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post #81 of 98
Quote:
Originally Posted by nikirj View Post
Unfortunately, whenever we talk about making homebirth transfer situations safer, the focus falls somehow on legislating midwives. Requiring that midwives have agreements makes life more difficult without improving the situation. What we need is some way to improve the way we are received at the hospital, and to remove the stigma against doctors who consult with us.

When midwives feel like their reception is going to be less than friendly, they consult less often and transfer later. I've seen this firsthand, working with a CNM with hospital priviledges, CPMs with very friendly relationships with doctors and hospitals in their area, and CPMs with shaky relationships with doctors and hospitals in their area. The issue wasn't the skill or safety of the practitioners, it was the political climate re: homebirth and midwives. In fact, the CPMs with the shakiest relationship practiced in the most conservative way of anyone I worked with. Poor reception at a hospital/ poor professional relationships aren't usually about how good or bad midwives are.

The unfortunate fact is that doctors are leaned on from several angles to avoid developing positive relationships with midwives. From ACOG, from their malpractice carriers, from hospital admin. From what I've seen in trying to hammer out smooth transfers is that the biggest problem is actually the malpractice carriers and hospital administrators, who insist that doctors not formally consult with midwives because they view it as opening the doctors up to liability. The fact is, we may then later have to transfer blind to one of those same doctors with a train-wreck-in-the-making...how is that any better?

When we talk about legislating a need for collaboration between OBs and MWs, that legislation should lean on the OBs, who are the ones with the power in this situation. If it leans on the MWs, it will just put us out of business.

And yes, FFS, how could anyone not believe that ACOG has it out for homebirth midwives after multiple issue briefs to that effect?
I am a avid homebirth supporter and chose hb for my second pregnancy. Ultimately, complications led my midwife to transfer me during labor to the hospital. There isn't that "good" relationship here that I agree with you is much needed. Fortunately, my midwife isn't swayed in a direction that would lead her to provide less than adequate care because of this kind of thing. I can see where the fear comes from absolutely, and I hate that it is present. I agree, legislation should focus on OBs providing backup care as needed, and hospitals accepting homebirth transfers as necessary without it being a "situation". Also, I think those providing in home maternity care should register with a board that would provide trainings on important things like neonatal resuscitation. I think a universal law legalizing midwives in all 50 states is crucial to making hb as safe as possible.
post #82 of 98
And what changes were brought about by this study, released four years ago, which showed a twofold risk of neonatal death with c-section? The rate has continued to rise, even with EVIDENCE that it's "not safe" or "higher risk" or whatever catchphrase you want. So I wonder...if a mother who would have a c-section in the hospital has a vaginal birth out of the hospital...don't the two "risks" cancel each other out and her risk is back to 1?

All of the meta analysis in the world doesn't change the state of birth care in this country. And arguing amongst ourselves about more regulation won't change it either. What needs to happen is the providers, the insurance companies, the legislators, the regulators, the boards, and the entire society need to value the lives of mothers and babies. THAT will change the state of maternity and birth care. Until then, we all have to do the best we can with what we have, which is a very imperfect, flawed, and sometimes dangerous system of care.
post #83 of 98
I cannot believe it they used the Pang study again!!!!!! insane
post #84 of 98
Quote:
Originally Posted by Charmie981 View Post
And what changes were brought about by this study, released four years ago, which showed a twofold risk of neonatal death with c-section? The rate has continued to rise, even with EVIDENCE that it's "not safe" or "higher risk" or whatever catchphrase you want. So I wonder...if a mother who would have a c-section in the hospital has a vaginal birth out of the hospital...don't the two "risks" cancel each other out and her risk is back to 1?

All of the meta analysis in the world doesn't change the state of birth care in this country. And arguing amongst ourselves about more regulation won't change it either. What needs to happen is the providers, the insurance companies, the legislators, the regulators, the boards, and the entire society need to value the lives of mothers and babies. THAT will change the state of maternity and birth care. Until then, we all have to do the best we can with what we have, which is a very imperfect, flawed, and sometimes dangerous system of care.
Anyway, we are talking about 3%, 0.2% increases in risk. Even if it was a perfect meta-analysis, does it really point to increased legitimate risks? Birth in and of itself is not something that goes perfectly all the time. Sure with a well trained professional, "situations" can be handled. But, when I see single digits, I counter it with the double digits of things like c-section and induction and risks associated. Being someone who has experienced c-section for no real reason, and c-section as a homebirth transfer, I have to say that my 2nd c-section was a safer surgery with better outcomes than my first and I have to say I think it was because of the patience and expertise of my midwife. What needs to be addressed absolutely is the hierarchy placed into the maternity care of this county and the horrible situations women are placed in because of this approach to caring for us.
post #85 of 98
I think that Gail Hart's article (which was just posted online today), Midwifery Today Responds to Study Questioning Homebirth Safety, is an awesome rebuttal to the conclusions that were drawn by this flawed meta-analysis. Gail Hart!


And as an aside, I just have to respond to this:
Quote:
Originally Posted by Charmie981 View Post
I've often said (in person, not online...because I know there will be backlash) that I don't "trust birth." I'd much rather trust that "birth is as safe as life gets." Life isn't safe and I don't trust that it will allow me to be here tomorrow. In some cases, birth can be made safer by swift and judicious intervention and in other cases, it can be made less safe. The ultimate goal for me (and my clients) is always a safe birth in which they know that any medical interventions were necessary interventions.
I feel like disparaging the term "Trust Birth" is almost like a personal attack on Carla Hartley and the whole Trust Birth movement. Both as a friend of Carla's and as a midwife who does trust birth, I'd just like to provide some clarification about Trust Birth. Written by Carla herself (and quoted with permission): "I am wondering, why those who are so riled up about Trust Birth take such an interest in slamming what we do and what we believe. How are we hurting you? Or more to the point, how will it hurt you if women take their births back and start trusting that they know how to do this? If they make the rules? If they un-invite you?
-Insert big sigh here-
I personally wish that there was no need for a Trust Birth movement. I wish I could just help women become authentic 'with woman' midwives. But wherever there are lies, there is the need for truth. The idea that birth is a medical event, or even one fraught with danger, is a lie. It doesn't matter who is telling it. Yes, midwives in any setting are usually better than OBs. Home birth is safer than hospital birth. But the truth has not quite been told if you stop at home birth and midwives. To tell women part of the truth and not all of the truth borders on criminal, in my opinion. Tell the whole truth: Birth is MORE safe than not. Interference is MORE risky than not. Birth belongs to the women giving birth and they have the right to choose who is there or not there. PERIOD. Women should be acknowledged, and deferred to, as their own authority and everyone else should agree to be in service to her....not to tell her what to do or give her permission to do what her body knows how to do.

Now, to you women reading this who are not midwives. Everything the Trust Birth Initiative does is for you and your babies. Even though the bulk of the criticism of the Trust Birth movement comes from midwives with a little slice or two from Dr. Amy, midwifery is peripheral to what we are about. Trust Birth is about helping you. No payment required. No need for titles or officialness. If you want someone to believe in you and help you research and prepare for birth..... or walk with you at any stage of your pregnancy, labor and birth, Trust Birth is here for you. We will help you find the facts and find your power. We want you to fully embrace your ownership of birth. We want to tell you the whole truth, not just the part that serves birth attendants. You were made to do this. That is truth."
~Carla Hartley, mother of the Trust Birth Initiative
http://www.facebook.com/carla.hartle...d=411391578603
post #86 of 98
Ah, and there's the backlash. I didn't attack Carla Hartley. I said that "trust birth" isn't what works for me in my practice and I'm happy to offer something different to my clients. I do wonder, after reading that, what Carla Hartley's response would be to women who have found, as some have on this very thread, that birth was not worthy of their trust.
post #87 of 98
Quote:
Originally Posted by TXmidwife View Post
The idea that birth is a medical event, or even one fraught with danger, is a lie. It doesn't matter who is telling it. Yes, midwives in any setting are usually better than OBs. Home birth is safer than hospital birth. But the truth has not quite been told if you stop at home birth and midwives. To tell women part of the truth and not all of the truth borders on criminal, in my opinion. Tell the whole truth: Birth is MORE safe than not. Interference is MORE risky than not. Birth belongs to the women giving birth and they have the right to choose who is there or not there. PERIOD. Women should be acknowledged, and deferred to, as their own authority and everyone else should agree to be in service to her....not to tell her what to do or give her permission to do what her body knows how to do.


If birth was not safe, the human race would've died out a long time ago.
post #88 of 98
Not to derail the thread too much but I do hope that as professionals anyone reading this thread will consider how horrendously hurtful it is for those of us who "trusted" our birth and ended up losing our babies or in seriously compromised positions to hear this trite way of describing a finely balanced biological and physical process.

I realize I haven't posted my birth story but I was pushing my daughter against her cord for four and a half hours until her heart stopped. I trusted the women around me who were telling me this is just part of being a woman. And it was awful to feel the dreadful weight of those lying reassurances, and to have bought into them. I had panicked about an hour before my daughter's heart stopped but I grit my teeth and refused to ask about a c-section because I trusted that "my body was made for this." Well that was a flat-out lie. It is brutal to watch people perpetuate it.

As for the human race would have died out long ago - lots of people and children did die, and continue to die around the world because they don't have access to medical intervention when they need it. The reason losing a child in childbirth in this day and age is so isolating is because it is not common. Even a few generations ago it would have been quite normal. I had older woman who understood around me, because they had lost children. But very few of my peers have.

I am a supporter of natural childbirth and homebirth, and I agree that many hospitals over-intervene and that change is needed. But this kind of oversimplification not just drives me nuts personally, it is extraordinary hurtful and you lose me as a political ally when you insist on trite phrases. I am sharing this in the hopes that some people might stop.
post #89 of 98
Charlotte, I usually agree with your posts, but you left yourself open to that when you used that phrase. Trusting birth does not mean that nothing will ever go wrong. It simply means that a mother is the ultimate authority over her birth. Anyone else involved is just a consultant, and to me, one of the main parts of my job is to help women find that ability to trust their own intuition. Even if things seem to be progressing quite normally during a birth, if a mama says, "Something's wrong" or something else along those lines, I listen to her. Sometimes it's just a matter of needing some reassurance, but a woman who is truly attuned to her body should never be made to feel like she doesn't know what is going on inside that body. The common thread in the stories of the women who have lost babies during homebirths seems to be that at one point, they *felt* like something was wrong, and their concerns were either dismissed by their caregivers or they felt afraid to speak up about their fears. Again--midwives are not the authorities on a woman's body. She is, and that should be respected by all caregivers above all else.

And I would also like to add that I am still dealing with a 2nd trimester loss of a baby that happened just a few weeks ago. Not the same situation, but my own grief still knocks me over. My comments were addressing a specific quote, and were noted as such.
post #90 of 98
My heart goes out to all the mamas who have lost babies. I can't imagine the anguish. I want to clarify how I (and I think many others) interpret the phrase "trust birth". I don't think it's a matter of believing that birth is 100% safe all the time, or that there is always a happy outcome. For me, it is about trusting the motherbaby, and listening to the instincts of the mother, and being tuned in but not interfering unless necessary. In both of the tragic stories shared on this thread, it appears that the midwife was not trusting the mother's intuition and that can be a terrible (and in these cases, fatal) mistake. IMO a midwife's default should be trust that the process of birth will unfold naturally, but to also have the skills and sense to realize when something is amiss. I'm so sorry that there are mamas hurting because of those two simple words: trust birth. Words that were intended to protect you and your baby from unnecessary meddling and harm. I'm sorry that your gut was not trusted.
post #91 of 98
Quote:
Originally Posted by Charmie981 View Post
Ah, and there's the backlash. I didn't attack Carla Hartley. I said that "trust birth" isn't what works for me in my practice and I'm happy to offer something different to my clients. I do wonder, after reading that, what Carla Hartley's response would be to women who have found, as some have on this very thread, that birth was not worthy of their trust.
I think I might have been the first person to mention "trusting birth" on this thread. I've been concerned about how much GUILT this type of mental attitude can pile on moms. I had a serious complication during my third baby's birth (second home birth). I had had no risk factors and no interventions. Did I not "trust birth" enough or otherwise cause it? Or did it happen because "birth is as safe as life gets" and sometimes $(*& happens?

Thankfully, my story had a happy ending. It still left me (and my midwife!) rather shaken, though. I had two more home births after that without complications. I would describe myself as a rather cautious birther with those, though. I wasn't sure I trusted birth anymore after what happened with my third baby. I took comfort in the knowledge that my odds of having an uncomplicated birth were very high and chose to focus on that.

I suppose I trust that birth usually goes well, but I know that it doesn't always. I want moms to understand that sometimes really horrible $(*% happens that is completely outside of their control and that it probably had nothing to do with whether or not they "trusted enough" in the process.
post #92 of 98
Quote:
Originally Posted by TXmidwife View Post
Trusting birth does not mean that nothing will ever go wrong. It simply means that a mother is the ultimate authority over her birth. Anyone else involved is just a consultant, and to me, one of the main parts of my job is to help women find that ability to trust their own intuition. Even if things seem to be progressing quite normally during a birth, if a mama says, "Something's wrong" or something else along those lines, I listen to her. Sometimes it's just a matter of needing some reassurance, but a woman who is truly attuned to her body should never be made to feel like she doesn't know what is going on inside that body. The common thread in the stories of the women who have lost babies during homebirths seems to be that at one point, they *felt* like something was wrong, and their concerns were either dismissed by their caregivers or they felt afraid to speak up about their fears. Again--midwives are not the authorities on a woman's body. She is, and that should be respected by all caregivers above all else.
Yes, I completely agree with this. However, this is trusting women, not birth. In the stories shared on this thread, the midwives trusted birth over their own clients intuition and tragedy resulted, and it's not the first time I've heard of such things.

Veritas and I are on the same page here. I think the inverse of the phrase trust birth is that you didn't trust enough, or that your trust was misplaced in providers and not birth or yourself. We have enough mommy guilt in our lives...we don't need some catchphrase making it worse for us when something doesn't go as planned or hoped. But that's enough on that topic. I know all too well that my opinion is not a popular one and I'm not charismatic enough to defend it to hoards of followers.

Back to the topic at hand. I think this blog post is the best dissection I've seen of the so-called "study."
post #93 of 98
Can I just say--?

Trusting Birth does NOT mean that if you 'trust enough', then nothing bad will ever happen to you!

For emphasis in explaining Trust Birth, I quote TXmidwife's phrasing: "Birth belongs to the women giving birth and they have the right to choose who is there or not there. PERIOD. Women should be acknowledged, and deferred to, as their own authority and everyone else should agree to be in service to her....not to tell her what to do or give her permission to do what her body knows how to do."

And I agree w/her as well--too many of the sad outcomes that are posted to a thread like this sure seem to be the outcome of women's disenfranchisement at birth--having that natural authority mistakenly taken over by others (such as docs and mws)--NOT an outcome of their trust in birth. An outcome of caregivers who trusted themselves too much...of mothers who believed that 'trusting the caregiver' was the same as 'trusting birth'. NO FAULT HERE! Because if/when that happens, it is generally because trusting birth/trusting mothers is new to us all in this era--we don't (in general) have it sorted out very well yet, neither mws nor mothers. I've seen a lot by way of confusion about this point--perhaps only naturally, moms and mws both assume that 'trusting the mw' is essentially part of trusting birth...but this just is NOT so.

Of course, we will never stop seeing the sorrow of *some* birth losses...because that is life, and birth: death walks near and we never know, aren't always warned when death will claim a beloved. Or are warned too late to do anything about it.

So I guess it isn't just about 'trusting birth', but as spoken by TXmw, trusting MOTHERS.

For myself, I see my job as mw being primarily about facilitating women's trust in themselves, encouraging (in part by staying out their way!) their empowerment and authority in their pregnancies/births. Of course their are other important elements to my care...but to me, helping women/families to trust themselves and become active as authorities in their pregnancies and births, is the most important part.

It is, as far as I can see, the one thing that makes the most difference in birth. My knowledge, skills and intuition as a mw are simply not enough on their own to make birth as safe as it can possibly be. Oh, that knowledge/etc does 'well enough' for the average normal birth...but NOT for every birth. I take mothers' words and actions (such as a panic moment) VERY seriously indeed--because I know too well by now that a mother may 'know' something that is beyond my own, or anyone's, ability to see no matter what kind of technology is applied. Her 'knowing' may only be expressed with a panic moment, or anxiety in pregnancy that is resistant to resolution through the usual measures--through a variety of signs that caregivers do well to clearly hear and acknowledge. She doesn't 'know' something in the rational, conscious sense--but her knowing is present just the same, and trying to make itself heard.

Those of us who would trust birth MUST realize that we have to trust mothers above ourselves and our skillset, and we have to realize that sometimes, birth is 'trustworthy' by giving us signs that all is not well. Sure, often those signs can be read in a heart tone, or a b/p reading or the appearance of blood, etc...then there are those signs that arise directly from a woman's heart and mind without 'clinical evidence' to prove them 'real'. I take those very seriously indeed--no matter WHAT my doppler or visual observation is telling me--because to me, trusting birth means first and foremost trusting mothers.

It is only to everyone's peril--but most especially a baby's, as the most vulnerable one--that any caregiver fails to trust mothers, that any caregiver holds their own approach, knowledge and technologies as an authority above a mother's/father's (occasionally it is actually dad who first expresses the 'warning sign', if he is an intuitive sort and especially close with his woman).

And finally...not all of us have had to deal with losing a baby at birth. But those of us who are mothers, and especially if we also do birth work, have a very good idea of the terrible sorrow of such a loss. In discussing this kind of topic, we have to be able to mention things like Trust Birth. Of course it may be painful to hear, if you are a mother who has known the loss of a precious baby...but to speak of such things is NOT a casting of blame, and NOT insensitivity to the feelings of the bereaved.

It is simply a 'truth' that bears witnessing, because of its value to all.

I think we all need to understand this 'trust birth' truth more fully...and in this format, we try to seek understanding through talking to each other...sometimes about painful things.
post #94 of 98
Still off-topic: Well the thing is in terms of "trust birth" vs. "trust women," etc. is that it was the natural birth community that disenfranchised me from any SMALL intuition I had (I certainly had no inkling about the cord) that things could go wrong.

Because I had made that choice to see birth as not dangerous. And I no longer agree with that viewpoint - I see it as not dangerous most of the time, which is quite different. And I don't trust it. It's a ridiculous process in human primates, which we often have conquered through our brains (I include intuition in that, but also training, research, and education) and social practices.

In my own small research afterwards I found that women have feared birth throughout history. For myself, and of course I'm forever biased, that is my new radical point of view: Nature red in tooth and claw doesn't care if my babies survive, but I do. That doesn't mean I think interventions are any better.

For me what it means is I want serious backup if things go wrong.

And I think that comes back to this study. I agree that it's flawed, but I still think it is asking the right questions in some ways, or at least it brings to mind some of the right questions to me. When is homebirth appropriate, do people understand the real statistical risks, what training and equipment is appropriate for whom when.

And additionally - when, oh when, will people stop posturing politically (which I agree this study does) and work together to transfer the small but significant cases when transfer is needed in the best possible way. In my case the only shot my daughter had was pretty much blown due to understaffing, but she got second and third chances with resuscitation teams and NICU teams. It wasn't enough, but with 5 minutes more at the labour end it might've been. That gave me an appreciation for that end of things.

I have confidence that homebirth can stand up to to truthful inquiry, even if this wasn't it.
post #95 of 98
Quote:
Originally Posted by Charmie981 View Post
Ah, and there's the backlash. I didn't attack Carla Hartley. I said that "trust birth" isn't what works for me in my practice and I'm happy to offer something different to my clients. I do wonder, after reading that, what Carla Hartley's response would be to women who have found, as some have on this very thread, that birth was not worthy of their trust.
yah like me. birth killed my daughter. i don't find it very trustworthy
post #96 of 98
Just because Trust Birth (capitalized) has been arbitrarily defined as "trusting women" doesn't mean that "trusting birth" has the same definition. I trust that the process of birth usually goes well. I trust myself and I trust my midwife to react appropriately if something goes wrong.

I have definitely observed midwives, doulas, childbirth educators, and other women in the natural childbirth community who make a negative moral judgment on mws/moms who use/need medical intervention or experience complications. I used to be one of those (before my third baby's complicated labor).

Moms who experience fluke complications during labor/birth should NOT be made to feel that it was somehow their fault. The phrase "trust birth" (even if people try to say it actually means something else) is a cruel thing to say to someone who has experienced trauma or loss caused by the (fallible) birth process.
post #97 of 98
I have one other question about the study. (Have we talked about this enough. Sorry! )

There is a claim circulating through cyberspace (is that vague enough, I hope? ) that the Johnson and Davis study proves the homebirth with a CPM triples the neonatal death rate. So why would the authors of a meta-analysis exclude that study--which arguably has the strongest possible methodology--if it allegedly proves their point?
post #98 of 98
Been loosely following this thread and I don't know if anyone's linked to this post by a CNM who received an advance copy of the meta-anaylsis and break it down study-by-study: http://www.themidwifenextdoor.com/?p...1#comment-2714.

Also, Turquesa, I think what you're referring to is a claim by She-Who-Shall-Not-Be-Named , who used her own methodology to recalculate the results of that study.
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