"Bravery" has nothing to do with it

This is a repost of a commentary Morgan McFarland wrote on her blog. It captures the reasons many women chose home birth.

When hearing the news that I had my last baby at home and am planning to have this one at home as well, the first response from most people is, "You're so brave."

This has to be one of the most irritating things that people say to homebirthers. The implication is that birth is dangerous and that we are willing to take on a tremendous risk to do it anywhere but a hospital. It negates the research and planning that we've done to come to this decision. It makes the choice about balls, not brains. After all, homebirth is "dangerous." Hospital birth is "safe." Therefore, it must be bravado alone that would lead a woman to choosing such an option. Right?

In 2003, over 20% of women had their labors induced, with a rate closer to 40% in many hospitals, while that rate should not exceed 10% (and has remained at 10% in most industrialized nations). Inductions are approximately 5 times more likely among planned hospital births than planned homebirths. An 1999 American Journal of Obstetrics and Gynecology "Green Journal" review of 7000 inductions found that 3 out of 4 of the inductions were not medically necessary. Inductions are performed unnecessarily for estimated size of the baby (too large or too small), going past the estimated due date, amniotic fluid levels that are low but not critically low (correctable in nearly all cases by rehydration of the mother), rupture of membranes without immediate start of labor, the mother being dilated/effaced but not in active labor, or scheduling reasons on the part of the mother or care provider. Approximately 40-50% of inductions fail (depending on the induction method used and the mother's Bishop score), and most failed inductions end in cesarean section. Inductions increase labor pain and length, and create, among other problems, an increased risk of fetal distress, uterine rupture, and cesarean section.

But homebirth is "dangerous." Hospital birth is "safe."

Over 30% of women in the US have cesarean sections, while overwhelming research has led the World Health Organization to set an ideal standard rate of cesarean sections at 10-12%, with 15% being the rate where more harm is being done instead of good. Cesareans are performed at a similar rate across all risk groups, low to high. The cesarean rate for planned births at home or in an independent birthing center is approximately 4%. Cesarean sections increase the likelihood of maternal death by as much as 4 times, and have other immediate and long-term heath risks for mothers that include, but are not limited to, infection, bowel or bladder perforation, hysterectomy, future infertility, and increased risk of uterine rupture for future pregnancies. Risks for the baby include respiratory distress, fetal injury, prematurity (if result of schedule section or failed induction), and breastfeeding difficulties. Four of the greatest causes for the increase in cesarean section are overuse of interventions during labor, concern for malpractice/liability on the part of care providers, failed labor inductions, and "failure to progress" (labor not progressing fast enough or regularly enough for care providers).

But homebirth is "dangerous" and hospital birth is "safe."

The ACOG and AMA have both come out against homebirthing, calling it a dangerous trend and referring to it as a "fashionable, trendy, [...] the latest cause célèbre," and they paint a horrible picture of complications arising in low-risk pregnancies with no warning that cannot be handled anywhere but the hospital. Despite that, the most thorough study ever done on homebirth safety, Kenneth C Johnson and Betty-Anne Daviss's Outcomes of planned home births with certified professional midwives: large prospective study in North America, BMJ 2005;330:1416 (18 June), found that the outcomes of planned homebirths for low risk mothers were the same as the outcomes of planned hospital births for low risk mothers, with a significantly lower incident of interventions in the homebirth group. The Lewis Mehl Study of home and hospital births, which matched couples in each group for age, parity, education, race, and pregnancy/birth risk factors, found the hospital group had 9 times the rate of episiotomies and tearing, 3 times the cesarean rate, 6 times the fetal distress, 2 times the use of oxytocin for induction/augmentation, 9 times the use of analgesia/anesthesia, 5 times the rate of maternal blood pressure increase, 3 times the rate of maternal hemorrhage, 4 times the rate of infection, 20 times the rate of forceps use, and 30 times teh rate of birth injuries (including skull fractures and nerve damage). Breastfeeding success rates are higher and postpartum depression rates are lower for planned homebirths.

But homebirth is "dangerous" and hospital birth is "safe."

The United States spends more per pregnancy/birth than any other country, the vast majority of women in the US give birth in hospitals, and yet the US's maternal death rate is the worst among 28 industrialized nations and the neonatal mortality rate is the second worst. The Netherlands, where 36% of babies are born at home, has lower maternal and neonatal mortality rates than the US. Denmark, where all women have access to the option for a safe and legal home birth, has one of the lowest maternal and neonatal mortality rates.

But homebirth is "dangerous," hospital birth is "safe," and Brutus is an honorable man.

I didn't choose a homebirth because I am brave. Bravery has little to do with it. If anything, I believe women who choose to give birth in US hospitals are the brave ones, because knowing what I know about our technocratic obstetrical system, I can't imagine voluntarily choosing an obstetrician and a hospital for anything but absolute medical necessity. My decision to homebirth wasn't made in a void, but based upon years of research. I wonder how much research the average woman puts into her hospital birth? Considering how many times I've heard someone say "I'm glad I was in the hospital because..." and then given as her reason a non-emergent situation (such as fetal size or nuchal cords), I'd say not that much.

Call me stubborn, because I wasn't willing to accept out of hand the culturally held belief that hospitals are safer. Call me an idealist, because I believe that birth can be a positive, safe, and empowering experience for child and mother. Call me a nonconformist, because I choose to birth at home in defiance of a powerful technocratic system. Call me outspoken, because I can't keep my mouth shut when I hear about yet another iatrogenic birth calamity. Call me a "birth nazi," because I believe it's the right and responsibility of every woman to educate herself about birth and take ownership of her birth experience.

But brave? Don't call me brave. "Brave" has nothing to do with it.

AP article on Big Push

The AP just published an article about the Big Push for Midwives, of which Iowa is a part! Read it here and forward everywhere! A key excerpt:

The states are now evenly split on legal recognition of certified professional midwives (CPMs) — those who lack nursing degrees and who account for most midwife-assisted home births.

Half the states have procedures allowing CPMs to practice legally — including five which have taken such steps since 2005. The other 25 states lack such procedures and CPMs are subject to prosecution for practicing medicine without a license.

Depending on legislative decisions, the balance could shift this year. Among the battlegrounds:

_In North Carolina, a House study committee recommended in December that the legislature develop licensing standards for CPMs. The committee said the current system doesn't meet the needs of women who chose non-hospital births because of the "extremely limited supply" of obstetricians and nurse-midwives offering to handle such births.

_In Idaho, advocates who failed previously to get a voluntary licensing bill through the legislature are back with a mandatory licensing bill. State Rep. Janice McGeachin, R-Idaho Falls, says the changes helped persuade the state boards of nursing and pharmacy to drop their opposition. The Idaho Medical Association, which fought the earlier version, has expressed respect for the changes in the bill and is deliberating on whether further changes might produce a version it could accept.

_In Illinois, advocates also are back with a new version of a licensing bill that failed in 2007. Rep. Julie Hamos, D-Evanston, says it toughens qualification standards for CPMs — changes that prompted the Illinois Nurses Association to drop its opposition. The Illinois State Medical Society remains opposed.

The challenges are real but the momentum is in our favor. Let's make Iowa the tipping state!

Quad Cities Chapter!

The Quad Cities chapter of FOIM is official! Please join their yahoogroup!

New Year, New News!

Although the blog has been quiet lately, there has been a flurry of activity within FOIM. We have an energetic and promising start to 2009!

First and most exciting, FOIM leaders and members met with Rep. Mary Mascher from Iowa City to discuss our cause. The room was filled with parents and babies and everyone eloquently argued for their stake in making out-of-hospital birth accessible to all Iowans. Mary was warm and supportive and gave us a ton of great ideas for making this a reality.

Second, it looks like a Quad Cities chapter of FOIM is in the making! If you are a Quad Cities member and want to be in on the action, please contact me and I'll put you in touch with its organizers. Hopefully we will have FOIM in all corners of the state soon.

We have a lot of amazing plans for the next few months as the legislative session opens. The bill committee is working on a draft to shop around and we are scheduling meetings with representatives.

What can you do?

First, write a letter. Please! You would be amazed at the difference these letters make. We need FOIM to be in the hearts and minds of our legislators and the only way to do that is for them to hear directly from constituents. Our website has a great section all about writing letters.

Second, schedule a meeting with your representative. As a consumer who cares about this issue, a face to face meeting -- even for a few minutes -- will make a great impact. Bring your babies/kids! Legislators are home on weekends and are happy to meet with constituents at that time. Gather a few friends from your area and go together. Bring handouts and talking points to share!

Looking forward to a GREAT YEAR!