Strollerderby

Yes, but if that same "competent midwife" messed up and killed or maimed you or your baby can she be criminally charged?  Wuold you want to sue her?  Not every midwife is a miracle worker.  They make mistakes too.  

I had three hospital births, overseen by midwives, with no unnecessary procedures.  I actually only saw a "real" doctor about 24 hours after each birth (some sort of hospital regulation).  

There were several reasons I did not opt for a home birth, including the fact that I live in an apartment (do my neighbors really need to hear that?), I did not want my older children involved in the birth ("Seriously, I can not get your sippy cup right now, you'll just have to wait until your brother is born" was not something I could picture myself saying), and I like the idea that someone cooks and cleans up after you in the hospital.

But that's just me.  I could care less where someone else has their child.  However, I do think it's kinda odd that this discussion usually implies that all hospital births involve a doctor, and giving birth at home is the only place you can have a midwife.  Ladies!  It's 2008.  You can have your midwife and your hospital, too!

The biggest problem with homebirth is that most homebirth advocates are not honest with women. There are at least 3 critical facts that women need to know about homebirth, and most homebirth advocates conceal these facts.

1. All the existing scientific evidence shows that homebirth increases the risk of neonatal death. Sure, there are papers that claim that homebirth is a safe as hospital birth, but they do so by comparing homebirth to high risk hospital birth (instead of low risk hospital birth) or by comparing homebirth in one year to hospital birth decades before (as in the Johnson & Daviss BMJ 2005 study).

Johnson & Daviss claimed to show that homebirth with a CPM in 2000 was as safe as hospital birth, but they compared it to hospital birth in a bunch of out of date studies extending back to 1969. Johnson & Daviss simply left out the fact that homebirth in 2000 had almost triple the neonatal mortality as moderate risk hospital birth in 2000.

2. Homebirth midwives belong to a second, inferior class of midwives with less education and training than ANY midwives in the industrialized world. American CNMs and European midwives deservedly have excellent reputations. They have rigorous educational requirements and extensive hospital based training in the diagnosis and management of childbirth complications.

Homebirth midwives (direct entry midwives including CPMs) try to trade on the reputation of other midwives. However, homebirth midwives have grossly deficient education requirements (they can obtain their education by correspondence course) and grossly deficient training, lacking any training in the diagnosis and management of complications. American women need to understand that American homebirth midwives cannot meet the requirements to be licensed in ANY first world country.

3. The Midwives Alliance of North America (MANA) the trade union for direct entry midwives, has been collecting extensive statistics on the safety of homebirth since 2001. Those statistics have been publicly offered to anyone who can prove they will use them for the "advancement of midwifery". Even then you must sign a legal non-disclosure agreement preventing you from revealing any data to anyone else. It does not take a rocket scientist to suspect that MANA is suppressing its OWN data because it shows that homebirth with a direct entry midwife increases the risk of neonatal death, and possibly the risk of brain damage as well.

Unless and until women contemplating homebirth understand these three points, they cannot make an informed decision about homebirth.

Geez Amy, don't you ever give it a rest?

I'm not getting involved with a debate here, I just wanted to mention that Amy's assertions in the above post are controversial and disputed.

The biggest problem with Amy Tuteur is that she is NEVER honest with women. There are at least 3 critical facts that women need to know about Amy 's shatstorm of lies, and on all days she conceals these facts

1. All the existing scientific evidence DOES NOT show that homebirth increases the risk of neonatal death. Sure, she gets off (gets paid??) to  troll the comments sections of blogs to slander midwives and home birth and the "well-read mothers" (thanks TIME Magazine!!) and families that choose them, and in the process fudgepacks any statistics she can find to obscure the fact that home birth IS as safe as (safer than?) hospital birth, and does so by completely ignoring some data and skewing other data.

2. She likes to put down home birth midwives, calling into question their education and training, and then turning around to to kiss the arses of other midwives she's deemed sufficient.  Funny, something like 26 states now like our home birth midwives just fine, but dear old Amy has a blog quota to fill and some midwives to slander, and by GOD she's gonna get that commission. Home birth midwives HAVE rigorous educational requirements and extensive out-of-hospital based training in the diagnosis and management of childbirth complications, but she wouldn't tell the truth about this either even if her life depended on it.

Certified Professional Midwives (CPMs) stand proud on their own reputations, and have many, many happy customers.  American women need to hear the TRUTH about American home birth midwives, who are licensed just fine thank you very much in nearly half our states, and the truth will never come from the Big Medicine shill of Amy Tuteurereurueur.

3. The American Medical Association has been trying to eliminate any health care professionals they deem to be unacceptable for whatever reason strikes their fancy (to whit, their lovely policies of discrimination and racism against black docs that they FINALLY came out and apologized for) since that TRADE organization was formed 100+ years ago.  Read up on their dee-light-ful Scope of Practice Partnership efforts ... if the AMA had their way, there wouldn't be any chiropractors, naturopaths, acupuncturists, or anyone else doing what they consider to be their turf.

It does not take a rocket scientist to suspect that AMA is trying to stamp midwives and home birth from the face of the earth because their see a threat to their pocketbooks, and frankly, because they hope to GOD the media don't wake up to the fact that here has been no improvement in maternal mortality since the early 70s, and since then there has most certainly been a back slide.

Personally I think dear sweet Amy and the docs should be scared (sh)witless, because sooner or later the real story is going to come out and it is going to show that the hospital is NOT a safe place for women to labor or birth.

Unless and until women contemplating the AMA and Amy's lies understand these three points, they cannot make an informed decision about any kind of birth.

Amy, go back to your hole.

OMG.  If you ask any pediatrician, obstetrician, neonatologist, post-partum nurse, or L&D nurse if they'd rather give birth at home with a midwife vs in a hospital...well, I'll give you one guess which we'd pick.  There's a reason for that, and it ain't cuz we need the money.  Birthing centers with licensed professionals close to a hospital are fine, but you must accept (or jeez, just acknowledge?) that you are absolutely increasing the risk to your health/life as well as that of your unborn child when you choose to birth at home.

also, GO AMY!  Keep fighting the good fight.  The rest of us in the trenches really appreciate you!

"The American Medical Association is urging lawmakers to restrict the home birthing movement, in part by making it more difficult for direct-entry midwives (who don’t have nursing degrees) to get licensed."

I have mixed feelings about homebirth. I think the advocates for it are often rah rah to the extreme which can end up sending a dangerous message. But I've also known several women who have had successful homebirths and were happy with them. They used a certified nurse midwife with a backup doctor on call.

But what is wrong with making it harder for midwives to get licensed? You don't think a midwife should have at least a nursing degree? The homebirthing community wants to be given more respect. Well, one way to do that is to make sure that all midwives have a certain standard of training like OBs do.

What am I missing here?

Actually, Amy's points are right-on and demonstrate a thorough analysis of the data.

Point 1) She is not skewing the data. She pointing out that the authors of the "study" skewed the data by not comparing apples to apples. You can't compare home births mortality to the mortality of high-risk births at hospitals. It's not the same thing. You have to compare home birth mortality (by definition, low risk) to low risk births at hospitals. I bet you'd come up with very similar results.

Point 2) if these midwives are so good, why are they not CNMs? Why a separate certification and association? If they're as good as CNMs, they should be certified as such. Further, why is the training different?

Point 3) Once again, she's right on.

Finally, to George Bailey, if you want people to respect your viewpoint, you need to respect the viewpoints of others. When you trash Amy in your response, it makes the rest of us respect her even more for her professionalism. She has stated facts, not attacked homebirth midwives with "clever" little almost curse words.  

To add to my previous comments, I am not against homebirths with a CNM present, doctor on call and for low risk patients. But I am very much against misleading parents with skewed data and subjecting them to unqualified pseudo-professionals.

The three points are mute when we consider that unassisted home births without a midwife or any medically trained individual are legal in all 50 states. There also exists a double standard in medical care. Poor and uninsured women in this country often have their pregnancies overseen by medically trained midwives as well as their gynecological care.  Sometimes these are the only people who will serve women on welfare or without insurance, such as in my community where I could not see a OBGYN a mile away from my house because I did not have insurance, but could get an appointment with a clinic over a half an hour away that only had one doctor for high risk patients. If midwives really are untrained why are they the normal care providers for the poor, uninsured and those on welfare? That's a double standard in care that should either not be accepted or midwives are trained individuals who should be able to deliver babies under whatever conditions they choose.  

Also considering lactation consultants need to do clinical rotations I highly doubt midwives are being trained in correspondence courses without any clinic or practical experience. Actually everything I have read is quite the opposite; midwives are highly educated, well trained women who attend home births before finishing their training. Even lay midwives may be highly skilled. There was a recent case in my community where a lay midwife was delivering children in the Amish community. She successfully delivered hundreds of children before she was charged with practicing medicine without a license.

What I find amazing is that in Canada, and specifically in Ontario, where I live, midwives are often considered the same as OBs and are allowed to practice in hospitals...and HOMES! They have two university degrees and their mdiwifery degree is a four year program, with almost two full years of practicum or like a residency for a doctor. The gov't pays them as much as doctors, and you can pick. Why is it that only a few miles north of the US border we have much much better neonatal and maternal death rates? Maybe it's the snow that makes us so healthy....or maybe it's the better pre-natal care that's provided to all pregnant women,should they avail themselves of it.

Hmm, just a thought.

dhsredhead and marcy:  I'm pretty sure there is a difference between the kind of midwives you are talking about and the midwives Amy is talking about.  There are Certified Nurse Midwives who work in hospitals and under the supervision of OB's and then there are Midwives who are not trained nurses who are not working under the supervision of an OB.  They are the ones that I think are under a lot of scrutiny.  There are ALSO Certified Nurse midwives that deliver babies at people's homes too.. when it's legal in the state.  (At least I THINK that this is the case.. someone correct me if I'm wrong).

I personally would never choose to do a homebirth.  Low risk doesn't mean "no risk" and I'd rather be close to the equipment/expertise in case of an emergency.  Though I'm a fan of natural birthing, I have seen the natural birthing community do whatever they want with data to support claims.  Before I had my son, I read "The Thinking Woman's Guide to a better Birth"  I was researching in particular the use of cytotek as a way to induce labor.  The statistics used were really contradictory.  It ended up pissing me off because it was so sensationalized.  I decided to let the doctor use it anyway and had a miserable time on it.  Had the book been balanced and less sensationalized, I might have made a different decision, actually!  (I know I'm getting off point here)  But, all the sensational crap and downright "campaigning" for natural births is really strange and misleading at times.

Sad but true: babies die in homes AND in hospitals. If I were to have a baby at home, and something were to go wrong, it is MY tragedy, MY decision, MY grief. We "care" so much about babies before they are born and where they are born...and yet our children grow up without adequate insurance, with terrible food choices, in abject poverty, and no one seems to care then. Parents make poor decisions about their babies and children ALL THE TIME. So why the focus on THIS particular issue? Doctors are trained to look at birth through a traditional medical perspective. They are doctors, after all. Let people make their OWN choices and live with the consequences. I don't need anyone, any other adult, doctor or not, telling me what to do! It is maddening!

"So why the focus on THIS particular issue?"

Why? Because homebirth advocates are currently conducting a publicity campaign that is fundamentally dishonest.

All the existing scientific evidence shows that homebirth increases the risk of neonatal death.

American homebirth midwives are trying to trade on the reputation of European midwives, but they do not have the education or training of European midwives.

The Midwives Alliance of North America (the DEM trade union) is currently doing everything in their power to hide their OWN safety statistics from American women.

The public campaign promoting homebirth is based on mistruths, half truths and outright lies. American women deserve to know the truth. What they decide to do with that information is up to them, but they are entitled to that information.

Tiffer, there are Certified Nurse Midwifes that work independently and do both hospital and home births. (They usually have OBs that they consult with or refer to when necessary, but are not supervised by Obs)If the issue is about qualified midwifes then I am all for rigorous standards. If that means adopting European standards so that American women can have the option of having a safe homebirth experience than great. However it is a different matter altogether to make the blanket statement that homebirth is dangerous. All the current research indicates that when planned homebirth with a qualified midwife is compared to hospital births there are no greater risks to either mom or baby. Additionally, medical interventions are greatly reduced among home births. I suggest checking out Journal Watch (or other peer reviewed medical journal) - you can get access to many free articles, studies, and meta-analysis of home birth studies (or other topic you may be interested in) and see for yourself.  

@marcy, just wanted to point out that midwives in Ontario ARE NOT equal to OBs. They DO NOT have two Uni degrees. And they are most definitely NOT paid nearly the same as OBs.

Midwives in Ontario are specialists in supporting low risk pregnancies and births, specialists in diagnosing high risk symptoms (and involving other midwives and OBs in consults and transfers of care based on specific protocols), have a degree in midwifery from a University (they are CPMs/DEMs) though some are also nurses (most new ones aren't anymore) and they are limited to 40 clients per annum at a lesser rate of pay than OBs (OBs tend to have at least 200, which was a condition forced on the midwives by OBs in the province when they were being brought into the health care scheme in order to prevent competition - so have no illusions that OBs aren't deeply threatened by busy midwives!).

In my city, midwives are so popular that they have splintered from one to three clinics in the last 10 years and each of those clinics have had to move to larger locations at least once as they've doubled their clinical rosters.

And, yeah, Amy skews data by conveniently leaving out scads of info.

I wanted to add/clarify that the data Amy speaks about - that which shows an increase risk of neonatal death - are studies that make no distinction between a planned homebirth with a qualified midwife and an unplanned homebirth without an attendant. Obviously, this is a gross methodical error. Again, in studies that compare planned homebirth with a qualified midwife to hospital births there are no greater risks to either mom or baby for low-risk pregnancies.

I live in the Seattle area. Although we known as being "progressive" very few hospitals allow hospital privileges to midwifes, even those with ARNP degrees. I understand the concern of having under-qualified midwifes, but it seems to me that if there were no politics involved then hospitals would have no problem granting hospital privileges to qualified midwifes.

I think it is all just something to argue over. I can tell you for a fact that none of you are right. It all depends on the woman, and the circumstances surrounding each and every single INDIVIDUAL. Women "were" having babies long before there were doctors, nurses, so called licensed mid-wives, ETC... They will continue to do so as long as the government doesn't keep restricting our every right in the name of our safety...BLAA BLAA BLAA....For the convince of Corporate America....And people keep falling for it. And calling it safer.Safer than WHAT? Every woman that has ever had a child in the history of time could have benefited from either having a hospital birth and the child standing a chance of living or suffering a loss of a child from the mistakes and bad practices of a hospital. Where one woman may have benefited another may have suffered a loss. Does it make either bad? NO. I came from a long line of women who either had no choice or chose to have their children at home. On my moms side, my mom was born at home as was her 5 brothers and sister. Her mom was born at home as was her 6 sisters and a brother. As for my grandfather all 15 of his brothers and sisters were born at home. For my dads side of the family all 5 of his bro. & Sis. were born at home except the last 2. My grandmother said she wished she had never been talked into going to the hospital. As for that all my dad's dads bro. & sis. were born at home. All 15 of them. None of my grandparents on either side according to questions i have asked ever lost a child and the women were back to house work within the week. Canning, cooking, cleaning, and taking care of kids.I had a friend recently decide on a home birth and she said she will have all her future children at home. I had my daughter in a hospital. My next child I am going to have at home. Not a thing to do with Ricky Lake. I want to prove to myself that I can do it and am not dependent on whether or not people think it is taboo. I believe as a mother and an American, as a human being I have that right to decide. I'll do it whether it be Illegal or not....It's just that simple.

Dr. Amy's claims have been debunked all over the internet... most recently here: vbacfacts.com/.../rebutting-dr-amys-information