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Archive for the ‘midwives’ Category

By GERADINE SIMKINS
Posted: July 17, 2008

One wonders what process the American Medical Association House of Delegates used to determine that its resolution on home deliveries was prudent and reasonable.

AMA resolution 205 attempts to outlaw a woman’s choice to give birth at home or in a freestanding birth center by calling for legislation to establish hospitals and hospital-based birth centers as the safest place for labor, delivery and postpartum recovery. Further, it seeks to establish that hospital-based midwives who work under the control of physicians are the only safe midwifery practitioners.

The Midwives Alliance of North America, which has represented midwives since 1982 and whose members are specialists in homebirth, finds the resolution arrogant, patronizing and self-serving.

We have three major objections. First, the resolution patently ignores the vast body of scientific evidence that has documented home birth to be a safe, cost-effective and satisfying option for women who prefer it. Second, it is seriously out of step with the ethical concept of patient autonomy, encompassing both informed consent and informed refusal. Third, it distracts from other critical issues, including increasing access to care, improving perinatal outcomes, reducing health disparities and fostering client satisfaction. The resolution is anti-home birth, anti-midwife, anti-choice and is unsupported by scientific evidence.

Why is the AMA not asking real questions instead of trying to debunk existing evidence on the safety and efficacy of homebirth and attempting to corner the market on maternity care? For example, why are midwife-attended births far more likely to have fewer interventions, fewer postpartum infections, more successful breast-feeding rates and healthy infant weight gain and to result in more satisfied, empowered mothers? Why are so many women left emotionally traumatized by childbirth experiences in hospitals and consequently why do rates of postpartum depression, anxiety and post-traumatic stress continue to escalate?

It is ironic that the AMA should have a quarrel with a known safe birth option while the epidemic rise in coerced or elective Caesarean sections puts healthy mothers and infants at greater risk and strains our health care system. The rate of Caesarean sections in the United States is unacceptable — one in three pregnancies end in major abdominal surgery — and the decline in availability of vaginal birth after Caesarean is deplorable. It is past time that the AMA and the American College of Obstetricians and Gynecologists realize that women and their partners are choosing home birth and freestanding birth centers to avoid ethically unsupported obstetric interventions.

In almost all areas of modern medicine except obstetrics, control in decision-making rests firmly with the patient and not with the medical provider. Informed consent has appropriately become the gold standard.

Why then do the AMA and ACOG believe that they can promote legislative efforts to deny women choices in maternity care providers and childbirth settings?

All maternity care providers should band together to reduce the rates of maternal and infant mortality and morbidity in the United States, increase access to maternity care for all women, reduce unnecessary Caesarean sections, encourage vaginal birth (including after c-section) for healthy women, reduce health disparities of women and infants in minority populations and promote breast-feeding. These would improve the health of mothers and babies far more than reducing the rates of home birth.

The Midwives Alliance joins the other individuals and organizations, including individual AMA and ACOG members, who have grave concerns about the stance articulated in this resolution, and calls for the AMA to abandon this resolution. Midwives everywhere honor and respect the numerous friendly physicians with whom we already partner and look to the day when midwives and obstetricians consistently will work collaboratively to support women’s choices in childbirth and provide the best and most appropriate range of services.

Geradine Simkins is president of the Midwives Alliance of North America.

http://www.jsonline.com/story/index.aspx?id=773731

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Ok, I know that the medical culture in the U.S.A. is horrible for women of all ages.   However, I find the entire “advanced maternal age” (i.e., AMA) thing to be such a joke.   Women are not dead at 40.  There are very few studies in women over 40 in the last 50 years that have accessed any “risks” with pregnancies, including genetic defects.   The ONE study that has been quoted over and over and over about Downs Syndrome being so much greater in women over 40 is 50 years old…almost as ancient as the 40 year old pregnant women right now.   Women who give birth in their late 30’s and 40’s are not at an increased risk of anything based solely on AMA.   Take care of yourself, eat well, be in tune with your body and your pregnancy, and you will be fine…even fine enough to tell sOB’s to take a hike and hire a midwife and birth at home…which is safest for women of all ages.

I am sooo tired of hearing of all the tests they run on women over 40…and how many of those tests are false positives…and lead to stress in the mother, which we KNOW for a fact has an adverse effect on babies.

Medical interventions are great if you have a pregnancy that is truly in need of intervention…however, regardless of age, few women fit that category.   The more interventions women allow themselves to be subjected to, the more interventions will occur, w/ little or not benefit, and in many cases, detriment to mom and/or baby.

All I can tell any woman is to research birth.  And please, not by reading What To Expect When You are Expecting..thats about he worse book on pregnancy ever written.

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Management of Suspected Fetal Macrosomia (which basically means “big baby”)
http://www.aafp. org/afp/20010115 /302.html

“A recent decision analysis estimated that to prevent one case of permanent brachial plexus injury, 3,700 women with an estimated fetal weight of 4,500 g would need to have an elective cesarean section for suspected macrosomia at a cost of $8.7 million per case prevented”

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Apparently, The American College of Obstetricians and Gynecologists (ACOG) has seen The Business of Being Born. Because they have issues a News Release that is about as preposterous as anything I have ever read from a medical establishment.

Below is the News Release, but I have to simply point out that ACOG’s conclusions are not based on evidence.

Lets look at some of their statements.

First, “ACOG acknowledges a woman’s right to make informed decisions regarding her delivery and to have a choice in choosing her health care provider, but ACOG does not support programs that advocate for, or individuals who provide, home births.”

Informed decisions in a hospital are less and less likely as time goes by. Women are not being given a choice! I have read many studies on my risks of having a repeat C-section vs. having another VBAC (I had my VBAC 2 years ago after 2 c-sections). I have determined that many risks of having a repeat c-section are much greater than having a VBAC. However there are very few hospitals in the U.S. that truly support a VBAC. Many will say they support moms attempting a VBAC, but when it comes down to the time of delivery, many women are then pushed into a c-section due to “large baby” determination, or “you are overdue” or “you have been in labor too long…failure to progress” diagnosis. Some of these reasons may be justified in some cases, but in many, they are not. It is those women and babies who are threatened. Inducing a VBAC has become more common and unfortunately, often leads to a c-section also. Women have very little control of their labors while in hospitals which leads to more c-sections.

ACOG goes further to state “Childbirth decisions should not be dictated or influenced by what’s fashionable, trendy, or the latest cause célèbre.” Are they kidding us? How fashionable has it become to have an elective c-section? Give me a break!

I especially love this fear tactic: “Despite the rosy picture painted by home birth advocates, a seemingly normal labor and delivery can quickly become life-threatening for both the mother and baby. Attempting a vaginal birth after cesarean (VBAC) at home is especially dangerous because if the uterus ruptures during labor, both the mother and baby face an emergency situation with potentially catastrophic consequences, including death. Unless a woman is in a hospital, an accredited freestanding birthing center, or a birthing center within a hospital complex, with physicians ready to intervene quickly if necessary, she puts herself and her baby’s health and life at unnecessary risk.” See the study below which shows that women are much safer and at less risk of a repeat c-section if attended by a midwife instead of an OB. This is all about money to ACOG. They have NO evidence to back this claim.

Lastly (because what they are saying exhausts me right now), ACOG states “Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby”. *I* am certainly not putting the process of giving birth over the goal of having a healthy baby and a healthy mommy. Neither are many women that I know who chose birthing at home, even if alone, to birthng in a hospital because we know that the medical professionals will not be patient with us..they will not respect our decisions..they will simply fall into their routine of time schedules and management and look at us as another mom who is bettter off being induced or sectioned. I chose not to be among people like that when I birth this child.

ACOG NEWS RELEASE

ACOG Statement on Home Births Washington, DC — The American College of Obstetricians and Gynecologists (ACOG) reiterates its long-standing opposition to home births. While childbirth is a normal physiologic process that most women experience without problems, monitoring of both the woman and the fetus during labor and delivery in a hospital or accredited birthing center is essential because complications can arise with little or no warning even among women with low-risk pregnancies.

ACOG acknowledges a woman’s right to make informed decisions regarding her delivery and to have a choice in choosing her health care provider, but ACOG does not support programs that advocate for, or individuals who provide, home births. Nor does ACOG support the provision of care by midwives who are not certified by the American College of Nurse-Midwives (ACNM) or the American Midwifery Certification Board (AMCB).

Childbirth decisions should not be dictated or influenced by what’s fashionable, trendy, or the latest cause célèbre. Despite the rosy picture painted by home birth advocates, a seemingly normal labor and delivery can quickly become life-threatening for both the mother and baby. Attempting a vaginal birth after cesarean (VBAC) at home is especially dangerous because if the uterus ruptures during labor, both the mother and baby face an emergency situation with potentially catastrophic consequences, including death. Unless a woman is in a hospital, an accredited freestanding birthing center, or a birthing center within a hospital complex, with physicians ready to intervene quickly if necessary, she puts herself and her baby’s health and life at unnecessary risk.

Advocates cite the high US cesarean rate as one justification for promoting home births. The cesarean delivery rate has concerned ACOG for the past several decades and ACOG remains committed to reducing it, but there is no scientific way to recommend an ‘ideal’ national cesarean rate as a target goal. In 2000, ACOG issued its Task Force Report Evaluation of Cesarean Delivery to assist physicians and institutions in assessing and reducing, if necessary, their cesarean delivery rates. Multiple factors are responsible for the current cesarean rate, but emerging contributors include maternal choice and the rising tide of high-risk pregnancies due to maternal age, overweight, obesity and diabetes.

The availability of an obstetrician-gynecologist to provide expertise and intervention in an emergency during labor and/or delivery may be life-saving for the mother or newborn and lower the likelihood of a bad outcome. ACOG believes that 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.

It should be emphasized that studies comparing the safety and outcome of births in hospitals with those occurring in other settings in the US are limited and have not been scientifically rigorous. Moreover, lay or other midwives attending to home births are unable to perform live-saving emergency cesarean deliveries and other surgical and medical procedures that would best safeguard the mother and child.

ACOG encourages all pregnant women to get prenatal care and to make a birth plan. 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. 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.

# # #

The American College of Obstetricians and Gynecologists is the national medical organization representing over 52,000 members who provide health care for women.

http://www.acog.org/from_home/publications/press_releases/nr02-06-08-2.cfm

 

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As part of my plan to be as healthy as I can be during this pregnancy and birth, I have decided to commit to the Dr. Brewer’s Diet.  You can learn more here: http://www.blueribbonbaby.org/

Basically, this Dr. is convinced that diet has more to do with maternal and infant health than we are being led to believe.

here is an exerpt:

Toxemia. Pre-Eclampsia. HELLP Syndrome. Premature birth.
Low birth weight. Intrauterine growth retardation.

It’s not genetics. It’s not random. The cause is NOT unknown. Toxemia CAN be stopped. PreeclampsiaA-toxic-condition-developing-in-late-pre... CAN be stopped. Best of all, YOU can stop it!

HOW? All the scientific research being done on toxemia and preeclampsia these days is focusing on treatment, and none of it is promising. But the research has already been done, many times and many ways in the past 50+ years, and we know that you can PREVENT this from happening to you in the first place, no matter what your personal history may be. The simple answer? GOOD NUTRITION.

Common sense tells you to eat right when you’re pregnant, and traditional wisdom says you’re “eating for two“. So why are doctors telling you to cut out salt, avoid gaining too much weight, and giving you little or no information about what IS a good diet for pregnancy? Why is the medical community so disinterested in this information? As one doctor put it, “No one is going to make any money off good nutrition.”

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J Epidemiol Community Health. 1998 May;52(5):310- 7. Midwifery care, social
and medical risk factors, and birth outcomes in the USA.

MacDorman MF, Singh GK. Centers for Disease Control and Prevention,
National Center for Health Statistics, Hyattsville, MD 20782, USA.

STUDY OBJECTIVE: To determine if there are significant differences in birth
outcomes and survival for infants delivered by certified nurse midwives
compared with those delivered by physicians, and whether these differences,
if they exist, remain after controlling for sociodemographic and medical
risk factors.

DESIGN: Logistic regression models were used to examine differences between
certified nurse midwife and physician delivered births in infant, neonatal,
and postneonatal mortality, and risk of low birthweight after controlling
for a variety of social and medical risk factors. Ordinary least squares
regression models were used to examine differences in mean birthweight after
controlling for the same risk factors.

STUDY SETTING: United States.

PATIENTS: The study included all singleton, vaginal births at 35-43 weeks
gestation delivered either by physicians or certified nurse midwives in the
United States in 1991.

MAIN RESULTS: After controlling for social and medical risk factors, the
risk of experiencing an infant death was 19% lower for certified nurse
midwife attended than for physician attended births, the risk of neonatal
mortality was 33% lower, and the risk of delivering a low birthweight infant
31% lower. Mean birthweight was 37 grams heavier for the certified nurse
midwife attended than for physician attended births.

CONCLUSIONS: National data support the findings of previous local studies
that certified nurse midwives have excellent birth outcomes. These findings
are discussed in light of differences between certified nurse midwives and
physicians in prenatal care and labour and delivery care practices.
Certified nurse midwives provide a safe and viable alternative to maternity
care in the United States, particularly for low to moderate risk women.

PMID: 9764282 [PubMed – indexed for MEDLINE]

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