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Regulating Midwives: The Debate Over Making Home Birth Safer

A midwife examining a pregnant woman during a home visit. (AP)

A midwife examining a pregnant woman during a home visit. (AP)

For any expecting mother, the decision over where, and how, to give birth is one of the most important decisions that can be made. Do you deliver in a hospital, with the aid of doctors and nurses, or do you go for a more natural delivery at home, with the help of a midwife?

Here in Massachusetts, the number of women who opt for home births is still very small, but growing. Most of the time those births go off without a hitch. Every once in a while, though, complications come up, with sometimes deadly consequences.

Take the case of Jen Holloman. Two years ago she tried to deliver her second child at home with the help of a midwife. She was in labor for nearly 24 hours when she decided it was time to go to the hospital. Shortly after arriving, the doctor on duty told her that her child was gone – dead from complications from an infection her midwife failed to detect. As Holloman told the Boston Globe afterwards, the year after her son’s death was the “longest and saddest” of her life.

Since her son’s death two years ago, Holloman has become an advocate for new legislation that was the focus of a hearing Tuesday on Beacon Hill.

The plan would establish practice guidelines for midwifery, and for the first time ever establish a state body that would regulate midwives.

Supporters say the plan will help make home births safer, while opponents say it can never provide the same level of care that women can get in a hospital delivery room.

We’ll be talking about midwives, and the debate over making home birth safer.

Guests:

  • Erin Tracy, obstetrician gynecologist, Massachusetts General Hospital;  vice-chair, Massachusetts chapter of the American Congress of Obstetricians and Gynecologists
  • Rebecca Herman, certified professional midwife and a member of the board of directors for the Massachusetts Midwives Alliance
  • Gene Declercq, professor and assistant dean, School of Public Health, Boston University.

 


Other stories from this show:

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  • Miriam

    Midwifery is not the practice of medicine.  In 1985 the Massachusetts Supreme Court in it’s ruling stated that midwifery is not the practice of medicine.

  • Meganhogan

    The U.S. has one of the highest maternal mortality rates in the developed world and the majority of women in this country give birth in hospitals.

  • Megan

    We’re talking about the Boston Globe’s story about the tragic story of the woman’s child who died during a homebirth … what about all the babies that die in hospitals during childbirth? Why are we not referencing those statistics?

  • Erose33

    Having a baby does not require medical intervention. Pregnancy is not an illness. In other countries, they have a much lower rate of postpartum and mortality around birth and the majority of births happen in the home. The costly and unnecessary planned Caesarian is a MUCH bigger problem than the planned homebirth. 

  • Jessica

    The US in general has a horrible record for maternal and fetal mortality.  People are really not getting the information about that in this coverage.  Perhaps hospitals don’t want the competition. I recommend the film The Business of Being Born.  I feel that people are scared by Dr’s (who are scared by the insurance companies). I am frustrated to hear the fear people have regarding home birth. The interventions hospitals push on EVERY PATIENT cause way more problems.  

  • Jessica

    A midwife missing an infection? Dr’s could have missed it too.  That doesn’t mean midwifery care is flawed, nor does it mean homebirth isn’t safe. 

  • Contactdavidf

        My wife gave birth to our first child in a hospital in 2007.  She was a patient of a group OB practice, and was delivered by someone in the group she had seen only once, and wasn’t thrilled with.  He gave her an episiotomy (that we’re not sure she needed), and after the birth, when he began stitching her back up, she told him the local anesthesia hadn’t kicked in yet.  His response to her was that it should have kicked in by now and that if she didn’t stay still, he would “knock you out, and you won’t be able to hold your baby until tomorrow.”  She gritted through un-anesthetized stitching of her genitalia, so that she could hold our son, and get him to latch on, basically because the doctor wanted to go home.  Needless to say, uber-medicalized care is not the best care.
         We had our daughter in 2009 at a birth center (in Cambridge, MA) with a midwife who, throughout the delivery, applied oils and massage to prevent the need for an episiotomy.  She was born healthy, and we all happily went home six hours later the same day.  Thank you midwives! 

  • Anne D

    Having my daughter at home with experienced midwives, without drugs, without forceps, without fetal monitors and all the other stressful interventions that  hospitals insist on, was the most wonderful experience in my life. Being able to really be in touch with my body and to be fully present during the whole labor gave my daughter the calmest and  most beautiful entry into the world. 
    My midwives only consented to work with me if everything about my pregnancy was going well. As a vegetarian I even ate liver for several weeks to get my iron count up.
    The only medical intervention I had was an amnio – a doctor swanned into the room for a 5 minute procedure and charged $1000!
    I was frankly scared to go have my baby in a hospital – I’d heard too many awful stories about birthing to the doctor’s timetable and having no control over my own body.

  • Makalary1

    Birth is not an illness. Midwifery is not the practice of medicine! Women and their families have the right to choose where and with whom they give birth.

  • Contactdavidf

       My wife gave birth to our first child in a hospital, in 2007.  She was a patient at a group OB practice, and was delivered by a doctor in the group she had seen only once before, and who she didn’t much care for.  He gave her an episiotomy (we’re not sure she needed), and after the birth, when he began stitching her up, she told him the local anesthesia hadn’t kicked in yet.  His response was to tell her that it should have, and that if she didn’t stay still, he would “knock you out, and you won’t be able to hold your baby until tomorrow”.  So she gritted through un-anesthetized stitching of her genitalia to hold our son and get him to latch on.  Needless to say, over-medicalized care is not the best care.
       When we had our daughter, in 2009, it was in a birth center (in Cambridge, MA) with a midwife who took the time to listen to my wife’s concerns about her previous experiences, and then regularly applied oils and massage to prevent the need for another episiotomy.  My wife and our daughter were both healthy, and we all happily went home six hours later the same day.  Thank you to all midwives!

    • Contactdavidf

      Sorry for the double posting.  I thought there was a problem with the first one, so I re-wrote the comment.

    • Nomass

      Yes, David a birth center is staffed with trained, licensed, nurses with master’s degrees in nursing and many hundreds of deliveries in hospitals.  The birth centers are affiliated with hospitals makes the possible transfer to a hospital seamless and not an unplanned for emergency.  Also, the birth centers take insurance—the home birth midwives in Massachusetts can not.  

  • Sababah

    Women and babies can get terrible care even from providers who are licensed with tons of credentials after their names…I have seen it many times over the 13 yrs I have done birthwork.  As others have mentioned, look at our morbidity and mortality rates…and dont get me started about the c/s rate…30% plus!  That is poor care.    To heap everything that is evil upon families and midwives who chose to do birth out of hospital is totally disingenuous and close-minded.

    Women and families deserve to have the right to homebirth, and even to hbac’s, twins, and breeches at home.    Even folks who want to do unassisted, that is their right! 

    ACOG’s stance on homebirth is the same old position of misogyny, we know what is best for you, you could never know what is safe.

    Does this mean I disagree with regulation, well I must admit some ambivalence because of my above statements…systems in place do not always work.  I know as a mama and a midwife that things can happen out of anyone’s (incl docs) control and a baby can be lost, and it breaks my heart.  It does, however, break my heart to know that there are some folks out there who are calling themselves midwives but who are not really trained or keeping up with research or are practicing unethically.  There are awesome lay-midwives out there!  There are also some scary ones.  All the CPM’s I have worked with thus far (dozens) are pretty sharp, it is a very good (and highly structured and accredited) credential to use for licensure.  BUT regulation should never be a substitute for true informed consent and informed decision making of the women and families in our state.

    BTW, I do love some obgyn’s, I am not personally attacking, although I could tell some sad stories… it is more the system that allows liability insurance to dictate hospital culture  and policy and ACOG.  Read ECONOMICS are more important then our bodies.  What’s new?

  • Olliemi

    legislating homebirth based on one tragic story is rediculous. I had 2 healthy babies at home, does that mean I can get legislation passed to get home birth covered by mass health?

    I am sorry that this woman had a terrible experience in her life but I deserve to have choices in birth. If I want my grandmother to catch my baby I should be allowed to do that.

    Women who choose homebirth should be accountable for their body, their babies and their choices.

     Women who deliver with OBs should know that the majority of OBs and CNMs in Massachusetts do not have adequate experience with unmedicated, nonsurgical, low tech birth.  Hospitals and birth centers  mandate electronic fetal monitoring- which was not even created for the purpose it is currently used for and it’s use has increased surgical birth with no know positive results.

     if you want an alert active drug free mom and baby- find a great home birth midwife!

  • homebirthmom

    I had a homebirth this past May and it was amazing.  I do believe in legislation however because a woman should be able to know that her care giver is required to uphold to a standard of care and if she doesn’t there are penalties.  No baby should die because of negligent care and when it happens there ought to be a governing body to say they performed malpractice.  Doctors and nurses have to answer to that why shouldn’t homebirth midwives. It could make birth safer for mom’s and babies at home.  You have laws telling drivers how much alcohol they can have before getting behind the wheel but now laws telling a midwife she has to offer beta strep with informed consent.  This is just ridiculous in my opinion.  Jen’s baby should still be here and he may of been if there was an enforced standard of care. 

  • homebirthmom

    I had a homebirth this past May and it was amazing.  I do believe in legislation however because a woman should be able to know that her care giver is required to uphold to a standard of care and if she doesn’t there are penalties.  No baby should die because of negligent care and when it happens there ought to be a governing body to say they performed malpractice.  Doctors and nurses have to answer to that why shouldn’t homebirth midwives. It could make birth safer for mom’s and babies at home.  You have laws telling drivers how much alcohol they can have before getting behind the wheel but not laws telling a midwife she has to offer beta strep with informed consent.  This is just ridiculous in my opinion.  Jen’s baby should still be here and he may of been if there was an enforced standard of care.

  • Carla

    Licensure and regulation does not make home birth safer…..education (both of the parents and of midwives) goes much farther….Birth is inherently safer than not, so leaving it alone is the best course. My goal and my life’s work for the past 35 years is to help parents take their births back, through education and encouragement and to help midwives attain the most excellent education possible.  I am all about education, but it is NOT my job to say who is or is not qualified to be a midwife.  That is the parents’ job.  They should be free to choose anyone they want.
     The push for legislation and licensure ignores the history of midwifery AND overlooks the fact that birth belongs to parents, anyway.  The monopolization of midwifery and midwifery education takes control out of parents hands and places the choices into the hands of a state entity or a midiwfery or nursing regulatatory body.  Midwifery should be legal by virtue of it being legal for parents to exercise their right to experience the biological function of birth as a private family event.  They have the right to choose to birth anywhere, with anyone, even if that is no one.
    The PUSH for regulation is NOT about making anything better for parents.  It is about the monopolization of midwifery and midwifery education.  If parents were really what people where worried about they would invest more in education and preparation, and they would charge something that the average parent can afford, without clamoring for payment by medical insurance, thus further smudging that line between midwifery (normal birth) and medicine (complications and emergencies.)

  • Anonymous

    I believe this is correct. I also believe this is the kind of plan that we are likley to end up with, though somewhat less generous as it will be forced on us by our creditors who won’t give a hair about healthcare for seniors and the needy. Read “Penny Health” articles if you dont have insurance.

  • anonymous

    I believe that most of this is correct, however I think that the doctor’s need to reread their studies.  Homebirths aren’t safe for everyone, I agree, but midwives have statistics as well.  All statistics show that there are equal risks for both birthing areas.  I like the comment about delivering with a midwife in either situation, notice noone wants the doctor because you meet them once, and then don’t develop a relationship.  I think that it is all about trust, and that is why America is turning toward homebirth.  I think that the midwives should assist in creating the legislature.  In fact, that is what we are working toward in Pennsylvania as well.  Good luck Massachusetts in your licensure! 

  • HeidiD

    Want to make home birth safer? Shift the focus from the
    midwives to the consulting OB/GYNS. Legislation and policy on making home births
    safer could most usefully focus on OB/GYNs, mandating they assist in complicated
    cases swiftly.  Midwives have a notoriously hard time finding OB/GYNs to
    cooperate and consult with, which can delay women’s access to medical care when
    they leave the realm of normal and healthy and move into the realm of needing
    medical consultation, be it in pregnancy or labor. I want to see the OB/GYN
    working to get their ranks to assist the midwives, and offer help when the
    pregnant women seeing midwives need it.  If OB/GYN consultation was readily
    available, perhaps the death in this story could have been prevented. Fostering
    a quick and seamless transition from midwifery care to OB/GYN care is  an area
    the OB/GYNs can control, Making higher level medical care in the form of
    prenatal consultation or labor transfers easy to access would make a huge impact
    on the safety of home birth. 

  • Linda And Rosa

    Anyone considering a homebirth should know a few things.  Homebirth midwives take tradeschool courses (to become “certified professional midwives” or CPMs) and have very little in the way of experience handling emergencies — and that’s what you need a birth attendant for. 

    CPMs don’t carry liability insurance.  Livelong neurological disability can occur to a newborn if it has trouble breathing for only a few minutes after birth. 

    The national organization for CPMs hide their perinatal mortality rate (PNMR)  from the public.  In Colorado, where CPMs have to report deaths, the 2009 PNMR was a whopping 11.3 deaths per thousand births.  That is ten times what it should be for only being allowed to deal with low risk pregnancies. 

    Many CPMs are birth hobbyists (delivering an average of one baby per month) and feminist ideologues who think of birth as an “empowering” experience; they claim home births can be less painful and can, if the woman is receptive to “opening up,” end in an orgasm. 

    CPMs deceive women that homebirth is safer than hospital care.   Simply being outside of a hospital it too far.  Physicians and nurses need to be familiar with a woman to best treat an emergency.  And collaborating with CPMs is not professionally possible, because it is unethical to collaborate with practitioners who are undereducated and deliver substandard care.

    I recommend a blogsite where women have told stories of needless tragedies because their homebirth midwives were less than helpful: http://hurtbyhomebirth.blogspot.com/

    Regulating CPMs is not the answer.  Making planned homebirth attendants illegal is.

    • Jess

      Linda, you are giving misinformation and that is being conservative! Every CPM is required to report deaths… that is laughable! Not only that, but to call a CPM a “birth hobbyist” is disrespectful and it sounds like you are bitter… did you flunk out of midwife school or something?! Birth orgasms are documented. My own mother had one. In a hospital. Naturally. When I was 3 weeks late. Of course, that was when Dr’s actually left well enough alone! The problem is that Dr’s (and some nurses) have God complexes and can’t comprehend a scenario where people who are in pain can’t be in need of medical attention. Going to an OB is like going to a maxiofacial surgeon for a tooth cleaning… If you find a cavity, a deformity, THEN fine, go to the surgeon. Linda, I’m sad for you… I hope some day you can experience what NATURE intended. Lastly, if a CPM doesn’t carry insurance (which I suspect is a bold faced lie) then it would only be bc insurance co’s get misinformation from lobbyists and liars like you. Have fun drugging babies and disfigured mothers for life literally and figuratively. With your attitude, I would have words for you if you were
      my nurse! Wow!

  • Linda Rosa RN

    One more commend:  Several people here have claimed that birth is not a medical event.  In states where certified midwifes are regulated, they ask for more and more *medical* privileges, such as the permission to start and maintain IVs, suturing perineal tears, giving medications such as Pitocin, etc.  The “birth is not medical event” is just a getting-the-nose-in-the-tent tactic.

  • Bubbaboo

    Linda Rose you have no idea what you’re talking about! Do research, look at the fact that the USA has one of the worst infant mortality rates in the Western World. Doctors are too quick to induce, augment, c section and force women to deliver their children in positions that are proven to be counter productive.  to you is that really the answer??? for force women to give birth in an environment where they are often times left alone for 95% of their labor? where the doctors only see them for 10 minutes at each appointment and by people who feel that women are not capable of giving birth naturally? That a woman’s body is defective?! give me a break!! Women have the right to delivery their babies where they want.  More babies die from circumcision than they do from homebirth, wheres the outrage from that?!

    • Linda Rosa RN

       *INFANT MORTALITY* rate is the wrong thing at which to look.  This statistic includes deaths during the first year of life and can include accidents, illness with no connection to L&D, etc. 

      The statistic to look at is *PERINATAL MORTALITY RATE* (28 weeks of pregnancy through 28 days of life).  The US has one of the lowest PNMR of all countries.   Doctors, nurses, and nurse-midwives didn’t achieve this safety record by not paying attention to their clients. 

      The national organization of CPMs (MANA) hides their PNMR.  Chances are it’s not so good.

      Claiming that doctors see “a woman’s body is defective” is an attempt at a slur and shows an ignorance of all the things than can and do go wrong with “normal” pregnancies, such as  less than ideal presentations, placentas that detach before they should, cords around the neck, etc., etc.  The crime is to misinform women that they should “trust their bodies to know what to do.” 

      Many normal pregnancies result in normal births.  Catching babies is something that many cabbies have done.  But when things go wrong, there may only be a few minutes between tragedy and a happy outcome.  And that’s when you want to be in a hospital. 

      There is no excuse for rudeness in medical personnel.  But that’s something that has also been experienced with CPMs, as well.  Again, take a look at the stories on “Hurt by Homebirth” blog.

      • Odifasa

        Actually Linda you are committing a
        logical fallacy,  a hasty generalization.  Over 28% of 
        PERINATAL MORTALITY RATE is from birth defects which mandate a hospital birth so that number is a bit scewed. But i think the term you are actually looking for is 
        intranatal (intrapartum) death. You should get your terms down to make a firm argument. I take it you were referring to this because of your usage of L&D. Actually the PNMR rates are available upon request at MANA. This is standard among organizations which use peer review publishing, as a method of keeping info fair and accurate. So you may not be used to accessing info this way but give it a try. Even in the hospital if things go wrong the chances of saving mothers is not so great however the c-section rate is above 50% in many areas which is ridiculous and leads to far more complications than the unforseen complications with birth at home. This is why according to almost all peer reviewed stats we can clearly see that home birth for low risk mothers is safer over all than hospital birth. Hard to hear i’m sure but once you figure out how to find that info on MANA you will figure it out. The W.H.O says that the c section rate should be about 15% and ours is over all  32.3% per the CDC. The bottom line is home birth is safer for low risk births. I’m sure your technocratic model of medicine side is screaming noooo but its true. Women who are pregnant need to give birth, not be cut open from side to side because of reasons which have been shown to be unnecessary.  Good luck familiarizing yourself with accessing peer reviewed studies it will help a lot in not engaging in ad hominem assertions of obfuscation against MANA when it seems that you may just not understand. Oh and by the way your statement  “Regulating CPMs is not the answer.  Making planned homebirth attendants illegal is” , seems to be just another method of controlling womens reproductive rights. Women have the rights to receive care or not, where and when they want. Not to mention you are suggesting controlling RNs and Doctors who are home birth attendants, as well as any body who may have religious imperatives and rights to chose home birth. That sure is a lot of control you want to have.  I recommend, just as a counterpoint, a website where women have told stories of needles procedures and awe full experiences in the hospital Birthraped.wordpress.com.  To all you women out there trying to make a decision about birth please inform yourself with research. Dont let people who use fear and misinformation and logical fallacies push you into their limited worldviews. Thanks guys
        Have a great day
        oh and ps by the way I am a man and my beautiful girlfriend is studying to be a midwife. 

        • http://www.facebook.com/LindaRosaRN Linda Rosa

          MANA does not release their stats to just anyone, least of all a critic like me.  But if you are right, then show them here.

          For the rest, I dispute your claims and reasoning. 

          • Odifasa

            First off, you are the one making the claim that you cannot access MANA data so the burden of proof is on you. So, show us here how it is you cannot find any of the information you are looking for in any published journals or online searches. I just said, there is a process to go through to retrieve that information. You are capable of going through it however I doubt you have tried. If you have and they denied you I doubt its because they are keeping tabs on you because of your important “critic status”. Its most likely because when research is being done they often do not release recent data until the project is finished or they may only release it to people doing current research. So your ad hominem claim that they are “hiding” their info is false. And to fulfill at least part of your burden of proof for you, the statistics on this topic have been published in midwifery journals as well as prominent, peer reviewed medical journals, such as in 2000 and 2005 in the British Medical Journal.  
            As for the rest, I find it interesting that you dispute my claims of citations to WHO and CDC statistics. As well as accurate terminologies according to birth statistics. Sounds like you need to take that up with them. As for my reasoning, anyone can go google the logical fallacies I accused you of committing and see that  epistemological soligisms are not up for debate. Those types of things are either right or not. I mean you can debate them but then you may land yourself in a situation where people who exercise reasonable discretion may be suspicious of you.  
            I actually have a link to the information of the kind you claim you cant access, but I would like you to fulfill your burden of proof before I do anymore of that for you. As for anyone else who would like the info just email me :P
            I would just like to say (and please dont take this personally – this is not a personal attack, but a statement regarding your credibility), considering you are a professional in this field and a self proclaimed critic, I find it strange that a layman such as myself can understand this information in a way that disputes your claims, logic and research abilities.  
            Oh and by the way, you may find it interesting to know that the required clinical experience hours for a CPM to sit for national licensure is 1350 hrs, whereas as an RN in California only has to complete 810 to sit for the NCLEX. So perhaps the CPMs who you claim are just feminist once-a-month catchers, are also CPMs with more clinical experience than RNs. 

          • http://www.facebook.com/LindaRosaRN Linda Rosa

            Let’s take care of one issue at a time: 

            http://mana.org/statform.html

            MANA statistics:  It takes $50 plus a letter of intent to get the 2004-2007 stats, from a researcher apparently from an approved  institution.  Plus a non-disclosure agreement.  That’s not exactly open records.

            If you are right, show some of the stats here if you dare.  But if you do, be warned that you could be sued.

            For more analysis:

            http://skepticalob.blogspot.com/2011/11/lies-damn-lies-and-midwives-alliance-of.html

          • kitaters

            Members of MANA have full access to the stats. 

            Additionally all the stats are announced every few years for publication in studies that are to be published in journals. 

            Any random person does not have access to this information until it is published. This is standard. 

            The last study that was released was in 2005, and includes statistics on PNMR:
            http://www.bmj.com/content/330/7505/1416.full?ehom

            My understanding (as a member of MANA), is that the last several datasets have included around 5000 births and spans about 5 years. For the current dataset,  they have decided to extend the number of years and hopefully collect information for closer to 25,000 births so the analysis  can encompass a larger body (and be more accurate). 

            The site you referenced is known to be blatantly anti-midwifery. Citing a blog by someone who is loudly anti-midwife (and clearly biased) doesn’t further your position. To maintain your credibility, I suggest citing a source that is not biased. Citing Dr. Amy’s website for anything related to midwifery is like citing Fox News for an opinion on global warming or gay marriage. 

            I am curious – what type of nurse are you? Have you ever attended a homebirth? Have you educated yourself on the educational and skills requirements of a CPM (and of a licensed midwife)?

          • http://www.facebook.com/LindaRosaRN Linda Rosa

            What is clear is that the stats collected from 2004-2007 (a 2008 report) by MANA are NOT available to the public.  One can assume that if they demonstrated the safety of lay midwifery, then they would be very easy to find. 

            Amy Tuteur, MD, presents the views of science-based medicine.  If that is a “biased”, then I am, indeed, biased for science. 

            I have worked in several areas of OB/GYN.  The closest I got to homebirths is working in the Amazon at an Albert Schweitzer Hospital.  I know how quickly a normal pregnancy can turn into an emergency.  The general public has no idea of the range of complications than can occur.  Neither do lay midwives who eschew formal education and ignore the risks of birth far from emergency services.

          • kitaters

            Did you not read my entire post? The 2004 – 2007 data is not available to the public because the dataset is not complete!  Releasing incomplete data is not customary in any scientific field, especially when collecting data for a study. 

            In addition, the reason MANA is collecting a larger body of statistics is because  it’s difficult to calculate rare events unless there are massive numbers because even one event in a small group will artificially raise the rate. A meta-analysis allows a researcher to combine many studies in order to get a larger data pool, but meta-analyses are prone to error when the groups are too small or are too dissimilar (this is exactly why ACOG’s report is flawed). Saying that MANA’s unwillingness to release incomplete data to the public is  a flimsy attempt to discredit homebirth. 

            Perhaps you should take a course on statistics so you can better understand how this works.Evidence definitively supports the assertion that homebirth, attended by a skilled attendant, for a low risk mom/baby, is SAFER than hospital birth. The CDC, the WHO, government agencies for several countries (including Canada, the UK, and other European nations), and many peer-reviewed, very well respected scientific journals (including the Lancet, the British Medical Journal, and Science) support this. Unfortunately for you and Dr. Amy, science actually contradicts your position. Besides nitpicking MANA’s 2004 – 2007  stats (which are consistent with previously reported, public stats) and citing one anti-homebirth doctor’s blog, you have cited no studies or scientific evidence that supports YOUR assertion that homebirth for low risk patients is unsafe. You say you support science and evidence, but you have provided none. If you can provide this, please do share. 

          • http://www.facebook.com/LindaRosaRN Linda Rosa

             http://mana.org/statform.html

            MANA says it is complete:

            “Data from 2004 through 2007 is available.”

            Not to me or the public.  How about you post it here?

          • kitaters

            Linda, the information is available to researchers and members of MANA. It is NOT available to the general public for the reasons I specified above. 

            Are you planning on continuing to argue in circles, or are you going to address the other points I made?

            Perhaps you can’t argue them and that is why you are choosing to ignore?

          • Alisonhime

            Amy Tuteur, MD has what appears to be a full time job posting hateful comments on the personal blogs of home birth mamas. Not only is it rude and petty, but it is a completely unprofessional way for a medical professional to deliver information. I challenge you to find a more reputable source before lobbying against our right to choose where we .

  • http://pulse.yahoo.com/_OPWYC5YLQLR53YIDY4OEWLT3R4 lucy

    “Most of the time those births go off without a hitch. Every once in a while, though, complications come up, with sometimes deadly consequences.”

    The problem with a comment like this is that it assumes hospital births are absolutely safe, obstetricians are regulated and professional and midwifes are not. It is utterly misinformed and entrenched with the usual misconceptions about what makes childbirth ‘safer’. When birth becomes a pathological event it becomes a medical event. There can be complications where ever a woman gives birth, the important thing is that she is supported throughout her labour by one professionally trained midwife. The support she gives is not just about making sure the biological process is happening as it should but equally providing emotional and psychological support. This has been shown in a large and varied number of studies to make birth safer by really knowing how a woman is progressing and reducing medical intervention.

    • Linda Rosa

      “Most of the time those births go off without a hitch. Every once in a
      while, though, complications come up, with sometimes deadly
      consequences.”

      To Lucy:  There is no problem with this statement.  It is a statement of fact.  

      You go on to set up a straw man — “…it assumes hospital births are absolutely safe…”  Of course, nothing is “absolutely” safe.  But if a complication arises, you want to be in a hospital and nowhere else.  The problem is that it takes too long to initiate emergency care if you are anywhere outside of the hospital.  Like home.

      There is a reasonable option:  going with a nurse-midwife who works in a hospital.  (Take care that she/he doesn’t endorse non-science-based practices, like acupuncture, homeopathy, herbalism, and chiropractic.)

      Regarding regulations of midwives:  In my state, one person — an administrator — is in charge of regulation. This is inadequate.  Real regulations should include a board with diverse membership of health care professionals.

  • Linda Rosa

    Jess,

    Please show me MANA’s statistics (2008) on the perinatal mortality rate of CPMs.

    What would you call dealing with only one birth per month?   Hobbyist
    implies amateur.   OB physicians start out delivering some 500 normal
    births in their training.  CPM do a fraction of that.

     In recent years, in my state, there were two infant deaths from the
    CPM not responding in a timely fashion (or not at all) to the mother’s
    steep rise in blood pressure.  That should be in the course Midwifery
    101. 

    In some rare neurological conditions, pain can be interpreted as
    pleasure, but for the general public, I think woman has as much chance
    of an orgasm on delivery as a guy does from being hit in the family
    jewels. 

    I found only one company  that offers liability insurance to homebirth
    attendants — the premiums are the same for any health professionals
    engaged in home births.  The recognition of this company is that home
    birth is inherently dangerous setting, no matter who is doing it, because it
    makes emergency care too long to get to, and catastrophic injuries can
    occur because of this. 

  • Stacy21629

    This topic should be revisited!

    A new study looking at MILLIONS of births using data direct from the CDC finds that babies born at home have a risk of death nearly FOUR TIMES HIGHER than babies born in a hospital.
    http://www.huffingtonpost.com/2014/02/03/home-birth-higher-rate-infant-deaths_n_4717618.html

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