Letters to the Editor
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Middle Ground
Only a handful of letters so far tonight and I'm already surprised at the diversity of viewpoints, especially the anti-homebirth letter. By the end of the weekend I would guess that the letters here could touch any number of related hot-button topics: breasfeeding, circumcision, abortion, sexuality, etc. Should be interesting and enlightening as usual.
Our family has recently experienced two births, both at a hospital. Age considerations precluded us from having a homebirth, at least with our physician. We had seriously considered homebirth and I've got to say that I (the father) was relieved when that was ruled out for us as a choice (unless we wanted to abandon our relationship with our doctor). Our doctor, by the way, is quite progressive and all of his children were homebirthed with a midwife in attendance. I understand that Ricki Lake and others feel so connected to their experiences that it prompts them to sort of proselytize in support of their experience, but when that enthusiasm chastises others for their choices something's amiss. I'm glad she's able to raise sorely needed awareness of the homebirth option, but what's prompting me to write is the recognition that there is a middle ground.
The middle ground I'm referring to is something available in the community where we live. Homebirthing is quite common, midwives and doulas are plentiful and busy and midwives are allowed to admit patients to the local hospital. There are several birthing centers in the area which offer an almost-like-home birthing choice with greater access to emergency care. And, then there's our hospital, which because of the progressive nature of the community it serves and the influence of all of the other options available, does not treat birthing in a purely clinical way. Most people here feel very fortunate. With such information and support common here, and the books mentioned in the article only 2 among a number of others in our home on the topic, although we felt slightly like we were copping out by having our first child at the hospital, in the end it was less of the typical hospital experience than we had imagined it might be and quite a good thing that we were there for several reasons. With our second child, although we still had somewhat mixed feelings, we were again quite glad to be there when all was said and done, and quite grateful for the hybrid-type experience our hospital offers. Some of our friends have had homebirths, some have gone to birthing centers, some had emergency c-sections, and some went the route we took (with a physician and a doula) at the hospital. The one thing, and rightly so, which unites all of these experiences is that all of the children are loved more than they'll ever know and they really don't care how they got here.
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Okay, more specifically:
Problem pregnancies are more likely to result in a hospital birth. They are also more likely to result in infant death, because dead babies are problem babies.
This also goes for preemies. I'm not up in arms over your post or anything, I just think your news flash was a little too much flash, a little too little news.
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Ken Erfourth, my father was a doctor
he was born in 1896 so this was a Long Time Ago. in those days there were just "doctors" and they did everything. one of the things he did was deliver babies, which were all born at home. one time a baby was threatening to be born breech - just like your unfortunate friends. my father had powerful hands. he reached inside the uterus and turned the baby around so it didn't press on the cord. both mother and baby did fine. i remember it so well because he said his hands hurt for a week and worse - they didn't pay! (it was $35). the point? MIDWIVES ARE NOT DOCTORS. perhaps a midwife should be there - but just to hold hands. (and speaking as a father of three - i wouldn't mind being *missing* at that "wonderful occasion" - it's horrible. wives are in pain and extra kvetchy, the baby looks totally yucky. i wouldn't mind visiting an hour later, to celebrate)
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Terrific choices
"Midwife vs. Hospital" is an oversimplification of the available choices.
I gave birth to my second child in 1983 in a hospital with the help and the supervision of a Certified Nurse-Midwife, using auto-hypnosis for pain management. It was one of the great experiences of my life, and a much happier experience than the more typical hospital delivery I had with my first child.
Granted, I didn't give birth in the bathtub. But I labored without interference, I held my son within seconds of his birth, and there was no immediate whisking-away of the baby.
CNM's are extremely qualified, and in a hospital or birth center setting, the resources for dealing with complications are nearby.
If you are curious about CNM's, check out the website of the American College of Nurse Midwives. Terrific people, terrific choices.
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Flawed Statistics
Next news flash: Statistics show that home birth is safer by far than a hospital birth as measured by infant mortality. Further the US is not even in the top 20 in the world in expected life span as applied to infants. (Meaning of course that for all our supposed technology we are falling behind third world nations in infant mortality.) I think it follows that if Costa Rica can manage to get more babies through childbirth with non-invasive techniques then perhaps we should at least listen to the alternatives??
There are two easy ways this statistic can be flawed (actually, three, but two are interrelated). The two interrelated ones are that home birth is most available to the wealthy, and most available to well-educated, highly motivated new parents. People with money can afford to pay for better care, and people who are very interested in their child's well-being will do everything that they can to make sure that the birth is ideal, whether it's in the home or in the hospital. You can't compare the two populations (home births versus hospital births) without controlling for those two factors.
The second issue, which relates to comparing US statistics to that of other countries, is that in the US most infant mortality is due to premature births, rather than lack of proper care. Premature births have nothing to do with where you have the child, they have much more to do with the age of the mother (an issue in the US, since both the very young - a factor due to our high teen pregnancy rate, and the very old - a factor due to the wide availability of fertility treatments in the US - are more likely to have preterm babies), and the quality of prenatal care. There is actually a perversity here, in that the better the prenatal care offered, the higher the number of premature births you might get (since babies that would otherwise die in the uterus might actually make it long enough to be viable). In that sense, better medical care could actually increase infant mortality, since still births aren't counted in the infant mortality statistics. A better discussion of this second issue can be found here:
http://forums.studentdoctor.net/showthread.php?t=386554
Finally - most of the countries ahead of the US have very similar medical systems. Do you really think a majority of the births in those countries are home births? I did some quick google searches, and according to what I found in the top five countries (Singapore, Sweden, Hong Kong, Japan, Iceland), in all cases hospital births are most common.
I'm not saying that the US system couldn't be better, but saying that home birth is unquestionably better than hospital birth is difficult to justify. The best option is probably the "middle ground" advocated by some other letter writers already - natural birth in a calm environment, but in a hospital or birthing center where emergency care is available when necessary.