Ricki Lake Fires Back in Debate on Home Birth
There's a battle brewing between physicians organizations and midwives who perform at-home births, and TV personality Ricki Lake has been dragged into the fray. She and filmmaker Abby Epstein came out with an interesting documentary in January called The Business of Being Born, which takes aim at doctors for treating every birth like a "potentially catastrophic medical emergency." The film included footage of Lake giving birth to her second son in the bathtub of her Manhattan apartment. Last weekend, the American Medical Association issued a resolution against home births at its delegates meeting and explicitly criticized Lake.
Making the case for home births, Lake and Epstein issued a joint response yesterday on the Huffington Post:
In fact, the largest and most rigorous study of home birth internationally to date found that among 5,000 healthy, "low-risk" women, babies were born just as safely at home under a midwife's care as in the hospital. And not only that, the study, like many before it, found that the women actually fared better at home, with far fewer interventions like labor induction, cesarean section, and episiotomy (taking scissors to the vagina, a practice that according to the research should be obsolete but is still performed on one-third of women who give birth vaginally).
The AMA was spurred into action by a recent statement from the American College of Obstetricians and Gynecologists that said that "the safest setting for labor, delivery, and the immediate post-partum period is in the hospital or a birthing center within the hospital complex." Clearly, physicians are worried about all those things that can go wrong unexpectedly, like the baby being in distress or the mom hemorrhaging after birth. But reproductive health blogger Amie Newman wonders what gives the AMA the right to legislate how a woman gives birth. And I'd like to know what role financial incentives play in all of this; some doctors' livelihood could depend on whether they maintain control of the childbirth process. Another resolution introduced at the AMA meeting concerned the regulation of nurse midwives who perform home births. The AMA—rightly, I believe—wants to standardize the practice of nurse midwifery and ban self-taught, nonformally trained "lay" midwives from delivering babies. The organization would like all midwives to go through the training and certification process defined by the American College of Nurse-Midwives and is planning to lobby states to adopt legislation to this effect.
This may be all very well and good, but nurse-midwives are a dying breed. Their malpractice insurance rates have skyrocketed in recent years, making it impossible for many to stay in business. States like New Mexico that have caps on damages insurance companies must pay when doctors are negligent don't have the same caps in place for nurse-midwives, so many have been forced to pay exorbitant premiums to get higher coverage than doctors. It seems to me that the AMA should put its muscle power behind lobbying for lower malpractice premiums for nurse-midwives—who, after all, handle the lowest-risk pregnancies—just as the association has stepped in to standardize the practice of nurse midwifery.
When I was pregnant with my third child eight years ago, I opted to go through labor without pain medication. Since my doctors weren't keen on natural childbirth, I consulted my friend Debby, who worked with a midwife practice as a birthing assistant. She taught me some breathing and relaxation techniques for those painful contractions, which, in addition to my super-quick labor, saved me from the epidural. Sad to say, the nurse-midwives Debby worked for are no longer in business. Their malpractice insurance rates simply rose too high for them to earn a decent wage.
Tags: doctors | medical quality | birth
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Reader Comments
Why is an 'experience' worth the risk?
I am a Labor and Delivery RN. Today a patient came in with a Lay midwife following behind. No one called to tell us they were coming and the patient had not seen our Certified Nurse Midwife since about 28 weeks. The lay midwife said they came in because she thought the baby's heartrate might be 'a little low'. After trying to find the baby's heartrate, an US was done and confirmed an intrauterine fetal death. The baby was perfect and appeared to have died about 2-4 hours previous (according to pathologist). What I will NEVER understand is why the experience of homebirth is worth this risk. This woman could have had a medication, intervention free labor in a hospital. Yes, she would have not been at home but tell me, why is it worth the risk? I am absolutely unable to understand how a lay midwife could not tell that the babies heartrate was not there or that she was listening to the mothers heartrate for 2-4 hours. She should be held accountable.
Gosh - does anyone advocating hospital birth for all actually care about the way these children are brought into the world? I'm not talking "they're alive, ergo the delivery was fine" - I'm asking what the quality of life is for the child in those first, very precious few minutes?
We seem to base many decisions in hospital on "quality of life", do we not? I can think of some life and death decisions made on those bases, but not decisions relating to the introduction of a new life into the world.
I seem to remember evidence is mounting as to the effects of those first few minutes on the child as a whole - in times stretching out from infancy to adulthood. The evidence would seem to point to the fact that the first few moments of life - the "business of being born" for the baby actually has some pretty profound effects on bonding, behavior and all sorts of other aspects of development.
The woman giving birth - the mother - what is her quality of life during delivery? Why is it that so many women chose epidural over natural delivery? You can say "well, because it hurts" - but it has been proven time and again that mindset and support is a HUGE influence on a laboring mother's experience of birth and the strong feelings that come with it - which can be interpreted a number of different ways - not just as pain.
So, what I am saying is, from a moral standpoint, is it better to simply take the baby in a clinical setting, greatly increasing the risk of life altering negative experiences for mother and baby for the sake of making sure both turn out alive - or is it better to let them both have the birth that nature intended: a beautiful, natural birth that is gentle and wonderful and right? Even if infant deaths are "three times as high" in home than hospital births - you can NOT use that as a valid pedestal to stand upon, because that's still an awfully low percentage of babies born overall - I mean come on, I've seen the figures and it's not exactly as though we're losing even 1 or 2% of babies born at home! I'd see your point if it were, say, 15%.
Nevertheless, to me, from a moral standpoint I cannot see that intervening and making birth traumatic for mother and baby can be "right" based on the mostly flawed statistics and medical data you can throw at me. I will be giving birth at home, in a relaxed and real environment. I am not afraid - I am empowered and perfectly capable of giving birth, because I am just a regular human female.
Home birth
I had my baby at a waterbirth center by the care of midwives, and I would have not had it any other way except maybe at home. My water broke, contractions started, and my son was born 52 hours later. When he was born into the birthing tub, he could only be put on my stomach, his cord was so short. So he had needed that time to stretch the cord out. My birth was uncomplicated, he was incredibly healthy, as was I. It was the most amazing experience, however, I know that if I had gone to a hospital, they would have done a c-section because of how long it was taking. I don't have a doubt in my mind. Would that have been unnecessary? Yes. Absolutely. The majority of the time, our bodies know what they are doing, and they know how to make and deliver babies. Just let nature take its course, and the majority of the time, you will have a sweet, wonderful, moving experience. I would recommend midwives and an out of hospital birth to everyone who did not have complications. Of course there are risks. There are risks in everything. I'd much rather trust a midwife who is doing something they are truly passionate about. My midwives were with me every minute, and even fell asleep between my contractions, when I did.
I recommend everyone who is passionate about this subject in either direction should watch "The Business of Being Born". I saw it when I was pregnant and it really was eye opening.
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