Make Room at the Table-

Oh, how I wish the Spokane and Coeur d'Alene community of birth professionals was healthy and happy. But, sadly I see isolation, territorial attitudes and fierce competition. The main problem is a lack of mutual respect for other kinds of midwives, doulas and educators. That's right ladies- simple R-E-S-P-E-C-T goes a long ways. We all want to promote natural childbirth, the midwifery model of care, and out-of-hospital options for birthing families. Why can't we work together and promote one another for the sake of serving our community? This is my prayer for North Idaho and Spokane.
Check out this post here from Midwifery Today. Well put.
Terri

Great website

I went to the Midwives Association of Washington State (MAWS) conference last Friday in Seattle. It was great- I learned a ton, and was very inspired. A friend introduced me to this website you all must check out: mothersnaturally.org
It has a fabulous due date calculator, among many other helpful tools, articles and info. I will add it to my link list on the right side of the blog here.

Well put, Jan Tritten

Please jump on over to Midwifery Today's community forum, where midwife Jan Tritten very beautifully articulates how I feel about birth.
Click here to read "Fear not; it is a miracle"

Study reveals conflict between doctors, midwives over homebirth

CORVALLIS, Ore. – Two Oregon State University researchers have uncovered a pattern of distrust – and sometimes outright antagonism – among physicians at hospitals and midwives who are transporting their home-birth clients to the hospital because of complications.

Oregon State University assistant professor Melissa Cheyney and doctoral student Courtney Everson said their work revealed an ongoing conflict between physicians and midwives that is reflective of discord across the country.

The pair recently examined birth records in Oregon's Jackson County from 1998 through 2003, a period when that county saw higher-than-expected rates of prematurity and low birth weight in some populations. The researchers wanted to assess whether those rates were linked to midwife-attended homebirths.

The findings revealed that assisted homebirths did not appear to be contributing to the lower-than-average health outcomes and, in fact, that the homebirths documented all had successful outcomes. But even more importantly to Cheyney, discussions with doctors and midwives uncovered a deep gulf between the two groups of birthing providers, with doctors expressing the firm belief that only hospital births are safe, while midwives felt marginalized, mocked and put on the defensive when in contact with physicians.

"We've been getting insight into their world view, and it's been quite illuminating," Cheyney said.

Cheyney, who is a practicing midwife in addition to being an assistant professor of medical anthropology and reproductive biology, said she was surprised that physicians, when presented with scientifically conducted research that indicates homebirths do not increase infant mortality rates, still refuse to believe that births outside of the hospital are safe.

"Medicine is a social construct, and it's heavily politicized," she said.

Last year the American Medical Association passed Resolution 205, which states: "the safest setting for labor, delivery and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex…" The resolution was passed in direct response to media attention on home births, the AMA stated.

What is interesting, Cheyney points out, is that 99 percent of American births occur in the hospital, but the United States has one of the highest infant mortality rates of any developed country, with 6.3 deaths per 1,000 babies born. Meanwhile, the Netherlands, where a third of deliveries occur in the home with the assistance of midwives, has a lower rate of 4.73 deaths per 1,000.

One of the biggest problems Cheyney sees is that physicians only come into contact with midwives when something has gone wrong with the homebirth, and the patient has been transported to the hospital for care. There are a number of reasons why this interaction often is tension-filled and unpleasant for both sides, she says.

First is the assumption that homebirth must be dangerous, because the patient they're seeing has had to be transported to the hospital. Secondly, the physician is now taking on the risk of caring for a patient who is unknown to them, and who has a medical chart provided by a midwife which may not include the kind of information the physician is used to receiving.

And because the midwife is often feeling defensive and upset, Cheyney said, the contact between her and the physician can often be tense and unproductive. Meanwhile, the patient, whose intention was not to have a hospital birth, is already feeling upset at the change in birth plan, and is now watching her care provider come into conflict with the stranger who is about to deliver her baby.

"It's an extremely tension-fraught encounter," Cheyney said, "and something needs to be done to address it." As homebirths increase in popularity, she added, these encounters are bound to increase and a plan needs to be in place so that doctors and midwives know what protocol to follow.

She is working with Lane County obstetrician Dr. Paul Qualtere-Burcher to draft guidelines that would help midwives and their clients decide when they need to seek medical help, based in large part on Cheyney's research, and another that would ask physicians to recognize midwives as legitimate caregivers.

Qualtere-Burcher said creating an open channel of communication isn't easy.

"I do get some pushback from physician friends who say that I'm too open and too supportive," he said. "My answer, to quote (President) Obama, is that dialogue is always a good idea."

Qualtere-Burcher said he believes that if midwives felt more comfortable contacting physicians with medical questions or concerns, there would be a greater chance that women would get medical help when they needed it.

"Treat (midwives) with respect, as colleagues, and they'll not be afraid to call," he said.

Qualtere-Burcher doesn't expect immediate buy-in, but hopes that if a small group on each side agrees to the plan, it will provide more evidence that a stronger relationship between physicians and midwives will lead to better outcomes for mothers and infants.

"We're having a meeting in early May to propose a draft for a model of collaborative care that might be the first of its kind in the United States," Cheyney said.

Cheyney is also pushing to get hospitals and the state records division to better track homebirths. The department of vital records had no way to indicate whether a birth occurred at home until 2008, and without being able to pull data, Cheyney said it's hard to explore the nature of home birth in Oregon.

She's also working on education programs for midwives in rural areas, including a cultural competency piece as demographics in Oregon continue to change.

###

The research was funded by Oregon State University's Department of Anthropology Summer Writing Fellowship, the Center for the Study of Women and Society, and the Stanton Women's Health Fellowship.

90-year-old woman catches her great-granddaughter

What a great family story!

Read about it here.

Home births "as safe as hospital"

The largest study of its kind has found that for low-risk women, giving birth at home is as safe as doing so in hospital with a midwife.

(Click here for audio interview)

Research from the Netherlands - which has a high rate of home births - found no difference in death rates of either mothers or babies in 530,000 births.

Home births have long been debated amid concerns about their safety.

UK obstetricians welcomed the study - published in the journal BJOG - but said it may not apply universally.

The number of mothers giving birth at home in the UK has been rising since it dipped to a low in 1988. Of all births in England and Wales in 2006, 2.7% took place at home, the most recent figures from the Office for National Statistics showed.

The research was carried out in the Netherlands after figures showed the country had one of the highest rates in Europe of babies dying during or just after birth.

It was suggested that home births could be a factor, as Dutch women are able and encouraged to choose this option. One third do so.

But a comparison of "low-risk" women who planned to give birth at home with those who planned to give birth in hospital with a midwife found no difference in death or serious illness among either baby or mother.

"We found that for low-risk mothers at the start of their labour it is just as safe to deliver at home with a midwife as it is in hospital with a midwife," said Professor Simone Buitendijk of the TNO Institute for Applied Scientific Research.

"These results should strengthen policies that encourage low-risk women at the onset of labour to choose their own place of birth."

Hospital transfer

Low-risk women in the study were those who had no known complications - such as a baby in breech or one with a congenital abnormality, or a previous caesarean section.

Nearly a third of women who planned and started their labours at home ended up being transferred as complications arose - including for instance an abnormal fetal heart rate, or if the mother required more effective pain relief in the form of an epidural.

“ The NHS is simply not set up to meet the potential demand for home births ”
Louise Silverton Royal College of Midwives

But even when she needed to be transferred to the care of a doctor in a hospital, the risk to her or her baby was no higher than if she had started out her labour under the care of a midwife in hospital.

The researchers noted the importance of both highly-trained midwives who knew when to refer a home birth to hospital as well as rapid transportation.

While stressing the study was the most comprehensive yet into the safety of home births, they also acknowledged some caveats.

The group who chose to give birth in hospital rather than at home were more likely to be first-time mothers or of an ethnic minority background - the risk of complications is higher in both these groups.

The study did not compare the relative safety of home births against low-risk women who opted for doctor rather than midwife-led care. This is to be the subject of a future investigation.

Home option

But Professor Buitendijk said the study did have relevance for other countries like the UK with a highly developed health infrastructure and well-trained midwives.

“ Women need to be counselled on the unexpected emergencies which can arise during labour and can only be managed in a maternity hospital ”
RCOG

In the UK, the government has pledged to give all women the option of a home birth by the end of this year. At present just 2.7% of births in England and Wales take place at home, but there are considerable regional variations.

Louise Silverton, deputy general secretary of the Royal College of Midwives, said, the study was "a major step forward in showing that home is as safe as hospital, for low risk women giving birth when support services are in place.

"However, to begin providing more home births there has to be a seismic shift in the way maternity services are organised. The NHS is simply not set up to meet the potential demand for home births, because we are still in a culture where the vast majority of births are in hospital.

"There also has to be a major increase in the number of midwives because they are the people who will be in the homes delivering the babies."

The Royal College of Obstetricians and Gynaecologists (RCOG) said it supported home births "in cases of low-risk pregnancies provided the appropriate infrastructures and resources are present to support such a system.

But it added: "Women need to be counselled on the unexpected emergencies - such as cord prolapse, fetal heart rate abnormalities, undiagnosed breech, prolonged labour and postpartum haemorrhage - which can arise during labour and can only be managed in a maternity hospital.

"Such emergencies would always require the transfer of women by ambulance to the hospital as extra medical support is only present in hospital settings and would not be available to them when they deliver at home."

The Department of Health said that giving more mothers-to-be the opportunity to choose to give birth at home was one of its priority targets for 2009/10.

A spokesman said: "All Strategic Health Authorities (SHAs) have set out plans for implementing Maternity Matters to provide high-quality, safe maternity care for women and their babies."

Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/7998417.stm

Published: 2009/04/15 08:08:24 GMT

© BBC MMIX

Jennifer Block: Extreme Birth, Indeed

Jennifer Block: Extreme Birth, Indeed

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Deaconess Midwives Rock-

Here's a good article for midwives in the Spokane Review.

Midwives say homebirths are up, despite warnings- NY Times

Hospital birth rates stay the same, despite warnings.

Article here.

Midwives do much more than deliver babies

A great little article about CNMs (Certified Nurse Midwives) here.