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Thursday, January 20,2011

Birth belongs to women, not doctors

By Pamela White
Photo by Bas Silderhuis

"Mom defies doctor, has baby her way,” the CNN headline read.

The news story described the ordeals that Aneka (who didn’t want her last name used) endured with the cesarean section births of her first two children — and her decision to have her third baby naturally at home attended by a midwife.

Rather than showing up on the date of her scheduled C-section, she stayed home and waited for her labor to begin naturally, certain her body could handle the task of delivering a child despite the slight increase in risks that comes with giving birth vaginally after having repeated C-sections. Although her doctor told her that her pelvis wasn’t wide enough to accommodate a vaginal birth — the pretext used by the physician to justify her two C-sections — Aneka gave birth in due time to a 9-pound, 6-ounce son after 20 hours of unmedicated labor.

Some hailed Aneka as a hero, a woman who bucked the controlling medical establishment to do what was best for herself and her baby. They understand that most women can safely give birth in the quiet safety of their own homes, and they support a woman’s right to place her trust in her body.

Others decried her as an irresponsible woman who should have done whatever her doctor told her to do to ensure

her baby’s safety. Apparently, some folks believe a pregnant mother ought to yield herself to the will of her doctor as if she were a problematic vessel and birth were an emergency that uniformly demands machinery and expertise in order to produce a safe outcome.

The debate over home birth is not new. It continues to rage in states across the country as increasing numbers of pregnant women reject the invasive hospital regimen — a regimen that carries its own risks — in search of a peaceful, natural birth that respects both the process of birth and the dignity of the mother.

In hospitals, women are typically subjected to a range of “prophylactic,” or preventative, measures such as IVs, constant fetal heart monitoring, repeated invasive vaginal exams, unnecessary episiotomies, pitocin to speed labor, the breaking of membranes and so on. Women who give birth in hospitals are much more likely to endure unnecessary C-sections than women who give birth at home. Many hospitals prohibit women who’ve had C-sections from even attempting to give birth vaginally, meaning that one C-section can result in a woman having to endure C-sections every time she has a baby. (Boulder County hospitals contacted by Boulder Weekly all said they permit a woman to attempt a VBAC, or “vaginal birth after cesarean.”) C-sections are major surgery, of course, and come with their own significant risks. With our nation’s current C-section rate hovering around 30 percent, that’s a lot of women who are undergoing major surgery unnecessarily. Aneka was told her pelvis was too small, a common reason doctors give for suggesting C-sections, but that turned out to be patently false.

She pushed a 9-pound baby through that pelvis of hers in 20 minutes.

At home, by contrast, there are no IVs, and a hand-held Doppler works just as well to monitor the fetus’s heart rate, freeing the mother to move around and keeping that often painful monitor belt off her belly. There are no strangers rushing in and out of the room, no episiotomies, and internal exams are limited.

Though pain medication isn’t available, the focus of a home birth is the mother’s comfort and dignity, not one-size-fits-all hospital policies based on fears about litigation. If complications arise that actually do require medical intervention, women can be transported quickly to a nearby hospital.

But having a home birth, though statistically quite safe, isn’t always easy. Doctors and most certified nurse midwives (CNMs) won’t attend home births, and direct-entry midwives face obstacles in many states. In some states, direct-entry midwives are still prohibited from catching babies.

That used to be the case in Colorado. It wasn’t until 1993 that the centuries-old practice of direct-entry midwifery was legalized in our state. Although direct-entry midwives operated in Colorado before then, they did so in the shadows, illegally. Though women were permitted to give birth at home alone, they weren’t allowed to have a direct-entry midwife beside them.

The situation was so stupid that even state lawmakers understood something needed to change.

But the statute that enables direct entry midwives to practice in Colorado is “sunsetting” this year and must be renewed if pregnant women are to continue to enjoy the benefits of midwifery in their homes.

There’s little doubt the law will be renewed. The Department of Regulatory Agencies (DORA), which has the job of regulating midwives, supports renewing the law for another five years with a new sunset date of 2016.

DORA also recommends that the state give limited prescription privileges to midwives so that they can administer intramuscular shots of vitamin K to newborns, Rho(D) immune globulin to Rh-negative mothers, and antihemorrhagic drugs to women who show signs of excess bleeding.

Direct-entry midwives already undergo training for these simple intramuscular shots, and DORA believes it is in the interests of women and their babies that direct-entry midwives be able to administer these sometimes life-saving medications, as they do in many other states where direct-entry midwives practice under state regulation.

DORA’s recommendations make sense and deserve the full support of state lawmakers. The only thing standing in the way might be the medical lobby, which views birth as the territory of physicians, hospitals and CNMs. Though certainly some of their concern about home birth is the result of emergencies they’ve witnessed as doctors, a portion of it is based on financial interests.

To put it bluntly, if every woman who was capable of giving birth safely at home under the skilled care of a midwife did so, those fancy hospital “birth centers” would find themselves hurting for cash. Any opposition they express toward home birth or home VBACs must be understood in this context.

In the end it comes down to one question: Can a woman decide how she wants to give birth and whom she wishes to have attend her, or is she subject to the demands of physicians and hospitals?

The answer ought to be obvious.

For more information on direct-entry midwifery in Colorado, including current legislation, go to www.coloradomidwives. org. To witness and compare the dignity and gentleness of home births and hospital births, including home VBACs, go to pregnancyvideos.googlepages.com. For more information on VBACs, contact the International Cesarean Awareness Network (ICAN) at www.childbirth.org/section/ ICAN.html.

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Colorado "direct-entry" midwives (DEMs or lay midwives) have a trade school education with little or no training in handling emergencies.  They claim to be experts at "normal birth" which is like a pilot claiming to be an expert at flying in good weather.  DEMs are really more like wedding planners than health professionals.

Colorado DEMs have a very high death rate which is ten time what it should be for only being allowed to deliver low risk pregnancies.  Yes, women have a right to choose their healthcare provider, but if they are interested in having a live and health baby at the end of the day, they will go to a hospital where emergencies care available should they need it. (A normal birth is, afterall, a retrospective diagnosis.) It only takes five minute to have a brain damaged infant.  

Woman post their stories about the pain and suffering DEMs have caused their families on "Hurt by Homebirth" (http://hurtbyhomebirth.blogspot.com/). 



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