My great, great grandmother Sarah Servatius died in childbirth in 1886, leaving six children and their father to fend for themselves.
Medicine has advanced dramatically since women regularly gave birth at home. According to the Centers for Disease Control, the mortality rate for babies has declined by 90 percent since 1900 and the maternal mortality rate by almost 99 percent. Now, some women are fighting to do it the way my grandmother did, even if it puts their baby at higher risk of death or injury during delivery.
Should we let them? Or should that be considered child abuse?
Enter “midwife” Amy Medwin. If a doctor’s track record for the last few months was like Medwin’s — the death of one baby and the injury of another — would you go to her for prenatal care, or to deliver your baby?
Supporters of Medwin, who now has three arrests for unauthorized practice of midwifery to her credit, apparently see the death of one baby and the injury of another under her care as an opportunity to promote the legalization of the prenatal and birth services Medwin provides to her patients. These people actually consider it an injustice that Medwin can’t work legally as a midwife in this state. Last week, they signed petitions and marched in Raleigh, demanding that midwives like Medwin be licensed to deliver babies.
To legally practice as a midwife in North Carolina, you have to have a nursing degree, complete midwifery education, pass an exam and be supervised by a doctor. Medwin is a certified professional midwife (CPM). No college degree, nursing degree, or medical degree of any kind is required for that certification. North Carolina is one of 10 states that doesn’t recognize Medwin’s certification, so she was practicing illegally.
Since doctors rarely consent to supervise a home birth, where they will lack the equipment to save the baby’s and mother’s lives in an emergency, home birth is essentially illegal here unless you want to do it without assistance.
That has those who want to return to 1886 all worked up. They say it’s their right to give birth at home if that’s what they prefer. The problem is that there’s a baby involved here, too. In North Carolina, you can face child abuse charges if you intentionally neglect to provide timely medical care for your child. Does giving birth at home with the help of a CPM who might not even have a college degree, much less a medical degree, fit that definition? Should it?
According to an American Journal of Obstetrics and Gynecology study of more than 500,000 births published this fall, planned home birth triples babies’ mortality rate. The risk is still low, 0.2 compared to .09 of those born at the hospital. The main cause of death was breathing difficulties and failed attempts at resuscitation, two factors the study attributed to poor midwife training and lack of access to hospital equipment.
Previous studies that showed no increased risk to the baby were flawed, the study found, because when complications arise and a woman is rushed to the hospital, which happens about 40 percent of the time during home birth, the death or injury to the child is recorded as a hospital birth.
Is putting your child at that kind of risk child abuse? Should it be? Home birth advocates, who are some of the most militant people I’ve ever encountered, claim studies like this can’t be trusted because they are engineered by doctors profiting off services that aren’t really needed. They say women should give birth where they feel most comfortable, and that childbirth has only recently been done in hospitals.
You could, of course, say the same thing about appendectomies. Claudius Aymand performed the first successful appendectomy in 1736 on a bed without anesthesia, the way many appendectomies were done for the next 100 years.
Would you have an appendectomy on the kitchen table just because that’s the way we used to do it? I doubt these women would either.
When a child’s life is involved, it’s not about what makes mom feel comfortable anymore. It’s about the baby. That’s why the state should leave the law just like it is — to protect babies from mothers who should know better. If Medwin wants to deliver babies, she should get a nursing degree.
For other takes on midwifery in North Carolina, check out:
Why is N.C. Afraid of midwives?
Sexism, xenophobia and midwifery in N.C.
This article appears in Mar 8-14, 2011.
I think Tara goes just a tad bit to far but she is generally correct.
Giving birth is a natural thing and if someone chooses to do it at home, in a boat or with green eggs and ham it is their biz.
BUT
When money changes hands for services then this opens the door for possible state intrusion into the situation. Normally I am against government involvement but when life and death or large amounts of money are involved I am willing to consider it. Delivering a baby is pretty serious biz so if the mid wife is accepting payment for her services I think the local government should have some standards in place. The government is not even saying you can’t do it. They are just trying to make the best of a non-perfect situation.
People have become so detacted from the dangers of life they do not understand how easy it is to screw up. I forget the exact figure but I think it was reported that 19% of women died in child birth just one or two hundred years ago. This was with medical people available. I wonder how non medical people would do today. Keep in mind that many women died from babies being in bad positions or getting stuck in some way. So yes it is a natural process but this natural process had an incredibly high mortality rate without modern medical knowledge and technology.
I am a Licensed (in California) and Certified Professional Midwife who does believe the midwifery process needs higher standards and more experience before sending new midwives out on their own.
However, it is *really* important to be aware of the distinction between midwifery care and medical care. Many states (CA, FL and WA for example) make clear distinctions between the two. Midwifery focuses on the normal in childbirth whereas medicine takes the more complicated cases. It is true that cases can become complicated mid-stream, so if they were having a homebirth (midwifery), they would transfer to the hospital (medical care) to receive advanced *medical* care.
I take great exception at Tara’s saying that 40% of homebirth clients transfer or are transported to the hospital. In over 25 years of attending births, I have never heard a higher rate than 15% from any homebirth midwife. Any midwife who had a 40% rate, needn’t be practicing homebirth midwifery because she’s taking on wayyyyyy too many high-risk women.
It’s also important to know that in most states where midwifery is legal, midwives *do* have life-saving equipment… from oxygen and neonatal resuscitation skills (required by law) to medications for a hemorrhage or antibiotics if mom needs them for her GBS prophylaxis. Licensed Midwives can suture (and yes, we do carry and use Lidocaine), have experience with sudden emergencies such as a shoulder dystocia or a surprise breech baby.
It *is* crucial for all midwives to be honest with their skill set and their knowledge limitations, but for those who are well-educated, keep learning over the years, adhere to the community standards of care and practice within their abilities, helping a healthy woman who wants one to have a homebirth is a valuable gift to women in our communities.
None of this speaks about the complications that can occur in the hospital *because* of the routines, many (most?) of which have zero to do with an emergency. Starving women, keeping them in bed, and anesthetizing them all have risks that do not occur in the home.
Women are *not* just choosing to have a homebirth for selfish reasons. Women are choosing to have a homebirth because they have weighed the pros and cons after informing themselves completely and deciding that, for them and their babies, a homebirth is safer.
Therefore, the women marching in your state are not marching to celebrate the midwife who’s having troubles, but are marching to bring the awareness of the incredible importance of licensing and legalizing midwifery in North Carolina. Women *are* going to have homebirths. Women who are, deserve to have a woman with a proven record of education and experience behind her. It is when midwives are legitimized that intercommunication between the midwifery and the medical models are able to provide the very best care… *individualized* care… so mothers AND babies are kept healthy and safe.
Please stop deleting Navelgazing Midwife’s comment.
HERE IT IS…
I am a Licensed (in California) and Certified Professional Midwife who does believe the midwifery process needs higher standar…ds and more experience before sending new midwives out on their own.
However, it is *really* important to be aware of the distinction between midwifery care and medical care. Many states (CA, FL and WA for example) make clear distinctions between the two. Midwifery focuses on the normal in childbirth whereas medicine takes the more complicated cases. It is true that cases can become complicated mid-stream, so if they were having a homebirth (midwifery), they would transfer to the hospital (medical care) to receive advanced *medical* care.
I take great exception at Tara’s saying that 40% of homebirth clients transfer or are transported to the hospital. In over 25 years of attending births, I have never heard a higher rate than 15% from any homebirth midwife. Any midwife who had a 40% rate, needn’t be practicing homebirth midwifery because she’s taking on wayyyyyy too many high-risk women.
It’s also important to know that in most states where midwifery is legal, midwives *do* have life-saving equipment… from oxygen and neonatal resuscitation skills (required by law) to medications for a hemorrhage or antibiotics if mom needs them for her GBS prophylaxis. Licensed Midwives can suture (and yes, we do carry and use Lidocaine), have experience with sudden emergencies such as a shoulder dystocia or a surprise breech baby.
It *is* crucial for all midwives to be honest with their skill set and their knowledge limitations, but for those who are well-educated, keep learning over the years, adhere to the community standards of care and practice within their abilities, helping a healthy woman who wants one to have a homebirth is a valuable gift to women in our communities.
None of this speaks about the complications that can occur in the hospital *because* of the routines, many (most?) of which have zero to do with an emergency. Starving women, keeping them in bed, and anesthetizing them all have risks that do not occur in the home.
Women are *not* just choosing to have a homebirth for selfish reasons. Women are choosing to have a homebirth because they have weighed the pros and cons after informing themselves completely and deciding that, for them and their babies, a homebirth is safer.
Therefore, the women marching in your state are not marching to celebrate the midwife who’s having troubles, but are marching to bring the awareness of the incredible importance of licensing and legalizing midwifery in North Carolina. Women *are* going to have homebirths. Women who are, deserve to have a woman with a proven record of education and experience behind her. It is when midwives are legitimized that intercommunication between the midwifery and the medical models are able to provide the very best care… *individualized* care… so mothers AND babies are kept healthy and safe.
I can assure you that Navelgazing Midwife’s comment was NOT deleted; it’s possible it may have been caught by our spam filter. Or it’s possible you didn’t look carefully for it, as it appears right before your post.
What a surprise! The same un-informed drivel in the editorial as on the radio show.
A few things to clear up:
1)Home birth is not “essentially illegal” in NC. It is perfectly legal and a valid choice. This state would just prefer couples to do it unassisted rather than with the help of women who have completed rigorous training, a national board, and have a nationally recognized lisense to do so.
2)The .2% statistic is actually lower among births attended by CPM’s. That stat takes into account ALL home births, not just those attended by CPM’s.
3)I see no mention in this article about how the U.S. is among the only industrialized countries that don’t seemlessly fit CPM’s into maternity practices and yet has one of the WORST maternal and infant mortality rates.
4)For someone who rails against Obamacare on a regular basis you seem to have no trouble with this sort of forced health care.
5) While I realize it creates quite the sensation for you say that Medwin was arrested three times, you once again fail to report the facts, not the least of which is that in at least one of those cases ALL CHARGES WERE COMPLETELY DROPPED.
6) And finally, one of your paragraphs was taken directly from comments made by someone who calls herself “Dr.” Amy. So not only is the editorial marginal on facts it’s not even original. Please in the future at least attempt to do your own research before spouting this garbage.
http://navelgazingmidwife.squarespace.com/navelgazing-midwife-blog/2011/3/9/comment-to-are-home-births-safe.html
I am a soon to be first time mom, and intend to deliver at home. I have also been accepted to graduate school for nurse-midwifery. I’m really surprised at how uninformed and biased this article is! My CPM has a transfer rate of 6% and a c-section rate of 4%. Where in the world did you come up with 40%? Women wouldn’t hire a CPM with that rate! I’d like you to post your resources and references please, I think you have been ill informed and are doing a disservice to the homebirthing community and those who are interested in homebirthing. Also, where do you get off calling us homebirthers militant? We are doctors, nurse-midwives, nurses, stay at home moms, active duty military families, hourly workers, and more. We are a diverse group united by one common characteristic: we want what’s best for our babies and don’t think that giving birth strapped to a table in a position that actually decreases the circumference of the pelvis hooked up to drugs that can cause fetal distress is a good idea.
In my opinion, medical treatment is only needed if something is wrong. & Comparing having an appendectomies and giving birth certainly demonstrates her ignorance. Birth is a natural process – the egg is fertilized, it grows, and after nine months it comes out of the womb. Having your appendix removed is medically necessary because something is wrong – your appendix ruptures and if left untreated you can die so you must seek medical treatment to have it surgically removed. Also, if other states like FL and California can license midwives and the midwives have the proper equipment to handle emergency situations and the birthing experience is successful, then why can’t NC? I haven’t heard a convincing argument for keeping the law as it is – and Tara’s argument is certainly a weak one.
This is just silliness. Tara Servatius is being purposely inflammatory. Creative Loafing knows this. Creative Loafing doesn’t need to demonstrate hard-hitting journalism, it just needs to be picked up for entertainment to satisfy its advertisers.
Servatius may pat herself on the back for asking what she might think are “tough questions,” but at the end of the day, no one who is actually pregnant and about to have a baby is going to take her advice over even that of someone semi-informed. She is clearly only writing to scare people.
There is another word for people who want to return to 1886: muckraker. Too bad for Creative Loafing, Servatius ain’t one of these people. I’ve read more informed writing on bathroom stalls. Perhaps readers should accuse Servatius of “journalistic abuse,” but my guess is that even the “militants” don’t really care.
What a terrible article! I am surprised she has a job as a professional journalist.
1. Check on her said facts. She is comparing “apples to oranges” http://www.thebigpushformidwives.org/index.cfm/fuseaction/home.showpage/pageID/67/index.htm
2. Birth became safer when better sterilization techniques became common practice, not because of hospital intervention. Proof? We are rank 50th in the world in maternal mortality rates. Who’s on top? The Netherlands were many more women give birth safely outside of hospitals http://www.arhp.org/publications-and-resources/contraception-journal/march-2011
3. Worried about what skills it takes to be a CPM, Certified Professional Midwife, see the North American Registry of Midwives website http://www.narm.org
4. Licensing CPMs will increase safety. Homebirth is a CHOICE!
frankgriffen makes some good points – It is a woman’s right to give birth at home if she chooses. And if people are providing services that require training, and can affect the health of others, they should be licensed.
This is what the families in North Carolina are asking for. They want to be able to choose home birth with licensed providers. Certified Professional Midwives are trained specifically in home birth. Studies support the safety of home birth with Certified Professional Midwives.
Having a homebirth midwife arrested frightened the families who are counting on midwives to attend their home deliveries. They don’t want the same to happen to their midwives, and they are asking the state to step in and regulate the only midwives who are specifically trained to assist their families.
Oddly, many of the women who died in childbirth 200 or so years ago, died because DOCTORS would examine laboring women after doing autopsies, without washing their hands. Women were afraid to deliver in the hospital because so many died there. Once doctors learned about germs, and started washing their hands, and better yet after the introduction of antibiotics, the death rates dropped. It had nothing to do with the training of those attending births. The women who stayed at home, and usually lived in those days were usually attended by midwives who were professionally trained in Europe.
Whether a woman delivers at home under the care of a midwife, or in the hospital under the care of a medical student (with an Attending Dr. a phone call away), she has to choose her own set of risks. A woman delivering in the hospital these days has a one in three risk of ending up with major abdominal surgery. Not a risk to take lightly.
This article was so poorly researched and written that it made me laugh in several places.
The hospitals where doctors did autopsies before examining women had mortality rates of up to 40%. This was way higher than the average of about 19%. The main point I was wanting to make is that childbirth is natural BUT death was also a common and natural part of child birth in the past due to people not having any modern day understanding of health practices. If people went about delivering babies without a doctor or a midwife we would probably get a large number of fatalities even today.
Personally I would want the drugs at a hospital because man this baby stuff looks painful! My wife had a hard time getting a female doctor. Since you cannot time when the baby would be born we ended up with a guy 2 out of 3 times. I am amazed that baby delivery has been absent women for so long. Nothing against the guys but most women would rather have another girl dealing with this issue.
You are right…people have become very detatched from the dangers of life. Especially since most OB’s throw out how “safe” and “necessary” routine C-Sections are. I have so many friends who were “advised” by their OB’s to get C-Sections for their breech baby/too big baby/too small baby/they sneezed wrong/they were “overdue”…on and on. They were all quite “surprised” at how major the surgery was…and STILL have issues with the procedure (pain, adhesion, etc).
Hospitals are for sick people. Hospitals are for people who NEED medical intervention. If a woman is high-risk from the get-go, she should be fully (and accurately) advised of her risks for homebirth and hospital births and given the choice to make. 200 years ago, we did not have the knowledge of sanitation and all. That 19% is NOT encompassing of “just” homebirths, but all births total. It is sad to think that in this day and age with all of our “great medical” care and health care system, we are ranked amongst the worst to have a baby.
There are a lot of procedures done in hospitals that DAMAGE the birthing process: 1) No food–how does a woman labor for 24+ hours with absolutely no sustenance? Ice chips? Really? It’s been proven that relying on ice/snow/etc. will actually speed up the body’s starvation. At home, women are allowed the freedom to eat. MOST women are not going to sit down to a 7 course meal in between contractions. The body self-regulates. A few chicken nuggets here, some raw fruits and veggies there…all in moderation so the body can continue to do what it, usually, knows to do.
2) Making women “stay”. Movement greatly decreases labor pains. In most hospitals, women are discouraged from moving around too much…they don’t want you walking the halls because they do not want you to fall. The rooms are too small to really get movement in there. At home, women are given the freedom to walk, squat, stretch, and move in ways that feel good to them. They are not attached to constant monitoring, forced to lay on their backs (the absolute worst of all positions) and starve themselves.
3) Vaginal exams. The hospital puts “progress” based upon how many centimeters a woman opens an hour. The very truth of the matter is…no one is the same. Yet, most hospitals tell women that if they do not deliver within 12 hours, they will need to undergo “an emergency c-section”. Vaginal exams are NOT indicative of progress or lack of progress. If mom and baby are fine, the best rule of thumb is to leave them alone.
Hospitals definitely have their place in our society. They have done many wonderful things and have saved many lives. However, MEDICAL care for low-risk moms only causes them to become “high-risk” for their next birth. Legalizing/certifying CPMs to meet the needs of women is the best course of action to take. If you are concerned with the “lack of education” of CPMs…keeping them “illegal or uncertified” will not improve it. Women are going to homebirth regardless of the status of CPMs. Homebirth is a very valid and safe choice…and can be made even safer by certifying the CPMs attending those births. Opening the doors for the hospitals to receive homebirthing women without contempt or disdain (and their midwives) will make the whole system much more mom/baby friendly and I’m sure our nation will become one of the top in maternal and infant safety.
I think that is safe, just cherish the life of modern people, and fear out of any accident.maybe you can see the soldes asics .
The number of C sections went way up when hospitals began getting sued by people like John Edwards. Trial lawyers tried to say that hospitals were negligent for not performing a C-section in certain situations. The consequence of this was that hospitals began performing defensive C sections. The number of abnormalities cited by people like Edwards did not change during this time proving that the hospital did nothing wrong but the damage has been done and now women are suffering the consequences of past actions by snake oil lawyers like John Edwards. This would be a topic that goes against Tara’s previous article. Some of the pain an suffering awards are completely unjustified and it was common enough that Edwards made millions of dollars off of it.
The damage from a C section makes normal birthing much more dangerous the next time around.
While you discuss the decline in mortality rate; you fail to recognize the rise in Autism.
Inductions, the use of Pitocin, has gone up drastically. So has the documented cases of Autism. Coincidence? I don’t think so.
The World Health Organization notes an Association between the use to Pitocin and Autistic disorders. http://www.autismtoday.com/articles/ATTN_Researchers.htm
Let’s dig a little deeper and look closer at the facts:
“The CDC’s most recent guess is that they could be missing as much as 2/3 of the maternal deaths. (Johnson & Rutledge, 1998) —surely, a conservative estimate. In that same publication, the CDC admitted that in 1996 that not only had there been no improvement in the maternal death ratio since 1982 but that the officially reported ratio was a substantial underestimate because there are so many classification errors in the system.”
“…Not only do we have a comparatively high death rate for women from causes directly related to pregnancy or birth, we are almost certainly failing to gather most of the data.” [excerpted from “Maternal Death in the United States: A Problem Solved or a Problem Ignored? Part I”
By Ina May Gaskin, CPM, MA
Originally published by Journal of Perinatal Education, 2008-03-04].
http://www.inamay.com/?page_id=79
The bar to be declared autistic has be lower so now everyone can be part of the autism spectrum. Since the definition of autism has change we cannot compare old numbers to new numbers. Also if you use a bigger net (loosen the definition of autism) you are going to catch more fish. Until we can again compare apples to apples, any autism stats are worthless.