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happymama's comments:
on Midwifery Controversy
I would like to add that some people have higher risk in birth where ever they give birth. The hospitals have as many or more as the homebirth midwives. Hospitals do insanely risky behavior on a daily basis as standard practice, like breaking water when a women is 4 or 5 cm dilated. There are probably way more cord problems from this alone, leading to emergency cesareans than occur naturally. This happens in aiding induction in women who are "postdates" who are nowhere near ready for labor! But because the practice is impatience for liability purposes, unripe babies are forced out of unripe mamas at tremendous risk to them. Do a survey of your NICU babies and see how many of them had some sort of heart rate event after rupturing membranes or increasing pitocin. I think it's pretty unbelievable to consider the risks of birthing at home without considering the very real and common risks of birthing in the hospital. This even applies to special circumstance births, like twins, breeches, and VBACs.
posted 2 years, 10 months ago
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on Midwifery Controversy
I agree and further down discuss that the ideal situation would be to take my twins, breeches, and VBACs to the hospital to have low interventive vaginal births unless emergency care was needed. However, the current birth climate, especially around these particular circumstances, does not allow moms the choice of having the safest birth in the hospital. Therefore, they must weigh the risks and benefits, and there are substancial risks to giving birth by cesarean just as much as there are increased risks to giving birth farther away from the OR in these circumstances. The point is there's absolutely no way for us as care providers to decide for women what risks they prefer.
posted 2 years, 10 months ago
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on Midwifery Controversy
For the 90% of moms who don't have to transport, the cost is much lower than a standard vaginal hospital birth.
posted 2 years, 10 months ago
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on Midwifery Controversy
Norarachel,
Thank you so much for your post! Would you mind sharing the name of your physician who allowed you to have a vaginal birth with your twins? Did you birth both vaginally or just Twin A?
posted 2 years, 10 months ago
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on Midwifery Controversy
Is this by chance the same source that includes miscarriages at any stage of care that was also used to initially fuel the discussion with the Oregon Congressional Committee that was later withdrawn from discussion because of the combination of all the losses made the statistics irrelevant?
posted 2 years, 10 months ago
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on Midwifery Controversy
Haha! I have this bumper sticker. I love it.
posted 2 years, 10 months ago
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on Midwifery Controversy
The research says it's equal in life/death outcomes, but also mentions that women at home have less interventions which can have life altering consequences to both mom and baby. Consequences like bladder incision which is happens more often than you think during cesarean. Also associated with cesarean is doubled maternal mortality due to post-surgical infection, blood loss, and blood clots. Risks also include perineal damage and standard episiotomy, hypoxic events leading to cesarean caused by drug managed labors and breaking of waters, instrument deliveries which are necessary because a mother is lying flat on her back during delivery, the "lithotomy position". Even augmentation of labor is more likely in a hospital simply because a mother is in an unfamiliar environment where her primal brain will respond with stress rather than an increase in labor stimulating hormones.
Just being in a hospital with nothing else done to "manage labor" is more likely to lead to infection for mom and baby because it's a hosptial, where people with infections go.
It is clear that interventions compound risks and morbitity, even if mortality is equal in the comparison group. Vaginal birth is not risk free in any event, but the numbers of complications from medicated versus unmedicated births, including and especially the likelihood of cesarean are much higher.
posted 2 years, 10 months ago
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on Midwifery Controversy
Haha! I'm asking the question is hospital birth safe, and so are many others. It is not inherently safe, and many interventions cause harm and are carried out without necessity. Thank you for saying so, but I disagree that people aren't asking about it. The World Health Organization certainly is, along with many other global organizations who have said the U.S. is on the verge of a humanitarian crisis if they do not address their hospital standards of care for women in childbirth. This is the primary reason I'm sure that ACOG changed their stance on VBAC this year.
posted 2 years, 10 months ago
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on Midwifery Controversy
I commented this earlier above but I have seen hospitals receive transports with full operating rooms, or refuse to prep the OR when we call saying we are coming with an emergency, both of which substancially delay emergency treatment. Thankfully, none of those emergencies have ended in damage or death to baby or mom. I agree it is more likely to get to OR sooner from within the hospital, but not guaranteed. If you have a true emergency and full OR, there is not much that can be done to speed up the operation. There are also times when even 10 minutes is fast enough.
I would like to add that midwives are trained and highly skilled in neonatal resuscitation, and what you are describing is not delayed resuscitation but delayed intubation, which again, is along the same lines as the cesarean, where it is more likely to be quick in a hospital but not guaranteed. Usually resuscitation alone is enough, and when intubation is done unnecessarily, it can be very harmful to a newborn.
The one thing I discuss in my own comment further down is that there are very real risks to babies in the hospital, including resistant infection strains, a lifetime of gut flora imbalance and digestion problems from not passing through the vagina, delayed breastfeeding, immune reduction from seperation stress in the immediate hours and sometimes days postpartum, etc. All of these, but especially the first and last are real and common and can be life threatening or altering. The last one because it intensifies the first. Not to mention, starting out life without a mom is also a risk to the baby, so the doubled risk for maternal mortality is important to the baby.
I agree with so much of what you said and personally am so tired of the endless arguing. We all want the same thing, but have different ideas about how best to achieve that end. In an ideal world, I would be allowed hospital privilages with my clients with twins and breeches, so they could have low interventive vaginal births AND access to emergency equiptment. I think we're a long way off from that as we stand now in the U.S., but if we use evidence rather than culture to start making our future decisions around childbirth, we will get there. In the meantime, families are left to decide which set of risks they think are the least.
posted 2 years, 10 months ago
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on Midwifery Controversy
If you read my post lower down on the list, you will see that hospital protocol is to have moms from emergency in their hospital room to operating table in 20 minutes, a protocol which is ideal but not always possible if the operating rooms are all in use. 20 minutes jacob, which means that even in the hospital, some emergencies are unavoidable, and not all babies make it. However, what we can do is avoid unnecessarily adding to the threat of those potential circumstances by doing things like leaving the bag of waters in tact so we don't CAUSE a hypoxic emergency for the baby. Midwives are experts in vaginal birth. If you are looking for expertise in birth, I can't think of better suited professionals.
posted 2 years, 10 months ago
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on Midwifery Controversy
I think the part of the midwifery discussion that was missed largely (with the exception of Jennifer's comment on cesarean risks to moms) was the risk of hospital birth, even with more complicated pregnancies. Babies are at greater risk for infection due to hospital exposure, some infections which are resistant to treatment and can cause brain/body damage and death to baby (and mom!). They are also susceptible to injury during cesarean or vaginal delivery, and a whole slew of medical interventions which can potentially damage babies like augmentation of labor with pitocin which squeezes the baby harder than a normal contraction would, increases risk for uterine rupture in both VBAC and moms with no previous cesarean. They practice breaking of water, which is routine in hospitals, and extremely dangerous to the baby. It may be the leading cause of emergency cesarean in the hospital. Also the use of delivery instruments like vaccumes and foreceps can pose huge risks to babies of brain and body damage, or even death.
Also the doubled risk of maternal death in a cesarean versus a vaginal delivery seems to directly correlate to a risk to the baby, which is starting it's life without it's mother. I don't agree that a selfish mother protects her life along with her baby's during a delivery.
Also I know that hospital protocol is to be able to get a mother from emergent situation to operating table in 20 minutes from WITHIN the hospital. If a hospital is notified of an incoming emergency transport, it is highly possible to get a mom from home to the operating table within 20-25 minutes from as far away as 15 minutes by car when she is riding in an ambulance AND the hospital believes the midwife and starts prepping the operating room. If the hospital is dismissive and biased, they have the potential of slowing down the emergent treatment and are adding to the risk to the baby and the mother.
We are not weighing the risks and benefits of a dangerous home birth versus a safe cesarean for these moms, we are weighing risks and benefits of each possible way of giving birth, all of which carry very real risks. Mom's do have the right to decide which they think will provide the best outcome for themselves AND their baby, given the risks and benefits of each possible cenario.
posted 2 years, 10 months ago
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