Friday, June 20, 2008

Making home birth illegal?

Much has been written this week about the American Medical Association, a trade association for doctors, drafting a resolution calling for the illegalization of home birth and blaming Ricki Lake for making it trendy with the film she and Abby Epstein made called "The Business of Being Born." (I highly recommend the film, which you can get on Netflix, and not just because I am interviewed in it. ;)

So I will try not to repeat what others, including Ricki, have said in response to the AMA, which boils down to a proverbial flip of the bird. Instead, I hope I can offer some context and history here.

1. The American Medical Association was a big part of the campaign to eradicate midwives nearly a century ago, a move that was largely successful, and this country is still grappling with the public health consequences of that -- with 99 percent of births taking place in a hospital; 1 out of every three births a c-section; and half the women in the hospital getting Pitocin. The campaign then was about money and power, as it is now.
2. I have NEVER heard a woman who has given birth at home say she made a mistake or that it was a horrible experience. If there are any such moms out there, I'd love to hear from you. By contrast, I hear more and more from women who have horrible hospital experiences with OBs who still think episiotomies are necessary and no woman should push for more than two hours.
3. Those who are against home birth will typically post on blogs with remarks that start like this: "My baby had shoulder dystocia...thank God I was in a hospital and that wonderful doctor saved me and my baby..." Well, guess what, that doctor probably performed the Gaskin maneuver, named after a MIDWIFE, who knows a thing or two about shoulder dystocia in home birth.
4. Throughout history, whenever women felt they did not have a choice in childbirth, they spoke out, voted with their feet, and forced change. Clearly, woman are beginning to feel pushed around, and many are choosing to stay home, in part, I hope, because they are being empowered by the FACTS, by scientific studies, by films, and by books such as mine and Jennifer Block's Pushed.
5. I had a home birth 6 months ago. It blew my mind. It was as birth should be and I am no radical. If home birth suddenly became illegal, and I suddenly became pregnant again, I would still find a way to give birth at home. Oops, guess I couldn't make it to the hospital in time. And you can bet that midwives would still come if called, regardless of the consequences. Tell me, how would illegalizing home birth do anything but force it underground and make it less safe?


Sarah said...

I completely agree! This is so frustrating to me. I plan on having ahomebirth with the next child we have and even if they made it illegal..I would still try and make it happen.

I hope it never happens! Please keep us posted on any other details.

AnnD said...

I can't believe the debate continues through the centuries. I first read about it you book and I had no clue (until I read it) the role that doctors played in demonizing and lying about homebirths and midwives! Catherine Taylor gives some powerful homebirth/midwives stats in the beginning of her book "Giving Birth." I read them outloud to my hubby and he was definitely impressed. I hope I can find the movie at the store or the library! Midwives are illegal in my state (Indiana) I believe. When I logged on to the CNM site to find one in my area, none were located.

Laura Shanley said...

Yes, many women are convinced that a doctor saved their or their baby's life. While occasionally this is true, more often than not I believe the "complication" might not have occured had the doctor not interfered with the birth in the first place. A cord around the neck, for instance, occurs 25% of the time and is rarely a problem. One woman I know had 7 homebirths and the cord was around the baby's neck every time - in one case twice, and in another 3 times. All the babies were fine (they simply unwound the cord). On the other hand, a woman wrote to me saying her hospital born baby died after the doctor compressed the cord during an unnecessary forceps extraction. I personally believe that for the majority of women homebirth is safer than hospital birth but would I ever encourage legislation that forced every woman to have a homebirth? Of course not. This isn't my decision to make. Unfortunately the AMA doesn't respect women enough to "allow" them to make their own decisions. If they think we are simply going to roll over and allow these (potential) laws to pass they are sadly mistaken.

I am a Monkey's Mama said...

I just finished reading The Birth House by Ami McKay and was astounded at the parallels between then (1918-ish) and now...It simply amazes me that women are so quick to "thank god I was at the hospital" when they don't even realize that it was most likely the hospital that created the situation she needed to be "saved" from. It all just makes me angry...which is not so great when I'm trying my best to GIP in the sunset of my pregnancy.

Glad to see you more active online, I missed your writing!


Madeline said...

You might be interested in what it's like to have a homebirth where it's illegal. I've written about mine over on the parenting website

Here's a link for anyone who is interested.

Tina, thanks for a great blog and book!

pinky said...

Now Tina you know I am not a big fan of homebirth. However, I don't think it should be illegal. Where have my civil liberties gone?

Remember also, not all homebirth Midwifes are competent either. So be careful when choosing someone to deliver your baby where ever you choose to deliver your baby.

Amanda said...

In my opinion, homebirths should not be illegal, however, I do think it necessary to have real trained, nurse midwives attending them. Women with not formal medical training calling themselves midwives, who are really nothing more than doulas, should not be attending births as medical professionals. Trained midwives such as the one in the film should be encouraged to attend homebirths.

Stephanie said...

Tina-I have four children, the younger two born at home. I believe homebirth is a viable option for women and should definitely not be made illegal. I do think there are some things women as consumers could do when considering homebirth to make it as safe as possible. There are certain factors that can make homebirth risky. The first important choice to make is to hire a VERY professional (organized, knowledgeable, feet planted firmly on the ground) and experienced midwife. Secondly, it is important to live close to a hospital with a competent OB on staff 24 hours a day. It is also important to assess how long it would take to get to that hospital taking into account traffic and weather conditions around the time baby is due. As I said previoulsy, homebirth is viable option for a safe birth, but all factors should be considered when making that choice and I just hope all women realize this. Most of the time it won't matter what the traffic and weather is like outside of a home birth or what level hospital you live closest to, but on the occassion that something goes wrong it can mean the difference between life and death.

emjaybee said...

Amanda, have you done any research on midwives? You should. There are three categories in the US:

1. CNM(nurse midwife) nurses with extra midwife training. Often, however, they are only allowed to practice in a hospital because they must have OB backup and OBs will not back them up for homebirth. I can tell you from experience that in a hospital setting, a CNM is just as likely as an OB to perpetuate bad hospital practice; those that try to resist are often given lots of grief. The good ones have a hard time.

2. CPM: Certified Professional Midwife: far more than "just a doula", CPMs undergo rigorous training, a long apprenticeship with a practicing midwife, and a strict licensing exam. If you think it's easy, I challenge you to pass it without a lot of sweat and study. In many states, they can legally attend homebirth once licensed. But they still face a great deal of discimination from OBs and hospitals when they need backup.

3. Lay midwife: self-trained or apprentice trained midwives. Can range from the very good, like those at the Farm, to the unqualified. Unfortunately, in states that make CPMs illegal and where CNMs can't help at homebirths, they are often the only choice for women, except unassisted birth.

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