all, the correct statistic to assess obstetric care is perinatal mortality, not infant mortality (which is a measure of pediatric care). According to the World Health Organization 2006 report on perinatal mortality, the US has one of the lowest rates in the world, better than Denmark, the UK and the Netherlands.

Second, American direct entry midwives have far less education and training than European midwives. European midwives have a university degree, and get their clinical training in the hospital. They have extensive training and experience in the diagnosis and management of childbirth complications. If they transfer a patient to the hospital, they can manage that patient in the hospital. In contrast, American direct entry midwives have a high school degree, and NO hospital training. If a patient develops a complication, they dump her in the local emergency room and hope that the doctors can save the patient. It is very important for women to understand that American direct entry midwives have less education and training than ANY midwives in the industrialized world. They would not be considered qualified to be licensed in any first world country.

One of the fundamental problems with homebirth advocacy is that most of what homebirth advocates think they "know" isn't actually true. It's just made up by other homebirth advocates.

Posted 6.26.2008 8:27 AM

Ruby

1 comments.

Member since 6/26/2008

I have now planned 2 homebirths to deliver my 2 children...the first pregnancy became complicated enough to warrent a "planned" C-section, at the time that I went into labor naturally. Now I have also had a VBAC at home. Midwives who safeguard women and their babies by trusting in the normalcy of birth, yet remaining alert to the arising hazards are a wonderful gift to maternal care. Bravo to a well-balanced article that promotes the benefits of giving birth--in all it's grunty sweatiness.

Posted 6.26.2008 9:08 AM

clairity

1 comments.

Member since 6/26/2008

The level of venom being spewed at Amy on this comments list is appalling. She's presenting reasoned arguments backed up by real studies, and she gets back vitriol? Part of the reason many of us women are turned off by doctrinaire homebirthers and lactivists and such is because of this knee-jerk, reflexive "you're a bad mom unless you do it MY WAY." You are not helping your cause or persuading anyone with the attitude displayed here. (My apologies to the homebirth advocates here who ARE being reasonable.)

I found the article well written and well thought for the most part... with some notable exceptions. The reporter accepts certain statements from her sources at face value, including some obvious logical fallacies:

One midwife says "We have one of the highest infant mortality rates in the developed world, and it's not because of home births--how could it be, there are so few--it's because of hospital births." This is a classic correlation-does-not-imply-causality fallacy. Namely, just because more babies are born in hospitals, and we have a high infant mortality rate, that does NOT mean (absent other evidence) that one causes the other. There would need to be longitudinal studies done on homebirth before that claim could be made. The speaker, as a trained professional with, one presumes, at least some scientific/healthcare training, should know that.

The article is full of antecdotal evidence like that, without corresponding evidence to back up its claims. Like "Muhlhan and Denise each end up transporting less than 5 percent of their laboring home-birth patients to the hospital. They report cesarean rates of 3.5 percent, meaning that 95 out of 100 patients in their care will deliver at home and 97 percent will deliver vaginally." Says who? Them? I'm not saying they can't be trusted, but as a former journalist, I know that these kinds of assertions need to be sourced, and if they come from an interested party, should be fact-checked. Was this done? It doesn't say.

Like all reproductive debates, this one is polarizing. I think the article was fairly balanced, and I agree with its premise that women's healthcare, particularly reproductive healthcare, is seriously flawed in this country. I don't agree that homebirth is the answer, not until I see some compellling evidence to the contrary; which isn't here.

Posted 6.26.2008 9:25 AM

triple07

1 comments.

Member since 6/26/2008

I found this article coming from a mainstream source (a large city newspaper) to be very refreshing. In a day and time where are such disgusting things going on as planned c-sections and the worst being designer births, a good article on homebirth for ALL the world to see, not just those women who are slightly informed who have the want too search out more information on it, is a such a wonderful tool.

As far as Amy goes, it seems that you are the one spewing off unbacked up lies that you are trying to call fact. I have researched statistics time and time again, so thoroughly it could make anyone's head hurt and what you are sprewing off is false and laughable.

And to clarity, it is funny you should mention a "my way or the highway" point of view when in our society women ask other pregnant women not when their due date is, but when they will be sectioned/induced. Most women theses days, completely uninformed and just wanting to please the adult (aka the doctors and obs who will at least 33% of the time lead those women to a high risk, unnecessary surgery when only 5% or less actually need the surgery), these women look at women wanting a natural, intervention-free birth as wierdos saying that OUR choice is crazy and saying that we should be going to a hospital instead. How is that for "my way or the highway" mentality.

There are even some women appahling enough to call emergency care or CPS on women who have made the informed decision to birth naturally at home, unassisted. How's that for sick and "my way or the highway".

I wouldn't be surprised if you women think that formula feeding is just as good as breastfeeding, or that if women do breastfeed they should stop at a tear or less. Or that the family bed is not a good option, or that cloth diapering is better for our environment and society. I can only hope and pray that when/if my daughter gets pregnant and gives birth, our society is significantly different, that she can actually feel safe going to either a midwife, doctor, or deciding to birth on her own.

Posted 6.26.2008 12:59 PM

informedchoice

5 comments.

Member since 6/26/2008

AmyTuteurMD : yes, I'm curious -- how *do* you sleep at night ?

It is sick, using and abusing your "MD title" so thoroughly as you do, in order to scare women into brthing in the hospitals. I feel physically ill when I think of how many unknwoing women put themselves and their babies in harm's way because of the obstetrical fallacies that continue to spill from your mouth.

Shame on you, indeed.

Posted 6.26.2008 1:18 PM

ppatin

19 comments.

Member since 3/20/2008

AmyTuteurMD & clairity:

It's nice to hear a couple voices of reason on here, however actual facts and evidence will never convince certain people. Look at how many idiots still believe that vaccines cause autism, or think that chiropractors are real doctors. The good news is that people who do decide to go for home birth are only putting themselves at risk, unlike the anti-vaccine fools who are a danger to everyone. People in a free society have a right to make dumb decisions.

Posted 6.26.2008 4:05 PM

BirthIsNormal

9 comments.

Member since 6/26/2008

The US currently ranks 20 in infant mortality rates. The CDC has clearly stated for several years now that the U.S. has one of the highest infant death rates in any developed nation. This is what we have to show for all the fancy interventions we have available during births. According to the National Center for Health Statistics, babies delivered via cesarean surgery have a 69% higher risk of neonatal mortality than a vaginal delivery. Furthermore, the advocacy of repeat cesareans accounts for a maternal death rate up to five times higher than a planned vaginal birth after cesarean surgery. In findings released in 2007 by the CDC also adds we see that the maternal death rate has increased significantly. This clearly means that in hospitals (where ACOG and the AMA both insist are safe places for women to have babies) throughout the United States, birthing mothers and babies are dying.

Most startling, a study published in 1996 focused on childbirth-related deaths occurring on the Isle of Man between 1882 and 1961. This study concluded that doctors played an important role in increasing maternal mortality due to the increased use of interventions.

It is a FACT that the US has incredibly high infant mortality rates. For a developed country, this is unacceptable.

Anyone who thinks this FACT is wrong can contact the CDC, the Wold Health Organization, the National Institutes of Health, the British Medical Journal and the National Center for Health Statistics.

Posted 6.26.2008 7:11 PM

Laura Shanley

1 comments.

Member since 6/26/2008

Wonderful article! To those who believe that women and babies in mass were dying prior to the advent of the modern day hospital I'd suggest reading Judith Goldsmith's book "Childbirth Wisdom from the World's Oldest Societies." Throughout history, healthy tribal women have successfully given birth without medical assistance. The majority of deaths both now and in the past are poverty related. The rest can be traced to physical and psychological intervention. Yes, true physical deformities exist and sometimes medical intervention is required. But every birth is not an accident waiting to happen.

Regarding Dr. Khouzami's comment - "If you are here long enough, we are going to do something to you. It's a matter of time. I will be the first one to admit that," he says. "The trade-off is that I am going to make sure that nothing happens to you or to the baby." - this simply isn't true. Doctors as a whole are NOT making sure that nothing is happening to mothers or babies. Babies in hospitals are being sliced into during c-sections and episiotomies, cords are being compressed during unnecessary forceps extractions, mothers are dying during or after unnecessary c-sections, babies are dying from being taken prematurely from their mother's wombs, and the list goes on and on.

Thankfully, women in mass are waking up. Homebirth is on the rise, and if the AMA and those who support them think they are going to stop it they are sadly mistaken.

Posted 6.26.2008 7:27 PM

AmyTuteurMD

29 comments.

Member since 6/25/2008

"The US currently ranks 20 in infant mortality rates."

Infant mortality is the WRONG statistic to evaluate obstetric care because it is deaths from birth up to one year of age. The correct statistic to evaluate obstetric care is perinatal mortality; perinatal mortality is the standard used by the World Health Organization. In the WHO 2006 report on perinatal mortality, the US had one of the lowest rates in the world, better than Denmark the UK and the Netherlands.

"Anyone who thinks this FACT is wrong can contact the CDC, the Wold Health Organization, the National Institutes of Health, the British Medical Journal and the National Center for Health Statistics."

You just made that up. Virtually none of it is true. The World Health Organization has specifically said that planned homebirth increases perinatal mortality. The latest statistics from the CDC (which only recently began tracking homebirth) shows that planned homebirth has a neonatal mortality rate double or triple that of low risk hospital birth.

The BMJ 2005 study by Johnson and Daviss ACTUALLY showed that homebirth increases the rate of neonatal death to almost triple the rate for low risk hospital birth in the same year. Johnson and Daviss conveniently omitted that from their paper. Instead they compared homebirth in 2000 to a bunch of out of date papers, some published as far back as 40 years in the past.

Moreover, Johnson and Daviss neglected to mention that they are long time, passionate, public advocates of homebirth. Johnson is the former Director of Research for MANA, the midwives trade organization, and Daviss, his wife, is a homebirth midwife. In addition, the study was funded by a homebirth advocacy foundation.

Homebirth increases the rate of neonatal death. The only people who appear not to know this are homebirth advocates.

Posted 6.26.2008 7:36 PM

AmyTuteurMD

29 comments.

Member since 6/25/2008

"Throughout history, healthy tribal women have successfully given birth without medical assistance. "

Ms. Shanley, perhaps you don't realize it, but that statement has a racist and sexist origin. The claim was first made by eugenicists in the 1920's and 1930's. They were preoccupied with the notion of "race suicide" whereby the white race would be overwhelmed by the children of "inferior" and "primitive" peoples.

Eugenicists, like other racists, portrayed "primitive" women (read women of color) as "natural", hypersexualized beings who understood that their job was to get pregnant and bear children. In contrast, the eugenicists, many of whom were quite sexist, believed that white women of the "better" classes suffered from "hysteria", infertility, shriveled ovaries and painful childbirth because they did not know the place and were agitating for economic and political rights.

Grantly Dick-Read, the father of "natural" childbirth, made up his theory in order to convince white women of the "better" classes to have more children. He believe that if they could be convinced that the pain of childbirth was all in their heads, they would save the race by having more children. As he said:

"the mother is the factory, and by education and care she can be made more efficient in the art of motherhood"

According to the medical historian, Dr. Ornella Moscucci:

"The argument developed in Natural Childbirth and in its more famous sequel, Revelation of Childbirth (subsequently Childbirth Without Fear), mixed Darwinian themes, neurophysiological theories, and cultural stereotypes of childbirth among "primitive" people... Whether women experienced pain or not depended on cultural attitudes to childbirth rather than on some property inherent to parturition. Dick-Read ... claimed that primitives experienced easy, painless labours. This was because in primitive societies the survival value of childbirth was fully appreciated and labour was regarded as nothing more than "hard work" in the struggle for existence. In civilised societies on the other hand a number of cultural factors conspired to distort woman’s natural capacity for painless birth, producing in woman a fear of childbirth that hindered normal parturition...

To eliminate pain, the fear-tension-pain cycle must be broken ... Women had to be "tactfully, gradually and carefully initiated into the job they were about to perform". Education in the "facts" of natural childbirth and instruction in the methods of relaxation were the chief weapons in the battle against fear... According to Dick-Read, these psychological techniques would not only eliminate pain, but also shorten labour and reduce the need for surgical interference."

The idea that "primitive" women experience painless easy labors with excellent outcomes is nothing more than a racist, sexist stereotype.

Posted 6.26.2008 7:47 PM

BirthIsNormal

9 comments.

Member since 6/26/2008

Amy-

The most current findings by the National Center for Health Statistics show that cesarean surgeries have a 69% higher risk of NEONATAL mortality than a vaginal delivery. Did you not choose to read that part?

And, no I did not make up the FACT that the CDC, the Wold Health Organization, the National Institutes of Health, the British Medical Journal and the National Center for Health Statistics have all released stats on mortality rates that put the US and all its interventions toward the bottom of the totem pole. If I made that up, I'd be fired from my job.

The BMJ '05 study reported zero maternal deaths and an infant mortality rate of 2.0 per 1000 live births. That same year, the National Vital Statistics Report shows an infant mortality rate of 6.9 per 1000 live births.

And another tidbit- In 1993, the two states with the highest infant death rates were Delaware and the District of Columbia. Vermont, on the other hand, has had the lowest infant and maternal mortality rates for quite some time. Incidentally, it is also the state with the highest rates of home births as well as a significantly larger portion of midwife-attended births

Posted 6.26.2008 7:52 PM

BirthIsNormal

9 comments.

Member since 6/26/2008

Question-

What does it matter to anyone where a woman and her partner decide to birth their child?

Posted 6.26.2008 7:56 PM

AmyTuteurMD

29 comments.

Member since 6/25/2008

"And, no I did not make up the FACT that the CDC, the Wold Health Organization, the National Institutes of Health, the British Medical Journal and the National Center for Health Statistics have all released stats on mortality rates that put the US and all its interventions toward the bottom of the totem pole."

If that's true, then you should be able to cite them. Please tell us where we can find that information.

"The BMJ '05 study reported zero maternal deaths and an infant mortality rate of 2.0 per 1000 live births. That same year, the National Vital Statistics Report shows an infant mortality rate of 6.9 per 1000 live births."

The problem is that the neonatal mortality rate for low risk hospital birth in 2000 was approximately 0.7/1000 (according to the CDC), so the homebirth mortality was almost TRIPLE the hospital neonatal mortality.

I'll be waiting for the citations.

Posted 6.26.2008 8:00 PM

BirthIsNormal

9 comments.

Member since 6/26/2008

Here are the citations your asked for. Check them out, you might learn something....

Stewart, David “International Infant Mortality Rates- US in 22nd Place” NAPSAC News, 1993

Division of Vital Statistics, National Center for Health Statistics “Neonatal mortality for primary cesarean birth…” March 2008

Division of Vital Statistics “Cesarean delivery: background, trends, and epidemiology” October 2006

Johnson & Davis, “Outcomes of planned home births with certified professional midwives” British Medical Journal, June 2005

National Vital Statistics Report, Vol 50 No 12, August 28, 2002

Globalhealthfacts.org “Infant Mortality Rate” 2007

Posted 6.26.2008 8:04 PM

AmyTuteurMD

29 comments.

Member since 6/25/2008

Sorry, bibiography "salad" copied from a book does not count. You didn't even copy them correctly. Please quote the passages that support your claims. I'm asking because I know that there are no such passages, so you won't be able to quote them.

Posted 6.26.2008 8:10 PM

BirthIsNormal

9 comments.

Member since 6/26/2008

Amy, I think you're simply running out of things to say. Just admit that you have an ideological bias. That its not about the stats or facts, but what you believe. Its simple and honest.

As per the "salad". Ha ha ha ha! That's all you have? I was actually looking forward to a further conversation with you. I actually just finished working on a to-be-published paper, which is where my citations and facts come from.

Quotations (not simply 'cause you asked but because others will find them informative):

"The most current findings are that cesarean deliveries with no complications (sometimes classified as ‘elective cesareans’) have a 69% higher risk of neonatal mortality than a vaginal delivery.Neonatal mortality refers to the death of a live-born baby within the first seven to twenty-nine days of life."

Division of Vital Statistics, National Center for Health Statistics “Neonatal mortality for primary cesarean birth…” March 2008

"approximately 91% of women have repeat cesareans . This carries increased risks and accounts for a maternal death rate up to five times higher than a planned vaginal birth after cesarean surgery, otherwise known as a VBAC"

Division of Vital Statistics “Cesarean delivery: background, trends, and epidemiology” October 2006

"Today most countries, except the United States, still support home birth, minimal use of interventions and midwifery care. Of these countries, 19 of them have a significantly lower infant death rate than the U.S."

National Vital Statistics Report, Vol 50 No 12, August 28, 2002 AND

Globalhealthfacts.org “Infant Mortality Rate” 2007

Posted 6.26.2008 8:19 PM

AmyTuteurMD

29 comments.

Member since 6/25/2008

You're simply making this stuff up.

First of all, you must write the citations so we can find them. That includes authors, journal, volume and year.

Second, I have read most of those papers and they don't say what you have claimed.

Try again.

Posted 6.26.2008 8:26 PM

BirthIsNormal

9 comments.

Member since 6/26/2008

You're living in an alternate-based reality, Amy. Its ok, I forgive you.

Thank goodness most women out there haven't forgotten that birth IS a normal, physiological process. Or are you going to argue against that too, "Dr" Amy?

Posted 6.26.2008 8:30 PM

AmyTuteurMD

29 comments.

Member since 6/25/2008

" birth IS a normal, physiological process"

So is death.

Posted 6.26.2008 8:47 PM

BirthIsNormal

9 comments.

Member since 6/26/2008

I guess that explains your point of view.

Posted 6.26.2008 8:50 PM

dalena

23 comments.

Member since 6/26/2008

Well, it has to be obvious, no, that Amy has no intentions of looking at things without bias. That is because only "Dr." Amy knows how to read statistics. And really, for someone who is always ready to prove someone wrong, "Dr." Amy has yet to acknowledge or refute the fact that she is not a practicing MD nor OB.

Thank you, BIrthsNormal for your posts :) You beat me to it, which I very much appreciate!

For women planning a hospital birth: your best information should come from Henci Goer, not Amy.You will then actually get the information you need to be well educated about your birth, about the choices you have and about how to avoid routine and unnecessary procedures in hospitals. We cannot put ourselves in the hands of people like Amy who treat birth like a disaster waiting to happen.

I hope to see more and more articles like this. It is really encouraging. The birth atmosphere will change, because as it is, those women having great births because of their own birth choices, are teaching their children about real birth and real facts.

And, I will also post what I posted about "Dr." Amy anytime I see her comment with her nonsense. I am not too worried though, most people I encounter and/or talk to about birth, are seeing through her quite well. I think her plan is failing, at least in my neck of the woods. People are smart enough to read studies on their own and educate themselves. If anything, at this point, because of Amy's nonsense, people are actually really looking into things deeper. So thanks, Amy!

And yes, I LOVE my freedom.

Posted 6.26.2008 9:55 PM

SarahJeanne

4 comments.

Member since 6/26/2008

LOL @ Amy Tutuer. Grasping for straws, calling people racists, claiming actual studies done are made up. Bravo ladies- expose her for the liar she is!! Let's see your credentials then, Amy- you spew constant madeup nonsense and ignore actual FACTS. You are wrong! I won't even charge five dollars for that (special intro price).

Sarah, MD

Posted 6.26.2008 10:21 PM

ppatin

19 comments.

Member since 3/20/2008

AmyTuteurMD:

I'm on your side in this debate, but I would strongly advise you to give it up. There are people out there who have an irrational hatred of doctors and modern medicine, and this board clearly has several of them. No amount of evidence will change their minds. You might as well be arguing with a Scientologist over the efficacy of psychiatry.

Posted 6.27.2008 12:34 AM

ppatin

19 comments.

Member since 3/20/2008

SarahJeanne:

Why all the hate? Amy Tuteur is citing plenty of legitimate studies, while the strongest argument you can put up is "you are wrong!"

Posted 6.27.2008 12:36 AM

ppatin

19 comments.

Member since 3/20/2008

"And yes, I LOVE my freedom."

You have the right to take all the risks you want. Please don't go making up facts and pretending that homebirth isn't riskier than delivering in a hospital though, because that's simply untrue. I'm not sure I'd call homebirth "dangerous" (1.15 out of 1000 doesn't seem that bad) but the evidence seems pretty clear that it is not the safest choice.

Posted 6.27.2008 12:38 AM

dalena

23 comments.

Member since 6/26/2008

Amateur MD will never give up LOL (thanks, Nichole :)

So places people have looked for her without success:

Massachusetts Board of Registration in Medicine

abma

ama

acog

harvard medical school alumni

harvard medical school facilty

harvard university

Also, from the back of her book:

"Amy B. Tuteur, M.D. has delivered thousands of babies and given birth to three of her own. ... Currently (1994), "

Someone wrote this about that and I am quoting her here:

"Is it just me that is scared by this thought? I mean really...the picture of "Dr. Amy" that is posted on her website looks like she is *at most* in her late 40's. So she'd have been graduating from medical school in the mid-80's, and then on to her residency/internships. Giving the benefit of the doubt, lets say that she started catching babies in 1984--10 years before this comment about her delivering "thousands" of babies was written. To qualify as "thousands," that means at least 2 thousand. So she was catching a minimum of 200 babies a year??? That would mean she saw 14 prenatal clients (a healthy woman tends to have 14 prenatal visits during pregnancy--even though I read an article once that said that research showed that anything over 8 really didn't improve maternal/fetal outcomes) and caught a baby EVERY working day of the year (52 weeks in the year, 5 work days per week, assume that she took 10 holidays, but no vacation or sick time)."

Amy Tuteur is twisting study outcomes, ppatin, and the only reason we are hateful against her is because this is an ongoing issue between Amy and pro-homebirthers. She is for one not who she says she is, nor is she capable of engaging in a normal, respectful dialogue but treats everyone disagreeing with her as a 5 year old.Not to mention she charges women $5,- for any advice she gives. Mmmm, scam anyone?

Most of the studies Amy mentions have been very clearly debunked by others in various places. It is not even worth discussing this anymore.

Posted 6.27.2008 1:01 AM

AmyTuteurMD

29 comments.

Member since 6/25/2008

"No amount of evidence will change their minds."

Of course, but the people who post on message boards are only a tiny fraction of those who read them. If women come away from this discussion with two important pieces of knowledge, I will be more than satisfied:

1. Homebirth increases the risk of neonatal death. This is accepted and acknowledged by the WHO, the CDC, NICE (The National Insitute for Health and Clinical Excellence), a healthcare watchdog in the UK, among other major health organizations. The only people who deny this reality are homebirth advocates.

2. American direct entry midwives have less education and training than ANY midwives in the industrialized world. They like to trade on the reputation of European midwives while conveniently neglecting to mention that they could not be licensed in Europe.

The vitriol from homebirth advocates merely helps to prove my point. People who are interested in whether my claims are true are looking for peer reviewed scientific research on the safety of homebirth, and a direct comparison of the qualifications of American DEMs and European midwives. The fact that homebirth advocates cannot provide these things, and the fact that they obviously don't care that they cannot provide them, simply confirms my claims.

Posted 6.27.2008 8:15 AM

ppatin

19 comments.

Member since 3/20/2008

AmyTuteurMD:

From what I understand there's a huge difference in the US between direct entry midwives and nurse midwives, with the education requirements for the latter being much more rigorous. Am I correct in assuming that nurse midwives are much closer to midwives in Europe?

Posted 6.27.2008 9:54 AM

AmyTuteurMD

29 comments.

Member since 6/25/2008

"Am I correct in assuming that nurse midwives are much closer to midwives in Europe?"

That's right. The American College of Nurse Midwives also has a new certification for non-nurse midwives, the CM, which is almost exactly the same as European midwives.

Both scientific evidence and national statistics have shown that American certified nurse midwives and European midwives are well educated, well trained and have excellent outcomes. In contrast, American DEMs have far lower standards, and all the existing scientific evidence shows that outcomes for them are worse.

This is not about midwifery. This is about a specific group of women who will not or cannot meet the international standards for midwives and have simply declared that those standards are unnecessary.

Posted 6.27.2008 10:14 AM

staceyjda

1 comments.

Member since 6/27/2008

. AmyTuteurMD said:

"'birth IS a normal, physiological process'

So is death."

Hee, hee, hee!!! Couldn't have discredited you better myself! LOL!!! This might be a good place to add that Hospice is bringing dignity back to people dying--allowing them to die at home w/loved ones, as homebirth and midwifery is bringing dignity and power back to women and their babies for birth. Something else that "Amy" doesn't mention in his citations (yes, "Amy" the tool could be a man) are those families who choose homebirth for a child who can not live after birth because of an abnormality (inoperable heart defect for example). In the medical model many OBs would push a woman to have her unborn child killed instead of letting nature take it's course. It would be insane to attribute those deaths to homebirth--since you are not also counting the children killed at the recommendation of the medical establishment w/similar defects.

It's sad to see how many sheeple willingly take "Amy's" word as the truth...so many people see MD as meaning Medical Deity...just isn't the case folks, although a lot of docs would like you to believe otherwise. And Henci Goer has a couple of excellent books w/all the citations about the stats relating to birth interventions and their (often) negative outcomes. Personally I'd like to know where "Amy" supposedly got "her" degree and in what state(s) "she" is licensed to practice medicine. Funny how someone so insistent on proof doesn't (probably can't) give that information...

Stacey in Texas--who actually gave birth...horror of horrors...at home in 2005. And everything was just fine!!! Surprise, surprise, surprise...

Posted 6.27.2008 1:44 PM

AmyTuteurMD

29 comments.

Member since 6/25/2008

"who actually gave birth...horror of horrors...at home in 2005. And everything was just fine!!! Surprise, surprise, surprise..."

That's like boasting that you drove to the grocery store with your baby unbuckled in the back seat "And everything was just fine!!! Surprise, surprise, surprise..."

I don't know why homebirth advocates have such a tough time understanding risk. An increased risk does not mean 100% risk; it simply means increased risk. Not buckling your kids into carseats does not mean they will automatically die on a ride to the grocery store. So should you stop buckling your kids into carseats? Obviously not. The same thing applies to homebirth. You risked your baby's life at homebirth. The fact that your baby didn't die is great, but you still risked your baby's life for your own "experience."

"And Henci Goer has a couple of excellent books "

What are her credentials and why should we listen to her? She has no credentials in medicine, midwifery, public health, epidemiology or statistics. She describes herself as an "independent expert" which is another way of saying "an expert in her own mind."

Homebirth advocates are happy to gobble up whatever she says, whether its true or false (they have no way of knowing), simply because they like what she says. Henci Goer writes for lay people because lay people can be tricked. You will never see her in a situation where she can be questioned by anyone with actual education and training in obstetrics, because she knows she can't trick those people.

Most of what homebirth advocates think they "know" is factually false. Anyone can tell them anything, and they believe it simply because they like it. Nonetheless, it is a complete mystery to them why no one takes them seriously.

Posted 6.27.2008 5:17 PM

dalena

23 comments.

Member since 6/26/2008

What you write here above goes for hospital birth and for you just the same. Just turn the tables. You have even less credentials than Henci, who does not pretend to be an OB or MD as you do. She holds her own very well with OB's and people with education.

Again, Amy, you are bullying and assuming that everyone who does not listen to you, the almighty Amy, must be uneducated and stupid.

You are in a situation being questioned right now (you have yet to say anything new as every thing you say has been discussed at length in other places) and have yet to answer what your credentials are.

Posted 6.27.2008 6:05 PM

dalena

23 comments.

Member since 6/26/2008

Some of us theorize that "Dr. Amy" is a disinformation strategy of the American College of Ob/Gyns. We can't prove it, of course, but as you may or may not be aware, it is not unknown for corporations and political groups to set up blogs and the like that appear to be independent but which are actually fronts.

Indeed, natural birth, home birth, and midwifery pose a huge threat to the status quo. There are so many OB/GYNs in this country. What would they all do with themselves if midwives took their rightful place as the primary caregivers for the majority of pregnant and birthing women?

Posted 6.27.2008 6:16 PM

AmyTuteurMD

29 comments.

Member since 6/25/2008

That's just like Henci Goer. She can't prove it, but she writes it anyway.

One thing is for sure, if she can't figure out who I am, despite my articles, book, websites, alumni affiliations, etc. over the past 25+ years, she can't be very good at doing research.

Posted 6.27.2008 6:21 PM

dalena

23 comments.

Member since 6/26/2008

Well, yes, I happen to agree with her. Of course she and others are going to write this. You are not who you say you are, plain and simple and all your work has but one intention: confuse innocent women looking for information, information which you distort. All the studies are out there, and yet you keep making the same "mistakes" in interpreting them so that they fit your agenda.

And again, bullying to try and make a point. Same MO as usual.

Posted 6.27.2008 6:56 PM

AmyTuteurMD

29 comments.

Member since 6/25/2008

"Well, yes, I happen to agree with her."

That's just what I have been talking about. You agree with her because you like what she says. She has no idea whether what she has written is true, and she has made no effort beyond surfing the Internet to find out if it is true. It's very easy to find out the truth, but the truth is so prosaic and boring (I'm just an obsetrician who got fed up with the half truths, mistruths and outright deceptions of homebirth advocacy), not nearly as useful in diverting attention as claiming some sort of conspiracy.

Posted 6.27.2008 7:13 PM

Brandy_Baker

12 comments.

Member since 6/27/2008

Friends,

I did some research on "Dr." Amy because I smelled a rat about her "credentials" because of some of her irrational and vitrolic arguments; crying racism about person's an argument which made no racist statements, downplaying US infant mortaility rates, etc. Most MDs, even if they disagreed with someone, would conduct themselves professionally on-line or in person when arguing a point.

It is Friday evening and I just now read the thread of this conversation for the first time. I was going to call the Massachusetts Medical Board first thing Monday morning to see if "Dr" Amy Tuteur is a licensed MD. Looks like someone beat me to it. I provide the link and letter below. Also, please note, there are many unlicensed folks with degrees but no licenses practicing medicine, counseling, etc. This is unethical and illegal. Dr Phil MacGraw, of "Oprah" fame is another one of those people; he lost his license in Texas in the 90s after inappropriate conduct with a 19 year old patient. "Dr" John Gray who wrote "Men Are From Mars, Women are from Venus" got his "degree" from a degree mill in California. As did his ex-wife, "Dr" Barbara DeAngelis.

I mention all of this because it is my position that these unlicensed doctors, psychologists, whether they have legitimate degrees or not, need to be called out. "Dr" Amy has no business giving medical advice if she does not have a medical license. I will still be calling the Massachusetts Medical Board Monday to voice my concerns. I encourage others to consider doing the same.

Brandy Baker

http://forum.myspace.com/index.cfm?fuseaction=messageboard.viewThread&entryID=54046639&groupID=104238280&adTopicID=17&Mytoken=B64FE826-E116-4218-AC774A17F412AEFC46483583

This is from a friend of mine, I have omitted her name as asked.

Hey Y'all,

Go after Dr. Amy. I just got off the phone with the Commonwealth

of Massachusetts Board of Registration in Medicine. Her license expired in

2003, and I filed a complaint concerning her activity dispensing medical

advice on her website via email for a fee, holding herself out to be

a doctor without currently being licensed and being listed as a consulting

physician on the website iemily.com which gives advice to teens and parents.

I specifically asked if more complaints would be better, and, while she

seemed intent on making sure that I knew my single complaint would be

investigated, she also agreed that more complaints would signal a greater

degree of concern.

So forward this all across this great nation to midwife advocates

everywhere. Too bad her license wasn't revoked, but we can't have

everything. Who knows, maybe the great state of Massachusetts will frown

on Ask Dr. Amy and revoke it or put a strike against her that can then be

used as an additional weapon.

Please don't use my name when you forward this to the national groups.

I've already called her out about her license using my full name, and she

knows where I live... I may have caught the tiger by

Mass Board

http://www.massmedb oard.org/ index.shtm

__._, _.___

Posted 6.27.2008 7:16 PM

AmyTuteurMD

29 comments.

Member since 6/25/2008

The complaint has already been dismissed, after I forwarded the above mentioned post, written by Jennifer A. McFarland, a doula in Pennsylvania.

So obviously, it is not that difficult to find out that I am who I say I am.

Posted 6.27.2008 7:30 PM

Brandy_Baker

12 comments.

Member since 6/27/2008

I will call and find out Monday morning. If you are not licensed, you have no business acting as a doctor. I am finished talking to you.

Posted 6.27.2008 7:59 PM

Brandy_Baker

12 comments.

Member since 6/27/2008

One final post just to clarify my position on this.

There are fields where professionals are not licensed because the states that they live in do not license the field that they are in. Example: Naturopathic doctors cannot be licensed in Maryland because there is no such licensure, but we do have a few who practice here in Maryland. They are limited in what they can do. My criticisms of unlicensed medical professionals are not aimed at them or at anyone who cannot get a license because a certain state does not license a certain field.

But there is absolutely no reason why anyone calling herself an MD, acting as a doctor, and giving medical advice for money, whether on-line or in person, should be not licensed. Absolutely NO reason. If indeed Dr Amy is licensed, I apologize to her, but as stated, I will find out for myself, which is what everyone should do in the debate of home v hospital birthing. Find out who is qualified to speak on this, find out if the person's position is based on research and training or ideology and corporate influence. Both sides should be under intense scrutiny: their medical backgrounds, biases, etc. If something does not sound right research it. You decide.

Posted 6.27.2008 8:34 PM

AmyTuteurMD

29 comments.

Member since 6/25/2008

"One final post just to clarify my position on this."

Oh, the irony! DEMs are providing health care without licenses, but that's okay. Henci Goer has no license to practice medicine or midwifery and never did, but that's no problem. Ina May Gaskin practiced for years without a license and without training of any kind, and that's wonderful. Yet you claim to be deeply concerned that I voluntarily allowed my license to lapse after I retired to stay home with my children.

Homebirth advocates are so frightened by the truth that they are desperately casting about for ways to silence the messenger. It's a more powerful demonstration of validity of my claims than almost any evidence that I can put forth. Homebirth advocates would not feel the need to silence me if they had any evidence to present, but they don't and they are afraid.

Posted 6.27.2008 8:50 PM

dalena

23 comments.

Member since 6/26/2008

"That's just what I have been talking about. You agree with her because you like what she says. She has no idea whether what she has written is true, and she has made no effort beyond surfing the Internet to find out if it is true. It's very easy to find out the truth, but the truth is so prosaic and boring (I'm just an obsetrician who got fed up with the half truths, mistruths and outright deceptions of homebirth advocacy), not nearly as useful in diverting attention as claiming some sort of conspiracy."

Well, no, I agree with her because I have drawn the same conclusions as she has regarding homebirth. If you would say this, I would agree with you. She has a very good idea, and so do I. I think you are the one not looking beyond what you want to see.

Again, you are coming back at me by insulting my intelligence, assuming I cannot possibly come to these conclusions myself.

I think your conclusions are the wrong ones. And no, you are not an obstetrician.

Posted 6.27.2008 8:55 PM

Brandy_Baker

12 comments.

Member since 6/27/2008

No one should listen to ANY "doctor" who is not licensed whether they are pro or anti-homebirth.

Posted 6.27.2008 9:20 PM

AmyTuteurMD

29 comments.

Member since 6/25/2008

"No one should listen to ANY "doctor" who is not licensed whether they are pro or anti-homebirth."

Why?

In any case, I'm not asking anyone to listen to me. I telling them where they can find the information to rebut the false claims of homebirth advocates.

By the way, you won't be able to quote Marsden Wagner any longer, since he no longer has an active license, either.

Posted 6.27.2008 10:05 PM

dalena

23 comments.

Member since 6/26/2008

This is Marsden Wagner's CV:

B.S. University of California at Los Angeles (UCLA)

M.D. UCLA School of Medicine

Internship in pediatrics, UCLA Hospital

Resident physician in pediatrics, UCLA Hospital

Chief resident physician in pediatrics, UCLA Hospital

Post-doctoral Fellow of National Institutes of Health in perinatology (Obstetrics and Neonatology) and perinatal epidemiology at the UCLA Schools of Medicin and Public Health

M.S. Post-graduate degree in perinatology (Obstetrics and Neonatology), perinatal epidemiology and reproductive science, UCLA

EXPERIENCE

6 years Assistant Professor of Perinatology (Obstetrics and Neonatology) and Public Health, UCLA School of Medicine and UCLA School of Public Health

3 years Co-Director, Maternal & Child Health, California State Dept. of Public Health

6 years Director, UCLA-University of Copenhagen Health Service Research Center

15 years Director, Women's and Children's Health, World Health Organization (responsible for Women's and Children's Health in 45 industrialized countries)

Present Private Consultant

Where is yours? When someone who has worked as director of Women's and Children's Health of the World Health Organization (responsible for Women's and Children's Health in 45 industrialized countries) says that home birth is safe, who are you amateur MD to sputter what you sputter?

Women in the USA are 70% more likely to die in childbirth in America than in Europe (and no, I am not going to provide a study, you know where to find them). Despite the most expensive maternity care system in the world, women have lost control over childbirth with disturbing results. And you keep advocating that women are safe in the hospital. You seem to conveniently ignore the sky high c-section rates in hospitals, the use of non-approved drugs for labor, the cascade of interventions and the list goes on.

As Marsden says, fish can’t see the water they swim in. Birth attendants, be they doctors, midwives or nurses, who have experienced only hospital based, high interventionist, medicalized birth cannot see the profound effect their interventions are having on the birth. These hospital birth attendants have no idea what a birth looks like without all the interventions, a birth which is not dehumanized. This widespread inability to know what normal, humanized birth is has been summarized by the World Health Organization:

“By medicalizing birth, i.e. separating a woman from her own environment and surrounding her with strange people using strange machines to do strange things to her in an effort to assist her, the woman’s state of mind and body is so altered that her way of carrying through this intimate act must also be altered and the state of the baby born must equally be altered. The result it that it is no longer possible to know what births would have been like before these manipulations. Most health care providers no longer know what “non-medicalized birth is. The entire modern obstetric and neonatological literature is essentially based on observations of “medicalized” birth.“

If you are right Amy, and if you really cared, then you should provide women with tools to make their hospital births safer. How do you sleep at night indeed, trying to send women to a place where money is the main drive. It is one thing to discredit home birth, it is another to try to convince women that the hospital is the better alternative. Shame on you.

The thing is, you don't care. This is where you differ from everyone else, including those like Marsden who do not have a license anymore: those people actually care about women giving birth. You don't. Just like most OB's, you only care about the numbers you want to see and the money you want to make (do I hear $5,- for a consult again...?) without ever listening to the women suffering from what they are put through during birth and without wanting to see how this is affecting our whole society.

Shame on you.

Posted 6.28.2008 3:04 AM

BirthIsNormal

9 comments.

Member since 6/26/2008

Amy says: "By the way, you won't be able to quote Marsden Wagner any longer, since he no longer has an active license, either"

I guess this means we wont be listening or quoting you either since you're not a real doctor.

Posted 6.28.2008 9:19 AM

BirthIsNormal

9 comments.

Member since 6/26/2008

Dalena says: "And no, you are not an obstetrician."

That reminds me, Amy, I recently had a chat with the district attorney about you "MD" credentials. Seems Mr. Sutter has heard about you before.

Posted 6.28.2008 9:23 AM

AmyTuteurMD

29 comments.

Member since 6/25/2008

"This is Marsden Wagner's CV"

So? He doesn't have an active license, either.

" When someone who has worked as director of Women's and Children's Health of the World Health Organization (responsible for Women's and Children's Health in 45 industrialized countries) says that home birth is safe, "

That is his personal opinion, nothing more. That is not the position of the World Health Organization.

The World Health Organization says (http://www.euro.who.int/HEN/Syntheses/antenatalsupp/20051219_8):

"Home-like settings for childbirth are associated with reduced likelihood of medical intervention. The evidence shows that the number of spontaneous vaginal births is higher, breastfeeding initiation more common and maternal satisfaction better in home-like institutional birth settings compared to conventional institutional settings. However, the evidence shows an increased risk of perinatal mortality, the reasons of which are not fully established. Thus, there is an increased need for monitoring early signs of complications in these home-like settings."

Wagner has written about his pride that both his superiors and his colleagues strongly disagree with his claims about homebirth. You can read his chapter "Confessions of a Dissident" in the book "Childbirth and Authoratative Knowledge" by Brigitte Jordan.

By the way, Wagner is a pediatrician, NOT an obstetrician. Here's what he wrote in the article Infant Mortality in Europe: Implications for the United States. Statement to the National Commission to Prevent Infant Mortality in 1998:

"As an American pediatrician and epidemiologist who worked for 15 years in the pediatrics and maternal and child health and then worked for 15 additional years in Europe in the same fields ...."

Here's what he said about infant mortality:

"Infant mortality is not a health problem. Infant mortality is a social problem with health consequences... [The] solution is not primarily medical but environmental, social and educational ... [The] first priority is ... to provide more social, financial and educational support to families with pregnant women and infants."

I'll be looking for your apology first thing Monday morning. Can't wait. Don't forget to call:

Harvard College where I received my degree in biochemistry in 1979.

BU School of Medicine, where I got my MD 1984.

Boston's Beth Israel Hospital, intership and residency, 1984-88.

Boston' Beth Israel Hospital, practicing obstetrician.

Brigham and Women's Hospital, practicing obstetrician.

Harvard Medical School, Clinical Instructior in Obstetrics.

Be sure to check out my book, "How Your Baby Is Born", Ziff-Davis Press, 1994. You can also look for it in multiple foreign languages including Italian, Portugese and Mandarin Chinese.

Posted 6.28.2008 10:07 AM

dalena

23 comments.

Member since 6/26/2008

Thank you for finally writing down your *past* credentials. What are the dates of the last 3 places? Now your Cv looks like your work ended 20 years ago and you wrote a book out of sheer despair.

Point remains that you are charging money to women who go to your AskDr.Amy site when in fact you are not licensed anymore. Anyone can give advice online about anything. Your information however is taken out of context, selective and sometimes plain false, and you refuse to be held accountable for that. This on top of charging for your information makes you an unethical former OB.

As for your book, based on the back of it, giving you the benefit of the doubt, lets say that you started catching babies in 1984--10 years before this comment about your delivering "thousands" of babies was written. To qualify as "thousands," that means at least 2 thousand. So you were catching a minimum of 200 babies a year??? That would mean you saw 14 prenatal clients (a healthy woman tends to have 14 prenatal visits during pregnancy--even though I read an article once that said that research showed that anything over 8 really didn't improve maternal/fetal outcomes) and caught a baby EVERY working day of the year (52 weeks in the year, 5 work days per week, assume that she took 10 holidays, but no vacation or sick time)."

I have read parts of your book (it's free now, yay) and there are some ridiculous statements in it and you do not present any dangers to the use of most common obstetric practices, nor alternatives to them. The pictures of women on their back are also very helpful.

You write: In almost every pregnancy, the membranes will rupture naturally at some point before the baby is born. In the rare cases that this does not happen, the membranes should be ruptured artificially. This will prevent the baby from being born in caul, which means the head would be covered by the membranes. If this were to happen, the baby would be unable to draw its first breath because it is still within the sac.

Baby gets oxigen through the cord, unless of course it get cut before anyone can even see the baby. You just remove the sac, there is nothing to it. I know so many women who have had a baby born in the caul, your statement is not even funny anymore.

Anyway, there are so many things I disagree with, I won't even go there.

I'll leave you to disagreeing with Marsden on your own. Yours is a personal opinion as well, nothing more and many are coming to see this. Quite a few women are finding Henci's site through yours, thank God.

I do not understand what point you are trying to make by quoting this: "However, the evidence shows an increased risk of perinatal mortality, the reasons of which are not fully established. Thus, there is an increased need for monitoring early signs of complications in these home-like settings."

It says quite clearly that the reasons are not fully established and that birth in home settings have better outcomes.

Perinatal mortality refers to the death of a fetus or neonaete and is the basis to calculate the perinatal mortality rate. Variations in the precise definition of the perinatal mortality exist specifically concerning the issue of inclusion or exclusion of early fetal and late neonatal fatalities. Thus the WHO‘s definition "Deaths occurring during late pregnancy (at 22 completed weeks gestation and over), during childbirth and up to seven completed days of life" is not universally accepted. The perinatal mortality is the sum of the fetal mortality and the neonatal mortality.

And by the way, saying that our perinatal mortality rate is low, that is just not true. They are, in fact, shamefully high for a developed country. It must be all those homebirths...

Well, I'll leave you to it, Amy. I have 4 autonomously home born kids to take care of.

Sleep well.

Posted 6.28.2008 12:40 PM

AmyTuteurMD

29 comments.

Member since 6/25/2008

dalena:

Where's my apology for all your baseless accusations?

Why should we believe your claims about homebirth have any more validity that the fabrications that you made up about me?

"And by the way, saying that our perinatal mortality rate is low, that is just not true."

Sigh. Why do you keep making things up, particularly things that are so easy to check?

Anyone can read the World Health Organization 2006 report on perinatal mortality (http://www.who.int/making_pregnancy_safer/publications/neonatal.pdf). It explains that perinatal mortality is the international standard and the reasons why perinatal mortality is a better measure of obstetric care than any other statistic. In addition, it shows that the US has one of the lowest perinatal mortality rates in the world, better than Denmark, the UK and the Netherlands.

Posted 6.28.2008 1:09 PM

dalena

23 comments.

Member since 6/26/2008

Apology for what? For saying you are not a practicing OB nor MD and make things up? You are currently not an MD nor an OB. The credentials you post here are 20 years old. In those time they put mothers out to give birth, lol.

I may or may not get back to you about that report. It will have to wait for now as I don't have time to sit down for it at the moment.

Posted 6.28.2008 2:39 PM

AmyTuteurMD

29 comments.

Member since 6/25/2008

Obviously I am an MD and an obstetrician, just like Marsden Wagner is still and MD and a pediatrician, even though he, too, is retired. A license to practice is entirely separate.

The real issue is not who am I , but what are the facts. The facts are that homebirth increases the risk of neonatal death and American homebirth midwives have less education and less training than ANY midwives in the industrialized world.

Posted 6.28.2008 3:42 PM

dalena

23 comments.

Member since 6/26/2008

Both those statements are false.

A quote from Care in Normal Birth: A Practical Guide, which is published by the WHO:

So where then should a woman give birth? It is safe to say that a woman should give birth in a place she feels is safe, and at the most peripheral level at which appropriate care is feasible and safe (FIGO 1992 [FIGO is the international Ob/Gyns professional organization]). For a low-risk pregnant woman this can be at home, at a small maternity clinic or birth centre in town . . . (p. 12)

And here is a quote from Sheila Kitzinger, writing in this year's March issue of Birth:

In September 2007 the UK National Institute for Health and Clinical Excellence (NICE) issued clinical guidelines on intrapartum care of healthy women and their babies during childbirth. Under "key priorities" it stated: "Women should be offered the choice of planning birth at home, in a midwife-led unit or in an obstetric unit." Information suggests that for "women who plan to give birth at home or in a midwife-led unit there is a higher likelihood of a normal birth, with less intervention" (p. 77).

Kitzinger K. Letter from Europe: home birth reborn. Birth 2008;35(1):77-8.

As for the canard that U.S. direct-entry midwives are poorly trained, a perusal of the North American Registry of Midwives (NARM) website gives the lie to that.

Thank you and have a good day.

Posted 6.28.2008 4:01 PM

AmyTuteurMD

29 comments.

Member since 6/25/2008

Goer's quote from the WHO is out of date. The WHO said in April 2006:

Home-like settings for childbirth are associated with reduced likelihood of medical intervention. The evidence shows that the number of spontaneous vaginal births is higher, breastfeeding initiation more common and maternal satisfaction better in home-like institutional birth settings compared to conventional institutional settings. However, the evidence shows an increased risk of perinatal mortality, the reasons of which are not fully established. Thus, there is an increased need for monitoring early signs of complications in these home-like settings. (my emphasis)

As far as the NICE report is concerned, Goer didn't even answer the question. She was asked if NICE reports a higher rate of neonatal mortality at homebirth, and they do. From the same report that Goer quoted:

... intrapartum-related perinatal mortality (IPPM) for booked home births, regardless of their eventual place of birth, is the same as, or higher than for birth booked in obstetric units.

* If IPPM is higher, this is likely to be in the group of women in whom intrapartum complications develop and who require transfer into the obstetric unit...

* When unanticipated obstetric complications arise, either in the mother or baby, during labour at home, the outcome of serious complications is likely to be less favourable than when the same complications arise in an obstetric unit.

Goer tried to sidestep the direct question that she was asked about DEM qualifications. American DEMs have less education and training than ANY midwives in the industrialized world. There's no denying it and she didn't deny it.

Obviously, neither claim is a falsehood, so why did Henci Goer say they were?

Posted 6.28.2008 4:21 PM

dalena

23 comments.

Member since 6/26/2008

Ha, I can see you too debating this back and forth for ever. Play of words, using one quote against another, just like Christians of different denominations quote the same book to prove their own points. I know where I stand, and my experiences and that of those around me reinforce my point of view.

In the end, every woman needs to give birth the way she feels is best for her and she needs to find the information and educate herself, regardless of her caregiver. You can't trust an OB because of his or her diploma, nor can you trust any midwife because she is pro homebirth and so everything will go well. In the end I am the sole person responsible for my birth.

Numbers become just numbers on either side of the fence. Women have to follow their own truth as this article shows. These women had the best hopes for a wonderful hospital birth and as so many they came away feeling violated and decided to do it differently next time. A healing experience for them.

Posted 6.28.2008 6:13 PM

joymum

2 comments.

Member since 6/25/2008

I had a hunch/fear that comments regarding this very well written article might turn into a "pissing contest". One of the posters left a disagreeable comment regarding one sentence of my first entry. I knew she would. Frankly, I don't care what she has to say and that is why I would never respond to her directly. She is not worth my time.

What is worth my time is to say yet again what a gret job Michelle Gienow did on this article and what a wonderful surprise to find it in of all places The City Paper. Thank you City Paper & thank you Michelle.

For anyone who has actually stuck with the back and forth comments and has read up to this point. If you are intertested in learning about all of the options you have for giving birth in this country educate yourself. Read, read, read,(pretty much anything except "What to expect . . .") ask questions of women who have had positive birth experiences to find what made them positive and see if their experience fits with what you would like/want for yourself. No one knows you like you do. Trust in yourself.

Posted 6.28.2008 9:46 PM

aaronrobinette

1 comments.

Member since 7/1/2008

hahahah, this is a strange day. i live in Czech Republic and i just had a home birth. everybody talks about home birth being popular in Europe. i am in Europe (Eastern Europe) but when we told our friends and family about having the baby in our home (relaxed and natural)...well, you should have seen the responses (not very pleasant). people went nuts because they have been fed by people like that AMY freak above that natural home birth is DANGEROUS...BOOOOOOOO. of course we have a very lovey perfectly healthy little girl...yeaaaaa. the only differece i can see is that my wife is proud of her pregnancy and guess what....all the friends and family are totally loving it!!! i dont recall any of her 7 friends in the past year who have had children light up with joy when they share their story...and 2 of them had the C-sections and ALL of them had nice synthetic medicines to help...FUJ!!! Our birth was so easy and our homeopath and midwife gave love and support in the 6 hours of labor. Czech doctors would have hormonoly induced her after 4 hours and gave her a nice CUT...can you imagine someone doing surgery for no reason???? this is the first time i have ever written a comment on-line and i have to say after reading all the crap above, i really dont care if you go to a hospital or do a home birth...some people are not meant to be strong and in control of themselves...they need to be treated like sheep and steered throughout most things in life that take strength. so be strong and have homebirth or be a SHEEP. oh yea and i am a vegan for over 20 years so i will be dead soon and my child will have major deficiencies i am sure...AHHHHHHHHHHHHHHHHHHHHH!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

what is wrong with you people??????????????????????????//

Posted 7.1.2008 1:30 PM

B Smarter

6 comments.

Member since 5/7/2008

Since Amy Tuteur MD felt the need to publicly post the name and town of someone who spoke out against her, I figured I'd do her the same favor.

Amy Tuteur 14 Horizons Rd. Sharon, MA 02067

MJTuteur@AOL.com

Aren't all of these public info sites a wonderful thing?!

Her husband's name is Michael.

She donated $500 to John Kerry for president in 2004.

Go back to Mass and keep your stupid nose out of our journals down here.

Posted 7.1.2008 2:13 PM

informedchoice

5 comments.

Member since 6/26/2008

I will repeat : I feel physically ill when I think of the number of women she is coercing into changing their minds from birthing where *they* feel is safest.

...and routinely subjecting women and their unborn to the obstetrical atrocities taking place in hospitals throughout North America.

Amy Tuteur, while not a licensed physician, is a woman, and that another woman can be so entirely unrelenting in her quest to subject women to unnecessary birth trauma is beyond me.

I feel sorry for you, Amy, as well as for your children, who likely never see the light of day, but are cooped up with you (their mother, who is no longer practising in order to be at home with her children... ?), in front of the computer during all your waking hours, propogating mass fear and paranoia of ourselves and our bodies all over the Internet.

One sick puppy, indeed.

Posted 7.1.2008 3:25 PM

SBG

1 comments.

Member since 7/1/2008

Great article. Women should be allowed the right to choose where they give birth and with whom. Whether other people agree that that choice is safe is beside the point. My first was hospital-born, my second born unassisted at home. I know which was preferable for me, no doubt.

Homebirthers do not believe hospital birth should be illegal, that OBs should be arrested for attending births in that setting. We don't believe women should be forced into the hospital. Most of us don't judge other women for how or where they give birth. We simply ask for the same respect.

And if people would quit responding to this Amy character, she'd lose all her power. Ignore her blog, ignore her posts everywhere. She's clearly a bit obsessive and an extremely negative person-don't validate her with your passion. She doesn't deserve it.

Posted 7.1.2008 6:52 PM

dalena

23 comments.

Member since 6/26/2008

Just for the record, Amy has tried and tried again to misrepresent the study she claims does not prove that home birth is safe. This exchange is but one of the few and very enlightening:

http://birthwithconfidence.blogs.lamaze.org/?p=113#comments

It is the same thing over and over again.

Also, you can find all the information you need about the Johnson and Daviss study and how it is misinterpreted by Amy on Henci's forum. This also goes for what the WHO actually said about home birth. It is again, not what Amy concludes it is.

Just FYI for those who wish to read more about this and make up their own minds. It's about time Amy kept her mouth shut.

And a correction: I meant neonatal mortality, not infant.

Posted 7.2.2008 3:08 AM

AmyTuteurMD

29 comments.

Member since 6/25/2008

dalena:

"http://birthwithconfidence.blogs.lamaze.org/?p=113#comments"

In the original paper, Johnson and Daviss tried to scam people by inflating the neonatal mortality rate in the hospital group. Now that the scam has been exposed, they are going to scam people by simply pretending that the homebirth group had a lower death rate than what they originally claimed.

In other words, Johnson and Daviss originally said that homebirth in 2000 had a neonatal death rate of 2.6/1000 (including congenital anomalies). Now that I've pointed out that the neonatal death rate for low risk hospital births in 2000 was 0.9/1000, they've responded: Did we say the death rate for CPM attended births in 2000 was 2.6/1000 (including congenital anomalies)? Guess what, we just discovered we were wrong. It was actually 0.9/1000. Lucky for us that we figured that out at the same time someone publicly accused us of using the wrong numbers for the hospital group in 2000. Oh, and the hospital neonatal death rate in 2000 was 0.9/1000? What an amazing coincidence!

However, we can apply the same adjustments that Johnson and Daviss applied. According to the 2000 dataset on CDC Wonder, in the group of white women, 37+ weeks, 2500+ gm, with singletons who delivered in the hospital in 2000, we find that there were 1863 deaths, of which 1001 were due to lethal congenital anomalies. That means that the neonatal death rate for hospital birth in 2000 was 0.34/1000 after we performed the EXACT SAME adjustment that Johnson and Daviss performed on the homebirth data. Now that the groups are once again comparable, the neonatal mortality rate for homebirth in 2000 is STILL almost TRIPLE the neonatal death rate for hospital birth in 2000.

Now that Johnson and Daviss have been caught trying to trick, they've simply switched to a new way of trying to trick people.

Posted 7.2.2008 8:07 AM

Deedee24

1 comments.

Member since 7/2/2008

This article was really eye-opening and well-thought out, the best article I've read in the City Paper since moving to Baltimore a few months ago. Thanks!

The current debate in these comments seems to be less well-thought out, because both sides (esp "Dr. Amy") are forgetting that home births in the US do not exist in a vaccuum. This is not a choice between the cave man era and complete submission to the medical establishment. This is about women learning about their options and taking advantage of everything available to them, based on what makes sense to them. Just because you have a home birth does not mean that you have to forgo all the benefits of the medical system. In many states certified nurse midwives may attend home births. They are often affiliated with hospitals and OB-GYN doctors, and don't have to "rely on the local emergency room" if there's a last-minute complication. There's also the in-between route of a birthing center, which has all kinds of modern medical equipment, but they don't push intervention on mothers like hospitals do (and of course they can't do surgery).

Another important and completely overlooked point is that home births are safer in this country than in developing countries (and in the past) because they are backed up by a pretty good medical infrastructure. You can get really good pre-natal care, educate yourself about the risks, and get help from good medical professionals. Just because you're having a home birth does not mean that you're rejecting the entire medical system. Even if the infant mortality rate for home births is double that for hospital births, they are both still very low rates- double almost zero is still almost zero.

Personally, the idea of giving birth in a hospital is repulsive to me. I get very anxious from routine medical procedures, which tends to make these things worse. I've had doctors yell at me for being afraid- some doctors are complete jerks, and from what I've heard about OB's delivering babies they are no better (i'm not just basing this on what i've read, this observation is based on what i've heard from friends). I know that I would do much better giving birth at home or in a birthing center, with a CNM who has ties to doctors. If I have a low-risk pregnancy, I'm going to try really hard to do that.

Posted 7.2.2008 11:52 AM

dalena

23 comments.

Member since 6/26/2008

Well shame on them then.

There are other studies that conclude home birth is safe though,

Posted 7.2.2008 11:59 AM

hathorthecowgoddess

1 comments.

Member since 7/3/2008

For me all the statistics in the world and they're all there for us all to interpret as we like (and statistical arguments always get bogged down this way, with the 'business as usual' side claiming that all statistics that work against their argument are flawed in some way, and asking over and over for the other's 'sources' and claiming that the other's sources aren't good enough, because they aren't 'mainstream'. Believe me I've been in my share of these debates!) don't matter as much as experience.

I'll listen happily (though squirm in my seat a bit) to Michel Odent talk about the saftety of the c-section and why we still shouldn't do it as much, because he's performed a LOT of c-sections, but he's attended a LOT of homebirths too. Marsden Wagner has worked within the mainstream medical model and then has worked in the homebirth movement, I'll listen to his 'facts' and his 'opinion'. He's seen both sides.

I've had 3 births, 1 in the hospital where I was lucky to have an overworked OB who didn't have time to deal with me and my 'natural' birthplan, she was SHOCKED when I started pushing 30 seconds after she performed a vaginal exam and declared I was at 2 centimeters. I gave birth about 10 minutes later and she was visibly irritated with me.

I had a midwife attended homebirth with my 2nd,

and a 3rd unassisted homebirth.

I feel qualified to speak on the differences (physical, psychological and emotional) between the three different births. very qualified.

I would give "Dr." Amy an ear if she had EVER given birth at home. I would perhaps even give her a listen if she had ever 'attended' a homebirth (though that fact would need to be verified first) But there is no way to officiate a debate of this nature without knowing at least a little bit about both sides. Funny, many nurses and OBs will choose to homebirth themselves, though I don't remember many midwives or other homebirth advocates choosing hospital birth. Perhaps it's birth satisfaction, an outcome that's not quantifiable, but wouldn't it be great if it could be?

http://www.thecowgoddess.com

Posted 7.3.2008 1:28 PM

knitted

1 comments.

Member since 7/3/2008

DA: "Anyone can read the World Health Organization 2006 report on perinatal mortality (http://www.who.int/making_pregnancy_safer/publications/neonatal.pdf). It explains that perinatal mortality is the international standard and the reasons why perinatal mortality is a better measure of obstetric care than any other statistic. In addition, it shows that the US has one of the lowest perinatal mortality rates in the world, better than Denmark, the UK and the Netherlands."

Okay...I did.

Right away I came across this quote:

"Neonatal deaths and stillbirths stem from poor maternal health, inadequate care during pregnancy, inappropriate management of complications during pregnancy and delivery, poor hygiene during delivery and the first critical hours after birth, and lack of newborn care. Several factors such as

women’s status in society, their nutritional status at the time of conception, early childbearing, too many closely spaced pregnancies and harmful practices, such as inadequate cord care, letting the baby stay wet and cold, discarding colostrum and feeding other food, are deeply rooted in the

cultural fabric of societies and interact in ways that are not always clearly understood."

Funny...to hear DA talk, reductions in neonatal mortality are SOLEY due to the implementation of obstetric technology and have NOTHING to do with implementation of hygenic procedures, or about maternal nutrition during pregnancy. And yet both of these are mentioned by WHO.

I read/skimmed all the text of the booklet. I noted charts that showed that perinatal mortality had reduced more drastically in the "North American region" in the 5 years between data collections than in various European regions. YAY North America! However, this could explain why natural childbirth advocates say that countries like "Denmark, the UK and the Netherlands" have better perinatal outcomes than the US...they are using data that was the most current up until 2006, and most likely were unaware of the 2006 WHO report.

However...I will point out that the perinatal mortality rate in the US is 7 per 1000, while in these three countries it is only marginally higher at 8--hardly shocking. Especially considering that all 3 of the countries have a lower neonatal death rate than the US, resulting in all of the countries (US, UK, Denmark, and Netherlands) having the same combined stillbirth plus neonatal death rate of 9 per 1000. Goodness...hardly a condemnation of homebirth in those 3 European nations.

Further, while the US perinatal death rate is certainly very good in comparison to the whole world, I doubt it is quite as good as most Americans would assess it. Where would most Americans assess it? Top 5% of countries? Top 10% if they are feeling "humble?"

Nope. Out of 159 countries with data in the report, 19 have better perinatal outcomes than the US, and 9 are the same (7 of those have better neonatal rates). This results in America being at about the 82nd percentile when it comes to ranking against the world--82.3% of countries have data that is worse than the US, while 17.6% have data that is better or the same (11.9% are "better," 5.7% are "the same").

Interestingly...2 of the 3 countries that my ancestors hail from (Sweden and Austria) have better perinatal death rates than the US, while the 3rd (Germany) has the same. Hope that means that I come from "good stock!"

Posted 7.3.2008 4:04 PM

AmyTuteurMD

29 comments.

Member since 6/25/2008

Hathor:

"I would give "Dr." Amy an ear if she had EVER given birth at home."

Since when is the truth of a claim dependent on whether it was made by someone from your cultural subgroup?

The scientific EVDIENCE shows that homebirth increases the risk of neonatal death.

American direct entry midwives (including CPMs) have less education and training than ANY midwives anywhere else in the industrialized world, and could not be licensed in any other first world country.

Those claims are FACTUALLY true.

One of the great things about the truth is that it does not depend on whether the person who says it is an ally or an enemy. The fact that you acknowledge that you judge a claim based on WHO says it, rather than WHAT was said, merely indicates that your primary concern is supporting your point of view, regardless of the truth.

Posted 7.3.2008 5:27 PM

hooved_goddess

4 comments.

Member since 7/3/2008

I'm sorry dr phill, oops, i mean amy, but as a fledgeling cow goddess myself, i'm going to hafta go with hathor on this one. My mate and I are expecting our first, and we've decided to do a home with midwife for our first (and hopefully unassisted for any more afterwards). I'd trust the experience of someone who's "been there done that" over a phoney doctor with no credentials.

~Aditi

(btw hathor i'm a big fan of your work, even before i was expecting ^..^)

Posted 7.3.2008 7:35 PM

dalena

23 comments.

Member since 6/26/2008

"American direct entry midwives (including CPMs) have less education and training than ANY midwives anywhere else in the industrialized world, and could not be licensed in any other first world country.

Those claims are FACTUALLY true."

Where do you base this on, Amy? As far as I know, it would be hard to really be able to compare information about this since midwives are so different in different countries. Show me a comparative study with facts that substantiate your statement.

Also, from what I can read online is that CPM is a recognized credential and a competency based credential. The North American Registry of Midwives (NARM) is an international certification agency whose mission is to establish and administer the credential called the Certified Professional Midwife (CPM). NARM was created in 1987 by the Midwives Alliance of North America (MANA) and is committed to identifying standards and practices that reflect the excellence and diversity of the midwifery community. The guidelines for certification were developed through a series of certification task force meetings and the 1995 Job Analysis of the Role of Direct-entry Midwives, which was based on the MANA Core Competencies. The NARM Written Examination, Skills Assessment, and the CPM credential follow the psychometric guidelines and standards for excellence formulated by the National Organization for Competency Assurance (NOCA). The NARM Written Examination is used as the regulatory examination in twenty-four (24) states that offer direct-entry midwifery regulation.

Posted 7.3.2008 8:49 PM

AmyTuteurMD

29 comments.

Member since 6/25/2008

"Where do you base this on, Amy?

I base it on the published requirements that are easily accessible to anyone.

Nurse midwives have a college degree, a masters in midwifery, and extensive hospital based training in recognizing and managing complications.

European midwives have a university degree, and extensive hospital based training in recognizing and managing complications. They work in hospitals and at home and switch between them.

American DEMs (including CPMs) have only a high school degree, and attend storefront midwifery "schools" accredited only by themselves (MEAC). Many attend by mail. Credits from midwifery schools are not accepted by most colleges and universities. They have no experience in diagnosing and managing complications.

American DEMs cannot be licensed in any other country in the first world unless they undertake additional education and training.

Posted 7.4.2008 10:38 AM

AlexisT

7 comments.

Member since 7/4/2008

"I'll listen happily (though squirm in my seat a bit) to Michel Odent talk about the saftety of the c-section and why we still shouldn't do it as much, because he's performed a LOT of c-sections, but he's attended a LOT of homebirths too"

And then will you, once again, quote his nauseating theory about how the lack of oxytocin changes babies' brains, and how we're raising a loveless generation? Your little "cartoon" on that one is one of the most offensive things I (and the other CS mothers I know) have ever seen. Not that any of your work is at all funny or thought provoking. (And I'm an AP, crunchy mama.)

The problem with the poor US neonatal mortality rate is that we don't have good prenatal care, or follow-up care for mothers and babies. This means we get smaller, sicker babies who are harder to treat. Birth is not the cause of most of these problems.

Posted 7.4.2008 12:18 PM

AlexisT

7 comments.

Member since 7/4/2008

Knitted, the other problem with comparing the US to Europe is that European home birth midwives work in an entirely different context. (I lived in the UK for 4 years and delivered my daughter there.) They are trained more like CNMs. They work in collaboration with OBs. They have strict risk out policies and accompany patients into hospital (attending them there if possible) if transfer is necessary.

In addition to being trained in all facets of midwifery, a UK midwife needs to do what is effectively a "training year" before being allowed onto a community midwifery team. A DEM can do their preceptorship, get the CPM and immediately go into solo practice.

if US midwives want homebirth there to be as safe as it is in Europe, they need to train and practice like European midwives. Right now, the leadership of direct-entry midwifery is against any compromise with the "medical model" of birth. They claim this is due to prejudice, but the facts are that a large part of the blame is on themselves. They've shown little enthusiasm for expanding their practice, integrating their training with the wider medical system or adopting the Certified Midwife route to non-nurse midwifery (the CM requires a masters degree in midwifery, similar to the MS that CNMs have). Many DEMs will explicitly argue against it.

The NARM standards aren't as good as ACNMs (a blogger had a very illuminating comparison and was forced to take it down) and even the minimal regulations can be skirted--you can go to a non-MEAC school and still get your CPM. There is too much reliance on the single preceptor method.

Posted 7.4.2008 12:28 PM

AlexisT

7 comments.

Member since 7/4/2008

Do their apprenticeship, even. D'oh.

Posted 7.4.2008 12:29 PM

hooved_goddess

4 comments.

Member since 7/3/2008

"I base it on the published requirements that are easily accessible to anyone"

now where's YOUR citation? hmm? I want to see these publications!

and btw, it's obvious from the fact that you were ever even once a "MD" that all the certificates in the world don't guarentee that some one's qualified for their position. i'd rather put my child's and my own lives in the hands of someone who has years of personal experiance and only a HSD than someone fresh outta med school with all the papers in the world.

Posted 7.4.2008 1:42 PM

dalena

23 comments.

Member since 6/26/2008

I see your logic, Amy, but knowing both midwives in the US and Europe, I can attest for both of their knowledge and competence. Their hands on experience is equivalent and the US training adequate.

Also, if you are correct, then our first goal should be to foster the creation of a higher degree program in the US, not the opposite, making home birth illegal which is the direction OB's want things to go.

No midwife from another country can come here and be licensed without passing tests or the like here either.

Posted 7.4.2008 2:24 PM

AlexisT

7 comments.

Member since 7/4/2008

Dalena, we HAVE higher degree programs in the US. As well as CNM programs, SUNY Downstate offers the MS Midwifery for non-nurses. But it's an orphan program and DEMs don't support its expansion. CMs are only legal in 3 states, and when DEMs push for licensing, they don't mention it, just the CPM.

Posted 7.4.2008 2:35 PM

AlexisT

7 comments.

Member since 7/4/2008

hooved_goddess, your statements are ludicrous. No, of course idiots pass med school (or anything else). But no one considers a freshly minted MD qualified to do anything. They aren't even licensed for another year.

Of course, personal experience is no good if you develop a major complication that your DEM hasn't been trained to handle.

Posted 7.4.2008 2:37 PM

faeriemama

1 comments.

Member since 7/4/2008

Hmmm... methinks "AlexisT" = "Dr" Amy. Nice try, but we're not that dumb.

Posted 7.4.2008 4:46 PM

AlexisT

7 comments.

Member since 7/4/2008

Now that's ridiculous. I'm absolutely not Dr Amy in any way shape or form, and if you quizzed me on my medical knowledge you'd soon realize that. (Or the site managers could confirm that my computer is physically located a few thousand miles from DA.) Is it so hard for some of you to believe that some people have quit drinking the HBA kool-aid?

Posted 7.4.2008 4:59 PM

wiffersnapper

1 comments.

Member since 7/4/2008

OK...two things stand out to me. Let's just say that the prenatal care given by most doctors certainly isn't responsible for their positive outcomes. When I was pregnant with my first, I used a large ob-gyn practice. My prenatal appointments were about ten minutes long, if that. They weighed me, scolded me for gaining too much weight (although they never gave me suggestions for NOT gaining weight!), took my blood pressure, and sent me home. I was required to have vast batteries of tests, even though I didn't have any risk factors for anything that they were testing for. At one point, they took so much blood from me that I was woozy, and then sent me home that way!

Secondly, one of the posters alluded to midwives who run into complications "dumping the mother on the emergency room". Where I live, the midwives have an agreement with the local hospital. There is no dumping- the midwife stays with the patient even after the transfer to the maternity ward, not the emergency room. I'm sure that isn't the case everywhere, but I wanted to point that out.

Midwives are specialists. They do one thing- they deliver babies. I'd think that just repetition itself would make them more skilled than someone who does many different things every day. There is a place for ob-gyns- women who do truly have problems. But for a low-risk, healthy woman, midwives have been proven to be safe.

Something else that wasn't mentioned- how many of the women who have "complications" are women who had trouble getting pregnant and required medical assistance? Should they even be pregnant in the first place? It is my experience that, if your body won't do something, there's a reason. How many doctors will help a woman get pregnant without paying attention to whether or not she can actually handle the pregnancy physically?

Posted 7.4.2008 8:17 PM

AmyTuteurMD

29 comments.

Member since 6/25/2008

"Midwives are specialists."

That's baloney. Direct entry midwives like to pretend that because they know nothing about diagnosing and managing complications of childbirth, they are "specialists" in uncomplicated birth. That makes about as much sense as a "direct entry" meteorologist who doesn't know how to predict bad weather but is a "specialist" in watching the sun shine.

Posted 7.4.2008 10:10 PM

hooved_goddess

4 comments.

Member since 7/3/2008

taken from askdramy.com:

"Disclaimer: Dr. Amy does not and cannot provide medical advice. Only someone who has examined you and reviewed your medical records can provide advice. Dr. Amy offers explanations and information"

if that's the case, you have no room terrorizing women like you are, your own website says so! and she still didn't answer my question on citing her sources.

and after some research, Amy, i have found that here in florida "Direct Entry Midwives must complete 3 years of school, not counting prerequisites, and pass the national exam. Licensing is very strict, these are not just random women with no education. They have studied at either a private school or public college and then interned as well, and passed a rigorous examination"

basically all that i can tell from my research is that since this amy always uses her real name even on anonymous boards, i deduct that she is simply attempting to get her name all over the web and get hits to her website. and on every board she posts to, she sits there like a child with her fingers in her ears screaming for citations and ignoring citations given, but shutting up like a clam when asked to do the same in return.

Posted 7.5.2008 12:57 AM

hooved_goddess

4 comments.

Member since 7/3/2008

I have just submitted this Amy's address and phone number to her local crimestoppers as well, for giving medical advice without a liscence is unlawful.

(nobody else on here was giving advice, but simply quoting statistics and sharing personal stories, so no one, on either side of the argument, was wrongdoing. just this amy lady)

Posted 7.5.2008 1:23 AM

dalena

23 comments.

Member since 6/26/2008

And that is what makes home birth safe, Amy. Midwives will transfer a woman developing complications. And, you are wrong, they do know about diagnosing. Unlike OB's, they are not trained in serious complications, nor do they need to be. This is the realm of the OB, just as normal natural birth of low risk women should be the realm of midwives. European midwives do the same thing, transferring when they risk out, and the beauty is that they mostly work with OBs and enjoy respect, not condescension. I really think you do not have a clue about the competency of midwives, nor the beauty of home birth.

But of course, we are never going to agree about this. You seem to hang the danger of homebirth up on this one study that according to you shows the opposite, which the researchers themselves acknowledged. There are many more studies about the safety of homebirth, and even though they are older, I can only imagine that things are better now, unlike for example the sky high c-section rate in the US (has anyone looked into the outcome of those?), the shameless off label use of Misoprostol/Cytotec which has set so many women up for a VBAC and now is probably the main reason VBACs are rarely allowed (shame on you ACOG) and the absolute non-sense protocol of anti-biotic treatment for GBS, to name a few.

For readers interested, I found this interesting about the Johnson and Daviss study http://understandingbirthbetter.com/section.php?ID=31&Lang=En&Nav=Section

To quote Ronnie Falco: "In many of my conversations with hospital-based birth attendants, they'll inevitably recall labors where things went very bad very quickly. However, in asking more questions, it is almost always the case that dangerous hospital-only interventions were being used, e.g. intrapartum pitocin and/or anesthesia. Yes, artificially rupturing membranes can cause cord prolapse or rupture a velamentous insertion, and babies can crash very quickly after that. Yes, women with epidurals can have their blood pressure bottom out, and babies can crash very quickly after that. Yes, women on pitocin can experience uterine hyperstimulation, and babies can crash very quickly after that. Yes, babies born under the influence of narcotics may have a lot of trouble adjusting to breathing air, and they may require special drugs to reverse the effects of the narcotics. However, these dangerous procedures are not done at home, so these intervention-caused complications will not be seen at home.

Many hospital-based practitioners have never actually seen a normal, physiological birth, where a woman is free to get into the position that her body tells her is best for her baby, often upright during much of labor, keeping baby off the cord, or sometimes on hands and knees for pushing, helping to rotate baby anterior to prevent shoulder dystocia. If you have no experience with homebirth, then it's going to be very difficult to imagine how homebirth can be safer."

Here are some more studies about home birth safety http://www.gentlebirth.org/archives/homsafty.html#Pre1998

Also, according to this study, the safe interval for emergency caesarean section is 75 minutes. Safe interval for emergency caesarean section is 75 minutes, with a goal of 30 minutes. For most homebirths this is ample time. In normal birth, "emergencies" usually develop over the course of hours rather than minutes, especially when they're not actively caused by interventions such as artificial rupture of membranes, administration of pitocin, spinal/epidural anesthesia or pulling on the umbilical cord to deliver the placenta.

Also, http://www.bmj.com/cgi/content/full/322/7298/1330

The current recommendations for the interval between decision and delivery are not being achieved in routine practice. Failure to meet the recommendations does not seem to increase neonatal morbidity.

It seems to me that with the proper preparation and care, there is no need to not labor and give birth at home for the low risk woman. It seems to me that the ACOG has made and is still making so many blunders, that they should not have our trust.

Posted 7.5.2008 1:25 AM

mim

2 comments.

Member since 7/5/2008

There are direct entry midwives in the UK, and they can enter without having completed high school - they just have to have an "Access" course.

this has details of the courses at a well thought of university (for midwifery).

Note one of the continuing development courses is "making normal birth a reality".

Don't go idolising European midwives until you know what they study and how. It could well be that the apprentice lay midwives have done EXACTLY the same studies as a UK midwife - the majority of a midwifery course is spent on clinical placement.

Posted 7.5.2008 4:15 AM

mim

2 comments.

Member since 7/5/2008

OK, it lost the link

http://courses.tvu.ac.uk/PublicSearch.aspx?SearchType=adv&KeyWord=midwifery&rptindex=1&isSorted=0&img=img&sortname=null&count=0&PageSize=0&Sub=Select&SubjectAreas=Select&StudyLeavel=&Mode=Select&Campaign=Select&Quali=Select&Location=Select&LocationReal=Select&Duration=Select&International=radInternational2&Year=&Month=&Ccode=&RC=Select&Faculty=Select&Department=Select&swKeyWord=&swTitle=&swAward=&swStudyMode=&SearchMode=simple

Posted 7.5.2008 4:16 AM

dalena

23 comments.

Member since 6/26/2008

Thank you, mim. The same is true for other European countries. There are different levels of education for different positions.

Posted 7.5.2008 12:21 PM

AmyTuteurMD

29 comments.

Member since 6/25/2008

mim:

"It could well be that the apprentice lay midwives have done EXACTLY the same studies as a UK midwife"

But they haven't. That's the point.

Let's compare the clinical requirements for an EU midwife and a US DEM (DEM data from Birthingway Midwifery School requirements, a MEAC accredited school):

EU midwife------------------------- DEM

100 ----- pre-natal examinations----- 75

40 ----- deliveries----- 25

40 ----- caring for high risk patients----- none

100 ----- postpartum patients----- 40

40 ----- newborns who need special care----- none

So when it comes to clinical requirements, DEMs have 25-60% LESS experience caring for healthy women, and NO experience caring for pregnancy complications and NO experience caring for newborn complications. This illustrates one of the central (and in my opinion, unacceptable) shortcomings of DEM training; there is no experience diagnosing and managing complications. Anyone can catch a baby; no special training is required. The most critical function that a birth attendant can perform is to diagnose and manage complications. DEMs have literally no clinical training in doing so.

Now let's look at coursework. At the Birthingway Midwifery School REQUIRED courses include:

Botanicals I and II?

Plant Medicine I, II and III?

Homeopathy????

Chinese Medicine?

Other Modalities: Introduction to a variety of alternative healing modalities including chiropractic, FLOWER ESSENCES, and AROMATHERAPY.

So out of 42 required courses, 8 are complete garbage, unscientific, and inane.

The remaining 34 courses include:

Medical terminology - simply learning definitions.

Midwifery culture?

3 courses about communicating with patients

Running a midwifery practice?

Of 42 required courses, 14 (of which 8 are a total joke) have nothing to do with delivering babies.

Some of the electives are truly bizarre:

Birth Stories in Life and Literature - Read, write, and tell birth stories while learning and EXPLORING EFFECTIVE STORYTELLING TECHNIQUES.

and my personal favorite:

Introduction to Vibrational Healing - Discussion of VIBRATIONAL MEDICINE and how it relates to health and HEALING FROM THE CENTER OUTWARD TO THE PLANET. Course focus is on ASTROLOGICAL MEDICINE and GEMSTONE ENERGY within midwifery. Didactic knowledge is integrated with experiential, hands-on learning and observation.

The course requirements for a degree in midwifery are pathetically inadequate and nothing short of appalling. Plant medicine? Homeopathy? VIBRATIONAL HEALING? It sounds like some sort of joke. Unfortunately, this is what passes for "education" among direct entry midwives.

Posted 7.5.2008 1:11 PM

dalena

23 comments.

Member since 6/26/2008

OB's may very well have less interventions and a lower c-section rate if they would include alternative treatments, Amy. They should try it. I actually know a couple of MD's who use alternative medicine professionals in their practices and the results are phenomenal.

Also, I have 4 children and have never done anything but.

As for the requirements, like I said different positions will require different training and there are different trainings. A DE midwife does not take care of complicated pregnancies, though she is able to diagnose them, nor of newborns who need special care. Those are risked out and/or transferred. Their core knowledge for is similar and adequate for normal birth.

You are comparing apples and pears by comparing a nurse midwife education with direct entry midwife education and their work field. The nurse midwife education is different from the DEM education in the US as well. We can disagree about the quality of course.

Posted 7.5.2008 2:57 PM

AlexisT

7 comments.

Member since 7/4/2008

You're setting up a false equivalence. The issue is not direct-entry, per se, because European countries do show that it works, as does the Certified Midwife qualification for non-nurses. Yes, British midwives have a 3 year (all BSc degrees are 3 years) degree. (by the way, the "Access" course is for all people who have not finished the sixth form; it's something like high school equivalency, and you can get onto a variety of degrees with it.) It is the nature of the training that matters. European midwives are better trained because they study in accredited universities, with faculty who have done advanced study in their fields. Half their course consists of clinical placements in a variety of settings--community and hospital based. Unlike an American DEM, a British midwife experiences all facets of birth. A American DEM never does a hospital placement, or a clinic, except possibly the ones at Miami-Dade (only course offered by a "real" college). I gave birth in an NHS hospital and was cared for--despite being a high risk pregnancy admitted for pre-eclampsia--by midwives in collaboration with obstetricians. The way a UK midwife practices is much more like a CNM. They are trained in handling complications (to a point) and they need to be--because a high risk pregnancy is not simply a matter of handing the patient off to an OB. Or, in the case of some DEMs, simply abandoning a patient--a practice not exclusive to illegal states, by the way. A CNM or European midwife does not have to hand off her patient. She can collaborate with the OB. This is not possible for most DEMs.

Dalena, you're committing the critical errors of homebirth advocacy. First, you set up the strawman argument (that people who don't support homebirth do support all of ACOG/AMA's positions or the practices of many obstetricians). Second, you swallow and regurgitate the rhetoric of people like Ronnie Falcao who create a false dichotomy between evil, depersonalized hospital birth (which is more common than it should be, but is not universal) and gentle, caring home birth. I have heard HBAs say--to my face--that these problems are inherent in hospital birth, and that the only way to have an "intervention free" birth is to avoid the hospital. "Dangerous interventions like pitocin and anesthesia"? That's ludicrous. I'll be the first to say that there are OBs who love to push the pitocin, but it is not a "dangerous intervention".

Posted 7.5.2008 3:01 PM

Christina

1 comments.

Member since 7/5/2008

Congratulations to the author for a very interesting article.

The debate above is saddening, because it represents what really chills me about birth in the US: the subject has become so polarized that people become intently focused on who is "right" (or who can/is authorized to navigate statistical studies), that they forget that each birth is about bringing a new life into the world in a way that is safe and positive for baby, mother, and family.

Both my births were low-risk, wonderful experiences -- one in a hospital with a midwife, and one at home. The discovery of midwifery care was a revelation for me (unfortunately, or fortunately perhaps, one borne out of flight from an OB who officiously put down my questions about interventions by telling me HE had done thousands of births). I would have been pleased to repeat the hospital experience, but apparently for economic reasons, midwives were squeezed out of that hospital. So by time #2 came, homebirth was the only midwifery option that I felt comfortable with.

In my view, we should be less focused on compelling even low-risk mothers to stay in the hospital under obstetric care and more focused on improving the conditions for healthy outcomes all around -- by improving and providing universal access to prenatal and neonatal care, by finding ways to challenge the "political economy of childbirth" and support midwifery care in cooperation with the medical establishment, and by breaking down legal roadblocks that drive some mothers and midwives underground.

One of the posters above expressed the hope that her daughter would be able to freely choose among a range of options; as someone who ultimately did have access to satisfactory options but who withstood tremendous psychological pressure to realize them, I also hope that attitudes toward people whose values and priorities may be different from the mainstream could become more respectful.

Posted 7.5.2008 4:47 PM

dalena

23 comments.

Member since 6/26/2008

Yes, it is

http://www.medicalneg.com/practice_birth_poil.cfm

http://www.childbirth.org/articles/pit.html

http://www.massagetoday.com/archives/2006/03/11.html

The Food and Drug Administration and the Physician’s Desk Reference, the bible of information on drugs, recommend against elective inductions. The FDA “disallows” it; the PDR says, “Since the available data are inadequate to evaluate the benefits-to-risks considerations, Pitocin [the trade name for oxytocin] is not indicated for elective induction of labor.”

All procedures and drugs used to induce labor can have a potentially adverse effect. Do you need links?

Posted 7.5.2008 5:04 PM

Helenkww

6 comments.

Member since 6/26/2008

Why have I not heard one word on how you want to help the problem? Dr. Amy why as an Ob-Gyn have you not chosen to help women have in hospital natural births if you really are so worried about them? I find your comments to be complete hypocrisy when you do not want to be part of the solution? One of my friends is an Ob-Gyn. He does natural births in hospital with no intervention in over 95% of his births. He will birth breach unless it is transverse or there are other complications and he has a less then 5% c-section rate - he averages less then 4 hours on all women from transition to birth and women love him. He gets strange comments from nurses who are new to him like "should I prep for the pit now" and "how would you like me to prep for the c-section " when he does not plan to do these techniques and he believes it is because the nurses are so conditioned to intervene. He has had no problems with any of his births and not problems with any of the babies or Mom's and the proof of this is that his mal-practice insurance is the lowest possible in our state. If you really sincerely care about women then why are you not part of a solution to help them? Why are you not an advocate for natural birth in hospitals? It is hard to take anyone seriously when they do not want to help and only want to blame. I wish you good will and the healing you obviously need and I hope you find a great therapist who can help you so that one day you can live a life with less anger and animosity.

Posted 7.5.2008 5:11 PM

dalena

23 comments.

Member since 6/26/2008

Wow, gone again...

Here the post I posted for anyone interested:

Well, I will repost the links again for anyone interested in looking into Amy's claims further since she has yet to post links to accompany her claims.

This is a link with a clear explanation about the Johnson and Daviss study

http://understandingbirthbetter.com/section.php?ID=31&Lang=En&Nav=Section

This study is interesting

http://www.ncbi.nlm.nih.gov/pubmed/17603954?ordinalpos=3

Also, check the MANA 2000 home birth neonatal mortality statistics.

Tienchin on Henci's forum explains Amy's confusion further:

Yes. Johnson and Daviss do not use the neonatal death rate in the hospital group in 2000.

The NEONATAL death rate includes live born babies that died in the first 28 days of life.

In their BMJ article, Johnson and Daviss examine the COMBINED INTRAPARTUM AND NEONATAL death rate which includes babies that died during labor and live born babies that died in the first 28 days of life.

The COMBINED INTRAPARTUM AND NEONATAL death rate for planned home births in the BMJ article was 2.0 / 1000 in 2000.

The COMBINED INTRAPARTUM AND NEONATAL death rate for planned hospital births in the BMJ article was drawn from ten sources with rates ranging from 0.5 to 3.4 / 1000.

See Table 4 at http://bmj.bmjjournals.com/cgi/content/full/330/7505/1416?ehom

No. The neonatal death rate published by the CDC for white women with 2500+ g babies was 0.9/ 1000 in 2000.

See Table 6 at http://www.cdc.gov/nchs/data/nvsr/nvsr50/nvsr50_12.pdf

***

As for US midwives, I have yet to encounter one who knows less about normal birth than a European midwife and I have worked in both worlds. I am a neonatal nurse by the way.

Posted 7.7.2008 8:07 PM

AmyTuteurMD

29 comments.

Member since 6/25/2008

"This is a link with a clear explanation about the Johnson and Daviss study

http://understandingbirthbetter.com/section.php?ID=31&Lang=En&Nav=Section

This study is interesting "

Yes, it is interesting. It is Johnson and Daviss' attempt to alter the mortality rate in the study of homebirth in 2000. Johnson and Daviss specifically acknowledge, that, yes indeed, the hospital neonatal mortality rate in 2000 was 0.9/1000 exactly as I have indicated.

But wait! They just realized that their calculations for homebirth mortality in 2000 were wrong. Wow, what a coincidence! If they simply remove all the congenital anomalies from the homebirth group, the neonatal mortality rate was (you guessed it) 0.9/1000. Isn't that amazing?

They are hoping that you won't realize that if you remove the congenital anomalies from the homebirth group, you MUST remove them from the hospital birth group, too. Once the congenital anomalies are removed from the hospital group, the hospital neonatal mortality rate is 0.34/1000 and homebirth STILL has a neonatal mortality rate that is TRIPLE that of hospital birth.

I posted this analysis on Henci Goer's website and she deleted it. That's because she knows it's true.

"The COMBINED INTRAPARTUM AND NEONATAL death rate for planned hospital births in the BMJ article was drawn from ten sources with rates ranging from 0.5 to 3.4 / 1000."

Right, and they are all out of date, extending back over 40 years. They even say, IN THE PAPER, that any comparison with that number is inaccurate:

"Direct comparison of relative mortality between individual studies is ill advised. as many rates are unstable because of small numbers of deaths, study designs may differ (retrospective versus prospective, assessment and definition of low risk, etc.), the ability to capture and extract late neonatal mortality differs between studies, and significant differences may exist in populations studied with respect to factors such as socioeconomic status, distribution of parity, and risk screening criteria used..."

They actually ADMIT that their comparison is invalid. They included an invalid comparison because they wanted to omit the correct comparison, the one that shows homebirth in 2000 had a neonatal death rate that was TRIPLE that of hospital birth.

Henci Goer deleted that comment, too.

You need to ask yourself, why does Goer need to delete explanations, questions and comments offered by those who do not agree. The answer is obvious. She cannot honestly address them, so they must be removed.

Posted 7.7.2008 8:49 PM

dalena

23 comments.

Member since 6/26/2008

Perhaps because you are rude and twist things? Anyone who reads can see that. Like you twisted the cord clamping post on your blog. Now that made it so very clear how you desire to read things. Why did you take it down?

According to the legend, the lethal congenital anomalies are excluded from both the hospital data and the homebirth date

http://bmj.bmjjournals.com/cgi/content/full/330/7505/1416/TBL4

The out of hospital rates are also spread over roughly the same period as the home births.

They did not alter anything. They did not deliberately try and fool anyone. Their explanation is quite clear, except of course, you have an agenda. They do not say it is invalid at all. They say that the data is for general comparison only and your quote above addresses *both* places of birth.

Besides, really, you seem to not be willing to comment to the article on the BMJ site as someone mentioned somewhere. Why don't you write the researchers and have them explain it to you? I dare you.

Posted 7.7.2008 9:40 PM

AmyTuteurMD

29 comments.

Member since 6/25/2008

dalena:

'According to the legend, the lethal congenital anomalies are excluded from both the hospital data and the homebirth date"

They are exluded from the out of date hospital data, but in their new apologia, which YOU cited (Understanding Birth Better), they ADMIT that the neonatal mortality rate for hospital birth in 2000 is 0.9/1000 (including congenital anomalies) , BUT they've "suddenly" discovered (a full 8 years after they collected and analyzed the data) that when you remove congenital anomalies from the homebirth group, the neonatal mortality drops to 0.9/1000 also. There's a big problem, though. If you remove congenital anomalies from the homebirth group, you have to remove them from the hospital group, (the one that was 0.9/1000). When you do that, the hospital neonatal mortality drops to 0.34/1000.

I know that you don't really understand the statistics, but you should be able to understand this: They have been forced to acknowledge that they deliberately used the wrong control group. They are trying to change the data that they PUBLISHED years ago, based on no better reason than because they want to make the homebirth neonatal death rate look lower. They and their surrogates (including Henci Goer) absolutely will not address the issue or answer simple yes or no questions.

They are afraid. The know what I have written is true. They know that you and other homebirth advocates don't have a clue about analyzing statistics. They are hoping that they can continue to fool you, because you cannot analyze the statistics for yourself.

You don't have to take my word for it. Find someone who has a background in analyzing statistics and ask them to look at the data. They will confirm everything I have said.

Posted 7.7.2008 11:21 PM

dalena

23 comments.

Member since 6/26/2008

Ah resorting to bullying again.

Whatever, Amy. Like I said, I dare you.

Posted 7.7.2008 11:50 PM

Count Tousser

241 comments.

Member since 8/21/2007

Another advantage to home birth might be that there won't be anyone (with a financial interest at stake) urging you to subject your new baby son to circumcision (genital mutilation) on the phony grounds that "it's cleaner" (untrue), "it's more normal" (untrue), "it's safe" (untrue, boys die from it every year but the medical-industrial complex doesn't want you to know that), "if you're Jewish you have to" (untrue) or other untrue CRAP....I mention this because it seems relevant to the home-vs.-hospital birth issue, and as an example of medical-establishment LIES that we should all be fighting.

Posted 7.9.2008 9:26 AM

Helenkww

6 comments.

Member since 6/26/2008

We who want natural birth s have a very different opinion then "Dr. Anne" and I agree with everyone and we will find stats to support us and she will find stats to support her. DR ANNE ARE YOU AFRAID TO ANSWER MY QUESTION(S)?

I ask again to "Dr Anne" why she refuses to answer my questions..it seems VERY suspect. Here is my question(s) for a 3rd or 4th time:

Why have I not heard one word on how you want to help the problem? Dr. Amy why as an Ob-Gyn have you not chosen to help women have in hospital natural births if you really are so worried about them? I find your comments to be complete hypocrisy when you do not want to be part of the solution? One of my friends is an Ob-Gyn. He does natural births in hospital with no intervention in over 95% of his births. He will birth breach unless it is transverse or there are other complications and he has a less then 5% c-section rate - he averages less then 4 hours on all women from transition to birth and women love him. He gets strange comments from nurses who are new to him like "should I prep for the pit now" and "how would you like me to prep for the c-section " when he does not plan to do these techniques and he believes it is because the nurses are so conditioned to intervene. He has had no problems with any of his births and not problems with any of the babies or Mom's and the proof of this is that his mal-practice insurance is the lowest possible in our state. IF YOU REALLY SINCERELY CARE about women then why are you not part of a solution to help them? Why are you not an advocate for natural birth in hospitals? It is hard to take anyone seriously when they do not want to help and only want to blame.

Posted 7.9.2008 10:46 AM

informedchoice

5 comments.

Member since 6/26/2008

Helenkww, don'tcha know ? it's only a problem if others can't answer HER questions. ;)

"Dr Amy", the android/ACOGoid, has recently been quoted saying that the routine use of medical interventions is, indeed, practicing evidence-based medicine, and that natural chilbirth advocates are just too stupid to realise it.

Now if that isn't laughable, then I don't know what is...

Posted 7.9.2008 2:20 PM

Helenkww

6 comments.

Member since 6/26/2008

LOL Dr. Anne remains silent,,,,

Posted 7.11.2008 1:13 AM

AmyTuteurMD

29 comments.

Member since 6/25/2008

Who's Dr. Anne?

Posted 7.11.2008 3:24 AM

informedchoice

5 comments.

Member since 6/26/2008

"Thou shalt not get my name wrong"

So high up there your horse, you can't even see the irony !? You do realise how off-putting your megalomania is, don't you ?

And ACOG's losing hits to HBdebate as a result, so I'd tone 'er down, if I were you...

Posted 7.11.2008 9:49 AM

Angela Hoy

1 comments.

Member since 7/12/2008

Congrats to the Gaffney's! There aren't many people who are brave enough to shun the powerful medical community and do what they know is right for them and their baby. I'm wondering why they must admit a nurse into their home when the mother is a nurse herself? That seems a bit authoritarian to me. If the wee one ain't broke, don't try to fix him! :)

He's beautiful!!

Angela Hoy, Author -

DON'T CUT ME AGAIN!

True Stories About Vaginal Birth After Cesarean

Posted 7.12.2008 5:13 PM

Helenkww

6 comments.

Member since 6/26/2008

Dr. Amy or Anne?, but a non practicing doctor regardless, and one who refuses to answer my question. I must believe that this is because the formerly practicing doctor does not really care about women. She only cares about being right. I find and so do my Psychiatrist pals that arrogant people usually are covering up a very low sense of self esteem. They find that good therapy (which normally takes years) can help them to find the root of their low self esteem and can help them to be happier and more productive people. I feel bad for someone’s kids if they have self esteem and control issues and choose to stop practicing or working to stay home with them when they are seem to be mentally disturbed. I wish you and others like you fast healing and send you many prayers because you seem to need them.

Posted 7.22.2008 11:58 AM

Kathy

1 comments.

Member since 8/8/2008

Dr. Amy,

First -- as one of VERY MANY people whose comments have been rapidly and peremptorily deleted from YOUR blog, I repeat what you said above: "You need to ask yourself, why does Dr. Amy need to delete explanations, questions and comments offered by those who do not agree. The answer is obvious. She cannot honestly address them, so they must be removed."

As far as the 2003-2004 stats go, 19 of the 29 births with "other midwife" were due to congenital anomalies and genetic defects; 1 was due to diaphragmatic hernia w/o obstruction (with that baby dying in the first hour after birth); and 4 were due to birth asphyxia or labor complications in women in the 42+ week group. In fact, if you exclude post-term births and congenital/genetic defects, the DEM-attended births have the lowest NMR in the 2003-2004 set.

Here is the link so that anyone can look up the information for themselves, and not rely on me or you or anyone else to figure it out (http://wonder.cdc.gov/lbd.html).

From the BMJ study, here is the breakdown of deaths: 1) intrapartum deaths: 1 due to AROM at the hospital; 2 due to breech birth (despite your "Health A to Z" article that says that most breech babies will do just fine born vaginally -- which you criticized me for saying on your blog, yet you wrote an article saying that!, these are typically considered higher risk, so would not typically be in a low-risk population of any home- or hospital-birth study); 1 due to hemorrhage in the brain, although no fetal heart irregularities were noted during labor; and 1 due to a nuchal cord wrapped 6 times (and this was a post-term pregnancy, which is also typically considered higher risk). 2) neonatal deaths: 3 due to congenital birth defects (despite your previous claims elsewhere about hospitals doing a better job of saving such babies, a reasonable assumption is that since many home-birthing women decline prenatal testing including ultrasound, they don't have abortions for fetal anomalies, so have a higher percentage of babies with defects, including severe and fatal ones); 2 due to SIDS (with Apgars of 9/10) and 1 possibly from SIDS; 1 due to vasa previa (which carries with it a 50-100% death rate); 1 due to anoxia in another post-term pregnancy, although no heart rate changes were noted; and 1 due to a previously undiagnosed Group B Strep infection.

Taking out the breech and post-term babies for being at higher risk, as well as the baby with vasa previa along with the babies with lethal congenital birth defects, and the one that died when they broke the mom's water at the hospital, there were 4 neonatal deaths and 1 intrapartum death. I will further note that the CDC statistics say absolutely nothing about stillborn babies, which includes babies who die during labor.

Then there is the MacDorman study which demonstrates a 3x NMR for C-sections vs. vaginally-born babies; and even when excluding fetal anomalies and low Apgars, there is still a statistical excess of neonatal deaths w/C-sections. Considering that the C-section rate among would-be home-birthers is probably about 5% or less, and the C-section rate among low-risk women planning a hospital vaginal birth is about 5 times that, it actually works out that the neonatal death rate is lower for home-born babies because of the scarcity of C-sections.

Finally, even if your numbers were correct, why are you expending all this energy into trying to stamp out home birth? The 2004 CDC stats in the Vital Statistics Report shows that smoking is associated with 3-4/1000 excess deaths compared to non-smokers. If it's really about saving babies, why not just convince 40,000 smokers to give up the habit and save 3,000-4,000 babies; instead of trying to convince home-birthers to have their babies in the hospital, which would save AT MOST (5 neonatal deaths, 4 of the intrapartum deaths -- I'm not counting the vasa previa or the AROM at the hospital -- out of 5418, minus the 0.9/1000 hospital death rate; times 40,000 home births per year) 31 babies. And you're more likely to be successful. All you have to do is convince some 10,000 women to give up smoking and - bingo! - you'll save 30-40 babies' lives every year.

Posted 8.8.2008 10:48 PM

LittleLamb

1 comments.

Member since 8/12/2008

Once a person gets an MD, they always have an MD. She doesn't cease to be a Dr. just because she chose for her license to lapse. Why is that so difficult to grasp? MD is the title she earned for going through 4 years of medical school, not for getting a license or becoming board certified. Honestly, if that is so difficult to comprehend, I worry about your abilities to comprehend anything more substantial than that.

I think this is a very bias and poorly written article with very little evidence to back it up. There is a lot more evidence in the comments section than in the article itself.

One thing I found utterly laughable was this:

"The reality is, many midwives have been driven out of practice themselves because of the difficulty of being able to afford malpractice insurance. What's sad is that midwives, dollar for dollar, get paid less than obstetricians for doing more. They spend more time with their clients, they have better interactions with their clients, and they get paid less."

Seriously? Midwives doing more so they should be paid more? Yes, and the garbage man works a heck of a lot harder than I do, but my skilled job requires a lot more training and expertise. Sorry, but we don't get paid for doing "more".

Posted 8.12.2008 2:19 PM

collin237

4 comments.

Member since 10/13/2008

I don't know about Amy Tuteur's claims about Grantly Dick-Read being a racist, but I have found this, which is Amy's own words:

24. Amy Tuteur said:

November 30, 2006 @ 7:31 pm

Kris:

Attempting to draw conclusions from comparisons of country to country neonatal mortality rates just shows a lack of understanding about the causes of neonatal mortality and what inter-country comparisons can and cannot tell us.

It is an unfortunate fact that race is a risk factor for neonatal mortality, independent of economic status. For reasons we do not understand, the neonatal mortality rate of babies born to women of women of African descent is considerably higher than that of babies born to women who are white, Asian or Hispanic. The neonatal mortality rates of industrialized countries are very closely associated with the proportion of women of African descent within their populations. It is not a coincidence that all the countries that have lower neonatal mortality rates have a lower proportion of women of African descent in their population. Japan, which leads the list, has virtually no women of African descent among the population. The fact is that neonatal mortality for low risk white women in the US is the same as neonatal mortality for low risk white women in Europe. So comparing country to country tells us nothing about the quality of care in those countries.

http://blog.imperfectparent.com/2006/10/22/home-births-natural-or-foolish/all-comments#comment-10659

Sounds like Amy Tuteur is a racist.

Posted 10.13.2008 8:40 AM

collin237

4 comments.

Member since 10/13/2008

If an MD can never be revoked, than it can't possibly say anything about Amy's present agenda. Amy is right about most of what she says, but she carefully phrases it so as to make it sound wrong. I think Amy is a shill for a Home Birth Advocacy group.

Consider the following:

* Prolactin causes anti-desire.

* Labor is an anti-desire.

* Prolactin is at its highest level during labor.

Coincidence? I don't think so. Funny that Amy never talks about prolactin. She'd rather have you blame the anti-desire on doctors.

Posted 10.13.2008 9:52 PM

collin237

4 comments.

Member since 10/13/2008

Right about most things except her racist theory, that is.

Posted 10.14.2008 3:33 AM

collin237

4 comments.

Member since 10/13/2008

I just fully read the main text of this page. It really strains credibility that a modern hospital would do such things. I suspect there are drug-induced hallucinations in reports like these.

Once when I was in the hospital I was unknowingly given compazine in my IV. A doctor from another hospital looked up my records and found out, based on depression, feelings of being haunted, and impotence.

This latter side-effect makes me wonder if compazine, or something like it, might be administered as an anti-inflammatory to facilitate the stretching required for delivery. But surely there are much better ways of doing this, such as topical medications.

To throw a gauntlet on the other side as well though, the topical medications used by midwives like Gaskin have, according to her claims, the opposite effect, which could only make things worse. One hopes, for the sake of their patients, that these claims are false.

Posted 10.23.2008 3:19 PM