Help! Need Statistics on Safety of Midwife Births

Went for my 10 week appointment with the OB today, and decided I am just not
going to stay with her. My first impression of her was very positive, but
today when I started to ask her about her c-section rates and epistiotomy
rates, her answers were not what I wanted them to be at all, and I felt she
was a bit defensive about answering my question.

Her c-section rates are 20-23%, which she pointed out, are "at the national
average." Well, that wasn't what I wanted to hear...I wanted to hear that I
had a better than average chance to avoid a c-section. She performs
episiotomies "as needed," and didn't really want to elaborate too much on
how often she deems them necessary, except to say that she finds they heal
better than tears do when forceps have to be used.

I also asked about induction, and she said she would be pushing hard for it
between 41 and 42 weeks. Since my Mom went to just about 2 weeks over with
all 4 of us kids, that worries me a bit, too.

So, I really want a midwife (even though it will mean big out-of-pocket
costs) and DH is suddenly dead-set against not having an OB. Apparently, one
of the women at work told him her daughter was a surprise breech, and had
they not been at the hospital, she thinks they would have both died. While I
doubt this is true, DH believes it, and it has turned him off to the Midwife
Center altogether.

So, I need facts and figures , medical articles from respected sources that
I can present as evidence that a midwife birth will be just as safe, if not
safer, than a hospital birth. As I look back through the archives, I see
many references to such articles and studies, but can't find citations for
the studies themselves. Can anyone help out?

Thanks a million!
--
Michelle
critter edd 3/14/04

"Shelly" wrote in message
...
Went for my 10 week appointment with the OB today, and decided I am just
not
going to stay with her. My first impression of her was very positive, but
today when I started to ask her about her c-section rates and epistiotomy
rates, her answers were not what I wanted them to be at all, and I felt
she
was a bit defensive about answering my question.

Her c-section rates are 20-23%, which she pointed out, are "at the
national
average." Well, that wasn't what I wanted to hear...I wanted to hear that
I
had a better than average chance to avoid a c-section. She performs
episiotomies "as needed," and didn't really want to elaborate too much on
how often she deems them necessary, except to say that she finds they heal
better than tears do when forceps have to be used.

I also asked about induction, and she said she would be pushing hard for
it
between 41 and 42 weeks. Since my Mom went to just about 2 weeks over with
all 4 of us kids, that worries me a bit, too.

So, I really want a midwife (even though it will mean big out-of-pocket
costs) and DH is suddenly dead-set against not having an OB. Apparently,
one
of the women at work told him her daughter was a surprise breech, and had
they not been at the hospital, she thinks they would have both died. While
I
doubt this is true, DH believes it, and it has turned him off to the
Midwife
Center altogether.

So, I need facts and figures , medical articles from respected sources
that
I can present as evidence that a midwife birth will be just as safe, if
not
safer, than a hospital birth. As I look back through the archives, I see
many references to such articles and studies, but can't find citations for
the studies themselves. Can anyone help out?

Thanks a million!
--
Michelle
critter edd 3/14/04



Sorry no hard facts but I live in New Zealand and the norm here is to have
a midwife or a midwife and a general practitioner. We do have OBs here but
most people I know have a midwife or shared care, the OBs tend to be more
for people with problems. As far as I am aware our statistics for deaths of
mothers and babies in childbirth are no higher than those of the states.
Most New Zealand midwives can deliver babies in hospital or a birthing
centre, is that an option for you?

As for the surprise breech, I have heard it said many a time that very few
OBs have the skills to deliver a breech baby. You are more likely to find a
midwife who could deal with that than an OB.

Others will be able to provide you with references for the safety of
homebirth. My advice is to go and see the midwife with your husband and get
him to ask her about things like breech babies etc.. They will have plans in
place for these sorts of situations. Maybe hearing that will put his mind at
rest.

Judy

Shelly wrote:
Went for my 10 week appointment with the OB today, and decided I am just not
going to stay with her. My first impression of her was very positive, but
today when I started to ask her about her c-section rates and epistiotomy
rates, her answers were not what I wanted them to be at all, and I felt she
was a bit defensive about answering my question.

Her c-section rates are 20-23%, which she pointed out, are "at the national
average." Well, that wasn't what I wanted to hear...I wanted to hear that I
had a better than average chance to avoid a c-section. She performs
episiotomies "as needed," and didn't really want to elaborate too much on
how often she deems them necessary, except to say that she finds they heal
better than tears do when forceps have to be used.

I also asked about induction, and she said she would be pushing hard for it
between 41 and 42 weeks. Since my Mom went to just about 2 weeks over with
all 4 of us kids, that worries me a bit, too.

So, I really want a midwife (even though it will mean big out-of-pocket
costs) and DH is suddenly dead-set against not having an OB. Apparently, one
of the women at work told him her daughter was a surprise breech, and had
they not been at the hospital, she thinks they would have both died. While I
doubt this is true, DH believes it, and it has turned him off to the Midwife
Center altogether.

So, I need facts and figures , medical articles from respected sources that
I can present as evidence that a midwife birth will be just as safe, if not
safer, than a hospital birth. As I look back through the archives, I see
many references to such articles and studies, but can't find citations for
the studies themselves. Can anyone help out?

Thanks a million!
--
Michelle
critter edd 3/14/04




I agree with the other responses you've gotten, but one other point is
that a midwife birth and a hospital birth are not mutually exclusive.
I had both my children in a hospital. The 2nd birth was attended by
a midwife, and was a much better experience than the first. (I also
had a much better OB nurse the 2nd time around, but that's just the luck
of the draw.)


Clisby

Clisby

Thanks everyone, for the responses, and especially Stephanie for the
resources. Wouldn't you know it, my "Thinking Woman's Guide..." is on order,
in the mail...hopefully it will be here soon.


--
Michelle
critter edd 3/14/04

Shelly wrote:


So, I really want a midwife (even though it will mean big out-of-pocket
costs) and DH is suddenly dead-set against not having an OB. Apparently, one
of the women at work told him her daughter was a surprise breech, and had
they not been at the hospital, she thinks they would have both died. While I
doubt this is true, DH believes it, and it has turned him off to the Midwife
Center altogether.


Bah. Most breech babies are born just fine, particularly
if the caregiver has experience delivering breeches. Some breeches
are more dangerous than others, but odds of a safe delivery are
*very* high with a frank breech and a skilled caregiver. You'd
be hard put to find someone who will attend a planned vaginal
breech delivery, but surprises happen and are generally fine.
I'm not saying there's no increased risk with a breech, but
doctors switched to planned c-sections because of a *small*
increase in risk, not because most breech babies died!


So, I need facts and figures , medical articles from respected sources that
I can present as evidence that a midwife birth will be just as safe, if not
safer, than a hospital birth. As I look back through the archives, I see
many references to such articles and studies, but can't find citations for
the studies themselves. Can anyone help out?


You might have an easier time presenting him with a
book or two. Henci Goer's books give some facts and figures,
plus arguments about a bunch of other issues he might find
persuasive. _Obstetric Myths vs. Research Realities_ is
heavier on the facts and figures than _The Thinking Woman's
Guide to a Better Birth_.

Best wishes,
Ericka

I just wanted to second Clisby's message. I am planning a
midwife-attended birth, but in a major metropolitan hospital. All my
care thus far (25 weeks) has been with the midwives, with one consult
with an OB due to a fibroid issue. I am expected to continue care,
labor and deliver with the midwives. They are within an OB practice,
so they are also covered by my medical insurance. My DH was
completely on-board with this practice after our first consultation.
Perhaps your DH would be too after you have a meeting with the midwife
and get that perspective explained to him, along with info on their
responses to "just in case" scenarios - fetal distress, dystocia,
pre-eclampsia, etc.

You didn't mention what city you're in. Let us know and perhaps
someone in this group can guide you to the care providers there that
would reassure your DH, but allow you the philosophy and scenario that
makes you most comfortable.

Robin (in Los Angeles)
#1, EDD early December 2003




I agree with the other responses you've gotten, but one other point is
that a midwife birth and a hospital birth are not mutually exclusive.
I had both my children in a hospital. The 2nd birth was attended by
a midwife, and was a much better experience than the first. (I also
had a much better OB nurse the 2nd time around, but that's just the luck
of the draw.)


Clisby

Clisby

"Usenet Fan" wrote in message
m...


You didn't mention what city you're in. Let us know and perhaps
someone in this group can guide you to the care providers there that
would reassure your DH, but allow you the philosophy and scenario that
makes you most comfortable.

Robin (in Los Angeles)
#1, EDD early December 2003


Thanks for the advice, Robin. Unfortunately, we are in a small Midwestern
City, with three options:

1) an in-network OB or Family Doctor in a hospital setting
2) an out-of-network birthing center that will be twice as expensive, if not
more, but probably managable if I don't get my doula
3) an out-of-network hospital midwife birth that is just way out of our
budget

I know we are very lucky, given where we live, to have this many options.
I'm still hoping to win DH over to the birthing center. We took the tour
there tonight. They have only been open for 6 months, and out of 13 births
they have had 3 transports to the hospital, a rate which did not do much to
reassure DH...especially since one of those was for a surprise breech - what
are the odds!

The "Thinking Woman's Guide" finally arrived...hoping I can get him to read
some of it, or at least sit and listen to me regurgitate some of it to him.



--
Michelle
critter edd 3/14/04

"Ericka Kammerer" wrote in message
...


You might have an easier time presenting him with a
book or two. Henci Goer's books give some facts and figures,
plus arguments about a bunch of other issues he might find
persuasive. _Obstetric Myths vs. Research Realities_ is
heavier on the facts and figures than _The Thinking Woman's
Guide to a Better Birth_.

Best wishes,
Ericka


Thanks for the recommendations, Ericka. I'll try to find a copy of Obstetric
Myths...just got the Thinking Woman's... today.


--
Michelle
critter edd 3/14/04

Thanks so much for all of the resources, Larry! I'll be sharing your post
with DH...I think he'll be glad to hear a father's perspective on this.

--
Michelle
critter edd 3/14/04

"Shelly" wrote in message ...

So, I really want a midwife (even though it will mean big out-of-pocket
costs) and DH is suddenly dead-set against not having an OB. Apparently, one
of the women at work told him her daughter was a surprise breech, and had
they not been at the hospital, she thinks they would have both died. While I
doubt this is true, DH believes it, and it has turned him off to the Midwife
Center altogether.

So, I need facts and figures , medical articles from respected sources that
I can present as evidence that a midwife birth will be just as safe, if not
safer, than a hospital birth. As I look back through the archives, I see
many references to such articles and studies, but can't find citations for
the studies themselves. Can anyone help out?

Sure. I second the notion that you should take your husband along
with you to meat with the midwife you've interested in using. That's
what I did, and it convinced my reluctant husband. And we were even
more radical...we were considering doing it at home, not even in a
center!

Years and years before we had our daughter, I researched birthing
options. It started out when waterbirth came up, and Chris told me the
OB he and his ex used said basically that "no doctor in the midwest
would do a waterbirth". (Not that the ex would have been comfortable
with it, but they were curious).

I didn't know much at the time, but I was interested in a
waterbirth...it seemed so right, so gentle, and the only way to get a
waterbirth in the midwest was to do it at home. I suggested it to my
husband and his response was "No way! At least not with the first
baby...I couldn't bear to lose you or a baby" So, I started exploring
my options, and talked with the head of the nurse-midwifery program at
MU, and told her I could bring my own rented tub, and she got very
excited at the idea. So I figured at the time, I'd have my waterbirth
in the hospital.

Fast forward several years. We had moved to NJ, were trying to
conceive, and I was investigating OBs. At least out here, many
birthing rooms in the hospitals are equipped with tubs (Unheard of in
Missouri, at least at the time). But all the OBs I contacted said that
they allowed their patients to labor in the water, but not birth
there. Everything I'd read suggested it was safe as long as baby is
removed from the water as soon as it's out.

So, I started looking for a midwife, initially with the idea that I'd
be doing it in the hospital. The midwife practice in my area does
both home and hospital birth, and do waterbirths in either location.
By this time, I'd done enough research to know that a homebirth - as
long as the pregnancy was normal and healthy - is as safe, or possibly
safer (similar neonatal and maternal outcomes, but no episiotomies,
C-sections, and fussy rules), that the infection rate is LOWER at home
(we are used to our own dirt and germs, and hospitals, no matter how
clean, are full of sick people, and it's difficult to keep those germs
from migrating). So, I shared the info with Chris and suggested it
again. He said, reluctantly, that he'd hear the midwife out.

She convinced him that it was safe, that it's a myth that hospital
births are somehow magically safer.

She made a couple of points that helped him out:

1. If a C-section is possibly needed, they call the hospital ahead,
which preps the OR and gets the Anesthesiologist there while you are
enroute. That the typical time you wait for a C-section is about 30
minutes, and the outcomes are the same whether you are waiting in the
hospital, or enroute in your car.

2. They are trained in breech births, but don't do them at home, and
if they detect the breech position, then they transfer. If the baby
is one of the lower-risk breech positions, then they often go ahead
and deliver vaginally - but at the hospital. One thing your husband
isn't taking into consideration, is that all women who birth in a
hospital transfer from home to the hospital. The difference is WHEN.
So if you turn out to be breech, the midwife will detect it, and send
you off to a hospital. In the other situation, the woman went and
THEN found out she was breech. Little difference in the outcome. My
midwives did have a surprise breech, and delivered it at home...but
the circumstances were extraordinary. The woman was a fast birther- 2
hours of labor, the baby had been head down the previous week, and by
the time they arrived, and discovered it was breech (and called the
ambulance) the baby was nearly born. Pam, the midwife, said she had
the choice to deliver the kid at home, or in the ambulance, and
decided home was better. The baby was born a minute or two later.
Think of it this way...breech is less than 10 percent of all births.
And what percentage of those births are going to do so in under 2
hours, and not leave time for a transfer?

And finally, fetal distress is very very very rarely such that if the
baby isn't born RIGHT NOW that it will die. And in those cases, it
really won't matter where you are.

The thing you've got to explain to your husband is that birth is a
normal, natural, and SAFE process. If it weren't, our species would
have died out. Your body evolved to birth babies safely under what we
could consider very adverse conditions today.

If it means anything, my husband, who was a reluctant homebirther is
now completely in favor of it. The birth of our daughter was a
wonderful experience, much better than the birth of his son had been.
He tries to convince all the expectant parents he works with to have
their baby at home. So far, he hasn't suceeded though. His ex,
though, did go with a midwife based on our experiences, but birthed
her second child in a hospital.

Cathy Weeks
Mommy to Kivi Alexis 12/01