Unassisted birth on GMA this morning!?

Kiwimid · Apr 1, 2008

i am training to be a midwife in New Zealand and our model of practice is quite different to what you guys have, in fact it is unique to New Zealand. It is based around a treaty that was singed with the Maori people about 160 years ago. We aim to work in partnership with our women, they can changed midwives when they want, and there is an equal sharing of power in the relationship. as far as i know, the only unassisted childbirths we have are the unplanned kind. we have planned homebirths, birthing centers and hospitals and the women can choose where they give birth. the thing that amazes me now is just how foruntane we are here. after i graduate, i can work in a hospital or become an independant midwife with my own clients.oh and by the way......i was direct entry with no nursing background.....come to new zealand...we have a huge shortage of midwives....and the weather is good too!!!!!

mommy2boysaz · Apr 1, 2008

i am training to be a midwife in New Zealand and our model of practice is quite different to what you guys have, in fact it is unique to New Zealand. It is based around a treaty that was singed with the Maori people about 160 years ago. We aim to work in partnership with our women, they can changed midwives when they want, and there is an equal sharing of power in the relationship. as far as i know, the only unassisted childbirths we have are the unplanned kind. we have planned homebirths, birthing centers and hospitals and the women can choose where they give birth. the thing that amazes me now is just how foruntane we are here.

You are fortunate! Unfortunately, in the USA, midwives who want to attend women at home, find it very difficult, if not impossible to find a physician backup (which is required almost everywhere). Most physicians won't do it because they wouldn't be able to afford the malpractice insurance rates they would be subjected to, for something that has been proven safe! Or, the physicians feel too threatened by the practice of CNMs and just plain refuse to work with them.

Also, as a L&D RN, I see too often how difficult it can be for a woman to get the kind of natural delivery she desires in the hospital setting. My hospital is a small, rural one that has much fewer interventions than the nearby bigger hospitals, but without our CNMs, moms would still find quite a bit of resistance to having "too natural" a birth. OBs truly don't want to be inconvenienced.

I also agree that many women in today's society are half the problem. We live in a very self-centered world. We have a generation of girls who have become women and still want everything their way all the time. :bowingpur They don't want to feel any discomfort, or have their schedules interfered with, or "get fat", or lose sleep, etc., etc. (Obviously this is a broad generalization, but a common thing.) I don't know if any of these attitudes would change or not, if these women were educated about the risks to their babies as a result of their mothers' desires for their "needs" being met, i.e. inductions, elective CS, excessive pain meds, etc. My fear is that many women who have this attitude, would still feel the same, even WITH the knowledge that it isn't in the best interest of their babies. :crying2:

I do believe that many of the problems in our country could be changed with education, however. If women begin to demand care based on their knowledge of what is in their and their babies' best interests, eventually someone will have to listen!

Midwifery care needs to be an option for all women, regardless of location. If a low risk woman desires a natural birth, in a hospital, birth center, or at home, they should have that option, with a trained, educated health care provider! Until that option exists, there will be those who opt to take chances with their lives and the lives of their little ones, by going it alone at home, rather than risk what they percieve to be potential risks associated with "medical" hospital births. It makes me so sad. I anticipate a news story any day now about a lost mama or baby because of an unassisted birth. How tragic and unneccessary! :crying2: :madface:

I do know that the ACNM is beginning a marketing strategy to try to increase the public awareness of midwifery. It might be a cause worth supporting! More info can be found at their website.

byrd262, BSN, RN · Apr 2, 2008

I think that we must recognize that women are going to choose to birth this way whether or not it is accepted. There are systemic issues we have to understand. SOME (I can't speak for all) women choose this option because their only option is a hospital birth. Unfortunately, other, more accepted options don't exist depending on where you live. For example many CNMs do attend homebirth, but they need physicain back-up to do so. Most physicians are not willing to do this. Therefore many if not most CNMs work in hospitals, hospital birth centers and free standing birthcenters (which there are very few). Another option would be the CPM and lay midwife who are not trained as nurses but usually have a lot of experience and/or a formal training through a midwifery school. The challenge here is that these professions are not recognized in all states which can get very tricky. So there is a legal risk for these midwives if they do homebirths where they are not "allowed to." Also, CPMs and lay midwives usually have a difficult time to sustain their business financially because of the cost of travel (for prenatal and post partum) and other expenses. What does this mean? Many non-nurse midwives leave the business. All of these issues lead to a lack of access to women who want a certain type of labor. So, for them their only option is to labor at home.

I also want to point out that the women who choose this option don't just "wing it." They prepare by educating themselves as much as possible and they have a back up plan. Of course there is no substitute for medical/nursing knowledge, however, that knowledge is not always needed.

mommy2boysaz · Apr 2, 2008

I also want to point out that the women who choose this option don't just "wing it." They prepare by educating themselves as much as possible and they have a back up plan. Of course there is no substitute for medical/nursing knowledge, however, that knowledge is not always needed.

OK, I was with you up until the above quote.

I'm sure many of the women do attempt to educate themselves and prepare a backup plan, but I'm quite certain that some don't. And, they can't possibly educate themselves about every possible complication or issue that may arise.

I agree that medical knowledge may not be needed with every birth, but you won't know you need it until after you need it!

With 10 years of OB experience, I know that the smoothest, easiest labors and deliveries can sometimes yield the sickest or most "depressed" (respiratory-wise) babies. It is usually completely unexpected. I've also had joyous births turn into emergencies when moms begin to hemorrhage after delivery. At times like that, you REALLY want someone with training present! I'm not saying these situations can't be handled in the home, but I do think they need to be handled by someone trained to handle them.

I agree wholeheartedly with the rest of your post. Most of these women just feel caught between a rock and a hard place. :banghead:

As CNMs, we have to fight to change this!

scootersuz, ASN · Apr 27, 2008

Ok I have to add my two cents worth here. I wanted to have a home birth with a mid wife. I was pregnant with twins and the pg went perfect. My girls were in the head down position, ready to go but I developed Pre-eclampsia quickly at the end. My blood pressures spiked and they decided to deliver early and do a scheduled C section. The fact that I was in the operating room for the c section saved my life. I ended up having a massive Bleed pot because my placenta was deeply embedded in the uterine wall. The delivery went code and they called in two other surgeons. They said if I had even tried to do a lady partsl birth in a labor room there was a good chance I would not be here today.

And one of my twins needed help breathing so she was taken into the NICU immediately.

So a at home unassisted birth. Thanks but no thanks. Things can go wrong.

LLLovely, BSN, RN · May 5, 2008

I know an RN who recently had her third child at home with just her husband. She had two previous hospital births, both with no intervention, but she hated them. While she is a strong person who is able to advocate for herself strongly, even while in labor which many women can't, she was tired of having to do it.

I don't know that I would do it, but I certainly understand the inclination. Why go to the house of bright lights, have people ask you over and over to insert an IV, have people interrupt you during a contraction with demands of changing into a hospital garment instead of the clothes you brought, disallow you to walk in the hall, have no access to a tub or shower, have no food or drink except what your husband can sneak in, etc?

She didn't want to deal with it and there is only one, yes just one, CNM who does homebirth in her state because of the complete lack of willingness of docs to back them up and lay midwives are illegal there. In her case, there really were no legal options other than hospital or UC. I greatly despise that many women are left with those two choices. I know there are direct entry midwives who do practice illegally in her state, but their numbers are dwindling as well since many of them are CPMs and do not want to risk their certification.

epiphany · May 7, 2008

Women are n-u-t-s for doing that.
Too many things can go wrong and I really think that a woman who chooses that option should be charged with criminal child neglect if a baby dies/injured due to total absence of medical care during a birth....just like they do with these teenagers that birth babies at home...I see no difference.
These women, if they don't care anything about whether they live or die, then so be it...but they shouldn't put their baby's life at risk just so they can have bragging rights later.
Things like this make me SO angry!!!! :angryfire:angryfire:angryfire
When women choose crazy birthing options like that...it's not about the baby, it's about their ego....which needs to be checked at the door.

Do you really believe that a woman who chooses this option is out to her hurt her baby?. That's the kind of reasoning I've heard over and over again whenever a woman resist the medical model of management that's forced upon them - if you don't do what we prescribe, you are unfit mother who is willing to hurt her child.

Please look at the evidence out there on hospital birth, rates of c/section, infection - not to mention the kind of empowerment that is experienced by a mother who feels in control of her own labor before you make assumptions about people as well as facts.

I believe that a woman should have the kind of pregnancy and labor care she wants, and many women choose this option because they don't think that they can find someone who advocates for their beliefs. That is truly sad.

I had a hospital birth that has traumatized me so much, I chose to become a midwife. I wish that I had had to courage to give birth myself so that I didn't have to be at the mercy of the heartless people around me at the time when I was most vulnerable and scared. If I had, I would have been able to hold my head up high and let my courage enter the spirit of my daughter. So now I choose hold another woman's hand in the hop that it will heal me, too.

I worked in an L&D floor before going to midwifery school, and I have heard so many abusive attacks at mothers who questioned their treatment - and it was always the same weapon that you are using - "are you trying to hurt your baby?".

I don't know if you are going to be nurse, but whatever your beliefs, you need to understand how to be therapeutic, and that people just want to know that they matter, and that it hurts the most when you are not treated like a human being. If I believed that an intervention was truly necessary, it never took much for me to convince the woman that it was the right thing to do, and I know that it was simply because she knew that I cared. What bothers me the most about your post is that you don't seem to have a clue about love and support. Maybe that's just from anger and misinformation, but I can tell you tell it is this kind of attitude from the health profession that drives people to extremes.

LLLovely, BSN, RN · May 11, 2008

I am headed towards midwifery for the same reasons epiphany mentioned. A physician actually told me, "You can sit here and watch your babies die on the monitor. We don't care if that is what you really want."

I had several physicians lie to me about the statistics of risk surrounding my choices and about the risks and benefits of many medical procedures. I had a physician strip my membranes, not just without my permission, but without even asking or telling me he was about to do it. I had a physician tell me that I didn't know how to push a baby out and I couldn't do it unless I listened to their experienced voices. (She had never birthed a child of her own.) I had a physician tell me that there was, without a doubt in all circumstances, a higher risk to breech delivery than to a C-section.

I absolutely understand what drives women to choose unassisted childbirth. The vast majority of them have no other choice that doesn't land them in a hospital, and so many women are scared to death of what happens in hospitals because they have experienced it previously or know someone who did. In my ideal world, low-risk women will be able to confidently, legally, and with adequate medical backup choose homebirth. My goal is to be a part of that solution.

Kudos to epiphany for being able to speak on this topic so eloquently. Her astute observations about the role of nurses as supportive caregivers, rather than judgmental "yes men" are right on the mark.

missjennmb · Jun 3, 2008

Despite thoughts to the contrary, not everyone has the ability to have a natural birth if they allow medical supervision. In SC, VBACs are not allowed to birth outside of the hospital. Not with a CNM, not with a DE midwife, not in a home, or a birth center, nothing. In fact, anyone who chose to assist such a woman would be severely risking their license. Not even a doula will risk being around a VBAC momma who wants to deliver outside of a hospital. Not if the scar is the perfect type, or if the uterus is "tried", or if every single indication is that they are a good candidate. Other places in this country, they not only CAN but it is strongly encouraged, but not in South Carolina.

To further complicate this matter... many many hospitals in SC will not allow a VBAC without their exact specifications to labor. A 29 yr old mother with a 11 yr old scar, in good health, good weight, educated and invested in her care (goes to all appointments, follows midwife/doctor advice, asks a lot of questions, brings a lot of questions to ask, etc) who's records are gone due to time limitations (Florida only has to hold them for 8? years or 10 years...) is not "allowed" to labor at all. Not allowed to wait for labor to have a cesarean (has to be scheduled at the estimated 39wk mark "just in case"). She is told that she has no choice (in those words) and that wanting to labor naturally means that she could be "killing her baby" by the very same person who told her that she should consider a VBAC in the first place, prior to hearing that her governing body (hospital/doctors/whatever) would not support it. Her husband is asked "are you going to let her risk your child's life" when he supports his wife in just wanting to understand the WHY of being required to have a cesarean, and wanting to be able to just go into labor, in a hospital, or have a reason that is evidence based for why its not possible. They are VERY friendly and really like the CNMs/OBs up to this point and are not "problem patients".

So what about them? tough luck? you have no say? c'mon

And what of the doctor who tells this husband that "some women need to be treated like children, and scared into doing what we know is best for them" when she asked "why" about a simple test. Not refusing... just asking "why" which is apparently seen as questioning a doctor's ability or some other nonsense.

Answer me this... why should a woman, why should ANY WOMAN, have to bring their baby into the world in this environment?

LLLovely, BSN, RN · Jun 4, 2008

Jenlaana, what you described is what angers me about the birthing environment in this country. That is coercion and unethical. For example, you wouldn't hear of an oncologist berating or lying to or manipulating a spouse against a cancer patient who elected a particular treatment plan that was contrary to the physician's recommendation. It would be ridiculous, but somehow in the birth world, it is "what some women need."

I feel it is part of a bigger systemic problem wherein medical education, particular of physicians, is male-dominated and male-centric. There is this underlying message that women are incapable of making educated decisions about their own care or are incapable of understanding the facts unless they are comined with the politics.

I don't know that I could do it, so I realize that what I say here is just a lot of talk. I am a person who doesn't/can't talk during labor. But, despite what a doctor tells you, he or she cannot give you a c-section without your consent unless you are unable to give consent and loss of life is imminent. There is the possibility of the doctor getting a court order to force you to have one, but that is unlikely I believe. In most states it is also illegal to deny medical care. In truth, physicians give the line about what is and is not allowed to nudge (or shove) women to consent to what they want to do.

I have been there and it stinks. I hope that BOBB and midwives (DE and CNM) are able to shift this pendulum back in the other direction soon. I should say that there are some physicians who are absolutely on board with this. They are fantastic people. In fact, there is a local OB where I live who proclaims that she will be the last doctor standing for VBAC if she has to be, despite organizations, hospitals, and insurance companies. I almost hugged her when she told me that!

CEG · Jun 9, 2008

Women are n-u-t-s for doing that.
Too many things can go wrong and I really think that a woman who chooses that option should be charged with criminal child neglect if a baby dies/injured due to total absence of medical care during a birth....just like they do with these teenagers that birth babies at home...I see no difference.
These women, if they don't care anything about whether they live or die, then so be it...but they shouldn't put their baby's life at risk just so they can have bragging rights later.
Things like this make me SO angry!!!! :angryfire:angryfire:angryfire
When women choose crazy birthing options like that...it's not about the baby, it's about their ego....which needs to be checked at the door.

What about women who choose elective c-sections or inductions? Should they be charged if something goes wrong? There are known risks to mom and baby with those choices. How about epidurals? Women choose them every day and yet we are okay with that risk. On my unit we had someone code after her epidural last week, are we denouncing all women who choose epidurals now? No! Women in the hospital are opened up to a different set of risks- infection, unnecessary surgery and interventions, PPH related to pitocin. Many of the complications we "save" people from are actually created by us.

It's not about "bragging rights" or "ego". I wouldn't choose a UC personally, but I am fortunate enough to have great health insurance that is paying for my upcoming homebirth. If I had the option of a hospital birth that I knew would result in unnecessary interventions or no provider at home that might just be my choice. It would be extremely difficult if not impossible to have an intervention-free hospital birth in my (major metropolitan) area. I work in a small community hospital and we are just as bad as the high-risk university hospital where I was before. Most of the women who choose this are extremely educated about the risks and benefits, stringent about prenatal care, (whether provided by a professional or they do it themselves) and have very good reasons for what they do. The larger problem is that they have to choose it in the first place. A scared teen mom giving birth in a bathroom stall at the Prom is a lot different than an educated adult woman choosing a UC because she can't find a provider to care for her in a manner she chooses.

Nefertari1279 · Jun 12, 2008

Hopefull:

Criminal charges? :banghead:Yeah, that go over well wouldn't it? (sarcasm off)

Gee, a woman can terminate a pregnancy on a whim but God forbid she delivers at home without any "professional" assistance. :confused:

Perhaps you consider the REAL reasons WHY women are choosing this path? Ego and bragging right have nothing to do with it. (not to say that there are not women out there who did it just to "prove a point")

If birth were are dangerous as the medical community would love women to believe, the human race would have died out before the Pyramids were finished. Yes, birth carries risk, but EVERYTHING in life bears some risk. We need to get back to trusting our bodies and allowing them to do what they are built to do.

Medicine has a place in birth, no doubt. I was born at 26 wks and without obvious intervention, I wouldn't be here right now.

If midwives were more widely available, women would truly have more choice. I don't think these women are "nuts": most don't just jump into this, they research their options and make educated choices . . . and from what I have read on various sites (personal sites of women who have chossen this) they are more than willing to take responsibilty of the outcome. I don't see women who are being "selfish and careless", I see women making choices that THEY feel is the best for THEM. I fully support their God-given right to make that choice. :up:

UC is something I have considered but would never do, I think midwives are wonderful and are the right choice for the births of my future childern. But that is just me . . . every woman needs to make the choice for herself.

Sorry for the rant, this is a hot topic for me, LOL:D