Thursday, November 29, 2007

Raging debate about illegal midwifery in Missouri

It is nearly unfathomable that home birth midwifery is illegal in some states, despite the many studies and the World Health Organization's stance that midwifery care and home birth are safe -- if not safer -- than hospital births for low-risk mothers. Anyway, here is a link to a Chicago Trib health blog on the topic which happens to quote from my book. Click on the link for some fascinating feedback.
Here is the link to the original story the blog post was based on:,1,398264.story?ctrack=2&cset=true

Originally posted: November 26, 2007

Midwives vs. men
In Missouri, using a midwife during a home birth is not just illegal, it's a felony. And in nine states, including Illinois, Iowa, and Indiana, some forms of midwifery are illegal, reported Chicago Tribune national correspondent Kirsten Scharnberg in "Black market for midwives defies bans."

It's not the first time states have tried to kill midwifery.

Though having a baby at home with a midwife regularly produces a better outcome than having one in a hospital--women attended by midwives ultimately have lower Caesarean rates, fewer interventions such as labor induction and episiotomies and lower infant mortality than those attended by doctors in in the U.S. and abroad--male physicians have been trying to kill the profession since at least the 1750's, writes Tina Cassidy in the fascinating book "Birth: The Surprising History of How We Are Born." (Grove Press, $14).

Hello, goodbye

This, from a New Zealand paper, is reminiscent of the "drive-through" delivery debate in the US in the 1990s. While it's true that studies show quick departures from the hospital are generally safe, there is certainly something unseemly about pushing women out the door by offering them cash, which American hospitals also tried, until there was a backlash.

Hospital pays mums $100 to go home early
11:47AM Thursday November 29, 2007
By Martin Johnston

Mothers will be given a $100 supermarket voucher if they leave hospital within hours of giving birth, in a bid to deal with the national shortage of midwives.

The two-month-long scheme has been tagged "bribery" by a health group.

Capital and Coast District Health Board spokesman Michael Tull said yesterday: "We're encouraging people to go home straight from delivery ... without going to the post-natal ward."

The vouchers cannot be used to buy alcohol or tobacco.

The scheme revives similar ones used in Auckland and Waikato that were ditched in the 1990s after they failed to encourage shorter stays.

Women who give birth in hospital usually go home within 48 hours of a straightforward delivery.

The Wellington Hospital scheme, which starts on Saturday, is for women who have had a straightforward birth and whose baby is well.

It excludes women having their first birth or a caesarean delivery.

Women having their second or subsequent birth were encouraged to stay in the delivery suite for up to six hours after an uncomplicated delivery, said the board's midwife leader, Robyn Maude.

If they felt up to it, they could go home once staff were confident they and their baby were fine.

"No woman who is not clinically ready for discharge will be sent home."

Maternity Services Consumer Council co-ordinator Lynda Williams was appalled by the scheme.

"It's bribery," she said. "The people it will appeal to most are those who most need a lot of care and support - people from poor areas."

Mothers should be allowed to stay in hospital as long as necessary after giving birth, to gain confidence in looking after their babies.

Going home too soon could adversely affect breast-feeding and mother-baby bonding.

Other midwifery experts say there is no evidence that going home early causes problems for mother or baby, as long as they are well and have supportive family or friends at home.

In the 1990s, Waikato Health offered $120 for home help and a week's free nappies to mothers who went home within 24 hours of giving birth.

The co-manager of Mothers and Midwives Associated, Linda McKay, said the Auckland maternity information service was contracted by health funders in the 1990s to give $180 to mothers who left hospital early after delivery or had a home-birth.

"One of the reasons the Ministry of Health stopped it was they were hoping to see an increase in women going home immediately, particularly in Waikato. It didn't happen. I don't think it will work in Wellington either."

Health minister David Cunliffe said the Wellington scheme was one organisation's response to a staff shortage and was not Government policy.

He had asked the ministry to advise him urgently on the reasons for the national shortage of midwives.

Mr Cunliffe said he had received an assurance from Capital and Coast DHB that no woman who needed to be in hospital after giving birth would be sent home.

The DHB had also provided an assurance that it would work to accommodate women who wished to be admitted to hospital after giving birth.

Mr Cunliffe said the DHB was in the process of appointing more midwives and would be back to normal staffing levels by February.

He had asked the Ministry of Health for urgent advice on the underlying reasons for the nationwide shortage of midwives, he said.

Green MP Sue Bradford said it was shocking that hospitals were bribing mothers to leave hospital immediately after giving birth.

"One of the major contributors to the battering and killing of babies and young children is a lack of successful bonding between mother and baby."

The situations where this was most likely was in households where people did not have enough money to survive in comfort, and it was also from those households that a mother was most likely to take the $100 bribe, she said.

"Such mothers risk not being able to establish breastfeeding properly, not bonding well with their new child, post-natal depression and despair, as well as sinking into the addiction and crime subculture to which such households are vulnerable," Ms Bradford said.

She said sending mothers home early was becoming common practice in New Zealand and giving mothers a guaranteed minimum number of days should be considered.

- With NZPA

Friday, November 02, 2007

Debate Down Under

This is a column from the Melbourne Herald Sun reacting harshly to the new British Medical Journal article that says that cesareans are more dangerous than vaginal births. Quite a debate follows on the the paper's blog. As an aside, I always chuckle over the casualness of the Aussie lingo -- describing c-sections as vaginal bypasses and the "decision to incision" rhyme lilnked to the idea that most docs take about 30 minutes to wheel a mother into the OR, so many c-sections are not true emergencies.,22023,22681497-5000117,00.html