What Will This Home Birth Summit Look Like?

The upcoming Home Birth Summit, supported by funding from the Transforming Birth Fund, is raising numerous questions in my mind, and for numerous others, such as: 

  • How are the agreed-upon ‘stakeholders’ being represented?  How are consumers, in particular, being chosen?
  • What percentage of invited participants have direct experience with home birth?  In my opinion, a representation of 1/3 HB midwives, 1/3 CNMs, and 1/3 OBs would not be an appropriate proportion from the practitioner group.
  • Why exactly is the American College of Nurse-Midwives interested in the issue of homebirth considering that very few actually attend home births?
  • Given the above question, I’d like to know if the home birth midwifery organizations (NARM, MANA) submitted a grant application?
  • How will the outcomes make home birth more accessible and more safe?  Will an outcome be that hospital systems and serving on-call OBs will be more respectful toward homebirth transfers?  Will OBs begin offering back-up services to homebirth midwives?  What might that look like?
  • What are the potential positive outcomes of this summit?
  • What are the potential negative outcomes of this summit, especially considering that the need for this summit originated outside of homebirth midwifery?

With permission, I share the following e-mail from retired homebirth midwife, Linda Bennett:

Are you invited? Who is going?

I have concerns about this “Summit”. I want to encourage communication with invited participants the same way I have encouraged communication with our elected representatives. These participants have been appointed to represent the interests of mothers, families, and, coordinated by a midwifery group, I also assume the interests of midwives. I have every hope this will be the case. My long experience with some of the groups that have been invited raises some doubt.

The “Home Birth Summit”, scheduled for some time and some place in the Fall of 2011, is being coordinated by the organization called “Future Search”. The ACNM originated and identified a need to hold this “Summit”.

The American College of Midwives has many CNM members who actively support families and mothers who want a low-tech physiologic labor and birth in the hospital, in birthing centers and at home. CNMs have demonstrated over and over the value of personalized physiologic management that dramatically reduces unnecessary major surgery while improving outcomes. Their work continues to be overlooked, ignored and impeded by Obstetric professionals in overt and subtle ways. If this summit was only held with these particular participants I would have little concern for the outcome.

Unfortunately the ACNM also has very vocal and politically active members who oppose home birth and/or non-nurse midwifery on local and national levels. Here in Oregon we have the “Home Birth Safety” committee organized by L&D nurses and CNMs in Portland at OHSU for instance. Nothing they have done has improved home birth safety in Oregon, rather their actions have polarized the birthing community and has caused even more mothers to consider unassisted home birth for their VBAC attempts after multiple cesareans.

It should not surprise the ACNM and Future Search organizers that home birth families, midwives with home birth practices, and long-standing Birth Activist groups and individuals feel uncertainty about the outcome of a “Summit” top-heavy with groups who have a history of opposition to maternal choice as well as to the independent practice of midwifery.

We have a vested interest in this “Summit” as its pronouncements will be used against maternal choice at every possible opportunity. Statements made in any documents released as a result of this “Summit” will be entered into testimony for or against legislation affecting mothers, families, home birth and midwives across the USA.

Amy Tuteur is an example of a vociferous emotionally-charged tea-party-esque commentator on the subject of home birth. She is not an expert on home birth. She has never been to one. In order to be allowed to deliver another baby in the hospital she would be required to re-train. If she is in any shape or form part of this “Summit” then it will be obvious that it will not represent the interests of mothers, families or address the real concerns of home birth.

Is Lynn Paltrow invited? Her work with NAPW has been as one of the most effective advocates for mothers in the USA in the tradition of  Doris Haire.

The reality is that home birth exists in the form it is currently functioning in the USA because of what it offers mothers and families AND because of what hospital-based ACOG-controlled maternity care does not.

Please communicate to individuals carefully selected for participation in this “Home Birth Summit”. They have been selected to represent you.

Future Search
4700 Wissahickon Ave, Suite 126
Philadelphia PA 19144
800-951-6333 or 215-951-0328
fsn@futuresearch.net

Here are additional links you might find interesting:

Today’s Notable Reads

Today is a banner day on my Facebook news feed.  Here are some things that piqued my interest.

  • Owen Wilson and his girlfriend welcomed their baby into the world at home!  I’m not providing a link – I figure you can go to your favorite celeb site if you’re curious.  ;)
  • Did you know that nearly 100% of us parents use car seats incorrectly.  Here’s a 5-minute video featuring “The Car Seat Lady.”
  • I haven’t read this yet, but check out this New Yorker article regarding the decline effect and the scientific method.
  • Homebirth: A Midwife Mutiny is a great blog.  I first read Risk, homebirth, VBAC and am now on to her take on a BBC News article about “womb tearing.”  Next, I think I’ll read Blaming Women, because HELLO it happens all the stinkin’ time.
  • I’m also curious to read a new-to-me blog today, particularly the article on “No, Actually, You Did Not Turn Out Ok.”  We’ll see – I’m a fairly mainstream mama, so I don’t know how I’ll respond knowing that this is one of the blogger’s perspectives: “Where I Post . . . And Kick Your Lily White Arse For Making Your Baby Cry-It-Out.”  We ended up doing CIO with our oldest.  Is she ok – not completely.  Is it because of CIO – not necessarily.  Are we ok – no completely.  Is it because of CIO – not exactly.  But hey, let’s blame ourselves (see blaming women above) and each other (a favorite past-time for some on Facebook) for our kids becoming assholes or freaks as if THEY have nothing to do with it.
  • DEEP BREATH
  • My favorite spot on the internet for sound pregnancy & birth related advice – Childbirth Connection

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.

Amniotomy? No thank you!

I am glad to see more attention being given to the problem of artificial rupture of membranes (AROM), also known as amniotomy.  I am encouraged to see this because I believe AROM is what lead to my unnecesarean.

Authors’ conclusions (Cochrane Review, July 13, 2007)

On the basis of the findings of this review, we cannot recommend that amniotomy should be introduced routinely as part of standard labour management and care. We do recommend that the evidence presented in this review should be made available to women offered an amniotomy and may be useful as a foundation for discussion and any resulting decisions made between women and their caregivers.

[Click here to read the review abstract.]

A few articles in the press that piqued my interest:

Childbirth: purposely breaking water does not speed deliveryNew York Times
“We advise women whose labors are progressing normally to request their waters be left intact,” said the lead author, Dr. Rebecca Smyth, a research associate at the University of Liverpool. “There is no evidence that leaving the waters intact causes any problems, and there is not sufficient evidence to suggest any benefit to either themselves or their baby.”

In labor, breaking a woman’s water may be futileLos Angeles Times
“The hormones in the amniotic fluid have been thought to stimulate contractions, but not only does an amniotomy fail to speed up and strengthen labor, it also fails to improve a woman’s satisfaction with the birth experience, an analysis by the Cochrane Review found. Nor does it result in the baby being in better condition after birth.”

Don’t ‘Break the Waters’ During Labor Without Good Clinical Reason, Concludes Cochrane ReviewScience Daily
“This Cochrane Systematic Review found that breaking the waters may be associated with a slightly (non-significantly) higher rate of Caesarean section. Breaking the waters may cause changes in the baby’s heart rate.”

Breaking waters not needed in routine birthsGlobe & Mail
“Yet many medical centres perform amniotomy for routine deliveries. One Toronto hospital does it for 80 per cent of the births under its roof.”
[The “annoying cough” begins a new brief and is not related to this discussion.]

Review Finds That “Breaking the Water” Does Not Speed or Help With LaborHealth Behavior News Service
“However, several American doctors said the findings are unlikely to change the way obstetricians help women give birth in the United States. “Most of us believe it works, so there will be a lot skepticism about this,” said Mark Nichols, M.D., professor of obstetrics and gynecology at Oregon Health & Sciences University.”

The Cochrane Group is an international independent non-profit organization whose goal is to help people like you and me make better-informed decisions about healthcare and interventions.  Archie Cochrane was a British epidemiologist and is the organization’s namesake.  The Cochrane Collaboration was founded in 1993.

In Born in the USA, Marsden Wagner hails the Cochrane Library as “a frequently updated, highly respected electronic library of reviews of the scientific evidence on different obstetric practices”.  Know that doctors (such as Mark Nichols, the man quoted in the Health Behavior News Service bulletin) don’t always practice evidence-based care.  They often “follow the crowd” (ACOG) or repeat unnecessary procedures just because “they work”.  My response to that style of practice is that it is unethical, unfounded, reckless, irresponsible, subversive, and the list of negative modifiers could go on and on for hours.  We all know that cesareans “work”, for instance, but that does not mean that even a significant minority (30% of all live births for example) should be undergoing this procedure.  “It works” is not acceptable.

Something else you should know about the Cochrane group is that several members produced a textbook called A Guide to Effective Care in Pregnancy and Childbirth.  You can download this book  for free from Childbirth Connection.  This is an amazing resource!