Thursday, December 29, 2011

Waterbirth in a Hospital ~ yes you can!

Here is a visual of how you can have a waterbirth in a hospital setting.  The most difficult obstacle is often the uninformed hospital staff.  They typically don't teach about waterbirth in nursing or medical school.

Hospitals and Waterbirths

Hear from waterbirth expert Barbara Harper.

One World Birth ~ the next great birth film

In case you've not been following the progress of this amazing film maker, check out the launch video!

Monday, December 12, 2011

Physiologic Birth Is Front and Center in the Media!

The end of 2011 and the beginning of 2012 spark excitement in the birth world! Two separate organizations honor two women who daily, stand up for physiologic birth and women/baby centered maternity care: Ina May Gaskin and Robin Lim.

For those of you who may not have seen Ina May Gaskin receive the Rightlivlihood Award earlier, here is the video.

And if you missed Robin Lim receiving her award at the CNN 2011 Hero(es) of the Year Ceremony, the link to that segment is not available for embedding at this time but is available by clicking here.

These awards and videos are important to share on any and every social media.  Expectant parents are constantly being bombarded by information about alternative means of giving birth and raising a baby.  We must, as birth professionals, share in the duty and honor of dispelling myths and sharing the truth.

Thursday, December 01, 2011

Just the facts: The Home Birth/Hospital Birth Conundrum Part 2

In Part 1, we took a  look at the Home Birth Summit from October of 2011. 

But a question still begs to be answered: If there was consensus amongst organizations, why is there still a conundrum?  Conflicting stories based on equally conflicting studies published in journals continue to flood the news.

“A new study (published in the BMJ) in England shows little difference in complications among the babies of women with low-risk pregnancies who delivered in hospitals versus those who gave birth with midwives at home or in birthing centers.”


“A study published in the BMJ, which was conducted by researchers from Oxford University has revealed that first time expecting mothers who opt to have home deliveries are at greater risk than those who opt for obstetric or midwifery unit.”

Ironically, they are talking about the same study in the same journal.  Why the difference? 

It leads us to the five basic reasons for the conundrum:

Media Influence
Media spin has a damning effect on childbirth, here in the US and world wide.  Documented in her video  Laboring Under an Illusion, Vicki Elson exposes the drama-seeking Hollywoodism and stretching of the truth in our every day viewing.  Seeing this, and not being exposed to the truth, leads to accustomization ~ where we begin to believe what we see because we are accustomed to seeing it!

Education Gap in Professional Training
A second reason for the conundrum is Statement 9 in the Home Birth Summit Consensus document:  “We recognize and affirm the value of physiologic birth for women, babies, families and society and the value of appropriate interventions based on the best available evidence to achieve optimal outcomes for mothers and babies”.  In reality, this is not done in our major universities, medical schools and nursing schools.  If it was embraced and taught, then all of the things that certified childbirth educators teach their classes or the information discussed by doulas would not be new information to nurses, physicians, and yes, even some midwives.

Fear of the Unknown
Childbirth is not a foreign event for women.  However, since we are such a mobile society, we are not routinely exposed to family and friends having babies.  Hence we have lost the ability to tap into the inner wisdom.  Dr. Amali Lokugamage  discusses finding the inner wisdom in her book The Heart in the Womb.  She states that “fear of childbirth really does prevent women from discovering their inner wisdom.”  Women with this fear (fear of the unknown, fear of pain, fear of disaster, etc) look to others to “solve” their problem.  To the rescue is modern medicine, and the discouragement of childbirth education classes or doula services.  It is viewed that with information and an informed support person, labors will be more difficult for the medical staff.  It boils down to whose birth is it anyway?

Incongruent ways of reading research
As demonstrated by the Summer of 2010’s Wax home birth meta-analysis , definitions make or break a study and the efficacy of the information in the study.  For example,  as Amy Romano pointed out the definition of neonatal death was different.  In the Wax study of 9,811 homebirths, neonatal death was defined as death of a live-born infant between 0 and 28 days.  In the Ank de Jonge study of 321,307 homebirths, the definition was the death of a live-born infant between 0 and 7 days.  The latter is also the definition used by the World Health Organization.  Wax also had no requirement for home birth eligibility.  The Dutch study defined who was eligible based on national guidelines – to ensure that homebirths are healthy and at very low risk for complications.

Professional Obstacles
I really didn’t know how else to phrase this contributor to the conundrum but there are professionals who are, either informed or uninformed, against homebirth.  Period.  No discussion.   Heidi Anne Deurr, MPH said in her recent article for titled “Home Birth Consensus Summit: Much Ado About Nothing?”:

While the intentions and words involved in the statement might be well-meaning, the merit of the summit and its consensus statements is questionable.  For one thing, ACOG has come out against home births.

Legal liability certainly has a hand in this last contributor to the conundrum.   As pointed out in Statement 7 of the Home Birth Summit Consensus, the legal system needs repair and there needs to be adequate access to homebirth and birth center births within an integrated health care system.

In reviewing the above five conundrum contributors, the bottom line, in my humble opinion, is consistency in research and education about the research.  We must talk the same language with the same numerical values and the same definitions.  If studies and research varies so greatly, no congruent statement can be made about any issue.  Second, practitioners of all kinds should be educated about this research and work together for healthy mothers and babies.  To do otherwise, is to ignore “First Do No Harm.”

Just the facts: The Home Birth/Hospital Birth Conundrum Part 1

There has always been a separation between ideals in the conversation between home birth advocates and hospital birth advocates.  Lately, the separation has become wider and more volatile.  It is vital that the facts surrounding both this summit and homebirth/hospital birth be clear.

The summit was held October 20 & 21, 2011 in Warrenton VA and present were birth professionals and leaders.  These professionals and leaders included representatives from the following prestigious organizations:  MANA, LAMAZE, ACNM, AWHHON, ACOG, AAP, ICTC, NACPM, AABC, and Our Bodies Ourselves with collaboration from Childbirth Connection, The White Ribbon Alliance, JPhiego, ICM, NARM, and the Farm.  These organizations along with representatives from hospitals and universities, examined the current research regarding the entire topic of birth and the impact of where birth happens.

With passion and dedication, nine common ground statements were achieved:

We uphold the autonomy of all childbearing women.  All childbearing women, in all maternity care settings, should receive respectful, woman-centered care. This care should include opportunities for a shared decision-making process to help each woman make the choices that are right for her. Shared decision making includes mutual sharing of information about benefits and harms of the range of care options, respect for the woman’s autonomy to make decisions in accordance with her values and preferences, and freedom from coercion or punishment for her choices.

We believe that collaboration within an integrated maternity care system is essential for optimal mother-baby outcomes. All women and families planning a home or birth center birth have a right to respectful, safe, and seamless consultation, referral, transport and transfer of care when necessary. When ongoing inter-professional dialogue and cooperation occur, everyone benefits.

We are committed to an equitable maternity care system without disparities in access, delivery of care, or outcomes. This system provides culturally appropriate and affordable care in all settings, in a manner that is acceptable to all communities.  We are committed to an equitable educational system without disparities in access to affordable, culturally appropriate, and acceptable maternity care provider education for all communities.

It is our goal that all health professionals who provide maternity care in home and birth center settings have a license that is based on national certification that includes defined competencies and standards for education and practice.
We believe that guidelines should:
  • allow for independent practice
  • facilitate communication between providers and across care settings
  • encourage professional responsibility and accountability, and
  • include mechanisms for risk assessment.
We believe that increased participation by consumers in multi-stakeholder initiatives is essential to improving maternity care, including the development of high quality home birth services within an integrated maternity care system.

Effective communication and collaboration across all disciplines caring for mothers and babies are essential for optimal outcomes across all settings.  To achieve this, we believe that all health professional students and practitioners who are involved in maternity and newborn care must learn about each other’s disciplines, and about maternity and health care in all settings.

We are committed to improving the current medical liability system, which fails to justly serve society, families, and health care providers and contributes to:
  • inadequate resources to support birth injured children and mothers;
  • unsustainable healthcare and litigation costs paid by all;
  • a hostile healthcare work environment;
  • inadequate access to home birth and birth center birth within an integrated health care system, and;
  • restricted choices in pregnancy and birth.
We envision a compulsory process for the collection of patient (individual) level data on key process and outcome measures in all birth settings. These data would be linked to other data systems, used to inform quality improvement, and would thus enhance the evidence basis for care.

We recognize and affirm the value of physiologic birth for women, babies, families and society and the value of appropriate interventions based on the best available evidence to achieve optimal outcomes for mothers and babies.

A full list of delegates who endorsed these statements is available at the Home Birth Consensus Summit website