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.

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;

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.

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.

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 crap clogging my uterus. The medical team went into "crisis mode," and I had a nurse straddling my abdomen, pushing down with all her weight, while the doctor reached her HANDS UP INTO MY UTERUS, scraping out the insides, and another nurse jabbed some sort of injection into my thigh. The process had to be repeated 3 times. Remember, I had NO anaesthetic or pain medication - I was screaming and writhing in agony, and the doctor looked me in the eye and said, "Let me do this or you will lose your uterus."

Eventually, I'm fine, and I'm sure that the medical team feels all heroic for "saving my life." I think that this happens all the time - a crisis that is induced by the hospital is saved by the hospital, and then everyone talks about how "she would have DIED at home!!!" Well, no .. I would've delivered the placenta on my own and been spared all this pain. It's similar to the "pitocin -> overly-strong contractions -> fetal heart rate drop -> emergency c-section" chain. No one talks about the fact that pitocin CAUSES the fetal heart rate drop, and the c-section could've been avoided without it.

I live in Missouri, and if I were planning to have another child (I'm not), I would definitely opt for home birth.

^I agree with Anne. Hospitals have a way of creating complications.
Every woman I know who's delivered at home has done so wonderfully, without complications. My sister delivered her 9+ infant in about 15 minutes, with no tearing, and afterward talked about how empowering the experience was. I think we have the best of both worlds nowadays- midwives can use modern technology to weed out potentially difficult births, allowing low-risk women to deliver at home with more confidence.

In the Netherlands, something like 75 percent of women have home births and the C-section rate is something like 5 percent. I highly doubt the Netherlands is tolerating really high levels of maternal and neonatal injury. We could have a different way here, where women could make choices they felt were best for them and have support of trained professionals, from midwives to nurses to doctors, for the birth they want in a safe environment.

The last two posts are spot on in terms of some of the things that can go wrong in hospitals. Obstetrics is a surgical specialty. If you need surgery, you need an obstetrician. But many, many women don't need surgery to have a baby, and hospitals have so many protocols in place that are more about the smooth functioning of the institution than the best interests of the patient, and those protocols can be bad for women and bad for babies and increase the likelihood of interventions. (And I say this as someone who was induced in a hospital, attended by a CNM, and probably would not have a home birth myself, though I have occasionally thought about it.)

for leah @7:34pm. I had two children in hospital. Both times, I was encouraged to do the walking, breathing and had a hot shower for pain management because I thought I wanted no drugs. Weellll, I was still have massive pain with contractions and chose---actually demanded--drugs. Women should be allowed to chose whatever method with get them their babied without being made to feel bad about it.
By the way do doulas get paid for doing whatever it is that they do? Then everybody is in it for the money right? I never understand these anti-medical establishment people. No one should tell a woman how to deal with her own body, not even other women.....

that is 'I was still having massive pain', and
'babied=babies

sorry, sometimes passion overrules correct spelling

Yes doulas get paid for what we do. We're also with the mother for as long as she wants us, before, during and after the birth, unlike the doctors and nurses who are in and out. And our role is to support the mother and her wishes -- including her wishes for medication and AROM and other optional interventions. Doulas reinforce the mother's stated goals, remind them of pain management (and other) strategies that have already (ideally) been discussed and provide support from a remove that cannot be found from a husband/partner or a mother or sister or best friend. We do not give medical advice, our role in birth is not medical.

Now, as it happens, it is rare that someone with an interventionist mindset sees the need to have a doula on hand, but when they do, there we are. Most doulas work in hospitals, and see births attended by doctors. We probably see more of what happens in hospitals than CPM/DEM midwives do since hospitals aren't their bailiwick.

"I had wanted to give birth in our local birth center, but my insurance doesn't cover it."

That sucks.

"I had two children in hospital. Both times, I was encouraged to do the walking, breathing and had a hot shower for pain management because I thought I wanted no drugs."

Cool, sounds like you had the best of two worlds available.

Meanwhile, now I'm wondering about options for women and girls in areas with low population density. What if there just aren't enough people giving birth in the area for a hospital maternity ward *and* a birthing center to stay open *and* for a range of midwives to stay in business in the first place? What kind of transportation improvements could help a rural woman or girl in labor who wants a birthing center but can't afford a car and/or is too young to have a driver's license? I think ambulances should help them get to birthing centers as well as hospitals, but do they? Australia has the Royal Flying Doctor Service - does that mean someone could choose having an OB and staying at home for the same birth? Could a Flying Midwife Service be feasible?

I'm really surprised no one has mentioned maternity/birthing centers. Those are a great option for women who don't want to be in a hospital but are worried about the risks of home birth. Maternity centers are equipped to deal with many medical complications that can arise. My mother had my sister in a maternity center because she had been treated horribly at the hospital during her previous two births, and because she has lost an infant due to SIDS and been treated carelessly and traumatically at the hospital when he died. The midwives at the maternity center got to know my mother before the birth and learned about her specific fears and concerns. When she delivered, serious complications DID arise which threatened the baby's life, and the midwives at the center not only handled it calmly and efficiently but were extremely comforting to my mother, knowing what she had been through in the past. I'm definitely not saying all maternity centers are the way to go because I'm sure not all of them are great, but it's definitely an alternative to consider.

I was just reading the government site about midwives in Ontario and found out you can deliver babies in a hospital with a midwife. This sounds ideal for anyone worried about having complications outside a hospital but want someone who'll "take the time to build a relationship of trust and safety with each woman" and "recognize and support the mother as the main decision-maker." Here midwife training takes FOUR years. Midwifery has been a standardized profession, recognized and paid for by the government since 1994 I found out. Before then I would've been wary about delivering with a midwife. I am impressed by anyone who'll go through that much training to be an expert in one specific area in a job that is very important but looked down upon.

"I'm really surprised no one has mentioned maternity/birthing centers."

Hey! ;)

"I'm definitely not saying all maternity centers are the way to go because I'm sure not all of them are great"

Just as not all hospitals are the same - and not all homes are the same either. A home you own yourself is one thing, a home you have to share with spoiled and loud siblings or unsupportive and meddling in-laws is another...

@kenyattice

That sounds great, and I wish it were the rule rather than the exception. That's the kind of information and choice I wish every pregnant female had.

About birthing centers, yeah they can be great, IF they are available. In my state there are only about 4-5, and they're all in the big metropolitan area. Because of where I live, I have the choice of driving 1.3 hours to birth in a center (once labor has started), or have a local midwife come to my house when I go into labor. It's a great choice, but a choice that has very limited availability.

I gave birth at home in Los Angeles county, where the C-section rate is bordering on 40%, and did not experience it as unsafe. On the contrary, I experienced the Ob/Gyn's whom I visited prior to choosing a CPM (not a CNM) to attend my labor and birth, as unsafe. I had a heck of a time getting my insurance to change my providers, when the first one told me that, in terms of nutrition, to just "eat lots of eggs," the second yelled at me and told me I didn't know what I was talking about when I said I wanted to have no anesthesia and be able to birth in a position other than flat on my back. I contacted a hospital who advertises it's policy of having midwives attend uncomplicated births. However when I called them and asked them if they had much experience with non-medicated births, they seemed to draw a blank and stumbled, saying, "um..not really, no. Almost all women who deliver here get epidurals."

I don't think it's fair to ever make generalizations about any profession or group of people. My own anecdotal information is that I had a *short* 10 hour first labor with no complications, experienced it as a continuum of my experience of "womanhood" and fertility rather than an experience full of disjuncture (i.e. starting labor at home, then driving to the hospital, checking in, doing their "test strip" of Electronic Fetal Monitoring, then being regulated in terms of time, positions, eating and drinking, etc.). My son was born 8lbs 6oz, healthy, and breathing right away, no complications. My midwife had 30+ years of experience and had all sorts of crafty, hands-on, non-invasive skills to help nudge my son as we was coming down the birth canal to get him into the ideal position. They gave me hour-long prenatal visits and talked to me about whatever I needed.

Some things that I learned are that, if I had had a complication, such as hemmoraging, for instance, CPM's and CNM's are able to administer pitocin, which EMTs cannot, as well as the standard other ambulance treatments like oxygen masks, resucitation equipment, IV fluids, etc. Also, it is usually safer for the baby to be born via the mother's own pushing, rather than vaccuum suctioned or forceps-delivered, or pitocin-induced. Standard hospital procedures, like cutting the cord right away, are not good for the baby; this deprives the baby of the iron-rich blood, which is her/his blood, in the placenta that is going into her/his body as the cord finihes pumping.

Sure, it requires informed consent EITHER way, hospital or home, MD or midwife. Both methods have their pros and cons. Just another area of choice that should be left up to pregnant women to decide.

I have to say that I am a certified doula, and I get paid for what I do about half the time. I do not request payment for my presence, and when asked, I leave it to the mother to determine what she can afford. We have no access to midwifery care in my town,and our rate of surgical delivery is very high. I would never deny a laboring woman whatever support and comfort I can offer because of finances. I greatly respect doulas who try to make a living at this, and fully understand that just because I am in a position to not ask for payment, not everyone is. NO ONE I know in the birth field who is not a obstetrician is making a comfortable living at birthing babies. Not doulas, not the midwives I know in other places, not even family practice doctors.

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.

THANK YOU. I've met wonderful midwives and wonderful OB-GYNs. Some of them might be motivated by profit but I haven't met one yet who I didn't feel was devoted to helping women and babies.

Also note that women can give birth in the hospital or in a birthing center with a midwife in many areas. This can be a 'best of both worlds' arrangement for a woman who doesn't want a home birth but wants more choice and control over her own pregnancy.

I really didn't want to even look at this thread. The culture is so messed up about childbirth.

It's amazing that with all the feminist work we do, we can still have a thread that has so much "what about your babeez" and "you don't know what to do with your own body." This shouldn't be a debate about facts of hospital vs. homebirth. The facts on both sides are out there, and women will choose the ones to believe that they weigh carefully according to their own logic and desires.

The "bad news" as described in the OP is a body of considerable power and cultural capital (ACOG) using that power to intimidate women regarding the safety of birth choices. That's bad news for all of us, not just midwives and homebirthers. The implication is that women won't research, think it through, decide on it themselves, and need a "daddy" to tell them what's right and safe for them in a press release. A more woman-friendly move that everyone here should support is their just publishing these findings for the OBs that the OBs women choose to use can draw upon. Stop the public smear campaign which is an effort to intimidate women who would make a different, legal choice. End of story.

Women who choose homebirth instead shouldn't be second guessed by grandmas and grandpas who read this press release, their partners, friends, or strangers on a blog. If they want input from any of those groups, they will ask, and to force it unsolicited is to reinforce a cultural plague of women's disempowerment and a perception of unfit judgment. THAT is the empowerment issue, people. There is enough evidence on both sides to support an educated decision either way, depending on a woman's values and personality. So if you're arguing that ACOG is right to post this, you're part of the problem. You may agree with them; fine. You are free to make a choice in alignment with their opinions, but realize that you cannot, as a feminist, endorse their intimidating other women's choices just because you agree with them in this case. If you're a man, STFU unless you're a doctor or a midwife in the service of a pregnant woman and you are saying "I respect your choices, and am eager to do what YOU decide is best." Anything else, and you're really showing your antifeminist ass.

Props to the midwives and doulas trying to represent their side, however. TWO percent of births in the US are at home, folks. This isn't an even playing field, and in a threadful of status quo medical opinions, I think they certainly have the right to contest the flood of prejudice that is the majority, as the underdogs in this game. But ultimately, even they would agree that a woman who wants to be in a hospital with an OB should be there. What a nightmare for them if she were forced (by culture? what a weird world it would be if the tables were turned, and the hospital was the minority opinion) to not be where she feels the need to be. They're sticking up for their two percent, as well they should, and so should every feminist, for that matter. It's LEGAL, people. It's their LEGAL RIGHT. Remember those? Guess why it's legal? Because no one has been able to make a credible enough case that it's unsafe to make it illegal in most places. Not doctors, not the drug companies, try as they might, and certainly not you. So back off, and stop being part of their intimidation campaign.

Finally, as a fun experiment, try telling a laboring, or even in the weeks close to birth, woman you know more about ambulance times than she does, and therefore what's best for her baby. But don't try it if she has access to something sharp at the time--we do want to hear what happens to you.

@ sage:

Can I just say "what sage said" from now on?

Personally, I feel more comfortable within the system of home birth and midwifery. This is, partly, because I just don't see how birth can fit into the medical model of care practiced in hospitals. Child birth is the most natural action that a woman's body can perform (think about all of the systems and parts that you possess that wouldn't even exist if not for your capacity for birth).
Hospitals are accustomed to dealing with medical emergencies, wherein you take steps x, y, and z, in that order, and have a predictable and reliable outcome. Birth does not and will never naturally fit into that prototype, but in hospitals (where people are on a strict time frame and other such restrictions) it is sometimes in the best interest of the hospital itself to just perform a c-section in a "difficult" birth [read: one that isn't happening quickly enough for their liking] and clear the bed for somebody else. I know that there are scores of well intentioned doctors in the world, and I mean them no disrespect, but a hospital IS a business, and birthing is better off being left to it's own devices.
The atmosphere at a home birth is important too, I think. Here the woman is in control, with her loved ones, in a place where she feels comfortable, with a midwife attending her that she knows and trusts. There is no frenzy, no rush. She is free to walk around, eat a snack, take a nap. The midwife or father will give her massages and apply warm compresses to her vagina. It is oftentimes a happy atmosphere where the birthing mother is revered and her body is listened to - can you imagine this scenario in hospitals?
I think the standard of care is far greater - most midwives meet with their patients around 12 times before the birth for an hour each time. Midwives will customarily come to your home after you give birth a few times to check on mother and baby. In total, you can expect about 15 hours of time with a midwife. With an OB, you can't even guarantee that you'll see the same doctor or nurse everytime you go to their office. You don't necessarily personally know anybody and they don't know you.
What is it exactly that hospital-birthers are so comforted by in the hospital? You are trusting in entirely impersonal comforts. You don't know the doctors, you don't know their tools or tricks, and you don't know their intentions. You're more trusting in the idea that medical advances can only help, never harm, and frankly that isn't always true. This is an ancient and natural process, and I trust in that.
Also, I think it's crucial the bear in mind that homebirth is the NORM in so many other cultures. And the successful birth rate in the US isn't so stellar. We're obviously doing something wrong.
I am not a mother, but I have attended a number of home births and I myself was born at home. I can say with confidence that if I ever decide to have a baby, i will do it with a midwife. It is less expensive if you're uninsured (costs hover somewhere around $2000 to my knowledge), it is a female-centered empowering experience of birth, and, yes, I believe that it's safer.

I'm coming to really not respect ACOG's opinion so much. They've put out some really backwards, heavily-biased material, strongly encouraging women who receive a prenatal diagnosis of Down syndrome and other disabilities to abort and now this. =(

Here the woman is in control, with her loved ones, in a place where she feels comfortable, with a midwife attending her that she knows and trusts. There is no frenzy, no rush. She is free to walk around, eat a snack, take a nap. The midwife or father will give her massages and apply warm compresses to her vagina. It is oftentimes a happy atmosphere where the birthing mother is revered and her body is listened to - can you imagine this scenario in hospitals?

Yes, I've experienced that scenario in both of my hospital births...one in Seattle, WA and one in Albuquerque, NM.

"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."

Amen Dreama. Five months ago, my wife delivered twins naturally, in a hospital, and talk about an ordeal. Thankfully, we had a midwife who has hospital privileges and who was the only level head in the "team" when the big day came. From the moment we walked in the door, we were met over and over again with offers of medical intervention.

We knew ahead of time we could labor in the labor rooms, but had to deliver in the OR due to the complication of having twins. Our midwife had worked with an OB/GYN during the pregnancy, and he was happy with our choice to deliver naturally. He was even ok with the possibility of having an internal version to turn the top baby if she didn't turn to follow her brother. But he was not available when my wife went into labor.

We were scoffed at by the anesthesiologist for choosing a natural delivery. The attending Maternal Fetal Medicine "Specialist" who was on call was minutes away from cutting (due to the possibly breach second baby). Luckily, the midwife was able to get the first baby's head over a tiny flap with a tiny little push on the perenium and he was on his way out before the specialist's ultrasound machine would boot.

And to boot, our hired Doula was not allowed into the OR as there could only be 1 "friend or family member" present.

A lot of this ground was covered the last time this legislation was discussed here, and most of the perspectives have been presented again this time. I did want to disagree with leah's statement toward the beginning:

"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."

My perspective is skewed against home births because #1) both of my wife's pregnancies were high risk and I would have lost her and the children had we tried to do them at home, and #2) I have been in several medical malpractice suits (against doctors and CNM's) where complications set in rapidly on what were thought to be low risk pregnancies.

I find an anti-western medicine bias in those touting "natural" childbirth as the only way. Intrauterine infection, oxygen deprivation and shoulder dystocia (shoulder gets caught and nerve damage can result) are natural processes, too, and can kill or injure babies and mothers.

The goal I have heard litigating these cases is that it should be NO MORE THAN 30 minutes from decision to incision.

That's correct, SixtiesLiberal. It's one of the reasons small hospitals and freestanding birthing centers have been closing in this country-- it's hard to get things ready to go that quickly, especially in rural areas. It is possible, though.

As an aside to the discussion of "natural" childbirth (i.e., with no pain medication):

Did you know that in the 19th century, the right to an epidural was actually a focus of the women's right and suffragist movements?

Pain management during birth was strongly opposed by religious fundamentalists because of Biblical verses such as this one:

(Genesis 3:16) - "To the woman He said, "I will greatly multiply Your pain in childbirth, In pain you shall bring forth children; Yet your desire shall be for your husband, And he shall rule over you."

So, your "natural" childbirth would please to no end the fundamentalist enemies of the early women's right movements. How we've come full circle.

Midwifery has been legal and fully funded by the provincial medical insurance in Ontario for over a decade and I have not heard of any horrible tragedies for mothers or babies in that time (and has a feminist health researcher, I pay attention to these things).

I used midwifery care, had two planned home births which led to transfer to hospital during labour due to some complications. In the end both my kids were born vaginally, in hospital, with my midwifery team by my side and minimal intevention. It was the best care I could imagine.

I was young, low risk and live close to hospitals in a large urban center. The rules in the province are clear and midwifery care and home births aren't good in all cases.

However assuming that biomedical births are better and safer is ludicrous and shows the dominance Western biomedicine has in determining issues of health and illness.

There are risks and benefits to both settings, and women should be allowed to decide how they wish to give birth.

Also, Midwives in Ontario must do a 4 year post-graduate degree including residency before they can practice. It is a rigorous discipline and they are well trained.

For goodness sake Forbidden Comma, all we're asking for is the right to choose not to have pain relief if we don't want it. I for one would infinitely rather have pain than numbness since in this case, the pain doesn't mean something is wrong, and I want to be able to feel what's going on. If anyone else wants an epidural, good for them, but as long as most women who ask for an epidural-free birth are laughed at or snidely dismissed by medical professionals, we have a problem. Besides, it's worth recognising that women wanted pain relief because they were expected to deal with birth quietly and 'decently'. Natural childbirth advocates call for women to be allowed to find positions and techniques that help relieve their own pain, not to grin and bear it, as women in the Victorian period were expected to do.

SixtiesLiberal it's interesting you choose shoulder dystocia as one of those complications that might need western medical intervention. Perhaps you're not aware that the most reliable solution for that particular complication (which it should be pointed out occurs less often when the woman can remain upright, or changing position) is the Gaskin Manoevre, brought to western medicine by the very non-interventionist midwife Ina May Gaskin. C-section is often unsuitable for shoulder dystocia since the baby is too far down the birth canal when it happens to be safely extracted through the stomach.

Mattjank, so your daughter turned around after her brother was born, then? Twins are SO cool.

Others:

I find an anti-western medicine bias in those touting "natural" childbirth as the only way.

Interesting. I find an anti-woman bias in strangers using personal anecdotes and spectator experience in the legal or medical realm as scare tactics. It seems to me they're trying to influence women who are presumably able to do their own research concerning what to do with their bodies, according to their legal rights.

So, your "natural" childbirth would please to no end the fundamentalist enemies of the early women's right movements.

I doubt that if those evil Victorian enemies could see a woman giving birth at home, reveling in her own personal power, it would give them the pleasure you imply. But your use of out-of-context "history lesson" rhetoric aiming to manipulate a woman into doing what you want her to do with her body certainly would.

I'm not telling a woman what to do one way or the other. My own sister declined epidurals, which is fine by me... well ok, I thought she was crazy, but I certainly didn't say so. :)

I am, however, bristling a little at the way people in this thread paint doctors and Western medicine as evil, patriarchal, and anti-woman, especially given my example of how "Western medicine" was once being actively denied to laboring women. There are rude docs, but there are rude people in any profession as well. Most OBs are in the field to help women, and not for the money or the miserable lifestyle. I point out again that over 3/4 of graduating OB docs are women. Also, there is not some sort of magic "empathy" class taught in midwife school that they forgot to include in OB residency. There are genuine problems with the U.S. healthcare system, to be sure, but there are issues with midwives as well that go strangely ignored.

ForbiddenComma,

Your expressed opinions typify the problem a lot of us have with Western medicine, especially in this context. The fact that women were denied pain meds by Victorian doctors and the fact that pain meds are pushed onto us by modern doctors are two sides of the same patriarchal/hierarchical coin: women (and patients in general) aren't competent to articulate what they need.

Frankly, the fact that 75% of graduating OBs are women means nothing to me, given the medical industry's resistance to feminist and other structural critique. I've received plenty of GYN exams, all by women, and so far only one of them has NOT been painful and humiliating. These nurses and doctors were all decent people, I'm sure, who meant well, and who got into medicine because they wanted to help people. However, that didn't imbue them with a decent bedside manner or the ability to do pelvic exams on conscious women instead of unconscious, unconsenting patients.

The difference between midwifery and medicine is not some "magic empathy class"; it's a foundational framework that, on the one hand, sees birth as a physiological process, and on the other hand, as a pathology to be managed. If hospital birth has become more reasonable over the last few decades, it's been at the impetus of women who have demanded a better way.

morrigan,

And what is this "foundational framework," anyway, that the patriarchal doctors are steered away from?

I'd like to know, as I am in med school (which explains why I take statements like yours a bit personally).

I haven't had my Patriarchy 101 class yet, but maybe I just slept through it.

Anyway, if you are trying to say that OB docs don't spend enough time with the patient, then I will fully agree with you. The modern healthcare system reimburses by quantity, not quality, which is why docs carry so many patients and spend such little time on each visit.

But as long as docs accept Medicaid, they must also accept its dictations.

And on that topic... does your midwife have a significant load of disadvantaged Medicaid patients? Or does she have a lot of cash-only patients? Why do you think she can afford to have such a smaller patient load than an OB at a teaching hospital? Why do you think she can afford to spend an hour a visit instead of 10 minutes? She doesn't have more hours in the day, after all. Just sayin...

Perhaps it's pendantic, but:

"Did you know that in the 19th century, the right to an epidural was actually a focus of the women's right and suffragist movements?"

Epidurals did not exist; laudanum and opiates (and some chloroform, later) were the only pain meds on offer. Nor were they given via spinal tap, the way epidurals are.

As a med student, perhaps you are aware that all meds come with side effects. A side effect of the anesthetics currently offered to laboring women via epidural is quite often immobility on her back, the absolute worst position for pushing. Her pain during birth is eliminated, but her birth safety in terms of risk of surgery and tearing (from not being able to feel and pushing w/ pitocin, or having to have suction used on the baby) is compromised. After birth, a woman with a c/sec scar or episiotomy can be in quite a bit more pain than a women allowed to move around, eat, push at her own pace and use gravity to her advantage to push her child out.

As an aspiring midwife, I'm not anti-medicine. I'm anti-bad practice, which is what is currently happening in most American hospitals. The system is so dysfunctional that doctors who want to give women better births are punished for "taking too long" while docs who c/sec so early that kids end up in the NICU are rewarded for their "caution." A better system would be better for docs as well.

As an aspiring midwife, I'm not anti-medicine. I'm anti-bad practice, which is what is currently happening in most American hospitals. The system is so dysfunctional that doctors who want to give women better births are punished for "taking too long" while docs who c/sec so early that kids end up in the NICU are rewarded for their "caution." A better system would be better for docs as well.

Again, I have no disagreement that the system is dysfunctional. It is not right that OBs are so harried by a system that penalizes them for taking their time.

And there is room for legitimate disagreement on c/s. You are right that we perform too many of them. But that does not mean that the c/s does not have its place. It is difficult for me to forget the midwife that recommended "natural" vaginal delivery for a woman who had a history of placental abruption. She lost the baby and nearly died as a result after her uterus blew open.

I think doing a c/s, even if it were earlier than 37 weeks, would have been a better option, don't you?

It's like antibiotics. We prescribe them too much, but that doesn't mean they can't be lifesaving.

Again, don't be so quick to judge ob docs. Your own midwife practice would change dramatically if you accepted Medicare. And don't forget that midwifery has its own problems, such as a lower standards that allow the quack from my anecdote above to more easily get a license.

As a last note, I'll just say that it would be better if OBs and midwives cooperated, if midwives could get into the hospital, if there were universal standards for midwife schools, and if the system allowed OB doctors to spend more time with patients and do home deliveries.

I like you forbiddenComma.
You have put my unease about this thread into wonderful words. Why is childbirth considered a political statement? Being at home surrounded by family and midwives is not my idea of a great way to give birth. It would not make me feel more empowered having a home birth. Like some sort of "take that!" statement to the patriarchy. Feelings of empowerment come from cradling your healthy baby no matter how he/she/they came into the world...

"What a nightmare for them if she were forced (by culture? what a weird world it would be if the tables were turned, and the hospital was the minority opinion)"

Aren't the tables turned IRL in some places where access to hospital birth is very limited? I heard that some women and girls out there can't go to hospitals because they can't afford it, they live too far away, their husbands and in-laws won't let them risk meeting male doctors, etc.

"Child birth is the most natural action that a woman's body can perform (think about all of the systems and parts that you possess that wouldn't even exist if not for your capacity for birth)."

Isn't that giving too little credit to the rest of the female human body, and to how natural things like breathing can be? I know my body is a lot more than my reproductive system (and that goes for everyone else and their bodies too!). :)

"Hospitals are accustomed to dealing with medical emergencies, wherein you take steps x, y, and z, in that order, and have a predictable and reliable outcome."

What about all the medical emergencies in which steps x, y, and z aren't obvious in the first place because different conditions can have the same symptoms and diagnoses aren't always easy? I heard that problems of the abdomen are especially difficult to diagnose.

"What is it exactly that hospital-birthers are so comforted by in the hospital? You are trusting in entirely impersonal comforts. You don't know the doctors, you don't know their tools or tricks, and you don't know their intentions."

From what my mother said about my birth, she did know her doctors and she was comforted by not giving birth in the same conditions her mother gave birth in.

"Also, I think it's crucial the bear in mind that homebirth is the NORM in so many other cultures."

Talk about damning with faint praise...

"I find an anti-western medicine bias"

Hey! Who said modern medicine = western medicine? The west has alternative-medicine traditions too and doesn't have a monopoly on modern medical research.

"in those touting 'natural' childbirth as the only way. Intrauterine infection, oxygen deprivation and shoulder dystocia (shoulder gets caught and nerve damage can result) are natural processes, too, and can kill or injure babies and mothers."

For that matter, I wonder how many rapists out there would claim that they just did what came naturally and that it's unnatural to control themselves instead of having sex with someone against her will...

"There are risks and benefits to both settings, and women should be allowed to decide how they wish to give birth."

Exactly. There should also be info about other options besides the home-with-midwife vs. hospital-with-OB polarization.

For one of many examples, what about unassisted homebirth? I've heard about both good (she chose it for herself and had the healthy baby she wanted to have) and bad (she wanted to hire a midwife but her husband wanted to save the household's money for his next wedding in case she died) cases.

"It is difficult for me to forget the midwife that recommended 'natural' vaginal delivery for a woman who had a history of placental abruption. She lost the baby and nearly died as a result after her uterus blew open."

OTOH, what were her priorities in the first place? Not everyone in labor wants to be a mother. For all I know, maybe she didn't have any opportunity to get an abortion any earlier and that was her last chance?

"It's like antibiotics. We prescribe them too much, but that doesn't mean they can't be lifesaving."

Good point.

kenyatticee, perhaps cradling a healthy baby is enough for you to feel empowered, but there are many, MANY women who come away from their child's birth feeling anger, fear, a sense of disempowerment. Others deal with terrible physical pain due to birth injuries from unnecessary intervention or lack of appropriate aftercare. Some are so disempowered and psychologically damaged by disrespectful treatment, they liken the experience to rape. If you made your comment to any of those women, they would probably be reduced to tears.

In the past 18 months, I have spoken to and read the vastly varied birth stories of literally hundreds of women. Some of those women had births exactly as they hoped. Others had births with all manner of interventions, and came out feeling good about them, because they were treated with respect and sensitivity, given choices, and informed at each step of the way. But there are many others who came out hurt and angry, because they were dismissed, treated as stupid, refused adequate information, or their preferences were ignored, for no good reason. Such a negative experience puts those women at far higher risk of postnatal depression, which can be a very serious and debilitating complication for a new mother to deal with.

Perhaps you don't find homebirth empowering. That's fine. I want ALL women to have empowering birth experiences, and if that means a hospital birth with electronic monitoring, epidural, whatever, that's FINE. But if that's absolutely not what a woman wants, she shouldn't be guilt-tripped into having it. A profoundly negative birth experience, wherever it happens, is not magically erased by having a healthy baby. Please don't dismiss the experience of many millions women, just because you don't think it would bother you.

downside-up, I am not dismissing the experience of 'millions of women'. If a woman does not want the homebirth experience, She should also not be guilt-tripped into having one. I just don't think that how a woman goes through childbirth should be some political tug of war.

If that's how you feel, kenyatticee, then by all means, please tell the ACOG to quit using its power as a "respected association" of "medical professionals" to try to make or keep midwifery illegal across the country, eliminate women's choice and wrestle ownership of birth away from us "for our own good." Midwives, homebirthers, doulas and other natural birth advocates are not the ones with a voice, we are not the ones lobbying legislatures or putting out dismissive, insulting and scaremongering public statements belittling women who choose a mode of birth we don't think is wise. You want and end to the politics then we're not the ones you have a quarrel with.

"Midwives, homebirthers, doulas and other natural birth advocates are not the ones with a voice"

It seems to me that all sides have voices in the matter. The guilt-tripping still sucks whether it's in a public "homebirth and midwives are dangerous!!!" statement from the ACOG or a private "hospitals and birthing centres are untraditional!!!" statement from a family's patriarch...

It seems to me that all sides have voices in the matter.

Only if you totally and completely ignore the dynamics that exist between majority and minority voices. 2 percent homebirth vs. 98 percent hospital in the US is not equal "voice." The so-called "guilt tripping" each side can do is not equal. And the stakes of the minority in this case are high. If prejudice and disinformation spreads about homebirth, it could limit women's choices politically. Not because of facts, because of prejudice. And that's what happens when the majority culture is against you.

It seems to me that all sides have voices in the matter.

Only if you totally and completely ignore the dynamics that exist between majority and minority voices. 2 percent homebirth vs. 98 percent hospital in the US is not equal "voice." The so-called "guilt tripping" each side can do is not equal. And the stakes of the minority in this case are high. If prejudice and disinformation spreads about homebirth, it could limit women's choices politically. Not because of facts, because of prejudice. And that's what happens when the majority culture is against you.

"Only if you totally and completely ignore the dynamics that exist between majority and minority voices. 2 percent homebirth vs. 98 percent hospital in the US is not equal 'voice.'"

So, you think minority = nonexistent?

"The so-called 'guilt tripping' each side can do is not equal."

Of course - it varies from case to case. Not every woman's or girl's circumstances will match the national average of women's and girl's circumstances. For one example, I bet that someone who's anti-birthing-center can probably guilt-trip pregnant women and girls who live under his roof more easily than he can guilt-trip pregnant strangers.

Forbidden Comma,

Let me try again.

What you're seeing on this and other women's health threads is not so much an irrational bias against modern medicine as it is a very reasonable wariness, based on the history of OB/GYN practice and our own _very very bad_ experiences with the medical profession. As a med student, you could take this as an opportunity to learn why so many thoughtful, intelligent women are suspicious of the way OB/GYN is practiced in this country. You might even ask about the good experiences people have had with their medical care, and what's distinguished those experiences, so you can provide better care as a physician. Instead, you've by and large dismissed our valid concerns and real experiences as "bias".

Which brings me to the "patriarchy 101" class. It's not offered in med school because because it's not needed. We live in a patriarchy, and we've absorbed everything that entails. I don't have time to give an theory lesson, but it includes your assumption, disclosed on another thread, that midwives and nurses have "lower IQ's" than doctors. If the med schools wanted to address issues of entrenched social inequity, they could start by training them to respect their patients as intelligent human beings, instead of assuming superiority.

My critique systemic. It is not about you personally. I understand that you're investing a lot of time and money in your medical education (and I really DO understand, having watched friends go through the process) and that you chose medicine out of a desire to do some good. I think doctors in general can do a lot of good if they choose to, and I think you can do a lot of good. I also think it requires setting aside your own investment in the medical profession from time to time and listening to critiques of the industry.

"Also, I think it's crucial the bear in mind that homebirth is the NORM in so many other cultures."

I agree.

So, in light of that, let's take a look at these stats from UNICEF about maternal deaths per 100,000 live births.

http://www.unicef.org/pon96/leag1wom.htm

You'll be able to tell, quite easily, which countries predominantly use homebirthing, and which ones predomnantly have hospital delivery.

SUB-SAHARAN AFRICA Regional average 560

MIDDLE EAST and NORTH AFRICA Regional Average 300

CENTRAL ASIA Regional average 560

ASIA AND PACIFIC Regional average 390

AMERICAS Regional average 140

EUROPE Regional average 36

Mauritius 120

Israel 7

Azerbaijan 22

Hong Kong* 7

Canada 6

Norway 6

South Africa 230

U. Arab Emirates 26

Armenia 50

Australia 9

United States 12

Switzerland 6

Botswana 250

Kuwait 29

Turkmenistan 55

Singapore 10

Costa Rica 55

Spain 7

Namibia 370

Iran 120

Uzbekistan 55

Japan 18

Panama 55

Sweden 7

Madagascar 490

Saudi Arabia 130

Kazakstan 80

New Zealand 25

Chile 65

Denmark 9

Gabon 500

Jordan 150

Kyrgyzstan 110

Korea, Dem. 70

Uruguay 85

United Kingdom 9

Cameroon 550

Algeria 160

Tajikistan 130

Malaysia 80

Trinidad/Tobago 90

Austria 10

Liberia 560

Egypt 170

China 95

Cuba 95

Belgium 10

Malawi 560

Tunisia 170

Afghanistan 1700

Korea, Rep. 130

Argentina 100

Greece 10

Zimbabwe 570

Syria 180

Sri Lanka 140

Colombia 100

Ireland 10

Lesotho 610

Turkey 180

Viet Nam 160

Dominican Rep. 110

Finland 11

Togo 640

Oman 190

Thailand 200

Mexico 110

Italy 12

Kenya 650

Libya 220

Philippines 280

Jamaica 120

Netherlands 12

Central African Rep. 700

Lebanon 300

Pakistan 340

Venezuela 120

Slovenia 13

Ghana 740

Czech Rep. 15

Tanzania 770

Iraq 310

India 570

Ecuador 150

France 15

Cote d'Ivoire 810

Morocco 610

Myanmar 580

Nicaragua 160

Portugal 15

Zaire 870

Sudan 660

Indonesia 650

Paraguay 160

Poland 19

Congo 890

Yemen 1400

Lao Rep. 650

Guatemala 200

Germany 22

Guinea-Bissau 910

Bangladesh 850

Brazil 220

Bulgaria 27

Burkina Faso 930

Cambodia 900

Honduras 220

Hungary 30

Mauritania 930

Papua New Guinea 930

Peru 280

Rep. of Georgia 33

Zambia 940

Nepal 1500

El Salvador 300

Lithuania 36

Bhutan 1600

Bolivia 650

Benin 990

Haiti 1000

Belarus 37

Nigeria 1000

Latvia 40

Gambia 1100

Estonia 41

Mali 1200

Ukraine 50

Niger 1200

Moldova 60

Senegal 1200

Albania 65

Uganda 1200

Russian Fed. 75

Burundi 1300

Romania 130

Rwanda 1300

Bosnia/Herz. no data

Eritrea 1400

Croatia no data

Ethiopia 1400

Slovakia no data

Angola 1500

TFYR Macedonia** no data

Chad 1500

Yugoslavia*** no data

Mozambique 1500

Guinea 1600

Somalia 1600

Sierra Leone 1800

* Colony.

** The former Yugoslav Republic of Macedonia, referred to as TFYR Macedonia in subsequent lists.

*** The Federal Republic of Yugoslavia (Serbia and Montenegro), referred to as Yugoslavia in subsequent lists.

Regional averages have been rounded (except Europe), and are weighted for population size.

Actually, G, that doesn't tell us anything relevant at all. What that list seems to indicate to me is that first-world countries with reliable electricity, running water, decent nutrition, and access to advanced health services have lower rates of maternal mortality.

Well, alert the fucking media. No kidding.

What would tell me something is if you compared maternal mortality, complication, birth outcomes, and experiences of first-world home births with first-world hospital births.

You see, giving birth at home in a first-world country with a professional midwife when one is comfortably middle-class has, well, nothing whatsoever in common with giving birth in a third-world country in which, for instance, the biggest hospital in the country only has electricity two days out of the week (Gambia).

Go on, compare the hospital birth stats between first-world and third-world countries. Compare the home birth stats between first-world and third-world countries. Hell, compare the ear infection stats between first world and third world countries. No matter what you're doing, it's safer to do it in a first-world country. That tells you nothing about the relative safety of different choices within a given first-world country.

G posted those stats in response to the statement "Also, I think it's crucial the bear in mind that homebirth is the NORM in so many other cultures," which doesn't say anything about safety (and which does damn homebirth with faint praise)...

"That tells you nothing about the relative safety of different choices within a given first-world country."

I totally agree, it says nothing about which method is safe! OTOH, was that post about safety or about "the NORM"?

I'd also like to point out that the homebirthers seem a little bit... well, IDEOLOGICAL about the whole thing.

And I mean that in a bad way.

Like this idea that it's somehow bad for a woman to want to use painkillers when she's giving birth.

Could somebody please explain that?

Is that some kind of feminist version of the sick misogynist concept that the Abrahamic religions have that God is punishing women for the sin of giving Adam the apple by forever subjecting them to the pain of menstruation and childbirth?

Beyond that, in a country where 98% of women are fortunate enough to give birth in a proper hospital (and if you don't think that's fortunate, ask an Ethiopian woman, or an Afghan woman, or a Gabonese woman ect ect ect) wouldn't it make more sense to talk about struggling to make the medical profession less sexist and more wonen-friendly, rather than some kind of medieval campaign to go back to women giving birth at home without painkillers?

Also, I'd like to add that there is an element of privilige in this whole homebirth discussion that has gone unexamined by most of the posters (with the exception of Mina).

There seems to be the implication that the 'mothers' we're talking about here are well educated middle class women, who are legally married to and/or otherwise in long term relationships with the fathers of their children, have relatively good health insurance, live in homes that are suitable for a medical procedure to be carried out in them and have access to medical professionals who "see the world the way they do" (that is, who share the same class background - and class biases - and who understand and accept the cultural assumptions of the community the mother belongs to).

Let's face it - only women like that REALLY get to have anything remotely resembling an "informed choice" on the midwives vs OBGYN's debate.

Meanwhile, the majority of American mothers-to-be do not have it like that.

If you're a pregnant 16 year old Latina out of school youth living in a small 3 bedroom tenement apartment in West Harlem with her parents and younger siblings, who's Medicaid Managed Care coverage restricts her to exclusively using NY Presbyterian Medial Center's facilities for major medical care, who's not married to the 25 year old $ 6.25/hr part time janitor who fathered her kid and who's US born White doctors have thinly disguised contempt for her and people of her color and ethnic background, is this debate even relevant?

“I'd also like to point out that the homebirthers seem a little bit... well, IDEOLOGICAL about the whole thing.
And I mean that in a bad way.
Like this idea that it's somehow bad for a woman to want to use painkillers when she's giving birth.�

Uh, what? Who here said that? So if a woman chooses to give birth at home, it must be because she wants to prove to you that “somehow bad for a woman to want to use painkillers when she's giving birth�. I am sorry you are just projecting your own issues onto other people’s decisions.
“Is that some kind of feminist version of the sick misogynist concept that the Abrahamic religions have that God is punishing women for the sin of giving Adam the apple by forever subjecting them to the pain of menstruation and childbirth?�
Right, it is misogynist to want women to have the OPTION of giving birth at home if they CHOOSE to do so, but it’s not misogynist to FORCE all women to give birth in hospitals even if they’d rather do it at home with a midwife. You are the one here deciding what is right for all OTHER women. Who is the misogynist here?

sojourner,

See the comments I posted immediately above yours for the whole "choice" issue (and how only a narrow segment of relatively priviliged mothers have that "choice" in any real sense).

And you totally didn't answer the whole painkiller question!

Frankly, it does seem to me that the homebirth crew have a lot in common with the fundamentalists, at least as far as this disturbing idea that it's somehow bad for women to use any kind of painkiller during what is a very deeply painful life event.

That was the quetion I put on the table - and it's still there, because you didn't answer it!

I agree.

It is a little strange how the pro-homebirth, anti-doctor crowd is politicizing their personal choices, for example, using the ever-present term "empowering."

When in reality, the only thing "empowering" the homebirther is her priviledged background and stable home, and her gold-plated insurance plan.

After all, unlike MDs at hospitals, midwives do NOT care for disadvantaged women on Medicaid.

"live in homes that are suitable for a medical procedure to be carried out in them"

Good point. Whether a home offers more peace and quiet than a birthing center can depend on how near and considerate the neighbors are. Maybe someone out there actually is cool with giving birth while loud jerks pound on their floor/her ceiling right above her, but I doubt that everyone in such an apartment would be...

"and have access to medical professionals who 'see the world the way they do' (that is, who share the same class background - and class biases - and who understand and accept the cultural assumptions of the community the mother belongs to)."

Hey, what about when having a CNM who sees the would the way you do means having a CNM who rejects some sexist cultural assumptions of your community they way you don't accept those either?

"If you're a pregnant 16 year old Latina out of school youth living in a small 3 bedroom tenement apartment in West Harlem with her parents and younger siblings"

...or a pregnant out of school 15 year old living in a small 3 bedroom house with your parents and siblings many miles away from the nearest hospital, birthing center, midwife's home/office, doula's homes/office, etc., and you can't get a ride (such as a ride to the nearest birthing center or hospital) or let a guest in the house (such as letting a midwife or doula in the house) without your parents' permission without getting in a ton of trouble...

"...to want women to have the OPTION of giving birth at home if they CHOOSE to do so..."

Yeah, there's a gigantic difference between being pro-homebirth-as-a-choice (like if one says both homebirth and other options should be accessible to all) and anti-all-choices-but-homebirth (like if a patriarch gets his wife pregnant and calls women who leave the house sluts).

@ morrigan

...and our own _very very bad_ experiences with the medical profession.

I'm sorry that you have had bad personal experiences with docs, but if you want to say my earlier anecdote about the incompetent midwife is irrelevant, then so are your own anecdotes.

We live in a patriarchy, and we've absorbed everything that entails.

Well sure, but midwives grew up in that same patriarchal society. I still fail to see how MDs are somehow more vulnerable to patriarchy than others, especially in a female-dominated field like OB/GYN. (for the record I am not going into OB)

I am constantly trying to see how I can change my own behaviors from the patriarchal old docs that you are probably thinking of. But at the same time, I do not want to dismiss their vast pool of clinical knowledge. The chair of the OB department is a guy with a personality like Mussolini, but he's forgotten more about OB than I or a typical midwife will ever know. In trying to develop a better approach to patients, I hope a good OB will absorb his knowledge and not his attitude.

And sorry about the crack about IQs... at that point in the other thread, I was trolling a little.

After all, unlike MDs at hospitals, midwives do NOT care for disadvantaged women on Medicaid.

They do here in Canada. In fact, you don't even have to be Canadian to have midwifery care for free. Free. If you're here and a non-resident, free for you, too. How lucky we are to have these choices available to everyone (and at the local midwifery clinic, the demographic is NOT upper middle class mothers. It's all kinds in equal proportions.) The US could be like that, but we'd need, oh yeah, people to speak in favor of homebirth to get there. Are you helping?

So if you're really interested in that outcome for the US, why are you arguing against midwifery care for those who choose it? Oh right, you're uncomfortable with other people saying they're "empowered." Words like "natural" make you twitchy. How nice for you. That's not a good enough reason to come here and add your voice to the sea of disinterested woman-unfriendly forces whow would limit other women's choices for childbirth.

A better idea? Get over your issues and squishiness and let other women decide for themselves whether "empowered" sounds plausible to THEM. Do you really imagine other posters here are interested in how these terms make *you* feel (unless there's an issue preventing you from having a baby in the hospital we don't know about)? It's supremely narcissistic to assume we do, so either state how this is relevant to anyone besides yourself, preferably to how this affects the welfare of women, since this is a feminist board, or realize you're asking a level of investment from us we simply don't have, all the while helping bolster the cultural forces that would limit our choices.

And just to address some of the ignorant trends on this thread: Thank you EG for taking time to point out the obvious (Feb 24 1:42 AM). I think it's pretty disgusting to use the appaling facts of our world, that decent health care isn't available to most people alive today, exploiting the situation of developing areas to try to draw conclusions about childbirth in the First World. EG is absolutely right, a list like that tells us nothing and, I would add, uses other human beings' suffering as a decoy. Nice.

Regarding the safety of homebirth, the bits of the list that instead are useful to anyone truly interested in education on the issue is the fact that several nations ranked well above the US have the majority of their births attended to by midwives with never a doctor in the room. These include Sweden, Denmark and the Netherlands, who all rank at the top of the list for lowest infant mortality. In addition, in the Netherlands, 43 percent of women who use midwives also have a homebirth. Look it up: these stats are available all over the net: see for yourself.

Regarding them, this is pretty interesting regarding Dutch homebirths and "feelings of satisfaction." Feelings of satisfaction should rank pretty high on the feminist agenda, and it would seem to me that those who think that the hospital is the way to go might want to work on the care that doctors give (how much power or not is given to women in hospitals) rather than just extolling the virtues of doctors. Just because women need care (and sometimes that is hospital care) does not excuse the appalling DISempowerment that many women experience when receiving it. So pro-hospital people...FYI...there's a pet project for you now that you've resolved to leave the homebirthers and their choices alone. (Wishful thinking, I know...)

http://www.ncbi.nlm.nih.gov/pubmed/17626631?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1

Sage: Actually, I think Sweden has nearly 100% hospital births, although the majority of them are attended by a midwife.

To those of you against home birth;

1) I don't actually understand what you're arguing in favour of. Are you saying that hospital birth should be entirely compulsory? Why? As feminists, we say that women are entirely capable of making rational choices about their lives, so why would it be the case that they can't make rational choices about this?

2) Noone on this thread has suggested that all women should have home births, although I know there are a (very small number of fundamentalist) people who believe that. Even in the 'home birth mecca' of the Netherlands, less than half of births take place at home (someone upthread said 75% - that's incorrect, though I've seen in quoted in several places on the net). Many, perhaps most women will always prefer the risks and benefits of a hospital birth to the risks and benefits of home birth. All we are asking is for women to have the right to choose, without being bullied for that choice by people who refuse to recognise that there are benefits to home birth, just as there are benefits to hospital birth.

So why is it so threatening for a group of us to want to have the right to choose homebirth, if we feel that the benefits outweigh the risks?

3) Women who choose homebirth don't do so for political reasons on the whole; you've been given a number of reasons in this thread, and dismissed them entirely, in favour of the theory that it's always political. Some of the rational and personal decisions mentioned include; wanting to be able to be in control of her positions and when she eats and drinks etc; wanting to avoid an epidural, or to try other pain relief techniques before trying drugs; wanting to avoid interventions that might lead to a c-section that would not have been necessary otherwise; having had a negative birth experience in a hospital that made her feel unsafe; wanting to ensure that she knows and trusts all the people present. All of those are personal, not political, and depend on the choices available to her - a woman may choose home birth from the outset, or may change to a home birth later in pregnancy because she cannot find an OB/GYN who can provide the sort of experience she wants. All of those decisions are legitimate and personal, and can be weighed up against the risks of home birth rationally. A decision is not automatically political because the minority of people make it.

I don't actually understand what you're arguing in favour of. Are you saying that hospital birth should be entirely compulsory? Why?

Nope, I don't think anyone here is arguing for "compulsory" hospital birth, although feel free to point me to where someone did.

What some of us are trying to do is counteract some of the "lol all doctors are evil patriarchs, and all home births are empowering" extremism evident on this thread.

Home birth might be a wonderful option for someone and a terrible option for another. Also, it is not an option at all for women without money. There are plusses and minuses to both sides.

"it would seem to me that those who think that the hospital is the way to go might want to work on the care that doctors give (how much power or not is given to women in hospitals)"

Right on! Likewise, even if you already do feel empowered in your local hospital, don't forget that many other hospitals out there aren't just like yours. This goes for non-childbirth hospital experiences too, of course.

"What some of us are trying to do is counteract some of the 'lol all doctors are evil patriarchs, and all home births are empowering' extremism evident on this thread."

Yeah, "You are trusting in entirely impersonal comforts. You don't know the doctors, you don't know their tools or tricks, and you don't know their intentions" seems condescending to those women and girls who choose hospital birth when they do know their doctors and don't feel their hospitals treat them entirely impersonally.

Hmm...speaking of knowing about hospital tools, what about when a pregnant OB/GYN who assists births in a hospital chooses to give birth in a hospital? Sometimes the same person has been at both ends of the tool.

"Home birth might be a wonderful option for someone and a terrible option for another. Also, it is not an option at all for women without money."

Isn't unassisted homebirth the least expensive of all birth options, and sometimes the only option for pregnant women and girls with the least money?

What some of us are trying to do is counteract some of the "lol all doctors are evil patriarchs, and all home births are empowering" extremism evident on this thread

And I don't think anyone here is arguing that either - saying the ACOG as an organisation is patriarchal in its attitude to women and their ability to make rational choices is entirely different from saying that an individual OB/GYN is patriarchal. I know many women who've been delighted with their OB/GYN and their hospital birth. And home birth is not automatically empowering, if a woman is expected to follow procedures she isn't comfortable with. But the only way women are going to get births, hospital or home, with which they're comfortable, is for both to be really viable options. Women have bad home birth experiences because they or their carer are too scared of the perceived risks of hospital birth to refer a woman when she needs it, whether due to an emergency, or because she simply needs an epidural. And equally, bad hospital births happen because women or their carers are too scared of the perceived risks of low-intervention births to trust a woman to birth without active medical management. Of course there's a middleground, and both midwives and OB/GYNs exist in it, but at either end of the spectrum, the birthing experience is only going to improve when practitioners recognise that women have different needs, that both natural birth, and high intervention birth can be empowering if, and only if, it's woman centred. Therefore, as long as the more powerful ACOG put out statements that claim homebirth can be a rational choice, there will be an equally extreme counterclaim. Meanwhile, everyone who values choice for women should be promoting the right of women to make a decision between home birth or hospital birth, based on an individual woman's rational balance of the risks against the perceived benefits.

Hmm...speaking of knowing about hospital tools, what about when a pregnant OB/GYN who assists births in a hospital chooses to give birth in a hospital? Sometimes the same person has been at both ends of the tool.

Yup, and the same applies to a hospital midwife who chooses hospital midwife birth, and a home birth midwife who chooses home birth. It seems logical to me that a woman would trust the method she uses to help women give birth to give birth herself.

I also meant to say - the problem with any and all birth decisions is that they are necessarily speculative. I will choose home birth, because the idea of possibly having to give birth under personnel I may never have met (I'm thinking nurses here) and may not like or trust or agree with, is far more scary to me (because I know stress or worry can hamper straight-forward birth) than the risk of possibly having to be transferred to hospital in an emergency. Another woman may not be bothered by the idea of strangers at her birth, but may be terrified of the possibility of haemorrage, in which case hospital birth is the far more rational choice, since fear of an emergency would make home birth terribly frightening and difficult - the point is, whatever choice we make, it's based on perceived risks and benefits, and not any actual certain risk in either case.

"Women have bad home birth experiences because they or their carer are too scared of the perceived risks of hospital birth to refer a woman when she needs it, whether due to an emergency, or because she simply needs an epidural. And equally, bad hospital births happen because women or their carers are too scared of the perceived risks of low-intervention births to trust a woman to birth without active medical management."

It gets even worse. I've heard of more reasons for bad examples of both too - a midwife pushing hard on a woman's or girl's belly, an OB not managing to keep flesh-eating bacteria away, etc.

"But the only way women are going to get births, hospital or home, with which they're comfortable, is for both to be really viable options."

Having just both be really viable is a start but isn't enough to ensure pregnant women and girls can each have the experience she wants. More than 2 options need to be available - homebirth, hospital birth, birthing center, abortion if she doesn't want to give birth in the first place, etc. I've even heard of some pregnant women choosing waterbirth in outdoor pools.

"Therefore, as long as the more powerful ACOG put out statements that claim homebirth can be a rational choice"

Did you mean to type "can't be" here?

Yes, can't be. Oops.

Sage: Actually, I think Sweden has nearly 100% hospital births, although the majority of them are attended by a midwife.

Right. That's actually what I said:

several nations ranked well above the US have the majority of their births attended to by midwives with never a doctor in the room. These include Sweden...

...though I concentrated on the dutch homebirth study because I found it interesting. There's been a lot of midwife bashing on this thread, and I thought it was important to note the countries with the highest outcomes were majority midwife societies. Apologies if it was confusing, though.

Interestingly, since we're on the subject, this study shows that women in Sweden are very interested in home birth and birth centers...

http://www.ncbi.nlm.nih.gov/pubmed/12581035?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1