Doctors unhappy about Ricki Lake's home birth movie

How do you know that your doctor has "seen it all?" If he has never seen a home birth, then he hasn't seen it all. This is a huge problem; very few obstetricians have actually observed, let alone participated in, a normal physiological labor. They have NO IDEA what women sound like, the positions they assume to facilitate the birth, or how to support the woman outside of using medications. Studies consistently show that home birth is just as safe as hospital birth and less interventions are used. Too many women don't recognize the real risks of interventions and too many women don't know that many medications used in labor have not been approved by the FDA for use on pregnant women. In fact, one of these drugs, Cytotec, has not only not been approved, the FDA warns doctors against its use (btw this drug is one of the drugs in the abortion pill RU486) Too many women don't consider the effects of any interventions on not only the baby but the mother and the labor itself. Women have the right to fully informed consent and to make their own decisions about the place of birth. If your doctor has seen a planned homebirth with a woman who was considered low risk then maybe he has seen it all; but most doctors haven't seen this. In light of the fact that they haven't likely observed this personally, they should look to the medical literature for evidence of the safety and efficacy of home birth. It is appalling to me that ACOG and AMA can take positions that are contrary to what one finds in the medical literature. peace....

Don, there are a bunch of studies available and they all show the same thing: there is little difference, statistically between home birth and hospital birth in terms of mortality (mother and/or baby) and a big difference in favour of home birth in terms of morbidity (mother and/or baby). So, when people say that home birth is safer, they mean that you have about the same chances of dying in hospital as in home and you have less chance of being injured (experiencing long lasting pain, infection, cutting...) at home than in hospital. Ergo, taking in all factors, home birth appears an as safe or safer option than a hospital birth FOR LOW RISK PREGNANCIES.

Concerning mother/baby pairs who have complications that arise in labour and/or birth, home birth attendants (who include OBs, GPs, FPs and midwives) are trained in assessing maternal and fetal health, know when things are starting to head out of their scope of practice and can treat, on site, for things that are within their scope of practice.

For example, in the case of hemorrhage, home birth attendants carry oxytocin injections for active management of third stage (designed to prevent or diminish hemorrhage) as well as back up meds in case a hemorrhage happens (which are administered as an ambulance is called for transport to hospital) - this happens pretty rarely and it's even rarer that the hemorrhage is so bad it is fatal, but this is exactly how it would be treated in hospital.

The midwives that I work with, who delivered one of my sons in hospital and one at home (hospital was because I as 36.6 wks when I went into labour with prolonged PPROM, making it the safest place for me to give birth when all my circumstances are factored in) can verify that the vast majority of hospital transfers are because mothers request epidurals. A minority of transfers are for suspected complications. An incredibly rare (as in a few times in a life of practice) mothers are transfers because there is an emergency underway and those transfers happen in a timely fashion that is not different than how fast an obstetric team can respond to a similar emergency in hospital.

I don't think anyone would ever claim that all births should happen at home, however it should absolutely be an option easily available to women who have low risks.

The Royal College of Obstetrics and Gynaecologists in the UK recently released a statement saying that home birth should be available to all low risk women who desire them. Most provinces in Canada have midwives on the government health scheme, providing service in hospital and home. What is it about Canadian and UK vagin@s and uteruses that is so magical? What is wrong with the uteruses and vagin@s of US mothers that makes them so dangerous that they MUST be in hospital?

Don, there are a bunch of studies available and they all show the same thing: there is little difference, statistically between home birth and hospital birth in terms of mortality (mother and/or baby) and a big difference in favour of home birth in terms of morbidity (mother and/or baby). So, when people say that home birth is safer, they mean that you have about the same chances of dying in hospital as in home and you have less chance of being injured (experiencing long lasting pain, infection, cutting...) at home than in hospital. Ergo, taking in all factors, home birth appears an as safe or safer option than a hospital birth FOR LOW RISK PREGNANCIES.

Concerning mother/baby pairs who have complications that arise in labour and/or birth, home birth attendants (who include OBs, GPs, FPs and midwives) are trained in assessing maternal and fetal health, know when things are starting to head out of their scope of practice and can treat, on site, for things that are within their scope of practice.

For example, in the case of hemorrhage, home birth attendants carry oxytocin injections for active management of third stage (designed to prevent or diminish hemorrhage) as well as back up meds in case a hemorrhage happens (which are administered as an ambulance is called for transport to hospital) - this happens pretty rarely and it's even rarer that the hemorrhage is so bad it is fatal, but this is exactly how it would be treated in hospital.

The midwives that I work with, who delivered one of my sons in hospital and one at home (hospital was because I as 36.6 wks when I went into labour with prolonged PPROM, making it the safest place for me to give birth when all my circumstances are factored in) can verify that the vast majority of hospital transfers are because mothers request epidurals. A minority of transfers are for suspected complications. An incredibly rare (as in a few times in a life of practice) mothers are transfers because there is an emergency underway and those transfers happen in a timely fashion that is not different than how fast an obstetric team can respond to a similar emergency in hospital.

I don't think anyone would ever claim that all births should happen at home, however it should absolutely be an option easily available to women who have low risks.

The Royal College of Obstetrics and Gynaecologists in the UK recently released a statement saying that home birth should be available to all low risk women who desire them. Most provinces in Canada have midwives on the government health scheme, providing service in hospital and home. What is it about Canadian and UK uteruses that is so magical? What is wrong with the uteruses of US mothers that makes them so dangerous that they MUST be in hospital?

Response to Mamaloo

It would be helpful if you could link some studies stating so(I.E. backing up what you say with evidence)

Yes the Royal College of Obstetrics and Gynecologists did say they fully support unassisted normal birth. They also stated that women should be fully informed about the risks involved and I Quote "The RCOG would like to stress that at present, the practice of free birth is new to the UK and little research exists regarding its safety and success".

Source: http://www.medicalnewstoday.com/articles/75424.php

I am all for women choosing home birth if it is safe, my wife had considered it with her midwife, however we had some previous complications so we decided to give birth in a hospital with our midwife as well as a OBGYN present(Our midwife and OBGYN share an office together), it was a great experience and there was little to no intervention with our sons birth.

Yes there are studies that show a positive outcome for home births. such as

http://www.medicalnewstoday.com/articles/29083.php

However in the United States you have to careful about how your midwife is, there has been a debate about people calling themselves midwifes that have no medical training.

http://www.medicalnewstoday.com/articles/40992.php

The only point I would like to make is make sure to get the proper prenatal care and carefully weigh the risk involved in home births before making any decisions. Make sure your birth is as safe as possible which is usually in a hospital, you can have a midwife deliver in a hospital.

Don, I didn't speak about UC in the UK, I spoke of home birth. Not only did RCOG make a public statement recently stating that home birth is considered as safe as in hospital birth for low risk pregnancies, it is actively promoting home birth as a partial solution to the financial crisis UK's maternity services are experiencing. Because, not only is home birth (with a trained attendant) as safe as in hospital birth, it's also very cost effective.

"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."
The Johnson, Davis Study, the most recent and most extensive study
http://www.bmj.com/cgi/content/full/330/7505/1416?ehom

"There was no increased maternal or neonatal risk associated with planned home birth under the care of a regulated midwife. The rates of some adverse outcomes were too low for us to draw statistical comparisons, and ongoing evaluation of home birth is warranted."
http://www.cmaj.ca/cgi/content/full/166/3/315?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=homebirth&andorexactfulltext=and&searchid=1091066389470_8790&stored_search=&FIRSTINDEX=0&sortspec=relevance&resourcetype=1&journalcode=cmaj

"No significant differences between the two groups regarding fetal and neonatal death, labor- related complications, or low 5- minute Apgar scores were detected, regardless of whether the comparisons were crude or adjusted for confounders."
http://www.thefarm.org/charities/mid.html

I am unaware of any study that shows that there is a large discrepancy in numbers showing that planned home birth with a trained attendant is markedly less safe for low risk pregnancies. And, ever if there were, it is a patient's right to choose their care, especially in the US where health care is a la carte.

If you had cancer that required chemo and radiation for treatment, but decided you wanted to limit your therapies to naturopathy, that is totally your right to do. There are no laws forcing you to undergo treatments that you believe are antithetical to your personal philosophies and spiritual beliefs, that you believe are unnecessary, that you believe are abhorrent, that you believe are ultimately detrimental to your health. Surgeons (which is what obstetricians are), do not have the right to force women to do what they don't want and often done medically need to do.

Noone would suggest that a women who feels hospital birth is the safest option for her or that women with a history of obstetric complications should be giving birth at home. Hospital birth has its place. So does home birth.

Statistics show that home births are generally safe. Midwives rule out the option for higher risk patients. We chose freestanding birthing center supervised by certified nurse midwives for 2 of our 3 children who were born in the late 80's and early 90's. They were wonderful experiences for us. I made this choice after having a regular hospital birth in 1986 in Gastonia NC which was overly supervised and not a good experience ---enema, shaving, unnecessary episiotomy (which tooks months to heal.) The staff was not supportive of my decision to avoid pain medications or to keep the baby with me after she was born. If we had any more babies, we would have strongly considered home birth. Childbirth is a natural healthy event, not a medical procedure. Women need to be able to make their own educated decisions on this. I worry that my daughters will not have the options I had when they give birth. I congratulate Ricki Lake for exposing the issues involved and working to keep choices available.