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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

July 21, 2008 - 1:01pm


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