Pregnancy In America... movie

[DoulaMD]

Has anyone seen the previews for Pregnant In America being released in 2007? If you haven't check out the site www.pregnantinamerica.com So what do you think of the preview? Are you going to see it? Any opinions on what you saw so far? How do you think it's going to affect OB/GYNs?

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[Good Mountain]

Has anyone seen the previews for Pregnancy In America being released in 2007? If you haven't check out the site www.pregnancyinamerica.com So what do you think of the preview? Are you going to see it? Any opinions on what you saw so far? How do you think it's going to affect OB/GYNs?

The movie name is Pregnant in America. And the correct link is http://www.pregnantinamerica.com (not pregnanCYinamerica.com)

woww... incredible! Who made this video???

These phrases are incredible
"Complications are caused because of (medical) interventions"

"I ended up having shoulder dystocia" (are they implying that this was the obstetricians fault?)

After the slide with the text "WHAT CHOICES DO WE HAVE?" all the patients say "I ended choosing a midwife". And the last conclusion "have your child at home but near a hospital".

So it clearly is bad propaganda. Dont know if its biased or if thats the way all patients think.

my 2 cents.

 

[DoulaMD]

Sorry about the mix up in the name, website. It is pregnant in america. I corrected it in the link it should now take you to the right link.

 

[pruritis_ani]

On first glance it appears to be an underinformed public using anecdotal information and a poor understanding of statistics, as well as the medico-legal issues in American Ob/Gyn to try to assault the current system.

By no means is the current system perfect...but, the sad fact is, American patients have a LOT to do with it.

 

[happyob]

I had a shoulder dystocia???? are you kidding me? and nobody seemed to notice initially?

Everyday I look at the threads we write. All I see is people from all over the country trying to figure out where to find the best place to train, trying to choose between family and carreer, worrying about what is going to happen to their future and their life.... I personally love OB/GYN and it is the only thing I want to do for so many reasons!!! and then I read this and feel insulted for everyone who is an OB, who is trying to be one and who will be one because people are so ignorant and they judge us without even knowing what they are talking about.

 

[tiredmom]

Did anybody notice that "industrialized" is spelled wrong on the trailer! Great quality control on that one.

In my previous life as a L&D nurse - I always HATED when the lay midwife patients would come into the hospital. They were always hateful to the nurses and doctors because "their plan didn't work"; like we were waiting at the hospital to cut them open or something! I can't tell you how many crazy things I've seen - women pushing for 2+ days - with a 4 cm cervix... arms out of a ruptured cesarean scar, for those at home VBACs that just don't go right... down syndrome babies that stop breathing 'cause the lay midwife didn't pay attention to the kid's airway after the delivery because mom was hemorrhaging... 12 lb babies whose moms are taking dandilion root for diabetes. And that's just the tip of the iceberg. I'm sorry, I know I'm ranting. I'm all for natural birth processes if it's what the patient wants, but it has to be safe. I love working with some of the nurse midwives in the hospital, but as we all know - delivering within 15 minutes of the hospital and in the hospital are two completely different things - especially when a long baby code is one that lasts more than 3 minutes.

And there are no unnoticed shoulder dystocias - I guess that doctor did too good of a job at looking calm!

No, I don't think I could keep from yelling at the screen if I went to see this movie. If I want stupid propaganda - I'll watch a white house press conference or something!

 

[allendo]

Did anybody notice that "industrialized" is spelled wrong on the trailer! Great quality control on that one.

In my previous life as a L&D nurse - I always HATED when the lay midwife patients would come into the hospital. They were always hateful to the nurses and doctors because "their plan didn't work"; like we were waiting at the hospital to cut them open or something! I can't tell you how many crazy things I've seen - women pushing for 2+ days - with a 4 cm cervix... arms out of a ruptured cesarean scar, for those at home VBACs that just don't go right... down syndrome babies that stop breathing 'cause the lay midwife didn't pay attention to the kid's airway after the delivery because mom was hemorrhaging... 12 lb babies whose moms are taking dandilion root for diabetes. And that's just the tip of the iceberg. I'm sorry, I know I'm ranting. I'm all for natural birth processes if it's what the patient wants, but it has to be safe. I love working with some of the nurse midwives in the hospital, but as we all know - delivering within 15 minutes of the hospital and in the hospital are two completely different things - especially when a long baby code is one that lasts more than 3 minutes.

And there are no unnoticed shoulder dystocias - I guess that doctor did too good of a job at looking calm!

No, I don't think I could keep from yelling at the screen if I went to see this movie. If I want stupid propaganda - I'll watch a white house press conference or something!

I know a girl that wanted the whole natural birth midwife thing and ended up in trouble during labor and the midwife had to get her to the hospital. The best part is that the midwife drove an older model vw convertible!! I bet the wind felt nice!

 

[Good Mountain]

And there are no unnoticed shoulder dystocias - I guess that doctor did too good of a job at looking calm!

Yes i totally agree! Im sure the doc made a miracle to deliver that baby, and the worse thing is that he is being blamed. Incredible!

 

[MichiMO]

I definitly think the obstetrical field is being mis-represented in this film, however, you cannot deny that a lot of women feel this way about their prenatal and delivery care and I think it does a disservice to our profession to completely write off sentiments like this instead of looking inward in an attempt to determine why they exist. I really think there is an inherent problem with the system that leaves women feeling like they weren't being cared for well.
Maybe it has something to do with time. I am sure it has something to do with the lawsuit friendly atmosphere surrounding child birth. I also think it has a big part to do with this new trend where women feel entitled to some sort of magical birth experience and are very focused on themselves during childbirth instead of the focus being on having a healthy baby.

On a personal note, when my daughter was breach I did a lot of agonizing on whether to attempt a version, go to someone who would do a vaginal breach, or just have a section and I heard one of my resident talking. She wasn't talking about my situation, but it resonated with me...."it is not about you, it is about the baby and what is best for the baby"
This is not to say that I don't think women should have the best experience possible with childbirth, but I do think the focus needs to be a bit more balanced.
That said, I ended up having a section that probably wasn't "necessary" and I had a miserable recovery. I definitly resented that the immediate answer to a breach in this country is SECTION. But, I also have a healthy beautiful baby....in the end, that really is what matters.

 

[FormerOB]

I definitly think the obstetrical field is being mis-represented in this film, however, you cannot deny that a lot of women feel this way about their prenatal and delivery care and I think it does a disservice to our profession to completely write off sentiments like this instead of looking inward in an attempt to determine why they exist. I really think there is an inherent problem with the system that leaves women feeling like they weren't being cared for well.
Maybe it has something to do with time. I am sure it has something to do with the lawsuit friendly atmosphere surrounding child birth. I also think it has a big part to do with this new trend where women feel entitled to some sort of magical birth experience and are very focused on themselves during childbirth instead of the focus being on having a healthy baby.

On a personal note, when my daughter was breach I did a lot of agonizing on whether to attempt a version, go to someone who would do a vaginal breach, or just have a section and I heard one of my resident talking. She wasn't talking about my situation, but it resonated with me...."it is not about you, it is about the baby and what is best for the baby"
This is not to say that I don't think women should have the best experience possible with childbirth, but I do think the focus needs to be a bit more balanced.
That said, I ended up having a section that probably wasn't "necessary" and I had a miserable recovery. I definitly resented that the immediate answer to a breach in this country is SECTION. But, I also have a healthy beautiful baby....in the end, that really is what matters.

You're c section wasn't necessary? Last time I checked, a BREECH vaginal delivery of a singleton was contraindicated. Did you even have a tested pelvis? (as you are a non professional, that means have you ever had a vaginal delivery before?) You resent the excellent care you received? You would have been the very first to seek a personal injury lawyer if your child had a complication. (and good luck trying to find an OB willing to take the chance with a singleton BREECH delivery)

With all due respect, a version could have been attempted, and if failed, you would have had to be inconvenienced in your VERY busy schedule by an NST to be sure your baby was OK, but unfortunately, you would have had to be NPO the night before in the event you would have needed, GASP, a C/S, if there was NRFHTs after the failed version.

That joke of a sizzle reel (and the joke of a person who posted this thread) mentioned the outrageous 33% C/S rate in this country. Why is that? Hmmm, I wonder... Could it be the deterioration of this country into being one that blames anyone else but themselves for a poor outcome and runs to a plaintiff's attorney whenever they can?

May I suggest you read Gabbe, Williams or search pubmed.org before you post a reply with no evidence based backing. Next time, reply after you have to do a BREECH extraction with head entrapment of an HIV+ and HEP C+ mother with no prenatal care in the parking lot of a hospital, then, and only then, can you comment on why we do cesareans for singleton BREECHES, that is unless you want to BREACH any contract you may have with any OB willing to accept you as a patient.

 

[MichiMO]

You're c section wasn't necessary? Last time I checked, a BREECH vaginal delivery of a singleton was contraindicated. Did you even have a tested pelvis? (as you are a non professional, that means have you ever had a vaginal delivery before?) You resent the excellent care you received? You would have been the very first to seek a personal injury lawyer if your child had a complication. (and good luck trying to find an OB willing to take the chance with a singleton BREECH delivery)

With all due respect, a version could have been attempted, and if failed, you would have had to be inconvenienced in your VERY busy schedule by an NST to be sure your baby was OK, but unfortunately, you would have had to be NPO the night before in the event you would have needed, GASP, a C/S, if there was NRFHTs after the failed version.

That joke of a sizzle reel (and the joke of a person who posted this thread) mentioned the outrageous 33% C/S rate in this country. Why is that? Hmmm, I wonder... Could it be the deterioration of this country into being one that blames anyone else but themselves for a poor outcome and runs to a plaintiff's attorney whenever they can?

May I suggest you read Gabbe, Williams or search pubmed.org before you post a reply with no evidence based backing. Next time, reply after you have to do a BREECH extraction with head entrapment of an HIV+ and HEP C+ mother with no prenatal care in the parking lot of a hospital, then, and only then, can you comment on why we do cesareans for singleton BREECHES, that is unless you want to BREACH any contract you may have with any OB willing to accept you as a patient.

Oh my goodness! Did you even read my post? I believe the entire point I was making was that women are too self-focused in the delivery process.
In the end, I decided on a section because I felt it was the best thing for my baby.
However, at the very time I was making the decison, new research was published in the green journal (July 2006) that said a vaginal breech delivery given correct fetal position (my baby was frank breech...the appropriate position) is as safe as cesarian with an experienced provider....hence my consideration of finding someone who would be comfortable doing a vaginal breech and my statement that my section may not have been "necessary" (note the " ").
I certainly was not making the argument that the position presented by this video was correct. I was merely stating that we should examine why these types of feelings exist among our patients. I included the personal example to show that even I, with quite a bit more education than the average patient...I am a fourth year with quite a few OB rotations under my belt, felt that I would liked some other options besides immediately having major abdominal surgery or at least a conversation about it with my provider. So imagine how our patients feel who don't know the reasons behind sections and the interventions they receive.
Reread my post and don't be so quick to make assumptions.

(By the way, correcting spelling on an internet forum where people aren't paying perfect attention to what they are writing is just silly and patronizing)

 

[FormerOB]

It is YOUR job as a provider to fully inform your patients of the interventions you are employing. It is not that hard to explain these concepts to someone with not as much education. Once you do that, try saying "Do you have any questions? Did all that make sense?"

Be very careful about singleton breech deliveries; even if acceptable criteria is met and you are lucky enough to find an experienced OB, you won't really have a leg to stand on if complications occur.

As a colleague of mine once told me, you only really regret the cesareans you didn't do, not the ones you did. That being said, you should ALWAYS have a definite indication for whatever you do.

 

[vegetables]

FormerOB, have you left OB/GYN? Just curious bc of the name.

 

[FormerOB]

Hi all,

First off, apologies for the flavor of my previous post. You guys are doing what you are supposed to be; you are thinking critically about the issues, weighing pros and cons/risks and benefits. Once you get more experience, then you will have a good foundation to make the best treatment plans.

One of the most exciting things, and a real milestone in my development as an Obstetrician, was to be able to perform vaginal breeches. It is absolutely exhilirating when you are able to do it with a non vertex twin B; despite what ACOG may say, my experience with planned and precipitous singleton vaginal breeches has been overall poor (need for durhsens, stat c/s, poorer outcomes) which can be substantiated in the literature, even with experienced handlers. Make sure you counsel your patients very well about head entrapment, in my opinion the most feared complication. You must get adequate training in the procedures however, as you will see fully dilated breeches in triage with no time for c/s.

While fulfilling, I said goodbye to OBGYN a year or so after my residency- sometimes you just have to move on, though I will look back fondly on those experiences.

Best of luck in your training, and sorry for the tangential nature of these posts relative to the topic at hand.

 

[DoulaMD]

In case anyone wanted to check it out here is a list of site information for the persons interviewed on the preview. I thought it might be interesting to see what the background is on the people who will be shown in the film. I did not find anything on the Dr from the Netherlands, or at least nothing in english. Here is what I did find.

Ina May Gaskin
http://www.inamay.com/statistics.php

Suzanne Arms
http://www.suzannearms.com/AboutSuzanne/

Kerry Tuschhoff
http://www.hypnobabies.com/kerry.php

Joseph Chilton Pearce
http://www.ttfuture.org/services/joseph_pearce/main.htm

George Ritzer
http://www.faculty.rsu.edu/~felwell/Theorists/Ritzer/RitzerBooks.htm#Major

Dr Bruce Lipton
http://www.brucelipton.com/

 

[obbyjobby]

I watched this preview a few times and found myself increasingly irritated after each time watching it. First off, I really resent the implication that the reason why our infant mortality rate is the lowest among "industrialized" nations is somehow the fault of obstetricial intervention. How about the fact that many of these countries have universal healthcare and as a result, EVERY mother gets consistent prenatal care? Also, why were no American obstetricians or MFM specialists interviewed?

The 2 articles the trailer flashes across the screen are both tragic, and both examples of hospital-born errors: the first is unsterile epidural placement resulting in fatal meningitis, and the second is that case in IN where the premie infants died because a pharmacy error was made resulting in these very tiny babies getting adult doses of heparin flush (and..um, not to sound glib, but had those babies (both <30 wks) not been born in a hospital where neonatalogists and neonatal resuscitation was immediately available, chances are they wouldn't have survived period.) I understand that the point here is that these tragic mistakes occurred because of "unnecessary" interventions, but the intervention was totally appropriate and really those things are more suitable for a documentary about hospital errors, and not about how we practice obstetrics wrong in this country.

Also, when the women in Times Square were being interviewed and one mentioned how "When you're at the hospital they poke you a lot. They're always around you, giving you shots, taking blood." and the other women bemoaned how "Doctors are very quick to give you antibiotics and pain medication," I laughed...that's ... just....stupid. (Nice touch setting these interviews to Portishead, by the way. That is some melodramatic music.)

Also...the shoulder dystocia?!?! That somehow being the result of intervention? Does that woman understand that she and her baby were LUCKY to be in a hospital for that? [Incidentally, my friend, a fellow M4 happens to be doing a NICU rotation in Sweden and just emailed me about how she's taking care of a baby born at home yesterday evening with severe shoulder dystocia who was pulseless for about 2 minutes before he was rescuscitated.)

The sad thing is, it is very true that there are many things about obstetrics (and let's face it, all fields of medicine) that could be improved in this country, but when it's presented in such a sensationalistic, overly emotional fashion, it's impossible to take it seriously.

 

[TheJayBee]

Hey there DoulaMD . . .looking over tone of the 24+ posts you have made in the 4 days since joining I am curious . . . .what be your agenda?

There is a huge distinction between an "opinion" and an "informed opinion".

No one of the folks you noted is an MD or hospital based CNM. If the film fails to include discussion from even one widely respected OBGyn, then where is the information balance?

 

[FormerOB]

Now, don't fall into the trap of engaging this person.

Let me paint this scenario as an example... You walk into a labor and delivery room as the doctor, and out of all the people there (laboring patient, other first degree relatives, sometimes the father), you see someone who really doesn't belong there. It is a person who is usually overweight (high BMI, > 40 in my experience), poorly dressed (old jeans, football windbreaker), chugging a can of coke and eating chips while the patient is NPO. You can't figure it out... You leave and later come back in the room and see that out of place person in the room, but now she is doing a back rub on the laboring mother at 4 cm. Well, by then you begin to wonder, until you finally hear from the nurse that she is the doula.

Now, alot of times these are people who are sitting at home, trying to decide on a career; they think, no, not gun repair, I don't think I would like hotel and restaurant management, hmmm, how about becoming a doula, doesn't sound too hard, and if there is a real emergency someone else can step in and save the day. This is the career for me!

(Disclaimer: this is in no way meant to characterize all in that profession, only the experience of one person, and without prejudice)

 

[obbyjobby]

One more reason as to why the US is "bottom of the pack" when it comes to infant mortality: could it be because we count all premature births, including the ones that in other countries would simply be considered unviable at birth and thus not included in their infant mortality statistics? Could it be because every neonate is resuscitated and intubated no matter how early and desperate?

Ugh. I'm just an M4 who hasn't even taken Step 2 yet; my expertise is non-existent. Based on the preview, any MFM worth her salt could deconstruct this documentary piece by piece. No wonder none were consulted.... all we're shown is a bunch of...people. With...opinions. How scientific and well-researched.

Ok, back to real work for me.

 

[DoItRightDoula]

I can't support anything DoulaMD said. As a previous Doula, I had many joys and many tribulations. My dream was to provide the best care possible with only the most recent advancements in homeopathic care. My moms loved delivering their babies the natural way. I once had a mom deliver in a tub of cherry flavored jello. You won't get that kind of care at a fancy-shmancy hospital.
I don't know what DoulaMD's background is, but for her/him to say such hatefull things about my profession hurts. A lot. I never comment about the inadequacies of physicians. I know you guys have it hard enough dealing with patients in the clinic, scheduling your c-sections, and planning vaycay's as well.
All I can say to DoulaMD is: Do not judge: Love.

 

[coolbabe76]

interesting that this post has come at a time when a very very preemie baby went home , thanks to the feat of modern medicine.
Does that say anything to the guy who made this movie and those who agree with his point of view

 

[DoulaMD]

What judgements have I made on this thread that you are so upset about. All I have done was post a link to a movie that is coming out and links to the persons who were interviewed for that movie. I have not made any coments about the movie itself or weather I support it or disagree with it. Why are some of you putting me down and making slurs about Doulas? All I wanted to do was to see what you all thought about the movie, and how you think it may affect the field of obstetrics. After all many of you future paitents may see this movie and ask you questions about it. Sorry I thought you might want to know about it before you start to get questions from your paitents apparently I was wrong. I promise not to post any future issues that might affect your job. Good By.

 

[happyob]

Thank you for posting and at least I appreciate knowing the movie exists because I know I could never sit down and see it. You are right, you have not given your opinion and I don't understand why you are being blamed... for what???
I believe patients and non-medical friends might question us about it....

 

[IrishKel]

I think DoItRightDoula is upset about the comments made by FormerOB, not DoulaMD.

 

[FormerOB]

I can't support anything DoulaMD said. As a previous Doula, I had many joys and many tribulations. My dream was to provide the best care possible with only the most recent advancements in homeopathic care. My moms loved delivering their babies the natural way. I once had a mom deliver in a tub of cherry flavored jello. You won't get that kind of care at a fancy-shmancy hospital.
I don't know what DoulaMD's background is, but for her/him to say such hatefull things about my profession hurts. A lot. I never comment about the inadequacies of physicians. I know you guys have it hard enough dealing with patients in the clinic, scheduling your c-sections, and planning vaycay's as well.
All I can say to DoulaMD is: Do not judge: Love.

Now, what do you do about your gestational diabetic patients? Do you send them to a fancy-shmancy hospital or do you use sugar-free cherry flavored jello?

 

[DoItRightDoula]

Ha Ha, very funny. I can honestly say that after thirty years of practice, I never once had a "gestational" diabetic. My dietary guidlines keep the mommies as healthy as can be. I'm sure your patients would do well with some healthy eating habits.

 

[iatrosB]

I'm sure your patients would do well with some healthy eating habits.

Much of that is beyond the physicians control. You can recommend and encourage, but looking across the board at patients, they aren't going to listen (as a whole, generalizing - yes).

 

[pruritis_ani]

Ha Ha, very funny. I can honestly say that after thirty years of practice, I never once had a "gestational" diabetic. My dietary guidlines keep the mommies as healthy as can be. I'm sure your patients would do well with some healthy eating habits.

How, exactly, do you screen for diabetes as a doula? I may be wrong, but I am pretty sure a doula is not licensed to either order or interpret the routine screening tests....and, I know they are not qualified to make a diagnosis!

All patients would do well with healthy eating habits. Unfortunately, that is often either not enough, or the pt chooses to eat outside of the recommended diet. Either way, for the sake of baby, you gotta get those blood sugars down.

 

[FormerOB]

Ha Ha, very funny. I can honestly say that after thirty years of practice, I never once had a "gestational" diabetic. My dietary guidlines keep the mommies as healthy as can be. I'm sure your patients would do well with some healthy eating habits.

Please, please... do not use the term "practice" to describe what you do... that is what doctors say; and rightfully so. The young student doctors in these forums are extremely talented and dedicated, and will devote their lives to the care of women. For you to imply that you are even remotely close to being in their league is a desecration, and frankly, blaspemous, in my opinion.

You may reply and say, "well, I too am talented and dedicated to the care of women", keep in mind that you are grossly limited in not only your diagnostic but also your theraspeutic capabilities.

 

[DoItRightDoula]

Whoa! Getting a little worked up? Calm down, please, calm down. This is why many of my mommies chose to employ the aid of a doula. There's no reason to get so out of control. Remember, we can work together, as a team.

And I agree with you, I am sure these young doctors are talented and dedicated. Not sure what your point was.

 

[peacefuljourney]

Hi all,

I'm truly ignorant about doulas. I'm studying in Europe where this position doesn't exist (and definitely wouldn't be in the delivery room!) - Dads only and barely that!

I have 4 kids of my own and gave birth to 3 in Canada and 1 here without doulas.

What are the educational requirements of a doula? How does one obtain this credential? Is there a professional association? AND

Are dr.'s held liable for the patients of doulas who (perhaps) do eventually present at the er etc.? What about in the delivery room - does the doula have a say in what goes on?

S-

 

[pruritis_ani]

...

Are dr.'s held liable for the patients of doulas who (perhaps) do eventually present at the er etc.? What about in the delivery room - does the doula have a say in what goes on?

S-

Hey there! I studied in Europe too, and it is quite a different scene over theree. I must say, it was a bit nicer. Less chaos and confusion, more organized, but also much less "interventional". I enjoyed it very much....but, to your question...

As far as being held liable...well, since the patients with doulas typically do not present until it is nearly a disaster, I have noticed that they seem to have a higher rate of complications and interventions. Couple that with this set of patients' tendency to veiw all intervention as unneccesary, and you have a situation ripe for litigation...I have had pts come in after laboring for >36 hours, and not moving past 4cm, clearly needing a section. I have seen term pts come in having been ruptured for 2 days, with fevers. The list can go on....and I am only a first year!

But, the patients can, and do, sue the doctors for whatever complications may arise. Not all do, I would bet not even that many do, but they can. And, when you get that particular patient that has done all she can to avoid the hospital, has had sub-optimal prenatal care, and she is in there with chorio, you can bet she will likely have complications....and, in her mind, NO WAY are these complications due to her beloved doula...they are the evil Dr's fault!

As far as in the delivery room....the doula's can usually stay in there if mom wants them there, but that is it. Hands off, no say at all. They are there to talk to mom and hold her hand, that is it.

 

[tiredmom]

My experience with doulas was a bit different... back in East Texas. We had doulas that were support people for the mom in labor - massage, breathing coaches, etc. We actually had some "on call" for l&d for those moms who were alone and really needed some support. It sounds like some on the board are using the term interchangable with "lay midwife". For us, lay midwives were the ones out in the community who were doing home deliveries, providing "prenatal care", etc. We would get train-wreck lay midwife patients all the time. The doulas didn't really have a practice, they were volunteers for the hospital - I usually would call on the teen pregnancies, esp. the ones with poor support. Doulas as a support were just there as a comfort for mom, not for any sort of labor management. The lay midwives usually wouldn't even come to the hospital when they would send their clients in... they wouldn't dare show their faces. The bad cases I mentioned in my earlier post were all lay midwife patients.
Is this terminology a Texas thing (like many other oddball things we only do/say here )?

 

[yadayadadude]

The movie may be sensational, but ... the notion that OB-attended hospital births are the only safe choice for American women isn't borne out by the evidence. I'm sure the OBs responding to this thread have seen this study:

Johnson KC, Daviss BA. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ. 2005 Jun 18;330(7505):1416.

OBJECTIVE: To evaluate the safety of home births in North America involving direct entry midwives, in jurisdictions where the practice is not well integrated into the healthcare system. DESIGN: Prospective cohort study. SETTING: All home births involving certified professional midwives across the United States (98% of cohort) and Canada, 2000. PARTICIPANTS: All 5418 women expecting to deliver in 2000 supported by midwives with a common certification and who planned to deliver at home when labour began. MAIN OUTCOME MEASURES: Intrapartum and neonatal mortality, perinatal transfer to hospital care, medical intervention during labour, breast feeding, and maternal satisfaction. RESULTS: 655 (12.1%) women who intended to deliver at home when labour began were transferred to hospital. Medical intervention rates included epidural (4.7%), episiotomy (2.1%), forceps (1.0%), vacuum extraction (0.6%), and caesarean section (3.7%); these rates were substantially lower than for low risk US women having hospital births. The intrapartum and neonatal mortality among women considered at low risk at start of labour, excluding deaths concerning life threatening congenital anomalies, was 1.7 deaths per 1000 planned home births, similar to risks in other studies of low risk home and hospital births in North America. No mothers died. No discrepancies were found for perinatal outcomes independently validated. CONCLUSIONS: Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.

Interesting, no?

 

[anamarylee]

Johnson KC, Daviss BA. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ. 2005 Jun 18;330(7505):1416.
The intrapartum and neonatal mortality among women considered at low risk at start of labour, excluding deaths concerning life threatening congenital anomalies, was 1.7 deaths per 1000 planned home births, similar to risks in other studies of low risk home and hospital births in North America. No mothers died. No discrepancies were found for perinatal outcomes independently validated. CONCLUSIONS: Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.

Interesting, no?

Very, but I wouldn't trust it until I see the p values for those incidences presented. I've learned the hard way that some authors will promise heaven and earth on the abstract, but when you read it, the study is full of flaws and p's > 0.05. Something else to look up in the library next time I'm near it.

 

[anamarylee]

The link to the movie is broken. I did a link on the 404 page offering information on "Is Your Mare Pregnant? Have a healthy mare and foal Affordable and practical advice "

 

[kupoliveson]

WOW!!!!! Here is what hurts me the most! I am a doctor (a vet) but a doctor with the same number of years of training, and I truly believe in evidence based medicine! I find it VERY VERY discouraging that the men and women who would deliver my very own human infant apparently like to throw big medical jargon around and correct people spelling rather than address the SCIENTIFIC evidence! There is NO scientific evidence that a GREAT many of the interventions the medical profession have any benefit to the either the mom or the infant! One of the participants mentioned pub med searches, well I have done EXTENSIVE pub med searches and I have yet to find any study condemning homebirths! What I found was exactly the OPPOSITE, study after retrospective study showing that at least in low risk women homebirth is AS SAFE as hospital birth with less morbidity!

Our neonatal and maternal death rate in this country SUCKS (to put it mildly!) What is even MORE scary is that by all accounts the maternal death rate in UNDERESTIMATED! My suggestion is for someone with a public health background do a retrospective study on the maternal deaths in any given state in the last 5- 10 years and see what their method of delivery was (cs versus vaginal), I have a sinking suspicion that what you will find is the vast majority of those women were sectioned and/or had above average interventions during labor/delivery!

Furthermore, OK I am a die-hard liberal (go figure right) and one of the things I HATED about the Bush administration was they used scare tactics of “WHAT IF?” and talked of dire grave non-specific threats ALL THE TIME! This is exactly what I see when the medical profession in this country addresses homebirth, WHAT IF????? Sure my placenta could separate from the wall of the uterus or the chord could prolapse, YUP that could happen however it could happen at the hospital too, often times with the SAME negative prognosis. The difference is I am not going to bleed out during surgery, my uterus will not rupture due to artificial hormones, I will not throw a blood clot to my lungs post “section” and my child will not be born too early due to inducement or section. Section babies have increased risks of death in the first 3 months of life, FACT- look it up on pub med! Sure you want WHAT IF…. I will give you WHAT IF… What if I hemorrhage following a section because of a nicked abdominal aorta or just plain catch a nasty drug resistant nosocomial infection?

I respect modern medicine, I practice modern medicine, I perform surgery myself, I am more likely to take a modern prescription BEFORE I turn to herbs- and I still DO NOT SUPPORT WHAT THE MEDICAL PROFESSION IN THIS COUNTRY IS DOING REGARDING MATERNAL OR FETAL CARE! I will have my child at home, maybe one of my veterinarian colleagues will come over to help, they have more experience with dystocia and difficult deliveries anyways!

SAD SAD STATE OF AFFAIRS! Do not give me the law suit line either, yeah it sucks but you got medical associations and political clout, stick by your guns and do what is right for your patients! If all of you did that, then things would change but as long as you all care more about your own schedules, time-tables and legal liability more and more patients like myself are going to see the light! This is not a problem that is going to go away for you guys!

(anytime you want the results of EXTENSIVE pub-med searches, please let me know)!

 

[deucerp]

I think I can speak for many in the Ob/Gyn profession by saying "Thank you" for having your baby at home.