The BBC News has reported on a a new study from the Netherlands, published in the British Journal of Obstetrics and Gynecology, on the safety of home birth. The study is the largest of its kind to date, including 530,000 births, and compared midwife attended births to low-risk women both at home and in the hospital. The Netherlands has the highest rates of home birth in the industrialized world, with a third of women choosing to give birth at home.

The study determined that there was no difference in the rates of death or serious illness for mothers or babies between the home and hospital groups.

Check out this letter in the Argus Leader. South Dakota advocates have been working for midwifery licensure for years. It looks like their persistance is paying off — and what a great example of an effective letter!

In Australia, the government is considering overhauls to their health care system, including improving maternity services by giving midwives a greater role and more autonomy. (Australian midwife Lisa Barrett has been covering this process on her blog.) Today, the Sydney Morning Herald published this delightful article about the benefits of midwifery care.

“Women who are cared for by midwives rather than GPs or obstetricians are less likely to lose their babies within the first six months of their pregnancies, an international review of maternity services has found. …

“The analysis, which is the largest undertaken in the world, also found that women in midwife-led models of care were less likely to be admitted to hospital during pregnancy, have instrumental deliveries, episiotomies or require analgesia and were more likely to have spontaneous vaginal births, feel in control during labour and better able to initiate breastfeeding.”

More details about this analysis can be found at the Cochrane Collaboration website. The study authors’ conclusion: “All women should be offered midwife-led models of care and women should be encouraged to ask for this option.”

From this Women’s E-News article (part of a series on black maternal health) come these sobering statistics:

“African American women’s rates for dying during pregnancy, labor and immediately after giving birth are more than triple the national rate of maternal mortality. Roughly 31.7 black maternal deaths occur per 100,000 live births in comparison to 12.4 maternal death per all 100,000 births in the United States, according to the Centers for Disease Control and Prevention.”

The article also addresses the AMA’s vendetta against home birth and the Big Push for Midwives:

“Certified professional midwives are a critical component to meet the growing maternal health needs in the black community,” said [certified midwife Shafia] Monroe, noting that every sort of midwife is needed to reduce maternal morality rates among African American women.

The Midwives Model of Care, which has been shown to have excellent results in high-social-risk populations, could be a critical key to addressing the deplorable racial disparities in maternal / child health. The AMA’s and ACOG’s push to keep Certified professional midwives unlicensed and underground contributes to the problem.

It’s been a fantastic year for birth documentaries. First there was the Business of Being Born (now available on Netflix) making a big splash in the media and causing panic in the AMA. Next came Orgasmic Birth (there will be big screen showings in Yellow Springs and Columbus this month), showing a beautiful alternative to the usual medicalized hospital delivery. And in December, Pregnant in America will be coming out as well.

The Other Side of The Glass takes a perspective that is completely different from any of these films. ACOG’s anti-home statement criticizes women for ostensibly prioritizing their “experience” above safety, but what is rarely considered is that childbirth is experienced by two people. And while mothers giving birth in hospitals often feel vulnerable and powerless, unable to prevent unnecessary procedures and interventions, their baby, fully conscious but unable to articulate his or her experience, is even more vulnerable.

This documentary will advocate for humanizing our treatment of newborn infants in all birth settings, and its target audience is fathers:  appealling to their natural role as protector of mother and infant, and empowering them to take up that cause for the sake of their families. The title is taken from the experience of a father in a hospital, watching helplessly from behind a plate glass window as his screaming newborn is poked and prodded by a stranger.

The ten minute trailer can be seen here.

The Concord Monitor just published a lengthy article centered around Jeanne Browne, who offers home and birth center births to New Hampshire moms.

This paragraph was of particular interest:

Through a series of legislative measures, New Hampshire has welcomed and regulated certified midwifery. Midwives like Browne do not have medical or nursing degrees, but they are required to complete coursework and to spend time as apprentices to practicing midwives. They are governed by a state board of midwifery and are required to apply for recertification every two years. Insurance companies are required to reimburse midwives who assist with births outside of the hospital. “New Hampshire is a leader in this area and has been for a long time,” said Ida Darragh, the chairwoman of the North American Registry of Midwives, the group that certifies midwives nationally.

Even when legal, licensed home birth providers are available, many women’s ability to access them is limited by financial considerations. Health insurance providers may use ACOG’s policy on home birth as grounds for systematically denying coverage for home birth, even though the cost of a home birth is substantially less than for a normal hospital delivery. Private insurance providers which do not have an official policy in place on coverage for out-of-hospital maternity services may or may not cover home birth with an unlicensed provider, and usually, the family must pay their midwife out-of-pocket without knowing whether or not their insurance will provide reimbursement until weeks or months after the birth.

However, even Aetna, whose official policy is to refuse coverage for home birth, has to pay up in New Hampshire.

Earlier this month, Childbirth Connection released the results of “New Mothers Speak Out,” their 6-month post-partum follow-up study to the Listening To Mothers II Survey. It made headlines in the Wall Street Journal with some alarming findings:  Nine percent of the women surveyed screened positive for all the criteria of Post Traumatic Stress Disorder,  and twice that many showed some signs of PTSD.  Mothers who had experienced high rates of medical interventions were more likely to report signs of PTSD. These mothers were also more likely to describe their experience of childbirth as “feeling powerless in a threatening environment.”

There are some excellent obstetricians, family doctors, hospital-based midwives, and nurses who are caring for laboring women and new mothers in a way that is gentle, respectful, and empowering. There are also practitioners who are not even aware of the way their customary manner and routine procedures traumatize their patients. Furthermore, the hospital system itself is frequently percieved as a “threatening evironment” in which mothers (and fathers) justifiably “feel powerless.” The result is that mothers and babies are subjected to unnecessary procedures and interventions, and face a significant risk of coming out of their birth experience both physically and emotionally scarred.

Of the 150,784 Ohio births recorded by the Health Department in 2007, 44,860 babies - 29.75% - entered the world through a surgical incision. Cesarean section, like any major surgery, carries physical risks for both the mother and baby. The psychological and sociological implications of having 1/3 of all children born by cesarean - frequently in an atmosphere of tension, fear, and stress - are barely beginning to be explored. But we now know that, contrary to the prevailing view only a few decades ago, newborn and preborn babies are conscious, aware individuals whose early experiences have a significant impact. Though babies have limited means of communicating with their parents and caregivers and may never be able to verbally express or consciously retain the memories of their pre-birth and birth experiences, they are laying down somatic memories during this period which they will carry for the rest of their lives.

An Israeli news report today announced dramatically higher incidence of adult schizoprenia for babies whose mothers were only two months pregnant during the 6-day war in 1967. If exposure to maternal stress hormones so early in gestation has a demonstrable effect, what is the long-term result for the infants of those 9%-18% of mothers whose labor and birth experience makes them feel so powerless and so threatened that they respond in the same way as war and disaster survivors? How do resuscitations and NICU stays (more common in cesarean-born babies), to say nothing of the routine hospital procedures for healthy babies, impact the newborn psyche?

Frederic Leboyer brought to light the question of the newborn’s experience of medicalized childbirth more than thirty years ago, but his work, and subsequent research on newborn consciousness, has done little to change institutionalized newborn care. In 2008, women who seek a gentle birth experience - for their infant as well as for themself - frequently find that the only way to get the birth they want is to avoid the hospital.

Home birth opponents, including the AMA and ACOG, denigrate mothers for placing an “experience” over the health and safety of their baby. (It is ACOG’s official opinion that “Choosing to deliver a baby at home… is to place the process of giving birth over the goal of having a healthy baby,” though all available evidence indicates that planned home birth with a qualified attendant is a safe and reasonable choice for healthy women.) By framing the issue in these terms, pitting the process against the end result, they deny the increasing weight of evidence that the experience matters. Of course the most important goal is a healthy baby - but it is also clear that the process of childbirth profoundly impacts the mental health and well-being of both mothers and their babies. Women and families, no matter where they choose to give birth, need and deserve maternity care that promotes both a safe birth, a healthy mother and baby, and a non-traumatic (or perhaps even positive and empowering?) experience of childbirth.

The Coalition for Improving Maternity Services (CIMS) latest project, available only in New York until this week, has now launched nationwide. From their website:

“For years, consumers have enthusiastically shared online reviews of movies, restaurants, products and services, but readily available information about maternity care providers and birth settings was nearly unattainable-no longer. As part of the Transparency in Maternity Care Project, CIMS developed The Birth Survey as an online resource for new mothers to share their consumer reviews of doctors, midwives, hospitals, and birth centers, learn about the choices and birth experiences of others, and view data on hospital and birth center standard practices and intervention rates. The Birth Survey is now accessible throughout the United States.

“The Birth Survey is an on-going online consumer survey that asks women to provide feedback about their birth experiences. Women’s responses about specific providers and facilities will be available online to other women in their communities to help them decide where and with whom to birth. As they become available, the official facility-level intervention rates gathered from the state departments of health will be paired with the women’s survey responses to help families make their birthing decisions.”

If you’ve given birth in the past three years, help improve this resource by taking the survey here.

The American College of Nurse-Midwives’ response to the recently adopted American Medical Association’s resolutions regarding home birth and midwifery may be found here, and it is a delightful read. In particular, the thoroughly documented addenda to the letter is not to be missed.

In the past, medical lobbyists have frequently counted CNMs as allies in opposing state licensure of direct-entry midwives, and the AMA and ACOG have made much of their position that only certification from the ACNM should be considered adequate for midwifery practice. In light of this, the following paragraph from the addenda was of special significance (emphasis in the original):

“It should be noted that Resolution 205 erroneously states that ACNM has defined Certified Professional Midwives (CPMs) as “traditional, independent (of the health care system), non-formally trained and community-based providers of care during pregnancy, childbirth and the post-natal period.” ACNM does not define CPMs in this or any other manner, and will not do so. CPMs have their own professional organizations to represent them and standards which address their education, certification and scope of practice. ACNM is in dialogue with these organizations with the goal of working toward the highest quality midwifery care for women and families in all settings.”

Thank you, ACNM!

Karen Brody’s play Birth is coming to Cincinnati August 29-31. More information in this Cincinnati Community Press article or see the Birth & Beyond website.

The issues, problems, and controversies around modern maternity care continue to make headlines. This ABC News feature discusses the dearth of natural childbirth while looking at a mom whose unexpected early labor caused her to give birth in a Cincinnati hospital instead of the NY birth center she’d planned on. “As labor pains increased and Speier asked about breathing techniques, the doctor replied, “How do I know? I’ve only ever done two [natural childbirths].” The article goes on to talk about the risks of medicalizing normal childbirth and the rising cesarean rate, as well as the advantages of midwifery care.