Midwives & Home birth vs. an OB & hospital ?

OK, this really bothered me so I will share it in hopes that I am just too
used to the "modern" way. A woman at work is having hr first child, she's
~5months and has had no visits to an OB or Doctor. She is completely relying
on a midwife. She will have a natural birth at home with the midwife and
husband in attendance.

I just can't identify with it. I LIKE knowing I've done tests and
ultrasounds and stuff to make sure - with modern technology - that my baby
is progressing fine. I just don't believe that a midwife can catch
everything - right ?

Hope this isn't a flame starter, I just cannot identify with the natural at
home no doctors thing. Give me an epidural, no problem...Mother hood is
demanding enough without being a hero when you don't need to. Vicki is
right - no one hands you a medal after labor and says "you get a gold medal
for having the most pain !"

However, I completely understand that each person has a right to their own
method, and just because I cannot identify with this, it doesn't mean it's
wrong. I just have this nagging feeling that if it were me, I'd be concerned
that I wasn't doing the best I could do for my baby. I can't help worrying
for her but I don't know why...I guess I can't imagine going through an
entire pregnancy without ever seeing a doctor when one has insurance and
access (can mid wives write prescriptions for prenatal tablets ?) My friend
works where I do and has excellent insurance...

L.
DS, 5-25-01 & EDD 4-28-04

LSU Grad of '89 writes:

: OK, this really bothered me so I will share it in hopes that I am just too
: used to the "modern" way. A woman at work is having hr first child, she's
: ~5months and has had no visits to an OB or Doctor. She is completely relying
: on a midwife. She will have a natural birth at home with the midwife and
: husband in attendance.

And just what is wrong with this. In most states midwives are professionals
with just as strong licensing requirements as doctors.

: I just can't identify with it. I LIKE knowing I've done tests and
: ultrasounds and stuff to make sure - with modern technology - that my baby
: is progressing fine. I just don't believe that a midwife can catch
: everything - right ?

Wrong? Your "from line" lists you as a graduate of a major university, but
it certainly seems you have not done your homework on the safety issues of
this one. Let me offer just a few stats to start with.

1. Did you know that there is no benefit to be shown from routine
ultrasound. Ultrasound has only proven beneficial when looking for
specific indications. It is grossly overused.

2. Did you know that NO major medical study in the last 20 years have
shown OB/hospital birth to be any safer than home/midwife birth for a
matched population? In fact, most studies have shown them to be almost
equal. A few studies have shown homebirth to be safer. What does come
out of the studies VERY STRONGLY is that the rate of complicaitons for
planned hospital births is much higher than for planned home births.

I have two very specific suggestions for you to increase your level of
objective knowledge in this area:

A. Do a search on MEDLINE. It is a national database of peer reviewed
journal articles in the medical area. You can looks for studies in almost
any specialty. Learn to use it. Look up the studies on birth. Find out
what the stats really are.

B. Read one of Henci Goer's books: "The Thinking Woman's Guide to a Better
Birth" is aimed primarily at birthing women who want to know what the best
and safest way to birth is, but it also contains plenty of references to
the medical studies that back up its conclusions. "Obstetric Myths versus
Research Realities" is aimed more at the medical professional, and contains
strong evidence based on the medical research why certian common procedures
should or should not be done.

I think either of these routes would give you the objective information to
be able to speak soundly on this subject.

: Hope this isn't a flame starter, I just cannot identify with the natural at
: home no doctors thing. Give me an epidural, no problem...Mother hood is
: demanding enough without being a hero when you don't need to. Vicki is
: right - no one hands you a medal after labor and says "you get a gold medal
: for having the most pain !"

Excuse me for saying it, but here is another statement based on total ignorance.
Again I will offer you two reasons your statement is off track.

1. This issue has been discussed on this newsgroup many times. If you take
a women who has experience both a medicated birth with an epidural, and an
unmedicated birth, which do you think that woman will say that she preferred.
At least 95% of the mothers on mkp who have done both say they would go
natural in an instant. I am sure you will get not a few replies to this
post from those women! :-) There is a good reason for this. The comfort
measures available to a woman who is allowed to labor naturally are far more
effective than the medications are to a woman who must labor passively while
hooked up to IVs and other mobility limiting devices.

2. Numerous studies have shown that the epidural anesthesia passes from the
mother to the babies bloodstream, and that babies who are born to moms with
epidurals have lower apgar scores, are more morbid, have more difficulty
breastfeeding, and in general do not respond as quickly or well.

: However, I completely understand that each person has a right to their own
: method, and just because I cannot identify with this, it doesn't mean it's
: wrong. I just have this nagging feeling that if it were me, I'd be concerned
: that I wasn't doing the best I could do for my baby. I can't help worrying
: for her but I don't know why...I guess I can't imagine going through an
: entire pregnancy without ever seeing a doctor when one has insurance and
: access (can mid wives write prescriptions for prenatal tablets ?) My friend
: works where I do and has excellent insurance...

Unfortunately you have a view of midwives that is straight out of the middle
ages. What you do not know is how modern and professional they are, and
how much the obstetric process has actually increased risks by the inappropriate
overuse of technology. I suggest that you do some objective reading on the
subject before becoming subject to such unfounded fears.

: L.
: DS, 5-25-01 & EDD 4-28-04

Larry

In article , Larry McMahan
wrote:

LSU Grad of '89 writes:

: I just can't identify with it. I LIKE knowing I've done tests and
: ultrasounds and stuff to make sure - with modern technology - that my baby
: is progressing fine. I just don't believe that a midwife can catch
: everything - right ?

1. Did you know that there is no benefit to be shown from routine
ultrasound. Ultrasound has only proven beneficial when looking for
specific indications. It is grossly overused.

No argument with that, but for those of us who haven't cultivated a
distrust in medical science, it can be reassuring. And it's not clear
what you mean by "specific indications." Our ultrasound involved a
bunch of specific measurements, which we enthusiastically asked a lot
of questions about.

out of the studies VERY STRONGLY is that the rate of complicaitons for
planned hospital births is much higher than for planned home births.

Mainly because pregnancies with identified risks for complications are
planned for hospital birth.

B. Read one of Henci Goer's books: "The Thinking Woman's Guide to a Better
Birth" is aimed primarily at birthing women who want to know what the best
and safest way to birth is, but it also contains plenty of references to
the medical studies that back up its conclusions. "Obstetric Myths versus
Research Realities" is aimed more at the medical professional, and contains
strong evidence based on the medical research why certian common procedures
should or should not be done.

I don't think lsugo89 said that nobody should do natural birth. We did
a planned hospital birth (with a midwife), but we read a lot about the
stuff you refer to--and we discussed them rationally with our midwives.
Some things we changed, some things we were reassured about.

I think either of these routes would give you the objective information to
be able to speak soundly on this subject.

See, it just sounds like she'd have to voice your opinion on order to
"speak soundly."

1. This issue has been discussed on this newsgroup many times. If you take
a women who has experience both a medicated birth with an epidural, and an
unmedicated birth, which do you think that woman will say that she preferred.
At least 95% of the mothers on mkp who have done both say they would go
natural in an instant. I am sure you will get not a few replies to this

Actually, our labor nurse said exactly the opposite--she had 2
unmedicated and 1 with an epidural, and she said the epidural was the
better experience.

2. Numerous studies have shown that the epidural anesthesia passes from the
mother to the babies bloodstream, and that babies who are born to moms with
epidurals have lower apgar scores, are more morbid, have more difficulty
breastfeeding, and in general do not respond as quickly or well.

My wife had an early epidural and the did a couple bolus' during labor.
Our daughter scored 9.9 apgar and breastfed like a champ. I don't
disagree that statistically epidurals are more likely to produce those
problems, but that's not the same as what you're stating.

Unfortunately you have a view of midwives that is straight out of the middle
ages. What you do not know is how modern and professional they are, and
how much the obstetric process has actually increased risks by the
inappropriate
overuse of technology. I suggest that you do some objective reading on the
subject before becoming subject to such unfounded fears.

I agree that many fears about home natural midwife birth are unfounded
and irrational, but there's plenty of axe grinding on both side of the
issue. And I doubt that a woman who has faith mainly in one side would
do very well in the opposite. Knowing a lot about both approaches is
probably the best strategy

APS
also an LSU grad of 1989 :-)

On Tue, 09 Sep 2003 21:30:40 -0700, aps wrote:

In article , Larry McMahan
wrote:

LSU Grad of '89 writes:

: I just can't identify with it. I LIKE knowing I've done tests and
: ultrasounds and stuff to make sure - with modern technology - that my baby
: is progressing fine. I just don't believe that a midwife can catch
: everything - right ?

1. Did you know that there is no benefit to be shown from routine
ultrasound. Ultrasound has only proven beneficial when looking for
specific indications. It is grossly overused.

No argument with that, but for those of us who haven't cultivated a
distrust in medical science, it can be reassuring. And it's not clear
what you mean by "specific indications." Our ultrasound involved a
bunch of specific measurements, which we enthusiastically asked a lot
of questions about.

I don't mistrust medical science - I am an ex-nurse, I respect medics,
I respect what medicine, and surgery, can do for people. However,
pregnancy in the main is not a medical or surgical problem. Why would
I need a doctor when I'm not ill? I have had consultant care during
this pregnancy because of previous problems, but it is the midwives I
rely on, and it is midwives who will, DV, be there when I have my
baby, not a doctor.

out of the studies VERY STRONGLY is that the rate of complicaitons for
planned hospital births is much higher than for planned home births.

Mainly because pregnancies with identified risks for complications are
planned for hospital birth.

Not necessarily. Women with no risks go to hospital to have a baby
and, if they don't conform to the expected timetable, find themselves
in the "cascade of interventions". And think about hospital-acquired
infections - those are a complication.

[snip]

Unfortunately you have a view of midwives that is straight out of the middle
ages. What you do not know is how modern and professional they are, and
how much the obstetric process has actually increased risks by the
inappropriate
overuse of technology. I suggest that you do some objective reading on the
subject before becoming subject to such unfounded fears.

I agree that many fears about home natural midwife birth are unfounded
and irrational, but there's plenty of axe grinding on both side of the
issue. And I doubt that a woman who has faith mainly in one side would
do very well in the opposite. Knowing a lot about both approaches is
probably the best strategy

The trouble is, the original poster didn't appear to know a lot about
both approaches.
--
EDD 1/11/03
32 weeks

Not necessarily. Women with no risks go to hospital to have a baby
and, if they don't conform to the expected timetable, find themselves
in the "cascade of interventions".

I'd be happier with this paragraph if there was a "may" inserted before "find
themselves in the cascade of interventions." Not all hospital births keep
women on strict timetables. (Mine certainly did not. My OB told me that as long
as my baby was doing well, and I was making any progress at all, I could labor
as long as I liked.)


Naomi
CAPPA Certified Lactation Educator

(either remove spamblock or change address to to e-mail
reply.)

Oh how I wish that were true for my hospital!

Here, a blue line is drawn on the partogram where the cervical dilation is
drawn.
If the dilation falls below that line, 'action' must be taken. It is called
an 'action line'.

Makes me sick.

Jo

Not all
hospital births keep women on strict timetables. (Mine certainly did
not. My OB told me that as long as my baby was doing well, and I was
making any progress at all, I could labor as long as I liked.)


Naomi
CAPPA Certified Lactation Educator

(either remove spamblock or change address to to
e-mail reply.)

--
--
Babies are Born... Pizzas are delivered.

"Naomi Pardue" wrote in message
...
Not necessarily. Women with no risks go to hospital to have a baby
and, if they don't conform to the expected timetable, find
themselves in the "cascade of interventions".

I'd be happier with this paragraph if there was a "may" inserted
before "find themselves in the cascade of interventions." Not all
hospital births keep women on strict timetables. (Mine certainly did
not. My OB told me that as long as my baby was doing well, and I was
making any progress at all, I could labor as long as I liked.)

Sorry, you're quite right, Naomi!

aps wrote:

No argument with that, but for those of us who haven't cultivated a
distrust in medical science, it can be reassuring. And it's not clear
what you mean by "specific indications." Our ultrasound involved a
bunch of specific measurements, which we enthusiastically asked a lot
of questions about.

Specific indications: presence or absence or partial development of
brain, four chambered heart, organs functional and present, abdominal
contents enclosed in the abdomen, spinal cord development internally,
identifying number of fetuses present, placental function, cord
integrity. Measurements of the fetus and fluid can be subjective and
not entirely helpful. Sure, it's neat to the look at your growing baby.
I had home births AND ultrasounds and they were not perfect,
especially the last one that was light by 2lbs, short on size, and the
gender.

Kris

aps writes:

: 1. Did you know that there is no benefit to be shown from routine
: ultrasound. Ultrasound has only proven beneficial when looking for
: specific indications. It is grossly overused.

: No argument with that, but for those of us who haven't cultivated a
: distrust in medical science, it can be reassuring. And it's not clear
: what you mean by "specific indications."

I'll spell it out in detail. When an ultrasound is used to determine
whether a specific suspected conditions exists (for example, ectopic
pregnancy, or to see if the fetus is still viable) then it provides
a positive benefit. However, if an ultrasound is done just because it
has been so many weeks and we want to look at the baby and see if all
is well, then no benefit is realized.

: out of the studies VERY STRONGLY is that the rate of complicaitons for
: planned hospital births is much higher than for planned home births.

: Mainly because pregnancies with identified risks for complications are
: planned for hospital birth.

This is absolutely wrong, and show a total misunderstanding for the way
that medical research is conducted. When comparing home versus hospital
(or any two situations) subjects are chosen from both populations *with
exactly the same risk profile*! This is a process called controlling for
confounding variables, and is done to prevent just the kind of bias you
note above.

: I don't think lsugo89 said that nobody should do natural birth.

luugo89 made a number of statements that she worried about her friend
who chose midwifery over obstetrics, and made other explicit and implicit
statements in her post that she thought midwife assisted homebirth was
less safe than OB assisted hospital birth, when, in fact, the research
shows just the opposite.

: I think either of these routes would give you the objective information to
: be able to speak soundly on this subject.

: See, it just sounds like she'd have to voice your opinion on order to
: "speak soundly."

I think what she would have to do to "speak soundly" is study the medical
research literature on the subject, both pro and con, and not just spout
off her uninformed opinion while ignoring the objective evidence.

: 1. This issue has been discussed on this newsgroup many times. If you take
: a women who has experience both a medicated birth with an epidural, and an
: unmedicated birth, which do you think that woman will say that she preferred.
: At least 95% of the mothers on mkp who have done both say they would go
: natural in an instant. I am sure you will get not a few replies to this

: Actually, our labor nurse said exactly the opposite--she had 2
: unmedicated and 1 with an epidural, and she said the epidural was the
: better experience.

Shall we take a poll? :-) See one reply in this thread already from a nurse
who has voted for unmedicated. :-)

: 2. Numerous studies have shown that the epidural anesthesia passes from the
: mother to the babies bloodstream, and that babies who are born to moms with
: epidurals have lower apgar scores, are more morbid, have more difficulty
: breastfeeding, and in general do not respond as quickly or well.

: My wife had an early epidural and the did a couple bolus' during labor.
: Our daughter scored 9.9 apgar and breastfed like a champ. I don't
: disagree that statistically epidurals are more likely to produce those
: problems, but that's not the same as what you're stating.

Excuse me? How are they different?

: Unfortunately you have a view of midwives that is straight out of the middle
: ages. What you do not know is how modern and professional they are, and
: how much the obstetric process has actually increased risks by the
: inappropriate
: overuse of technology. I suggest that you do some objective reading on the
: subject before becoming subject to such unfounded fears.

: I agree that many fears about home natural midwife birth are unfounded
: and irrational, but there's plenty of axe grinding on both side of the
: issue. And I doubt that a woman who has faith mainly in one side would
: do very well in the opposite. Knowing a lot about both approaches is
: probably the best strategy

Hmm. I think this is exactly what I was arguing. See also the other
responses in this thread.

Larry
Rice Grad 69, 73, 75. BA, MS, PhD :-)

aps wrote:

In article , Larry McMahan
wrote:

1. Did you know that there is no benefit to be shown from routine
ultrasound. Ultrasound has only proven beneficial when looking for
specific indications. It is grossly overused.


No argument with that, but for those of us who haven't cultivated a
distrust in medical science, it can be reassuring. And it's not clear
what you mean by "specific indications." Our ultrasound involved a
bunch of specific measurements, which we enthusiastically asked a lot
of questions about.

Meaning, I think, "We have reason to believe this baby has that problem.
Let's use ultrasound to confirm or deny that the problem exists." All
of the very specific measurements they take at an ultrasound can be very
interesting and seeing the babe can be reasuring, but this kind of
information and assurance doesn't change the outcome of the pregnancy.

FWIW, I've had 4 ultrasounds (I'm currently 29 weeks), at 8 weeks
(dating), 20 weeks (routine, but couldn't see the heart), 24 weeks (saw
the heart, but diagnosed a two-vessel umbillical cord, and 28 weeks (to
confirm the cord thing and check baby's growth rate because of same;
baby is fine, even somewhat bigger than expected).

From that, you could argue that it was a darn good thing we had those
ultrasounds, because use deep, heavy, voice here] now we know about a
potential problem with the baby, [end deep, heavy voice] since the
two-vessel cord is associated with some birth defects.

However, the association between the two-vessel cord and birth defects
for babies who have no other risk factors is very low. Most babies with
this kind of cord have no problems whatsoever. From what I can find, if
there are problems and the problems are major, the fetus would have been
non-viable. If the problems are minor, they are the kind of things that
would be caught in routine post-natal well-baby checks.

So, what have we gotten for all those ultrasounds? something to worry
about, more doctor visits, and more visits to come since this moves my
pregnancy closer to "high risk" just out of medical paranoia, more
insurance paperwork and overall increased medical costs [for us, for our
insurance carrier, and for society in general]. Frankly, I've
appreciated the assurance, but I'm not sure it's worth it. As DH
pointed out, had we not had the first ultrasound at all, we'd still be
in pretty much the same position knowledge-wise, with less hassle.
Pretty ironic.

JMO,
Valerie