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I'm not sure whether or not this is anti-the film, because (to a certain degree) the author makes some good points about the film:<br><br><a href="http://www.slate.com/id/2181860/" target="_blank">http://www.slate.com/id/2181860/</a>
 

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I read that thinking that the author kind of just doesn't get it. The reason advocates of change seem so crazy most of the time is because if they whisper and say things like "well the old way is fine too" no one listens.<br><br>
One thing that really stuck out to me was how she pointed out that Ricki Lake said her hospital birth was disapointing but never elaborated as to why. Why does it matter? Can a hospital birth only suck if you end up with a c section? No, maybe she got an on call OB who was abnoxious and told her women can't give birth without an epidural, that would be enough to annoy me for sure.
 

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Well, I don't like the stats he gives; he claims homebirths have nearly double the infant mortality rate of hospital births.
 

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Discussion Starter #4
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<div>Originally Posted by <strong>carriebft</strong> <a href="/community/forum/post/10277336"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Well, I don't like the stats he gives; he claims homebirths have nearly double the infant mortality rate of hospital births.</div>
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Yeah, that did bother me.<br><br>
I guess my issue with it is that as the husband of someone who has tried two homebirths and failed (and ended up having c-sections both times) I can see why there is an issue with the all-or-nothing approach to homebirth.<br><br>
Sometimes it is just not feesible.<br><br>
However, that doesn't mean I don't understand that hospital births are much more risky than homebirths ... they are, simply by the nature of them ... well, I don't know where I was going with this. Its hard to divide my brain between typing here and looking like I'm working <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/orngbiggrin.gif" style="border:0px solid;" title="orange big grin">
 

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<div>Originally Posted by <strong>NewCrunchyDaddy</strong> <a href="/community/forum/post/10277428"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
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I guess my issue with it is that as the husband of someone who has tried two homebirths and failed (and ended up having c-sections both times) I can see why there is an issue with the all-or-nothing approach to homebirth.<br><br>
Sometimes it is just not feesible.</div>
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But that's a problem with the culture surrounding homebirth, not homebirth <i>itself</i>. Just because it might or will make some women feel bad if they don't achieve it doesn't mean it shouldn't be available to all women. Maybe if it's less of a big deal, the discourse surrounding it will be less all-or-nothing. Certainly homebirths don't work perfectly for all women all of the time -- the film shows that clearly enough -- but does that really have anything to do with the need for access to qualified care providers and improved maternal-fetal care in the US?
 

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It is a bad article, I do not like slate.com generally, but this article confirms it.<br><br><div style="margin:20px;margin-top:5px;">
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<div>Originally Posted by <strong>carriebft</strong> <a href="/community/forum/post/10277336"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Well, I don't like the stats he gives; he claims homebirths have nearly double the infant mortality rate of hospital births.</div>
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Which study is she referirng to? I have read two studies that conclude there is an elevated risk -- the Pang study and then the study on homebirths in Austuralia. There have been problems identified with the Pang study and the Australian study -- I can see many distinctions that took place with the homebirths there than would say in my area. Are there any other studies or did she make up this number?<br><br>
The author, Dana Stevens, closes with this:<br><br><div style="margin:20px;margin-top:5px;">
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<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Ultimately, the business of being born ain't nobody's business but our own.</td>
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Which I completely agree with, but the reality is in the US right now -- women often do not have a choice to escape forced or pressured interventions or to VBAC.
 

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"There's so much to critique about this documentary: its unacknowledged classism (Epstein and Lake, like all but one of the mothers whose births they document, are white women in a financial position to customize their birth experiences."<br><br>
This was an interesting quote from the article and to a large extent, I do agree. Homebirth was important enough to me to fork over almost $3,000 to cover the portion of the midwifery fees that health insurance would not. I am grateful every day that we are in a financial position where the option was not midwife or food/rent. I am also fortunate enough to know homebirth is an option and passionate enough about homebirth to do whatever I had to to make it an option for me. Amongst women of color, I am in the vast, vast minority who even know that you are *allowed* to birth at home and I'm one of the very few who see the value in it and do not believe that hospitals/OBs should be the default for all pregnant women.<br><br>
Do a quick search on youtube or on any website about homebirth or natural childbirth or child-rearing (cloth diapering, breastfeeding, elimination communication, homeschooling, etc . . . ) and you will see that this author's commentary about classism is accurate. You'd be very hard pressed to find any of the information out there addressed to women of color or even including women of color. It's almost like these things are reserved for White women with money or means. It's damn near impossible for women of color and women who are not well-off, except for a fortunate few, to find support to do these natural things. Options always seem limited.
 

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I completely agree and that was the one point in the articulate that resonated with me. I am faced with serious financial issues and no insurance will cover the midwives in my area. So the homebirth that I have desparately researched and wanted may be out of my financial reach. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad">
 

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<div>Originally Posted by <strong>rootzdawta</strong> <a href="/community/forum/post/10282328"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">"There's so much to critique about this documentary: its unacknowledged classism (Epstein and Lake, like all but one of the mothers whose births they document, are white women in a financial position to customize their birth experiences."<br><br>
This was an interesting quote from the article and to a large extent, I do agree. Homebirth was important enough to me to fork over almost $3,000 to cover the portion of the midwifery fees that health insurance would not. I am grateful every day that we are in a financial position where the option was not midwife or food/rent. I am also fortunate enough to know homebirth is an option and passionate enough about homebirth to do whatever I had to to make it an option for me. Amongst women of color, I am in the vast, vast minority who even know that you are *allowed* to birth at home and I'm one of the very few who see the value in it and do not believe that hospitals/OBs should be the default for all pregnant women.<br><br>
Do a quick search on youtube or on any website about homebirth or natural childbirth or child-rearing (cloth diapering, breastfeeding, elimination communication, homeschooling, etc . . . ) and you will see that this author's commentary about classism is accurate. You'd be very hard pressed to find any of the information out there addressed to women of color or even including women of color. It's almost like these things are reserved for White women with money or means. It's damn near impossible for women of color and women who are not well-off, except for a fortunate few, to find support to do these natural things. Options always seem limited.</div>
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I guess the way I see this is that when homebirthers are 1% of the population it isn't likely to be something that is "available to everyone." That is why films like this are important, maybe in my daughter's generation homebirth will be more normalized and will be more accessible. Not everyone can be a pioneer, whether because of personality or finances, but that is no reason to fault those who choose to do so.<br><br>
Were the original suffragets poor women or were they upper/middle class women? Just curious I don't know much about it but my guess is that poor women were too busy feeding their families and it was wealthy women who decided to try to make a change. Yet today we can all vote.
 

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I just wanted to point out that in some states, medicaid will pay for a homebirth or freestanding birthcenter childbirth. I know for a fact that it will in my state, because I used it (although I choose to birth in the freestanding center, not at home due to my living circumstances). So, options are beginning to appear, but documentaries like this are so, so, important to get the information out there that homebirth can be safely executed under the proper circumstances.
 

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The author mentioned a study showing newborn deaths being twice that of homebirths. I'm not sure what study he was talking about, but I remember reading somewhere that those types of studies include all homebirths, not just planned homebirths, like homebirths that happened before they could get to the hospital or homebirths without a trained midwife. Any study that only looks at planned homebirths attended by a trained, experienced midwife, shows that homebirth is just as safe for the infant if not safer, at least as far as I've seen.
 

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I thought that article was awful and just reflected the author's own bias. Of course some women have amazing and wonderful hospital births, but let's face it... most do not. Most American women consider an agonizing hospital ordeal to be part of the baby package automatically. The whole idea is to present options. When the hospital gives you a tour of the maternity ward, they aren't going to point out that you can also get staph infections if their nurses don't wash their hands well, or you might stay up all night listening to a woman in pain and forced to labor on her back shrieking... they show you the good side. Ok, so the film focuses on the good side. So what?<br><br>
As for double the rate of death at home, I wish they'd linked to the study. That sounds fishy to me.<br><br><img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/irked.gif" style="border:0px solid;" title="irked">:<br><br>
OP, I'm sorry homebirth didn't work out for your wife, it doesn't always. C-sections exist for good reason. I hope your wife is happy with her birth experiences even if they weren't what she'd originally planned for.<br><br>
ETA:<br><br>
As for financial issues; hopefully with more women becoming aware of homebirth and with more insurance companies getting requests to cover it, eventually it will be covered and more accessible to more women.
 

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I couldn't read any more once the author referred to Michel Odent as a "crackpot". <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/angry.gif" style="border:0px solid;" title="angry">
 

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<div>Originally Posted by <strong>GracesMama</strong> <a href="/community/forum/post/10284203"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">The author mentioned a study showing newborn deaths being twice that of homebirths. I'm not sure what study he was talking about, but I remember reading somewhere that those types of studies include all homebirths, not just planned homebirths, like homebirths that happened before they could get to the hospital or homebirths without a trained midwife. Any study that only looks at planned homebirths attended by a trained, experienced midwife, shows that homebirth is just as safe for the infant if not safer, at least as far as I've seen.</div>
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As I stated above I am only aware of two studies that document a higher death rate for homebirths. The first study is the Pang study which had serious flaws. The second study took place in Australia in the 80s-90s and there are important differences between the homebirths observed there and the ones that I see taking place in the US.<br><br>
My one main problem with the homebirth studies is that they are small, there are no large broad based studies but I do think these would be difficult to do and there is likely not many funders of such studies. Penny Simkin cites this as a similar problem with the homebirth studies -- they are supportive and encouraging but it is hard to use them to argue definitively or use as evidence when they are so small.<br><br>
I am <span style="text-decoration:underline;">not</span> saying that homebirth is unsafe or this makes the studies unbelievable, but I am just pointing out a problem with the studies and what makes it difficult.<br><br>
I emailed the author of the Slate article to ask which study she is referring to -- I doubt she will answer.
 

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I haven't seen this film yet - got my ticket to see it next Saturday here in AVL... I had so been hoping that it might be one more small contribution chipping away at the current medicalized view of birth - just that it might open more people's minds to the fact that other options are out there. Hopefully most people won't go into it with such blatant bias that all they can do is find faults with it, as the author of this article did.<br><br>
That said, I agree with the point brought up regarding white privileged women having more access to homebirth, midwives and other 'alternative' options - but as a PP argued, that problem is not with homebirth itself, it's just a part of the force we all have to fight against. It's the health care industry. It's insurance companies, lobbyists and politicians who see nothing but $$$. The author was kind of missing the point with that barb.<br><br>
I'm not poor, at least according to the government. In fact, my husband and I make too much to qualify even for the supposedly 'high' income caps for pregnancy medicaid in our state. But, since I have to buy individual insurance, the costs I'm looking at for pregnancy and childbirth are astronomical, and we have to come up with most of that out of pocket. Insurance will pay for part of it, but not until after the fact (and we'll be lucky if they don't try to fight reimbursement). We are a writer and a cook living paycheck-to-paycheck in a rental - we're having to scrounge up/cut back as much as possible to afford having a baby. There's something very wrong with that. We are those lower middle class people that fall through the cracks in the system.<br><br>
I don't know where I'm going with this exactly, other than man, the system is screwed up in this country.
 

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Alice -- I completely agree. It isn't the practice of homebirthing or the movement itself that is the problem -- it is the system.<br><br>
In the past few months I have read almost all the academic studies on homebirth and different authors who pen pregnancy books' opinion on homebirth (i.e. Penny Simkin and Dr. Sears) -- one of the main problems with homebirth in the US, the one problem that could arise into a serious issue is the inability of ease of transfer and the lack of continuity of care. Some areas in the US have it down, definitely. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/thumb.gif" style="border:0px solid;" title="thumbs up"> But it is not consistent and in my mind it is manily due to restrictions by malpractice insurers and hospital procedures. I live in a large metropoitan area with lots of hospitals. The midwife group I want to use only has admission privileges at two hospitals -- two admittedly large hospitals. However, I live 5 minutes from a decent hospital and the ones they have admission privielges can be as far away as 40 minutes in traffic -- which is fine if I am transferring for exhaustion or pain relief but not for an emergency. Anyway, the midwives I want to use have no privileges at my local hospital. So, in order to make sure I have continuity of care I need to pay for another provider as back up. What happens if I deliver at the hopsital? My insurance pays the HCP at the hospital and my midwife still demands payment (via a signed contract) and I am out about $3800. The system has created it to be a situation where a family racks up debt to have a homebirth, the midwife is potentially out of $$$ for her services, or it ends up being only privileged women who can afford to HB. Sucks.
 

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I think it would be great if everyone on this thread registered for Slate's discussion forum and posted these responses -- it's about ACCESS! it's about integrating homebirth into "the system" so it isn't something only a privileged few can afford! and GET YOUR FACTS STRAIGHT, Dana Stevens! Seriously, I hate to let this article "stand" as accepted!
 

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3cuties - yeah, I know what you mean. The midwife practice I plan to use is only one of two in this city that have hospital privileges (the other practice is part of the city's largest ob/gyn practice, so um, no thanks). Luckily, since they're really my only choice, I like them, however I'd choose a CPM rather than a CNM if I didn't have that fear of ending up in the hospital with an on-call OB that I'd never met before in the event of an emergency (DEMs are illegal in NC, and CPMs don't have hospital privileges and aren't allowed to attend homebirths). I am lucky to have a hospital with a level III nicu five minutes from my house (which is where my midwives attend births and have a backup OB).<br><br>
It's true, too, that for many women, forking over the extra cash to have a CNM attend a hospital birth (for those who are high risk or have been frightened into thinking they need to be in the hospital), they're still not getting what they're paying for as much as they should since hospital protocol dictates what the CNMs can do. The backup OB can always come in and override the midwives' decisions. That is part of what is so frustrating about it all.<br><br>
I think I need to find some other homebirth advocates locally to discuss these issues with, so I can work them out in my own head. My mother is a NICU RN and frequently wants to debate me about various pregnancy and childbirth related subjects, and I never really get to say what I would have wanted to, looking back. So, when discussions like this come up on MDC, I find myself hashing out my opinions on all of it. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/redface.gif" style="border:0px solid;" title="Embarrassment">
 

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Classism - my problem with the article is that it said the movie is classist, not the system. I'm sure part of Abby's and Ricki's mission with this film is to champion the choice of homebirth for ALL women, and that they recognize that the current system basically prevents poorer women from having access to safe homebirth.<br><br>
Safety stats - there are two studies, mentioned above, that conclude that hb has 2x the infant mortality rate of hospital birth. The problem is that these studies are seriously flawed. In fact, ALL studies on the issue are flawed to some degree, including the ones that conclude that hb is SAFER than hospital births. There has never been a single prospective study that compares a large number of low-risk planned homebirths versus low-risk planned hospital births. Until there is a study like that, we won't know for sure. But if you take all the retrospective studies (and their flaws) into account, the general sense you get is that hb may be marginally more risky in rare, serious instances (or may not), but that hospital birth is definitely riskier in terms of moderate negative outcomes (side effects of epidurals, episiotomies, c-sections, etc.).
 

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What do you think of this study?<br><br>
BMJ*2005; 330:1416*(18*June), doi:10.1136/bmj.330.7505.1416<br><br>
Outcomes of planned home births with certified professional midwives: large prospective study in North America<br><br>
Kenneth C Johnson, senior epidemiologist1, Betty-Anne Daviss, project manager2<br>
1 Surveillance and Risk Assessment Division, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, PL 6702A, Ottawa, ON, Canada K1A OK9, 2 Safe Motherhood/Newborn Initiative, International Federation of Gynecology and Obstetrics, Ottawa, Canada<br>
Correspondence to: K C Johnson <a href="mailto:[email protected]">[email protected]</a><br><br>
Objective To evaluate the safety of home births in North America involving direct entry midwives, in jurisdictions where the practice is not well integrated into the healthcare system.<br><br>
Design Prospective cohort study.<br><br>
Setting All home births involving certified professional midwives across the United States (98% of cohort) and Canada, 2000.<br><br>
Participants All 5418 women expecting to deliver in 2000 supported by midwives with a common certification and who planned to deliver at home when labour began.<br><br>
Main outcome measures Intrapartum and neonatal mortality, perinatal transfer to hospital care, medical intervention during labour, breast feeding, and maternal satisfaction.<br><br>
Results 655 (12.1%) women who intended to deliver at home when labour began were transferred to hospital. Medical intervention rates included epidural (4.7%), episiotomy (2.1%), forceps (1.0%), vacuum extraction (0.6%), and caesarean section (3.7%); these rates were substantially lower than for low risk US women having hospital births. The intrapartum and neonatal mortality among women considered at low risk at start of labour, excluding deaths concerning life threatening congenital anomalies, was 1.7 deaths per 1000 planned home births, similar to risks in other studies of low risk home and hospital births in North America. No mothers died. No discrepancies were found for perinatal outcomes independently validated.<br><br>
Conclusions 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.
 
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