This might make you angry. If you’re a midwife.

Posted on Nov 27, 2012 | 14 comments

300 doctors in a room = polite applause (and a few shouts of “Bravo! Bravo!” Okay, I made that last bit up.)

1 post where I question why anyone would choose a home birth over a hospital = reader RAGE

Admittedly, I don’t get it. It seems far too risky to me, during a very risky event: birth. If your toddler stopped breathing, where would you choose to be located: in your living room or in a hospital? Every single parent, in the entire world, would choose the hospital.

I can’t imagine putting myself or my baby at risk, even if it was only a 15 minute ambulance journey to the hospital from my home. 15 minutes is a long time when your baby has stopped breathing, or you won’t stop bleeding.

Having said that, I’m still reading the research to discover if my opinions have any basis in fact. And – let me tell you – it is hard to find research that is conclusive or unbiased about this issue.

Of course, because of what happened to May, midwife-led births make me nervous. Not the midwives themselves, but the fact that there is no team to consult, no life-saving equipment, no hospital and all the resources there. I continue to believe that in a hospital, my infection would have been treated sooner. That, in and of itself, may have saved May.

If you want to throw tomatoes at me about it, here’s what I said:

May, at three weeks, in the special care unit of the hospital

Clearly, not all midwives are bad; all doctors aren’t necessarily good. But medical science has come a long way, and the drive away from doctors and the safety mechanisms of a hospital, by many soon-to-be-parents, is one I find completely baffling.

I agree with Carol Sarler, writing in The Daily Mail this week, that doctor-led births are not promoted and the reasons why are pretty shocking. As she says, “for the NHS, it’s cheaper, on its current costings: a home birth averages £1,066, a  midwife-led unit birth £1,450 and a hospital birth £1,631. So, seemingly for the sake of a measly few hundred quid, misinformation is routinely delivered and anti-obstetric philosophy deliberately spread.”

The phrase birth choice is batted around, with many mothers feeling their choice is stigmatised or refused. For me, there didn’t seem to be a birth choice. I arrived at my local GP’s surgery, pregnant, and they referred me on to their attached midwife clinic.

I was a nervous first time mother, but the midwife leading their birthing classes shrugged off my worries as silly. She was as stereotypical as you can get: a hippy who spoke lowly of pain relief and, while she kept insisting that we could have the birth we wanted, promoted heavily their home birth service, calling contractions a “bit of discomfort”.

“You may feel like you are about to die,” she once said, “but pain never killed anyone.”

Maybe not, but birth can. Romantising it, or glamoursing it, or even shrugging it off as a natural process can not escape the fact that until very recently, birth killed. It still is the biggest killer of teenage girls worldwide. Why isn’t it in the UK? Hospitals

There’s more. You can read the full article on the BabyCentre Blog.

14 Comments

  1. I am with the school that is close to a hospital or in a different wing if you want it to be home like. I also agree that May’s issues were from your prolonged labor and not testing the waters for infection after your waters broke and you weren’t taken to the hospital for way too many hours. This is a common issue and is most always found and the baby is delivered safely and with issues needing more than an antibiotic, maybe.

  2. I used to have a friend that ended up getting preeclampsia just prior to her due date. She’s obese so, at least as far as I’m concerned, I wasn’t surprised that this happened. She had to go in for a c-section and still, 2 years after her son’s healthy birth, she cannot “forgive herself” for having had a c-section. She is trying to become a midwife so she can keep more people from having to experience this.

    I was friends with her on Facebook, and unFriended her for a different reason. I was only friends with her (on Facebook) for so long because she got pregnant again, right around the time her son turned 1, and *refused* to involve any doctors. I can’t remember if she was even having a midwife involved. She was going to do a home birth. The female body was made for birthing, after all!! I said Friends with her because I really wanted to find out how that went — but, alas, I couldn’t take her anymore and unFriended her. I *really* have to do a Google search to see how that turned out … She refused to listen to, what I would consider logic, and surrounded herself with people with the same mindset — the female body was made for birthing!

    Adrianne

  3. I think your article skips over the fact that births are much more likely to go wrong in a hospital where unnecessary interventions are given (like pitocin, which makes labor more painful and can cause issues with the baby’s vitals), and c-sections which are worse for babies. I live in the U.S. were the c-section rate is 32%. The highest in the free world. We also have the second highest infant and mother mortality rate. Only 2% of homebirths experience complications which lead to a hospital transfer. I’m hardly anti-hospital, but I believe that when it comes to birth, many conditions in a hospital make it a terrible experience.

    One situation occurs all too often: a woman goes into labor. She arrives at the hospital and checks in. A little while later she’s not progressing as fast as they want her too so they give her pitocin. The pitocin makes her pain 10x worse so she get’s the epidural. The epidural makes her labor stall, so they give her more pitocin. This causes the baby to go into duress. She ends up with an emergency c-section. It’s a giant snowball effect which could have been avoided if the OBs weren’t trying to get the woman in and out to make more money for the hospital, or get it done by the end of their shift. So now the woman has been cut open, and will now have a painful recovery and is left vulnerable to serious infections or her wound reopening. And her baby is having breathing problems because his lungs weren’t properly squeezed on the way out.

    Of course, one way to mitigate the harshness of hospitals is to make them all mother and baby friendly. But that isn’t going to happen for quite a while. I considered a homebirth, but ultimately decided on a freestanding birth center that was 3 minutes away from L&D of the hospital. The hospital is notoriously mom and baby friendly, so I knew if I had to transfer there, I would not be confined to a bed, I would not get an IV, and my baby would never leave my room. I did end up transferring at 9cm because of meconium in my fluid (I was 10 days overdue, so it wasn’t surprising), and during the short walk to l&d I went to 10 cm and was ready to push by the time I got on the bed. My midwives made quick and sound decisions. My baby was delivered in about 10 pushes and is a healthy 7 week old. Something I realized during my birth experience, had I been confined to a hospital bed, it is unlikely I could have done it naturally as the pain was so much worse laying down. And if I’d had an epidural there’s no telling how that would have ended.

    Also, I’m guessing this isn’t the case in the UK, but in the U.S. all women are tested for GBS around 35-36 weeks. You’ve often written about the incompetence of some of May’s doctors. OBs and midwives are no different. Some are good, some are bad. I know here, many OBs barely come in to check their patients and are really only there to catch the baby. It’s up to the patient to choose a good provider. I chose my midwifery based on their reputation. They answered any questions I had and were very professional, knowledgeable, and supportive.

    I understand you are biased by May’s experience, which is understandable. However, I think you should consider how narrow minded your opinion comes off. I think in one of your earlier posts your mother blames socialized healthcare for what happened to May. It sounds just as ridiculous for you to denigrate midwife care. Their training should be taken into account. The countries with the best birth statistics (Sweden, Germany, etc.) have most of their births attended by midwives. Whether it be homebirth or hospital, there are positives and negatives to either choice.

    • Just want to clarify something you said about my mom blaming socialized healthcare. I amended that because she disagreed with my assessment of her position. I know it is a small point after all that you said, but because it is my mom, I want to make it clear that she doesn’t think that.

      My opinions have far more to do with people choosing not to use hospitals, than using midwives themselves. I think this point has been lost because people get hung up on midwives. But, I make the point in the very first line that not all midwives are bad, or doctors good. I’m glad your experience was a good one, and in an ideal world I think we’d all choose to have our babies in the comfort of our own homes. But things can go wrong – even with the best midwife (or doctor) – and if that happens at home or in a birth center far from a hospital, I fear for the mother and baby.

  4. I find it kind of indulgent that in the UK we wax lyrically about women being made for birthing and the joys of a homebirth when lots of women in poorer parts of the world would kill for hospital care. I agree with you Stacie. Freakin hippies.

  5. I agree with you. My first baby had meconium in the amniotic fluid and unfortunately she had trouble breathing when she was born. She was completely quiet – no crying or anything. She was rushed to the NICU and they saved her. I know that some would argue that if she were birthed at home, it would have been so non-stressful that she wouldn’t have had a bowel movement before birth, or she would have had one but wouldn’t have breathed it in, or she would have breathed it in but would have been totally fine. But there is no way of knowing whether that point of view is correct. And for me, that in itself is scary enough.

  6. Oh, and I DO consider myself a freakin’ hippy (in response to the last comment)

    • Hippies welcome here. Freakin’ and otherwise.

  7. The whole goal is to have a healthy baby and healthy Mama – why do people get hung up on style points? I was in labor for 12 hours, my daughter was stuck, and there were signs of fetal distress. I adored my obstetrician, so when she calmly suggested that nothing good would happen if I kept on (and that something bad might), I chose a c-section. It wasn’t until later that I was told just how serious things had become – an infection was already taking hold, and my daughter’s heart rate was quite unstable. We have a wonderfully healthy girl now, which would not be the case if I had not had good medical care or a c-section. I advise everyone to have proper medical care, because you never know – I had sailed through pregnancy up until the delivery.

  8. I have to agree Stacie. My personal comfort level was that on the off chance something had gone wrong either time, and the result had been bad because I wasn’t close to good medical care, I couldn’t have forgiven myself. I get frustrated when people fall back on “women have been giving birth not in hospitals for thousands of years”, which is true, but that overlooks the high rates of mom and infant mortality that accompanied those births.

    One other point – not all interventions during birth snowball and lead to a bad outcome. With kid #1 I was induced with pitocin and also had my waters broken due to preeclampsia. The contractions were intense, so I got an epidural. For me, the epidural and lack of pain allowed my body to relax enough that I went from 6cm to 10cm in about 20 minutes. Same situation with kid #2, minus the preeclampsia. I understand that I may be unique, but those kinds of generalizations bug me. Interventions are not all bad!

  9. Birth interventions are a good invention, but that doesn’t mean that every single one of them is appropriate in every single case. A lot of mothers shy away from hospitals because they are afraid of being put onto that treadmill unnecessarily, not because it has a better outcome for the mother and baby (unnecessary interventions are in fact detrimental to mother and baby), but because it makes the process of birth– an inherently unpredictable one– easier and more predictable (and, particularly in the US, less likely to result in a lawsuit) for health care providers. Stacie, you have more experience than most of us with that kind of cookie cutter mentality from doctors and other providers. I’m surprised you don’t recognize that concern for what it is: consumers of health care choosing not to be treated like chattel.

    That said, what you are describing as your experience on the NHS sounds like the mindset that is rampant there: ignore it and 95% of the time it will go away. And we’ll deal with the other 5% when they start screaming loudly and impolitely enough. And, frankly, from an epidemiological perspective, that mentality may be the most cost-effective and medically correct response in the majority of situations. The trouble is, of course, that it people like May don’t get the help they need. To my mind, it is the NHS’s worst fault (in an otherwise pretty remarkable system).

    • First of all, I question the idea that health care should focus on anything other than health. It should always be safety over consumer choice. The question is whether it is safer or not – and that is debatable. Also, I don’t agree with your assessment of the NHS. Perhaps, I have given you the wrong impression because I complain about aspects of it sometimes.

  10. Having babies is a dangerous business. Here in australia home births are few and far between and not supported by government. We are lucky to have such fantastic medical support I am always baffled by people who opt out. While women and babies in the third world die. I once read a fantastic article about why so many births need intervention these days. It spoke of natural selection being disrupted. for example, I have no trouble making babies but they don’t want to come out. If i wasn’t in a country with services both myself and my child would die. But instead I have a lovely daughter who arrived without much fuss but who intern may have inherited my birthing issues and the cycle continues. So women who are having home births today are taking a greater risk then the generations before them as we are changing the structure of society, no longer survival of the fitest. And intern doctors are having to interviene more then ever not because they choose ( you hope) but because of the nature of the beast. I have many friends all with different birth stories and here I have found doctors try to do as little as possible but step in when required.

  11. I can’t agree with the sentence every parent would opt for a hospital birth. I *know* one blogger who has three dangerous home births.

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