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Unfortunately, the role of obstetrics has never been to help women give birth. There is a big difference between the medical discipline we call "obstetrics" and something completely different, the art of midwifery. If we want to find safe alternatives to obstetrics, we must rediscover midwifery. To rediscover midwifery is the same as giving childbirth back to women. And imagine the future if surgical teams were at the service of the women and the midwives, instead of controlling them." --Michel Odent, MD, French Obstetrician, 2006

The miracle of birth creates babies, changes women into mothers, and turns individuals into families. Being born and, in turn, giving birth, are the most transformative and miraculous events human beings experience. Yet, in our society, most families experience birth as a technological and medical event, fraught with the possibility of disaster. Currently, 25% of babies born in the United States are surgically delivered from their mothers' bodies. Another 50% are born to mothers who are numb from the waist down and tangled in a web of tubes and wires. The rate of Cesarean section in the United States has more than quadrupled in the past 30 years, with no corresponding improvement in neonatal outcomes. In the midst of all of this birthing technology, the U.S. maintains one of the highest rates of maternal and neonatal mortality among all developed nations. When it comes to birth, most American families equate "safe" with the sterile, closely monitored, technological environment of the hospital. Giving birth in a "sterile" medical environment, designed to monitor and control the birth process, does not improve the quality or safety of birth. In fact, healthy women with low-to moderate-risk pregnancies, giving birth in a hospital is actually less safe than giving birth at home with a trained midwife.

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There is an overall cultural belief that women are inadequate. This is the same line of thinking that kept them out of medical schools for centuries. That denied them the vote. That prevented the passage of the Equal Rights Amendment. Pregnancy and birth are the work women’s bodies are designed for. Women are meant to give birth. Babies are designed to be born, not cut out on some preplanned date and observed in the newborn nursery for 24 hours for the increased risk of respiratory distress that comes with cesarean delivery. If pregnancy and birth were as difficult as the medical community would have us believe, we would have died off as a species a long time ago. Instead, we are overpopulating this poor planet at ever-increasing rates. In one comparative study, the results showed that planned hospital birth resulted in greater numbers of birth injuries, maternal and infant infections, hemorrhages, and low apgar scores than planned, midwife-attended homebirth. Many other studies support these findings and no study has ever proven hospital birth to be safer than planned, midwife-attended homebirth.

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Where are the women whom midwives are meant to serve? How is it that an entire population has been convinced that pregnancy is unsafe and birth is dangerous? What can we do as a united population of believers to reverse this nightmare, the final worst result of which may be an entire population of women unable to birth their babies as their bodies were meant to do? The notion of walking into a practitioner’s office and sitting down to discuss when to have an elective cesarean is an absurdity that needs to be stopped before it gains any more momentum. Women give birth. Babies are born. Cesareans are for those rare occasions when the body or the baby cannot tolerate the normal. Women are not told about cesarean scars, about how their bellies, no matter how thin, will always hang over the edge of the scar because the layers of tissue no longer slide back and forth over themselves, but are stuck together with scar tissue. Women are not told of the risks to them or their babies. Women are not told, really told, how long it takes to heal. What makes the notion of an elective cesarean so inviting to so many women?

Most labors today are induced at some point primarily because obstetricians are closing the birth canals of women by placing the expectant mothers in bed, keeping them on their backs and sacrum. "Being forced to immobilize her sacrum in a dorsal position, the laboring woman closes her birth canal up to 30%--a terrible mistake that is only aggravated when the OB chemically whips the uterus to contract violently with either Pitocin or Cytotec", writes Dr. Todd Gastaldo, a chiropractor who deals with the realities of the spine and the sacrum. Most midwives understand the basic physics of birth where as obstetricians seem to want to defy the laws of gravity, deliberately making birth much more difficult than it has to be. Dr. Gastaldo warns us that pressures from a closed birth canal can distort the brain case causing brain bleeds and asphyxiation (prolonging delivery of the baby) of brain tissue. This compression leads to a series of complications forcing interventions--episiotomies, c-sections and drugging of the mother, which of course means the babies are drugged. Mothers in labor are routinely given several different drugs without any way to know if the unborn baby is vulnerable to toxic side effects. The propensity to have an adverse reaction must be multiplied by the number of drugs received, and then must be doubled again for the newborn, whose virgin brain is being directly influenced by these substances. The risk of side effects is both immediate and life-long for infants.

Dr. Gastaldo, says IT'S A CRIME that OBs are closing birth canals and making women beg for the "extra" outlet area. He seems to be alone crying out against the "mass child abuse that is going on when OBs keep birth canals closed when babies get stuck--then performing GRUESOME spinal manipulation--pulling with forceps or vacuums. Sometimes OBs pull so hard they rip spinal nerves out of tiny spinal cords. Sometimes it's fatal--but usually babies "only" have their necks gruesomely wrenched." Gastaldo has no idea why his fellow chiropractors are silent on this issue, an issue of birth canal mechanics and physics that depends on the position of the sacrum during delivery. Dr. Gastaldo goes on to say that, "As naive, impressionable med students, MDs are TRAINED to perform felonies--and not just the close-the-birth-canal felony. OBs are senselessly slicing everything in sight--infant penises, adult vaginas and abdomens." Truly we are still in the Dark Ages of Medicine.

The primary objective should be to reduce the need for drugs, since all drugs used during labor are pharmacological substitutes for the hormones a woman is supposed to release when giving birth. All of them block the release of the natural hormones and don’t have the same behavioral effects. Decreased needs for drugs and lower rates of cesareans should be the result of rediscovering the basic needs of women in labor, rather than a primary objective. The essential first step is to improve our understanding of birth physiology and to rediscover the basic needs of women in labor. These basic needs are shared by all mammals. All mammals need to feel secure when giving birth: They postpone the delivery if there is a predator around.

All mammals need privacy: They have strategies for avoiding observation during the period surrounding birth. Stress hormones, like adrenaline, inhibit the release and the action of the hormone necessary to induce and maintain effective uterine contractions during labor and delivery. The most important aspect of the art of midwifery is, therefore, to protect the mother-to-be against anything that might increase her level of adrenaline. A good understanding of the physiological processes leads the midwife to make sure that nobody is under the effect of adrenaline in the environment of a laboring woman. After thousands of years of culturally controlled childbirth, decades of industrialized childbirth and a proliferation of “methods” of “natural” childbirth, these basic needs have been forgotten.

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More and more families are choosing to birth their children in the comfort of their own homes with the help of midwives. Licensed midwives specialize in caring for healthy women throughout their childbearing years. The care provided by licensed midwives differs from that of nurse-midwives in many important ways. Unlike nurse-midwives, who receive their training and practice primarily in hospitals, licensed midwives train and provide care in home and birth center settings. Nurse-midwives typically are unable to spend large amounts of time with individual clients in prenatal visits. Large hospital practices leave clients unsure of which particular nurse-midwife will attend their births. Licensed midwives work in private practices and are able to dedicate great amounts of time to their clients. They recognize that birth is a profound rite of passage and needs to be treated as more than just a medical event. Licensed midwives offer hour-long prenatal visits, providing ample time to perform the necessary checks on mom and baby's physical well being, as well as to address the emotional and spiritual needs of the mother. Families who hire licensed midwives choose and know who will attend their births as licensed midwives do not work in shifts and they remain on call for each of their individual clients.

Birthing at home offers many distinct advantages over birthing in the hospital. In nature mammals instinctively seek out quiet, dark, familiar places to give birth; their labors stop if their space is disturbed. Humans also birth best in privacy, and one's own home is the ideal place to create such surroundings. Most women innately choose to move around during labor, finding the most comfortable positions in which to give birth. At a home birth, midwives encourage such position changes and a woman's freedom of movement is limited only by the size of her house and yard. Licensed midwives also offer their clients the choices of laboring and birthing in water, delivering their babies with their own hands, or having the father catch; none of these options are routinely available at any typical hospital. After birthing at home, mother and infant may bond without interruption. A comprehensive newborn examination is done right on the family bed next to the mother. Home birth also allows for greater sibling involvement in the birth process. If the parents desire, older children can be present at the births of their new siblings, an option that is not routinely available at hospitals, especially during the cold and flu season. The familiar comfort of home makes it the safest birthplace for healthy, low-risk women.

In the safety of their own homes, women are less likely to experience complications of labor, such as hypertension and meconium staining, which may be brought on by stress. The freedom to move about as desired, decreases both length of labor and the need for pain medications, therefore lowering the risk of maternal exhaustion, fetal distress, and cesarean section. Whereas a woman's home usually contains only microbes to which she and her baby are immune to; in daily exposure, the hospital is full of disease-causing microbes, many of which are resistant to most antibiotics. In fact, any person being admitted to an American hospital has a 4 to 10 per cent chance of acquiring a hospital based infection. Newborn babies are especially susceptible to such infections due to their immature immune systems. Birth is by nature unpredictable and in some instances families who choose to birth at home may have to transfer to the hospital for technological assistance. The small chance of such a transfer being necessary should not deter women from planning to birth at home. Birth is a family event and, with very few exceptions, happens most naturally and safely in the mother's home. Families who birth at home with the help of midwives generally report far greater satisfaction with the birth experience than those who have given birth in hospitals.

Women who birth at home and the midwives who attend them understand that birth is as safe as life ever gets, and that attempting to control birth actually causes more complications than it prevents. Midwives maintain the safety and sanctity of the natural birth process, mainly through the practice of non-intervention. When excellent prenatal care has been given, addressing all aspects of a woman's life and relationships, a mother is well equipped to birth her baby with minimal assistance. Midwives specialize in normal birth; they are quick to recognize any deviation from normal and to use the appropriate measures to help correct the situation. Midwives and families who birth at home are not anti-hospital, but feel that the hospital should only be accessed when truly needed. Midwives trust in women's ability to give birth normally and they help instill and reinforce this same trust in the families they serve. Far from being a medical event which must be suffered in order to receive a baby, a midwife-attended homebirth is a joyful celebration of life and the family.

Homebirth: As Safe As Birth Gets

Each year in America, approximately 1% of the births occur in home settings. It is probable that many more homebirths actually took place than statistics show, that weren't recorded due to a discriminatory birth registration practice that places the responsibility for registering midwife-attended homebirths on the parents and requires a different mechanism than is used for any other occurring births. One measure of the safety of birthplace is infant mortality, specifically, neonatal deaths within the first 28 days. According to the Center for Disease Control, there were 19,098 neonatal deaths for 1990 for babies born in a hospital. For those babies born at home, there were 260 newborn deaths. Infant mortality is figured as the number of deaths per 1,000 live births. The death rate for babies born in the hospital was 5.6 and for those born at home was 11.1, which would seem to indicate that a hospital is a better bet for a baby's survival. However, when the homebirth statistics are further broken down into who attended the birth, the picture changes dramatically. Direct Entry Midwives had the best outcomes with a death rate of 1.9 compared to CNM-attended births (2.9) or physicians --D.O.'s (15.1) or M.D.'s.

Until 1900, homebirth was the place of birth for most every American. Over 90% of those alive on earth today were born at home! Hospital or institutional birth is a fairly new occurance, which began to gain in popularity during the 1920's due to physician promotion and increased use of automobiles. As is the case today, it is a much more economic use of a physician's time to attend patients in a single place. There is also an economic incentive since a physician can attend to more than one patient at a time in the hospital and other, less important helpers can attend to the more mundane tasks of birthing. Part of this shift in birthplace must be attributed to the propaganda, denouncing midwives, which took place during this same time. With their economic and organized power, physician groups were able to legislatively increase hospital births by eliminating those who still attended homebirths--by eliminating the midwife. From the 1930's through the 1960's state after state changed their laws to either restrict the practice of midwifery or wipe out the legal practice entirely. Yet no valid study then or to date has proven planned homebirth to be less safe than hospital birth.

History

In 1900 half of all Americans were born into the hands of a midwife, at home. Early studies comparing the birth outcomes of physicians versus midwives showed that midwives had fewer maternal and infant loses than the doctors. The United States had a very high percentage of maternal deaths compared to other countries. Reports done by the White House Conference on Child Health and Protection, the National Committee on the Costs of Medical Care, and the New York Academy of Medicine in the 1930's all concluded that midwives were safer than physicians. These reports chastised doctors for their frequency of interventions which led to problems. Many physicians, in response to the findings of the reports, placed the blame on the midwives claiming that midwives were "ignorant," "dirty," untrained and a threat to the safety of childbearing women. Medical journals and popular magazines contained many articles bashing midwives and blaming them for the nations appalling maternal mortality and infant mortality rates. Many physicians and public health advocates spoke up for the midwives and their excellent statistics, but the prestige of the anti-midwife physicians and the strong push to move births into the hospitals far over-shadowed their voices. This barrage of anti-midwife articles and propaganda continues today despite the lack of any studies or statistics to prove claims that physicians guarantee the safest outcomes or healthier babies or mothers.

Undoubtedly the number of births attended by midwives of all kinds is higher. In some states, nurse-midwives mainly work as employees under physicians and the insurance companies pay more for a physician attended birth. In order to receive the largest monetary compensation for births, and because the midwife is "under physician supervision" by law, the birth certificate is completed as though the doctor were attending, even if this was not the case. Additionally, in states where Direct Entry Midwives are not licensed or Direct Entry Midwifery is prohibited, many births either go unreported or are reported as unattended or the category of midwife is absent from the birth certificate. Statistics from Center for Disease Control, US Birth Cohort of 1990, Table 43, May 18, 1995.

Cesarean Section

Figures released in the summer of 2003 by the Centers for Disease Control and Prevention show that the cesarean rate in the U.S. has reached an all-time high of 26.1 percent. The five states with the highest rates are Mississippi at 31.1 percent, New Jersey at 30.9 percent, Louisiana at 30.4 percent, West Virginia at 29.3 percent, and Alabama at 28.7 percent. Of the 18 states with the highest cesarean rates, 11 are in the South and 8 are in the East.

In contrast, of the 18 states with the lowest cesarean rates, 10 are in the West and 5 are in the Midwest. The states with the lowest cesarean rates are New Mexico, where 25 percent of babies are delivered by midwives, at 19.1 percent, Utah at 19.1 percent, Alaska at 19.4 percent, Idaho at 19.7 percent, and Wisconsin at 20.6 percent.

Both the World Health Organization and the Coalition to Improve Maternity Services suggest that an acceptable cesarean rate is from 10 to 15 percent, a figure based on international scientific evidence. The federal goal of the U.S. is a 15 percent cesarean rate. In the 1960s, the cesarean rate in the U.S. was just 6.6 percent.

The cesarean rate reached its previous high of 24.7 percent in 1988. A public outcry ensued, women insisted on vaginal births after cesarean, and surgical births steadily declined from 1989 to 1996. By 2000, however, the cesarean rate was back up to 22 percent and climbing.

Many experts believe that the rise in the cesarean rate is due to complex factors including doctors' habits and beliefs; the monopoly of obstetrical, hospital birth; the climate of malpractice; increased public acceptance of interventions in childbirth; and lack of education about and public advocacy of normal birth. Tragically, the high rate of surgical birth in the U.S. does not result in better birth outcomes. The current increase in cesarean births means that more women are dying in childbirth; women are four times more likely to die during cesarean birth than during vaginal birth. In fact, in the last 25 years, there has been no decrease in the number of U.S. women who die during pregnancy and birth.

The U.S. ranks 21st among nations in infant mortality and has not improved measurably since the 1970s. The ten countries with the lowest rates are Sweden, Finland, Japan, Norway, Austria, France, Switzerland, Belgium, Germany, and Spain. Since the late 1970s, the U.S. has dropped to and lingered at around 16th in the world in maternal death. Both infant and maternal mortality can be reduced in the U.S. by adopting five standards common in the countries with better birth outcomes. These standards are:

1. Nutrition--The top ten countries place great emphasis on good nutrition and healthy lifestyle; during prenatal visits, women are educated extensively in appropriate diet.

2. Midwifery--Skillful midwifery, not obstetrics, is the standard of birth care in all of the top ten countries. The majority of pregnant women in these countries are cared for exclusively by midwives; teams of midwives and physicians care for a small percentage.

3. Natural childbirth--Unmedicated birth is the standard. Girls grow up familiar with birth, don’t fear its pain and hard work, and appreciate the advantages of childbirth without drugs.

4. Homebirth--Homebirth, not hospital birth, is the standard of care in the top ten countries.

5. Breastfeeding--Breastfeeding rates in the top ten countries are more than 90 percent. Breastfeeding is socially expected in these countries, some of which even have incentives to encourage breastfeeding.

Studies

Many studies have been done in an attempt to prove that hospitals are the safest place to birth. Some of the earlier ones included all births, which took place out of the hospital, regardless of the gestational age or planned place of delivery. Those studies included miscarriages, which took place at home, as well as precipitous births, and births that were unattended. To be valid, a study must compare equals and change only one item. One study did this by matching 2,092 women and compared their birth outcomes. The result was that homebirth with a trained attendant was safer than a hospital birth. Most families do not want to know the statistical odds of having a good outcome; they want to know more concretely exactly how a homebirth will be safer. Many studies address this by listing criteria and comparing the results. Many complications seem to occur with greater frequency in the hospital. Many women are told they will need an episiotomy in order to prevent tears but the data from these births shows that this is not so since there were 9 times as many tears in the hospital group! Fetal distress, often cited as the complication necessitating a cesarean section, occurred 6 times more frequently in the hospital group. There were 4 times more newborn infections, 22 times more forceps deliveries, 30 times more birth injuries and 3 times more cesarean sections in the hospital group.

Estimating Preventable Childbirth Related Deaths

The following statistics, derived from data accumulated between 1940 and 1980, are conservative estimates of lives lost due to our system of treating pregnancy as a medical event requiring medical intervention and care. About 1,000,000 babies died at or before birth that should have lived. About 1,600,000 babies died before their 1st Birthday who should have lived. At least 1,500,000 children were left severely brain damaged by medical procedures. At least 45,000,000 children had minimal brain damage who would have been normal. Today, it is estimated that 50 newborns die unnecessarily each day whose deaths are preventable if the five standards for safe childbearing were employed. This breaks down into a preventable baby death every 29 minutes, every hour of the day, each day of the year. NAPSAC writes, "Since 1940 at least a million babies have died in American hospitals who would have lived were it not for the doctor-dominated maternity system that dictates the Standards for American Childbirth."

Who Decides What is Safer?

Childbirth is not a laboratory project that can be reproduced at will with the outcomes compared with each other. Nor is birth a medical event, like planned surgery, that can be timed, controlled or forced to obtain the desired outcome. Each year, it seems, scientists discover some aspect of birth that had been unknown or unverified. Also, it would seem that the technologies that are initially hailed as the "cure" for a certain problem are found to produce unacceptable side effects, or increase risks for more serious complications. Birth also has a psychological component, which can place some women at incredible risk in a hospital. A recent article in a prestigious magazine looked at homebirth and asked the question, "Is it safe? Is it ethical?" The physician writers concluded that homebirth has a "definite small risk" and that "hospital births entail a wider range of risks." They also felt that since the actual risk factors inherent in a home birth are very small, perhaps 1/1000, and the consequences of the birth decision will be borne exclusively by the parents, physicians should support parents who are willing to accept this risk so as to make the experience as safe as possible.

The Oxford Perinatal Project also came to this conclusion after an exhaustive look at every scientifically valid study performed since the 1950's addressing aspects of care of pregnant and birthing women and their babies. Since science cannot prove homebirth to be less safe than hospital birth, each family has the constitutional right to choose where to give birth. Until science can prove a detrimental effect on those who choose to birth at home, medical personal should support families in their decision. The National Association of Parents and Professionals for Safe Alternatives in Childbirth, NAPSAC, shares this view and asks, "Who is to decide what is the optimal balance between medical and psychological risk? It must be the parents."

Risks And Benefits Of Hospital Procedures

In spite of all the advertising touting "home-like" birthing rooms in hospitals, for most women, a hospital birth will be nothing like a home birth. Interventions are routine in the hospitals. Every laboring woman will be hooked up for some period of time to electronic fetal monitor, given vaginal exams, and be told where and in what position she must give birth. If her membranes are ruptured, she will be required to deliver her baby within a certain time period. If her labor is moving too slowly, she will be given pitocin to augment it or have her water artificially ruptured. She will be told how many companions she may have with her. If she has other children she may or may not include them at the birth. How long she is kept in the hospital will vary depending on her physician and the particular hospital. How soon her baby will be released also will depend on the baby's pediatrician and hospital policy. Some of the more common interventions that take place during hospital births are discussed below.

Amniotomy

Artificially breaking the amniotic sac is done routinely at many hospitals to speed labor up, get labor going, to test the fluid or to get it out of the way so that an internal monitor can be screwed into the baby's head. It was believed that breaking the water would speed up labor by 30 to 60 minutes, but the only randomized control trial done disproved this. This procedure causes cord prolapse, a serious complication for the baby and increases the chances of an infection. With less amniotic fluid in the uterus during labor, the baby has a greater risk of cord compression problems leading to fetal distress and malpositions of the head.

Drugs & Epidurals

Nearly every woman giving birth in a hospital will receive a drug at some point during her stay. Pitocin is frequently used to induce or augment labor. Because it causes abnormally strong contractions, many women receive a pain-relieving drug such as a narcotic. Unfortunately, narcotics also are received by the baby and can affect the condition of the baby at birth and for years after. Some of these side effects are respiratory problems, impaired muscular, visual and neural development in the first week of life and in the following years, lower reading and spelling scores, difficulty in solving problems or performing tasks when they pose a challenge. The new drug of choice at many hospitals is the epidural. It must be administered by an anesthesiologist and requires the mother to remain in bed afterward. She must be flushed with an IV fluid prior to getting it to keep her blood pressure up. A needle is inserted into the woman's back and small catheter is left in place where the medication is injected. It numbs the woman's body from the ribs to the toes. Many women ask for this drug because they do not want to deal with the pain of childbirth and believe it is safe for themselves and their babies because the physician who administered it, their obstetrician and the labor and delivery nurses all encourage the use of it and give no information regarding side effects.

The known complications are many ranging from requiring electronic fetal monitor (EFM), IV, immobility, and urinary catheterization. An epidural also may allow no sensation of labor or the pushing urge, lower blood pressure, abnormally relax the pelvic muscles which may encourage the baby to adopt malpositions of the head, may decrease the production of oxytocin at critical times, and increase the need for forceps and cesarean section. Epidurals cause some serious complications such as heart attack, spinal damage, and spinal headache. After the birth, chronic backache is a common complaint as well as headache. The baby may be exposed to narcotic drugs given to enhance the effect of the epidural and which if given alone can compromise the baby's respiratory efforts as well as require the newborn to metabolize the drugs. We do not know the short or long term effects of the epidural or other drugs on the baby. Some claim that the baby is unaffected unless the mother becomes hypotensive.

Some non-interventionist birth attendants recognize that occasionally epidurals may be useful for certain situations. Some examples when an epidural may permit a normal birth are for maternal exhaustion, severe back labor, certain malpresentations or psychological dystocia. Although the FDA approves drugs as safe or unsafe, they have no definition of safe and do not guarantee safety of drugs. Many who work with brain damaged children, believe the disability is due to obstetric drug use. They also question if women would make the drug choice if they were given complete information about side effects. The American Academy of Pediatricians discourages the routine use of obstetric drugs.

Enemas

This procedure is still done routinely at many hospitals, although no research proves any benefits for the mother or baby. Home birth and natural birth advocates recognize that for the vast majority of women, the process of labor will empty the bowels.

Episiotomy

Although many believe that an episiotomy is necessary to have a baby to prevent damage to the baby's head, trauma to the mother's perineum, and the cut will heal faster and prevent 3^rd and 4^th degree tears, no research supports these myths. Shiela Kitzinger writes that in the U.S., 9 out of 10 American women will have an episiotomy with her first baby, although in Holland, only 2 or 3 out of 10 will. The facts are that episiotomy is a cultural phenomenon. Research shows that episiotomy is done because the doctor was trained to do it, not because it was a necessary procedure. It can be avoided by using more physiologic positions to give birth (not lithotomy), pushing only when mom feels need to, giving birth gently, slowly to the head, preparing for the birth by doing perineal massage and Kegel exercise, avoiding forceps delivery.

Forceps & Vacuum Extractor

Forceps are obstetrical tools which are shaped like large spoons have been in use since the 1500's. Years ago, forceps were used for many problems which are now handled by cesarean section. Today, most forceps deliveries are low forceps, which means they are applied when the babies head is low in the pelvis and birth is imminent. According to Henci Goer, "There is no research to support the elective use of forceps." The risks to the mother are perineal trauma, extensive episiotomy, and possible extension tearing from episiotomy, hematoma, and nerve damage. Lasting effects of forceps or vacuum extraction to the mother may be anal incontinence in spite of a repaired third degree tear. The baby may have damage to the head, eyes, the nerves that lead to the face and neck and arms. However, an article, written by a physician, that appeared in Parents magazine claims, "Medical studies comparing outlet forceps deliveries with spontaneous (no forceps) deliveries have shown that there is no difference in risk to the baby." Vacuum extraction is a newer technology that sometimes takes the place of forceps. As with low forceps, the baby's head must be very low in the pelvis before the suction cup can be attached. It has the benefit of not requiring an episiotomy and maternal perineal trauma is less than with forceps, but the baby still has the possibility of trauma to the head and face. Chiropractors also recognize that pulling a baby out by the head tractions the spinal column and affects alignment, although this is not recognized in any medical texts.

Immobility

Along with the lithotomy position comes immobility. It is impossible to move around when you are flat on your back. It's even more difficult if you have internal and external fetal monitors attached to your body, an IV running into your arm and after a narcotic drug was given to "take the edge off." If you have an epidural, you will not be going anywhere at all as your legs would have no feeling. Some hospitals encourage walking and moving around. Others do not like you to be out of your room, which may be quite small and loaded with equipment, making any real walking about nearly impossible. Studies have shown that moving about and being upright can shorten labor as well as changing positions.

Induction

According to statistics from health departments, one-third of all births in some states are the result of induction, the artificial starting of labor. Most inductions are accomplished using pitocin in an intravenous solution or artificially rupturing the amniotic sac. The reasons for doing this are many. One of the most common for healthy full-term women is fear of going too far past the "due date" and having a baby with postmature syndrome or meconium staining. Another reason is fear of having a big baby.

Benefits of inducing would seem to be avoiding postmature syndrome, attempting to deliver a baby that had grown too big for the mother and bypassing meconium staining. However, studies fail to confirm this line of thought. The actual amount of time needed for a baby to grow to term varies and figuring an exact due date for each baby has not yet been done. Ultrasounds have at best a 10 day window of error if done in the first trimester. The phenomenon of postdates, is poorly understood. Macrosomia occurs prior to postdates as does "postmature syndrome." The entity of postmature syndrome is based on a single physicians "subjective evaluation of 37 babies." Research seems to indicate that watchful waiting is the more prudent course of action for healthy women.

IV

At a great many U.S. institutions, one of the first items of care to be rendered to the obstetric patient will be her IV, "just in case." Just in case she needs drugs or surgery or her veins collapse making insertion of an IV impossible. Many labor and delivery nurses have been interviewed to find out how frequently a laboring woman's veins collapsed They learned that this does not happen. This is not the way birth happens in other nations, where a laboring woman is permitted to eat and drink lightly. This cultural warping began in the 1940's when anesthesia was being given to nearly all birthing women by mask and vomiting and food aspiration were risks associated with this. Eliminating food and drink, they felt would eliminate this risk. Today, however, anesthesia methods have improved and this is no longer the problem it once way. Improved intubation techniques make this problem virtually a thing of the past. It seems that the cause was not eating or drinking prior to the surgery, but caused by incompetence of the anesthesiologist.

General anesthesia is given to approximately 4% of those who undergo cesarean section. Approximately 0.3% cesarean surgeries will require intubation that will be difficult to do yet not all women who require intubation will aspirate. This translates into denying all laboring women food and drink because 1 cesarean-sectioned woman out of 10,000 may aspirate. Although IV's are supposed to keep the stomach empty, a glucose IV actually works to slow down the emptying of the stomach. It also may encourage tissues to swell so that it makes it more difficult to intubate, if that becomes necessary. IV fluid accumulates in the bladder and that may slow down labor. Some women may have sensitivities to the IV and have a reaction from one. It restricts the woman's mobility. The needle in the arm is painful and inhibits free movement. The baby also may suffer from the mother's IV, as studies are being done to determine if the excessive sugar administered through a glucose IV may harm the baby.

Lithotomy

Lithotomy used to be the position of choice for physicians doing hospital births. The mother lies flat on her back with her knees in the air. It is a most unphysiologic position for mom and baby, but it does give the physician a good view of the mother's perineum. While in this position, the mother must push the baby out uphill. It is known to cause fetal distress due to the baby lying on the mother's arteries and veins. Most women will not choose this position if given alternatives. Dr. Roberto Caldeyro-Barcia is considered an expert on this position for labor and delivery. He and his researchers found that this lithotomy or supine position is the worst one for laboring women because it adversely affects every facet of birth: makes labor more painful, reduces uterine activity, and can dangerously lower blood pressure. He says, "Except for being hanged by the feet, the supine position is the worst conceivable position for labor and delivery."

Monitoring

Electronic fetal monitoring is required at nearly every hospital for at least a short time. When it was first available, it was used only for the most high risk situations. However, it is now used for everyone regardless of risk status. A large reason why EFM is used so extensively is that staff is in short supply and this technology allows for fewer caregivers. There are two kinds of monitors: external and internal. The external monitors are attached to a heavy elastic band that is strapped across the mother's abdomen. She must lie quietly so the monitors do not slip. The baby's heartbeat is recorded on a machine that documents the moment-to-moment heart rate on graph paper along with the mother's contractions. The internal monitor does the same things, but it is attached directly into the baby's head by a metal screw. The uterine contractions are monitored by a probe that is inserted into the uterus. Some feel that this is a more accurate reading. During most labors and deliveries, no other method of monitoring the baby's heart rate will be used.

However, EFM does not reduce infant deaths, improve outcomes or give information that permits potentially bad situations to be corrected or avoided. The strips are frequently mis-read. One study found that 71-95 % of babies diagnosed by EFM as distressed were not. Additionally, studies have shown that most causes of brain damage are not related to actual distress during the birth process but rather due to distress prior to labor. In spite of near universal use of EFM, little evidence exists that any change has taken place in the numbers of brain-damaged babies being born. Auscultation with a fetascope, stethoscope, pinard horn and other low-tech devices for listening to the baby have been found to be as effective for monitoring most laboring women. The risks of using EFM are well known: higher intervention rate of all kinds due to misinterpretation of strips leading to a misdiagnosis of fetal distress. The use of EFM may increase the risk of cerebral palsy by increasing the risk of infection. More babies have abnormal fetal heart rate patterns when monitored by EFM than by auscultation, and it may be that this finding is caused by EFM rather than simply being detected by it. Mothers may report not remembering parts of their labors due to anxiety that was created by using the monitors. One of the greatest risks to the baby who receives an internal monitoring electrode is that of infection at the insertion site. The woman with a history of herpes may be wise to forego internal monitoring out of concern of passing this disease on to her baby via the scalp electrode.

Cord Clamp Injures Your Baby's Brain

Immediate cord clamping is clearly identified as a cause of newborn neurological (brain) injury ranging from neonatal death through cerebral palsy to mental retardation and behavioral disorders. Immediate cord clamping has become increasingly common in obstetrical practice over the past 20 years; today, rates of behavioral disorders (e.g., ADD/ADHD) and developmental disorders (e.g., autism, Asperger's, etc) continue to climb and are not uncommon in grade school. A major error in modern obstetrical practice is routine premature clamping of the umbilical cord. The error was defined very clearly over 200 years ago: "Another thing very injurious to the child, is the tying and cutting of the navel string too soon; which should always be left till the child has not only repeatedly breathed but until all pulsation in the cord ceases. As otherwise the child is much weaker than it ought to be, a portion of the blood being left in the placenta, which ought to have been in the child." Erasmus Darwin, (Charles Darwin's grandfather) 1801.

Despite repeated publications illustrating the effects of the error, and official notification, medical academia and its peer review press have yet to acknowledge the possibility of any error. Public exposure and knowledge of the issue is intended to accelerate correction of the error. The nature of the injury caused by this practice unhappily precludes a cure; for the unfortunate parents of an impaired child, the knowledge may assuage any guilt they may have and give them reassurance regarding future births. Modern obstetrics ignores the normal functions of the cord and placenta from the moment that the child is born, and in most hospitals the umbilical cord is clamped and cut at the earliest convenient time after birth. At premature births and when the newborn is depressed or "at risk," immediate cord clamping is routinely performed in order to rush the child to a resuscitation table and to obtain cord blood samples for medico-legal purposes. Placental blood, which ought to have been in the child, is either thrown away or used to provide stem cells or other commercial products. Doctors are taught (and believe) that delayed cord clamping / placental transfusion gives the baby too much blood, (hypervolemia) while neonatal intensive care units (NICU) are filled with weak, fast-clamped newborns exhibiting signs of severe blood loss--pallor, hypovolemia (low blood volume) anemia, (low blood count) hypotension (low blood pressure), hypothermia (cold), oliguria (poor urine output), metabolic acidosis, hypoxia (low oxygen supply), and respiratory distress (shock lung)--to the point that some need blood transfusions and many more receive blood volume expanders.

At this point, an explanation of the terms anemia, polycythemia, hypovolemia and hypervolemia is required. Blood is a mixture of red cells and plasma, a fluid. Blood is usually about half cells and half plasma. When blood contains too few cells, the term anemia is used; the blood is "dilute." Polycythemia means there are too many red cells--"concentrated" blood. The -volemia terms refer to the total volume of blood in the child's heart and blood vessels; blood vessels are elastic and are constantly filled by the heart pumping blood through them, like a long, circular balloon. Too much blood volume (hypervolemia) overworks the heart and overfills the "balloon." Too little blood volume (hypovolemia) lets the balloon and the heart collapse; it makes no difference if the blood is diluted or concentrated. Anemia and polycythemia are about the quality of blood; hypo- and hyper-volemia are about quantity of blood. An anemic baby may be hypervolemic--too much fluid, and a polycythemic child may be hypovolemic--dehydrated. A normal child that suffers acute blood loss will have a normal blood count and low blood volume (hypovolemia). During recovery from the hemorrhage, blood volume is restored with fluid (plasma), and the child becomes anemic (diluted blood) as it takes much longer to restore the lost red cells. Early infant anemia is a strong indication that the child has suffered significant previous blood loss.

Before Birth, the Cord and Placenta "Breathe" for the Baby

Humans and all other mammals have evolved, over millions of years, a very safe mechanism for closing umbilical cords at birth without interrupting "breathing," and ensuring optimal survival of their offspring. An occasional natural accident such as a ruptured cord may rarely occur, but it is biologically impossible for that mechanism to routinely give a child too much, or too little, blood; mammals that routinely give their offspring the wrong amount of blood for survival become extinct in one generation. Erasmus Darwin's late clamping method is safe because the tie is placed on vessels that the child has already closed physiologically (by natural constriction) after it has received the right amount of blood; the tie does no harm because it virtually does nothing. Safe cord closure at birth involves closing the placental life support system and starting the child's life support systems without significant interruption of life support during the changeover process. Oxygen supply and blood to carry the oxygen are crucial to life support; blue blood contains little oxygen, red (pink) blood is saturated with oxygen. Brain cells die quickly from lack of oxygen; they do not regenerate, and asphyxiation (choking / lack of oxygen) for about six minutes will cause permanent brain damage.

Normal Cord and Placental Function after Birth (No Cord Clamp Used)

Before birth, the lungs are filled with fluid and very little blood flows through them; the child receives oxygen from the mother through the placenta and cord. This placental oxygen supply continues after the child is born until the lungs are working and supplying oxygen--that is, when they are filled with air and all the blood from the right side of the heart is flowing through them. When the child is crying and pink, the cord vessels clamp themselves. During this interval between birth and natural clamping, blood is transfused from the placenta to establish blood flow through the lungs. Thus the natural process protects the brain by providing a continuous oxygen supply from two sources until the second source is functioning well.

Placental blood transfusion occurs by gravity or by contraction of the mother's uterus which forces blood into the child. Transfer of blood into the child through the cord vein can occur after the arteries are closed (no cord pulsation). The transfusion is controlled by the child's reflexes (cord vessel narrowing) and is terminated by them when the child has received enough blood (cord vessel closure). The switch from placental to pulmonary oxygenation also involves changing the fetal circulation to the adult circulation--the one-sided heart (body blood flow only) changes to a two-sided heart (blood flows through the lungs, then through the body). Ventilation of the lungs and placental transfusion effect this change. This is a very basic account of a very complex process. It all happens usually within a few minutes of birth, and when the cord pulsations have ceased and the child is crying and pink, the process is complete. Clamping the cord during the changeover process disrupts these life support systems and may cause serious injury.

The Effects and the Injuries of Immediate Cord Clamping (ICC)

The American College of Obstetricians and Gynecologists (ACOG) and the Society of Obstetricians and Gynecologists of Canada (SOGC) advocate immediate cord clamping at birth before the child has breathed. This instantly cuts off the placental oxygen supply and the child remains asphyxiated until the lungs function. Blood, which normally would have been transfused to establish the child's lung circulation, remains clamped in the placenta, and the child diverts blood from all other organs to fill the lung blood vessels. After immediate clamping, the normal term baby usually has enough blood to establish lung function and prevent obvious brain damage, but it is often pale, weak, and slow to respond. Occasionally, a child will cry as soon as the head is delivered, and the uterine contraction that delivers the child may also squeeze in some placental transfusion before the fast clamp can be applied; however, cord clamping before the first breath always causes some degree of asphyxia and loss of blood volume: (1) It totally cuts off the infant brain's oxygen supply from the placenta before lungs begin to function. (2) It stops placental transfusion--the transfer of a large volume of blood (up to 50% increase in total blood volume) that is used mainly to establish circulation through the child's lungs to start them functioning.

Cerebral Palsy Can Result From Premature Cord Clamping

While ICC is a danger to all newborns, if a child is born asphyxiated and depressed following fetal distress from cord compression (e.g. a tight cord around the neck) immediate cord clamping may very well be fatal. A child deprived of oxygenated placental blood before birth is in dire need of oxygenated blood after birth. Immediate clamping in such circumstances often produces a hypovolemic and asphyxiated child who cannot begin to breathe adequately to relieve the asphyxia; oxygen in the lungs will never reach the brain if the newborn does not have enough blood to flow from lungs to brain. The medical term for the condition that causes cerebral palsy (CP) is hypoxic, ischemic encephalopathy (HIE). Hypoxic means lack of oxygen--the child has no placental oxygen supply; ischemic means lack of blood flow--half of the child's blood is in the placenta; encephalopathy means brain damage. HIE is often treated with blood transfusion or blood volume expanders after a large part of the child's own oxygenated blood has been discarded with the placenta. In addition, babies with HIE usually develop anemia. The obvious correct way to resuscitate the depressed child is to keep the cord and placenta functioning while ventilating the lungs. If a child is born depressed with a knot in the cord, should the knot be loosened or tightened? A newborn depressed from lack of blood and lack of oxygen is quickly restored to normal with a large transfusion of oxygenated placental blood and is unlikely to develop HIE. Rapid restoration of oxygenation is crucial in preventing brain damage in the depressed child, and that child must have enough blood to transport oxygen to the brain.

If hypoxic brain damage has occurred before birth, placental oxygenation and transfusion will not cure it after birth--nothing will--but progression of the damage will be prevented. Blood transfusion given after the child has developed HIE will not restore the dead brain cells. Blood transfusions given in the NICU are usually examples of "too little and much too late." Fetal distress (intra-partum asphyxia from cord compression, such as occurs with a cord prolapsed during labor (a cord squeezed between the head and the cervix,) may be rapidly reversed by relieving the compression--elevating the presenting part (head) or changing the mother's position. The fetal heart rate and monitor tracing soon return to normal and at delivery by emergency c-section, the child may show no sign of asphyxiation. The same result can be obtained at birth in a child asphyxiated with a tight cord around the neck by reducing (unwinding) the cord and allowing the placental circulation to resuscitate the child. The current standard obstetrical practice is to clamp the cord immediately to obtain a cord pH--this maximizes the asphyxiation and hypovolemia, and accelerates HIE; the life-saving blood in the placenta is thrown away while parts of the child's brain die.

Learning Disorders and Mental Deficiency

The varying degrees of cerebral palsy and spastic paralysis are usually evident soon after birth in the movement and reflexes of the child, but lesser degrees of hypoxic, ischemic brain damage may remain hidden for years. Iron deficiency anemia in infants is associated with learning disorders and behavioral problems to the point of mental retardation when these children reach grade school; the degree of mental retardation increases with more severe degrees of infant anemia. At birth, no newborn is anemic; adequate iron is supplied from the mother regardless of her iron status. Any newborn that receives a full placental transfusion at birth has enough iron to prevent anemia during the first year of life. It is, therefore, reasonable to conclude that full placental transfusion will prevent the mental retardation, behavioral disorders and learning disabilities that occur following infant anemia. The immediately clamped newborn may be missing one third to one half of its normal blood volume and is very prone to develop infant anemia, and as shown previously, it is also at risk for hypoxic, ischemic brain damage at birth.

While some studies on treatment of the anemia in infancy have shown some behavioral improvement, most studies show no improvement or prevention of the brain dysfunction following correction of anemia, making it difficult to establish a cause and effect relationship between anemia and brain dysfunction. In HIE and CP (severe brain dysfunction) anemia develops AFTER the brain is damaged. Moderate hypovolemia and hypoxia at birth will produce infant anemia; it may also cause undiagnosed minor brain damage that will later produce behavioral defects. Evidence strongly points to infant anemia and behavioral brain dysfunction having a common cause--immediate cord clamping; in other words, both anemia and brain dysfunction are effects, not a cause and an effect.

In a comprehensive review of cord clamping in 1982, Linderkamp concluded: "immediate clamping can result in hypovolemia and anemia. A medium placental transfusion appears to be more appropriate in order to avoid the risk of hyperviscosity, whereas iron deficiency in later infancy is probably less dangerous." And in a similar review in 1981, Peltonen stated: "Closing of the umbilical circulation before aeration of the lungs has taken place is a highly unphysiological measure, which should thus be avoided. Although the normal infant survives without harm, under certain unfavorable conditions, the consequences may be fatal." Within a few years, reports of these unharmed, "normal," anemic infants being mentally retarded in grade school began to appear in the literature. While Linderkamp never proved that hyperviscosity, (a hematocrit of >65%) was any risk at all to a newborn, Peltonen's remarks were based on his observations of newborns' chests viewed under a fluoroscope, and he described incomplete filling of the cardiac ventricles (decrease in heart size) following immediate clamping; his use of the word "fatal" indicates that, after immediate clamping, he witnessed a cardiac arrest that was not reversed. His blunt advice to avoid the procedure (he mentions no exceptions) emphasizes that the "normal" child may not be free from risk. He did not advise repeating his experiment; ACOG and SOGC do. Cardiac arrest, or inadequate cardiac output for a few minutes, will produce permanent brain damage.

To Announce To Every Obstetrician In Very Large Print:

1. That immediate cord clamping is no longer officially sanctioned as standard care.

2. That the person who clamps the cord before the lungs are oxygenating the child should have sound, documented, clinical justification for doing so and

3. That the person who clamps the cord immediately or prematurely is individually responsible and liable for the resulting injuries.

Scientific Evidence of Psych-Drug Damage Relating to Pregnancy

From Byron Richards PhD. we learned that the dangers of psych drugs during pregnancy and lactation have been reported for a number of years.  However, within the past six months a stunning amount of new data has become available which I will now summarize for you.  A lot of this information is new since the Senate bill was first crafted.  Any Senator who was truly interested in the health and well being of mother and child would put the Mothers Act on hold until the true risks of these drugs are fully known.  It is completely irresponsible of Senators to create laws which will directly injure mothers, unborn children, and new babies.

It is a well known scientific fact that psych drugs readily cross the placenta and expose the fetus to pharmacologically active levels of these drugs.  It is also known that nursing mothers have pharmacologically active levels of these drugs in their breast milk.

Exposing a fetus or new baby to these drugs is far different than exposing the adult nervous system which has already established brain circuitry.  The fetus’s evolving nerves are trying to form core nerve circuitry (like computer hardware) that cannot easily be changed later, establishing connections throughout the body – such as to the heart and lungs, and setting up how these organs will be run by the nerves over the course of a lifetime.  Available evidence clearly shows that psych drugs interfere with these natural processes and pose a grave risk to the unborn – a risk that can result in a lifetime of poor health.

A meta-analysis published in May of 2007 showed that women taking antidepressants in the first trimester of pregnancy had a 72% increased risk for a child with cardiac malformation (birth defect).  A study published in Dec of 2006 reviewed earlier studies showing that the use of antidepressants during any phase of pregnancy carried serious risks for birth defects, especially cardiovascular.  It reviewed a Danish study showing 60% increased risk, an American study showing 100% increased risk, and a Swedish study showing 120% increased risk for cardiovascular defects.  The American study showed 4% of women who used antidepressants during pregnancy had a baby with any type of birth defect; 2% of women having babies with cardiovascular birth defects.  It is clear that antidepressant medication interferes with how nerves communicate to the heart as the fetus is evolving.  Click here to read the story of Manie – a baby born with an antidepressant-induced heart defect.

A Dec of 2007 Dutch study reports on the broad array of side effects in babies whose mothers took antidepressants during pregnancy.  These include respiratory distress, feeding and digestive disturbances, irritability, and convulsions.  The authors also point out that animal studies have shown “permanent changes in specific parts of the brain and altered behavior in adulthood after perinatal exposure to SSRIs.” A Dec of 2007 Swedish study confirms much of this information, again pointing out the high rates of respiratory distress, convulsions, hypoglycemia, and overall poor health (low Apgar scores).  An Oct of 2006 study explains that 30% of babies born to mothers who used antidepressants have significant inability to adapt (adjusting to being born and then thriving).  This means that even when there are not blatant birth defects, general health of the newborn is compromised across the boards – an incredibly dangerous situation.

Indeed, data published in Oct of 2006 showed mothers who took antidepressants are much more likely to have premature deliveries and low birth weight babies – indicative of general malnutrition induced by antidepressant medication.  Studies in sheep clearly show that this is because antidepressants reduce the flow of blood to the uterus, in turn reducing the amount of oxygen and nutrition that can get to the baby.

An Oct of 2007 U.S. study reviewed the animal data that shows exposure to antidepressants causes lifelong abnormalities in behavior and stress tolerance.  A Feb of 2005 study demonstrated that 2 month old infants already had a depressed and inappropriate response to pain – a key factor indicating disturbed development of the nervous system.  This issue is directly related to properly coping with stress or pain as an adult, the failure of which leads to anxiety, fibromyalgia, and increased risk for sudden death from a cardiovascular event.  This is a profound neurologic change because it means that the developing nervous system, as a result of exposure to psych meds, has been “traumatized,” adversely priming nerves to hyper-react to future stress.

Several studies have tried to identify childhood behavioral and attention issues in those exposed to psych drugs during pregnancy. (Jan of 2007, June of 2006) While poor coping trends are evident, a clear pattern has not emerged because these children are still living in high stress environments due to parental instability – which is never good for children whether they have been exposed to medication or not.

The bottom line of all of this information about psych drug use during pregnancy is that it is one huge experiment with many unknown and likely adverse health consequences.  Once again we see the failure of the FDA to protect the public, as the FDA does not demand Big Pharma do studies to prove these drugs are safe for pregnant women.  To the contrary, most available science tilts in the direction that they are quite unsafe and carry extreme risks for the baby – with ominous implications for future poor health for the child and health care costs to society.  Senators in favor of this legislation, which would steer 80% of pregnant women on to these meds, need their heads and morality examined.  They should be personally held accountable to the mothers whose babies their law injures.

Selecting Your Midwife

Questions to Ask

How long has she been a midwife?

Where did she attain her training?

How long did she train?

How many births did she attend while under supervision?

How many children does she have and where were her births attended and by whom?

How many mothers has she delivered and how many were home births?

Does she work alone? With apprentices? Other midwives?

What happens if she must transfer to the hospital?

What is her transfer rate?

What are her views on episiotomy? What is her rate?

How often do mothers have intact perineums?

How often do they require stitches?

Does she suture?

When does she go on vacation?

Does she have a back up if something happens during her absence?

What is her fee? What does this include? When does it have to be paid?

Ask when she attended her last three births.

Ask to be given their names and phone numbers as references.

What if Your Doctor Advises Against Home Birth?

Why should you want a home birth, if your doctor is against it? Because your doctor might be wrong. Many experts in childbirth--midwives and obstetricians--believe that home birth is a safe and sensible option for healthy women with normal pregnancies. There's much of research which supports this view. Of course, there are also plenty of midwives and doctors who do not support home birth. Their views may be based upon their own experience, beliefs and fears, or just on habit. It may be that they are not aware of research on home birth safety--family doctors may not have time to read specialist literature, for example. Their reasons will vary. If you ask 100 doctors for their beliefs on this subject, you will receive 100 different answers--not all of them compatible. They can't all be right! Listen to the opinions of your medical advisors, but remember that there are other experts who might well have a different view on the matter. Your doctor/midwife can offer you advice based on her own experience, but she is not infallible, and you do not have to take her advice. Ask what evidence the advice is based on. Ask what particular details of your own case lead them to recommend/not recommend a home birth.

It is not an insult to your doctor to ask these questions; it just shows that you are an intelligent adult who wants to know more about her healthcare options. Consider showing your doctor some printed pages from this site and other sources. The sources that are likely to carry most weight are the respected medical journals. Some family doctors are opposed to home births because they worry that they will be asked to attend the birth, and that their experience and skills will not be sufficient. It is understandable that this would concern them, as the job of a family doctor is demanding enough without the need to keep up to date on obstetric research and practice. However, your doctor will not usually be needed to attend the birth--the lead professional will normally be a qualified midwife. In some situations your midwife might want to call upon a doctor in an emergency, but she can arrange cover from another doctor if your family doctor is not comfortable with this. Your family doctor should certainly not be required to have any specialist obstetric skills--if these are needed, you should transfer to a hospital. There are some surprising misconceptions among family doctors about home birth. The recent family doctors' magazine, had an editorial explaining why many GPs did not support home births, primarily because they "do not have the time, skills or inclination to spend hours with women in labor.." There is no reason why a GP should normally be expected to attend a home birth. If a respected publication, which is widely regarded as the family doctors' trade journal, can be so misinformed about the doctor's role in a home birth, it would not be surprising if some individual doctors were also misinformed about what might be expected of them.

Their negative reactions to the idea of home birth might reflect the thought that their own skills would not be adequate to cope with an emergency, rather than a realistic assessment of the safety of home birth attended by a specialist midwife. There are some situations where home birth will be safer than hospital birth, and others where it will be less safe. You might decide, after studying the evidence that home is not the best place for you to give birth this time. Just remember that it is your decision. If you feel that your doctor or midwives do not support your wish for a home birth, or you think that they are not giving you objective advice on the matter, then you could consider hiring an independent midwife. Many independent midwives specialize in home births and are experts in the field. Data which lump planned home births together with unplanned out-of-hospital births are misleading; the unplanned out-of-hospital births are very high-risk, including teenagers who deliver their babies in secret, and unexpected rapid premature births at 28 weeks, for example. In one study, 976 women who booked a home birth were compared with a matched group of 2,928 women planning a hospital birth. Women in the home birth group had longer labors (presumably because they would not have been accelerated with drugs or other interventions), but were less likely to have induction, caesarean, or other operative delivery, and were less likely to have complications of labor overall.

Babies in the home birth group were in better condition at birth--hospital group babies were more likely to take a while to start breathing, to need resuscitation, and to have Apgar scores under 8. Perinatal mortality was slightly higher overall in the home birth group--no explanation for this is given--but the authors of the study state that the increase was not (statistically) significant. However, neonatal mortality (after birth) was significantly higher in the hospital group. Another study found no significant differences between the two groups in maternal morbidity (ill mothers), or fetal morbidity of mortality (ill or sick babies). The only difference which the researchers found significant was that more mothers in the simulated home birth group were satisfied with the care they received. There is more to home birth than sympathetic care in a nicely-decorated room. For many, the benefit comes from being at home, where you feel secure, and where you are in control. Humans are territorial animals. We do not know enough yet about the way environment affects the production of hormones necessary for birth. For those giving birth in hospital: if providing midwife-led care and comfortable birthing rooms is just as safe as consultant care in conventional delivery rooms, and if women prefer it, then why are all women not offered this option? Cost should not be an obstacle, as midwife-led care is cheaper than consultant-led care; the savings should help to furnish a few birthing rooms. Researchers looked at data on damage to the perineum for 1068 women who deli