May 24, 2012 | 10:53 AM |

NYT: The Battle Over Home Births

FILED UNDER: Personal Health, c-section, childbirth, home birth

http://www.youtube.com/watch?v=siLbqthiTWo

Before Ricki Lake gave birth in her bathtub and before “Orgasmic Birth” was a top movie pic among the doula set, there was Ina May Gaskin, the earth-mother-high-priestess-venerated-goddess of natural childbirth.

This weekend, The New York Times discovers what proponents of home birth have known for decades: Ms. Gaskin, a self-taught midwife who launched her communal birthing center, The Farm in Summertown, Tennessee, with her husband Stephen in the 1970s, has helped deliver thousands of healthy babies without any medical help.

Gaskin’s statistics are eye-popping: out of approximately 3,000 total births, The Farm’s C-section rate is about 2 percent, The Times reports (compared to a more than 30% rate in the U.S.) and epidural anesthesia has been used only once. “Failure to progress,” a frequent diagnosis for long-laboring moms in American hospitals (and often the trigger for a cascade of medical interventions, including C-sections) are virtually non-existent at The Farm. This less-medicalized approach is, once again, gaining momentum and Gaskin’s ideals are increasingly going mainstream.

Samantha Shapiro writes:

Unmedicated home birth is being chosen by a growing minority of women. Between 2004 and 2009, giving birth at home increased 29 percent. Most of this rise is among white women. Recent pregnancy documentaries like “Pregnant in America,” “Orgasmic Birth” and “The Business of Being Born” — all of which feature Gaskin — present hospital birth as profoundly disempowering to women.

Shapiro weaves her own birth story into her profile of Gaskin. She wants a natural childbirth but in the end, with a failure to progress diagnosis, she ends up with a C-section. Her story concludes on a bittersweet note:

“…it is unfortunate that the choices and the rhetoric around birth — like many of the choices and rhetoric around motherhood in general — are so polarized. It should be possible both to have a baby in a place that doesn’t have financial and legal incentives to medicalize a low-risk pregnancy and to still have immediate access to top-level care if it’s needed. It shouldn’t be necessary to leave the medical establishment entirely to give birth vaginally to a breech baby or after a previous Caesarean. It should be possible both to acknowledge that something real was lost in the way my baby was born and to know that this loss is finite; there is not one pure route to authentic motherhood. Eight months with my son have offered ample evidence that there is not only one opportunity for joy.

About the author

Blogger, CommonHealth Rachel Zimmerman worked as a staff reporter for The Wall Street Journal for 10 years, most recently covering health and medicine out of the paper’s Boston bureau. Rachel has also written for The New York Times, the (now-defunct) Seattle Post-Intelligencer and the alternative newspaper Willamette Week, in Portland, Ore., among other publications. Rachel co-wrote a book about birth, published by Bantam/Random House, and spent 2008 as a Knight Science Journalism Fellow at MIT. Rachel lives in Cambridge with her husband and two daughters. View all posts by Rachel Zimmerman →

  • Mom

    Birth can not be guaranteed to be blissful, orgasmic or devoid of all medical intervention. But it is much more often than not safe. My second son was born at home and while it was far from what I envisioned when I chose that route, it proved to be potentially a life saver for my son. He decided to flip from head down to frank breech at full dilation and pushing progressed so rapidly there was no time for much other than delivering him vaginally (he was born 15 minutes after he flipped – no one can prep for a section that fast). 

    Some might theorize we would have been better off had we been in the hospital. They would have some argument had we any assurance our care provider there had the same training in delivering vaginal breech our midwife had. By the time my son’s chosen presentation was discovered his entire butt and hips were through my cervix. With so few OBs trained in delivering vaginal breech these days I shutter to imagine what might have happened had I elected to return to the hospital where my first son was born. 

    These birthing skills matter. Not every situation can be resolved with safely with forceps or surgery. 

    • Captain obvious 66

      I have found no cases of a baby turning when a woman was completely dilated. It would be seriously impossible. More often it is an undiagnosed breech that is finally realized it was breech. Did a home midwife tell you the baby was initially head down? Did she even examine you? Or as guest123 suggests, you were not birth raped (examined) and once the baby came out you found out the baby was actually breech? Makes a good story though.

  • Ayla Stewart

    I have had four wonderful, healthy homebirths. I love Ina May and her decades of births on the Farm are proof that homebirth is successful and safe! :)

  • Reasonable?

    To understand this trend, one has to dig deeper.
    This approach can very well be safe for HEALTHY mothers with low risk factors for complications (health weight gain, normal fetal activity, no STI’s, normal tensive etc, etc).
    A reasonable homebirth plan, should also have an approach if things go awry.

    This good medicine, because encouraging mom’s to have healthy pregnancies can lower short term and long term health cost and give many mom’s the opportunity to give birth outside of the hospital setting.

    Instead we tolerate escalaing risk factors and apply heroics in most hospital obestric environments.

    If those things are in place, this approach should be total fine.
     

  • AmyTuteur

    1. ALL the existing scientific evidence, as well as state and national statistics show that homebirth with a homebirth midwife dramatically increases the risk of neonatal death. The most recent CDC statistics for PLANNED homebirth with a non-nurse midwife has a death rate 7 TIMES HIGHER than comparable risk hospital birth.

    How about individual states with licensed homebirth midwives? Colorado statistics on planned homebirth show an appalling death rate double that of all births (including high risk and premature births), California has a mortality rate double that of low risk births, and over the past 10 years planned homebirth in Oregon has had a death rate at least 3 times higher than comparable risk hospital birth.

    2. The studies that claim to show that homebirth is safe are examples of bait and switch. The widely quoted Johnson and Daviss study (BMJ 2005) compared planned homebirth in 2000 with hospital births in papers dating back to 1969. Comparing planned homebirth in 2000 with low risk hospital birth in 2000 (the data was available) shows a death rate 3 times higher for homebirth.

    Moreover the authors do not disclose that Johnson was the former Director of Research for the Midwives Alliance of North America, and Daviss, his wife, is a homebirth midwife. They do disclose that the study was funded by a homebirth advocacy foundation.

    3. There are two types of midwives in the US, certified nurse midwives and certified professional midwives. Certified nurse midwives are real midwives with education and training that exceeds all other midwives in the world. In contrast, certified professional midwives (CPMs) are not real midwives at all. The “credential” was made up by women who would not or could not complete real midwifery training. CPMs lack the education and training required of midwives in ALL other first world countries. The CPM is not recognized and is not eligible for licensure in ANY other first world country.

    4. Most women who have the CPM designation haven’t attended midwifery school of any kind. They have completed a program of unmonitored “self-study” and paid the fee.

    5. The “thought leaders” of homebirth are a self-proclaimed midwife who has no midwifery training (Ina May Gaskin) and who let one of her own children die at homebirth, a self-proclaimed “expert in obstetric research” (Henci Goer) who has no training in obstetrics or research, and a washed up talk show host (Ricki Lake).

    6. According to the WHO, the best measure of obstetric care is PERINATAL mortality, and according to the WHO, the US has one of the lowest rates of perinatal mortality in the world.

    7. The Midwives Alliance of North America, MANA, the organization that represents homebirth midwives, spent the years 2001-2008 collecting data on the outcomes of planned homebirths. During that time they publicly proclaimed that they would release the data to show that planned homebirth is safe. Once the data was analyzed, they changed their mind. MANA REFUSES to release the death rates for the 24,000 planned homebirths in their database. It doesn’t take a rocket scientist to figure out that MANA’s OWN DATA shows that homebirth increases the risk of neonatal death and they are hiding it so that American women will not find out.

    8. Two out of three babies who died at homebirth would be saved in the hospital. Zero babies who die in the hospital would be saved at homebirth.

    Homebirth leads to preventable neonatal deaths. All the existing scientific evidence confirms this and all the available state and national statistics demonstrate this. Even MANA knows that homebirth leads to preventable neonatal deaths; they just don’t want the Massachusetts legislature and American women to find out.

    9. The Netherlands has one of the highest rates of perinatal mortality in W. Europe. A study in the BMJ found that low risk birth with a Dutch midwife (home or hospital) has a HIGHER perinatal death rate than high risk birth with a Dutch obstetrician.

    Homebirth kills babies and Gaskin has blood on her hands. The only people who are unaware of these facts are homebirth advocates.

    • guest123

      But hospital birth can lead to an experience of birth rape.

      • Captain obvious 66

        Guest123- nice reply. You thought that out, researched your points, provided links to your thought. I want you on my debate team