Anyway, you know all that. I can’t wait to share my story with you soon. But, you know, newborn in the house! So, be patient

When I was pregnant and had my second doctors appt at 8 weeks I verified my desires regarding ultrasound to a nurse and then was ushered into the doctors office where the doctor proceeded to listen for a heartbeat and found one. He then proceeded to go on about how he had never heard a heart beat that early (he had been practicing at least 30+ years, but anyone can tell you that is BUNK), and that he thought my baby was older than 8 weeks. He told me that if I didn’t get the ultrasounds they wanted me to, when they wanted to do them, my baby could be born later than anticipated and they wouldn’t know for sure when my baby was really supposed to be born and could in fact end up stillborn. It’s kind of a strange and convoluted transition, but that is flow of our conversation. He was totally playing on my emotions (and pregnant ones at that!) to defend his point and get the outcome he wanted…

Things like that do happen. Things like you have suggested do also happen, have happened, etc. But when educated fact-based decisions are made those outcomes you suggest are so terribly rare some would say they are practically (although not realistically) unheard of.

I tell you this, because I think you should carefully read and research these topics ( find solid, reliable sources) because I think you will find that research and evidence line up with what Jenna shows you below.

Also… regarding doulas: In the US it is totally illegal to have a doula birth you. A lot of people don’t know what a doula is, but I’m pretty sure that basically anyone that knows what a doula is knows they are not trained or experienced to birth a baby. I haven’t heard of any doulas trying to usurp more “power” than they are supposed to have either… =)

You are obviously very well read and educated on the issue and have done a great job of focusing on the real feelings behind emotions obvious to outside observers when a birth does not go as hoped.

Thank you for sharing your experience and bringing some necessary perspective to the discussion.

The basic care and treatment you receive with a midwife throughout your pregnancy is usually different with a midwife than an ob. The midwife gets all the same info from you as an ob would, but tends to focus on you, how you are feeling, what your activities and diet are like, etc. I think it’s probably one of the reasons why women like them so much. When you go to an ob you get weighed, have your blood checked, a nurse asks you how you feel, your doctor checks your cervix tells you what he can, asks you if you have any questions, and your usually done. It’s not usually as “personal” (although there are always exceptionally personal obs who aren’t so “NEXT” minded… if you know what I mean).

On The Farm, 95.1% of the births were completed without transport to the hospital. Of the 2028 births there were 13 total deaths (including 4 deaths which happened within the first week, not during labor), including babies who were transported to the hospital. # of c-sections? 1.4% Number of inductions? 5.4% Number of intact perineums? 68.8% If you know anything about hospital statistics you know that The Farm blows hospitals out of the water when it comes to maternal morbidity. As for mortality rates? Just about equal to what you find in a hospital.

You should check out the appendix in the back of “Ina May’s Guide To Childbirth”, I think you’ll find it interesting.

Another example of how normal childbirth can be is found in her book as well. Catharina Schrader practiced in what is now the Netherlands from 1693 until 1745 and attended 3017 births. Number of spontaneous births for her was 95%. C-section was not an option during that time. Of the 3017 cases Schrader recorded, only 20 women died.

Again, for me it’s about looking at what has changed. Have women’s bodies physiologically changed to force us to need a 30% c-section rate and and episiotomy rate of 90%, or has care changed?

I’m a complete hospital-birthing-epidural-getting woman, but the fact that I didn’t want to induce if/when I reach 42 weeks or unless there was a problem…well, you would think I was a medical rarity. Even hosptial staff were so surprised when I’d go in for tests passed my due date and I wasn’t yet asking for an induction. Baby was doing fine so I saw no reason (until 42 weeks) to kick him out. Sure I was uncomfortable, but my own comfort didn’t seem like a good enough reason. Besides – when you have a baby, you don’t just snap back into perfect feeling again. It takes a little while. Sure you might not sleep well the last month, but hey – when that baby gets there you won’t be sleeping through the night for some time either.

I guess the whole induction discussion is only worth it depending on how much getting a C-section bothers you. I want to avoid c-sections at (almost) all costs, and since quite a number of inductions lead to c-sections…well that’s partly why. Some women aren’t all that bothered by a c-section, so inducing and possibly getting that end result wouldn’t bother them.

your study between in & out if home mortality rates is for “low risk pregnancies.” you later go on to say that 95% of pregnancies are in fact low risk. Normally I would not ask, but since you cited everything else… Where did you get the 95% number from? I worked in L&D before, in a non-medical capacity, and id never heard that (I’m not disagreeing, but I was encouraged by this figure!). If it’s easily accessible, would you share?

I’m sorry, but your just not basing your claims on facts.

“What happens if an ambulance doesn’t get to you within fifteen minutes time?”

I believe this argument would be valid IF statistics showed that infant mortality rates for outside of hospital births were higher than in hospital births. BUT THEY ARE NOT. This study (http://www.bmj.com/cgi/content/full/330/7505/1416c) concluded: “Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.” I have only read or heard of ONE study out of many many studies that has suggested that hospital birth is “safer”, and that was funded by (surprise! surprise!) the American College of Obstetricians and Gynecologists. The emergency transfer argument just doesn’t hold up for me because statistically, home birth and hospital birth mortality rates are just about equal. There are risks for both home and hospital births, and in my opinion, with the way births are treated in hospitals, they are just about equal. A woman who chooses a hospital birth avoids an emergency transfer situation, but her chance of having a c-section, going under anesthesia, or coming down with serious infection (among other things) significantly increase. Both in and out of hospital births come with risks, and both must be weighed and considered carefully before a choice is made.

What happens if your particular birth plan doesn’t include heart monitoring and you don’t even know that the baby is in distress?

Continuous EFM is actually not essential for low risk pregnancies/labors (although the hospitals here in the US don’t seem to know that!). In fact The American College of Obstetricians and Gynecologists (ACOG) recommends that for healthy, low-risk women (which according to statistics is close to 95% of pregnancies), fetal heart rate be monitored with a fetoscope or Doppler every 30 minutes in active labor and every 15 minutes during pushing. The World Heath Organization (WHO) encourages intermittent manual listening and warns that EFM is often used inappropriately. (http://www.lamaze.org/ExpectantParents/PregnancyandBirthResources/MoreTipsandTools/InterventionIndications/EFM/tabid/395/Default.aspx) I’d love you to find something that discredits this, but every single thing I have read says that EFM does not make labor safer for baby. Why is it used so frequently? Because it’s essential for women who are given pitocin or an epidural. Epidurals are impossible outside of a hospital, and a good midwife will either monitor more frequently if she administers pitocin or transfer to a hospital. This study (http://www3.interscience.wiley.com/journal/119286169/abstract?CRETRY=1&SRETRY=0) found “There were no significant differences in the immediate neonatal outcome in terms of umbilical artery pH, Apgar scores, or admissions to the neonatal care unit” between intermittent and continuous fetal monitoring.

What happens if the midwife isn’t one who happens to carry equipment?

I’m sorry, but this is just absurd. Any woman who chooses a midwife who doesn’t carry the appropriate equipment did not do the proper research. These are questions that should be asked when interviewing a midwife and a well-researched prepared mother will already know the answers she wants to hear. Women who aren’t willing to educate themselves about the dangers and pitfalls of hospital birth, and how to deal with those situations, should NOT be giving birth outside of a hospital, in my opinion.

Then what do you do, wait for fifteen minutes (at the very least) while your baby strangles?

It sounds like you have had a lot of experience with cord prolapse, cord being wrapped around that babies neck, and other issues with the umbilical cord at birth. However, I think you may be confusing the difference between cord prolapse (extremely dangerous situation) with the baby having the cord wrapped around its neck. Cord prolapse occurs in somewhere between 0.14% and 0.62% of all births and I believe is a situation where mothers would be better off in the hospital. But it’s important to remember that even not all hospital situations featuring cord prolapses have positive outcomes, with between 11-17% of those cord prolapse situations ending in death for the fetus (http://en.wikipedia.org/wiki/Cord_prolapse). In this study (http://www.homebirth.org.uk/homebirth2.htm) of home birth v. hospital birth in the UK cord prolapse occurred once and cause death for one fetus out of 5971. Wikipedia (http://en.wikipedia.org/wiki/Cord_prolapse) cites that cord prolapse death is given as 11-17%[6]. This applies to hospital births or very quick transfers in a first world environment. One might try to argue that the “first world” births in this instance (meaning home birth) swayed the data, however, in the United States only 1% of births occur outside of hospitals. So, again, cord prolapse is a risk, but must be weighed against all of the other risks involved AND is not necessarily solved by choosing a hospital birth. As far as other complications with the umbilical cord, you might find this article interesting: http://www.drspock.com/article/0,1510,5332,00.html. Also, this site talks about Nuchal Cord situations, something I believe midwives are actually better prepared to handle than doctors: http://www.homebirth.org.uk/whatif.htm#cord

Or in the case of my cousin’s wife and her friend, while the baby aspirates its own faeces with possibly fatal results?

A Canadian study found that infants born at home were also 0.45 times less likely to have aspirate meconium (inhaling a mixture of their feces and amniotic fluid). (Reference: http://www.cbc.ca/health/story/2009/08/31/midwife-home-births.html) Also, meconium is easily detected in the amniotic fluid and a mother in such a situation would be advised by a competent midwife of the risks to her baby upon delivery and possibly advised to move to the hospital (http://www.homebirth.org.uk/meconium.htm) According to Wikipedia Meconium passage into the amniotic fluid occurs in about 5-20 percent of all births. This is more common in postdate births. Of the cases where meconium is found in the amniotic fluid Meconium Aspiration Syndrome develops less than 5 percent of the time (a situation to which you seemed to be referring with your cousin’s wife). An educated intelligent mother who is taking charge of her own birth should know the risks of meconium aspiration (and that there is a significant increase of such a thing happening with overdue births) and should have a competent and experienced midwife who understands the warning signs and dangers if such a thing were to happen. I think it’s important to note that distressed babies are more likely to have problems with meconium aspiration (http://kidshealth.org/parent/medical/lungs/meconium.html#), and distressed babies are more likely to be found in hospitals where interventions such as epidurals and pitocin are routinely administered.

Hannah I don’t want you to think I am singling you out and attacking your opinions, but I find them to be very anecdotal and not based on facts or statistics. If you are going to mention situations or ask questions that may come across as critical of others choices, I believe they should be well-researched ones that will encourage those you are targeting to think intelligently about their choices and seek to educate themselves about the risks. I encourage you to continue to educate yourself as well.

Cord prolapse is a large risk… for high risk births. But no one in their right mind argues for out-of-hospital birth for high risk pregnancies.