Wednesday, December 26, 2012

The Business of Being Misled


I loved the movie The Business of Being Born after I watched it a few years ago. I thought it was amazing. I even went to a showing of it up in LA and got to meet and take a photo with Ricki Lake.



I was obsessed and convinced that every mom-to-be needed to watch that movie. Hello, we need to know what we're getting into at hospitals! Or even better, opt out of a hospital and give birth at home, because it's (apparently) safer!

It wasn't just the film. But it was a starting point for me. I started reading Ina May's books (for example) and doing all kinds of research on childbirth and on home birth - everything I could get my hands on. I hadn't given birth in a hospital... how was I supposed to know what it's like? That movie played a part in making me fear giving birth in a hospital. Big time. Yes, I knew family and friends that had obviously had babies in hospitals... but I didn't really know what their experiences were like and I came to believe after watching this movie that if they didn't admit to how horrible their birth experience likely was, then it was because they just didn't know how horrible their experience likely was.

If you've read other posts on my blog, then obviously you know that I've changed my tune.

I had to go back to the movie.... I needed to figure out what it was that resonated so vibrantly with me now that made me feel so upset with the film. I decided to watch it again. And take notes. 

I realized what made me feel so upset: I find the film very misleading. And it's misleading about such an intimate topic: childbirth. And once I learned the truth, I almost felt violated for believing so much in this film. So I want to share with all of you the parts of the film that I found to be misleading.

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  • Two minutes into the film, shortly after a midwife arrives at the home of a woman in labor, this pops up on the screen: "Midwives attend over 70% of births in Europe and Japan. In the United States they attend less than 8%." This comes up in the film more than once - twice in just the first 10 minutes.
It leads you to believe that if you want a birth like other women of developed countries, then you should do it at home with a home birth midwife. It doesn't talk about midwives in hospitals. It just talks about midwives out of hospitals, even though majority of births in developed countries take place in hospitals, with a midwife, OB or other doctor. Yes, you are more likely to have a midwife in other parts of the world - but the birth is taking place in a hospital. The Netherlands has the highest rate of home births, with approximately 20% of women who choose home birth with a midwife - women who are carefully screened so that only low risk women have the option. Every other developed country? It's a fringe practice, just like it is here in the USA, with a home birth rate around 1%. (Update March 1, 2017 - home birth rate in the Netherlands continues to drop and is now at 13%)

So let's talk midwives. This film is obviously very pro-midwife. Which I love because I love the midwifery model of care and have oodles of respect for Certified Nurse Midwives (CNM). But in the US, if you're having a home birth, you are likely not seeing a CNM (you might be, but you are not in the majority if you are).

Yes, in other developed countries, midwives are more popular. But they are also very different from what we have here in the United States

For example, in the Netherlands, the midwife candidate must first be accepted into one of four higher education academies, which is a very competitive process. Each academy follows a strict four-year curriculum and is for full-time students only. Approximately half of the curriculum is practical internships and the other half is studying science-based medicine. Low-risk pregnant women have an option of home birth or hospital birth with a midwife but if the woman becomes high-risk or if complications arise during pregnancy, labor or delivery, she is referred (or transferred) to an obstetrician. Twins, VBACs, breech, etc are transferred to the care of an OB in a hospital. One type of midwife in the Netherlands. That's it.

In the US, it is very different. There are three types of midwives in the US
1. AMCB-certified midwives
2. NARM-certified midwives
3. Lay midwives

The American Midwifery Certification Board (AMCB) is the Gold Standard for midwifery certification and it certifies Certified Nurse Midwives (CNMs) and Certified Midwives (CMs). The North American Registry of Midwives (NARM) certifies Certified Professional Midwives (CPMs) and Licensed Midwife (LMs; essentially a CPM that has been licensed to work in a particular state). Lay midwives have no certification, education or training requirements - technically anyone can call themselves a midwife.
Though some CNMs attend home births, most work in hospitals - the training and education of a CNM is more similar to the training and education of a midwife in other developed countries.

Mass majority of home births in the US are attended by a NARM-certified midwife (a CPM or LM). The typical route to become a CPM or LM (and most popular route of all currently practicing CPMs) is the Portfolio Evaluation Process which consists of an apprenticeship program and passing a skills assessment and one written exam. The time length to become a CPM or LM varies on an individual basis. CPM standards do not meet the standards of the International Confederation of Midwives (ICM). No other developed country allows midwives to attain certification through the types of program that NARM allows.

If a CNM has current hospital privileges, then she may be able to continue care alongside the hospital staff in the event of a transfer. CPMs and LMs do not have hospital privileges and are legally regulated in only 26 states.

Next...

  • "They're surgeons (obstetricians). They should be doing surgery... they should not be doing normal births." This is a quote made by Elan Vital McAllister. This sentiment has been echoed many, many times by home birth advocates. 
Yes, surgery is one aspect of the job of an obstetrician. It doesn't mean that every OB prefers surgery or even likes surgery. It just means they are able to perform surgery when needed. To lump all obstetricians together like that is just stereotyping. Yes, I'm sure there are going to be some OBs out there who prefer to attend c-sections... there are going to be some who prefer to attend vaginal births. There are also going to be some with awesome bedside manner, some that could use a lesson in TLC, some that would get down on their hands and knees in a delivery room to accommodate a mom in labor, some that only want mom to delivery in one position, some that insist on use of continuous EFM, some that are prefer intermittent EFM or even a doppler, etc.... in any profession you are going to have some good, some bad, some that do it this way, some that do it another way, and some that might seem horrible to you but are precisely what another person prefers. 

This sentiment and skewed view of OBs really tainted my view of OBs. But then... I had my first baby and delivered with the on-call doctor that I'd never met before and she was great to me, as was my nurse... and  I became a doula and saw more OBs in action (even random on-call docs and Laborists).... and I started to hear more about the birth experiences of my sisters and cousins and friends (women I know and trust.... women with no hidden agenda)... the good I was experiencing and hearing was much more than the bad. 

Now, I'm not saying the bad doesn't exist. But I do think it's misleading and a scare tactic to say that OBs are surgeons and should only be doing surgery. A lot of women and a lot of OBs would disagree with that.

Next...

  • This caption pops up on the screen: "The United States has the second worst newborn death rate in the developed world." Then you hear the voice of Eugene Declerq saying "The United States is ranked poorly in terms of infant mortality."
Totally misleading and something I completely fell for when we watched this. Infant mortality is not the correct mortality rate for assessing whether or not childbirth in a country is safe. The correct rate to look at is perinatal mortality. Here's the difference: 

Infant mortality refers to the death of a baby within the entire first year of life. (reference is linked) Infant mortality does not include fetal or intrapartum deaths. Again, infant mortality refers only to babies born alive that die before they turn one. If a baby dies at 4 days old or 364 days old it will affect the infant mortality rate. So yes, it includes pregnancy and birth-related issues that may later cause a death like birth defects, low birth weight and neonatal hemorrhage but also includes things like accidents, disease, and SIDS… those are all encompassed (and more) in the infant mortality rate. According to the CDC, in the United States, SIDS is actually the leading cause of death of infants 1-12 months of age.

Perinatal mortality is the most accurate way to assess the outcomes of pregnancy and childbirth (even the World Health Organization acknowledges this). It includes prematurity, fetal mortality (death of baby in utero of at least 20 weeks gestation), intrapartum mortality (death of baby during labor and delivery) and neonatal mortality (death of baby during first 27 days of life). (reference is linked)

So, how does the US compare to other countries in this regard? The United States perinatal mortality rate is one of the lowest in the world. Our rate tied with countries like France and Japan and is actually lower than the Netherlands and the UK, surprisingly enough. (reference is linked)

Next...

Edited to add: I quickly want to address maternal mortality. In the film it is brought up about the high rate for maternal mortality in the USA. As far as that goes, the real issue in our country is health of pregnant women. Maternal death is very rare (which is why it's measured per 100,000). And it's even more rare for healthy, low risk women.

Our number one pregnancy-related killer for women in the USA is cardiovascular disease.

Some important information to read/consider:

"In the U.S., deaths from hemorrhage, sepsis (infection) and abortion (the medical definition of which includes ectopic pregnancy, miscarriage and induced abortion) are on the decline.... But deaths from medical complications that were either exacerbated by pregnancy or started during pregnancy -- things like congenital heart disease, diabetes, obesity and kidney problems, are on the rise." (my emphasis; quote from Maternal Mortality Article << this link includes a recent study on maternal mortality around the globe)

In other words, mass majority of the women dying due to pregnancy-related issues in the USA need more intervention, not less.

And here's more food for thought on maternal mortality: Chronic Disease and Maternal Health

Next...

  • Cara Muhlhahn is the home birth midwife featured in this film. At one point she lists all of her education and training and it sounds awesome. 
She definitely sounds like she is qualified to deliver a baby. She is a CNM. She's been to nursing school and has several years under her belt delivering babies in and out of hospitals. BUT.... did you also know she has had two lawsuits against her? One for a stillborn baby and one for a baby born partially paralyzed both born at home under her care. You can read more about that here. She also does not have hospital privileges and is known for not risking out women and referring them to OB care if they become high risk (breech, twins, etc), even though in the film she talks about how important it is to screen women to make sure they are good candidates for home birth. 

The baby that was partially paralyzed was born in 2003. This film was made in 2008. I found that interesting.

Next...

  • At 27 minutes in, Cara Muhlhahn assists a woman in her water birth... she has her hands in the water and appears to be applying counterpressure presumably to help the woman from tearing... I'm not exactly sure though but in any case, she has her hands down there on the woman's vulva and then helps the mother catch the baby.
What's my issue here? SHE ISN'T WEARING ANY GLOVES!!!!!!!!!! If a midwife or doctor or nurse ever has their hands any where near my vulva and/or my brand new baby, they most certainly will have gloves on. Come ON. So unsanitary.

Can you just imagine if a MALE doctor put his ungloved hand on his patient's vulva? Did this woman in the film give consent to that? Was she aware that it happened? This just blows my mind.

Next...

  • Around 35 minutes in, they discuss c-sections. And basically, we are led to believe that c-sections happen b/c either doctors want to go home for the day or because they are afraid of getting sued. C-sections are "extremely doctor-friendly."  That's their whole spiel on c-sections. How unnecessary and scary they are for women, yet convenient for doctors.
C-sections are also life-saving. And they aren't all scary. There are some beautiful c-section stories out there of women who peacefully birth their babies into this world via cesarean. I know there is a whole slew of people out there who believe that most of the c-sections done in our country are unnecessary c-sections (or "unnecesareans"). I'm sure there have been cases when a c-section has been performed for the wrong reasons - and I'm sure that happens in a lot of developed countries, not just the US. How do we know what's unnecessary and what's not if we don't have the details on each individual case? If they are unnecessary in the moment, then why aren't women saying no to the procedure? If they are only unnecessary in hindsight (in someone's opinion), then how do we know the doctor doesn't feel the same way? How do we know the doctor that performed a c-section isn't thinking "maybe I could have let her labor longer but I was worried about her baby and I truly did what I felt was best in that moment for the health of that baby and mother." Or does it not matter what the doctors thoughts are about it? Once deemed unnecessary by someone - someone that may or may not have any medical expertise in obstetrics - then it becomes the doctors fault and he or she is evil for that potentially unnecessary c-section. The doctor had no good intention in their actions. It was purely out of convenience.

For those who were coerced into a c-section they did not want when there was truly no medical need for it, when labor could have continued on without the mother or baby in danger, then that is horrible. And I don't dismiss those. B/c I know that has happened (and continues to happen). I think sometimes there is more to the story that I don't know, or maybe that even the mother doesn't know - but not always. Sometimes yes, convenience may be the driving factor in a woman getting a c-section. And I do not believe that is OK. At all.

However, I do not believe this overall negative attitude toward c-sections is serving women well. It's filling them with fear and doubt and a sense of failure for those that need c-sections. Empower women with information, such as evidence based practices that have been proven to lower a woman's chances of a c-section. Don't just make sweeping and negative generalizations about c-sections being scary, unnecessary and extremely doctor-friendly. 

Fast forward for a moment to the end of the film when the on-screen producer, Abby Epstein, needs a c-section for her breech, pre-term baby (she says she is about 35-36 weeks pregnant)... what does Ricki Lake say to her afterwards (8 months later) when they are discussing her birth? She so kindly asks "Do you feel cheated? Do you feel like you missed out?"

Nice.

I can understand wanting and desiring the birth to go one way, then having it go another and feeling upset about it. It could have been a totally terrifying experience for her and if it was, hopefully she has found a way to sort through that. But this was evidence based care that she received. I don't think she needs someone poking at her to see if she feels like she "missed out," making her feel guilty and insinuating that she was cheated in some way. How about asking "how do you feel about the way that it all happened?"

Abby Epstein then goes on to say that her son "probably would have survived" a vaginal birth... and then talks about how they had a hard time bonding and a hard time breastfeeding. And she thinks this is from the C-section??!!!

The C-section is what is blamed here for her "lack of bonding" and the breastfeeding issues? How about the fact that her baby was in the NICU for a few weeks? How about the fact that her baby was very underweight due to IUGR, weighing only 3 pounds 5 ounces? How about the fact that he was pre-term? Why is the C-section getting the blame for her postpartum issues?? The C-section SAVED her baby. She would not have a child to bond with or breastfeed at all if that baby wouldn't have survived birth - which is completely possible given the state of her baby and his presentation.

Next...

  • What makes homebirth safe? According to Eugene Declerq, outcomes for home birth are very good when "the people there are trained, that there's backup, that they can transfer to the hospital quickly." 
There are other studies that have been done in other countries that show that home birth, under those circumstances, can certainly be a reasonably safe option. But again, those are different types of midwives with different health care systems. You cannot use studies done in other countries to try to demonstrate the safety of home birth in the United States. You're comparing apples to oranges.

What we know about home birth in the USA is that the outcomes are much worse than hospital births. Every study we have demonstrates this. And I'm not referring to the Wax study. I'm talking about:
The 2015 New England Journal of Medicine study
The 2014 Midwives Alliance of North America (MANA) study
The 2014 Cornell study
The 2013 Grunebaum study
The 2013 Cheng study
The 2005 BMJ study

These home birth outcomes are not good:

Notes from the above chart:
NNM = neonatal mortality
BC = birth center
Home "Other" refers to accidental home births (a woman intends to give birth at hospital or birth center but accidentally gives birth at home unattended) or planned, unattended childbirth (a woman purposely gives birth without a professional care giver present).

Home births in the USA aren't just more dangerous than USA hospitals, home births here are more dangerous than home births in other developed countries. Here's some food for thought regarding our awful home birth outcomes from this piece by the Coalition for Safer Home Birth (fully referenced, follow link for the studies used):

"Looking at combined intrapartum plus early neonatal mortality rates (early neonatal death means the baby was born alive but died sometime in the first seven days), a baby is three times more likely to die at a home birth in the USA with a mortality rate of 1.71/1000 versus only 0.64/1000 babies dying in the Netherlands.
        Let’s give a little context to what these numbers mean: for every 10,000 babies born at home in the Netherlands, only 6-7 babies will die; for every 10,000 babies born at home in the USA, 17-18 babies will die. That is an excess of 10-12 babies that die per 10,000 births. According to the CDC Wonder Database9, in 2013 (the most recent year available) in the USA there were over 40,000 births that took place in a non-hospital setting (home or freestanding birth center) with a midwife in attendance, which means, within a single year, 40-48 babies died who would have lived in a safer home birth system like that of the Netherlands."

And also, when Eugene Declerq mentions being "trained" I have to wonder what he means by that? Does he mean the training of a CNM? CM? CPM/LM? Lay midwife? The training varies greatly from one midwife to the next in the US - to which is he referring? If you'd like to see an interesting breakdown on the qualifications so you can see just how little it potentially takes in order for one to get the title Certified Professional Midwife or Licensed Midwife, check out this post at the Safer Midwifery for Michigan blog.

Next...

  • "Today in the United States, we know that there is serious increase in minimal neurological problems in children and in attention deficit disorders, in autism, and all these things are increasing at the same period of time that we're increasing all these obstetric interventions," says Marsden Wagner
What a horrible way to try and scare women away from childbirth interventions. No studies or evidence offered to support this nice little scare tactic. This is called correlation (not to be confused with causation). These things could be completely unrelated! Let me explain.... take this graph below, for example. It represents data for organic food sales compared to autism rates. It clearly shows that the rate of individuals diagnosed with autism increased at the same time and same rate that organic food sales increased. One look at it and one might think "organic food causes autism!!" 



But can we really conclude that autism is caused by organic food? Of course not. But that is exactly what Marsden Wagner is doing: using correlation and trying to convince people that it means causation. Don't fall for it! This is just a crappy scare tactic based off correlation. Beware the correlations and cherry-picked data, my friends.

This next and final part disgusts me. DISGUSTS me.

  • Michel Odent says this: "With mammals in general, there is immediately after birth, a short period of time which will never happen again and which is critical in mother/baby attachment. Until recently, in order to give birth, a woman, like all mammals, is supposed to release a complex cocktail of love hormones. As soon as baby is born, when mother and baby are together, both of them are under the effect of a sort-of morphine, an opiate, natural morphine endorphins. We know the properties; they create states of dependencies. Addiction. When mother and baby are close to eachother it is the beginning of an attachment." While he says this in the background, you are watching moms/babies shortly after birth at home births. They are over-the-moon with happiness, cuddling their sweet little gooey babies. 
He continues, "But today, most women have babies without releasing this flow of love hormones. I'll just give an example of animal experience. In general, if you disturb the hormonal balance of a female giving birth, it's simple, the mother does not take care of her baby. It's simple, if monkeys give birth by cesarean section, the mother is not interested in her baby. It's simple, easy to detect on an individual level. So you wonder but what about our civilization, what about the future of humanity, if most women have babies without releasing this cocktail of love hormones, can we survive without love?" While he's saying this in the background, you are watching epidurals being placed and c-sections and women who look disconnected from the process. 

Wow. He is reaching pretty far there. Really far. No love cocktail at birth = humanity doomed to try and exist without love. WHAT? Yes, ladies who have had or will have a c-section, you aren't going to feel bonded to your baby. Sorry, but you won't have that "love cocktail" that enables you to feel that bond. We're just like monkeys after all so you probably won't even feel interested in your baby. Moms who have had or will have interventions, please know that if our species stops surviving due to lack of love, it's your fault. For moms who adopted their children and experienced no pregnancy or birth hormones what-so-ever with their adopted child, well, yikes, according to Odent you are pretty much screwed!! All of humanity is!

What a load of nonsense. Horrible, offensive nonsense. 

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These are my main issues with the film, the things I found to be the most misleading. Does this mean I'm anti-home birth?? Nope. Read here to find out how I even got started writing about all of this. But this film is misinformation and full of scare tactics. They clearly want women to take with them the message that if you choose home birth, then you are empowered, you know how you want to do things, you are a go-getter (and it's not just insinuated, there are direct quotes, like this one from Marsden Wagner "If you really want a humanized birth, the best thing to do is to get the hell out of the hospital")... and the rest of us women who choose to give birth in the hospital? We are not empowered, we don't know how we want to do things, we don't desire a humanized birth, we are just willingly poked and prodded when we go to L&D, basically. Amiright, Ricki?

I suppose since it's a documentary it's bound to be biased. Clearly, this film is biased toward scaring women away from hospitals and childbirth interventions.

I remember discussing the film with my cousin a couple years ago. She was not impressed at all by the film and I couldn't understand how that could be possible! We went back and forth about it and just couldn't see eye to eye. I thought, maybe it's b/c she's a little younger than me or something, she just doesn't get it. 

Well, Juls, now I get it. :)


Edited to add: I was interviewed by the New York Times regarding this film. Click here to read about it. 







Monday, November 26, 2012

Does Baby Really "Know" When to be Born?


Photo courtesy of MaceyBuchanan

I have heard and read it a million times on my natural childbirth (NCB) websites and forums that "baby will know when to be born," "baby won't come until he (or she) is good and ready," "your baby wants to choose her (or his) birthday," etc....

This was something I once really believed.... that the baby will be born when ready and not a minute too soon.... but in past 6 months (or more like year, actually), I have been doubting more and more. Here are some lingering questions I have that fill me with doubt....

What about those babies that are born via induction at 41+ weeks, mom who passed all BPPs and NSTs, but placenta shows signs that it was shutting down.... had mom refused induction, what would have been the outcome?

What about babies that are born premature and then spend weeks in a NICU? Or worse, what if baby is born too early to live outside the womb? These are purely anecdotal but I know of two very healthy, low-risk moms who went into preterm labor prior to 30 weeks.... one whose labor was able to be stopped with medical assistance at the hospital but the other whose labor couldn't be stopped and baby lived but had a long NICU stay. (no problems or assistance with conception in either case, in case you're curious)

Yes, due dates can be wrong, so a baby born at 42 weeks might actually only be 40 weeks.... but what if it swings the other way? What if mom waits until 42 weeks and baby is actually 44 weeks?

And finally...

What about the babies that are born at 41+ weeks that are stillborn because the placenta stopped functioning completely.... all signs and tests were good until it was "too late."

According to ACOG, a baby is considered full term from 37-42 weeks.... but can being too close to either end of that range be dangerous? Does it mean all babies born in that range are full-term and ready to be born? Or does it mean most babies? Also, how do we know which "due date" to use? Which is ACOG using according their definition? As many of us moms have experienced our due date based on last menstrual period might differ from our due date given during the first trimester ultrasound.

I would love to hear your thoughts on this! Please chime in, leave a comment.... any particularly thought provoking comments I will quote and add to this post.

Thanks!

**To be clear, I realize - and always have - that a baby does not make an actual decision to be born. But rather, what I'm questioning is that for a normal, low-risk pregnancy, all the pieces would fall together at the right time and baby would be born at the right time.... baby would be ready, body would be ready, and labor would start.

Update 01/12/2013:
I expanded on this thought looking at evidence for induction vs waiting for spontaneous labor. Click here to read the post.


Monday, September 17, 2012

Due -- A Birth Story

I came across a birth story about a month ago that touched my heart. I know sometimes we may take for granted why due dates are important and why many doctors and midwives alike get anxious with each passing day over 40 weeks. Here is the story about the birth of sweet Clara linked below with a note here from Clara's mother, Heather:

"As a mama who just went through a pregnancy that went to 42w3d and ended in a perfectly formed but stillborn baby, I know that I would do things differently if I had a chance. If I'm ever fortunate enough to be pregnant again, I will do things differently then.

I believe strongly in natural unmedicated birth, but there comes a point where there is a risk to the baby... and that risk is NOT worth it, not even for a second. It's not just about the mama's comfort level... my comfort level was just fine, because I heard all of the "I went to 43w+ and my baby was fine" stories and I believed that my baby girl would be fine too, if I just allowed nature to take its' course. I was wrong.

Nature doesn't always take the right course, and not always in the right time frame. Believe me, no soapbox or belief system is worth the loss of your sweet baby."


Here is the birth story of Clara Edith:
http://www.thedestinymanifest.com/2012/08/she-was-still-born.html


(shared with permission)


Friday, August 17, 2012

Dr. Biter

I heard about a home birth death with Dr. Robert Biter a few weeks ago but there weren't any details. Today, I saw this on Yelp:

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Review from Amber L, dated 8/11/12:

My baby died 6 weeks ago because Dr. Biter was our doctor.  Any way I review the course of events, the result is always the same, this would not have happened with another doctor.  I chose him based on all these wonderful reviews on this site as well as word of mouth from women all over Encinitas.  I saw the couple of bad reviews here, but I thought, how can he be bad if  this many women go to him and rave about his care. There was very little information out there about his numerous malpractice suits and infractions with the medical board.  I wish that more people knew the truth then so that someone could have warned me about his reckless practice so my baby could have been delivered safely and lived.  This is why i am writing this review, so that other families won't have to go through what my husband and I are going through and so that no babies will lose their lives or be harmed by his inability to make the right call when things start going wrong.

Initially when I called to inquire about an appointment, I asked about his lack of privileges at any local hospital and was told that he was working on getting them back... I ended up seeing Dr. Cobb, who was so nice and seemed very caring, but he left the practice soon after I started going to Seaside Womens Health, so we started seeing Dr. Biter.   In December, when he asked where and how we wanted to deliver and we said, Scripps Encinitas, he said - "Oh i don't do that, but i am opening this amazing birth center very soon!"  He said it would have all the emergency equipment that a hospital would have with the exception of anesthesia.  So great!  Now we are all set to deliver at this birth center and decided to do it naturally.   Around April, he informed us that the birth center may or may not be ready - but that he performed home births, so that could be our plan B.  At first we were skeptical, but he made it sound so calm and serene and anyone i talked to who had homebirths thought that was their best birth experience ever, so finally we were pursuaded to take that approach.  He did not give us any risk factors for homebirth and said we would be transfered to a hospital as soon as we needed to be if anything came up that warranted it.  We live 2 minutes from Scripps Encinitas and thought that we were in good, safe hands because he is a doctor.  This turned out not to be the case.

I asked Dr. Biter repeatedly when it was no longer safe to do homebirth, especially as I became more overdue and labor hadn't started.  He said he wasn't worried and that he would tell me when he was, he did not however give me a list of risks allowing me to go so late nor did he indicate that homebirth was no longer a safe option for me. I was over 42 weeks when my water finally broke, after close to 30 hours of contractions.  

After my water broke, I was in labor 22 more hours during which a number of complications arose that were either ignored or downplayed by Dr. Biter, all of which  could have been dealt with effectively at the hospital.  I ended up in an ambulance transferring to the hospital after my baby's heartbeat was lost.  I also had a fever of 104 and was in danger of losing my uterus.  I was told that if he had gotten us to the hospital sooner, they would have given me antibiotics and our baby would have had a chance.  He died of a severe infection that had been present  for many hours.  I feel very betrayed.  You have to put your trust in your OBGYN, you have to trust them to tell you what to do during labor and trust that their advice is safe and cautious and with your's and your baby's best interest at heart.  I think his judgement is clouded, and he is just not able to make the necessary calls when faced with complications and life-threatening decisions.

I would highly recommend searching elsewhere for your prenatal care.  I will never forgive myself for not seeing the signs and entrusting delivery of my perfectly healthy little boy to him.  We will never get our little boy back, but hopefully his life can save the lives of other babies and moms by sharing our story.



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So very sad :(

For those unfamiliar with Dr. Biter, he is/was a very popular doctor in the San Diego area. Here's one article about him..... feel free to Google him...

Update 8/17/2012:

To read about his current issues with the medical board and to read about his probation and suspension, click here. It's a very long document but read it. Disturbing. An easier-to-read version of the probation details is available here.

The probation and suspension decision was signed on May 15, 2012 but the suspension doesn't begin until September 7, 2012. The infant death of Amber L's baby occurred around July 1, 2012. Not sure what will happen to his license once the Medical Board learns of this infant death.

Update 8/29/2012:

The couple spoke to the news about their loss. You can read their story here. You don't get the full story from the news piece so reading it in conjunction with the Yelp review helps put the pieces together.

Update 10/21/2012:

Here's the latest being investigated by the Medical Board of California regarding the above home birth death (starts on page 12 of the document). It is very hard to read, very disturbing, extremely sad.

Update 01/04/2013:

Dr. Biter's license has been suspended indefinitely by the Medical Board of California due to the above home birth death. Same link above gives the details.

Update 12/02/2013:

Dr. Biter surrendered his medical license, effective November 26, 2013. "According the Medical Board’s order, Biter has now agreed that if he ever asks the Medical Board or any other health care licensing agency to reinstate his license or grant him a new license, “all of the charges and allegations” in that accusation will be considered true and correct and could be used against him in the application process." Click here to read more about it.

Thursday, August 2, 2012

Hindsight is 20/20


Hi. I'm Danielle. I'm the owner and only writer of this blog. Thanks for stopping by to read what I have to share. I'm a thirty-something mother of two and wife to my one-and-only. Here's us:



But this is actually more like it:



I'm also a daughter, sister, friend and a few other things.

For my work outside of my home, I'm a certified birth doula and certified childbirth educator. I love witnessing, discussing, teaching and learning about childbirth. I believe I have learned quite a bit but don't consider myself to be an expert by any means. My views of birth have evolved from once being quite extreme to now being more middle-of-the-road.

Your comments are welcome on my blog - I don't moderate or delete them, but I do ask that you keep them appropriate. I read each of them even if I don't respond. If you ask me any questions directly via comments, I try my hardest to respond. If you have a note or story to share that you don't feel comfortable leaving in the comments, you can email me at douladani1 at gmail dot com.

There were several reasons why I decided to write my original post and to start this blog.

More than anything (much, much more), it's been cathartic for me to write - it's been a way for me to process certain things. I went from someone who desperately wanted a home birth and thoroughly believed in it and it's safety down to my core; to someone who no longer felt it was the safest option for me and questioned the safety of home birth as a whole in our country. It was a huge change of heart and mind... and there was definitely some pride that had to be swallowed... and writing it out really helped me understand why things changed so drastically for me. A lot of people find comfort in writing - it has always been something that works for me (my husband and friends/family can attest to this as they have all been on the receiving end of one of my many long-winded emails or letters!).

But this blog has also helped me shed some guilt I had (and still have) about certain things.

I have to to say that there was a certain amount of selfishness in my desire to have a home birth. Please note - I am not saying that every or any woman who has a home birth shares these same feelings or desires. I'm truly only speaking for myself. 

Of course my selfish desires were not major factors in my decision to have a home birth - I had read so much literature and I was truly and absolutely convinced home birth was the safest option for me and my baby. My little selfish desires were more just the icing on the cake or the cherry on the sundae, if you will. But they were still there... and I have guilt about that... guilt that those desires even existed to a point that they were a part of my driving force, even if they were a very small part of it. Had it worked out for our first birth to take place at home as I was hoping, if anything would have happened to my baby, even as small as those desires were, I know that they would have haunted me forever.

My former attitude that I had regarding childbirth in general - and parenthood, too - affected several aspects of my life... and it greatly affected my perception of my hospital birth experience.

After giving birth at our hospital, I knew that the experience was good for the most part (for example, our nurse was so phenomenal that I brought her chocolates at work a couple weeks later) - but I still had some things to complain about. It took me a while to realize it but I went into that birth at the hospital wanting to hate it so badly. So man, did I pick it apart afterwards. I overlooked all the positives and went right for the negatives - and there weren't very many negatives, but I sure clung on to them. My attitude was just bad. I'm honestly surprised that my OB continued to be as friendly as she was and is to me!

It wasn't until I started to learn more about childbirth and attend more births - specifically home births - that I started to realize how nice my experience was after all. I realized that certain aspects of my birth would have been handled in relatively the same way regardless if I were at home or at the hospital. What was I so bent out of shape about? I'll be honest, certain complaints were due to downright ignorance. I'm too embarrassed now to admit some of the things I found to complain about....

As months went by I started to process my birth more and more.... and I felt very guilty for the person I was around that time in my life. Several months ago I remember sitting and crying to two of my friends over the guilt I felt for painting such a horrible picture of my birth experience at our hospital.... I couldn't help but wonder if anything I had said or so foolishly complained about made other women fear giving birth in a hospital.

It's amazing how much our attitude can affect our perception of things.

It wasn't just my birth experience that my attitude affected. It started to mold and take shape of a pretty judgmental and know-it-all person. Who was I becoming? I had an opinion about everything childbirth-related and boy did I sure think that everyone cared about it! I found myself pitying moms so often, "poor thing, she just doesn't know how bad her birth experience was / how wrong it is to do this or that / etc."

I never stopped to think.... why the heck does it matter to me how other women choose to give birth? Who cares what "parenting method" other parents choose to utilize or if they use any "method" at all? Who cares if other moms breastfeed? The list goes on......

But while I'm at it.... breastfeeding is another perfect example. I feel passionately about breastfeeding, I do. But for me to judge other women for not breastfeeding is not right. I have no idea what their journey has been like. I have no idea the reasons they have for breastfeeding or bottle feeding. I have no idea if there is a physical problem that makes breastfeeding not an option. I have no idea if they desperately wanted to breastfeed but didn't have the money or resources to get passed certain obstacles they may have faced. I didn't know if they needed to be on certain medications that aren't compatible with breastfeeding. Hey, I didn't know if someone just didn't want to breastfeed - it's as much a woman's choice to breastfeed as it is her choice to decide where to give birth, right? I didn't know any of those things but it didn't keep me from judging women if I saw them bottle feeding. Why?

Why I didn't I ever stop to think, "this doesn't affect me or my family, so who cares?" So much wasted energy on caring too much about things that were none of my business.

What was with my attitude? Why did this "stuff" consume me so much? Why did I feel so.... superior?

I know part of it is b/c I felt it validated me, sadly enough. It made me feel like I was doing it "the right way" when I knew other moms who did things the way I was doing them. Parenting is a big deal... it's the biggest deal.... you are raising another human being and you are their guardian and protector and how the heck are we supposed to know if we're doing a good job? We don't have a boss to praise us or a promotion to get when we are excelling.... how do we know if we're not messing up?! So it's a nice feeling of "ok good, they do this or that and they are smart and nice people, so it must be a good thing what we're doing this or that, too!"

Validation wasn't all of it, though. I don't know what it was. Perhaps just the thrill of feeling like I was "right" and others were "wrong." Perhaps in feeling like I was doing things the more "challenging" way then it made it seem more rewarding. I don't know. But I'm ashamed of that person now. That's not the person I want to be the mother to my children.

There's a happy medium out there regarding childbirth and parenthood and the attitudes we have about them. I'm striving to get there.

I'm starting out with a simple yet rational realization: I... am not better... than anyone else.


Except for the fact that I'm a redhead. Obviously.



Friday, July 13, 2012

Take on Home Birth, Part II

I just want to quickly mention a few things.....

1. I don't think every woman has had a perfect hospital experience. I know some women have had some downright horrible experiences in hospitals. I don't mean to gloss over those. But for the same reason that we can't assume that every baby at a home birth will die, we can't assume that every hospital experience will be horrible. Not every midwife practices negligently, not every OB pushes interventions. There is no black or white. All I can base my opinion of hospital births on is my own experience, now that I've had one.

Watching the movie Business of Being Born scared me. Talk about trying to instill some fear in women! I had never given birth in a hospital before so when I saw that, I thought, "YIKES! That's how it happens in majority of the hospitals in the US? I don't want that!!" It was pretty much all I knew of hospital birth at that time until I had my own.

After our birth, my opinion changed. It changed based on my own personal experience.

No one bases their decision to have a home birth on experience alone (or, at least, I hope they don't). I, personally, no longer had "fear of hospital birth experience" on my list of reasons for wanting a home birth. So I continued on down my list..... I took into consideration as much as I possibly could. If I missed anything, please tell me. Honestly, what else can I consider? I am not basing my decision solely on a desired experience, or solely on anecdotes, or solely on any one thing... I can't imagine that any woman does... I am basing my decision taking into account everything I knew to consider. 

2. I'm not suggesting that home birth all of a sudden become illegal in all 50 states. But what I think we should all be striving for is for regulation of home birth midwifery in the US to ensure it is being practiced as safely as possible. If people want to continue to compare the US to other first world countries to show how we are failing with childbirth and they are thriving with childbirth b/c they have more home births with midwives than we do, then the US should have a home birth midwifery system that is somewhat comparable to those other countries - but we don't at all. Our home birth midwifery system in the US is flawed.

I think it would be wonderful if we had a home birth midwifery system like they do in the Netherlands, where home birth is an option for low-risk pregnant women and the home birth midwives are an integrated part of the hospitals.

Some things I think that could help:
  • That the title "CPM" not include such a wide range of education and training. As it is now, you could have a CPM that never received a high school diploma or you could have a CPM that has her masters in a health-related field. You could have a CPM that apprenticed for 2 years or one that apprenticed for 5 years. And etc. Perhaps CPMs don't want hospital privileges, I don't know... but for the sake of consistency of care for their clients who need to transfer in labor, I would think it would be something they would like. Why not set the standards for education and training so that they can have hospital privileges?
  • Mandatory reporting of records and outcomes to the state, signed off by the parents (to ensure accuracy).
  • Mandatory malpractice insurance - if they want to be considered health care professionals, why would they be an exception to this?
As I mentioned in one of my comments, perhaps if midwifery were more regulated, then more states would legalize it and maybe even more insurance companies would provide coverage for it... therefore, giving more women the option of having a home birth. 

While I don't see myself ever seriously considering home birth again, I am not trying to take away that option from anyone who wants it. I am just advocating for a safer home birth midwifery system here in our country.

3. Why didn't I add neonatal death rates? Because, just like infant mortality, neonatal mortality does not include stillbirths. Regardless, I didn't leave them out on purpose - I simply did not look up the most recent ones. If anyone would like to add them in the comments, please feel free. Even if we considered neonatal statistics, what would it tell us about home birth safety in the US? Nothing. Perinatal mortality rates, neonatal mortality rates and infant mortality rates of the US vs other first world countries tells us nothing about the safety of home birth in the US. Even if the US was #1 for safety for each of those rates, would that mean every woman would want to give birth in a hospital? No.

Until we have some accurate data of home birth outcomes in the US, we're never going to know how safe or not safe it is.



Monday, July 9, 2012

A Birth Doula's Take on Home Birth


I fell in love with the idea of a birth at home when I was pregnant with our first child. 

Here's us, with my preggo belly :)





I had devoured Ina May’s Guide to Childbirth, watched the movie The Business of Being Born, read that 2005 Johnson and Davis article in the British Medical Journal, met some amazing midwives that seemed to have an answer for me about everything childbirth-related, and was introduced to this new, wonderful community of women that all doted on home birth and its safety. I was sold. I wanted a home birth. I wanted empowerment, water, privacy, minimal interventions, and the safest, most peaceful entry into the world that I could possibly give my child.

So during my pregnancy, along with studying to become a birth doula, I spent my time fighting our insurance company (because they wouldn’t pay a dime for a home birth), reading more books about natural childbirth and information that supported the safety of home births, and trying to prepare myself, my husband, and our home for our first child. A few weeks into my third trimester, I got one final letter back and it sealed our birthing fate. Our fight was over… the insurance company was NOT going to pay for our home birth. We were covered 100% for our OB care and hospital birth – I didn’t even have co-payments; our home birth would have cost $4500+. A baby on the way, buying a new house... OB and hospital it was. I was devastated and scared.

To make a long story short, I’ll fast forward about 2 years and give some highlights along the way: we had a baby boy in the hospital and it was a really good experience (I was actually shocked but our nurse and doctor were both very kind and I somehow managed to get out of there with a med-free birth as I had hoped and a healthy baby who was breastfeeding like a champ); a few months later, we switched our insurance companies to one that would pay for 80% of a home birth (our hospital birth was great, so can you imagine what our home birth will be like for our next child? Can we start on Baby #2 now, please?!); I started to attend births as a doula at home, birth center, and hospital; I became a certified birth doula through DONA and began the process of becoming a childbirth educator through ICEA; I was a part of an emergency home birth transfer that left me with many questions; I started to go outside my comfort zone by reading material and information that was against home birth; I started to doubt some of the things I had learned – and swore by – regarding home birth; I got pregnant with Baby #2 and started debating if I was really convinced of the safety of home birth; my husband and I ultimately decided we did not want to give birth at home; I decided I could no longer support mothers as a doula at home births because home birth here in the USA was no longer something I supported at all.

Talk about a 180! And that’s where I am today. I am a birth doula who does not support home birth. You won’t find a lot of women in my community who aren’t all about home birth let alone someone who doesn’t support it at all. Not so long ago, I was like the majority who support home birth and like the majority of mothers who have a home birth: I was a non-expert who read enough material and talked to enough of the right people in the home birth community that had me convinced of its safety.

What changed?

Do I Really Need to Fear my Hospital?
I can’t lie; a huge source of my hospital fear came from watching the movie The Business of Being Born. It wasn't just that movie - but being a film it painted a very real, and scary, picture of what I was reading about all over the place -- it shares that same message regarding hospitals that is echoed loudly in the home birth community, even the natural childbirth community. I didn’t want some passionless OB who had some kind of hidden agenda. I didn’t want to be stuck in a bed to labor. I didn’t want to be swept up in the “cascade of interventions” that could possibly lead to an unnecessary c-section. I didn’t want to end up with drugs in my and my baby’s systems. I didn’t want extra hurdles that would make breastfeeding more challenging. I didn’t want any of it and I was surely scared of it. What I knew at that time was that childbirth would be just as safe at home or in hospital, so then why not be in a place where I can avoid all those discomforts and interventions? I could be in the comfort of my own home and have someone taking care of me that I knew would be truly passionate about childbirth.

But then we had our hospital birth. And it was really nice. I didn’t even end up with my OB, I had one of her partners on call – whom I’d never met – and she was great. No one pushed interventions, I wasn’t stuck in bed when I labored, I could squat when I pushed, and I held my baby the second he was born. And the hospital births that I attended as a doula, those were pretty awesome, too. Wow, there are actually some fantastic OBs and nurses out there who love what they do. What was all this? Was avoiding interventions really such an impossible task? Were hospitals and OBs really all that scary? Maybe hospitals circa now aren’t so shabby after all?

Experts in Normal Birth
The whole idea behind having an “expert in normal birth” for my pregnancy and birth sounded so right-on: I wanted someone who knew how to attend to a woman in a labor and allow me to give birth vaginally with as little intervention as possible. I believed (and still do) that pregnancy is a normal and healthy event usually… but, I couldn’t help but wonder, maybe I should think about this from another angle? What if things become not-so-normal? What then? Yes, a home birth midwife is trained to identify when things become complicated, but maybe I want someone who can not only identify any issue but someone who can also remedy any issue with any technology or equipment needed to do so (or immediately turn over my care to someone who can, say if I was under the care of a CNM in a hospital).

So what about OBs? As our c-section rate in the US proves to us, most of the deliveries an OB oversees are vaginal, not surgical (though some or many think too many are surgical). Yes, majority of them may not be “normal” due to interventions but is that the OBs fault? Or is that the woman’s choice? Most women want an epidural (an intervention). Are OBs supposed to deny a woman an epidural so they can attend only “normal births?” Of course not.

OBs see and deal with and train for every type of scenario that can come up during childbirth: from “normal” to post partum hemorrhage to vasa previa to newborn diaphragmatic hernias to amniotic fluid embolism to cardiac arrest to much, much more. They are experts in all things birth-related.

Telling myself “that won’t happen to me… complications are rare… birth is almost always normal” wasn’t going to work. What if my next birth veers outside of that range of “normal?” Or what if it veers way outside of that range? If we transfer to a hospital, from a financial perspective, I then have to pay my home birth midwife plus a hospital (and potentially an ambulance, too). And, no, I completely understand it’s certainly not all about money. You can’t put a price tag on the safety of you or your baby. But the truth is, many women have a home birth because it’s the more affordable route… and if they transfer, what then? They end up with two (or more) bills to pay instead of one.

I have met some of the most amazing, well-educated, caring home birth midwives that exist in the US (CNMs and CPMs). Their track records are astounding. There’s no doubt they love what they do and they are good at what they do. But my what if’s had officially run wild and there was no reeling them back in without something concrete. I truly love the midwifery model of care so I considered a hospital CNM but they aren’t offered through our hospital – and I actually really liked our hospital now. Plus, my OB and I developed a really great relationship. My office visits with her are personal and I don’t feel rushed. I started to feel so torn… my gut was telling me I should go with my OB but my heart was still leading me toward home birth with a midwife.

So now what? Statistically, which is safer: home birth or hospital birth?

The Confusing Statistics and Many Types of Midwives
If you try to look at this statistically - home birth safety vs hospital safety - it’s more confusing than trying to understand a debate in a foreign language. One study will show that home birth is just as safe as hospital birth (the 2005 Johnson and Davis Study in the British Medical Journal) and another study will show that home birth has triple the death rate of hospital birth (the 2010 Wax Study in the American Journal of Obstetrics and Gynecology). Which study is better? Which is more thorough? Which is more accurate?

How was I to know if the authors of the study haven’t made any errors? What if they are coming from a biased standpoint, could that affect their outcomes? There are critics on both sides of the home birth debate that will point out the flaws in both of those studies - or in any study (or even data) that you will be able to find. Basically what we’re left with is this: in the United States, we don’t have any studies that have been performed to accurately assess how safe or unsafe home birth is. It truly doesn’t exist. For various reasons it doesn’t exist… from the way death certificates vary from state to state to the fact that home births midwives aren’t required by law to report their outcomes (except in Colorado). A thorough and accurate study of the safety of homebirth in the US versus hospital birth in the US, does not exist.

So what about comparing childbirth-related death rates in the US where the majority of births take place in a hospital, to childbirth-related death rates in other first world countries where home birth with midwives is much more common? This could be a good indicator of whether or not home birth is safe, right? Well, there are two big problems there:
1.      Which type of death rate do you consider?
2.      If we compare midwives in foreign countries to midwives in the US are we comparing apples to apples?

I’m using the most recent data that I could find. Since home birth advocates often compare the US to the Netherlands, that’s what I will do.

Often when people refer to safety of childbirth, they use the infant mortality rate. If you consider infant mortality, then yes, the US doesn’t do so well when compared to other first world countries that have a higher rate of home births with midwives - the US infant mortality rate is higher than the Netherlands.1 But what is infant mortality?

Infant mortality refers to the death of a baby within the first year of life.2 Infant mortality does not include intrapartum fetal deaths (when a baby dies during labor and delivery). Again, infant mortality refers only to babies born alive that die before they turn one. If a baby dies at 4 days old or 364 days old it will affect the infant mortality rate. So yes, it includes pregnancy and birth-related issues that may later cause a death like birth defects, low birth weight and neonatal hemorrhage but also includes things like accidents, disease, and SIDS… those are all encompassed (and more) in the infant mortality rate.

Makes you wonder… is comparing infant mortality rates between countries really the best way to determine if childbirth in that country is safe or not? Is there another mortality rate that is more specific to childbirth? Yes, there is. Actually, there are two: perinatal mortality and neonatal mortality.

Perinatal mortality refers to death around the time of delivery and includes both fetal deaths (of at least 20 weeks of gestation) and neonatal deaths (death during the first 28 days after live birth – neonatal deaths obviously then determines the neonatal mortality rate).3 Neonatal mortality is encompassed within perinatal mortality. Seems to me that perinatal mortality is the more accurate way to assess the outcomes of pregnancy and childbirth… that’s because it actually is.

So, how does the US compare to other countries in this regard? We do quite well! The US perinatal mortality rate is actually lower than the Netherlands.4

Now you have to compare the types of midwives they have in other countries to what we have here in the US. Again, I’ll stick with the Netherlands.

The midwives in the Netherlands must first be accepted into one of four higher education academies. Each academy follows a strict four-year curriculum and is for full-time students only. Approximately half of the curriculum is practical internships and the other half is studying science-based medicine. Once you graduate and become a professional midwife, you can work either as a midwife who attends home births or who attends hospital births. A home birth midwife in the Netherlands has hospital privileges even if that is not where they primarily work. Low-risk pregnant women have an option of home birth or hospital birth with a midwife but if the woman becomes high-risk or if complications arise during pregnancy, labor or delivery, she is referred (or transferred) to an obstetrician.

In the US, it is very different. There are three main types of midwives in the US: Certified Nurse Midwives (CNM), Certified Midwives (CM), and direct-entry midwives. Direct-entry midwives refers to Certified Professional Midwives (CPM), Licensed Midwife (LM; which is essentially a CPM that has been licensed to work in a particular state); and, lay midwives (no certification, education or training requirements - technically anyone can call themselves a midwife). 

Though some CNMs and CMs attend home births, most work in hospitals - the training and education of a CNM or CM is more similar to the training and education of a midwife in other developed countries. 

Mass majority of home births in the US are attended by some sort of direct-entry midwife (a CPM, LM or lay midwife). The typical route to become a CPM or LM (and most popular route of all currently practicing CPMs and LMs) is the Portfolio Evaluation Process which consists of an apprenticeship program and passing a skills assessment and one written exam. The time length to become a CPM varies on an individual basis. 

If a CNM or CM has current hospital privileges, then she may be able to continue care alongside the hospital staff in the event of a transfer. CPMs and LMs do not have hospital privileges and are legally regulated in only 26 states.

When you consider education and training requirements in addition to hospital privileges, you aren’t comparing apples to apples at all when you’re looking at home birth midwives from one country to the next.

After taking all of this into account, I was no longer sold on the safety of home birth based on any of the studies or data or comparisons of rates or midwives from country to country. The whole idea of having some sort of statistical proof to back up our home birth beliefs flew right out the window. I suddenly felt like I was grasping at straws… was I?

What else can I consider? If I stayed low-risk in my pregnancy, I believed the odds would be in my favor. And if things were starting to veer into not-so-normal-land at our home birth, my midwife would catch it and we’d just go to the hospital, right? But…

Is Our Hospital Really Close Enough?
Have you ever heard a woman defending her choice to have a home birth by saying “we only live 5 minutes from the hospital if something comes up.” Well… is that really the case?

Have you ever seen a woman in active labor? They don’t move very fast. Even if you live across the street from a hospital, it’s going to take you longer than 5 minutes to get her there – or simply just to get her out of the door. Now if it’s a situation where the midwife sees a potential emergency happening before it actually becomes an emergency, then getting to the hospital in time might not be a big deal at all. But what if it’s a situation where every minute matters (which it can be – and with little to no warning – even for a low-risk mom with previous vaginal births)?

Things to consider if it becomes one of those every-minute-matters situations: Do you know approximately how long it will take for an ambulance to arrive at your home? Is traffic something you need to worry about? Does your midwife have complete and accurate records for you and will she have them when you’re in labor to take to the hospital (blood type record is important)? If you don’t go via ambulance, the hospital likely won’t even know you’re coming (unless someone calls ahead) so do you know what your hospital’s protocol is when a woman comes in during active labor in an emergency situation? Depending on the type of hospital it is, that can make a huge difference in how fast they can get you the help you need.

One of the home births I attended as a doula was a hospital transfer. For that particular transfer, it took over an hour from the time the decision was made to go to the hospital until the baby was delivered… and this was one of those every-minute-matters emergencies. One second everything was great and the next, it wasn’t. The midwife said an ambulance would take too long, so that idea was quickly vetoed (and for good reason). On the way, the midwife called the charge nurse at the hospital in the Labor and Delivery unit to let her know we were coming so they could be ready for us. The mother had also seen an OB during her pregnancy so the hospital already had her records. We were only 6 miles away from the hospital, it was mainly freeway, and we hit zero traffic. The baby was stationed low enough that the OB was able to use a vacuum to get the baby out (if a c-section were needed, it would have taken more time). All those things considered, it still took over an hour from the time the midwife said “we need to go to the hospital” until that baby was out.

Be honest with yourself. How long do you really think it will take for you to get to a hospital? We’re not just talking door-to-door here. We’re talking from bed or bath or where ever you are laboring in your house all the way into a hospital and in the right hands at the hospital. An emergency in childbirth can happen with little to no warning even for a low-risk mother, even with the most skilled caregiver in attendance. If it’s an emergency for something like cord prolapse and if that baby is being seriously deprived of oxygen and blood, then you can see how every single second becomes precious. Is cord prolapse common? No (it is more common if your baby is breech, though). But is “not common” good enough for you when it comes to your baby’s life? Or what if your baby just goes into distress for no reason? The home birth transfer I mentioned above was for a young, healthy mother with a textbook low-risk pregnancy. Baby just stopped tolerating labor for no apparent reason and went into distress (perhaps his cord was being compressed? Changing positions did nothing to help so who knows what it was).

Just a quick side note… Your midwife isn’t going to have a vacuum with her and neither is an ambulance. Nor will your midwife or an EMT be able to perform an emergency c-section. Believe it or not, there are many that do not know this.

When we really took into account our distance from a hospital, it scared the crap out of me… could we really get to a hospital in time? Even if my body was pumping out enough adrenaline for me to fly there, would that be fast enough in an emergency? What if minutes matter for my child’s life or well-being? What if it matters for my own life or well-being?

BUT… “Babies Die in Hospitals, Too”
Yes, they do. And this was something I, too, once argued to defend home birth. But again - putting things into perspective - when, in the past 10 (even 20) years, is the last time you heard of a full-term baby who died in a hospital born to a low-risk mother? 

More importantly, I had to ask myself: how many healthy, full-term babies are dying in hospitals that otherwise would have lived had they been born at home?

I’ve heard plenty of stories of babies that were born prematurely that died in a hospital, or babies that died in a hospital because of severe congenital defects, and etc. So yes, it’s very sad but true: babies die in hospitals, too. But for full-term babies, it’s not often. Not often at all.

A Woman’s Right to Choose
Yes, I know… ultimately, what it all comes down to is that women should be allowed their own choice of where to give birth and with whom. After all, it’s “her baby, her body.”

The HUGE problem with that is: in order for a woman to make an informed decision about her baby and her body, she needs to have all of the information in front of her. She needs to know what is considered high-risk and needs to know why it is considered high-risk. Even if the mother is low-risk and a “perfect home birth candidate” it doesn’t mean that birth can’t be dangerous to a point where minutes can mean the difference between life and death… or life and severely physically or mentally injured.

I recently had a conversation (via Facebook commentary) with a home birth supporter (she may even be considered a home birth activist to some, perhaps even to herself – I don’t know). In her comments she wrote, “yes, there are bad midwives out there- I have no idea how many. No one does. But I do know that there are also many midwives who are cautious and do not deserve to be lumped in with the reckless ones. And the women who proceed cautiously when choosing home birth also don't deserve to be lumped in with those who take on many risks… A quick google search and you can find all sorts of information that lets you know that giving birth at home when you are high-risk is a bad idea…. Some people don't want to know the reality of a situation and that is their deal. What can you do if they are not willing to listen? And I am speaking for myself because I can't speak for anyone else. But if you are choosing to do a VBA3C twin birth at 42 weeks at home.. I mean, come on, you better own that choice.”

That’s just it. That right there hits the nail on the head for me and is the number one reason I have a huge issue with home birth in the US. Doesn't every woman think she is proceeding cautiously when choosing home birth and her home birth midwife? How does a woman know her midwife isn’t one of those “bad midwives” who simplifies very high-risk situations? How do you know your midwife is giving you true informed consent? A woman trusts her midwife implicitly – no woman would knowingly risk her child’s life!

Homebirth midwives in the US vary so greatly in their training, their education, and their philosophy of childbirth. There are many, many midwives in the US - and well-known ones like Ina May Gaskin - who take on high-risk mothers. What may be considered high-risk to one midwife may just be considered a “variation of normal” to another. Even if a midwife acknowledges a high-risk situation, if she tells her client that she knows exactly how to handle it, what is the client supposed to do? No matter how well-read a woman (and/or her partner) may be, she is not expected to know what her midwife does. If you can't trust your professional caregiver to tell you when things become too risky, then who the heck can you trust? Google?

There seems to be a very fine line between "proceeding with caution" (which is apparently what women are supposed to do) and "living in fear" (which is apparently what women are not supposed to do). How does a woman know on which side of the line she falls?

No midwife or OB wants to see anyone harmed of course. But at least an OB has the fear of a lawsuit, fear of losing their job, and fear of losing their license to keep them in check. A home birth midwife doesn’t. You could essentially be a midwife’s guinea pig and not even know it.

Not For Me My Baby
I was filled with doubt about the safety of a home birth and the proof I once believed in, no longer existed. I was done grasping. All those sayings and ideas that once meant so much to me: home birth midwives are “experts in normal birth,” high-risk situations like breech presentation are just a “variation of normal,” we should all “birth without fear,” and of course, just “trust birth,” did they really mean enough to me anymore? What once sounded so profound to me eventually became more like horrible clich├ęs than anything else.

I do believe that birth is normally safe for low-risk pregnant women but that was not enough for me. It did not matter how many amazing home births I could witness or read about. I couldn’t base my decision on anecdotes alone. My baby’s life deserves more consideration than just anecdotes. That proof… that proof of safety… I couldn’t find it. I still can’t. The appeal of home birth is still there… I don’t think it will ever go away. But how could I choose a home birth now? How could I even attend one as a doula?

I know some will think that I just don’t know enough about home birth or that I just don’t “trust birth” enough. Well, the latter is certainly true. If all it takes is to “trust birth,” why do some babies die at home births from issues that were very likely preventable or treatable in a hospital? I can’t help but think of the woman whose labor ended with a placental abruption at her home birth and her baby who didn’t survive it – and she was a perfect home birth candidate: low-risk, previous vaginal birth, healthy… or the woman whose attempted breech delivery at a home birth also ended with the death of her child after his head became stuck for more than 10 minutes... or the many others. I read their stories, I saw their photos, and I cried. Did those babies die simply because those moms didn’t “trust birth” enough? No. No, of course not.

I promise you that you are going to find anecdotal stories to support either side of this debate: scary hospital births, scary home births, happy hospital births, happy home births. You’ll find studies and statistics and data that seem to support either side. So how do you choose? When you find yourself confused about what to believe or who to believe and your baby’s life is at stake, perhaps fear is just your instinct in disguise.


Please see my two follow-up pieces:

Take on Home Birth, Part II
Murphy's Law


References
1 “Country Comparison:: Infant Mortality Rate,” The World Factbook, Central Intelligence Agency, 2011, https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html
2  “Definition of Mortality, Infant,” MedicineNet.com, 2012, http://www.medterms.com/script/main/art.asp?articlekey=14274
3  Marian MacDorman, Ph.D. and Sharon Kirmeyer, Ph.D., “National Vital Statistics Reports,” U.S. Department of Health and Human Services, 2009, http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_08.pdf
4  “Neonatal and Perinatal Mortality,” World Health Organization, 2006, http://whqlibdoc.who.int/publications/2006/9241563206_eng.pdf











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