St. Vincent Hospital was ‘extremely midwife friendly‘ and had an overall philosophy of ‘minimally invasive obstetrics.’ “The array of alternatives at St. Vincent’s, in Greenwich Village, was about as extensive as any pregnant women could want, whether you require a planned Caesarean or you want to give birth at home on your couch, it was geared for everything.”

Now Manhattan women are left scrambling to find a place to have babies where natural birth is accepted, nurtured and encouraged. It was also the ‘transfer’ hospital of choice for midwives who assist with home births. It’s closing might also put home birth midwives back-up plans in jeopardy.

As a former New Yorker I am deeply saddened by this news. What a very terrible state of affairs for the future moms of New York. I hope someone, somewhere will step up to the plate and provide similar services to what were available at St. Vincent’s.

Hawaii’s program is just a couple of month’s old, and currently employs five certified nurse-midwives. One of the midwives interviewed feels like the program has been a great success so far and looks forward to the future.

I will pull some interesting figures:

-In 2007, there were more than 4.3 million births — the largest number ever registered — in the United States.
-Cesarean section was the most common operating room procedure in the country in 2007, with a cumulative increase from 1997-2007 of 85%.
-The rate of vaginal birth after cesarean (VBAC) within childbirth-related hospitalizations was 9.7% in 2006, a decline of 73% from 1997, when the VBAC rate was 35.3%
-In 2006, combined facility charges billed for “mother’s pregnancy and delivery” and “newborn infants” ($86 billion) far exceeded charges for any other hospital condition in the United States.

Childbirth is is most cases a natural event (not a sickness) which requires a pregnant mother, a bed, a knowledgeable birth attendee, and a couple of blankets. It should not be the single most expensive medical event in the US. Something is very wrong with this picture…..

Childbirth Connection used these stats and others to compile a report entitled Evidence-based Maternity Care: What It Is and What It Can Achieve.

The report states that “practices that are disproved or appropriate for mothers and babies in limited circumstances are in wide use, and beneficial practices are underused. Rates of use of specific practices vary broadly across facilities, providers, and geographic areas, in large part because of differences in practice style and other extrinsic factors rather than differences in needs of women and newborns”.

It is a nearly 70 page report and I hope to bring you the highlights here. Stay tuned!

It is rebuttal directed at the recent ‘story’ aired on the Today show called “The Perils of Home Birth” (which was originally going to be titled “The Perils of Midwifery”.)

Although much of their commentary has been said before and cited in statistics from all over, they did make one key point that I thought was worth highlighting.

“While midwives and obstetricians will continue to debate the safety and appropriateness of home birth, less controversial is the fact that some women seek to give birth in alternative settings because they do not see hospitals as meeting their needs. This should be cause for reflection and action by hospital leaders, and result in measures to make hospitals safer for women to birth. Changing childbirth practices in hospitals will make them a welcoming place for families and will likely result in better care for all.”

It’s a great point.  Basically many doctors and the media are pointing fingers at midwives, citing women who choose home birth as reckless and irresponsible, and sensationalizing the rare cases of home birth gone bad, but no one is talking about WHY women choose home birth and how bad hospital birth really has become.

Women are consumers of health care and don’t want to subject themselves to unnecessary interventions and a one in three chance of having a c-section.  If faced with this as their only alternative, they often choose home birth. Seems logical to me.  (I will note that if a mom chooses to have a hospital birth with a certified nurse midwife, her chances of undergoing interventions or c-section decrease dramatically.)

Why are doctors and hospitals not trying to change hospital experiences to meet the desires of women?  I think it ultimately comes down to philosophy.  Most obstetricians look at pregnancy as an illness or condition to be ‘fixed’, not an natural event to be gently managed.  Hospitals (theoretically) are places that sick people go to get better.  Perhaps the better question to be asking then is “Why are healthy women who are predicted to have normal pregnancies sent to hospitals to give birth?”

Interpretation: Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician.

: )

The mortality rate per 1,000 births was 0.35 in the home birth group, 0.57 in hospital births attended by midwives, and 0.64 among those attended by physicians, according to the study. Women who gave birth at home were less likely to need interventions or to have problems such as vaginal tearing or hemorrhaging and the babies were also less likely to need oxygen therapy or resuscitation.

The one issue that can, and does admittedly skew the results is that women who elect home birth are usually in better health and more fit than those who choose hospital birth…SO, if your fit and healthy, have a midwife assisted birth!  Higher quality birth experience (practically) guaranteed.