If You're an Expectant Mom, or Know One...PLEASE READ THIS!!!

As a follow-up to this discussion, I would like to caution any potential readers, other than those of us who have contributed to this dialog:

Dr. Tuteur has quoted and suggested many "facts" and "statistics" that largely have been baseless and without reference. Again, as I have suggested, as well as several others--don't take ANYTHING for face value--especially when statistics start getting thrown around.

This is not to say studies and articles like the one I initially reference by Ina May Gaskin are not valuable in relaying important information. But always check your facts. Cross reference numbers and statistics. Especially if you are in the position of being pregnant, and undertaking your due diligence regarding where, and with whom, you will birth your baby.

As Ashley Shelby, writer and editor of the blog "Science For Sale" always says, "Consume Intelligently."

"No one EVER dies from iatrogenic causes during childbirth"

Malpractice is NOT an iatrogenic complication. Iatrogenic complications result from the proper use of medical technology, such as an allergic reaction to a medication.

There are two important points in regard to malpractice:

1. Malpractice is a result of being human. There is no reason to believe that the incidence of malpractice is lower in DEMs than in anyone else caring for people.

2. You still don't seem to understand the basic point: Even when you INCLUDE malpractice in the hospital setting, homebirth has a HIGHER rate of neonatal death. So if you think malpractice results in too many neonatal deaths, you should be appalled at the number of neonatal deaths that occur at homebirth.

Amy Tuteur, MD

"Dr. Tuteur has again and again pointed to the God-like power of modern obstetrics, and how many thousands of lives it saves each year. However, Sasha's rebuttal is a strong one: are obstetricians saving women and babies from BIRTH itself, and the small number (less than 10%) of organically-birth related complications, or are they simply "saving" moms and babies from the side effects of the meds, technologies and procedures they themselves created."

Birth itself .... obviously.

A 10% complication rate is HIGH, not low. That would mean that 400,000 and 400,000 babies would be affected each and every year.

Let's look at the facts:

The maternal death rate from medication, technologies and procedures in any given year is ZERO!

The neonatal death rate from medication, technologies and procedures in any given year is ZERO!

Medication, technologies and procedures have lowered the maternal death rate by 99% and the neonatal death rate by 90% in the last 100 years.

The ONLY places in the world where the maternal and neonatal death rates are low are places where modern obstetrics is practiced.

Modern obstetrics has been so spectacularly successful at making birth safe, that some people are confused about how it happened. It is only the routine use of medications, technologies and procedures that makes birth appear as safe as it appears to laypeople. Without routine use of medications, technologies and procedures, literally hundreds of thousands of deaths would occur in the US each year.

To all who have read, and participated in this discussion, let me say a few final words:

Sadly, and fantastically, this discussion turned into so much more than my original post which was about an article recently released in the Journal of Perinatal Education by midwife Ina May Gaskin. The article highlighted the most recenlty measured US maternal mortality rate, and questioned whether or not 15.1 women out of 100,000 dying each year in our country is acceptable for our culture or not. (Note: as pointed out earlier, and widely suggested even by the World Health Organization, this number is most likely abysmally low--due to insignificant reporting requirements...or lack thereof...in our country.) The article certainly touched on birthing options and how maternal mortality rates tend to differ around the world.

It is a no-brainer to realize that places like Subsaharan Africa and Afghanistan will have higher mortality rates...due to lack of access to meds and technology. But, as Dr. Tuteur has done, to compare these scenarios with the US--where potential access to meds, technology and excellent prenatal care is entirely different, is no better than comparing apples to oranges.

For my part, this was never meant to be a debate about home birth vs. hospital birth (which Dr. Tuteur very quickly turned it into). It is about raising the question: how good are we doing in our care of pregnant women and their babies, and can we do better?

Dr. Tuteur has again and again pointed to the God-like power of modern obstetrics, and how many thousands of lives it saves each year. However, Sasha's rebuttal is a strong one: are obstetricians saving women and babies from BIRTH itself, and the small number (less than 10%) of organically-birth related complications, or are they simply "saving" moms and babies from the side effects of the meds, technologies and procedures they themselves created. (See the several references above to risks of epidurals, c-sections, pitcoin, cytotec, etc.)

In some respects, I can see where Dr. Tuteur is coming from with some of her comments. Perhaps she works in an urban setting, or at a university hospital where the worst of worst maternity emergencies tend to land. Perhaps she has seen women hemorrhage to death during childbirth, or babies die in the process. When a person sees something like that, it tends to taint their view forever. And yes, of course, even in the grand old US of A, those things can happen here too...on occasion. But not always. Not inherently.

On the same token, I have to wonder, Dr. Tuteur: Have you EVER witnessed normal childbirth? Have you set aside the time in your, I'm sure, very busy schedule to spend a week with a midwife...perhaps even a midwife that practices in a hospital setting, and observe the differences in how she practices maternity care? It's certainly hard to see the other side, if you've never even taken a look. I'm sure ANY midwife in your area would be pleased to host you for a week, if you'd just be willing to ask. In fact, I publically challenge you to do so.

(I have, by the way, witnessed, and personally experienced both kinds of childbirth. I do not speak from an isolated vantage point. I speak of obstetric emergenices and of normal birth from first hand experience.)

Midwives are not back alley snake sales(wo)men, as Dr. Tuteur would lead us to believe. The majority of them are professionally trained health care providers who happen to practice under a DIFFERENT philosophy of care than OBs.

Since the point of this website is about EMPOWERING women to make good choices for themselves, I will add a couple final thoughts to Sasha's list of books and resources that a pregnant woman might want to consider:

1. . Choose a midwife, or a doctor with a midwife-like philosophy of care (statistically, women who birth with midwives in attendance have a much higher safety rating, a much lower c-section likelihood, and a much better over-all experience with their prenatal, labor and postnatal care. Check out ANY health care provider thoroughly when it comes to providing maternity care. Look into their credentials, their statistics, and their in-depth level of care.

2. Take a thorough childbirth preparation class so you understand all the pros and cons of medical interventions and other options related to pregnancy, childbirth and the postpartum period. Empower yourself with information.

3. Hire a doula (a professionally trained labor assistant) who can help you safeguard your path toward a satisfying, safe birth.

4. Remember that you are just as much a part of the decision making team as your health care provider(s). Make decisions with awareness, intuition, and thorough consideration.

The good news is that there ARE some fantastic maternity care providers out there, but as a health care consuming public, we need to do our due diligence in finding them. Our life just may depend on it.

***Does this list sound familiar to any of you? Oh, yes---that's because it's what I started this whole dialog with!***

Think for yourselves. Ask questions. Be intuitive.

Kimmelin Hull, PA, LCCE
author of A Dozen Invisible Pieces and Other Confessions of Motherhood

"so one in three women or babies will die? because that's our c-section rate."

That's like asking if 85% of women will die without a Pap in light of the fact that 85% of women have Pap smears. And the answer is, no, of course not. So lots of Pap smears are done "unnecessarily" in retrospect, since most women who have a Pap smear don't have cervical cancer. Unfortunately, there is no way to tell IN ADVANCE which women need to have Pap smears and which women could have safely avoided them.

No one ever said that all C-sections are life saving in retrospect. The problem is that there is no way to tell IN ADVANCE which ones are guaranteed to be the lifesaving ones. Women who boast that their doctor recommended having a C-section for breech, and instead they had a successful breech vaginal delivery at home are like smokers who boast that their doctors recommended they should stop smoking and instead they continued and didn't get lung cancer. They're lucky, not smart.

"a century and half ago a main cause of maternal death was child-bed fever, many times caused by drs' stubborn refusal to simply wash their hands after they had autopsied (even after desperate attempts to convince them that they were spreading contagion and causing death)."

That's just another fantasy story concocted by homebirth advocates. According to I. Ignaz Phillip Semmelweis' studies of death in childbirth (http://www.jameslindlibrary.org/trial_records/19th_Century/semmelweis/se...):

"This was many years before the role of bacteria in diseases was discovered, and Semmelweis suggested that the training procedures of the first clinic resulted in the transfer from the corpses of what he first called 'morbid matter', and later 'decomposing animal organic matter', on the hands of the students. In 1847, he therefore introduced a system whereby the students were required to wash their hands in chloride of lime before entering the maternity ward. The result was dramatic. In 1848, the maternal mortality rate in the first clinic fell to 12.7 in the first clinic compared with 13.3 in the second clinic. The process of admission to the two clinics on alternate days produced, by accident rather than design, a controlled trial, and the large numbers of deliveries ... mean that chance could confidently be excluded as a possible explanation for the differences observed."

Why didn't more people listen? Probably because Semmelweis refused to publish his findings:

"...Although urged by his friends to publish, he waited for thirteen years before he published his treatise, 'The Etiology, Concept, and Prophylaxis of Childbed Fever', which is dated 1861 but was actually published in 1860. The treatise of over 500 pages contains passages of great clarity interspersed with lengthy, muddled, repetitive, and bellicose passages in which he attacks his critics. No wonder that it has often been referred to as 'the often-quoted but seldom-read treatise of Semmelweis'. When he wrote the treatise, Semmelweis was probably in the early stages of a mental illness that led to his admission to a lunatic asylum in the summer of 1865, where he died a fortnight later..."

Moreover, the notion that Semmelweis was a tragic hero whose great work was ignored is wrong:

"...But most of the claims made about him in the twentieth century - that he was the first to discover that puerperal fever was contagious, that he abolished puerperal fever (or that if he did not, it was because of the stupidity of his contemporaries), and that his treatise is one of the greatest works in nineteenth-century medicine - are sheer nonsense..."

Furthermore, midwives had absolutely no role in the discovery, understanding or treatment of puerperal sepsis:

Did homebirth midwives know about hand washing? No.
Did homebirth midwives understand the germ theory of disease. No.
Did homebirth midwives perhaps discover the germ theory of disease and correct the error of the doctors? No.
How did homebirth midwives learn about the germ theory of disease and the importance of handwashing? Doctors told them.

Childbirth is inherently dangerous. Hundreds of thousands of babies and women would die in the US each year without the application of large amounts of obstetric technology. The only people who appear to be aware of these basic facts are homebirth advocates.

Amy Tuteur, MD

"Afterall, women have been doing this for thousands of years. There must be SOMETHING normal about it."

I know that this statement seems to make sense to the homebirth advocates who say it, but even a moment of reflection reveals that it is utterly untrue. It reveals a lack of understanding of both childbirth and population growth. In fact, population growth, even explosive population growth is COMPATIBLE with the fact that childbirth is inherently dangerous. All you need to do is consider most third world countries; in those places the maternal and neonatal mortality rates are astronomical yet their populations are growing. Very few places have higher rates of maternal and neonatal mortality than Afghanistan or sub-Saharan Africa, yet they suffer from overpopulation.

Death of the mother or baby during childbirth is NATURAL. It is not a rare complication. It is a common complication of childbirth. As I mentioned above, the rate of miscarriage of established pregnancies is appoximately 20%. Almost every woman will have at least one miscarriage during her reproductive life. Miscarriage is a normal part of human life, and it does not prevent the population from growing. Similarly, a maternal mortality rate in nature of 1% and a neonatal mortality rate in nature of 7%, while extraordinarily high from our perspective, are completely compatible with population growth.

Homebirth advocates don't realize that EACH YEAR in the US alone, modern obstetrics saves approximately 225,000 babies and 39,000 mothers who would have died! In the absence of modern obstetrics, childbirth would kill the same number of women each year as breast cancer. How does modern obstetrics save literally hundreds of thousands of lives EACH and EVERY year? It does so through the routine application of tests, procedures and interventions. Without the routine use of tests, procedures and interventions, astronomical numbers of women and babies would simply die.

Sasha,

You summed up several of the points I've been trying to make.

For me, this debate really has not been about home v.s hospital birth. It has been about understanding when medical interventions are truly necessary, when they are overkill (no pun intended), and when they are done simply because medical staff "know how to do them."

No one here is arguing that there aren't those rare occurences when moms and babies benefit from the life-saving hands of medical staff, technologies, medicines and techniques. That is indisputable. Thank God we've made those advances. But study after study has shown exactly what Sasha pointed out: in OUR COUNTRY, it tends to only be 10% of the time.

I can't tell you how many times I have had one of my students describe to me their experience of an emergent assisted delivery, or "emergency c-section" within an hour of having an epidural placed in her back. Even though there is a known potential side effect of drop in fetal heart rate and drop in mom's blood pressure (thus the constant FHM and BP measurment) during and after epidural administration. Nonetheless, these women are made to believe the hospital staff "saved" their baby from some ambiguous cause of distress--when it was the epidural administration that caused the distress in the first place.

The above scenario is just one of many that contribute to the gap between the WHOs recommended 10% reasonable c-section rate, and our present 30+% c-section rate.

Am I 100% against epidurals, c-sections, pitocin, etc.? No. Am I against the overuse of these technologies? Yes.

Birth IS inherently a normal process that OCCASIONALLY becomes dangerous.

To suggest childbirth is potentially dangerous for all women and all babies all of the time is a severe and frightenly extreme statement.

Afterall, women have been doing this for thousands of years. There must be SOMETHING normal about it.