MA looks to set up new rules for home births

[dawn9476]

http://www.boston.com/bostonglobe/edito ... _midwives/

[shesinsane]

from the article:

But the numbers are growing, led by women who wish to avoid what they see as overly intrusive or restrictive hospital practices, such as the constant monitoring of fetal heart rates, or the restrictions on vaginal births for women who have previously had caesarean sections.

I hope the reporter got it wrong. I could understand a home birth because of religion, because you won't want to the kid to get vaccines right away, even because of fear of hospitals. But to have a home birth because your doctor won't allow a VBAC (vaginal birth after caesarian)? That's a receipe for a dead mother and/or baby*.

*Assuming the doctor insists on another caesarian because of risk of uterine rupture and the like, not so the doctor can get the birth done at a convenient time.

[keen23]

The risks of uterine rupture during a VBAC, after a standard bikini line c-section are actually pretty low. It's when you get into multiple c-sections or a vertical cut that the risk of uterine rupture rises. There are multiple other things to take into consideration when you consider a VBAC, including the reason for the c-section in the first place, and a blanket ban on VBACs really shouldn't happen.

[Jencendiary]

It's way past time for these to be regulated. When women have births unattended by real medical professionals, they die. Basic historical fact.

[liltwinstar]

I'm sort of torn - I really don't like the idea of unassisted home births (and I would count a birth attended by an unlicesened midwife to be unassisted birth). That said, I think a woman's comfort during that time is important too, so I'm not 100% opposed to home birth when it's attended by competent medical staff. It seems to me that birth is now divided into two camps - either you go to the hospital and do everything the doctor tells you to do, or you labor at home with very little in the way of care. Seems like there should be some middle ground there, where women's comfort is taken into account, but also where both mother and baby can be assured of a successful outcome.

[Kitchen Princess]

from the article:

I hope the reporter got it wrong. I could understand a home birth because of religion, because you won't want to the kid to get vaccines right away, even because of fear of hospitals. But to have a home birth because your doctor won't allow a VBAC (vaginal birth after caesarian)? That's a receipe for a dead mother and/or baby*.

*Assuming the doctor insists on another caesarian because of risk of uterine rupture and the like, not so the doctor can get the birth done at a convenient time.

My DIL had two home births at home after a c-section. The risk of uterine rupture is INCREDIBLY low. It is blown all out of proportion (though I can't quote the numbers now). I read all up on it when she had the first one, and I'm convinced that she was did the right thing.

[FakePigtails]

I'm sort of torn - I really don't like the idea of unassisted home births (and I would count a birth attended by an unlicesened midwife to be unassisted birth). That said, I think a woman's comfort during that time is important too, so I'm not 100% opposed to home birth when it's attended by competent medical staff. It seems to me that birth is now divided into two camps - either you go to the hospital and do everything the doctor tells you to do, or you labor at home with very little in the way of care. Seems like there should be some middle ground there, where women's comfort is taken into account, but also where both mother and baby can be assured of a successful outcome.

I think there's plenty of middle ground but not enough people know about it. I see pregnant women on message boards convinced they'll be tied to their bed and once the baby's born the doctor's going to tear their baby away from them right away and poke and prod it for an hour before they get to hold the child (only a slight exaggeration here on my part). Yet I've also read of plenty of women who labored naturally with the assistance of a midwife or doula. Or with an epidural and a midwife or doula. Maybe it depends on where you're reading? In which case, it's too bad these women are scared of a hospital birth because of only reading fear-mongering websites.

[Kitchen Princess]

I'm sort of torn - I really don't like the idea of unassisted home births (and I would count a birth attended by an unlicesened midwife to be unassisted birth). That said, I think a woman's comfort during that time is important too, so I'm not 100% opposed to home birth when it's attended by competent medical staff. It seems to me that birth is now divided into two camps - either you go to the hospital and do everything the doctor tells you to do, or you labor at home with very little in the way of care. Seems like there should be some middle ground there, where women's comfort is taken into account, but also where both mother and baby can be assured of a successful outcome.

There absolutely is a middle ground. You just don't hear about those middle-ground births because there is nothing exciting, risky or controversial about them.

Unfortunately, the fact that the medical establishment insists on the extreme of interevened birth in virtually all cases (if they have the opportunity) forces some people out of the middle ground into the extreme.

[emmiedahl]

It depends on a lot of things, including the type of c-section, the conditions under which it was performed like what happened to necessitate it, the conditions of the current pregnancy, etc. There are so many variables that I would find a doctor I trust and ask their personal opinion on it.

One reason that many doctors and hospitals are against VBACs in many cases is because of insurance. If insurance has to pay out enough money for adverse events, they will start asking for changes in policy. Thank your local malpractice lawyer for that one. The doctors and hospitals have their hands tied. If you perform a somewhat risky procedure at the mother's insistence and it goes bad, then she will sue you.

The risk I think is 7 or 8 out of 1000. That is huge if we are talking about my life and my baby.

[maybeizfundie]

There would be fewer people doing homebirths, particularly unassisted ones, if hospital policies re: VBAC and intervention in general changed.

I had to fight to avoid intervention in my births at the hospital. There was no reason given to me except "this is policy" and "the statistics scare me" and finally one doctor just straight up admitted that it was all about liability for her. And the insurance/liability thing is a big part of this. I would have appreciated being treated as an individual with individual circumstances (which did not require medical intervention to keep me alive, or my baby). I'm not scared of hospital birth. And I have the benefit of seeing midwives for the pregnancy and letting them be the "buffer" between me and an itchy-fingered obstetrician. But I can definitely understand why some women get to the point of frustration or even fear, and because their options are limited decide to go the more extreme route.

I don't think a majority of women are doing it because of religion, no matter what their faith is. There's the "Zion Birth" thing but it's not something I've noticed as being huge among fundies. Maybe a lean towards natural birth, but not necessarily for spiritual reasons.

gah, this thread is bringing back a weird memory. The cult I was in had a love affair with Mumia Abu Jamal, and someone did a slide show, with him narrating, about his organization. The only slide I remember is a very naked woman laboring on straw in a basement of a building in Philly. They did the whole unassisted thing, apparently, and that was part of their anti-system ideoogy. I was 11 and didn't even know what I was looking at for a moment. I'm pretty sure whoever let that one in the slide show got in big, big trouble. :D

[desertvixen]

I agree with Creaky Steel that there is a middle ground - it's a little boring and not perfect, but it exists.

Five years ago today, I was in it, with a doctor I didn't know (at Fort Gordon, births are done at Medical College of GA, and if you give birth during "not-business hours" you get pretty much whatever doctor is on call) and some awesome L&D nurses and no epidural because the lab was apparently too busy doing whatever, and a medical student watching the birth. Perhaps the fact that it was a teaching hospital had something to do with it, but in my own personal experience, the middle ground was okay.

[emmiedahl]

I had a lot of interventions, all of them totally necessary. If I had believed that hospitals are evil and that interventions are something that selfish asshole doctors force on you for no reason, I would be dead now.

Consider the numbers. 7 or 8 VBACs out of 1000 produce a placental abruption. My doctor probably delivers 300 babies a year. So he probably encounters at least one every year. Potential lawsuit there; why didn't he do a c-section to protect the mother and baby? Isn't that what's most important? Asshole doctors just don't care, right? But if he does a c-section, then he is promotingg the medicalization of birth or whatever and OMG not respecting the mother's right to a natural labor.

The hospital I delivered at probably has ten births a day. So they see placental abruptions and other "rare" side effects every day. Hell yes they are going to be proactive. No one wants to see a baby die because they made the wrong judgment call. They'll lose their insurance and stop delivering babies if it happens too often. One hospital in town already gave up that business because of liability. If the other did so as well, we'd have to drive a few hours to give birth even though I live in a moderate sized city.

I guess I mean that hospitals are not evil and doctors are not out to get you. They see those 'rare' complications every day in women just like you. If you don't like it, take your chances I guess. I won't be.

[Kitchen Princess]

If you don't believe in home birth...

Don't have one.

But don't take away the rights or shame or criticize those who do.

[Patsy]

I don't think regulation of midwifery standards from within their groups, or through the law, or indirectly from high insurance costs, takes away the right to home birth.

[Jencendiary]

Home birth regulation isn't just about the rights of the mother - it's about the safety of the child. Back to the seat belt analogy - the government doesn't say you can't take your kids in the car, but it does say you can't stick them in the trunk or strap them to the luggage rack. . .

[Alecto]

I find it funny we regulate hair salons, nail salons, restaurants, all kinds of businesses....

but the minute you bring up regulating home birth, which has more risks than getting a hair cut, people freak out.

[Deleted03]

I think it has to be regulated, but in the meantime, they have to provide funds/help to center for the formation of midwives, not just dropping a "hey y'all you get out of there" it will only reinforce counter reaction from women who will feel left behind.

I also think that the experience of birth depends on the hospital, thing is, do you really have the means to choose the right hospital for you? Maybe not. And asking for stuff while you're laboring is not really easy if doctors and nurses are being difficult.

I think midwives are a precious resource, and listenning to a group of women asking more recognition to their needs is also important :) bring midwives to the hospital too!

[lilah]

even because of fear of hospitals. But to have a home birth because your doctor won't allow a VBAC (vaginal birth after caesarian)? That's a receipe for a dead mother and/or baby*.

I think even ACOG recognized that the risk of a vaginial rupture is low enough that most VBAC candidates should be allowed to have a vaginal birth. Most doctors won't allow it for insurance reasons. (I would argue to anyone who wants to reform birth practices you first need to reform malpractice insurance and tort reforms. OBs are liable for a baby up to their 18th birthday and that makes most of them very very very gun shy)

Incidentally Michelle has had multiple VBACs, she had one Cesarean for John David and Jana and then went on to have homebirths and vaginal births for another dozen, then had a Cesarean for Jackson and gave birth to Jennifer and Jordyn vaginally.

[fundiefan]

If you don't believe in home birth...

Don't have one.

But don't take away the rights or shame or criticize those who do.

Just to play devils advocate, the same can be said in reverse. If you don't believe in hospital births don't have one but don't shame or criticize those who do (or demonize the doctors those women rely on and trust).

[cindyluvs24]

My OB/GYN has stopped delivering babies b/c her insurance premiums had gone thru the roof. When I (many years ago) went in to have junior, I actually was annoyed by the nurse asking "do you want this or this" I didn't have a "plan" b/c I didn't know what the evening would bring. I remember telling the Dr. " Listen, you went to med school, you're getting paid, whatever, just get the kid out. As long as we're both OK, I don't care." Went on to have an 8 lb, 12 oz, 22 inch, sunny side up presenting boy. (Owwww) I don't hold it against him :P The experience I had that evening had such nothing to do with the subsequent years of actually raising a child. I am amazed by women who rail about their episiotomy or c-section years later. Sorry, but it seems to me, you were lucky enough to get pregnant and have a wanted baby. Quit whining about the fetal monitor.

[jenny_islander]

IME, what women whine about is:

"I am the OB. I don't want to wait around for you to go into labor naturally because I have other things to do, so I will make up some nonsensical reason to induce. Or, my education was so lousy that I don't realize that the estimated due date has the word "estimate" in there, and I will actually panic if your labor doesn't begin "on schedule." Or I will declare from your ultrasound that your baby is 'too big.' In any case, induction time! Oh, your body is 'failing' to produce the baby on my schedule? And now it's time for a C-section? And the baby turns out to be small and premature? :hand: You have a healthy baby! And once the surgical wounds heal, you'll be a healthy mom!"

"I am the OB. I am such a control freak that the possibility of having to stitch an irregular perineal tear frightens me. So I will cut an episiotomy so that I can be sure of stitching a nice straight surgical wound. Even though you might not tear at all if I just back off. Even though you are shouting 'I do not consent.' "

"I am the nurse. I don't like your attitude. I am going to punish you by turning up the pitocin. Even if you are saying no."

[maybeizfundie]

Exactly.

btdt with some OB's. It's not that I think they're all bad. But I can't put blind trust in them because of the personal experience I have with OB's being flat out wrong. And with them wanting to make major medical decisions for me and my baby based on non-medical reasons.

When medical intervention is warranted and rightly applied, it is a wonderful thing, for which I am very grateful. When medicine is wrongly applied, it does not heal. It often harms. It is not unreasonable to be upset about that happening, or to want to avoid it.

[Austin]

IME, what women whine about is:

"I am the OB. I don't want to wait around for you to go into labor naturally because I have other things to do, so I will make up some nonsensical reason to induce. Or, my education was so lousy that I don't realize that the estimated due date has the word "estimate" in there, and I will actually panic if your labor doesn't begin "on schedule." Or I will declare from your ultrasound that your baby is 'too big.' In any case, induction time! Oh, your body is 'failing' to produce the baby on my schedule? And now it's time for a C-section? And the baby turns out to be small and premature? :hand: You have a healthy baby! And once the surgical wounds heal, you'll be a healthy mom!"

"I am the OB. I am such a control freak that the possibility of having to stitch an irregular perineal tear frightens me. So I will cut an episiotomy so that I can be sure of stitching a nice straight surgical wound. Even though you might not tear at all if I just back off. Even though you are shouting 'I do not consent.' "

"I am the nurse. I don't like your attitude. I am going to punish you by turning up the pitocin. Even if you are saying no."

You know, I don't doubt that this happens but to present it as "the norm" is a bit disingenuous. I am a mother three times over and know a pretty huge circle of women who are also mothers multiple times over and I don't think what you describe is a typical experience - at all. Does it happen? Sure. Do things go terribly wrong with homebirth sometimes? Sure. But most doctors and medical professionals are not assholes just as most homebirths go fine. Why do people have to put down a whole profession just to validate their own experience? I don't get it. There should be no need for this and the need is brought on by this stupid competitive thing that some moms do.

There are no guarantees with anything, so women should just do what they want after they've carefully weighed all of their options and neither side should have their experiences invalidated or ridiculed (even if they were good ones). I don't care one bit where other women have their babies.

the mommy wars rage on :roll:

[jenny_islander]

The prevailing problem with OB-attended births in the U.S. is not that OBs and their nurses are assholes, although the pitocin-punishers do exist. It's that they are ignorant. Dangerously so.

This problem stems from the medical model of birth vs. the midwifery model of birth.

The midwifery model--which, BTW, used to be the medical model back when GPs attended births at home--assumes that the overwhelming majority of women and fetuses are fit for labor without intervention. Fat women. Small women. Women over age 30, or 35, or 37. Teenaged women. Twin fetuses. Fetuses that don't settle low in the pelvis several weeks before the EDD. Fetuses larger or smaller than average. Fetuses that don't trip the labor process until the end of the EDD bell curve. All of these categories come in for intervention under the medical model simply because they are who they are, before there is any sign whatsoever that mother or fetus is in medical distress. The medical model assumes that all women and fetuses are a hairsbreadth away from danger at all times and must be "delivered" from being not like the ideal in the textbooks. OBs and nurses who don't act like this are bucking the overwhelming trend. Remember that obstetrics used to be the branch of medicine that dealt with labors that really had gone wrong. When all you have is a hammer . . .

The midwifery model also assumes that normal labor can exhibit an enormous range of variations that are cues for intervention under the medical model. Women can fall asleep in labor; labor can start, stop, and restart; labor can stall due to the mother being scared, cold, or intruded on by strangers; labor can be "precipitous" and still be perfectly okay (I had two of those); labor can start well after the EDD and if there is no sign that the mother and baby are actually in danger--a real, tangible, physical sign, not just the date on the calendar--that's okay too. The midwife's job is to be the spotter, stepping in when labor does depart from this normal course and staying the hell out of the way the rest of the time. And the midwife's first response is to guide the labor back into this broad channel of normalcy--not decide to depart from it entirely and extract the baby some other way. The real emergencies--a transverse lay that won't shift, for example--are the OB's business, of course, and also there are lousy midwives who are worse than no help at all, but that doesn't invalidate the model.

Finally, the medical model ossified when most women were knocked out, manipulated physically while unconscious and supine, and handed a baby after they woke up. So the idea that the woman is conscious, even mentally competent to make decisions, and not only able to move around but probably better off doing so--many OBs treat this as crazy talk. The midwifery model encourages women to assume the positions that seem best to them because they are laboring the baby out. The midwifery model adjusts monitoring to the need of the mother for unrestricted movement and comfortable positions. And midwives, the overwhelming majority, do not strip a woman's membranes without telling or asking, or cut an episiotomy while the woman is shouting "I do not consent," or tell women that they are too stupid or incompetent to understand the process of labor. Again, the woman is the person doing the work; the birth attendant stays out of the way.

The midwifery model is also called "evidence-based care." Midwives present evidence gathered from attending hundreds of births; OBs dismiss it because midwives don't have the right letters after their names, so evidently they don't know what they are talking about. Not all OBs. But that is the overwhelming trend.

[katy]

Have any of you seen the documentary "The Business of Being Born" (it's on Netflix) I think those that advocate automatic c-sections underestimate the risks that this MAJOR surgery carries both to mother and baby. All this talk about VBAC risks, but none of c-section risks ... which are far worse and do include death as well. I know, I almost died last Feb. Anyone ever heard of Placenta Accreta? One of those c-section side effects no one talks about. I have had 3 c-sections, twice due to placenta previa/accreta and once due to a forced repeat, which I consider inhumane. I've also had a VBAC and a VBA2C. I will go to a teaching hospital for a trial of labor to attempt a VBA3C next time. With a healthy and easy pregnancy, it is safer than the risks a 4th section carries. I personally know a woman who had 4 horrific sections-vertical and horizontal scars- and went on to have 8 natural VBACS, 6 at home and 2 in a teaching hospital, with no complications at all. But they (drs)never let you hear about those stories, just try to terrify you that even trying will be a death sentence. At the end of the day, a woman should not be treated like a statistic. Most ruptures in VBACS occur in women who have been given Pit. Naturally done, the risk of rupture is much lower than the risks carried with a c-section... depending on the reasons for the original section.