OMG, OB friend trying to scare dh out of homebirth! LONG

[Quirky]

The backstory - dh's best friend's wife (we've known both of them since college, more than 15 years) is an OB/GYN. 3 kids, one vacuum extracted and 2 c-sections. Very conventional thinker. We had ds at a nearby birthing center with a medwife and I was NOT happy about my experience - long story, but lots of interventions incl. AROM and episiotomy, ds ended up in NICU for 4 days (I believe because of deep suctioning). All-around blah.

So this time I want a homebirth, and a midwife who will be one-on-one with me rather than a birth center (there are 2 nearby) where I get whoever's on call. And there is exactly 1 CNM (direct entry midwives not legal in my state) in solo practice close enough to us - and she does waterbirths, so that's a plus. I have had HUGE fights with dh, who wanted to go back to the birth center - he's also very conventional medically speaking (former EMT) and discounts my bad experience, and says it wasn't so bad.

So I finally get him to agree to the homebirth (well, he finally realized he had no choice, I'm not proud of forcing him into it but really there was no other way) and he tells his best friend, who then proceeds with his wife to talk to dh at ds' birthday party picnic on Sunday about the dangers of homebirth. This is the email she sent dh:

Dear (dh):

As a follow up to our conversation on Saturday, I’m sending the link to the 2002 study on home births. Things to consider about all articles on home births are:

No study can ethically be a placebo controlled randomized, controlled trial. All studies have to be retrospective in nature and based on chart review, which is not the best way to conduct a scientific study.

Studies on home birth will over estimate the safety of home birth because they compare low risk women giving birth at home to a mixed population in a hospital. Rarely will some one with a heart transplant deliver at home, but she will be pooled into the hospital birth data. The ideal study (which doesn’t exist) would compare low risk women in spontaneous labor without anesthesia with singleton gestations to women who choose to give birth at home who presumably will share the same characteristics.

ACOG article: http://www.acog.org/from_home/public...ng13594fla.htm

You asked for hard numbers on transfers to ERs after home births. I have looked and have not found any recent, relevant data. (There is a study from several European countries). I cannot even estimate the percentage of home births that end up in the ER. The reason is I do not know how many women choose to deliver at home. The fraction doesn’t work without the denominator.

My personal experience has not been positive. When I was a resident at Holy Cross, I covered the ER for 24 hours every third day for three months at a time. I would see two or three transfers each month. This obviously has no statistical significance, it’s just my experience. The women who transferred were not well received at the hospital. As a rule, the newborns were sent directly to the NICU, with or without parental consent. (Just ask me sometime about the Reagan administration’s rules which permit this to occur. I’ll rant for hours!) In general, the Dads would go with the infants to NICU, leaving the mothers alone in the ER. The staff was hostile, at best, to the mom, who usually was in pretty bad shape. Women were transferred for a variety of reasons – post partum hemorrhage neonatal distress from a variety of causes, severe lacerations which required repair, uterine inversion, etc. Blood transfusions were very common in this population.

In the state of Maryland, it is impossible to have malpractice insurance for home deliveries. There are three companies who provide malpractice insurance and none of them will cover anyone who participates in home deliveries. Therefore, your midwife cannot have insurance. This means that she cannot have hospital privileges or participate with any insurers. Who will take care of Jane and the baby in the event of a transfer? The midwife will not be able to due to the insurance issues. You need to meet the “back up” OB and make sure that he or she will actually cover. This again is a huge liability issue. There may be an OB who has an informal arrangement where he will not participate in any capacity in the home birth (phone consult, etc), but would agree to assume care should hospital transfer be necessary. In the current malpractice climate, I’m not sure such a doc exists, but certainly may.

I can’t tell you exactly how a birth center birth differs from a home birth, because I’ve never been involved with a home birth. However, there are some obvious issues. Does the midwife come with an additional midwife or RN? Birth centers have a minimum of two healthcare providers available at all times. This is a safety issue. It is very difficult to do internal uterine massage and start an IV simultaneously in the event of a hemorrhage. Maneuvering a woman with a shoulder dystocia is impossible by yourself. A second non-medical person, like a doula, would be useless in an emergency.

Is there oxygen and backup oxygen for the mother and or child? A birth center has hard wired oxygen lines with supplemental tanks. One oxygen tank can fail, as I sure you know from EMT days. I would have the same concerns for IV equipment, Ambu-bags, neonatal resuscitation equipment, etc. Redundancy is essential for safety.

Will EMS transport to the nearest hospital from your home (i.e. Suburban) or to the OB facility you choose? They most likely have a relationship with the birth center and will go to the facility of choice, even if it is not the nearest. Believe it or not, in this area, we have pregnant women taken to North Arundel hospital by EMS, despite the fact that they do not have OB facilities.

Will the midwife go with you to the hospital if transfer is necessary? How do you feel about moving in labor or postpartum to a new healthcare provider, most likely someone you’ve never met , who is not happy to accept you as patients? A transfer is bad enough, but with a birth center at least you get to keep your midwife!

Can antibiotics be administered if Jane is GBS positive again?

Is the midwife certified in Neonatal resuscitation, adult CPR and ACLS?

In summary, most home births will turn out fine. The odds are overwhelmingly in your favor that Jane and the baby will do great. However, you are increasing the risk of neonatal death, low APGAR scores, blood transfusion, maternal hemorrhage, etc. This risk is very small, but very real. I would compare home birth to taking a child in a car without a car seat. The overwhelming odds are that you will not be in an accident and that nothing would happen to the child. But, why risk the safety of your family unnecessarily?

As a mother of a “special needs child” who spent most of the day arranging for my son’s speech, occupational, and behavioral therapy, I would do anything to fix Alex. I cannot imagine dealing with his problems, knowing that I could have done something, anything to prevent them. The risk of home birth, however small, just seems unreasonable versus the benefit. I see this as trading the best interests of the child for an experience that the parent wants to have. The child just seems so much more important than any experience could be.

Hope this is helpful. I sincerely hope everything works out well. It upsets me greatly that Jane is doing this. Obviously, it is her choice and her decision. Unfortunately, I have a very different perspective on the very small risks of childbirth because I’ve seen them. Every time I deliver a dead baby, or visit a child I’ve delivered in the NICU, or do CPR on a pregnant woman, I go home a hug my beautiful children. I thank God my kids are alive and somewhat healthy. I cannot imagine doing anything intentionally to potentially hurt them.

ARGHHH! I have the links to counteract the Pang study, but now I'm going to have to get dh (who's not a big reader or researcher) to plow through all this stuff so I can make sure he's on board and not chicken. I am considering sending this woman an email, too.

If you've gotten this far, thanks - do you have any thoughts on studies to send? Or what to do to get dh to a zone of comfort? Or how I should talk to this woman - if at all - about this issue?

Grrr. I'm pissed.

[candiland]

I don't know where to find it, but the largest study to date consists of over 2500 homebirth women and 2500 low risk hospital women. Everything regarding maternal/fetal morbidity was equal; HOWEVER, everything regarding injury to mom and baby was significantly higher in the hospital group. Look up "Mehl, birth statistics" or something on your computer. It may come up.

I live in MD, too. CPMs and DEMs are *not* illegal; they are allegal. Meaning a shade of gray. I used an extremely qualified CPM for both of my births. If anything were to go wrong, the midwife would get into trouble, *not you*. My midwife, during the few transfers she's had over the years, stays with the woman throughout the admittance process and acts as a doula once the woman arrives at the hospital. She has gotten threatened and harrassed, but she does not stand down.

What was your medwife's name? I'm familiar with the majority of mw's here in the state of MD.

[candiland]

Originally Posted by medwife

I cannot imagine doing anything intentionally to potentially hurt them.

Try birthing in an unfamiliar environment, where the body shuts down to prevent birthing in an unnatural atmosphere, then every intervention is used to *help* the woman and baby, ending in traumatic and sometimes physically damaging births :grr

[Breathless Wonder]

I would be spitting nails!!!

Have you looked at the Sheila Kitzinger book? I beleive the statistics in "Homebirth" were matched for age, class, etc. and showed better outcomes in the homebirth group.

[candiland]

Oh, and I would kindly e-mail back to this woman: "Thank you for your concern, but this is none of your business. The statistics that I have found compare low risk hospital deliveries to low risk home deliveries, and every statistic shows that home birth is safer for both mother and baby. This is my baby and my body. Please do not discuss *me* with *my husband*. Thank you."

[Quirky]

Wow, I didn't realize that about the CPMs/DEMs - although it doesn't matter because there is no way my dh will consent to someone who isn't a CNM. I've pushed him to his limits on this one.

DS was born at the Maternity Center in Bethesda with Michelle....don't remember her last name if I ever knew it. I could look it up in my records. She's not there any more (ds was born in 2002).

I've chosen Evelyn Muhlhan this time around - she was at the Baltimore Birth Center until it closed, and now has her own practice in Randallstown. Which is a bit of a haul from Bethesda but that's OK.

I am on a mission to compile a list of studies....she is going to hear from me on this one. I am going to kill her with kindness, though.

(BTW, candiland, don't know if you remember my rant in the Circ forum....this is the one who has 2 intact sons but still does circs - "hey, it's the parents' choice, and it's not like female circ AT ALL." Yeah, whatever helps you sleep at night.

[candiland]

Ooooh, I've doula'd at quite a few births with Evelyn! She's great! My CPM acts as her back up, on occasion. One of my good friends had my mw while Evelyn was on call at the hospital.

I've found the Mehl study:
http://www.orlandomidwife.com/birthcenter/page2.html

Hope that helps!

Oh, and btw, my husband wouldn't let me have a home birth, much less with a CPM. I did what I wanted to, anyway Now he is one of the biggest homebirth advocates I know! I think it kinda falls under the same gun as circ. does; it's your body, not his... just as it's your baby's penis, not his... kwim?

BTW... scroll down to #2 on that website. Good luck!

[captain optimism]

Hmm--well, I'm not a doula or a midwife and I had a hospital birth that wasn't the greatest nor the worst experience. That's my disclaimer. I don't know what kind of birth I would have if I were privileged to have another baby--I'm just on this thread because I like you, Q.

I want to point out something about this email that you quote here. The writer is saying that the problem isn't with homebirth, but with the attitudes of hospitals toward homebirth and the attitude of insurers toward homebirth. She said that when she was a resident, that homebirthers in distress came to the hospital and that the other medical staff treated them badly. (I'm not sure how she can live with herself in that case, it seems pretty horrible to be part of a profession in which you blame patients in distress for their injury or illness. Digression...)

It seems like she is saying, most homebirths turn out fine, but if you are smart you will choose a medical setting because otherwise if something bad happens to you doctors will treat you like crap. Doesn't that kind of sound like a threat? It's not that you really need to be in a hospital, it's that you need to be in a hospital so just in case you get sick or injured we won't be mean to you. On that theory we should all just grab our beds now, in case we get hit by a car. After all, hospital staff is really mean to patients that get hit by cars, unless we plan to be in the hospital anyway.

If you are using a CNM, doesn't she have to know how to do the things that your OB friend mentions? I mean the antibiotics, the neonatal recussitation, etc.

If she is so concerned for you, why doesn't she volunteer to be your backup doctor? Or is that something you would rather avoid?

[Quirky]

CO, you hit the nail on the head (as per usual ) - the argument that it's better to birth in the hospital because OBs and L/D nurses may treat transfers like crap is an indictment of the obstetric profession, not of homebirth! It's completely ridiculous - OBs refuse to act as backups for homebirth midwives, then punish women who have the audacity to choose midwives instead of them.

I really need to go to bed instead of obsessively surfing the Web and PubMed for studies on the safety of homebirth. I have found some very good critiques of the Pang study, including a great Mothering article that was published by one of our MDC mamas ( can't remember her screenname, but she's Jill, the head of ICAN). That study is as leaky as a sieve.

And speaking of putting her babies at risk...I shouldn't even go here but may I just mention the fact that a) she weaned all 3 of her babies before 1 year old, b) she thinks FF is a valid choice and doesn't push BF on her patients, gives out all the FF samples and "goodies" in her office, and c) had baby #3 in the carseat they'd bought for baby #1 that was so inadequate and crappy (and improperly installed) that I wouldn't let them leave our house without borrowing our carseat and having dh install it! Baby was practically falling out of the 3-point restraint, it was so loose and permanently twisted. She didn't even know that you're supposed to drop the carry handle down while driving - and this was the third baby! So I think the reference to carseats and accidents is just a little ironic.

OK, you can tell I have issues....I really do like her overall, even though I think her perspective on this (and other medical issues) is warped by her training.

[cottonwood]

How infuriating! It would be one thing if she actually had some facts on her side...

"Studies on home birth will over estimate the safety of home birth because they compare low risk women giving birth at home to a mixed population in a hospital."

Oh boy, she's already in trouble. I'd ask her to provide these studies (since she seems so familiar with them) then point out that the Pang study that she seems so fond of makes the same kind of mistake (in that case, not differentiating between planned and unplanned homebirth.) Then give her a list of matched-population studies that have been done on homebirth (quite a few can be found here: http://www.homebirth.org.uk/homebirth3.htm#bmj )

"The women who transferred were not well received at the hospital."

Certainly a consideration to balance against that of the risks of planning a hospital delivery in the first place.

"In the state of Maryland, it is impossible to have malpractice insurance for home deliveries."

Just for perspective, there is a lot of good insight about malpractice insurance on this thread: http://mothering.com/discussions/sho...d.php?t=181651

"Maneuvering a woman with a shoulder dystocia is impossible by yourself."

Huh?? What on earth is she thinking has to be done for a shoulder dystocia?

Her questions about emergency care in general are valid, but certainly don't rule out homebirth, any more than the fact that a hospital that doesn't have a level III NICU and in-house anesthesiologist should rule out hospital birth.

"...you are increasing the risk of neonatal death, low APGAR scores, blood transfusion, maternal hemorrhage, etc."

Evidence? Studies? Stats? (It's SO easy to make these claims, not so easy to back them up...)

"I would compare home birth to taking a child in a car without a car seat."

Oh, that's an original thought. :LOL But let's run with it. I'd compare homebirth to taking a stroll down a country path (where certainly accidents can happen) and hospital birth to driving in a car down the highway with the seat belt on. You can take all the precautions you want, but that doesn't mean the basic scenario is inherently safer.

"As a mother of a “special needs child” who spent most of the day arranging for my son’s speech, occupational, and behavioral therapy, I would do anything to fix Alex. I cannot imagine dealing with his problems, knowing that I could have done something, anything to prevent them."

I assume that as a physician, she understands the definition of "iatrogenic". Of course, I'm sure that nothing she does could possibly contribute to dysfunctional birth and birth complications. But she must be aware that iatrogenic illness and injury that results in damage and death is considered a huge problem by the medical establishment itself. How does she suggest you ensure that does not happen? And does she really think you would feel any less bad if that were the cause of your child's problems rather than natural ones? Or does she believe that iatrogenic complications are less likely than natural complications? If so, what is the evidence for this?

"It upsets me greatly that Jane is doing this."

This would be unbelievably snarky and unproductive, but if someone told me this I'd be tempted to say, "and it upset me greatly that you planned your births to be managed in such a way that it increased the risk of dangerous interventions."

[Artisan]

Yeesh. This woman sounds incredibly uninformed -- she doesn't know if someone with a graduate degree in midwifery would know how to resuscitate an infant? Umm, Ok.

Have you looked at Ina May's Guide to Childbirth? There are some great homebirth stats in there.

And I believe the name of your midwife was Michelle Fineman. She delivered my son too.

Interesting about direct entry midwifery being "alegal" -- Midwifery Today says it is ILlegal.

[crazy_eights]

Originally Posted by blueviolet

Huh?? What on earth is she thinking has to be done for a shoulder dystocia?

She's thinking that you have to do McRobert's (knees to the ears) with someone giving suprapubic pressure - b/c that is the only way most OB's are taught to deal with shoulder dystocia. She is also, mostly likely, vastly overestimating the incidence of sd based on her experience as a hospital based OB dealing with epiduralized woman delivering on their back with greatly reduced pelvic dimensions.

FWIW - a mw on a list I'm on pointed out that the same population and statistics (from birth certificates from Washington State hb's) were used for the Pang study were used by the state of Washington to show that homebirth is SAFE and that state medicaid should cover it. It was a prior study and the years varied slightly (something like one was 1985-1994 and Pang was 1989 - 1996). Makes you wonder who is monkeying with the numbers - esp. since the state of Washington would presumably have an interest in showing hb to be unsafe and therefore not have to spend tax payers money to cover them!

Oh - and despite the fact that ACOG trumpeted the study, the study authors themselves said that they didn't think any conclusions could be drawn from the study given the multiple problems with it.

[tinyshoes]

How should you talk to this woman about your homebirth? In actuality, I don't think you can talk with her, because she sure can't talk with you; she can just spew her opinions and biases at you.

That said,

Originally Posted by Quirky's annoying OB friend

I can’t tell you exactly how a birth center birth differs from a home birth, because I’ve never been involved with a home birth.

Why not dare this judgemental closed-minded prick of an OB to ATTEND a homebirth? Since she doesn't think it's flat-out murderous to homebirth, simply akin to not using a car seat, it wouldn't be 100% morally impossible for her to observe one, right?

Something amazing could happen to this woman, if she saw a proper birth. I think of Peggy Vincent's book, Babycatcher, and when she first saw a 'proper' labor (the first chapter, when we meet Zelda who insists on laboring pacing on her bed, moaning, at the hosptial.)

I think of Dr. Grantly Dick-Read, and his famous experience with a laboring woman who birthed without pain or drugs and she muttered something like, it didn't hurt doctor; was it supposed to?

And I think of my hb mw, who spoke of a skeptical L&D RN sister or friend (or whatever) who attended her sister's or friend's (or whatever's) birth, as an observer--not involved with the actual home birth.

This die-hard L&D RN, after witnessing the beautiful, natural, normal birth of her sister/friend/whatever, was FOREVER TRANSFORMED, and wrote an 8-page letter to that effect to the homebirth midwife.

Sometimes, some things need to be seen to be believed.

And lastly, this jerky OB wife of your dh's friend, she's gunna be tough to drag over to the "birth is natural" side--LOOK at her, vacuum extract, 2x c-secs........she would need to admit that she could have had different birth outcomes. She'd need to feel the anger, at having had a vacuum shoved into her vagina, when maybe there could have been other ways to coax that firstborn out of her pelvis. She'd need to examine the possibility that her 3rd c-section--and since I don't know why she birthed the way she birthed her babies, I can only be so bold as to assume her 3rd was a result of her 2nd birth/1st c-sec--didn't need to happen, and that according to her own beloved ACOG data, a scheduled c-sec will have risks that a vaginal birth never has (like a scapel nick to baby's face, for example.)

And what's up with this:

As a mother of a “special needs child” who spent most of the day arranging for my son’s speech, occupational, and behavioral therapy, I would do anything to fix Alex. I cannot imagine dealing with his problems, knowing that I could have done something, anything to prevent them.

Why does her son have these special needs? Was this in any way a potential result of care she received during Alex's birth? Did the hosptial "save him" from a worse fate, when maybe there was something mismanaged during her labor.

Often, unusual passion against something can be a smokescreen for a person's own torments and issues. Perhaps this dh's friend's wife has a few issues, and she must guard them and keep them, lest her weakness as a regular human--a human who makes mistakes, might learn from them, might change her mind in light of new information--be revealed.

Had my daughter been a boy, she would've been circ'd. When pregnant, I would hear NOTHING from these anti-circ 'zealots'; most Americans circ their sons! I changed after she was born, I opened my mind and my heart to other ideas, and it's funny; while I don't agree with circ'ing at all, the bizzare passion that I used to exude when defending my choice is not the 'bizzare passion' that I have now, when I explain why my son has his foreskin.

"When you know better, you do better," says Maya Angelou...if a person refuses to know better, by keeping her mind nice and shut tight, there's no need to do better. Just keep doing the same thing, saying the same thing, living the same life.

OKAY........one last stone you could un-turn with this lady:

She says:

In summary, most home births will turn out fine.

You just toss back at that woman the "in sum" results of every hospital birth:

"In summary, most hosptial births will include AROM, EFM, an IV, epidural anestheisa, limited ability for the patient to move/ambulate during the labor, forcep or vacuum extraction, a 1 in 4 possiblity of a cesarian section, an episiotomy, umbilical cord traction to remove the placenta, and this is also described as a birth that 'will turn out fine.'"

[gottaknit]

I don't think you owe this woman any explanation or need to provide her with further research studies or stats. It is absolutely none of her business, and her arguments against it are incredibly weak.

I agree with a previous poster who suggested you email her directly. Tell her if you want her professional opinion, you'll make an appointment and pay her for it. In the meantime, remind her that HIPPA regulations prevent her from discussing private health information about you with others, even your spouse, and even if you're not her patient. She is breaking a federal law by badmouthing your homebirth plans to others. So there.

[girlndocs]

ITA, gottaknit!

And then, if it was me, I'd inform my husband that she's full of crap (and breaking Federal law), and inform him that I WOULD be giving birth at home unless he could find hard numbers that prove the hospital would be safer. :

[Quirky]

I am just : reading some of your suggestions....although as much as I would luuuuvvv to be the Queen Snark to her, her email pissed me off so much, I really can't. Her dh is my dh's closest friend (maybe even his only friend that isn't through me). Besides, for as much as she pisses me off on this issue (well, and some others, like vax and FF and RIC and....) she has been really helpful to me in the past, when I was first pregnant with ds, when I've been really sick and needed prescriptions, when my mom had a breast cancer scare....

I really do understand where she's coming from, although I don't condone it. I think she's also under a tremendous amount of stress because her middle child was just diagnosed with autism (hmmmm, any possible link to vaxes and multiple abx for ear infections? ), her dh can't work because of a bad back (multiple surgeries), and her OB practice has to support the whole family.....so it's not like she can really turn her back on her profession and go become a homebirth midwife working for peanuts.

Believe me, I'm still pissed at the email....I'm just trying to understand where she is coming from so I can respond to her (if I do - still haven't decided) from a rational place rather than an enraged place that might damage our families' friendships irreparably.

My biggest concern right now is to get dh back to a calm place. As he's a former EMT, some of her questions about emergent situatons are really resonating with him. I asked, so what's the difference between birth at home and at the birth center - she's going to bring the same gear they have there, and we're all of 5 minutes further from the hospital with the Level III NICU - and he kinda went, hmmm, maybe the birth center isn't safe enough either. I have a real education job on my hands. I think I'm going to force him to read Goer's Thinking Woman's Guide to a Better Birth and take it from there.

Thanks to everyone for all your understanding - it is so helpful to have this place to vent and be heard!

[Proudly AP]

i truly can't believe the gall of that ob, no matter what her intentions. she is, as everyone has eloquently pointed out, dreadfully misinformed.

quirky, you are oh-so-kind to be taking the high road on this, and trying to see it from her perspective. i tip my hat to you. in your shoes, i'd likely turn into a stark-raving-mad lunatic/radical (you know, same thing in some people's books)

i really hope that your dh will see the light, and that you have a peaceful, joyous birth!

[Quirky]

Oh, believe you me, the stark-raving-mad lunatic is still in there.........I'm working on composing an email to her in my head that will get my points across without messing up the relationships (well, any more than they already are).

But in my head....hoo boy have I let her have it!

I've had a couple conversations with dh and he apparently is not as freaked out as I thought at first blush, so that's good. I still think I have my work cut out for me though. I have a friend IRL who did an HBAC (UC because her midwife didn't get there in time!) whose dh was against homebirth, and is now the world's biggest fan - I think I'm going to have the dh's talk at our next potluck.

[mezzaluna]

quirky, i'm glad you're trying to understand where she's coming from. of course i think she's wrong on a lot of her points, and i hope you will be able to change her thinking even a bit... but her message seemed written in genuine concern for you, not out of spite. she just comes from such a different perspective. i agree that she probably has issues with her 3 births having been so medicalized - maybe she feels it had to be that way, and her babies would have been in danger without those interventions, and thus she's scared for you... and her personal experience with a disabled son makes her even more fearful. finally, yes, the OBs do have to see the worst cases, and being exposed to that regularly would make just about anyone fearful...

stay strong - you're choosing a wonderful birth for your baby, and i hope it melts her heart a bit (and your DH's).

[KittyUK]

Where I live (in the UK) we carry our hospital notes. In our notes we have a section about where we want to give birth.
Homebirth is one of the boxes we can tick. These notes are given to everyone who births with the hospital's team of community midwives. These notes are put together by the hospital.
This hospital is the one that did this study :
http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract
Although a small percentage of women homebirth in the UK, my hospital (which is a training hospital too) obviously doesn't think homebirth is "out there" or dangerous, or they wouldn't be offering it to the public as a service/option.