An article on a recently released government study finds a correlation between babies of poor mothers and incidences of birth injury. Baby boys were also found to have increased risks. Intriguing!
Doctors Marti Glenn, Marsden Wagner and Sarah Buckley, along with many other respected birth professionals, join forces to help create better healthcare policies in the film Reducing Infant Mortality and Improving the Health of Babies.
OSU 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 homebirth 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, similar to that found in other studies of the dynamics between the two groups 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 mistrust 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.
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.
While Qualtere-Burcher believes it would be wonderful, but Utopian, for all midwives to agree to seek medical assistance under the guidelines they’re proposing, and for all physicians to learn to deal more collegially with midwives, he 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.
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.
“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.
From Midwifery Today E-News 11:13. You can subscribe here.
I know many of you are very eager to help with BOLD. Here’s your chance!
If you are interested in volunteering, we are having a short informational meeting at 10:00 a.m. this Friday, June 26th. We’ll meet in the same location as BirthChat – The Tap Room @ Catalyst, 3501 S. Shields, Fort Collins (if the Tap room is busy, see if we’re in the cozy corner on the Espresso Side).
The purpose of this meeting will be to gauge how much help we’ll have and what your interests are in helping.
Please feel free to bring your children. We are attempting to secure some childcare help so that you can focus on the meeting. 
We invite you to be a part of a movement that is shaping Birth Culture by becoming a member of The Family Journey.
Members of The Family Journey Receive:
- Two electronic newsletters annually. You can share these with anyone you choose!
- A discounted rate on the purchase of BOLD tickets!
- The satisfaction of funding a change in local birth culture!
These benefits come with a new, lower rate of just $25 per year!
Since it’s inception in January of 2007, the average number of attendees at BirthChat has more than doubled! We are growing all the time!
Thanks to our members, we are able to offer monthly BirthChat discussions, participate in outreach events such as Birth On Labor Day, and provide a setting where people can find support, information, and community.
To become a member, contact Keri at (970) 556 1291 or
via email at birthadvocate (at) msn (dot) com. Let’s change birth culture together!
The Family Journey is a Colorado non-profit organization.
The Midwives and Mothers in Action (M.A.M.A.) Campaign is
launched! The goal of the M.A.M.A. Campaign is to increase
women’s access to midwives and to quality, affordable
maternity care by securing federal recognition of Certified
Professional Midwives (CPM). We have hired a federal lobbyist, a
campaign manager will be hired by next week, and the M.A.M.A.
Campaign website is almost complete.
This campaign is a partnership of the National Association of
Certified Professional Midwives (NACPM), Midwives Alliance of
North America (MANA), North American Registry of Midwives (NARM),
Midwifery Education Accreditation Council (MEAC), Citizens for
Midwifery (CfM), and International Center for Traditional
Childbearing (ICTC). This historic partnership is now at work to
get federal recognition of Certified Professional Midwives so
that women and families will have increased access to quality,
affordable maternity care in the settings of their choice. We
look forward to working with everyone who supports this work and
in concert with other national initiatives to achieve our common
goals.
Our federal lobbyist, a specialist in health policy, will move
our agenda in Washington, D.C. Billy Wynne is a former Senate
staffer, an expert in Medicaid and health care reform, with a
diverse portfolio of connections. He is excited to be promoting
the values and important services provided by Certified
Professional Midwives and is implementing a strategy with the
M.A.M.A. campaign steering committee, based on our priorities,
for achieving success in this Congress.
A campaign manager will be hired by next week to work with the
network of volunteers already lining up to support the M.A.M.A.
Campaign. A campaign website is nearing completion; watch for
the website launch announcement at the end of this week!
Your support will be essential to the success of the campaign.
Watch for weekly updates and action alerts about how you can
become involved!
We look forward to working with you in this effort!
The M.A.M.A. Campaign Steering Committe
The American Medical Association is at it again! (Remember their resolution a little over a year ago?)
They want to create CPT (Current Procedural Terminology) codes that label patients as ‘non-compliant’ or ‘hostile’. This, in turn will provide an avenue for insurance companies to deny claims. Not only is this insulting to those who choose to challenge the recommendations of their physician (a repeat cesarean, for example), but it could make finding a provider more difficult.
International Cesarean Awareness Network has put together a comprehensive list of ways to ACT against this insulting proposition. It only takes a second and needs to be addressed immediately!
It will be interesting to see what further research shows since this study analyzes quite a small sample . Need we MORE benefits of breastfeeding? (It can’t hurt, though, can it?!)
To spark an interesting conversation, or for a laugh (especially after the sad nature of the last post), read the Man-Nurse Diaries blog Being a Man in the Delivery Room.
The sentence, “I think you can drive this down the street and shoot babies at people” was especially amusing!
While we usually try to steer clear of the horror stories about childbirth, this one was too poignant to pass up. I appreciated that the blogger reiterates the importance of understanding that a cesarean carries real risks – it’s an abdominal surgery, after all.