Belly Tales

The AMA has recently issued a resolution supporting ACOG’s Statement on Homebirth which agrees that the safest place to have a baby is the hospital, of course, where obstetricians work and get paid.  What’s really awful is that they’re using Ricki Lake’s movie, The Business of Being Born, as a tool to try to pass laws that would mandate that all births occur in hospitals, since hospitals are the “safest” place to give birth.  Nevermind that in this country (at least for now) all women have the right to make their own choices about their bodies and the health care they receive, or the fact that the U.S. has one of the worst rates of neonatal and maternal mortality among developed countries and that (wow, what a surprise) 90% of all our birth occur in hospitals, or that other countries with much better mortality rates wholeheartedly support and embrace homebirth and that there is strong evidence-based research which backs this up.  Nevermind all that.  In this country, it’s money that does the talking, and money which sets the agenda and passes laws….and now, the AMA, with all its money, has unsurprisingly agreed with ACOG’s ridiculous statement.

The Huffington Post has an article up detailing all of the furor, along with a raging debate in the comments section.  Please, if you care about this even a little bit, visit the article and post a comment.  The more comments the Huffington Post receives, the higher the likelihood that they’ll move the article to their “favorites” section, which will keep the article up on their website for days.  The more comments and press this topic gest in the blogosphere and in the media, the more women will hear this message, and the more this subject will become part of our national debate.  Every comment counts!  Here’s the link again: Docs to women: Pay no attention to Ricki Lake’s homebirth

The American College of Obstetricians and Gynecologists (ACOG) recently issued a Statement on Homebirth which condemns homebirth and all those who are willing to attend homebirth (aka midwives), concluding that only “…the safest setting for labor, delivery, and the immediate postpartum period is in the hospital, or a birthing center within a hospital complex, that meets the standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.”

Many other websites have covered this topic in exhaustive detail, so I’ll refer you to them in just a moment, but first a few comments of my own. As Rixa rightly pointed out on her blog The True Face of Birth, ACOG’s sudden acceptance of out-of-hospital birth facilities (i.e. freestanding birth centers) flies directly in the face of their earlier November, 2006 Statement on the subject, where they were adamant that the hospital “is the safest setting for labor, delivery, and the immediate postpartum period,” and that “ACOG strongly opposes out-of-hospital births.” I wonder what caused the sudden change of heart? If you recall, during the time, ACOG and the American Association of Birth Centers (AABC) were not on such buddy-buddy terms. In fact, the AACB wrote a scathing denouncement of ACOG’s statement. Opposing out of hospital birth included births that occurred in freestanding birth centers as well as in homes. I guess in deciding to attack homebirth directly, maybe ACOG decided that it would be better off having the AACB as an ally rather than an enemy, and included freestanding birth centers in its list of “acceptable birthing places” this time around. Who knows. There has got to be so much back-room wheeling and dealing and politics involved in all of this that one can only wonder at the motives. But crucially, why must support of freestanding birth centers be at the expense of homebirth?

It’s also interesting to note that the ACNM has yet to issue a response to this. Is that because they’re partly mollified by ACOG’s acceptance of certified nurse-midwives to the exclusion of all other midwives? From the ACOG statement: “For women who choose a midwife to help deliver their baby, it is critical that they choose only ACNM-certified or AMCB-certified midwives that collaborate with a physician to deliver their baby in a hospital, hospital-based birthing center, or properly accredited freestanding birth center.” Making distinctions like that among midwives in our country (CNMs v. CPMs) only hurts our profession as a whole and is going to get the overall profession of midwifery absolutely no where, but I’ve already written about this ad nauseum. And what about the hundreds of Certified-Nurse Midwives/ Certified Midwives who attend homebirths? Dear ACNM: Just because the majority fo CNMs/CMs work in hospitals doesn’t mean that those who work in homes don’t need a response statement from you. You’re still the professional organization for ALL Certified Nurse Midwives and Certified Midwives—even those who perform homebirth. If you won’t stand up for a woman’s right to give birth in a home, at least stand up for the midwives you represent who deliver in homes….even if it means butting heads with your beloved ACOG.

As Rixa conjectured, maybe all of this is indeed in response to Ricki Lake and Abby Epstein’s documentary The Business of Being Born, which has done a terrific job of raising awareness regarding homebirth. The real question we need to continue to ask ourselves is this: Why is it that America, with all of it’s insistence on hospital birth and safety, still has one of the highest rates of neonatal and maternal mortality among developed countries? That question lies at the heart of The Business of Being Born, and clearly, the American way of doing birth, for all its emphasis on hospitals and safety, has not adequately addressed this. What we need is a statement from ACOG more along the lines of the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives (RCM), which both jointly support homebirth, in sharp contrast to what ACOG has churned out (kudos to Rixa for finding and posting this in its entirety). Just read the first few lines of the document:

The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) support home birth for women with uncomplicated pregnancies. There is no reason why home birth should not be offered to women at low risk of complications and it may confer considerable benefits for them and their families. There is ample evidence showing that labouring at home increases a woman’s likelihood of a birth that is both satisfying and safe, with implications for her health and that of her baby.^1–3

What a refreshingly different point of view. Surely American women aren’t that different from British women? Surely our healthcare systems are not that different? Why can homebirth be safe on one side of the pond, and unsafe on the other? Yeah, you guessed it: one side is actually basing its policy on research and fact, while the other is pandering in fear, uncertainty and doubt. And don’t forget the economics at work here. ACOG is a professional organization supporting and marketing the services of its members: obstetricians. In other words, a lobby. Again as the Business of Being Born points out, the bottom line is always the bottom line. If we had a national healthcare system like the NHS, where homebirth actually translates to increased savings, rather than a competitive profit-driven healthcare system and a surplus of obstetricians, we’d probably be seeing a lot more governtment-funded support for homebirth.

This is the line that really sticks in my craw: “The main goal should be a healthy and safe outcome for both mother and baby. Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby.” You selfish, selfish mothers, trying to enjoy your relaxing, all-natural births at the expense of your babies! The mother and the baby have become hopelessly estranged in the minds of American medicine, and the emphasis (and increasingly, the legal rights) of the baby are always seen as more important than those of the mother. Rather than motherbaby, where the two are linked and the health and wellbeing (physical, mental and emotional) of one is dependent on the other, we have fetal rights outstripping maternal rights, in courts as well as in hospitals. Why can’t modern medicine seem to get it through its skull: what’s good for the mother is ALSO GOOD FOR THE BABY. The two are not diametrically opposed. When a woman feels safe, supported and relaxed, she’s able to sink into her labor and allow her birth to unfold in the manner that’s best for the baby, without all of the stress hormones and cortisol, without all of the fear….and more often than not, with stunningly good outcomes.

In any case, you should go read the rest of Rixa’s post on The True Face of Birth ASAP: 10 Responses to ACOG’s statement on homebirth, as well as the other responses cropping up around the blogosphere.

I’ve been sick as a dog for the past three days, for the second time this season (I was so sick right before Thanksgiving that I actually lost my voice and had to call in sick to work…something which I NEVER do).  Luckily I’ve had the past 3 days off to recover, but I’m due to be back at work again tomorrow, and I’m not sure how my voice will hold up.  I keep coughing up icky green stuff, and I feel like this is potentially moving into my lungs.  I’m so rarely sick!  It must be all of the chronic stress of being a new midwife which has absolutely blitzed my immune system.  Joy.  At least I’m over the contagious part of it, so that when I’m at work tomorrow I won’t be getting pregnant women ill as well.

In any case, I’m not up for writing much of anything, but I found another amazing video over at Sage Femme’s, and thought I’d share it too.  It’s been up at Sage Femme’s for awhile, and I’ve seen it before, but since I only just recently learned how to embed You Tube videos, might as well polish the new skills, w00t!  This one is ultimately brought to you by the folks over at International Cesarean Awareness Network.  Just goes to show what a bogus diagnosis “cephalo-pelvic disproportion” (CPD) often is, and what a VBAC can accomplish when it’s actually allowed to proceed (which is why the declining VBAC rate is an absolute tragedy).  Baby heads are made to mold, and pelvises are made to stretch.  Given enough time and patience, I believe that almost all babies, regardless of size, will make their way into the world.   And just look at the triumph on these women’s faces.  Talk about blowing a raspberry to the entire technocratic fear-based model of birth!

I just discovered the most amazing videos over on You Tube about a traditional midwife working in Mexico. I’m sure many of you have probably seen them already, but I was just blown away!! It’s amazing to watch the way she uses her hands to massage, assess, palpate…turn a breech baby. A midwife’s greatest tool is her hands. I wonder how many of the women I see in the clinic come from traditional midwifery practices like this. American midwifery must seem very different to them. At it’s heart, I think the respect and tenderness and kindness to pregnant women remains the same, but we could learn so much from traditional practices like this. It makes me want to quit my job, fly down to Mexico and study with her for a year. In any case, enjoy!

The other day I discovered a postcard at my local yoga center urging women to participate in a birth survey, which instantly piqued my interest; apparently this survey has already been going on for some time, although I have only now heard about it. A little research has revealed that the Coalition for Improving Maternity Services (CIMS) has launched a new program entitled The Transparency in Maternity Care Project, which is intended to research and explore maternity care in this country, with an emphasis on improving the transparency of maternity care. Unlike other areas of medicine, hospitals and maternity care providers are still pretty cagey when it comes to being open with their numbers. What is the c-section rate for specific doctors or hospitals? What is the VBAC rate? How many providers perform episiotomies? How many elective cesareans or inductions occur annually? Hard numbers like this are always notoriously hard to come by. And of coruse, beyond the actual numbers themselves, women’s experiences with maternity care providers and services and overall satisfaction is often something which is overlooked. It seems like The Transparency in Maternity Care Project is trying to fix all of that, and is acting as a follow-up to the Listening to Mothers surveys which occurred in 2002 and 2006. Like Listening to Mothers I and II, a survey lies at the heart of The Transparency in Maternity Care Project, which can be found at the following website: www.TheBirthSurvey.com. The pilot survey is occurring in New York City right now, between July 2007 and July 2008.

There were many reasons to choose New York City as our pilot site.

First: New York is a large, high profile city offering a wide variety of birth options.

It is a densely populated and well-networked urban center. There is easy access to multiple press/media outlets. Approximately 125,000 births occur in NYC per year. Forty-four hospitals provide maternity care services. The majority of the country’s obstetricians are trained in NYC. Two Free-standing Birth Centers are in operation. An established homebirth community thrives. Nearly 10% of births in NY are attended by midwives.

Second: The Grassroots Advocates Committee will be piloting the project in partnership with Choices in Childbirth (CIC), an active grassroots organization based in NYC.

CIC is well connected with the NYC birth community. CIC publishes The New York Guide to a Healthy Birth – in 2007, 20,000 copies advertising The Birth Survey will be distributed free to the public. A member of the GAC and CIC is based in NYC and will be engaged in the day-to-day oversight of the pilot.

Third: New York State is one of only two states with a Maternity Information Act.

The MIA provides the public with legal access to intervention rates at the facility level. Choices in Childbirth is connected with the NYS Department of Health and has already collected the intervention rates for all New York hospitals.

So, if you live in NYC and have given birth in NYC, here’s your chance to discuss your experience and provide valuable information and feedback about birth in our country. Please participate in the birth survey ASAP. As for the rest of the country, the project plans to unveil a national survey next summer, but if you’re super motivated, you can provide feedback about your birth experience at www.drscore.com.

There was a recent article in the NY Daily News on the homebirth practice of Joan Bryson, a Brooklyn midwife who has been delivering babies at home for over seven years now.  Joan also served as president of the local NYC ANCM chapter last year.

Last year, Bryson delivered nearly 50 babies throughout the city. The business, which grossed about $250,000, has grown steadily since its inception in 2000, when Bryson handled just four births.

Wow, so nice to see homebirth practice growing in New York right now.  And now nice to see a well-written, balanced, pro-midwifery article in a mainstream newspaper with a high-readership.

Miles for Midwives, yesterday, was also a great success.  There were 282 people participating, the largest number so far.  This event has also grown every year that it’s occurred, which is another really promising sign.  Let’s hear it for midwives and midwifery getting out into the news!

Last Friday I was a very lucky duck: I was able to attend a screening of The Business of Being Born at the Tribeca Film Festival, hosted by Friends of the Birth Center, along with a post-show talkbalk with the Abby Epstein, the director of the movie, and Ricki Lake, the producer, followed by a cocktail reception. Given that the tickets to the screening (with proceeds going to Friends of the Birth Center) had sold out in less than 24 hours, and the line waiting to get in was a roll-call of who’s who in the New York City birthing community, I felt very lucky and very privileged to be part of this experience.

Most of the early press on the film has been encouraging rather than caustic, and everything I had heard by word-of-mouth was nothing but positive. I actually know many of the midwives and nurses and one or two of the doctors that are feautured in it, and I trusted their voices and their ability to speak accurately about birth and midwifery. Even so, I must admit I’m always a bit trepidatious when it comes to anything about midwives in the mainstream media. I’m always worried that somehow the media will get it wrong—they won’t get the full picture, they won’t understand the smaller details, they’ll paint our profession in broad, misinformed strokes, or they’ll fall back on stereotypes—with the end result being that the much-needed media attention, instead of being a welcome and helpful boon, actually does nothing more than continue to misinform and confuse the public about exactly what it is we do. It’s often a mixed blessing. I was also concerned that this film might be disregarded as too far out on the fringe—that it would come across like a very slanted Michael Moore documentary and therefore not have the universal appeal needed in order for it to be taken seriously by the mainstream public.

These fears were somewhat allayed when the announcer for the film—a man—came out and assured the men in the audience that if they were expecting to suffer through a “chick flick”, they were in for a very pleasant surprise. Apparently he had been on the Tribeca Film Festival selection committee, and it was one of the other men on the committee who had first approached him about the film, saying that he had really kind of liked it and needed a second opinion. As it turns out, the film’s biggest supporterters on the selection committee were these two men, both of whom had known absolutely nothing about birth prior to watching the film, but had found it to be a very fascinating, informative and well-researched documentary. The announcer kept it short and sweet, and then, without further adieu, the lights went down, and the film began.

The Business of Being Born sets out to explore the business of maternity care in our country. Along the way, the film raises a lot of difficult questions, which it then attempts to answer: why are the infant and maternal mortality rates in the US the second worst in the world when compared to other developed countries? Why do midwives deliver 60-80% of all births in other developed countries, but only 8% here? Why is our cesarean rate so high, especially when compared to other countries which have a much lower cesarean rate but much better overall outcomes? Why are so many mothers so disatisfied with their birth experience or maternity care? Why do so many of our births occur in hospitals? Why is the prevailing attitude towards birth one of fear, rather than of trust and normalcy? You know, just the sort of complicated questions which keep midwives up at night, but which very few other people ever stop to think about (I’m pretty sure it was Pat Burkhardt, director of the NYU Midwifery program, who rightly points out that most people do more research on buying a new car or appliance or camera than they do on their choices and options when it comes to birth). The film tackles these complicated questions from several angles, including the vicious circle of medicated birth (epidural leading to pitocin leading to more epidural leading to nonreassuring fetal status leading to cesarean, all done in cute cartoon format), the pervasive fear-mongering of birth on TV and in the media, the status symbol of “too posh to push” and “designer deliveries”, insurance issues, malpractice issues, even touching upon possible implications of disturbing the delicate “love cocktail” of hormones present in unmedicated births which facilitates bonding and maternal instinct. Quite a big mouthful to bite off for one small film.

The opening sequence of the film begins at 3:25 am, as a homebirth midwife (Cara Muhlhahn) prepares her birth bag before heading out to a birth. This footage is interspersed with people discussing their initial perceptions of midwifery and midwives. Not surprisingly, many of the people being questioned have either never heard of midwives before, or assumed that they were untrained granny-midwife types. A few people express disbelief that anyone would choose to have birth somewhere other than a hospital, or with someone other than a doctor. One man says something like “I didn’t even know midwives still existed”. We cut back to the homebirth midwife in her apartment, packing her bag. The idea that midwives are untrained grannies more likely to treat you with herbs than a prescription is quietly challenged by her preparations: we see her checking her oxygen tank, preparing her suture and syringes, counting vials of pitocin and other medicines, packing liters of IV fluid still neatly sealed in their bags, along with IV tubing, and then setting off to the birth.

Without a doubt, one of the best things about this film is the sheer number of unmedicated births that it shows. While attending and seeing births was something that was familiar and commonplace to many people at the turn of the century, in its move from the home to the hospital, birth has become isolated from everyday life, no longer thought of as a routine, normal occurrence. Today, most people have never been to a birth prior to having their own baby. What few births people do see are usually on TV, where they’re either wildly dramatic, such as the screaming, frantic woman on ER, or complicated and scary, such as on A Baby Story, where it seems like routine, normal vaginal births are often passed over in favor of dramatic life-and-death births, which probably garner much better ratings. Also, whenever birth is seen on TV, it is unfailingly (inevitably) set in the hospital. However, The Business of Being Born thankfully turns all of this on its head, showing what real, normal, uncomplicated, unmedicated birth actually looks like—something most people have probably never seen before. The audience is exposed, perhaps for the first time, to the sights and sounds of unmedicated labor. Instead of screaming and drama, women are shown rocking and swaying, moaning and grunting and sweating. Instead of beeping machines and alarms sounding, heads emerge from between legs in relative silence as the mothers are left undisturbed, pushing with quiet concentration and determination. We’re shown births attended by midwives in homes and birthing centers, births in tubs and pools, births squatting and standing; we even see Ricki Lake’s homebirth, in a bathtub.

While many famous, leading authorities (Michel Odent, Marsden Wagner, Ina May Gaskin, Robbie Davis-Floyd, to name a few) and many leaders in the New York City birthing community spend a lot of time discussing the issues behind the business of birth in the film, it’s often the images themselves which speak the loudest. Forget what the experts are saying: the audience is actually able to see it, with their own eyes. The images of women concentrating and pushing with power and strength, in tubs, kneeling on beds, supported by their partners, squatting or rocking, versus the images of women flat on their backs in the hospital, covered in tubes and oxygen masks, being told to “push!”, their legs in stirrups or held by staff, supine on gurneys being wheeled to the operating room, provides a message far more clear and visceral than any book or 5-hour lecture on the subject could manage. This, more than any other aspect of the film, probably provides the greatest education to the audience.

One of the issues raised at the talk-back session after the show was the decision to include director Abby Epstein’s birth in the film. Although she was planning on having a homebirth with Cara Muhlhahn, she went into labor at 35 weeks, and because her baby was breech, she needed a cesarean. While including this birth at the end of the film does put a bit of a damper on the natural-birth/homebirth high of the film, at the same time it demonstrates a very crucial point: homebirth and midwifery care is safe care. Midwives don’t take stupid risks, they have good clinical judgement, and they make good calls; they’re not going to try to deliver a premature breech baby at home. I also think it’s important for the audience to see that birth doesn’t always go according to plan, and that flexibiilty and the ability to roll with a change in circumstance is one of the most important aspects of a successful birth experience, and that support during these difficult transitions is also key. This birth also shows the system working exactly the way it should: the midwife takes care of the low-risk patient, but when low-risk becomes high-risk, the patient is transferred to the back-up doctor, and seamless, excellent healthcare is provided to the woman.

Perhaps the only problem with this is the fact that the care is almost too seamless. When Abby Epstein mentioned to her doctor that she was planning a homebirth, his enthusiastic response is just a little too quick. You can’t help but wonder: if the camera hadn’t been there, capturing the moment, would he have so readily offered to serve as back-up, or would he have tried to talk her out of having a homebirth using scare tactics or punitive manipulation? (This is by no means a statement on this particular doctor in the film, whom I personally know to be very supportive of midwives and midwifery, but rather a statement on the larger, more generalized attitudes of doctors towards midwifery and homebirth). In reality, it’s rarely so smooth a transition, and doctors are rarely so enthusiastic when they hear that their patients are planning a homebirth. While the film touches briefly on the competition between doctors and midwives and the fact that many doctors are vehemently anti-homebirth, the smooth transition of care between Abby Epstein’s homebirth midwife and back-up doctor is potentially misleading. The audience can walk away from the film thinking that this is a very easy thing to arrange, when actually, one of the biggest barriers to providing homebirth as a viable option to more women in this country is the lack of back-up providers and the challenges faced in trying to arrange appropriate back-up; rather than being smooth and easy, it’s often complex, frustrating and fraught with politics.

My only other critique of the film is that it is perhaps a bit too black and white: homebirth v. hospital, midwife v. doctor, unmedicated, natural childbirth v. monstrosity of tubes and terror. While the film did follow a hospital-based midwife (Catherine Tanksley), and showed midwives in hospitals, the emphasis seemed to be on homebirth. The truth is that in this country far more midwives practice in hospitals than they do in homes, and the word “midwife” is not synonymous with “unmedicated childbirth”. While midwives are experts in normal, unmedicated births, we’re not anti-epidural or anti-hospital. We can prescribe narcotics and pain relief in labor, we can order epidurals, we can support a woman through a medicated birth experience just as easily as an unmedicated birth—it really just boils down to the desires, needs and expectations of the woman and her family. Unfortunately, I can very easily see a woman walking away from this film and thinking “well, midwives are great for natural childbirth, but I want an epidural, so I guess that means I’ve got to go to a doctor”. While all of the beautiful, natural homebirths in this film are a joy and privilege to watch, I think one or two equally beautiful and joyous hospital births attended by midwives might have added a more balanced perspective to the film.

Nevertheless, overall I thought the film was truly amazing; it brought tears to my eyes on several occassions. Rather than being far out on the left fringe as I had feared, I was actually blown away by how mainstream and accessible it was. It begins with the assumption that the audience knows absolutely nothing about birth and the business of birth in this country, and then moves on from there, using a simple and easy-to-understand, yet powerful and engrossing format and narrative. Forget the Ricki Lake Show; I think this film will be a new highlight in her career, and I’m very grateful that a film like this has finally been made. I want all of my friends, my beloved boy, my family, my peers, to see this film so that they can finally see and understand exactly what it is that I do, and why I do it, and what I believe in. Hopefully this film will be picked up by a national distributor and shown in cities all over the country; hopefully soon it will be playing at a theater near you. If it is, you’ll have to go and see it—and bring all of your friends with you!

My post last week on the UK’s new birth agenda Maternity Matters prompted a UK midwife, Anna Skye, to write the following response on her blog Tales of Midwifery—the Truth. Rather a much-needed reality check, I suppose, to someone (yours truly) whose knowledge of the matter was based only on what she was reading in the media and on government websites. Somewhat deflating, as well, but at least it’s comforting on some level to know that midwives in the UK face just as many challenges as midwives here in the US, and that the true commonality between us may very well be our committment to continue to fight against overwhelming odds and overwhelming systems. When you decide to become a midwife, I think you are committing yourself to a life of pouring your energy and passion and heart and soul and blood and sweat and tears into a cause and a goal that requires enormous work and enormous sacrifice, but does, indeed, make change….just very, very, very slowly. But then, I am still a student, and not yet burnt-out or jaded. Perhaps you should ask me again in another 20 years; hopefully I’ll still be here, still fighting.

So, I didn’t think I’d be doing much blogging over my holiday, but as luck would have it, there’s a big debate about birth occurring in England right now—so big it’s been splashed across the pages of many of the newspapers I’ve been reading, and absolutely impossible to ignore. UK Health Secretary, Patricia Hewitt, recently released a new document entitled Maternity Matters which outlines the UK’s proposed new agenda to provide consistent, individualized midwifery care and increased birth choices within the NHS by the year 2009. Looking through the document and the changes it proposes, I can only cheer; Maternity Matters is aiming to provide improved safety, accessibility and continuity of care to all women in the UK, including a choice gaurantee:

“By the end of 2009, women will be able to have:

- choice of how to access maternity care - women will be able to go directly to a midwife or via a doctor.

- choice of type of antenatal care - women will be able to choose between midwifery care or care led by both doctors and midwives

- choice of place of birth - depending on their medical history and circumstances, women and their partners will be able to choose between home births, or giving birth in a midwifery unit or with midwives and doctors in hospital

- choice of place of postnatal care - women will be able to chose how and where to access postnatal care.”

If these changes are adopted, homebirth in the UK will become a viable option again for many women with uncomplicated pregnancies who meet certain low-risk criteria. From a London Times article on the subject:

At the moment just 2% of deliveries in England take place at home but midwives believe this could increase to a third of all births.“The proportion of overall deliveries at home remains static at 2% and we believe that, given a genuine, properly-supported choice many women would choose a home birth,” said Lewis.

“Part of this strategy is to ensure that a home birth becomes a serious and realistic option. …“We know that, if we look at the evidence from other countries, where women have the confidence and support to make this a safe option, there is evidence of a significant increase in women choosing home births.”…

In Holland a third of all women give birth at home. In Wales, where 3% of deliveries are home births, the Welsh assembly has set a target of 10% by the end of this year. In Scotland 1% of births are at home while the figure for Northern Ireland is 0.4%. Devon is the English county with the highest number of women giving birth at home, with a rate of 5%.

Belinda Phipps, chief executive of the National Childbirth Trust, said: “If Holland can manage 30% of all births taking place at home then Britain can do the same.

Of course, this will require a careful assessment of the resources available, as well as a large increase in the number of midwives in the UK (right now, the Royal College of Midwives estimates that the UK is several thousand midwives short of what will be needed to implement these target goals), but listening to a BBC radio interview with Health Secretary Patricia Hewitt, I was encourged to hear how carefully customized the approach will be, examining the needs of each primary care trust, and assessing what resouces are needed to make these proposed changes reality by 2009. If these changes are implemented as proposed, I think the results will be absolutely outstanding.

I say “if”, however, because while I was in England, I was amazed by the amount of negative press I kept seeing on this proposal. If the media’s very loud, very uninformed voice is able to sway public opinion on this matter, I fear these changes will never become reality. Nevermind the BBC interview above, where the interviewer began bullying and interrupting Patricia Hewitt before she could even finish explaining what the proposal was all about—other authors have written even more poorly researched and grossly stereotyped articles. For example, Alice Miles’ London Times article Natural birth! Hello? This is the 21st Century:

Yet we must do more than chuckle, for Maternity Matters is no joke. It is the next stage in a midwife-led campaign to limit the choice available to women giving birth. …A “normal” birth . . . birth without medical intervention: why? Why should we? This is an extraordinary conspiracy against women, a sort of quasi-religious belief in the virtue of pain, which Ms Hewitt is bafflingly encouraging. …We are not expected to have our hips fixed naturally. We are not even expected to endure a mild headache without a paracetamol. Yet somehow the deeply painful and, for some, traumatic experience of giving birth is forced upon woman after woman in the name of some Earth Mother concept. …These midwives trained to help women give birth are for some reason trained only to help them give birth naturally. They are the chief conspirators against us. Please, let us have fewer of them, not more, Ms Hewitt.

Good gods! She’s on a mission, that’s for sure. And while I do feel that on some level this article is motivated by a deep-seated fear of pain, there are several things which must be addressed here. First of all, no one here is proposing to FORCE a woman to have a natural childbirth. Nor do I think it’s the normal modus opperandi of midwives to ignore a woman in pain, or to ignore her desire for pain relief; yes, midwives are trained to help women give birth naturally—we are specialists in normal birth—but I can’t imagine any situation where pain medication would be refused, if that’s what a woman wants. It seems to me that what this proposal is doing is trying to offer more choice, not less. Birth with epidural anesthesia is already widely available and the norm for many women in the UK; for those women who feel very strongly about pain relief, they have the option of planning for a birth in the hospital, with their epidural waiting for them on arrival. They have always had this option, and no one is going to take that away. But for those women who would prefer to have their child at home, and who often encounter resistence of difficulty in pursuing this option, the UK’s new proposal is simply intending to make this choice more readily available to them as well.

While Miles seems to be painting homebirth as a backwards, Luddite option, something akin to squatting behind a bush, and a choice only made by ludicrous, fringe elements of society—earth mothers and hippies—in actuality, research has shown that a planned homebirth for a low risk woman, with emergency transport arrangements made in advance and trained care providers (that would be those natural-birth obsessed midwives, Ms. Miles) attending, is just as safe as hospital birth. Period. In painting homebirth as a choice made by the fringe, she’s mocking and alienating all of the women who make that choice, and who probably wouldn’t consider themselves earth mothers or hippies at all. And who in their right mind would compare childbirth to having your hip fixed? In one case, something is seriously wrong, and needs immediate repair; in the other case, usually nothing is seriously wrong, your body is going about a perfectly healthy, normal process that it has, in fact, been painstakingly designed to do (from an evolutionary perspective), and which often works best when medical intervention is avoided.

Maybe a “predictable, pain-free [cesarean] birth…with a sugeon I had met and trusted, accompanied by lots and lots of drugs” is what Miles would advocate, but the entire point of this is informed consent. Advocating for planned cesareans across the board is just as obsessed and single-minded as painting all women who choose homebirth or pain-free birth as freaks. Nevermind the fact that solid research has shown that cesarean birth is nearly four times as risky as vaginal birth; what about the postpartum pain? A cesarean is major abdominal surgery, with a very slow, very painful recovery period afterwards. If you’re trying to avoid pain, it seems like having a cesarean is a very poor way of going about it.

Birth is always a surprise, and doesn’t always go the way you expect it to (sort of like parenting); those who plan homebirths sometimes end up having to go to the hospital. Those who plan natural childbirth sometimes find that they need pain medication. Those who plan to get an epidural the second they walk through the hospital door sometimes end up having their babies in the car on the way to the hospital, or arrive fully dilated and pushing, and deliver before they can even ask for pain relief. Things don’t always go as planned: that’s part of the beauty of birth. But scheduling a cesaraean before you even know if your birth will medically require one is signing up for major abdominal surgery, point blank, with all of the risks inherent in that, and not even giving your body the chance to try to deliver normally (i.e. vaginally).

Cotton-Pickin’ Days makes another good point in response to Miles:

Guess what, honey? All those drugs and a pain-free birth is just momentary denial. Childbirth and parenting are meant to be painful. It’s what makes you appreciate your children so much more. What’s worth doing in life takes effort and if you think that it’s possible to glide through childbirth, you’re sadly mistaken. Even if a c-section appears to be the tidiest way to go about giving life to children, it isn’t. And it’s wrong to tell women who’re considering their options that your way is the best.

And meanwhile, over at the Guardian, another of Britain’s largest newspapers, Catherine Bennett was also hard at work slamming Maternity Matters in her column: While women in the developing world are dying in childbirth, why are we fetishising doing it at home? While I think the root of this article is lodged firmly in the time-honored tradition of grousing about NHS expenditures, and the decision to prioritize, and therefore spend more resources on birth and on women’s satisfaction with their births, the article nevertheless comes off as poorly researched and highly patronizing.

Bennett begins by focusing on how dangerous birth is, stating that the “consequences [of birth] for at least 529,000 women a year are fatal”. While she acknowledges the inequalities in these statistics, where the risks are obviously higher in undeveloped countries versus developed countries, the underlying message is that despite these advances in developed countries, birth is still a dangerous and risky business, and the women and organizations which support homebirth and the idea that birth is not a medical condition are clearly deluding themsevles, recklessly and arrogantly putting their own lives and the lives of their children at stake. “Such is the hostility to medicine among some natural-birth enthusiasts that doctors are presented as a greater risk to a mother’s health than childbirth”. Which then, of course, leads her to the crux of her argument: how selfish and willfully negligent it is to demand or want a satisfying birth experience, and why should the NHS be spending its limited resources on womens’ satisfaction?

‘Sometimes, even the most fanatical home-birthers have to accept that natural isn’t synonymous with safe. “Our own birth story was as far from perfect as we could have envisaged” posts a mother whose home birth was replaced by a caesarean, following a diagnosis of pre-eclampsia. “My overhwlming feelings in the 48 hours after the birth were of failure.” The baby, you gather, was completely fine.’

Ah, yes. The baby was fine. That classic, soul-destroying argument of “you have a healthy baby, why are you complaining?”, as if a healthy baby, and a healthy outcome, is the only imporant criteria by which satisfaction can be measured. How many times have I heard this used against women? How many times have I seen this argument whipped out to quiet, or perhaps comfort, a woman’s sense of disatisfaction or failure or guilt regarding her birth? You have a healthy baby, shut up and be grateful.

Which is not in any way to deminish how important the health of the baby and mother are, of course. There are certainly times in birth when things don’t go as planned, and a diagnosis of pre-eclampsia is certainly something which must be taken very seriously, but trying to silence a woman’s grief by focusing only on the baby implies that her grief is selfish and egotistical. She becomes caught in this strange paradox where her own feelings are unacknowledged and unaccpetable, and why does she feel so sad and upset when everything turned out just fine? Our society’s constant focus on the baby, the baby, the baby as the only measure of a successful birth is one of the chief contributing factors to our society’s high rates of postpartum depression and birth-related post traumatic stress disorder. So long as we continue to use the health of the baby as the only criteria of a successful birth, we will continue to see advances in “fetal-rights” which place the importance of the baby over the rights of the mother. One has only to look at the fetal rights movement in our own country to see the terrifying implications of this, where pregnant women are losing their constitutional rights and blaming and prosecuting pregnant women in the name of their fetus is becoming de rigeur.

Comparing birth in undeveloped countries to birth in a developed country is a fruitless endeavor, and I still don’t understand why Bennett decided to even mention this in her article in the first place. Unfortunately, women in undeveloped countries are often grossly malnourished, receive little or no prenatal care, have limited access to skilled birth attendents, are often remote from emergency medical care, and practices such as female genital mutilation and epidemic disease, such as HIV, are often rampant, all of which make birth a much riskier undertaking. A low-risk birth in London is a world away from a low-risk birth in sub-Saharan Africa; the two are not comparable, and quoting WHO statistics on world maternal mortality has very little bearing on the fact that a homebirth for a healthy, low-risk woman receiving prenatal care from the NHS, with swift and immediate transport to medical facilities as necessary, can be just as safe as giving birth in a hospital, and is, and should be, a viable option for women in England. As for the argument regarding precious NHS resources, a homebirth is always going to be less expensive than a cesarean, and avoidance of a hospital-stay, which uses hospital staff and resources, will probably prove to be highly cost-effective.

In the end, all I can say is this: best of luck to you, England! Whether Maternity Matters is a success or not (and I certainly hope it will be!), you get huge props just for proposing such changes in the first place. The very idea of individualized, universal midwifery care, with increased choices and rights for birthing women, including homebirth as a real and viable option for low risk-women, is something that the US is years, if not centuries, away from embracing.

Via The Lactivist and Women’s Health News, there is a new documentary in the works entitled Pregnant in America which explores the medicalization of birth and the creation of the birth industry—the American birth machine—for profit and corporate gain, often at the expense of the health (and sometimes lives) of women and babies in this country. From the website itself:

Pregnant in America examines the betrayal of humanity’s greatest gift—birth—by the greed of US corporations. Hospitals, insurance companies and other members of the healthcare industry have all pushed aside the best care of our infants and mothers to play the power game of raking in huge profits.His wife pregnant, first-time filmmaker Steve Buonaugurio sets out to create a film that will expose the underside of the U.S. childbirth industry and help end its neglectful exploitation of pregnancy and birth.

Pregnant in America is the controversial story of life’s greatest miracle in the hands of the nation’s most powerful interests

Looks quite fascinating, and I can’t wait to see this film. Not that any of this is news, since it’s already something that midwives have been aware of and fighting against for years, but perhaps this documentary will help raise more widespread awareness of this issue. To view the trailer, visit the links above.