Here is the abstract and link to the new study put out on homebirth with CPM's. The largest study to date. Unlike the study done by Pang et al. in Washington, which was so poorly done as to be laughable (yet still published in a respected medical journal), this one seems to be well done and confirms what other studies have had to say about homebirth and the safety of midwives. I'll be interested to see what Henci Goer has to say about this study.
Conclusion: Planned homebirth for low risk women in North America using certified professional midwives was associatedwith lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.
I think the US has high infant mortality due to the lack of universal prenatal care, not because of the practitioner at the delivery or the location of delivery. I say , hooray, stay out of those germ factories that we call hospitals, if you can.
yeah, we had a healthy pregnancy with no apparent risks. so we should have done it at home with a midwife right?
well unbeknownst to anyone, our baby had the umbilical cord wrapped TWICE around his neck. it was a very difficult delivery, he stopped breathing, and he had to be resuscitated. He very easily could have died.
so thank god we didnt go with the homebirth and some local yokel midwife.
i want my pizza to be home delivery. But sorry if I have higher standards when it comes to the life of my baby and my wife.
and you say hospitals all have a $ agenda in preventing midwifes from moving into their market? well midwifes have agendas too, sorry. I mean these people claim "electronic fetal monitoring" is somehow A Bad Thing. Even that BMJ study implies just that on Page 2.
and i've read countless tragic stories where some arrogant midwife refused to call for medical intervention until after it was too late.
look, i just googled "certified professional midwifes", and here is one of the first links i get, to some woman who runs her own birthing clinic. You want to put your life in her hands?
I, Leather Dupris, hereby state that I am not a medical physician, registered nurse, doctor of osteopathic medicine, or any other licensed medical practitioner recognized by the laws of the Commonwealth of Massachusetts. I am, however, an experienced, trained, primary care direct entry midwife (DEM), but I do not hold any type of medical degree. Direct Entry status refers to the method of entering the profession of midwifery, which means that I entered midwifery "directly" without having obtained a nursing degree prior to practicing my profession as a midwife. In the Commonwealth of Massachusetts, midwifery and homebirth is legal. There are no provisions for licensure in the Commonwealth of Massachusetts for non-nurse midwifes. I began my training in 1978 as a student to a Naturopathic Physician, who was also in the profession of midwifery. He continued to mentor my midwifery practice until his death in 1981. I have been a primary care, domiciliary (homebirth) midwife since 1979. I am currently involved with obtaining the Certified Professional Midwife (CPM) certification through North America Registry of Midwives (NARM). I am a certified childbirth educator through Informed Homebirth (IH) and Informed Childbirth Association (ICA) since 1980. I am certified by the Commonwealth of Massachusetts as a Certified Nursing Assistant (CNA) and as a Certified Home Health Assistant (CHHA). I am also an ordained minister and a high priestess of Wicca. I have my Reiki II Certification and am a practicing Reiki therapist. I am also a Notary Public for the Commonwealth of Massachusetts.
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well, that's just great. when your delivery complicates, and she starts praying to the moon-god, rather than providing trained medical intervention, at least she'll be able to notarize the death certificate.
well unbeknownst to anyone, our baby had the umbilical cord wrapped TWICE around his neck. it was a very difficult delivery, he stopped breathing, and he had to be resuscitated. He very easily could have died.
What did they do to resuscitate him? There is a common misconception that somehow hospitals have "magic powers"; what they can do is surgery, intubation and critical care monitoring/treatment. A midwife at home *can* resuscitate a flat baby; they do the same things in the first half hour that any hospital would do.
i want my pizza to be home delivery. But sorry if I have higher standards when it comes to the life of my baby and my wife.
The *evidence* does not support your opinion which amounts to nothing more than bigotry based on anxiety and ignorance.
BTW, check out staphylococcal infection rates among newborns in hospitals, and then tell us how high your standards are.
Specializes in med/surg/tele/neuro/rehab/corrections.
I don't see anything wrong with her description of her practice. For Salem Massachusetts I believe this description is perfectly acceptable. So maybe your not into Reiki or Wicca but that doesn't mean that this woman is a crack pot as you infer. Her track record would be what a pregnant couple would judge her on.
The *evidence* does not support your opinion which amounts to nothing more than bigotry based on anxiety and ignorance.
that's not true. i base my opinion on anecdotal evidence. and a little bit of hearsay.
look, we considered midwifery and birth centers. and after the experience we had, we are glad we had a hospital delivery with fully trained staff ready to intervene, as it so happened to be necessary to do so.
yes, i know about secondary staph infections from hospitals. and we didnt get any.
so, yeah, if the person is trained and licensed by the state as a Registered Nurse and a Midwife, and theres a Obstetrician available if necessary, sure go with the midwife. fine and great.
but if you want to go with some back alley lay-midwife, you are putting your lives in the hands of some unprofessional person whom the state has little oversight on... well, thats your choice i suppose. i hope i don't read about you in the next midwife lawsuit.
Nuchal cords occur in about 33% of deliveries, and generally cause no problems, despite the "miraculous" saves that doctors perform on babies born with a nuchal cord.
As far as those "back alley midwives", we'll have to keep an eye out for them since they are soooooo prevalent.
I had my fourth at home also. And he's a perfectly, healthy, happy 3 month old. :)
that's not true. i base my opinion on anecdotal evidence. and a little bit of hearsay.
look, we considered midwifery and birth centers. and after the experience we had, we are glad we had a hospital delivery with fully trained staff ready to intervene, as it so happened to be necessary to do so.
yes, i know about secondary staph infections from hospitals. and we didnt get any.
so, yeah, if the person is trained and licensed by the state as a Registered Nurse and a Midwife, and theres a Obstetrician available if necessary, sure go with the midwife. fine and great.
but if you want to go with some back alley lay-midwife, you are putting your lives in the hands of some unprofessional person whom the state has little oversight on... well, thats your choice i suppose. i hope i don't read about you in the next midwife lawsuit.
Your argument doesn't stand with me. Here's an article about women who are leaving the Ob profession in droves. Why? Because 75% of ALL Ob/Gyn's have been sued and their malpractice rates are astronomical. http://womensenews.com/article.cfm/dyn/aid/1858
(bold emphasis in this article are mine)
Data from the Physician Insurers Association of America indicates that in 2003 almost as many lawsuit claims were closed out (through settlement or jury verdict) against ob-gyns as against internists--992 and 1100. But ob-gyns comprise a much smaller segment (about 5 percent) of the total physician population than internists (about 17 percent.)
The American College of Obstetrics and Gynecology says 75 percent of its members have been sued at least once. In 2003, the organization surveyed a portion of its membership and found that, as a result of lawsuits or the fear of lawsuits and high medical Liability Insurance costs, 22 percent of respondents reduced the number of high-risk obstetric patients they accepted, 15 percent stopped doing lady partsl deliveries for pregnancies subsequent to a Caesarian section and 14 percent stopped practicing obstetrics altogether, but kept their gynecology patients.
All these changes diminish women's access to care, according to a February 2004 bulletin from the American Medical Association. Among hundreds of examples, it cites hospitals in Arkansas, Pennsylvania and Florida that have been forced to close their maternity services; women who must cross state lines to deliver their babies and women with high-risk pregnancies who have great difficulty finding doctors.
The problem is compounded because, while many physicians have cut back or eliminated their obstetrical practice, fewer U.S. medical school graduates are choosing to pursue ob-gyn, according to five-year statistics from the American Medical Association. "They're voting with their feet," says Dr. Charles Lockwood, chair of Obstetrics and Gynecology at Yale-New Haven Hospital and an internationally recognized expert in infant pre-maturity.
In 2003, U.S. graduates filled just over two-thirds of available ob-gyn slots--the lowest percentage ever--while graduates of foreign medical schools filled 23 percent and 9 percent of slots went unfilled.
Increase in Caesarian Sections
Members of the Association of Trial Lawyers of America bring most medical malpractice cases against obstetricians on behalf of parents whose babies have suffered some harm at birth.
In an effort to avoid being sued, obstetricians are increasingly delivering babies by Caesarian section, if fetal monitoring shows the slightest abnormality. But the increased C-section rate in the United States--now at 26 percent of all live births, according to the National Center for Health Statistics--has not reduced neo-natal mortality or the occurrence of cerebral palsy, a birth outcome that has prompted many of the lawsuits.
Both doctors and lawyers agree that only a small percentage of those who suffer harm file lawsuits, so there are no accurate data on the number of infants injured every year. But tens of thousands of people die or are injured each year in U.S. hospitals due to preventable medical errors, according to a 1999 study by the Institute of Medicine.
Several physicians interviewed for this story agree with attorneys that the medical profession doesn't do enough to discipline incompetent doctors. "There should be zero tolerance of adverse outcomes unless they're biologically impossible to prevent," Lockwood says. "We need more transparency among doctors, but that's hard to achieve when they are so terrified of being sued."
The number of lawsuits has not risen in recent years, but jury awards in the 30 percent of cases that plaintiffs win have skyrocketed. The median award for medical negligence in childbirth cases, $2,252,645, was the highest for all types of medical malpractice cases analyzed. In 2002, juries awarded $80 million in one birth injury case and $95 million in another, according to data from Pennsylvania-based Jury Verdict Research, an independent publication that maintains a nationwide database of more than 213,000 plaintiff and defense verdicts and settlements resulting from personal injury claims.
Lockwood says these high awards are largely driving the steep increase in medical malpractice insurance, a trend that began in the mid-1990s but has escalated recently. Factor in lower reimbursement rates from managed care and there's a financial crunch.
The American College of Obstetrics and Gynecology has called for legal reforms and specifically for a cap on damages for pain and suffering, something the trial lawyers' association opposes as unconstitutional.
Currently, 23 states have some kind of cap, but a spokesperson for the doctors' group says some of the caps have been ruled unconstitutional and some make exceptions for lawsuits filed against ob-gyns. Efforts to enact federal caps are stalled in Congress.
Minkin says without significant reforms, a medical crisis is on the horizon.
"We will see an increase in infant mortality and in maternal mortality. We'll end up with a few doctors doing the bulk of deliveries, and they will be the younger, less experienced docs because the older ones, with established practices, will be able to make a living doing just gynecology. If this is what the American people want, God bless 'em, but I don't think it's what they want.
So you see, there are all kinds of problems with your ideal place to have your baby born. It's not safer, as you are claiming, to have a birth in the hospital. As far as I know, 75% of CPM's or lay midwives aren't being sued. No one here is asking you to change your mind about where you and your wife have your babies, but I think it's reasonable, based on the evidence, to expect that you would realize that homebirthing is a legitimate choice for low risk women and babies. Please provide some evidence, otherwise, that proves your position because I don't think I've seen anything supporting it.
Lisa - that was a good article but my take on it was the skyrocketing malpractice rates are putting good doctors out of business . . . the first doc mentioned won Obstetrician of the Year and was a great doc but quit due to the malpractice rates.
The crux of that article, for me, is malpractice insurance and trial lawyers forcing docs out of business. Or forcing docs to choose cesarean in the case of "the slightest abnormality" on the fetal monitoring strip. And then the following paragraph:
"In 2003, the organization surveyed a portion of its membership and found that, as a result of lawsuits or the fear of lawsuits and high medical Liability Insurance costs, 22 percent of respondents reduced the number of high-risk obstetric patients they accepted, 15 percent stopped doing lady partsl deliveries for pregnancies subsequent to a Caesarian section and 14 percent stopped practicing obstetrics altogether, but kept their gynecology patients."
It sounds that good docs are being forced out . . .rather than docs have a bad track record.
steph
p.s. I copied the article and put it in all our ob doc's mail.
but if you want to go with some back alley lay-midwife, you are putting your lives in the hands of some unprofessional person whom the state has little oversight on... well, thats your choice i suppose. i hope i don't read about you in the next midwife lawsuit.
well, this study, and this thread, aren't about "back alley lay-midwives" or "unprofressional person whom the state has little oversight on". Certified Professional Midwives may have differering educational paths and backgrounds, but the national standards in place for the use of those credentials are pretty tight. There are many paths to get there, but all CPMs must establish that they are safe and experienced (through education and apprenticeship, usually) providers and this study's outcomes says far more about the established safety of CPMs than your "hearsay"
Lisa - that was a good article but my take on it was the skyrocketing malpractice rates are putting good doctors out of business . . . the first doc mentioned won Obstetrician of the Year and was a great doc but quit due to the malpractice rates.
The crux of that article, for me, is malpractice insurance and trial lawyers forcing docs out of business. Or forcing docs to choose cesarean in the case of "the slightest abnormality" on the fetal monitoring strip. And then the following paragraph:
"In 2003, the organization surveyed a portion of its membership and found that, as a result of lawsuits or the fear of lawsuits and high medical liability insurance costs, 22 percent of respondents reduced the number of high-risk obstetric patients they accepted, 15 percent stopped doing lady partsl deliveries for pregnancies subsequent to a Caesarian section and 14 percent stopped practicing obstetrics altogether, but kept their gynecology patients."
It sounds that good docs are being forced out . . .rather than docs have a bad track record.
steph
p.s. I copied the article and put it in all our ob doc's mail.
Yes, that was my take on the article, too , Steph. :) I liked it, too. The point I was trying to make was that there are problems in the OB world. The fact that 75% of OB's are being sued is scary, first of all. Then there is the whole thing that the GOOD ones are leaving! Yikes! I don't think people realize that just because someone has M.D. behind their name doesn't mean that the person has a clue what they are doing or that the standards that we desire as patients are going to be met. To simply say that going to a hospital, where there are doctor's, is better than going to a lay midwife or CPM just doesn't make sense to me. Wouldn't you want to find out the quality of your care provider? I think the article just helped point out that we just can't assume that we are going to get good care by going to an OB and that there are a LOT of people who are not receiving good care. I hope the trend of OB's leaving doesn't continue, for obvious reasons, but it should give everyone pause when considering who will attend them at their birth. Be it an OB, family physician, CNM, CPM, or lay midwife, we must look at the individuals history of providing care. I would rather have a lay midwife who has never lost a baby or mother over an OB who has 3 lawsuits filed against him for harm or malpractice. I do not mean to diss OB's. They are a valuable part of the medical world and should be used when needed. I hope that we keep the good ones around! I think I'm talking in circles now. I keep having to get up and break up fights between kids. :chuckle Let me know if you need more clarification, Steph. It's probably as clear as mud now.
Oh, and edited to add: The reason I chose the article in the first place was because one of the posters seemed to believe that lawsuits against midwives are fairly common and that fact should be used to rule out their use when choosing where to birth babies. :)
Yes, that was my take on the article, too , Steph. :) I liked it, too. The point I was trying to make was that there are problems in the OB world. The fact that 75% of OB's are being sued is scary, first of all. Then there is the whole thing that the GOOD ones are leaving! Yikes! I don't think people realize that just because someone has M.D. behind their name doesn't mean that the person has a clue what they are doing or that the standards that we desire as patients are going to be met. To simply say that going to a hospital, where there are doctor's, is better than going to a lay midwife or CPM just doesn't make sense to me. Wouldn't you want to find out the quality of your care provider? I think the article just helped point out that we just can't assume that we are going to get good care by going to an OB and that there are a LOT of people who are not receiving good care. I hope the trend of OB's leaving doesn't continue, for obvious reasons, but it should give everyone pause when considering who will attend them at their birth. Be it an OB, family physician, CNM, CPM, or lay midwife, we must look at the individuals history of providing care. I would rather have a lay midwife who has never lost a baby or mother over an OB who has 3 lawsuits filed against him for harm or malpractice. I do not mean to diss OB's. They are a valuable part of the medical world and should be used when needed. I hope that we keep the good ones around! I think I'm talking in circles now. I keep having to get up and break up fights between kids. :chuckle Let me know if you need more clarification, Steph. It's probably as clear as mud now.
Lisa - I have nothing against home births being available by the way. I just wouldn't choose it myself, being an OB nurse and seeing how things turn on a dime.
So I'm glad your experiences were all you hoped them to be.
I have a friend up here in the mountains who had all 4 of hers at home too. Me - I'd be thinking about the big mess . . . . probably because I just got through cleaning up after a delivery at 0947 today . . . . what a mess. :)
Lisa - I have nothing against home births being available by the way. I just wouldn't choose it myself, being an OB nurse and seeing how things turn on a dime.
So I'm glad your experiences were all you hoped them to be.
I have a friend up here in the mountains who had all 4 of hers at home too. Me - I'd be thinking about the big mess . . . . probably because I just got through cleaning up after a delivery at 0947 today . . . . what a mess. :)
steph
:) Thanks, Steph. I had an awesome midwife and didn't have to deal with any of the mess, but you aren't the first person who has had that same concern. The majority of folks feel the same way you do and I respect that. I would not encourage anyone to have a homebirth who doesn't feel comfortable with it. I'm glad that you have shown respect as well. Of course, you ROCK, so I knew you would. :)
Geeg
401 Posts
I think the US has high infant mortality due to the lack of universal prenatal care, not because of the practitioner at the delivery or the location of delivery. I say , hooray, stay out of those germ factories that we call hospitals, if you can.