Saturday, September 12, 2009

the perils of misrepresentation

I'm sorry, I can't hold back from a rant. Just a wee little rant.

Yesterday, there was a segment on the Today show about homebirth. It's title? "The Perils of Midwifery."
Sounds nice and balanced, doesn't it?
Apparently, a couple hired a very well-known midwife (Cara Muhlhahn, who appeared in Business of Being Born) in Manhattan to attend their home birth. Their daughter had no heartbeat when she was born after four days of labor. These poor people are understandably grieving and looking for answers. They blame their midwife.
Now, let me be clear. I don't know the case, and I don't know if Muhlhahn is at fault. It's certainly possible. What I do know is this: one negative outcome with one midwife says nothing about whether home births in general are safe. And: I've read about Muhlhahn: in 18 years of practicing midwifery, she's lost only one other baby. I don't know what her infant mortality rate is--what percentage of births this is. But it is fear-mongering to say that if a practitioner has one bad outcome, they are a bad practitioner. Or, that if there's one bad practitioner out there, that every practitioner is bad.

Of course, this wasn't mentioned in the Today show segment.

What they also don't mention: midwives monitor heart rates during the course of labor. (Yes, they bring along actual medical equpment!) They are happy to transfer if something seems out of the ordinary. During my first labor, my midwife was a little concerned that Lucy's heart rate was slowing. She mentioned that we might need to transfer if Lucy wasn't born quickly (which thankfully, didn't happen) Lucy (just like the baby mentioned on Today) had the cord wrapped around her neck--three times.
Also not mentioned in the Today segment: about 25% of babies have their cords wrapped around their neck. This is cause for caution, but not panic.

What Today did mention? Home births are apparently popular among celebrities. So home birth is now like a "spa treatment", and the American College of Obstetricians and Gynecologists (ACOG) strongly objects to women choosing their birth locales based on what's trendy.

Yes, this is why I chose a homebirth for my first (and second) child. Because Demi Moore did.

Today made some attempt to show the other side of the story; an interview with a different, satisfied Cara Muhlhahn client, and one sentence from Marsdon Wagner, who is a perinatologist and perinatal epidemiologist. He was director of Women's and Children's Health in the World Health Organization for 15 years. He mentioned that in a hospital, you have a one-in-three chance of a caesarian.

That's all they gave him a chance to say. Then, they cut to the poor grieving mother: "A caesarian wouldn't have been the worst thing. Losing our daughter was."

Not mentioned: There is a significantly increased risk of maternal and infant death with a caesarian. Besides the risk of death, babies born by caesarian section have lower apgar scores, and mothers have negatively impacted fertility after the surgery, and all subsequent labors become more dangerous for mother and child. That does not even touch on the "less serious" side effects, like how caesarians make it harder to care for a newborn, negatively impact breastfeeding, cost a lot of money, and leave some women feeling like they (or their bodies) failed.
In fact, the WHO recommends that caesarians account for no more than 10% of births. Because they are not safe unless there is a real reason for them. Here in the US, they are at 30% and rising.
We are not just talking about avoiding a scar around your bikini line.

A few other things not mentioned about the "perils" of midwifery: lots of other countries have midwives attend births far more often than OB/Gyns. In some countries, you have to pay extra for birthing in a hospital if you're low-risk. They have lower infant mortality rates than we do.
For low-risk births, home-birth stacks up really well against low-risk hospital birth. There are no double-blind randomized trials to prove this, which is why the ACOG can still claim that it's not safe. But tell me: if you're pregnant, do you want to be randomly assigned to a birth location? No? Then don't expect a randomized trial to be published any time soon.

Anytime I tell someone about birthing at home, they say, "Wow, you're so brave." or, "That's commendable."
What I don't say? I'm about the least brave person I know when it comes to taking physical risks. Don't like heights, horror movies, putting my face in water, surfing, roller coasters, bees, going downhill too fast on a bike. When I got an ear infection a few years ago, I went to the emergency room, convinced my brain was about to explode. They laughed at me, then told me to go home and take an aspirin.
Personally, I chose home birth because I don't want to fight a system in a hospital that is not safe for my baby or for me. I don't want a doctor inducing me with a non FDA-approved drug that radically increases the risk of uterine rupture and infant death (Cytotec). I don't want to be induced and have much more painful contractions. I don't want to be bullied into giving birth before my baby is ready to be born. I don't want to be strapped to a machine instead of being able to move around to ease my pain. And I don't want drugs that increase my likelihood of caesarian many times over. Most of all, I want to be someplace where I feel safe, comfortable, and in charge.
Believe me, "bravery" has nothing to do with my decision to birth at home.

Listening to our country debate healthcare, and then hearing a segment like this on Today, I'm starting lose hope that our country can ever have a rational system of medicine. Because if anything would help our country save money on health care, it would be increasing the role that midwives have in delivering babies. Birth is the most common reason people go into the hospital. And caesarian is the most (or one of the most) common surgeries. I can understand that home birth isn't for everyone. When it's needed, obstetrical care is lifesaving. Caesarians are lifesaving. Hospitals are lifesaving. And giving birth can be a scary prospect for women. I completely understand that a lot of my friends think I'm a little cuckoo for choosing to birth at home. I understand that epidurals help a lot of women avoid pain in labor--and I'm always happy to hear when that happens well, when the drugs don't cause other complications. I don't think "natural" birth is something to be commended for--it's just a choice, and one that a lot of women aren't prepared ot make.
But it makes me angry that our culture does not empower women to see that choice for what it is: a safe alternative. It makes me angry that friends whose births did not go as they were hoping call me, saddened, after their birth. I don't think my friends are at fault; I think the system they entered into does almost everything possible to prevent them from feeling empowered, safe, and calm.
And honestly, I'm angry that in all this debate about healthcare, I've heard nothing coming from official channels that midwifery might be used as a cost-saving measure. Because what a way to save money--provide women with better care (someone that stays with you during labor! Someone that empowers you to believe you can do this incredibly difficult thing! Someone who won't cut you or cut you open unnecessarily!) while not spending money on unnecessary procedures.

But when a show like Today represents this choice as vanity, as trendy--no, as foolhardy and dangerous, I'm afraid that there's no way that our culture will ever change enough to truly empower women to make real choices about where to give birth.

For anyone wanting to learn more about birth, and the medical studies that support (or, really don't support) current obstetrical practices, I invite you to read "The Thinking Women's Guide to a Better Birth" by Henci Goer. Or, check out some sample chapters here. This woman (no not an MD, but as she says, "I can read.") has read the medical literature to find out what the experts really say about the efficacy and safety of our current birthing system. She talks about the statistics and conclusions behind different medical studies, and helps interpret the results in laymans terms. Unlike the Today show, she even talks about her biases and includes information even if it doesn't buttress her point. The book isn't just a negative rant (like this post); it would also be a great resource for learning what you can do to have a safe, less-painful, more successful labor.


Heather said...

There's one other maddening thing about the fear-mongering that goes on about home birth. If the system is so dead set against home birth, it makes it less safe for those of us who chose it. If hospitals believe that those who choose home birth are foolhardy, vain, and stupid, how do you think they'll treat us if we transfer to the hospital in a case of real need? Will they work constructively with our primary caregiver if they think she's little better than a witch doctor?
Or: Do you think that it's easy for a midwife to get malpractice insurance if the ACOG says that home birth isn't safe? Do think it's easy for midwives to establish working relationships with doctors to back them up in cases of emergency if the doctors have to take on the liability of working with a "completely unsafe" practitioner?

Idyllic Youth said...

The only thing that gives me hope is knowing we are moving forward, albeit slowly, towards homebirth being more accepted. When my mom delivered me and my siblings at home back in the 80's and 90's she told me that she encountered a whole host of problems. With me she couldn't get a birth certificate in 1985, with my sister in 1987 no pediatrician would dare treat a "dirty" home birth baby. When my brother born in 1990 had some mucus in his lungs (from being born really quickly 45 min WHOLE LABOR) the hospital told my mom she was irresponsible for not giving birth to him in a hospital, and when my youngest brother was born in 1995 her own general practitioner refused to see her claiming she was stupid to have a home birth at age 35. At least when I had my daughter in 2008, my pediatrician applauded me for having her naturally, never ran into problems with refusing vaccines, my midwife filed for the birth certificate and even when I hemorrhaged after the birth the OB in the hospital never once told me that if I'd been in the hospital for the birth I could have avoided trauma.

Melissa said...

I have a hard time understanding how ACOG lobbyists and fear-mongering practitioners and sensationalistic media representations can outweigh evidence, in the public debate about birth. Or wait, maybe I do understand, I just wish it wasn't so.

Are you familiar with The Big Push for Midwives campaign? Their main goal is for CPMs to be legal practitioners in all 50 states. They've also recently been trying to educate lawmakers about the value of CPMs. They've also got a press release about the Today Show nonsense on their home page right now. I like them.

And please be sure to email this blog post to the Today Show-- their email address is They need to hear how wrong they got it, and that viewers want fair and accurate reporting.

Diana said...

Fantastic post, H. I wish every child-bearing woman could read this. Not that one choice is necessarily the right choice (as you point out), but that every woman should be informed of her options and the truth. I know I wish I had.