Afraid of homebirth? You should be!

Grieving family with an infant's coffin

Yesterday’s Washington Post contained a puff piece on homebirth. It’s entitled Afraid of a home birth? These two first-person accounts will give you a new perspective, and is followed by two anecdotes, one of a mother who had a homebirth in the US, and another of a mother who had a homebirth in the Netherlands. But neither story will give you new perspective for two important reasons.

First, although anecdotes may reassure you or frighten you, by their very nature they can’t give you perspective. If you’re afraid of homebirth, you want to know the risk to YOUR baby, not two women’s personal experiences. Imagine, for example, that you want to know whether you should buckle your infant into a carseat when driving to the store. The fact that a random mother drove to the store with her infant unbuckled and the baby survived tells you nothing about what is likely to happen to YOUR baby. The fact that another mother drove with her infant unbuckled in a different country with very different rules of the road and using a car with a plethora of safety features that we don’t have in the US tells you nothing about what might happen to YOUR baby. And the fact that both babies survived does not change the fact that not buckling your infant into a carseat is a very bad idea.

Second, the Post reporter leaves out two critical facts when relating the anecdotes:

Homebirth dramatically increases the risk of neonatal death.

Dutch midwives caring for low risk women (home or hospital) have a HIGHER perinatal mortality rate than Dutch obstetricians caring for HIGH risk patients in the hospital. That’s a scathing indictment of Dutch midwifery care.

Afraid of homebirth? You should be. It raises the odds that YOUR baby will die during childbirth.

The anecdotes themselves, while meant to be reassuring are anything but.

You know you have a problem when the title of your piece promoting homebirth is I had a home birth and I’m not stupid. Or brave. It’s an even bigger problem when the piece demonstrates that you are stupid and reckless.

When I began really looking into what evidence based birth meant, it seemed like the exact opposite of what I had received. It turns out laboring on your back is not conducive to letting your body open and your baby come down. While I knew it was best to stay out of bed, I hadn’t known how listening to the nursing staff like a good patient might alter the course of my birth. It seems like commonsense now, to make use of gravity, one of the most natural forces in the world. But at the time, I was trying, against my better judgment, to listen to my care providers. I should’ve been listening to my body.

I can’t comment on Sarah Bregel’s native intelligence, but I can tell you that it is monumentally stupid to believe that you can educate yourself by reading homebirth books, websites and message boards. Would you trust a money manager with your life savings if he told you that he is sure that he can increase the value of your portfolio because he read about it on the internet? Would you trust a pilot to fly you safely to your destination if she told you she had researched flying by reading a bunch of websites? No, and no. Why not? Because anyone who isn’t living under a rock is aware that the internet is packed with bogus “experts” peddling bogus products and taking your money in exchange. Reading homebirth websites to find out if homebirth is safe is like reading Big Oil websites to find out if solar power is a good way to heat your home. You’d be a fool to think you could find the truth by doing so.

While the most common reactions to having a home birth are either that it is very stupid or very brave, I’m here to tell you that for me (and many others) it’s neither. Home birth is a safe option for many women. While hospital transfers do happen, the midwifery model of care typically means being monitored very closely. So in the case of an emergency, it’s not often the dramatic, rush to the hospital, last minute C-section, tearing the baby out in the nick-of-time fiasco that you’d imagine…

And I’m here to tell you, Sarah, that if you believe that you are foolish and gullible.

Who am I? I’m an obstetrician and mother who has spent years cataloging the literally hundreds of babies who have died preventable deaths at homebirth, because their mother’s were hoodwinked and flattered into believing that they know more about childbirth safety than obstetricians who have spent years studying, training, practicing and routinely saving infant lives. Just last night I was informed of two more babies who died at homebirth this past weekend, and within the last month I learned of two MOTHERS who had died at homebirth in Texas within days of each other in December.

Homebirth is NOT a safe option, though I doubt any homebirth advocates would tell you that. In the most comprehensive collection of homebirth statistics ever analyzed, Judith Rooks, CNM MPH (and homebirth advocate) looked at PLANNED homebirths with a LICENSED homebirth midwife in Oregon in 2012. She found that the perinatal death rate at homebirth was 800% (that’s right, EIGHT HUNDRED PERCENT) higher than comparable risk hospital birth. That data was released in March 2013, and if you didn’t know that, Sarah Bregel, than you didn’t know anything about the safety of homebirth.

I happen to know the details of many of these deaths and I can tell you that these babies died in fiascoes DESPITE dramatic rushes to the hospital, last minute C-sections and tearing the baby out NOT in the nick of time, but after it was already dead or so profoundly brain damaged that it could not survive.

And they died in fiascoes where they were born not breathing or even dead because clueless midwives weren’t monitoring the babies’ heart rates appropriately or didn’t understand what they were hearing.

Homebirth is NOT a safe option, and the organization that represents homebirth midwives (the Midwives Alliance of North America) is well aware of that fact and DELIBERATELY, and UNETHICALLY lying about it. Their own paper (actually a voluntary survey completed by only 25% of members) shows that homebirth increases the risk of death by 450%! They know that; they lie about that: and they trick gullible women like Sarah Bregel so they can make money attending births despite being so unqualified that they would not be eligible to work as midwives in ANY other first world country, (not the Netherlands, not the UK, not Canada, not Australia, not any industrialized country).

The second anecdote, How pregnancy and birth overseas is so different than in the U.S., is hardly an endorsement of homebirth, and that’s despite the fact that the author is unaware of the terrible perinatal mortality rates of Dutch midwives.

Over the course of my pregnancy, however, I started to see the appeal of giving birth outside of a hospital setting. It was comforting (and, in retrospect, highly delusional) to think that I wouldn’t experience any pain my body couldn’t handle, that childbirth was fail-safe process engineered by Mother Nature for peak results…

I’ll spare you the details of my delivery. Suffice it to say, it was not quite the pool party I had hoped for. By the time I finally broke down and demanded to transferred [sic] to a hospital so that a real doctor could administer an epidural, it was too late.

But childbirth is hardly a fail-safe process engineered by Mother Nature for peak results (and both infertility and miscarriages are evidence of that). The insistence by Dutch midwives that it is fail-safe has led to the Netherlands having one of the worst perinatal mortality rates in Western Europe, and the appalling reality that high risk babies delivered by obstetricians are actually MORE likely to survive than low risk babies delivered by midwives.

Afraid of homebirth? You should be. It’s promoters and practitioners, both in the US and in other countries are not honest about the death toll at homebirth.

Hospital birth is like a carseat. Don’t use it and your baby will probably survive anyway … no thanks to you or your midwife.

  • Natural Nurture

    You sorry SOB…or may I call you Amy?

    How can you spend your life hunting up failures to scare the power and prowess from American women? For what reason? Who pays your invoices for being the princess provocateur of private parturition prevarication? How do you sleep at night?

    Is your boss the ACOG? AMA?…the Pharmaceutical consortium?… or the eugenics elite? …are you getting a hit on casket sales?

    How can you let yourself be A COG in the the gears of the American medical model of hight interventionist industrialized birth?

    Who pays you to create this drivel of fear mongering, misinformation, myth-information and indirect money making for them?

    Why not tell the truth?

    ❝ In a time of universal deceit, telling the TRUTH
    becomes a revolutionary act. ❞ — George Orwell

    The American people pay more for health care and childbirth than anywhere in the world and YET THEY GET THE POOREST RESULTS and More Americans die in hospital form nosocomial mistakes, infections and iatrogenic harm than those who die from gun violence? How can you present fiction as fact with such a straight face?

    TIME TO RETIRE AMY and LEAVE POOR AMERICAN WOMEN ALONE. THEY have been frightened enough by false flag terrorism ..they don’t need you turning their most auspicious time of life into terror too.

    YOU ARE ONE BAD BOOGIE WOMAN!

    • Sarah

      Do you think Americans get the poorest results for healthcare and childbirth in the world? I feel like there might be countries called Niger,and Afghanistan.

      • Natural Nurture

        Thanks Sarah, I neglected to finish that up with: ” 2 up from the bottom of the list of developed nations [so called] not in all the countries of the world. Glad you caught that. Thanks!

        • Sarah

          You’re right, you did neglect it. Nobody here believes you just forgot, though. You reek of someone who’s actually daft enough to believe what you wrote in your first post is true.

          • Natural Nurture

            So Sarah…you speak for everybody on the blog?…or just Amy the SOB?
            There is no need for ‘belief’…check the facts yourself.
            Thanks for keeping me on my toes. Best wishes.

          • Sarah

            I reckon I do in this instance, yes, but if any of our regulars wish to disagree I’ll stand corrected. And don’t tell people to check the facts when THEY ACQUANITED YOU WITH THEM IN THE FIRST PLACE.

          • LibrarianSarah

            No you are right. Burden of proof is on Natural Nurture. She made and extraordinary claim she needs to provide the extraordinary evidence. Saying “check the facts yourself” is pretty much a guarantee that she doesn’t have any and you should consider it a victory.

          • Natural Nurture

            URL http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3170075/

            Rank— Country— IMR—

            Infant deaths per 1000

            ___________________

            1—Singapore—2.31

            2—Sweden—2.75

            3—Japan—2.79

            4—Iceland—3.23

            5—France—3.33

            6—Finland—3.47

            7—Norway—3.58

            8—Malta—3.75

            9—Andorra—3.76

            10—Czech Republic—3.79

            11—Germany—3.99

            12—Switzerland—4.18

            13—Spain—4.21

            14—Israel—4.22

            15—Liechtenstein—4.2

            16—Slovenia—4.25

            17—South Korea—4.26

            18—Denmark—4.34

            19—Austria—4.4

            20—Belgium—4.44

            21—Luxembourg—4.56

            22—Netherlands—4.7

            23—Australia—4.75

            24—Portugal—4.78

            25—United Kingdom—4.85

            26—New Zealand—4.92

            27—Monaco—5.00

            28—Canada—5.04

            29—Ireland—5.05

            30—Greece—5.16

            31—Italy—5.51

            32—San Marino—5.53

            33—Cuba—5.82

            34—UNITED STATES—6.22

            URL http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3170075/

            Rank— Country— IMR—

            Infant deaths per 1000

            ___________________

            1—Singapore—2.31

            2—Sweden—2.75

            3—Japan—2.79

            4—Iceland—3.23

            5—France—3.33

            6—Finland—3.47

            7—Norway—3.58

            8—Malta—3.75

            9—Andorra—3.76

            10—Czech Republic—3.79

            11—Germany—3.99

            12—Switzerland—4.18

            13—Spain—4.21

            14—Israel—4.22

            15—Liechtenstein—4.2

            16—Slovenia—4.25

            17—South Korea—4.26

            18—Denmark—4.34

            19—Austria—4.4

            20—Belgium—4.44

            21—Luxembourg—4.56

            22—Netherlands—4.7

            23—Australia—4.75

            24—Portugal—4.78

            25—United Kingdom—4.85

            26—New Zealand—4.92

            27—Monaco—5.00

            28—Canada—5.04

            29—Ireland—5.05

            30—Greece—5.16

            31—Italy—5.51

            32—San Marino—5.53

            33—Cuba—5.82

            34—UNITED STATES—6.22

            CIA. Country comparison: infant mortality rate (2009). The World Factbook. http://www.cia.gov (Data last updated 13 April 2010).8

            https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html

          • SporkParade

            Infant mortality includes all deaths in babies up to 1 year of age and does not include stillbirths. It is often a reflection of access to pediatric care. The statistic you want is perinatal mortality, which measures stillbirths and newborn deaths. The US does pretty darn well in it.

          • Natural Nurture

            Thanks. Please post the perinatal stats.

          • SporkParade

            http://apps.who.int/iris/bitstream/10665/43444/1/9241563206_eng.pdf It’s 7 per 1000, which is the same as just about every other developed country (the UK is 8 per 1000, Norway is per 100, etc.).

          • Natural Nurture

            Good morning Sarah/AmySOB/and all…

            If we ALL are AWARE… of ALL the FACTS— not merely FACTOIDS and the shadows of misinformation SPILLED out WILLY NILLY by Amy and her negative cohort hunting for stories in an attempt to vindicate their own choices [which were likely not their choices AT ALL but were forced by coercion and socially engineering upon them].

            Amy and her quixotic quest to be right no matter the cost along with her vile and volatile narrative effectively removes choice for naïve women who have faith in the failed system and the evil perps and provocateurs like Amy—and her ACOG buddies.

            But sadly…not ALL THE FACTS are KNOWN, BY ALL THE PEOPLE. Because if they were, then there would be no need for this discussion or this one sided platform. Sadly that is not the case. The ‘facts’ as Amy knows them are cherry picked and tell little; except her passion as a SOB provocateur.

            If understanding of fact vs fiction and factoids, rather than forwarding Amy’s commercial ideologies are the goal, then I highly recommend the book:

            The Business of Baby by Jennifer Margulis— if you choose to really know the facts about childbirth in North America and beyond.

            You might want to watch the great DVD BirthStory by Ina May Gaskin— America’s greatest midwife.

            The feature-length documentary BIRTH STORY: Ina May Gaskin and The Farm Midwives tells the story of counterculture heroine Ina May Gaskin and her spirited friends, who began delivering each other’s babies in 1970, with great success and overwhelming optimal outcomes. Learn here also about misuse and abuse by the likes of: Cytotec… and other misogynist OBGYNS who have put way too many women and their babies in the grave from greater arrogance & confidence than competence.

            A great take-away from this movie is this quote:

            Marsden Wagner said it best in this direct quote:

            ❝ This is why, if you really want a humanized birth,
            the best thing to do, is to get the hell out of the hospital! ❞ —Marsden Wagner, M. D., former Director, Women’s Health – World Health Organization [WHO]

            Wagner goes on to say:

            ❝ Midwives attend over 70% of births in Europe and Japan.In the United States they attend less than 8%. ❞ —Marsden Wagner, M. D.,

          • SporkParade

            Note to self: Natural Nurture thinks that letting your own baby die because you are too stubborn to seek medical attention when you go into preterm labor is “great success.” (c.f. Ina May Gaskin’s “Spiritual Midwifery”)

          • Natural Nurture

            I am not familiar with that practice being used at the ‘FARM’. Can you elucidate, please?

          • Houston Mom

            She gave birth to a premature son on a bus and her husband didn’t want to stop to take the baby to a hospital if I remember correctly. He was born in the late 60s at the same level of prematurity as a friend of mine born around the same time who survived. Of course he was born in the hospital.

          • SporkParade

            Before the Farm, when the Gaskins were just leading a bus caravan of hippies, Ina May went into premature labor, was in labor for days, and her baby survived 12 hours before dying. At no point did she seek medical attention. Again, this information is coming from her own writing. She estimates that her baby weighed about 3 lbs. Given the state of technology available at that time to treat preemies, her baby might well have survived had he been born in a hospital and put into an incubator. Instead, she signed his death warrant.

          • Who?

            Nice use of all caps there, you’re definitely making your point more powerful by using them.

            Your position, however, is moronic.

            Anyone who holds Ina May up as a paragon of anything other than dead babies and sexual harrassment of labouring mothers needs their head examined.

          • Natural Nurture

            Thanks for sharing your vitriol. I hope you are feeling better now.

          • yentavegan

            European midwives are not the same as American Homebirth Midwives. European midwives are university educated licensed insured collaborative professionals. CPM, DEM, are made up credentials by under educated snakeoil charlatans who proclaim to be experts in normal birth…

          • demodocus

            You really adore alliteration

          • Natural Nurture

            And Marsden Wagner…rest his blessed soul.

            Marsden Wagner (23 February 1930 – 27 April 2014[1]), was a perinatologist and perinatal epidemiologist from California who served as a Director of Maternal and Child Health for the California State Health Department, Director of the University of Copenhagen-UCLA Health Research Center, and Director of Women’s and Children’s Health for the World Health Organization. He was an outspoken supporter of midwifery.

            As a minstrel I suspect you too enjoy alliteration in your tunes?

          • demodocus

            No, actually. I prefer instrumental music.

          • Sarah

            Knew it, you’re one of those!

            Yeah, do a search on Ina May, Marsden Wagner and particularly TBOBB here. We’ve all got a lot to say about that lot. Ina May let her own baby die at homebirth and thinks it’s fine to rub a birthing mother’s clitoris and rub her breasts. Marsden Wagner is the douchebag responsible for the WHOs ill-fated, non evidence based 15% section, so he can kiss my arse. And Ricki Lake is a fully fledged moron. Incidentally, don’t be lecturing me about births outside the US. I, like many regular commenters here, am not stateside. I come from a system that does indeed use more midwives than the US, and this is why I’m well able to enunciate the problems with it. For example, despite our higher use of midwives our perinatal mortality rate is no better than yours and our stillbirth rates worse. Explain that.

          • Hoter

            I dunno who these people are but there is a reflex from the clitorus to the cervix which will dilate it, it is probably more professional to just put a hot pack on it. Of course I can see people freaking out about this but modern jewish American people think it is ok to cut the end of a babies’ dick off with the Rabies fingernail, sharpened. So each to their own. I saw a documentary on that in the UK.

            Is it more logical to use syntocinon to stop a bleed at the end of labour, or a well applied hot pack to the lumbar spine and a cold pack on the Clitorus.

          • Who?

            A cut with a rabies fingernail would be disastrous. A rabbi’s fingernail, I couldn’t comment on.

          • Sarah

            There’s a reflex between your brain and your bumhole.

          • Wren

            Evidence for this reflex please.

          • Monkey Professor for a Head

            I’m pretty sure Dr Tuteur and the regular posters here have checked he facts and have come to a different conclusion than you. Perhaps you have different facts?

    • namaste863

      I see. So-called natural birth is better because gub’ment conspiracy. Got it.

      • Natural Nurture

        Tell me about the conspiracy of which you speak? I don’t believe there is any government conspiracy. I do believe that the powers of profit…ACOG, AMA, Pharmaceutical consortiums are responsible for DYSTOCIA by DESIGN. Much like the “Munchausen by Proxy Syndrome”…of setting up the harm and then dancing in the room with a scalpel to save the day and solve the calamity as too many of the GODs in GREEN do. They are so good at this high risk parlour game* that poor innocent women who have no idea they have been duped into high risk surgery [1 in every 3 end up with an C-section] end up glorifying the GODs in Green by naming their little miracles after the Doctor who— “arrived just in time to save our lives”…”oh thank GOD we were in a hospital when the situation turned bad…if we had been at home [in reality, unlike in the theatre of the absurd, the harm would not have happened nor escalated as it does in a hospital with synthetic high risk induction] we would be dead!” [Not!]

        * “Pit-to-stress” is just one of the calamitous false flags set up to get the doc home in time for dinner or to the golf course for tee time, insuring a higher income and fast [high risk] birth. A birth that creates a loyal returning customer to fix the many harms created in the high risk rush to “save the day”…the harms she assumes are because of her incompetence and “failure to progress”.

        • demodocus

          I got pitocen. still took 19 hours of labor, and my doc stayed several hours *after* his shift, shooing his replacement off to go see other women on the floor that day. Dr. K. probably missed 2 meals with his family, since Dr. P popped in to say hi around noon.

          • demodocus

            and my kid was delivered vaginally at 630 pm

  • Lily

    At the very end there’s a typo – “no thanks to your or your midwife.” It should be you or your midwife. 🙂

  • Amy M

    What I found kind of appalling was the policy in the Netherlands to kick the new mothers out mere hours after the birth. Sure, the nurse came the next morning, but that leaves a pretty big window of time for something to go wrong. I know that we have heard stories of this happening in CPM units in the US, but this was in Europe, with well-trained staff, right?

    This lady said she went home after 5hrs. My personal example is that my PPH was 8 or 9 hours after my babies were born. If that happened to this lady, she could have died, because she was sent home. Or if the baby had GBS or some other respiratory thing that didn’t really manifest until 10hrs post-partum. I’m no doctor, but 5hrs seems like an awfully short monitoring time.

    • MegaMechaMeg

      It freaks me out how soon we let women leave the hospital in America. Two or three days doesn’t seem like nearly long enough. I thought in the 50s and 60s women stayed for at least a week and pretty much slept and recovered while other people watched the kid.
      I guess thing are different now though, my friends have mostly told me that they were practically itching to get home and away from the nursing staff so maybe I am just thinking on an old model.

      • Daleth

        Even into the 70s you got 5-7 days in the hospital for an uncomplicated vaginal birth. I speak from familial anecdata here. 🙂

        • Wren

          I think that varied. I know my mother never got that long in hospital, and I was born in 1975.

      • Kelly

        I left after 36 hours with my first one because everything was going well. I decided to go home so I would not be woken up every hour with either the baby or hospital personnel.

      • Jessica

        I left the hospital about 27 hours after my son was born. I was induced and had checked in about 20 hours before his birth. Neither my husband nor I slept very well at all, and we were flat out exhausted thanks to the near-constant interruptions from nursing staff and having the baby in the room at all times. My OB had no problem discharging me at the 24 hour mark; the biggest issue was discharging my son, who was not nursing well. Once the pediatrician confirmed we were open to formula if he continued to not nurse well, there was no issue with discharging him, too.

      • Amy M

        I spent 3 days in the hospital with mine–we had an extra day because they wanted to be sure my boys weren’t losing any more weight. At that point, I wanted to leave, because after 2 days, thanks to insurance, only the babies were patients, and I was merely a boarder, there to feed them, for the third day. Granted, the nurses were no longer taking vitals every 10minutes, but they were also less helpful with the babies. I guess once it was clear that everyone was healthy and likely to remain so, it was more comfortable to be at home, even wo/the night nursery. In the hospital, they brought them to me every 3hrs to feed, if the babies weren’t already with me. At home, my husband and I were able to set up an alternating schedule so we could both get some sleep.

        • Sullivan ThePoop

          I spent a full nine days in the hospital after my first was born because they couldn’t get my blood pressure to come down. I was miserable and dying to get out of there

          • Amy M

            I spent 4 weeks in the hospital BEFORE mine were born, so I totally get that! 🙂 I did have the advantage that they were my first/s, so the only one at home was my husband.

        • KBCme

          The recovery room I had for my second (a c-section) was so, so tiny I felt like I was claustrophobic. I was ready to get out of there after 36 hours, but had to wait for paperwork, discharge orders etc and it ended up being like 40 hours. I was so glad to get home and I had an impossibly easy recovery (planned 2nd cs). The first one I was in the hospital for close to the full 72 hrs, but the rooms were so big and it was so hot outside (and no ac at home) – I was not in too big of a hurry. Also, the recovery was bit rougher with first one since I labored for about 12 hours.

      • I began my career in 1967, and we discharged mothers 72 hours after birth if they and the baby were oK. C/Ss went home on the 5th post op day if no complications. But in the US, once at home, a woman is ENTIRELY on her own, possibly not even having the telephone number of a pediatrician.

        In the UK in mid-70s, the home had to meet certain very basic criteria for a woman to be discharged 48 hours after birth, but the local district midwife was responsible for her until 10 days after birth. If the home wasn’t suitable for early discharge, a woman stayed, in the Cambridge area, a full 10 days in hospital.

        There were pluses and minuses to both systems. A great deal depends on the woman’s support system and the number of other children in the house. I know that, after my C/Ss, I “pulled rank” and went home barely 72 hours post op, but [1] my 4 sisters-in-law did everything, and I was forbidden to lift a finger, and [2] I do know, after all, if my recovery isn’t progressing properly. Israeli hospitals in the early 80s were not really comfortable places to be, with 6 in a room, etc.

      • momofone

        I had a c-section and would have been fine leaving 3 days after, but we had ABO incompatibility and my son was not ready for discharge, so I stayed an extra day (insurance coverage was approved for 4 days). Was discharged the next day, and he came home 4 days later. I had read/heard horror stories about c-sections and recovery, but I was fine by the time he came home. I am very fortunate, though, to have a husband who is an excellent caregiver and great support, so I didn’t have to do much except nurse and pump.

      • Cobalt

        Depends on the hospital. The constant interruptions, plus added strain of BFHI requirements can make the postpartum ward a very unrestful place.

        Now, if there’s a good voluntary nursery setup, and mom is treated as though she is in recovery, then an extra day or so may well be appreciated.

        • Cobalt

          Another thought:

          Could some of the changes in length of postpartum stays over several decades be related to birth being less physically taxing than it used to be? We have better monitoring, safer interventions, better medications and medical protocols, etc. Rates of serious complications from hemorrhage, infection, major lacerations, etc. are much lower than in the past.

          How does the average mom’s recovery now compare to the average recovery 50 years ago?

          • DaisyGrrl

            I’m not sure that birth would be entirely less taxing. Mothers are older than before, and they are often less healthy going into the pregnancy (overweight, more sedentary, chronic health problems, etc.). A 23-year-old would probably recover more quickly than a 38-year-old.

            While complications of childbirth are handled better, the characteristics of women giving birth has also changed.

          • Cobalt

            But how to those changes translate to recovery times? I honestly don’t know, that’s why I’m asking.

            I know hemorrhage used to be a leading cause of maternal death, heavy blood loss was pretty common, transfusions were much less available and advanced, and recovery from them often meant weeks of rest.

            Now, hemorrhage itself is less common, major hemorrhage even less so (active 3rd stage management with pitocin, better monitoring for surgical referrals, better surgical procedures), and blood products are better and easier to give.

            So yes, we have more older moms, moms with diabetes, heart conditions, etc., but are modern older, more compromised moms having longer recoveries than the typical mom in the 1950s?

        • MegaMechaMeg

          It is true about not treating mom like a patient. My SIL is a postpartum nurse and she says the meanest things about the women that she treats. She had a pelvic deformity that meant she had two C-Sections without a TOL and she is of the opinion that a mother who had a vaginal birth can have no reason to need help and will turn down all requests full stop. She said one of the junior nurses took a baby from a vaginal birth to the nurses station and she immediately took the baby back because the mother had to learn to do her job and take care of her own kid. She also admits to “forgetting” requests for formula so that the mother will try harder. I cannot imagine having somebody like that for a nurse.

          • Busbus

            How terrible.

          • MegaMechaMeg

            She asked if I would give birth at her hospital so that she could be my nurse too…

          • Daleth

            Your SIL sounds like an angry psychopath. Or, as they might say on the street, a stone cold bitch. If I knew someone like that I’d probably report them to the hospital and the nursing board.

          • MegaMechaMeg

            I don’t know what her deal is. The hospital is BFHI which can’t help and she has been doing this job for ten years and maybe that and her relatively easy births she just has lost the ability to empathize with new mothers. She is also a bit of a Mommy Martyr with a husband who doesn’t do shit around the house so maybe that is just her perception of normal.

          • Mac Sherbert

            This must why at my hospital they started rotating the nurses! I never had the same nurse twice with my second baby, but with first I the nurse only changed with the shift so in the morning I got the nurse I had the day before.

          • Cobalt

            That’s pretty evil.

          • Danielle

            No. Just no!

        • kt

          I couldn’t agree more! I’m from Australia and just had my baby last Nov. The private hospital I birthed in isn’t BFHI but staffed by some crazy BFHI midwives and nurses. One of them even tried to lie to me that there is no nursery (like hell there isn’t, I saw it during the tour!). Finally my baby got to spend a precious few hours there due to having a low body temp and I got some much needed rest recovering from pre-eclampsia & emergency csec).

          The post natal ward could only be described as a battle zone with no rest and constant interruptions throughout the day… How is this good for a mother’s recovery?! Talk about a rough start to parenthood.

      • Wren

        I had both of mine in the UK. With my first, an unplanned c-section, I was sent home 3 1/2 days after delivery, but that was down to one bitchy midwife I actually filed a complaint about. I was discharged at 7 pm and up until 6 pm we believed I was staying in until early the next afternoon as no one would be at home to help me until then. (My husband had a huge deal promotion panel at work that morning.) This particular midwife was just awful, though the rest were lovely.

        With my second, a VBAC, I was discharged 12 hours after delivery at my request. I could have stayed in longer had I wanted to, but I find sleep in the hospital very hard to come by and I had both my husband and my mother to help at home, plus a 1 1/2 year old little boy who cried at leaving his mummy in the hospital.

        In both cases I was seen by a midwife the next day and at least once more before I was discharged from their care at 10 days, when a health visitor came to take over. If there were no community midwives or health visitors, I would not have deltas comfortable with being discharged when I was.

      • Mac Sherbert

        While my nurses were very nice…they are required to check every x number hours for things, especially after a C-section. In my hospital they then had a second nurse come check the baby every x hours. It drove me nuts because one would come then the other…you could not rest. I finally threw a fit and my RN took over both jobs. I felt bad giving her extra work, but I needed to sleep.

      • Linden

        I’m from the UK. I left about 18 hours after an epidural, episiotomy and forceps delivery. I wanted to leave earlier, but they wanted to check out my iron levels (I lost >0.5lt of blood), and get me to pee twice. I had no idea it was regarded in any way as dangerous! They did possibly stall me for hours saying they had to complete my paperwork.

    • Mattie

      Pretty much like that in the UK, well women who did not have c-sections usually go home a few hours after birth, although our unit generally didn’t send women home in the middle of the night so they stayed either on delivery suite or on the PN ward until the next morning. Most women wanted to go home asap but bed-wise there just wasn’t the space nor the staffing to keep all women in hospital for a significant time. Midwives visit at home on day 1 which can catch some problems with the mum or baby but GBS is definitely a concern, especially as screening isn’t routinely done. I didn’t realise you could have a PPH that late after giving birth, that does seem scary =/

      • The Computer Ate My Nym

        The solution is obvious: raise taxed on the wealthy, increase funding to the NHS, and build more hospitals and labor wards. Problem solved.

        • Mattie

          if only it were actually that easy, although it’s a general election year so we’ll see who wins and what they do

    • Mac Sherbert

      “In 1999, Rose Church, a Haleyville mother, died after blood loss caused a heart attack. She was released from the hospital 36 hours after giving birth.” – Rose’s law mandates insurance companies pay for a woman to stay in the hospital for 48 hours after birth.

      http://www.tuscaloosanews.com/article/20150331/news/150339916?p=1&tc=pg

      • Somewhereinthemiddle

        My mom and I were just talking about this case over the weekend. Apparently the guy pushing for the reduction in the allowable covered time in the hospital was the guy who was that lady’s physician unbeknownst to the public or the legislators voting on it or some such nonsense.

        Well, I guess I have no choice but to spend some time looking into it because now my curiousity is piqued to know the details.

        • Mac Sherbert

          Yes. The article mentions that. It doesn’t make any sense for him to take that position, which must be why he withdrew the bill to repeal that law.

          • Somewhereinthemiddle

            Ahaha, you are right. My reading comprehension is less than stellar with three children at home and climbing on me. 😉

      • Cobalt

        I remember headlines about that. “Drive-thru deliveries”. There were a lot of bad outcomes associated with the early discharges the insurance companies pushed for.

    • The Computer Ate My Nym

      This is likely part of why the Netherlands has a high neonatal mortality.

  • FormerPhysicist

    I’m so tired of the idea that having a CPM in the room with you the whole labor is being closely monitored. Monitored is monitored. A nurse at the main desk remotely watching multiple fetal monitors is more effective than anyone sitting in the corner knitting and occasionally using a Doppler and saying “there there”.

    Let’s look at teaching. In almost every school, there’s a teacher (or multiple) in the room with the students 100% of the time. Are the students always being monitored and taught? Or is sometimes the teacher checked out or ineffective? We all agree on the answer to that. And yes, I know it’s not one-on-one in a classroom, but the point is still there. A warm body in the same room does NOT mean effective monitoring.

    • Cobalt

      It’s the difference between being able to read a foreign language in a familiar alphabet, and actually knowing what all those sounds mean.

    • Amy M

      And how many stories have we heard about the midwife not getting there in time? Or “I liked this midwife because she was so hands-off! She left me alone in my room, while she stayed in the other room.”

    • yugaya

      Human monitoring device = possibility of human error, which happens far more often than when machines with human oversight are involved.

      And teaching is extremely improved if you incorporate new technologies and perform the monitoring by checking task progress via classroom apps in real time. 😀

  • Mel

    I’d also disagree with Ms. van der Kwast’s false dichotomy between the US hospital birth w/o postnatal nursing visit and the Netherland’s out-of-hospital birth w/ postnatal nursing visits.

    If postnatal nursing visits were a priority in the US, you’d be surprised how quickly a hospital birth w/ postnatal nursing visits model would pop up.

    I say this because the model already exists in my state (and others, I suspect) for first time parents under the age of 25. The posters were visible all over the place at my OB/GYN and GP’s office in multiple languages.

    • demodocus’ spouse

      In Cleveland, Ohio’s county, they send a nurse over to visit once or twice in that first month to check the baby and ask a few questions about both mother and child, and make suggestions if she feels its needed. I got the impression that this was not a common program in the rest of the area.

  • Mel

    ” By the time I finally broke down and demanded to transferred to a hospital so that a real doctor could administer an epidural, it was too late.”

    This does not sound like an empowering birth to me.

    If midwives are so good at providing “personalized” care, shouldn’t the midwife have realized that the patient was having too much pain/suffering BEFORE the patient needed to “demand” to be transferred?

    Who let the patient know it was too late for an epidural? The birth center staff where she delivered – not an anesthesiologist.

    • Cobalt

      I’ve a friend who got an epidural at 10 cm, after already pushing for a while. She just couldn’t handle the pain anymore. Her baby was out 15 minutes later, the epidural wasn’t even fully effective yet.

      Sooner is better than waiting until the last minute, but epidurals work whenever they are applied. In this case, it may have been too late to safely transfer before the birth, which is the midwife’s fault for not “seeing the signs” and being prepared for a safe transfer.

      • Kelly

        I got mine at I think ten and it started working just while I was pushing. I don’t understand the too late to get an epidural unless the anesthesiologist can’t come in time. Maybe it just depends on the hospital or how you are handling labor. I had enough control to sit still for my epidural so I don’t know if that made it possible to have mine so late.

        • 2boyz

          Too late could simply mean the baby came already. I had a precipitous labor and came into the hospital shrieking for an epidural, and they did page for one, but the baby was out five minutes later. Forget the anestesiologist, my ob didn’t make it either. I was delivered by the two nurses who got me intothe room just in the Nick of time.

          • Kelly

            I have just heard that some people can’t get it if they are eight or nine centimeters and I was surprised that I could get mine so late. I was thankful for it as I was terrified of the ring of fire.

      • Therese

        I don’t understand. The patient, if she was the typical NCBer, would have refused to transfer before the pain became unbearable. Were the midwives supposed to transfer her against her wishes because they somehow were supposed to know she would request it at the last minute? Were they supposed to say, yes, you think you are handling this fine now but we know you will request an epidural during transition so let’s transfer you now, so there will be time to get it?

        • Cobalt

          The CPMs are the ones selling the idea that they can foresee the need for transfer before it’s too late to do so.

          She’s lucky it was an epidural, and not a few pints of blood, that she couldn’t get before it was too late.

          • Therese

            It wasn’t a CPM and too late probably just means, not enough time before the baby was born. It does hurt the worst right before you are ready to start pushing. Midwives and out of hospital births have their faults, but I don’t think we can blame them for not getting their client an epidural in time if she requests it right before the baby is born.

        • Kelly

          I think that what she is saying that the CPM should be starting that conversation when she sees the patient in that much pain and not wait until the patient is begging to be transferred.

          • Amy M

            I don’t think it was a CPM–this was the Netherlands, so the midwife was integrated into the hospital system, and should have been properly trained. Doesn’t mean she didn’t “encourage” the patient to hold off on the epidural (Why would you want to transfer, honey? You are almost there! And you don’t want a drugged up baby do you?)

        • AllieFoyle

          It’s a reflection of dutch culture, which is in some ways very progressive, but also values traditional, naturalistic ideals like stoicism and the coziness of home, especially with regard to motherhood. Medical care can be very good there, but they also make value judgements about what kind of care people should have that I think americans would find very ethically sticky. The attitude toward pregnancy and birth is pretty cavalier, and it can be difficult to access medical care if you have a concern or get an epidural if you want one. The idea is that you shouldn’t want anything like that, and if you do it’s sometimes seen as being overly fussy or having the wrong attitude. It’s a lovely country, but I would not want to have a baby there. The kraamzorg idea is brilliant though.

    • Amy Tuteur, MD

      But think of how empowered the midwife was!

    • Amy M

      Notice the wording she uses though—“a real doctor.” Based on what we saw yesterday, with the bullying midwives on social media, I’d be scared to voice that opinion in front of a midwife who was responsible for the safe delivery of my child. She might double down on the turf war, and my child or I could end up dead because of her bruised ego.