Thoughts on new study showing homebirth increases risk of nenonatal death? - Page 4 - Mothering Forums

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#91 of 98 Old 07-07-2010, 11:09 PM
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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.

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#92 of 98 Old 07-08-2010, 12:04 AM
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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."

Charlotte, midwife to some awesome women, wife to Jason, and no longer a mama to all boys S reading.gif('01), A nut.gif ('03) S lol.gif ('08) and L love.gif ('10).
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#93 of 98 Old 07-08-2010, 09:24 AM
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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.
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#94 of 98 Old 07-08-2010, 09:52 AM
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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.

~ Mum to Emily, March 12-16 2004, Noah, born Aug 2005, Liam, born January 2011, and wife to Carl since 1994. ~
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#95 of 98 Old 07-08-2010, 10:17 AM
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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

mdcblog5.gif   Liz mama to DS 10, DSS 9, DD 6, DS 3, DD 2 , Aquila- dec 19th 2009 died at my homebirth, and....welcome Willow born 9-16-10 (9 weeks early)  nut.gif
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#96 of 98 Old 07-08-2010, 10:50 AM
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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.

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#97 of 98 Old 07-09-2010, 07:58 PM
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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?

In God we trust; all others must show data. selectivevax.gifsurf.gifteapot2.GIFintactivist.gif
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#98 of 98 Old 07-10-2010, 09:51 AM
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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:

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.

Fledgling midwife on hiatus, Wife to B, mama to C (c/s ribboncesarean.gif 12/04) and S hbac.gif (12/07), angel3.gif m/c (3/12) and expecting another bean 6/13 stork-suprise.gif.

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