Home birth from the view of orthodoxie
I received the following comment from my posting related to the article Extreme Birth. I thought I would post it as an entry along with commentary, rather than just add it as a comment, as I think it illustrates the conflated sloppy thinking that is so commonly associated with these topics.
Here are the comments by Tori Kropp RN along with my responses in ALL CAPS.
Birthing babies is what I love most in the world. The fact that I now have women ask me –is it really bad for me to have my baby in a hospital? –breaks my heart and has forced me to come out swinging. Enough is enough. I can no longer sit back and listen to this dialogue about homebirth come up again and again without inserting some badly needed facts and a serious reality check.
The argument is always the same by homebirth advocates. Hospitals are loud, hectic, bright, insensitive, uncaring machines full of greedy doctors and overworked – medical personnel – (I am pretty sure as a nurse, that means me) who are just waiting to hook women up to unnecessary medications and prevent them from -trusting their bodies.
I FOR ONE HAVE NEVER MADE THIS ARGUMENT. AND I BELIEVE THIS MISCONSTRUES THE DEBATE. YES HOSPITALS ARE OFTEN PORTRAYED AS BEING INFLEXIBLE AND INHOSPITABLE TO BIRTH, AND OUR EXPERIENCE IN NEW YORK, AT LEAST, HAS BEEN GENERALLY CONGRUENT WITH THIS ASSERTION. THIS IS NOT TO SAY THAT SOME HOSPITALS HAVE TAKEN STEPS TO UPDATE LABOR PRACTICES.
BUT IN GENERAL, THEY ARE INHOSPITABLE TO BIRTH ON BECAUSE THEY ARE FUNDAMENTALLY BASED ON A DIFFERENT MODEL OF CARE – BASED ON PATHOLOGY. THIS CREATES BARRIERS TO NATURAL BIRTH ON TWO FRONTS.
ONE IS PHYSIOLOGICAL — WHEN YOU ARE HOOKED UP TO A CONTINUOUS FETAL HEART MONITOR YOU ARE IMMOBILIZED. DATA DEMONSTRATES THAT THE ADDITIONAL INFORMATION PROVIDED BY CONTINUOUS MONITORING DOES NOT LEAD TO BETTER OUTCOMES — INDEED IT PROVIDES TOO MUCH INFORMATION THAT LEADS TO UNNECESSARY INTERVENTIONS INT EH SAME WAY THAT MRI’S OF THE BACK DO. FLUIDS AND FOOD ARE RESTRICTED IN ANTICIPATION OF SURGERY, EVEN THOUGH THESE PRACTICES IN FACT HELP TO PRECIPITATE A SURGERY. HOSPITALS INSIST ON BEING HOOKED TO AN IV, FURTHER RESTRICTING MOBILITY, FURTHER HINDERING LABOR AND ADDING DISTRESS TO THE FETUS. ONCE THE CHILD IS BORN, THERE IS OFTEN LIMITED CHILD-PARENT CONTACT. VERNIX IS CLEANED OFF. SO THEY ARE NOT JUST LOUD AND UNFRIENDLY, THEY ARE BAD FOR NORMAL BIRTH.
THE OTHER IS PSYCHO-SOMATIC IN NATURE. WHEN YOU ARE IN AN UNFAMILIAR SETTING WITH STRANGERS COMING INN AND OUT OF YOUR ROOM, IT IS DIFFICULT FOR YOUR CERVIX TO DILATE. THERE IS SIGNIFICANT DATA DOCUMENTING THIS, WHICH INA MAY GASKIN APTLY CALLED “THE LAW OF THE SPHINCTER.”
I HAVE NEVER SEEN ANYONE DEPICT THE DRIVER OF THIS BEHAVIOR AS “GREEDY DOCTORS.” INDEED THERE ARE DOCTORS OUT THERE WHO WOULD SIGNIFICANTLY MODIFY THE PROTOCOLS IN PLACE, BUT THEIR HANDS ARE TIED. RATHER I HAVE SEEN THE INCENTIVES OUTLINED AS BEING DRIVEN BY THE LITIGIOUS NATURE OF OUR SOCIETY COMBINED WITH INSTITUTIONAL DRIVES TO MINIMIZE RISKS. HOSPITALS AND INSURANCE COMPANIES ARE USING WORST-CASE SCENARIOS TO DRIVE PROTOCOLS. THIS DRIVES BEHAVIOR THAT IS OPTIMIZED TO REDUCE INDIVIDUAL RISK AT THE EXPENSE OF OPTIMAL POPULATION-LEVEL OUTCOMES.
The argument goes on to state that homebirth is safer, more satisfying, more loving, more empowering, less interventive, healthier for the baby, more spiritual and on and on. Anyway you shake it that very implicitly pronounces that to give birth at home is… – better -. Period. But always, at the end of any article, blog or comment about it by it’s proponents, are the words – but a woman should be encouraged to give birth wherever she feels most comfortable, including a hospital.
THERE IS QUITE A BIT OF CLINICAL DATA THAT DOES BEAR OUT THAT HOME BIRTH IS SAFER FOR LOW-RISK PREGNANCIES. NOW WHILE THE CLINICAL DATA MAY INDEED BEAR THIS OUT, THIS SAYS NOTHING OF THE MENTAL STATE OF A WOMEN WHO IS DUE. MANY MANY WOMEN ARE FAR MORE COMFORTABLE GOING TO A HOSPITAL THAN GIVING BIRTH AT HOME, AND FEAR WOULD INTERFERE WITH BIRTHING AT HOME. THE WRITER CONFUSES THE OVER-RIDING DESIRE TO SUPPORT WOMEN AND TRYING TO DRIVE A GRADUAL CHANGE IN PERCEPTION AND BEHAVIOR. THIS SHOULD NOT BE CONFUSED WITH A DISCLAIMER.
Wait a minute. Is that what you just said? Let’s assume I am having my first baby. I am very excited and I want to learn everything I can, and of course, I want to do what is best for my baby and myself. Do I choose to have the -scary, cold hospital birth – that I was told about or the – loving, empowering, spiritually-fulfilling homebirth? I am very likely to make the choice to give birth in either a birth center or a hospital but wow – what a set-up for feeling badly about my choice.
Let’s look at some actual facts about birth in the United States:
Over 4 million women give birth each year
97% of women give birth in a hospital
2 million women live below the poverty line and have limited access to adequate maternity care
100 years ago, a woman had a significantly high chance of dying during childbirth . Medical advances, including the use of antibiotics, oxytocin to induce labor, safe blood transfusions and better management of hypertensive conditions during pregnancy, are directly responsible for the decline in maternal death rate.
WELL I AM NOT SURE WHAT CONCLUSIONS THE WRITER IS TRYING TO SURMISE AT THE NUMBER OF BIRTHS OR THE PERCENTAGE OF BIRTHS IN THE HOSPITAL. BUT FALSE CONSENSUS IS NO ARGUMENT FOR WHICH PRACTICE IS BETTER FOR A POPULATION. NOR AM I SURE WHAT THE AUTHOR IS TRYING TO SAY ABOUT POVERTY. NO ONE IS ADVOCATING FOR WOMEN TO GIVE LABOR WITHOUT NECESSARY CARE (INCLUDING PRENATAL).
COMPARING INFANT AND MOTHER MORTALITY RATES NOW TO 100 YEARS AGO TO ARGUE AGAINST HOME BIRTH IS A LITTLE STRANGE. IT IS LIKE SHE IS EQUATING CONTEMPORARY HOME BIRTH TO BIRTH CONDITIONS 100 YEARS AGO. HOW ODD. THE DECLINE OF THE MATERNAL DEATH RATE IS NOT JUST DUE TO OXYTOCIN TO INDUCE LABOR BUT THE ENTIRE HOST OF PRENATAL CARE, PLUS GENERALIZED HIGHER NUTRITION, ETC.. WHAT A FALLACIOUS ARGUMENT… IT DOES REVEAL HOW MANY PEOPLE VISUALIZE A HOME BIRTH, A LONE HOUSE ON THE PLAINS, A POT OF BOILING WATER ON A FIRE, A LEATHER BELT TO BIT ON…
Today, around the world, every 60 seconds, a woman dies during pregnancy or childbirth, often from an avoidable cause. There are no well-documented, large-scale studies that show that homebirth is either safer or more satisfying than hospital birth. We have -far from perfect – health–care in this country when it comes to taking care of moms and babies. However, there is truly a disconnect with what is really important here. Perhaps those who exert so much energy on faulting the U.S. maternal/health care system could spend even ¼ of their time working to provide better access to care for the 2 million underprivileged women here who really need it.
THERE IS QUITE A LARGE AMOUNT OF CLINICAL DATA AND I HAVE POSTED SOME OF IT ON THIS BLOG, INCLUDING METASTUDIES. THIS, OF COURSE, IS FOR LOW-RISK NORMAL PREGNANCIES.
NO ONE IS ARGUING THAT MEDICAL INTERVENTION IS NOT A VALUABLE TOOL TO IMPROVE THE HEALTH OUTCOMES OF THE POPULATION. THE DEMONIZATION OF THE HOSPITAL SYSTEM, I BELIEVE, STEMS FROM THE ITS MIS-APPLICATION TO NORMAL BIRTH.
I AM NOT SURE HOW ADVOCATING FOR HOME BIRTH IS AT THE EXPENSE OF UNDERPRIVILEGED WOMEN. HOME BIRTH IS MUCH CHEAPER THAN HOSPITAL BIRTH, AND THE MEDICAL SYSTEM WOULD CERTAINLY SERVE THIS POPULATION BETTER IF HOMEBIRTH WAS INCORPORATED. HOMEBIRTH LIES MOSTLY OUTSIDE OF THE MEDICAL ESTABLISHMENT, SO THE INABILITY OF THE MEDICAL SYSTEM TO SERVE THE POOR HAS LITTLE RELEVANCE
I have shared in the births of several thousand women at homes, in birth centers and in hospitals. I have seen miracles, tragedies, difficulties and wonder in all of those places. What angers me so deeply is the direct insinuation that giving birth in a hospital denies a woman a safe, positive and life-affirming birth experience. What kind of support is that? A woman deserves to feel nurtured by other woman, not faulted, questioned or criticized. There is no -better or best -way to give birth and I am no longer going to be quiet about it.
WAIT A SECOND. THE WRITER IS FURIOUS THAT HOMEBIRTH ADVOCATES ALWAYS END WITH THE CAVEAT THAT YOU SHOULD HAVE THE BIRTH YOU ARE COMFORTABLE WITH. BUT NOW SHE IS LIVID THAT THESE SAME ADVOCATES DENY THAT ANY HOMEBIRTH CANNOT BE POSITIVE FOR ANY WOMAN. IS IT SAFE, WELL NOT AS SAFE AS A HOME BIRTH IF YOU ARE LOW-RISK. SAFER IF YOU HAVE A HIGH-RISK PREGNANCY. POSITIVE AND LIFE-AFFIRMING, WELL THIS DEPENDS ON HOW YOU WANT TO BE TREATED. I AM SURE THERE IS QUITE A LOT OF VARIATION IN PATIENT CARE ACROSS HOSPITALS, AND THERE CERTAINLY IS A BIG QUALITATIVE DIFFERENCE BETWEEN BIRTH CENTERS AND HOSPITALS.
IT IS IRONIC THAT SHE SAYS THAT WOMAN SHOULD NOT BE CRITICIZED FOR HAVING A HOME BIRTH. BUT AS SHE NOTED, 97% HAVE HOSPITAL BIRTHS. THE FEW MOMS WHO GIVE BIRTH AT HOME ARE MADE TO FEEL LIKE PARIAHS. THOSE WHO HAVE WONDERFUL NATURAL BIRTH STORIES HOLD THEIR TONGUES FOR FEAR OF MAKING OTHER WOMEN FEEL INADEQUATE ABOUT THEIR BIRTHS. THIS IS THE TRAGEDY. WOMEN SHOULD KNOW THERE IS AN ALTERNATIVE AND A HEALTHIER ALTERNATIVE. ONE THAT IS BETTER ON MANY ACCOUNTS.
AND THE CLINICAL DATA IS WHAT IT IS. THERE IS A BETTER WAY TO HAVE A NORMAL LOW-RISK LABOR. AT HOME. THE DATA FROM N AMERICA AND W EUROPE IS OVERWHELMING AND ROBUST. SHOULD WOMEN FEEL BADLY ABOUT GIVING BIRTH IN THE HOSPITAL? NO ONE IS ADVOCATING THAT. IT IS IRONIC THAT THE WRITER FEELS OUTNUMBERED BY THE HOME BIRTH MOVEMENT WHEN THIS COMMUNITY IS CONFRONTING THE MEDICAL ESTABLISHMENTS INTERESTS. HOSPITALS MAKE A LOT OF CASH OFF OF BIRTHS. ACOG HAS AN INVESTED INTERESTED IN PREVENTING HOME BIRTH. AND THEIR STATEMENT ON HOME BIRTH, WHICH IGNORED VAST AMOUNTS OF DATA THAT HAS SHAPED PUBLIC HEALTH POLICY IN MUCH OF WESTERN EUROPE, IS EVIDENCE OF THE BIAS. MOST WOMEN DO NOT CHOOSE A HOME BIRTH BECAUSE THEY ARE SCARED INTO A HOSPITAL BIRTH. WHO IS BEING IRRESPONSIBLE HERE? HOW IS ADVOCATING FOR POLICIES THAT LEAD TO UNNECESSARY INTERVENTIONS AND ALL THEIR COMPLICATIONS?
THE BOTTOM LINE, IS THAT THERE IS A BETTER WAY. YOU CAN STILL CHOOSE TO HAVE A HOSPITAL BIRTH BECAUSE YOU ARE MORE COMFORTABLE, BECAUSE YOU ARE AFRAID, BECAUSE YOU DON’T BELIEVE IN DATA. BUT IT DOES NOT CHANGE THE FACTS.