Not sure how I feel about Maryland

I just read a press release from Maryland’s Department of Health and Mental Hygiene. First, how strange is that term . . . mental hygiene . . . MENTAL hygiene?

Anyway, on the one hand I am glad that steps are in place to give women access to home birth. And if physicians and CNMs will actually attend these home births, then it’s possible that insurance will cover these births. Hooray!

However, I don’t believe that a physician or CNM is necessary for a great outcome at home. A trained midwife, CPM or otherwise, should be just as capable of handing low and lower risk births at home.

Furthermore, many women who fall outside of the definition of low risk will have better birth experiences outside the confines of a hospital. Typically, physicians and CNMs are not able to provide homebirth services to these women and their babies. I don’t recommend limiting their ability to find qualified providers who will attend them at home. I hope this board will use better mental hygiene and reconsider their ban on lay midwifery.

Where to birth

I found this rather simple yet possibly effective intro mainstream news article about birthing “venues” on Cape Atlantic ICAN’s blog.  Check out this site, because Tiffany is posting really great stuff there.  Kudos to Montrose, CO and the care providers there who are doing their part to improve birthing outcomes in their community.  I’d like to discuss a few points made in the article:

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“I think our society, we control so much — we control (birth) too.”

LAY MIDWIFE

“The worst machine in the hospital is the clock,” [Bill] Dwelley [midwife] said, adding that he allows the natural process to continue for as long as needed if everything is moving along healthy.

He said 90 percent of children are born without complications. Of that 10 percent that do have complications, an experienced midwife or doctor can handle 7 percent; 3 percent require surgical care.

But because of increased inductions, which increases the risk of c-sections, surgical intervention is rising. MMH has a 17-percent c-section rate.

“It’s about keeping the right to choose,” Dwelley said. “We are doing it in the spirit of the woman gaining power.”

These are powerful and perceptive statements.  Indeed, a woman who labors in the hospital is put on a clock.  Labor that does not happen according to established norms will be “helped”.  A 17% cesarean rate is really not that bad – perhaps that is a reflection of a fairly healthy birth culture?  It is important to remember that only a small percentage of babies are born with complications, most of which can be resolved with time, confidence, and supportive care.  When these complications cannot be resolved, transfer to a hospital is prudent.

NURSE MIDWIFE

“I love that this is available to us,” Baskfield said. She added that she feels she can choose to have her baby naturally and that she is comforted with the idea that she can take as long as she needs “without feeling like it’s wrong.”

As far as inductions and c-sections, CNM DeEdda McLean said they don’t offer the option unless there is a medical reason.

The nurse-midwife experience is about encouraging empowerment and supporting the road the mother wants to take.

Consider that these births are taking place in the hospital and therefore more succeptible to the medical model of birth.  Keep in mind that CNMs are generally overseen by obstetricians.  This nursing group is managing more than a third of the hospital births in this area, and it is likely that their cesarean rates are lower than that of the obstetricians.  In my case (I must admit my bias), the CNM began suggesting intervention as soon as she arrived at the hospital.  I believed, as did Baskerfield (quoted above), that a CNM would not take me down the road of intervention, and in the heat of the moment we both caved.  In retrospect I am diappointed that her care in labor & delivery didn’t match the excellent care given prenatally.

HOSPITAL

In a larger hospital, there may be a nurse taking care of the mother before, another during and even more attending to the baby. In Montrose, she said, it’s usually one nurse and so a bond can be formed with the family.

But she said patients do choose a hospital and the hospital has rules. This means an IV tube must be set up for emergencies and intervention is possible.

“When they are coming here we have to be ready for a disaster. If they choose a hospital, they choose to have interventions available,” she said.

In a small town, mothers may receive more consistent care.  It is important to find out about the nurses’ schedules and how many would be attending you in labor and recovery.  I had excellent care from my nurses.  I also recommend knowing the hospital protocol ahead of time.  You can refuse things such as automatic IV, heplock, or continuous fetal monitoring.  Yes, you can refuse it.  Those are interventions that are unnecessary if you are a low-risk patient.  “If they choose a hospital, they choose to have interventions available.”  Keep that in mind – if the interventions are available to you they are also available to your staff.

Physician Jacqueline Garrard said the birthing world is “pretty liberal,” allowing mothers to choose when and how they want to deliver.

Liberal is not how I describe the birthing world.  Childbirth is still largely governed by men who treat the female body like personal property.  Besides, not all mothers are “allowed” to choose how they deliver.  Ask any number of women who are denied VBACs in this country every year.  We have a long way to go before someone like me will call the birthing world “liberal”.