Homebirth Featured by Christian Science Monitor

What a great story about Diane Goslin, a Christian midwife in Pennsylvania.  If you haven’t read this article, I highly recommend it!

“The [issue of] the medicalization of childbirth has been around for a long time, now,” says Arthur Caplan director of the Center for Bioethics at the University of Pennsylvania. “There will always be [people like] the Amish, who want no technology” on one end of a continuum, and those who will refuse to have a baby “if they can’t deliver at University of Pennsylvania” on the other. He argues that the home-vs.-hospital argument should be removed from the ideological push and pull, and instead be driven by safety data specific to the woman‘s age and risk factors as well as the availability of emergency backup care.
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Upcoming Interview

In about an hour I will be interviewed for a local news station regarding Montana’s cesarean rate.  I don’t know much more than that.  The reporter has a young child.  The reporter is supposed to be meeting with a local hospital official.  Other than that, who knows what her focus will be.  In anticipation of this interview, I decided to review some things that I have read and wrote regarding cesarean rates.

With regard to rates, it is important to consider that the US cesarean rate (2006, preliminary) is 31.1%.  The rate has increased by 50% since 1996.  The rate recommended by the World Health Organization is 10-15%.  Once the cesarean rate exceeds 15%, the risks (statistically speaking) outweigh the benefits.  The Montana cesarean rate (2006, preliminary) is 28%, nearly a 3% increase from the year prior.  According to a source at the local hospital, our local rate is around 31%.  I was told that only 16 VBACs took place in 2006 at my hospital.  (A local CNM questioned the accuracy of the VBAC figure, suggesting that VBACs were under-reported.)

I can list many contributing factors to the continued increase in the cesarean rate:

  • Medico-legal concerns on the part of doctors, hospitals, and insurance providers (it’s HUGE, actually)
  • “So and so had a cesarean . . .”
  • Hollywood stars having elective cesareans
  • Young and underpriviledged mothers are more at risk for cesarean surgery
  • An unchecked trust in care providers – most women do not seek second opinions when it comes to maternity services
  • Sensationalization of birth – Baby Story and OR Live come to mind
  • Society – our view of birth has changed; the culture of fear has spread to childbirth
  • Cesareans ARE more safe now than they ever have been

Of course I’ll direct the reporter to resources such as:

  • ICAN
  • The Mother-Friendly Childbirth Initiative
  • Childbirth Connection
  • Conscious Woman

April: Cesarean Awareness Month

Cesarean Awareness Month (CAM) is an internationally recognized awareness month which sheds light on the impact of cesarean surgery on mothers, babies, and families worldwide.  Cesarean birth is major abdominal surgery for women with serious health risks to weigh for both moms and babies.  Cesareans may be safer now than they ever have been, but this surgery is being conducted more frequently than is prudent or safe.  The acceptable rate established by the World Health Organization (WHO) is 10-15% – what is your community’s cesarean rate?

The blogosphere is atwitter about Cesarean Awareness Month.  Here are some posts I found today that deal directly with CAM:

  • Instinctual Birth’s post
  • No Womb Pod’s post
  • Strain Station’s post
  • Cesarean Awareness’s post
  • CT Birth Experience’s post
  • She Got Hips’s post
  • CT Doula’s post

If you have blogged about Cesarean Awareness Month and don’t appear on my list, please leave a comment so we can read your post.

To learn more about cesarean awareness, support, and education, visit the Internation Cesarean Awareness Network (ICAN) website and/or look for a chapter in your area.  Another great resource to consult when weighing the benefits and risks of intervention in chilbirth is Childbirth Connection.  Also, I recommend looking at and considering the Mother-Friendly Childbirth Initiative.

How do you plan to honor Cesarean Awareness Month?  How can you let people know that natural birth is an important issue for you and for them?  I promise that there is some way, no matter how small it may seem, that you can have a positive impact on your birth community.  Even wearing a cesarean awareness ribbon several days this month will help.  If you need ideas, feel free to ask.

Midwifery legislation called for in Idaho

Homebirth midwives in Idaho have asked for legislation that would put in place a licensing mechanism and give homebirth midwives the ability to offer broader services. 

According to the recent Times-News article (2/22/08):

Proponents say midwives have provided safe birthing assistance for centuries and that expanding their privileges when it comes to dispensing medications, including intravenous fluids, antibiotics, painkillers and emergency oxygen, will boost the value of their services. They say this will especially help people in less-populated areas around the state.

The debate, [Connie Wolcott, CNM] said, is especially important given that 40 percent [sic.]* of births in the U.S. are done by cesarean section. Licensing, she said, would make it easier for people to become midwives and ease what she described as a huge backlog of patients.

“As a woman, that terrifies me,” Wolcott said of the cesarean rate. “As a scientist, I am appalled.”

I agree with Wolcott.  It is terrifying to know how easily a woman can end up with a cesarean section even when she thinks she’s done all of the preparation necessary to avoid an unnecessary cesarean.  As a researcher (qualitative) and educator it is appalling to witness it happening every day in my community and across the United frickin’ States. 

And this is what the opponents had to say, according to the article:

Idaho medical doctors and nurses who testified against the bill said creating a licensing system that still allowed uncertified birth assistants to practice could confuse unsuspecting members of the public who wouldn’t know the level of training of their care provider.

Confuse the public?  Because expectant parents aren’t smart enough to check a midwife’s credentials and history of experience?  Moooooooo?

They also said that the rules would allow midwives to do things that registered nurses aren’t allowed to do on their own.

Ah, here we go.  The nurses are mad because they don’t get the same priviledges that would be extended to midwives serving a small portion of the birthing population?  They’re jealous because they’re governed by doctors whereas homebirth midwives operate independently unless obstetric back-up is needed.

I’ll be interested to see how things progress in nearby Idaho.

* The national cesarean rate (projected, 2006) is 31.1% though certain areas of the country have cesarean rates more than double the national rate.  The cesarean rate is not expected to decline any time soon.

Maryland Midwifery Legislation

Thanks to Jen at VBAC Facts for her post bringing attention to current midwifery legislation in Maryland:

CALLING ALL BIRTH OPTIONS ADVOCATES!
(especially those in Maryland)

We have a bill! The Birth Options Preservation Act is House Bill 1407.

This bill proposes to end the requirement that nurse midwives practicing in Maryland have a written agreement with a doctor. This will go a long way to ensuring greater access to nurse midwives throughout the state! Final language is now available on the web site, directly from
http://mlis.state.md.us/2008rs/billfile/hb1407.htm. That page will also throughout the process have up-to-date public information on the bill.

You have all been asking for some time now: what can we do to help ensure that practices like the Takoma Women’s Health Center and the Maternity Center stop closing? Well, here is something you can do right now: We need to all work together to make sure this bill passes! We have the sponsoring Delegates and their staffs all working hard, lobbying not only their colleagues, but
other interested organizations, and things are looking very positive, but without the VISIBLE and AUDIBLE support of midwives and their clients or would-be clients, legislators have no reason to listen.

LET’S GIVE THEM SOMETHING TO LISTEN TO!
Below are instructions and driving directions for attending a Nurse-Midwives Rally Night on Monday, February 25th, in Annapolis. Yes, it is a long drive for some of us, but the forecast is for sun and mild temperatures, and we urge you to try your very best to get there, to stand and be counted. This bill could make a huge difference for the women of Maryland ! If this law had been in affect 5 years ago, some of the midwifery practices which were forced to close over the past few years might still be open.

Here’s how you can help:

1. Come to the Rally! We will gather for inspirational speeches from legislators, midwives and clients, then go to visit our legislators, armed with talking points and other materials to make our case. We will try to send a midwife with as many groups of consumers as possible. They love hearing from constituents, and will be very welcoming!

2. Bring your family and friends to the rally! Post this announcement on any listserves you are on, put up a notice up at work, post it at your favorite coffee shop, nursery school, pediatricians, etc.

3. Write to your legislators! Whether you attend the rally or not, it is a good idea to write to your legislator and let them know you support HB 1407. Email your letter to your friends and family and encourage them to write to their legislator, too!

4. Volunteer to help the legislative committee! In the next ten days, we will be doing phone calls to members, and to legislators to set up appointments. We can use all the help we can get! Please contact Mairi Breen Rothman to let her know if you will come to the Rally, and how many friends you hope to bring with you. We can help you identify your legislator, so we can make appointments for you to visit your own delegates when you come to Annapolis . (Don’t worry—you’ll go in a group with a packet of information!) If you can’t come, you can still write to your delegate, and we would be happy to give you sample language, so contact Mairi even if you
can’t come! Please call Mairi or Tina with any questions (Mairi 301-674-9976,
Tina 410-937-5824)

Hope to hear from ALL of you in the next couple of days. If we all work together, we CAN make this happen!
Mairi Breen Rothman & Tina Fisher, Legislative Liaisons
American College of Nurse-Midwives , Maryland Chapter
============================================================
Nurse-Midwives Lobby Night in Annapolis
Where: Rally @ the Assembly Room (rm. 114) of the Office of the Comptroller
* Enter at the front door on Calvert Street
* All visitors are required to sign in at the front desk with the
Department of General Services Police. Be prepared to show identification
* Parking information listed below! 
* Rally begins @ 6:00 P.M (Please arrive by 5:45!)
* Please plan on being at the Assembly Room by 5:45 P.M. to begin the rally promptly
* Plan on arriving in the Navy-Marine Corps Memorial Stadium parking lot by 5:00 P.M. in order to arrive by shuttle on time
* Park: Navy-Marine Corps Memorial Stadium, 550 Taylor Avenue, Annapolis, MD 21401

Due to severe parking restraints in the area around the Maryland State Government Complex, we recommend that you park in the Navy-Marine Corps Memorial Stadium visitor’s parking lot. A shuttle service will pick you up in the visitor’s lot and bring you to the Complex, which is only a 2-3 minute ride. Please be prepared to pay a maximum of $5 for parking.

Directions (from Washington, D.C. metro area):
Take the Beltway and merge onto US-50 East towarAnnapolis. Get off at Rowe Boulevard South, exit 24, toward Annapolis. Stay in the far right lane as you exit Route 50 onto Rowe Blvd/Md-70 east. Make a right at the second traffic light onto Taylor Avenue/MD-435. The Navy-Marine Corps Memorial Stadium will be on your right before you turn. After turning onto Taylor Avenue, turn at the second entrance to the stadium lot, posted “visitor’s parking.”

Visitors are required to withdraw a ticket from the parking meter machine at the bus stop. If the machine is broken, do not worry about getting a ticket. Depending on when you leave the lot, you will most likely not be required to pay the parking fee. BE PREPARED TO, THOUGH! Take the shuttle bus to the Department of Legislative Services stop, the last one on the loop (do not hesitate to ask the driver for assistance). When you get off, you will be on College Avenue between the Department of Legislative Services Building and the Lowe House Office Building, adjacent to Bladen Street. Proceed down the left side of Bladen Street until you reach the corner of Bladen and Calvert Street. The Office of the Comptroller will be right in front of you! Enter at the front door.

Contact Information

Mairi Breen Rothman – Legislative Liaison, American College of Nurse Midwives Maryland Chapter (301) 674-9976
Patrick Metz – Legislative Director for Delegate Heather R. Mizeur (301) 858-3493

Contrast these homebirth news stories!

I have followed homebirth legislation news in Utah and South Dakota with interest and concern.  I don’t want Montana getting any stupid ideas. 

UtahI blogged about their nonsense recently.  Yesterday, the Utah Senate voted to restrict homebirth practices.  The bill was supposed to have been a compromise, but what resulted was something restrictive and punitive.  Women will be forced to attempt VBACs in hospitals or on their own.  Were this the case in my state, I would have an overwhelminly large chance at “failure” since my hospital’s VBAC rate is a pitiful <1%.  They only had 16 successful VBACs at the hospital in 2006.  Utah legislators have chosen a path that makes homebirth less safe.  To search for Senate Bill 93, click here.

South DakotaI also blogged about their homebirth “situation,” and it appears that both the SD House and Senate have approved a homebirth bill. 

The bill would require midwives to become registered nurses, get master’s degrees in nursing, and pass additional tests. Certified nurse midwives wanting to attend home births would need approval of both the Nursing board and the Board of Medical Examiners.

Allowing certified nurse midwives to attend home births in South Dakota would be allowed on a trial basis until 2013.  (click here for source article)

My concern is that CNMs were previously required to have OB back-up, and evidently no OBs were agreeing to provide back-up services.  What will be different?  And I’m not sure that having a Masters Degree makes anyone particularly qualified to attend labor.  Shouldn’t these homebirth midwives have assisted on “x” number of births before they become licensed?  Why is it always about the piece of paper??

Also, the bill states that CNMs will be able to attend homebirths “under certain circumstances” but doesn’t clarify what those circumstances may be.  I suppose we must find the Board guidelines to find more clear language.  To read the bill, click here.

Thought Provoking

By now most people involved in childbirth advocacy are aware that ACOG released a statement reaffirming its opposition to homebirth.  I was directed – via Bellies and Babies and Enjoy Birth- to House of Harris’s response and dissection of the statement. 

People who read my weblog know that I’m certainly all for a woman’s choice of childbirth venue.  I’d like to think that birth can be empowering regarless of venue, but the most likely location for empowering, rewarding, and safe birth is home, assuming that you feel safe in your home.  I am not suggesting that homebirth is necessarily safer than hospital birth.  But I cannot show any evidence that hospital birth is necessarily safer than homebirth for low-risk women and babies.  Even though I bear a cesarean scar, I am not “high risk”.

One thing that concerns me as I consider and plan for a homebirth in the Fall is what might happen to me and the baby should we need to transfer.  I’ve asked the midwives I interviewed about their experiences with transfers.  Most of them say that it really depends on which OB is on call.  Great.

Team Harris addresses this in the comments section of the above post:

I’ve heard the argument that it’s inconvenient for hospitals to have to rally around and scramble when a homebirth mother takes that risk and it fails. While I see what these people are saying, I must also point out that we also rally around for every other emergency in life. We don’t judge the drug addicts who come in overdosed – we treat them. We don’t judge the obese who come in with MI’s. – we treat them. We don’t judge the diabetic who refuses to take his meds yet wants medical help when he has a diabetic crisis – we treat him. We don’t judge the elderly for forgetting their CHF meds and overloading – we treat them. We don’t judge many other behaviors which really ARE obviously poor choices – because they are just that – choices. Mothers deserve the same treatment.

What an excellent point!  Why is it that homebirth transfers are treated as “trainwrecks” and sometimes subjected to chastisement, intimidation, and contempt at a particularly vulnerable time?  I wish OBs who have no appreciation for and understanding of homebirth would take the above comment to heart.

I know in our area, the midwives are very good about calling ahead to apprise of situations so that we CAN have all hands on deck when they arrive. In fact, we did a section recently for a homebirth transfer (a very needed section) and the timing was perfect. Midwife called ahead to warn us. We called the team, and everyone arrived at the same time. Will it always work out that easily? Sadly, no. But that is life. I’ve had to really learn to come to grips with what life is all about. Sometimes bad things happen. And while it’s tragic and horrific, we can’t save the world.

Again, I read last night in Marsden Wagner’s Birth Plan book that the decision to incision time is about 30 minutes, even if a woman has been laboring in a hospital.  Because homebirth midwives are in direct and regular contact with normal/natural birth, they are better able to recognize emergent problems that can only be rectified at the hospital.  In most cases there should be enough time to transfer and receive an emergent cesarean should it be necessary.  I live 10 minutes away from our hospital, so I feel comfortable with the choice to birth at home.

When I was conducting my interviews I learned that the midwives are required to call the hospital and let them know that a woman is in labor at home.  The midwives are not sure what the hospital does with this information.  I wonder that myself and should probably investigate . . .