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The Texas Department of
Health's own statistics show that midwives in Texas have a lower
infant mortality rate than physicians.
(Texas Lay midwifery Program, Six Year Report, 1983- 1989,
Berstein & Bryant, Appendix Vlllf, Texas Department of Health, I 100
West 49th St., Austin, TX 78756-3199.)
New CDC Report
"Trends in the
Attendant, Place, and Timing of Births, and the Use of Obstetric
Interventions: United States, 1989-1997," Sally C. Curtin,
Melissa M. Park.
In
1997:
-
99% of all births
took place in hospitals
-
92% of all births
were attended by physicians (4% with Osteopaths)
-
7% of all births
were attended by midwives (of the midwife-attended births,
95% were attended by CNMs)
-
The state with
the most midwife-attended births was New Mexico (20%)
-
The states in the
Northeast with the most midwife-attended births were New
Hampshire (14%), Massachusetts (13%), and Rhode Island (12%)
From
1989 to 1997:
-
Cesarean section rates decreased from 22.8% to 20.8%
-
VBACs increased from 18.9% to 27.4% - still shameful, but it
represents a 50% increase
-
The use of electronic fetal monitoring increased 22% (to 83%
in 1997)
-
The use of at least one ultrasound during pregnancy
increased 35% to (64% in 1997)
-
Stimulation of labor (oxytocic augmentation of labor after
labor has been established) increased 6% (to 17% in 1997)
-
Induction of labor (initiating labor without oxytocin)
increased to 18% in 1997
-
Forceps deliveries fell 49% (from 5.5% to 2.8% of all
births)
-
Vacuum extraction increased 77% (from 3.5% to 6.2% of all
births)
-
CNMs became more likely to practice in hospitals than in
out-of-hospital settings (their attendance at births in
birthing centers and private residences dropped between 1989
and 1997)
-
"Other" midwives attendance at births in private residences
increased; in birthing centers dropped
-
Among births in out-of-hospital settings, home births are on
the rise and birthing center births are decreasing
The report
concludes, "In general it appears from the data in this
report that despite the increase in midwife-attended births,
obstetric interventions are increasing. Although cesareans
have generally declined, induced vaginal births have
doubled.
Note: The
accuracy of CDC statistics on "other midwives" is
questionable, since only a few states include this
information on the birth certificates (Texas is one of the
states that does), and in illegal states "other midwives"
rarely sign birth certificates.
"In The five European
countries with the lowest infant mortality rates, midwives
preside at more than 70 percent of all births. More than half of
all Dutch babies are born at home with midwives in attendance,
and Holland's maternal and infant mortality rates are far lower
than in the United States..."
("Midwives Still
Hassled by Medical Establishment," Caroline Hall Otis, Utne Reader,
Nov./Dec. 1990, pp. 32-34)
In the Western European
countries that have lower infant and maternal mortality, lower
cesarean birth rates and lower health care costs than the U.S.,
midwives are the primary care providers for over 70% of births;
about 5% of US babies are delivered by midwives. For years the World
Health Organization has recommended that most births should occur
outside the hospital, attended by midwives, without routine
technological interventions. In the US, only about 1% of births take
place outside the hospital.
". . . why, in the
interest of improving care, so many hospital maternity services
have uncritically introduced interventions that have been shown,
in well-designed studies, to be useless, inappropriate,
excessively costly, and frequently dangerous for mothers and
babies. . ."
World Health
Organization
by David Stewart,
PhD:
...Every study
published shows midwives to be safer than doctors. Every study.
No exceptions. If your physician disagrees with this, challenge
him or her to produce the data that supports otherwise. They
won't be able to do it. Such data does not and never did exist.
In a nutshell, that is the strength of the case for midwifery.
It is unanimous.
. . . over and over again, throughout history, the data shows
that when doctors displace midwives, outcomes get worse.
BMJ No 7068 Volume
313 General Practice Paper Saturday 23 November 1996
"Home versus hospital deliveries: follow up study of matched pairs
for procedures and outcome"
Conclusion - Healthy
low risk women who wish to deliver at home have no increased
risk either to themselves or to their babies.
Why Homebirth is
Safer, an excerpt from the book, A Woman in Residence, by
Dr. Michelle Harrison, M.D. (who is a family practitioner and did
residency work in OB/GYN) will make us all do some reflective
thinking.
"Imagine dancers on a
stage. Once, doing a pirouette, a woman sustained a cervical
fracture as a result of a fall; she is now paralyzed. We try to
make the stage safer, to have the dancers better prepared. But
can a dancer wear a collar around her neck, just in case she
falls? The presence of the collar will inhibit her free motion.
We cannot say to her, 'This will be entirely natural except for
the brace on your neck, just in case.' It cannot be "as if" it
is not there, because we know that creative movement and
creative expression cannot exist with those constraints. The
dancer cannot dance with the brace on. In the same way, the
birthing woman cannot "dance" with a brace on. The straps around
her abdomen, the wires coming from her vagina, change her
birth."
In response to: "Is
homebirth safe?"
Rather a large number
of studies have been done on this. To date, the studies show,
without exception, a lower rate of mortality and morbidity for
mothers and infants in all risk categories with home birth.
How can home birth be
safer than hospital birth? Most "problems" in hospital births
come about due to "failure to progress". This leads to
interventions, and interventions have consequences and side
effects. In the hospital, this often leads to more
interventions, etc. Why failure to progress? Imagine for a
moment that your cat is about to have kittens. It will seek a
warm comfortable place, where if feels safe. Imagine you bring
it out into a strange, brightly lit area full of strangers, who
poke it and examine it. Do you think it will give birth? Or will
this profound and difficult process be interrupted while it
takes in its new surroundings?
Home Birth - An Old
Tradition, A Safe Choice by Jennifer Houston
"Home Birth can be
safer. Unnecessary medical interventions, which can lead to
complications, are avoided (restrictive, continuous, electronic
fetal heart monitoring, routine I.V.'s, drugs, etc.). There's no
handling of the infant by numerous hospital personnel. Exposure
to hospital bacteria and viruses is avoided."
...After studying
homebirth in depth, the British government concluded:
[We] must draw
the conclusion that the policy of encouraging all women to
give birth in hospitals cannot be justified on grounds of
safety...[It] is no longer acceptable that the pattern of
maternity care provision should be driven by presumptions
about the applicability of a medical model of care based
upon unproven assertions...Hospitals are not the appropriate
place to care for healthy women...We recommend that the
Department of Health vigorously pursue the establishment of
best practice models of team midwifery care...
Home Birth and
Out-of-Hospital Birth: Is it Safe?
How Safe is that Hospital Anyway?
Information compiled by Jennifer L. Griebenow 4/97
Dr. Lewis Mehl did a
study comparing home and hospital birth with mothers from
California and Wisconsin with matched populations of 2,092
mothers for each group. Midwives and family doctors attended the
homebirths; OBGYNs and family doctors attended hospital births.
Within the hospital group, the fetal distress rate was 6 times
higher. Maternal hemorrhage was 3 times higher. Limp,
unresponsive newborns arrived 3 times more often. Neonatal
infections were 4 times as common. There were 30 permanent birth
injuries caused by doctors (Jones 99).
Robert C. Goodlin
reported in the Lancet on 1,000 births, half occurring in a
hospital, half in a birth center. There were no IVs, monitors or
anesthesia used in the birth center, but the babies were born in
better condition. Besides that, three times as many cesareans
were performed in the hospital (Korte and Scaer 37-38).
A British research
statistician, Marjorie Tew, did long term studies of the safety
of birth in various settings during the 1980s. She found that
among a sample of 16,200 births, the perinatal mortality rate
was lower for out-of-hospital births, even for very high risk
mothers! At a relatively high risk level, perinatal mortality
was three times higher in hospital (Korte and Scaer 49).
Tew then expanded her research by using information from the
Netherlands, a nation where both obstetricians and midwives
practice. The perinatal mortality rate was ten times higher in
the hospital births there, even though the risk status of the
mothers at the time of delivery was not much higher than that of
mothers who chose midwives(Korte and Scaer 50).
Carl Jones says, and
I concur, "No one can tell a mother she is perfectly safe giving
birth at home. Whether she is safer at home than in a hospital,
however, is another question"
Aidan McFarlane, a
British physician, notes that while 68% of hospital mothers
experience postpartum depression , only 16% of home birth
mothers do.
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