Freebirth controversy

Dr. Crippen suggests that mothers who freebirth are opening themselves to lawsuits:

The controversial NHS doctor who writes an award-winning blog under the pseudonym “Dr Crippen” has proposed that at some future point women will be sued by their (damaged) offspring for having had a home birth (let alone an unattended one).

Comments

Anonymous
The problem is, as always, the monopoly power of doctors. Through pernicious legislation and influence, they have limited the non-medical options available to women for birthing—i.e., midwives. This is particular gauling because midwife births are just as safe as medicalized births–but with dramatically less risk of invasive, dangerous procedures.
The practice of obstetrics is so resistant to evidence based procedures that there is reason to believe that radically different approaches to birth may produce better outcomes.
Mike
OB/GYN’s are rapidly leaving places in NJ due to malpractice costs, so you’ll get your wish soon. It can just be midwives and no doctors.
I’m sure everything will be hunky dory then. With those pesky doctors out of the way, there won’t be any complications. And no pain either.
And for anyone who believe that, I have a bridge I want to sell you.
Anonymous
Sorry, Mike. US obstetrics has nothing to brag about. It has 5-8 times the rate of C-sections and worse perinatal death rates than its peers in Western Europe–a place in which physicians involvement in birthing is the exception not the rule.
Oh, and don’t blame the lawyers. C-section rates have been increasing even in states that have imposed liability caps.
Mike
There are midwifery centers everywhere, at various medical schools (like Columbia… I know because I dated a student there) and at hospitals. So no one is keeping anybody from using a midwife.
Here’s a solution: DONT GO TO A DOCTOR! No one is forcing you.
Just stop bitching about the “influential doctor lobby”. Yeah, we’re so influential, and yet we can’t seem to negotiate better rates for oursleves with insurance companies or the governement.
If you hate doctors, than just say so. But don’t couch it in pleasing cliches and “statistics”.
Anonymous
Mike, you’re simply ignorant. In numerous states, midwives are not licensed to deliver alone. Further, many insurance companies refuse to reimburse solo midwives, even if they are certified in their state to deliver. That’s been my experience in Michigan. And, who sits on the boards of insurance companies as well as their advisory committees that set reimbursement . . .ah, yes, a large number of DOCTORS.
I wouldn’t be surprised Mike if you’re a doctor. Your self-assured incompetence and your self-interest couched in noble terms give it away.
Happyman
I have heard from neonatologists of major DISASTERS with meconium aspiration among babies delivered by midwives in manhattan – some were practically brain dead from anoxia by the time they arrived to an ER.
Technology and years of education has improved outcomes for both mothers and babies over the last hundred years – you’d have to be crazy to set the clock back when it comes to your baby.
And it seems nowadays, with chiropractors, naturopaths, and every other quack getting a “license” nowadays, doctors have NO influence over insurers or anyone else.
So go ahead, freaks, go to such charlatans. For me & my family, I’ll choose an MD (and a hospital, for childbirth that is).
Anonymous
Happyman, you are woefully ill-informed. Technology and medicine have NOT been improving outcomes over the “100 years.”
As Dr. Gawande in THe New Yorker admits, ut in 1933 the New York Academy of Medicine published a shocking study of 2,041 maternal deaths in childbirth. At least two-thirds, the investigators found, were preventable. There had been no improvement in death rates for mothers in the preceding two decades; newborn deaths from birth injuries had actually increased. Hospital care brought no advantages; mothers were better off delivering at home.” http://www.newyorker.com/archive/2006/10/09/061009fa_fact
And, if you bother to look at the stats, midwife birth for normal pregnancy is SAFER for the mom and just as good for the baby. The most recent, prospective study: http://www.bmj.com/cgi/content/abstract/330/7505/1416
Oh, but Mike doesn’t believe in stats because they’re cliches.
Ignorant jerks, doctors, who are raping American women–and must be stopped!!!
Happyman
anon 7:05 (gee I wonder if you’re a midwife):
from the cdc website:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm
“At the beginning of the 20th century, for every 1000 live births, six to nine women in the United States died of pregnancy-related complications…from 1900 through 1997, the maternal mortality rate declined almost 99% to less than 0.1 reported death per 1000 …advances in clinical medicine, improvements in access to health care, improvements in surveillance and monitoring of disease…contributed to this remarkable decline “
That’s the difference between doctors & midwives – doctors get and understand actual training in science & reasoning.
But nobody is stopping you from marketing your quackery to whomever you please.
Anonymous
uhh. . . happyman, perhaps it would be of interest to you to learn that much of the mortality in the late 19th and early 20th century was from puerperal fever–which OBSTRETRICIANS spread by failing to wash their hands.
Indeed, mortality has declined, for a variety of reasons, some of which certainly include improved clinical practice. Physicians are no doubt bet equiped to handle difficult pregnancies.
However, that’s NOT the question– the question is for healthy, non-problematic pregnancies what is the best approach. Given obstetrics high rates of dangerous interventions –and given the FACTS that midwife birth is just as same, it seems as if serious re-thinking of the standard of care is necessary.
you bizarre genuflecting before medicine is really part of the problem.
Happyman
“much of the mortality in the late 19th and early 20th century was from puerperal fever–which OBSTRETRICIANS spread by failing to wash their hands”
to anonymouse midwife- please site a reliable source for this (i think the cdc happens to be reliable).
“you bizarre genuflecting before medicine is really part of the problem”
I don’t really understand your language, but YOU seem to be genuflecting by stating things as if they’re factual (e.g. puerpueral fever) without citing evidence.
Perhaps your agenda is getting the best of you.
Mike
Anonymous, if a doctor is sitting on the board of an insurance company, who do you thin khe is working for? Insurance companies, or other doctors?
And as for improved outcomes with midwives for NORMAL pregnancies, in what way should doctors CHANGE clinical practice??? Please enlighten me.
Anonymous
Mike,
The processes of natural childbirth are not well understood. The fact is, however, the midwives deliver far more babier naturally. Do midwives provide a psychologically more supportive environment discourages production of the labor-stopping stress hormone catecholamine? Who knows. But, shouldn’t doctors try to find out–or maybe imitate.
Anonymous
Happyman,
you want puerperal fever cites, here’s what the wikipedia folks say.
http://en.wikipedia.org/wiki/Puerperal_fever
Happyman
anonymous midwife:
your wikipedia reference is RIDICULOUS, and irrelevant to this discussion (did you even read it???)
To apply historical statements from the mid-1800′s, before Louis Pasteur’s work, is ludicrous – did you even take high school biology?
I urge readers to check out anony-midwife’s wikipedia link (talk about digging your own grave).
Mike
Every doctor is taught that Semelweis figured out about the hand washing.. and was taunted by all German physicians until he went insane.
What in the f%^$ that has to do with the last 100 years of OB/GYN practice, I have no clue.
Midwives have a place in births… a very SMALL place. OB/GYN’s and their invasive “dangerous” procedures probably stems from OB’s not waiting for natural birth, because if something goes wrong, theres like a hundred thousand lawyers (like JohnEdwards) to pounce. The OB’s are scared crapless. And the malpractice goes up and up and up.
The problem is, midwives like you anonymous dont seem to know their place. They make grandiose (and weird) statements about doctors “raping” patients.
God forbid an OB wants to do evidence based care for a pregnant patient. I guess we better make every woman deliver their own baby before these nuts will be happy.
Anonymous
Well, if you read to the end of the wikipedia entry, this is what you’ll find:
Semmelweis began experimenting with various cleansing agents and, from May 1847, ordered that all doctors and students working in the First Division wash their hands in chlorinated lime solution before starting ward work, and later before each vaginal examination. The mortality rate from puerperal fever in the division fell from 18% in May 1847 to less than 3% in June–November of the same year.[7]
While his results were extraordinary, he too was treated with skepticism and ridicule (see Rejection of Semmelweis).
The true mechanism of puerperal fever was not generally understood until the start of the 20th century. In 1879 Louis Pasteur showed that streptococcus was present in the blood of women with puerperal fever.
Thus, well into the 20th century, OBs were killing women due to their unsanitary habits.
Ah, and you Mike the apparent OB who complains about women “not knowing their place” — oh, excuse me, it’s midwives not knowing their place. Well, I suppose that a women’s place is in stirrups so that you and your professional confreres can rape her more easily.
as for obstetrics being evidence based, ha, ha,ha!!! Indeed, your refusal to even respond to the one bit of real evidence cited in this whole tedious discussion, the study comparing mortality in homebirths and physician-attended births, demonstrates your hatred of real science.
Happyman
anon: you are a nut-job as clearly demonstrated by your last post. I just don’t know what else to say.
Anonymous
The facts that hand-washing reduced the rate of pueperal fever, and that pueperal fever still occurs and is due to streptococcus, in no way implies, suggests, or should leave any one with a minimum of medical training to conclude that these remaining cases of pueperal fever are due to “unsanitary habits.”
This demonstrates a complete lack of understanding of epidemiology, and common sense. Has there been prospective study comparing the rates of pueperal fever in those cared for by an OB/GYN vs. those cared for by a midwife? No one under the care of a midwife has ever developed puerperal fever? (I am fairly certain that if there has been, it has been blamed of the care rendered by the previous provider.)
Anonymous
I think women should have the choice to “freebirth” or not without all this controversy and hooplah (i.e. all this banter between anon and Happyman).
We just need to recognize that women have been giving birth for AGES without physician intervention and humanity for the most part has done just fine. When a birth goes well, heck nobody (except of course the active participants) really need to get involved. I’d even venture to say that the majority of births would do just fine without intervention.
Freebirthers just need to be aware that _in case_ potentially life saving procedures are required (i.e. an emergency c-section for a persistent and unremitting fetal heart deceleration remote from delivery, or a hysterectomy for intractable uterine atony and bleeding) such procedures would be immediately unavailable, which could lead to a severely disabled baby, a dead baby, or dead mother.
That being said, bad outcomes are bound to happen whether or not you’re at home or in the hospital. The only difference is how you’ll feel if a loved one dies at home, or at the hospital where at least they may have had a fighting chance and have had “everything done”.
The cynical side of me says that if I were a practicing Obstetrician tired of beind sued for unavoidable bad outcomes (which i’m not…i’m just an interested reader), I’d secretly fund the Freebirther movement to get as many women as possible to deliver at home…but make darn sure I tell all patients that’s the worst thing they could possibly do.
At least malpractice rates might go down.
Anonymous
I fail to understand the animosity between obs/midwives/freebirthers. Isn’t the whole point to give women information so they can make an informed decision about their own healthcare? I am a granny midwife, and help women through pregnancy and birth without charging anything. But I would certainly not discourage anyone from seeking medical help, nor would I discourage them from birthing on their own. I just want to give them information, a little insight, and support so they feel empowered to make good decisions. Childbirth is not something to be feared. It is to be honored, welcomed, and blessed.
DS
I believe this controversy is rooted in the fallacious assumption that “natural” is safe and efficacious while “medicine,science,and drugs” are tainted by the flawed hand of man and therefore untrustworthy.
Regardless of the incalculable number of natural things that can cause great harm or the manner in which nature conducts her business (e.g. Prey being eaten alive by its ‘natural’ predator)
there is an unasailable purity and sense of perfection that is assigned to her. Crede quod habes, et habes.
Doctors, medicine are bad ergo Natural childbirth is good.
The rest then becomes an exercise in distorting the meaning of factual information while cherry picking data to support a preconceived notion about the nature of man. Timendi causa est nescire.
Anonymous
This discussion seems to have disintegrated to a war between medicine and midwifery – which has little to do with the actual “Freebirth controversy”. Freebirth does not include the presence of a midwife. It is the mother alone delivering her own baby – without the presence of midwife or dr.
This is dangerous, I believe. Those who support it claim “we’ve been having babies for thousands of years…” etc, but neglect to mention that even the earliest records of civilization indicate the presence of midwives – even if they were only older, more experienced women of the community.
These women were able to detect potential problems in the birthing process and often to circumvent those problems. To have a child at home, with no one more experienced and knowledgable is dangerous, not only to the child, but to the mother.
For an uncomplicated pregnancy & labor, there is no reason to run off to the hospital, but to assume there will be no problems during delivery that might require the aid of a midwife of some sort is silliness.
CL
Anonymous
I believe there is a much more basic underlying question here that needs to be addressed – the question of freedom. For generations there was no question, for the options were few. Now that there are hospitals, birth centers, OBs, midwives, and freebirthers, suddenly there must be a definitive answer of what is correct behavior. Since in remote areas there are fewer options, their healthcare choice must be correct, since traveling during labor could be more dangerous than staying home. Why, then, should people in more health-care diverse areas not have the same options available to them? My point is that a woman’s choice on her own childbirth venue should not be legislated. She should have access to all birth options, and be allowed to make an informed decision based on all of the facts.
Anonymous
My grandmothers and my mother didn’t have any medical help when they were giving birth, as there was simply none available. This also goes for most of my aunts. None of them had any problems that they couldn’t deal with themselves. This really makes me wonder what is so incredibly dangerous about childbirth that everybody keeps telling women to get medical help. My own children were born without any midwife attending as they simply didn’t make it in time. My children are all healthy and so am I.
I personally believe that its simply a case of being healthy, eating healthy food and being educated on the birth process, as I was told to do by my GP and midwife. Of course I do not see any use in playing russian roulette when someone has the feeling something is wrong to not see a doc.
On the other hand I personally know a few women who told their OB’s that they knew something was wrong, which was ignored, which resulted in handicapped and dead babies. So this also makes me wonder if those docs should then be sued just as Dr. Crippen says that the moms should be for their choice, or should it be the moms for trusting the doc who said nothing was wrong when something was wrong…..
Very difficult decision, especially as all choices are made with the best of intentions.
Sambo
Eating the “right” foods doesn’t keep an umbilical cord from being wrapped around your baby’s neck. It doesn’t keep you the possibility of bleeding to death (which is the number one cause of death during childbirth), it isn’t necessarily the cause of your blood pressure getting to high, and it isn’t the cause of a breech birth. This is just another example of people believing that health problems, complications, and death all have to do with whether or not you are a good person. You don’t need a doctor because nothing could happen to you–you eat organic food. If others need a doctor, they must not be taking care of themselves. This is nonsense. Essentially: shit happens. You had no complications because you lucked out. But according to lime.com, 15% of the women who die in childbirth die because of complications that could not be predicted–and therefore, not prevented. However, the complications could be treated if they were in the presence of a doctor. Maybe 15% seems small, but I bet it wouldn’t if during one of your childbirths you’d had a complication that took your life. This nearly happened to my sister–her blood pressure got dangerously high while she was giving birth. Had she been at home, we wouldn’t have known–and she would have died. But luckily, she was at a hospital. And she’s doing fine. When my mother was giving birth to my other sister, the umbilical cord got wrapped around the baby’s neck. Again, if she had been at home, no one would have known, and the baby would have died. But she was at a hospital and they fixed it. So now we’re two for two–you have two examples of how a homebirth went okay, and I’ve got two examples of how medicine was crucial–for events that had nothing to do with a high risk pregnancy. So don’t give us anecdotes as evidence–because if we’re going strictly off of anecdotes, a 50/50 shot of your homebirth going awry doesn’t seem like good odds to me.
Scott
Unfortunately, the disturbing trend here is that for many, this is *not* about providing information for the mother to make an informed choice. There seems to be a sense among some that they know better than the mother what is best for her and her child, and their will should be imposed upon her by force of law if need be.
Anonymous
My problem with the doctors is that they want to feel like they’ve done something, contributed to society. This is good, if properly utilized. In birth, it isn’t. They jump in too soon with their medical procedures, rather than let nature take it’s course. Example: Failure to Progress… Generally caused by inducing labor too early with petocin or oxytocin, when the cervix simply isn’t ready to dilate. Than, rather than wait another hour (at 12 hours they start pushing a C-Section), they do “emergency” surgery… In a situation that they created in the first place. If they’d simply waited for the mother to go into labor naturally, when the cervix was ready to be softened, there wouldn’t have been a problem.
Also, to Sambo, the cord around the neck isn’t an issue at a home birth, either. You say no one would have known? All you have to do is look at the baby when it comes out, and take the cord off it’s neck. And don’t say “but the baby wouldn’t be able to breathe.” They still draw oxygen from the umbilical cord for anywhere from 5-30 minutes after birth. Basically, until the placenta is born.
I am not a doctor, or a midwife, I am soon-to-be mother, who is fully researching all options to determine what’s best for my child. I live 2 hours from the nearest good hospital, and 3 hours from a midwife.
In the course of my research, I’ve learned that, yes, doctors are great IF something big goes wrong, but they merely complicate simple things in a normal, healthy pregnancy. Midwives are good, though it’s best to do your research, and question them to make sure they know what they’re talking about, and that they know what to do. In Texas (where I live), all midwives are licensed, and carry oxygen, IV’s, petocin (for hemmorhaging), sutures, herbs, etc.
My best advice for anyone interested in FreeBirth, which I am currently researching, is that you shouldn’t do it if you aren’t willing to take the time and research what to do if something goes wrong. Find out about the most common problems and how to fix them, learn the warning signs of the problems you can’t fix, and know when to go to the hospital. Be willing to take responsibility, it’s yours whether you go doctor, midwife, or unassisted.
If you aren’t willing to take the time and do the research, a hospital (or at least a birthing center) is probably the best place for you.
This is simply my opinion, based on the research I’ve done. I don’t want to get in the middle of a fight with anyone, you’re entitled to your opinions and views. I just think that fear-based medicine is not the healthiest option. Hope for the best, know what to do if something goes wrong. Don’t “prepare for the worst” by doing unneccesary procedures, tests, shots, cuts, whatever, unless there is a REAL need.