Hmmmmm.

So on the one hand you have ACOG speaking out against women's choice to have a home birth, and on the other you have CPMs speaking out against Cesareans, another issue implicating choice w/r/t elective Cesareans.

I really do not look forward to getting pregnant someday (if I do) and having to sit around while *other* people argue about what I "should" do when my body decides to spit out another human being. Personally, I imagine it's stressful enough having your body tear itself apart from the inside for hours on end, without the added judgment. But, you know, that could just be me.

Some links to studies on this topic:

Study 1

Study 2

Searching briefly, I found several studies related to home birth and midwives. They aren't too terribly recent, but I think they hint at the conflict in the literature. The first study says low risk (and only low risk) pregnancies are equally safe in hospitals and at home with a midwife. The second study shows a clear increase in risk for the mother during home births with a midwife.

It seems that for the whole population of women, it is statistically safer to give birth at a hospital (ie if you lump high, medium, and low risk together you get an average with better chances in a hospital). However, if someone is demonstrably a low risk pregnancy, their outcome will be the same whether they choose a home birth with a certified midwife or hospital birth (survival, health of mother and baby. Anecdotal evidence suggests that the midwife experience would be more enjoyable.

I think it's disingenuous to call ACOG a "trade union." I also think that it is seriously misleading to imply that OB/GYNs as a group place their profits above the health and safety of their patients.

That being said, I think that midwives should be allowed to practice and that a recognized accreditation process in each state would benefit mothers, babies and their families. I think the most important thing you could do to ensure healthy outcomes with a home birth is to have a medical team (including a certified or licensed nurse midwife) who is in contact with the mother's OB/GYN, and who is trained to know and act on any signs of danger.

I don't think that this sort of inter-professional sniping helps anybody, least of all patients, and I agree with Law Fairy that each side heaps judgment on the women who choose to go with the other one. Really, everybody has the same goal: healthy mothers and healthy babies. Why can't we all act like it?

I realize that this is a choice for women to make, and me as a man should really shut up about it, but I don't really understand the case for home-births.

When my older sister was born, complications arose and my mother had an emergency c-section. Had she given birth at home, there is a very large possibility that me, my mother and/or my sister wouldn't be alive.

My mother sees the choice as simple, and I agree with her. In cases like this, I tend to listen to the opinion of both doctors and women I trust (me not being in the position to choose), and they all agree.

But, hey as someone said, it ain't up to me to tell women what to do. If someone want to give birth at home, they should of course do so. Just as long as they know all the risks, and go into it with open eyes.

Personally, I trust doctors and scientists. It's not like the midwives don't have a vested financial here.

The real question is whether "good news" for midwives is actually "good news" for mothers. It doesn't seem to be; home birth has a higher rate of death than does hospital birth.

That is still a choice issue (some may feel that the state shouldn't license more-dangerous providers, but arguably they could be available for women who wanted them) Except for the problem that choosing a more dangerous option MUST ABSOLUTELY involve fully informed consent... and that the HB community generally does not acknowledge the added danger.

Statistically speaking, the probable result of adding more CPMs is that more infants will die. That'd be OK if it was a matter of choice (since women have the right to abort, they damn well have the right to choose a more-risky method of delivery!) but it is very problematic absent the disclosure.

Readers should be aware that a CPM is a degree with comparatively little medical training which is not even vaguely in the same league as that of an OB or CNM.

A cNm (certified NURSE midwife, not to be confused with a cPm, or certified PROFESSIONAL midwife) is a great, safe, much more highly trained option which is preferable to a CPM, or (worse) a DEM.

I will not fill this blog with statistics, but I encourage readers to consider visting homebirthdebate.blogspot.com if they are interested in discussing facts and specifics.

I know a few women who have chosen to give birth at home, one thinks it was probably a bad idea, the other one would have it no other way.

As for me, I'm six months pregnant, and the thought of giving birth at home scares me to death. I'm glad that midwifery has been decriminalized in Missouri, but i don't agree that American College of Obstretics and Gynecology coming out against home birthing is a bad thing. The initial move from midwives to obstetricians did prove more deadly to women to begin with, but we have come a long way since then. I'd rather have access to pain medication and a doctor... just in case something does go wrong.

Something that ACOG is ignoring, and many people don't know, is that a midwife will generally refuse to do a home birth if the home isn't within a 15 minute drive of a hospital (which is probably 5 minutes for an ambulance) in case of an emergency. Furthermore, most emergencies during childbirth don't need to be treated immediately; even in a hospital C-section there is a MINIMUM 30 minute surgical suite prep wait time between the declaration by the doctor and the beginning of surgery. If an emergency arises, the midwife can call ahead to the hospital and usually you can see a doctor with no wait, and the surgical suite prep will be underway by the time you get there. It's not that much different than starting in a hospital and waiting there while the prep occurs.

I live a 10 minute WALK from my hospital; if I end up having a low-risk pregnancy I will deliver at home with confidence, knowing that should the need arise I can get to the hospital in plenty of time to deal with whatever problem arises.

So, just so we're clear, being a nurse-midwife is legal in all states. Nurse-midwives often work closely with OB/GYNs. Certified Professional Midwives do not have to be nurses, and their education can consist largely of self-study and apprenticeship, correct?

From what I've heard, the rise in C-sections has occurred largely because older methods of extracting babies who get "stuck" in the birth canal are very hard to teach, and can result in many problems for the baby if done incorrectly. And since OB/GYNs are the most-sued profession, they have to err on the side of caution. Since C-sections are very reliably safe for the baby, their decision to perform a C-section is much less likely to be challenged in court than if they used forceps.

@Sailorman,

There are an equal number of studies saying that it is about the same or LESS risk of both infant and maternal morbidity and mortality in home-birth as those that say that home-birth has a higher risk. Taken together, all the studies done so far indicate that for low-risk pregnancies (of which 90% are), home birth carries about the same risk for infant and maternal morbidity/mortality as hospital birth.

What women need to be informed of is the risks involved in each choice (most people assume hospital birth is without risks - not so! There is increased risk of grade 3 and 4 tearing at hospital births) and also pain management...if a woman is afraid of pain during labor, she has a right to know about ALL the methods that can relieve pain, whereas most docs will only tell her about drugs. Positions, walking, breathing, bath/shower and massage all reportedly greatly increase pain relief, but a lot of hospitals do not permit women to do these things and also do not inform the women of them. Informed consent during hospital childbirth is a huge problem.

Sailorman, I don't know where you're getting your stats from, but it's a complete fallacy to say that more midwives will equal more deaths given the better maternal/neonatal outcomes in a number of countries which have far more midwives than the US.

I know this site is very American-centric, and looks at birth and other women's health issues from within the current health system in the US, but I loathe hearing comments that totally dismiss the contradictory experience of other countries. Compare this statement from the UK's Royal College of Obstetricians and Gynaecologists with the ACOG's homebirth statement.

http://www.rcog.org.uk/index.asp?PageID=2023

Spot the difference.

The maternal mortality statistics also give the lie to the assertion that midwife deliveries increase the risks;

http://www.who.int/reproductive-health/publications/maternal_mortality_2005/mme_2005.pdf

OK, can't resist:

Something that ACOG is ignoring, and many people don't know, is that a midwife will generally refuse to do a home birth if the home isn't within a 15 minute drive of a hospital (which is probably 5 minutes for an ambulance) in case of an emergency.

Well, no. To get treatment you have to:
1) decide to call
2) call dispatch
3) get through
4) dispatch calls ambulance
5) ambulance leaves, and drives to the house from wherever they are stationed
6) go in, assess, load patient
7) travel time to hospital
8) unload to ER
9) assess/prep as needed
10) to surgery!

Which of course assumes that the ambulance doesn't happen to be otherwise booked, with another patient, etc. You can be 10 minutes from a hospital and it can take a loooong time to get there.

Furthermore, most emergencies during childbirth don't need to be treated immediately;

This is true. Minor emergencies are... minor. Major emergencies are major. The major ones are what'll kill the infant though.

even in a hospital C-section there is a MINIMUM 30 minute surgical suite prep wait time between the declaration by the doctor and the beginning of surgery.

This is simply not true Major hospitals generally have a emergency decision to incision time of a fraction of that. 5 minutes is not uncommon. I've known OBs that have made it in two minutes in a serious life or death emergency.

If an emergency arises, the midwife can call ahead to the hospital and usually you can see a doctor with no wait, and the surgical suite prep will be underway by the time you get there.

This is.... less true than it may seem. Depends on the midwife's relationship with the hospital. Problem is, many midwives don't have hospital privileges and don't interact with OBs much, either because they have philosophical differences or (more common) because the MDs don't want to get involved with untrained people. You might get them to page OB and have a scrubbed in surgeon standing in the PR when you pull in. But probably not.

It's not that much different than starting in a hospital and waiting there while the prep occurs.

It's completely different. in a hospital you have access to an enormous number of people, many/all of whom are trained specifically to manage emergencies and handle them (unlike midwives), who have access to a full hospital's worth of equipment (unlike a home birth.) And of course, even if you don't happen to have an OB, you've certainly got a few MDs in the hospital.

In a home birth, you've got a midwife--maybe with a less-trained attendant. You're at home, of course. You also need to transport which is no fun.

I live a 10 minute WALK from my hospital; if I end up having a low-risk pregnancy I will deliver at home with confidence, knowing that should the need arise I can get to the hospital in plenty of time to deal with whatever problem arises.

That is certainly better than living farther away and it's certainly your choice. You should know, however, that many of the most serious obstetrical complications cannot be determined in advance by ANYONE. If you have a real honest to goodness SD or abruption then you're farther away than you want to be.

You can still do it of course (it's your choice) but you shouldn't pretend about the risks: they're not huge, but they exist.

Childbirth is a normal, physiological event that does not "tear [the body} apart" for hours on end. Childbirth is not inherently harmful to women or children. Childbirth is not a dysfunction, although dysfunctions can occur. We have had to endure and discard many myths we have been fed regarding our bodies and their strength and worth; let's let this one go as well.

Please see this article regarding the second study:
http://www.mothering.com/articles/pregnancy_birth/homebirth/under-fire.html

Homebirth is not offered as an option to many birthing women in our society; they must make a concerted personal effort to learn about it in order to make an informed decision about it. Medical professional are extremely dismissive about it, scare tactics are employed to keep women from exercising their choices concerning it, and it is so divisive and controversial that only a dedicated few commit to becoming knowledgeable professionals in the field. Does any of this sound familiar? If this were contraception or abortion we were discussing, there would be no arguments at all.

And the ACOG is a self-regulating agency that does not offer itself to review by non-members.

"A cNm (certified NURSE midwife, not to be confused with a cPm, or certified PROFESSIONAL midwife) is a great, safe, much more highly trained option which is preferable to a CPM, or (worse) a DEM."

Yeah, good point about how there's way more than 2 options. Also, what's a DEM?

"I know this site is very American-centric, and looks at birth and other women's health issues from within the current health system in the US, but I loathe hearing comments that totally dismiss the contradictory experience of other countries. Compare this statement from the UK's Royal College of Obstetricians and Gynaecologists with the ACOG's homebirth statement..."

Thanks for the link, and give full credit! The first link isn't just from the RCOG, it's a joint statement from the RCOG *and* the Royal College of Midwives *together*. :)

Meanwhile, speaking of the UK, what about birthing centres and the NHS?

http://news.bbc.co.uk/2/hi/health/4429386.stm

"...According to the NCT, 16% of women give birth in birth centres, 2% at home and the rest in hospital..."

Meanwhile, I got the impression a few years ago that while some American people seem to think encouraging hospital birth is more money-grubbing than encouraging home birth (higher profits for doctors), some British people seem to think encouraging home birth is more money-grubbing than encouraging hospital birth (lower costs for the NHS therefore lower costs for taxpayers). How widespread or rare are those attitudes IRL?

I must say, I find sailorman's arguments very convincing. I think it's foolish to say that you are as safe and prepared at home as you are in a hospital. A perfectly low-risk pregnancy can get dangerous, and it can get dangerous fast. Being in an environment where there are lots of people that have been specifically trained to handle emergencies and panic-inducing situations is going to save your life.

This is a situation where there's lots of data and arguments pointing in different directions, with people arguing in different directions. Ultimately, I have to put my faith in the people with the most experience and education in these matters, the doctors.

I find the insinuation that medical professionals care more about their profits than the health of their patients insulting. I've known a few doctors in my life, and they choose their profession because they passionately want to help people, and give them the absolute best care that they possibly can. Besides, if you are going to make that argument, it goes two ways; midwives have arguably a much greater profit incentive in home births than doctors do in hospital births.

That said, this is ultimately a choice for women to make for themselves. If they want to give birth at home, they should be allowed to do so, as long as they have fully informed consent are close enough to a hospital in case something goes wrong.

"Besides, if you are going to make that argument, it goes two ways; midwives have arguably a much greater profit incentive in home births than doctors do in hospital births."

It goes a third way too: *unassisted* childbirth is less profitable for anyone who gets paid to assist birth than any option involving a midwife and/or obstetrician...

@ Oskar

I think that men should have SOME say, insofar as the safety of the baby is concerned. The baby is the father's as much as it is the mother's.

I would encourage everyone to also read Feministing's interview with Joan Bryson (the link is displayed on the right-hand side of the site) which dispels some myths about midwives' training, among other things.

@Mina

My point was that I think it's grossly insulting to accuse either midwives or doctors of caring more about money than about healthy babies and mothers. I firmly believe that both sides are arguing their points sincerely and that they all genuinely believe that their method is superior, and that their motives are pure. Specifically:

"I still think this is very much about childbirth as a business, and a fear that OBs will lose the current monopoly they have on the practice."

I find such an accusation to be in very distasteful. Remember, these are people who went to school for a gazillion years and then dedicate their lives to helping others, people who live and die by the health of their patients. If you disagree with them, that's fine, but lets remember who you are talking to.

@Mina

My point was that I think it's grossly insulting to accuse either midwives or doctors of caring more about money than about healthy babies and mothers. I firmly believe that both sides are arguing their points sincerely and that they all genuinely believe that their method is superior, and that their motives are pure. Specifically:

"I still think this is very much about childbirth as a business, and a fear that OBs will lose the current monopoly they have on the practice."

I find such an accusation to be very distasteful. Remember, these are people who went to school for a gazillion years and then dedicate their lives to helping others, people who live and die by the health of their patients. If you disagree with them, that's fine, but lets remember who you are talking to.

(sorry about the double-post)

What I don't get is how according to the mythos among many feminists, OB docs are only looking out for their own profits and ACOG is a mere "trade union"; whereas all midwives are noble, self-sacrificing, holistic practitioners standing up to the Establishment.

There is quite a bit of rhetorical excess to be found here, including from Miriam, who has a vested interest in tearing down the OB profession.

The reality is that OB docs joined a low-appeal, high-stress, long-hour, high-litigation field (as opposed to something cushier such as radiology) specifically due to their interest in helping women through childbirth, as well as health situations such as cervical cancer. Believe me, OB/GYN is not considered an attractive field for most med students, so only the people most interested in the field will pursue it.

Also, over 75% of graduating OB residents these days are women -- a higher percentage than any other medical field, including pediatrics. http://tinyurl.com/38qxwm

Read some of the above posts, especially from Sailor, who does a good job at dispelling some of the myths. Both MD hospital births and midwife home births have their pros and cons. Home births can be wonderful, but don't view it as some sort of political statement. And always go to a midwife with references and better training (i.e. a NURSE midwife).

Finally, it WOULD be better if midwives and docs worked more together, as they do in Europe... but given the screwed up healthcare system in this country, not to mention fiery denunciations of OB docs as evil patriarchal greedheads out to shut down the competition... I don't see cooperation happening anytime soon. :/

"What women need to be informed of is the risks involved in each choice (most people assume hospital birth is without risks - not so!"

Meanwhile, pregnant girls need to be informed of the options and risks as well as pregnant women.

Anyone else noticed how teen-and-younger pregnancy is the focus of some other threads here but seems forgotten in childbirth threads?

To those who do not understand the desire to have a homebirth. Personally, it is about control. The idea of giving birth in a hospital terrifies me.

I do not have a problem with hospitals, not at all. Nor with doctors. But doctors are individuals and I don't want to have someone taking choices away from me when I'm in no position to do much if I don't want it.

I do not want children, but if I did I would not want a doctor delivering my baby. There are far too many old school doctors out there and the idea of being made to give birth in a position not comfortable to me, be given drugs I don't want, or otherwise made to go along with what's easier for them actually makes me feel panicky.

An emergency c-section is a totally different kettle of fish, no objections there :D

Ultimately, I have to put my faith in the people with the most experience and education in these matters, the doctors. I find the insinuation that medical professionals care more about their profits than the health of their patients insulting.

You do realize that midwives are medical professionals, right? I see no reason to believe that doctors have more experience in childbirth than midwives.

given the screwed up healthcare system in this country, not to mention fiery denunciations of OB docs as evil patriarchal greedheads out to shut down the competition... I don't see cooperation happening anytime soon.

As I recall, on previous threads, you've compared midwives to high-school students. ACOG has fought midwives' ability to practice every step of the way. But you think the problem preventing OB/GYN-midwife co-operation is anti-OB/GYN sentiment?

Mina,
Unfortunately I think that's a fault of a lot of feminist discussion of birth; it assumes that all pregnant women can get access to information about alternatives if they want it. There's also a tendency to suggest that if the pregnancy wasn't planned, it doesn't matter what sort of birth experience a woman has.

On a number of occasions I've heard self-labelled feminists blame women for getting the birth they did because they didn't do sufficient research into the alternatives. As long as the mainstream media and information sources present the alternatives as unviable or completely irresponsible, they're hardly 'alternatives' at all, unless you're the sort of person who really questions and researches thoroughly for yourself.

The first link isn't just from the RCOG, it's a joint statement from the RCOG *and* the Royal College of Midwives *together*. :)

Quite right! Can't believe I missed that!

Meanwhile, I got the impression a few years ago that while some American people seem to think encouraging hospital birth is more money-grubbing than encouraging home birth (higher profits for doctors), some British people seem to think encouraging home birth is more money-grubbing than encouraging hospital birth (lower costs for the NHS therefore lower costs for taxpayers). How widespread or rare are those attitudes IRL?

I don't know to be honest - I'm in New Zealand, not the UK. I think people probably would say that the government was saving if there was a sudden big push to promote homebirth, but I suspect it wouldn't last long if homebirth gained in popularity. We have similar percentages to the UK I think.

"it assumes that all pregnant women can get access to information about alternatives if they want it."

That assumption is so inaccurate. What if a pregnant and migrant 34-year-old can't read the local language and doesn't have access to info in the languages she can read? What if a pregnant and unmarried 14-year-old's parents won't give her a ride to the library or raise her where she can safely walk, bike, or take mass transit to the library herself?

"There's also a tendency to suggest that if the pregnancy wasn't planned, it doesn't matter what sort of birth experience a woman has."

Of course it matters! I mean, being forced to give birth against one's will is already horrible. Having the choice of *how* to give birth taken away on top of that adds insult to injury (if not adding injury to injury). I bet it's even more awful when the same asshole takes away both choices...

All right! Another game of Risk vs. Risk: The Homebirth Edition!

Let's put some facts on the table:

1. There are good OBs. However, the history of obstetrics is, let's say, a little checkered, especially in the U.S. Until the advent of antibiotics, women and babies were much more likely to die in hospital than out of it due to infection. Ignatz Semmelweis was run out of his practice in Austria for asserting that OBs not washing their hands was a cause of high mortality. And midwives in the U.S. were actively persecuted, legislated against, and denied hospital privileges (still are!) because they are competition to OBs.

2. Obstetrics introduced the following harmful practices to birth: lithotomy position, over-anesthetizing the mother, episiotomies, and the consequent complications that required use of forceps (which was often deadly) and, more safely but not necessarily more wisely, C-sections today. Many of these practices are still common, despite much research demonstrating their harm.

3. World Health Org. studies show a c/sec rate of 10-15% is optimum in a healthy population, which we have; the US rate is about 30% and rising. Non-emergency C/secs increase possibility of maternal and infant mortality by 4x. But in the hospital, common OB practices such as those mentioned and others, greatly increase your risk of stalled labor and c/sec.

4. CPMs are *highly* trained and go through a long apprenticeship, tough exams, and periodic licensing renewals. They are authorized to administer drugs like Pitocin (which is useful to slow/stop hemorrhaging) and must have current lifesaving certification. Like an OB, they must attend many births before they are certified. Unlike many OBs, they actually know what the actual spectrum of natural birth looks like.

5. Death happens in hospitals. Babies die and mothers die, and if it's a truly serious problem, they often don't make it even when the surgery is down the hall. You also get to worry about antibiotic-resistant infections that thrive in hospitals. I personally know of one local OB who commonly sections women far too early (37 weeks) meaning the underdeveloped infants spend time in the NICU. It's bad practice, but increasingly common. OBs are surgeons; midwives are experts in normal pregnancy, the non-surgery-needing kind.

Many good facts and links to studies are here:

http://www.seattlemidwifery.org/action_research.htm

"You should know, however, that many of the most serious obstetrical complications cannot be determined in advance by ANYONE. If you have a real honest to goodness SD or abruption then you're farther away than you want to be.

You can still do it of course (it's your choice) but you shouldn't pretend about the risks: they're not huge, but they exist."

Wow that was really condescending. How the fuck do you know I'm pretending about any risks? I am actually very well informed on the risks of both home and hospital birth, thankyouverymuch. I work in a hospital and have institutional access to the latest research from medical journals around the world and have kept up with the literature about this. I know the statistics. I know the risks. The things I have said come from that research as well as conversations with friends of mine who are OB's and Gyn surgeons. How dare you assume that you know better than me the risks for my own body and how dare you tell me where I want to be.

I find it flabbergasting to suggest that someone who spends years studying pregnancy and birth, hands-on, in the face, in the flesh, who has to be a part of hundreds of births to even begin their certification process, whose work is completely focused on birth is somehow less knowledgeable or capable than someone whose academic and hands-on education are not only far less specific, but also predicating on the concept that birth is meant to be managed, interfered with and most conform to statistical averages or is otherwise abnormal and must be fixed.

I am biased in favor of naturalautomatically better, safer, wiser, etc. than someone whose academic education and practical training gives them the perspective that birth is a normal physiological process and whose career focus is birth, birth, birth and more birth.

Unlike many OBs, they actually know what the actual spectrum of natural birth looks like.

So you assert that during an OB's 4-year residency plus med school, she won't see many natural births? And not only that, but will actually see fewer births than a lay CPM?

Bwahahaha! :)

Talking points from an advocacy group are not the same thing as "data." Especially when they fail the laugh test.

But you think the problem preventing OB/GYN-midwife co-operation is anti-OB/GYN sentiment?

Well, this site and its commenters certainly are evidence about the anti-OB/GYN attitudes.

I don't agree with ACOG's blanket anti-home-birth stance, and think that nurse midwives should be able to get hospital priviledges similar to what nurse practitioners can get. But neither do I agree with some of the ridiculous anti-physician statements such as above. I believe the truth is more commonsense: Go where you want for a low-pregnancy birth (with a competent nurse midwife or doc), and go to a hospital for a high-pregnancy birth.

Part of my comment was eaten. It should read as follows (italics indicate what was lost above):

..interfered with and must conform to statistical averages or is otherwise abnormal and must be fixed.

I am biased in favor of natural childbirth (that is to say, not simply vaginal but not brought about with chemical hormones and electronic machines and plastic devices placed inside bodies). I am also a (not-quite-certified yet) doula (though the idea that doulas are anti-OB is facilely ignorant) so perhaps my perspective is skewed. Just the same, I reject any premise that where birth attendants are concerned, surgeons whose perspective of birth and standards of care demand its medical management, and whose education and training cover a vast array of other issues, well beyond birth, should be deemed automatically better, safer, wiser, etc.

So you assert that during an OB's 4-year residency plus med school, she won't see many natural births? And not only that, but will actually see fewer births than a lay CPM?

A hospital birth in the US has very little chance of being natural, because the insistence of hospitals on interventions which are deemed inconsequential by medically-minded people still have an effect on the birth that would not otherwise exist. The very fact of being in a hospital has an effect on a birth. (There's a biological reason why animals do not birth until they are in a secluded place where they feel safe, secure from intrusions, and physically comfortable.) Limitations on free movement, even if only temporary (the 15-minute per hour "light" version of external fetal monitoring) limitations on intake of hydration and nutrition (because it's more important to be NPO in case of emergency c-section than to fuel the body to do work so hard it's called labor), limitations on access to pain relief methods that don't rely upon drugs, introduction of IVs, even if only saline solution, frequent manual checks of cervical dilation, the watched clock once water has broken and the charge it puts into the atmosphere even if specific deadlines aren't mentioned, the insistence on bed-based, and most frequently, lithotomy positioned pushing in that stage -- all of these interfere with the natural processes of labor and birth. And all are routine in hospitals as if no other ways exist. You can get around some, but you can't get around all, and often you can only get around with compromises that may be less physically invasive but are still create disturbances in the body's normal processes. It's the nature, or rather, the unnature, of the environment. So yes, by their very presence in a hospital, the "natural" births (which should technically only be called unmedicated) that an OB sees and takes part in are not the natural births a midwife sees and takes part in.

I gave birth two months ago, in a hospital. I had wanted to give birth in our local birth center, but my insurance doesn't cover it. Rumor says that the hospitals (3 in this town, owned by the same company) threatened major insurance companies to cancel if they chose to cover the birthing center.

I had a major medical emergency during childbirth (improper separation of the placenta), and I have no doubt that the hospital saved my life.

Of course, the hospital also CAUSED the major medical emergency, but ... isn't that the way it goes?

I gave birth with no anaesthetic, and pushed out a healthy baby girl. Afterwards, I was on my back and the OB started YANKING on my umbilical cord. HARD. It HURT, a lot worse than shooting the girl out the vaginal canal. I told her, "Stop, you're not supposed to be doing that, and it HURTS." She did not stop.

Shortly thereafter, I delivered the placenta, and began to bleed profusely, with chunks of