A California licensed midwife emailed me the news that journalist Michelle Goldberg was writing an article for publication on the “home birth debate”. My friend provided the journalist’s email address and suggested that I contact her.
Ms. Goldberg is someone I actually know of from the MSNBC week-end news program “UP W/ Chris Hayes“, which I regularly watch. She comes across as an interesting person who speaks up on behalf of good government, economic and gender equality issues, especially rejecting policies that discriminate against women in regard to healthcare.
I figured Ms. Goldberg was on our side and was so excited to think this accomplished woman activist would devote her consider talents to writing a thoughtful, fact-based article. I looked forward to her addressing the specific issues of PHB (relative safety, the bias of the medical profession, efforts to marginalize or criminal traditional midwifery). I wanted someone identify and describe the gender and economic politics that for 30+ years has rightfully triggered many women to reject highly medicalized, hospital-based obstetrical care and seek out different alternatives, including PHB. That should be the focus of any national debate about PBH.
As a result, I spent all day yesterday writing an email with information and resources, which I sent off just a few hours ago.
Turns out the article is already a done-deed and unfortunately, Ms. Goldberg did not do as I’d hoped — that is, she certainly didn’t shed the cool light of reason and scientific evaluation on the topic. Instead, her 3,800 word article, titled “Home Birth: Increasingly Popular, But Dangerous” pored white-hot heat on this frequently misrepresented and misunderstood subject.
Like most other bad articles on alternative healthcare choices, it portrays one or two specific practitioners as doing crazy or incompetent things and generally betraying the trust of their patients and leading to a very regrettable outcome. The writer wants us to generalize from those specific persons and assume that all healthcare providers of that type — in this case, midwives providing out-of-hospital care for normal birth — are awful and should be put out of business.
I actually don’t have ANY information about the cases Ms. Goldberg discusses — they may or may not have done the awful things she reports. What i know for sure, is that she miss a great opportunity to take a good look at WHY so many women in the US feel unserved by the mainstream system of medicalized maternity care and are moved to make ‘alternative arrangements’.
As mentioned above, I worked hard to amass information that would have permitted her to tell the story that so desperatey needs to be told. So here is the first installment of the material i put together for Michelle.
Maybe she will reconsider. That would be nice. 
Dear Michelle ^0^
An acquaintance sent me your email address and suggested I contact you about your article on planned home birth (PHB) as a national debate.
I am a former L&D nurse, professionally-licensed PHB midwife, and long-time political activist. I was appointed to the California Medical Board’s Midwifery Advisory Council in 2007 and am currently serving my second 3-yr term.
I am also a mother of three and have two teenage grandsons. Having spent my adult life as a student of these contemporary and historical issues, I have, for better or worse, become an ‘idiot savant’ on the maternal-infant aspect of our healthcare system.
My midwife-friend believes this information would provide helpful background information on “why American women who could afford an obstetrician-attended birth in the ‘safety’ of a hospital would do something so apparently irrational and dangerous as planning to give birth at home”. It’s an important question.
I don’t know if you had the privilege of watching the first 10 minutes of the new HBO series “Newsroom” Sunday night, but the same impassioned ‘diatribe’ and fact-based response by its mythical news anchor (actor Jeff Daniels as ‘Will McAvoy’) in relation to the question of America being “the best in the world” could (and should) be applied to the critique our maternity care system. Ditto the idea that “America CAN do better”.
We aren’t the 1st, 2nd, 3rd, 4th or even 20th in ANY of the relevant metrics of maternal infant health except for being 1st in how much money we spend on maternity care (25% of our entire HC budget) and ranking 2nd in how many inductions and Cesareans American doctors perform.Each year a third of all babies born in the US — equal to the number of students that graduate from college — are delivered by major abdominal surgery at a cost roughly equivalent to 4 yrs tuition at a public community college. Complications of this tsunami of surgical deliveries include a substantial increase in maternal mortality since the mid-1990s.
Adding insult to injury, these expensive surgical interventions are not even buying us better babies — no improvement in neonatal mortality rates or reduction in cerebral palsy. The CP rate in the US has been exactly the same for the last 30-plus yrs, something ACOG is quick to point out in defense of obstetricians.
Factoring in the many scientific improvements in neonatal care over this time period means we are actually loosing ground for mothers and babies both. This is a national issue for many reasons, including the fact that 40% of all births in the US are paid for by the federal Medicaid program and that we want/need our economy to remain competitive in a global economy.
As contrasted with the surgical speciality of obstetrics, the stated purpose of normal maternity care is to protect and preserve the health of already healthy childbearing women and their unborn or newborn babies. Society rightfully expects that modern American obstetricians would have the utmost most expertise in this area, but unfortunately, these are the very attributes missing from the current system of medicalized maternity care.
Mastery in normal childbirth services for healthy women with normal pregnancies means bringing about a good outcome without introducing any unnecessary harm or unproductive expense. Logically this is achieved by seeking out the point of balance where the skillful use of physiological management, and the adroit use of medical interventions when necessary (or requested by the mother), provides the best outcome with the fewest number of medical/surgical procedures and least expense to the health care system.
Unfortunately, the 20th century system of ‘pre-emptive’ intervention cannot provide this type of care. However, I don’t want you to think that I am anti-doctor or anti-hospital. I would never want to live in a place or era without timely access to comprehensive medical and surgical services, which depends on well-equipped hospitals and well-trained doctors.
I want hospitals to work and work well. I want physicians of all kinds to be skilled and seamlessly available. I also expect the medical professionals to be knowledgeable about physiologically-based practices and work cooperatively with mothers and midwives. We actually are all on the same team — the one that wants to use the best practices all the time for everyone.
I never see medicine and midwifery as an ‘us versus them’ issue. I am well-known for insisting that healthy women should never have to choose between a midwife and a physician, or between home and hospital, in order to received physiologically-based care for a normal childbirth.
The current debate about PHB is simply a proxy in a fight that is either for or against normal (non-medical or physiologic) care for normal childbirth. As a principle of care, physiological management is actually not (or should not be) location specific quality.
A science-based standard of care would integrate the principles of physiological management with best advances in obstetrical medicine to create a single, evidence-based standard for all healthy womenwith normal pregnancies that reserves obstetric interventions for complications or as requested by the mother. This model of ‘best practices’ would apply to all birth settings and be used universally by all categories of birth attendants when providing care to healthy women.
Under those circumstance, place-of-birth would become what it was always suppose to be — the right choice for the particular situation for that specific mother & fetus — with hospital and OOH both seen as responsible choices in an integrated, cooperative and ‘minimalist’ model based on scientifically-established ‘best practices’ and patient consent.
These are the many reasons an honest national debate on de-medicalizing normal childbirth is vitally important. We need a debate that is thoughtful and fact-based instead of hysterical or motivated by a political agenda. The real issue isn’t place-of-birth (home vs. hospital), its the type of care provided for normal childbirth in a healthy population — cost-effective, physiologically-supportive care vs. expensive interventive and invasive care.
As mothers and midwives, the heart of the poorly-named “home birth movement” is actually to end the unexamined agenda of ever-escalating medicalization of normal childbirth in healthy women, while the obstetrical professional attempts to marginalize and/or criminalize all ‘alternatives’. We seek to replace the early 20th century default of routine medicalization with a science-based normalization of labor and birth, irrespective of the category of birth attendant (physician, midwives, obstetrician) or the setting (home or hospital).
This problem can only be fixed by acknowledging physiological management as the universal standard of care for healthy women, while continuing to provide women with unfettered access to obstetrical procedures as they deem necessary for themselves, such as labor induction, epidural anesthesia and elective Cesarean section (abet with full information on associated risks).
Here is a link to an article to help you make sense of the OOH-PHB safety arguments. Its from a document entitled “Evidence-based policies for Maternity care and a plan for action“, section II: “Safety & the Maternity-care Continuum in an essentially healthy population”.
http://healthcare2point0.com/MCDG_contrast-studies_feedback_28Aug2010.htm#Part_II:
I’m happy to provide additional material or reply to questions. I will email (i.e., post) the installment on historical issues – 1910-1940s – in the next 24 hours, unless I am called away by the Stork, who is indeed a jealous and temperamental mistress.
Tomorrow ~ Historical perspective ~ 1910 to 1940s
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