[Vision2020] Home Birth and Birthing Clinics

[Rosemary Huskey]

Recently a proposed "birthing center" in Moscow has received publicity in
the local newspaper.  The providers of this do-it-yourself style medical
care who are self-educated in obstetrics/pediatrics and apprenticeship
trained by other similarly self-educated lay people continue to defend their
services as reasonable and safe for most pregnant women, including women who
have had previous Caesarian sections.  Professionally educated medical
personal have a different understanding of the risks involved based on their
formal educational training and years of supervised direct experience.  (A
compelling source of a lay person's awareness of obstetrical and pediatric
emergencies can be acquired in an afternoon by wandering through a 19th
century cemetery.)  It is my profound hope that in the near future our
community will have access to the services of nurse midwives (practitioners
who have a BS in Nursing and post graduate training in midwifery) so that
the granny-style midwife  - known in Idaho by the manufactured title
"certified, professional midwives" - an example of extraordinary hyperbole -
will be a distant, embarrassing memory.  I agree with the position held by
American Academy of Pediatrics described below, except, in my opinion, a
"birth center" staffed by self-educated, apprenticeship "trained" midwives
obviously carries the same risks as a home birth attended by the same women.


Rose Huskey

source
<http://www.skepticalob.com/2013/04/aap-to-homebirth-advocates-dont-trust-bi
rth.html>   

"The American Academy of Pediatrics has issued a policy statement on
homebirth
<http://pediatrics.aappublications.org/content/early/2013/04/24/peds.2013-05
75.full.pdf+html> . It has been getting a lot of press, but most mainstream
media sources seemed to have missed its true significance. NBCnews.com,
Time, The Huffington Post and The Atlantic, among others, have highlighted
the fact that the AAP issued guidelines at all, and haven't noticed that
most American homebirths fail to meet virtually all the guidelines. Rather
than supporting homebirth as it currently exists, the AAP is actually
condemning it.

The policy statement starts by stating the obvious: the homebirth is not as
safe as hospital birth.  The American Academy of Pediatrics concurs with the
recent statement of the American College of Obstetricians and Gynecologists
affirming that hospitals and birthing centers are the safest settings for
birth in the United States .

But for those women who would rather choose the less safe option, the AAP
offers guidelines to minimized the increased risk, summarized in the
following chart.  [Please follow the link provided above to see the chart in
its original form.]

They can be summarized as follows:

No homebirth midwives (only certified nurse midwives are safe
practitioners.)
No twins.
No breech.
No VBAC.
No postdates.
No macrosomic babies.
No pregnancy complications of any kind.

Contrary to the prattling of homebirth midwives, NONE of those issues are
variations of normal; ALL are complications.

Once all complications are excluded, there are still additional safety steps
that should be taken:

The midwife must be practicing within the medical system.
A second midwife (or pediatrician) must be available to care for only the
baby.
Physician backup.
A PRE-EXISTING arrangement with a hospital for transfer.

In other words:

Don't undertake homebirth when there is ANY increased risk of complications.
Don't undertake homebirth without 2 midwives, integrated into the health
care system, who have physician back up and a pre-existing transfer
arrangement with a nearby hospital.

The AAP recognizes that childbirth is dangerous, complications are common,
any risk factors mean that the mother is not an appropriate candidate, and
systems must be in place for the additional complications that will
inevitably occur.

The AAP guidelines can be summed up very simply:

Don't trust birth!

Even leaving aside their inadequate education and training, American
homebirth midwives (CPMs, LMs, DEMS and lay midwives) routinely violate
every guideline set forth by the AAP. That's why they are unsafe
practitioners and why the CPM credential must be abolished.

Mainstream media sources seemed to have missed the central point of the AAP
guidelines, homebirth as it is currently practiced in the US not merely less
safe than the hospital, it is unsafe."

 

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