Don't Pick on Midwives

The fire back in response to our story.

Doug Clifton The Plain Dealer
I felt compelled to respond to your recent "Midwife Crisis" article [June 28]. It distresses me that the only study quoted was the one commissioned by a group not supportive of midwifery.

There are numerous studies that show that home birth is as safe as, if not safer than, hospital birth. The most recent study was published in 2005 in the British Medical Journal, proving the safety of home births when attended by certified professional midwives.

At the other end of the spectrum, modern obstetric standards would lead you to believe that cesarean sections are safe and can be conveniently scheduled. We must not forget that women are four times more likely to die as a result of this surgery.

Childbirth has become increasingly managed by obstetricians who, first and foremost, are surgeons, and by hospitals, which are all about profit.

Women can and should look closely at all their options surrounding childbirth. Having a baby can be an empowering event, if treated with respect and dignity, as it is at home.

Kimberly French, President
Home Birth Option of Cleveland

The sad tale described in "Midwife Crisis" [June 28] is so unfortunate, and my heart goes out to everyone involved. But I was surprised to see the midwife cast as the villain, and the entire practice of midwifery portrayed in such an unrelentingly negative fashion.

Sadly, babies suffer damage from shoulder dystocia in hospitals, too. Women are also sometimes traumatized by hospital births that they feel are "taken away" from them when one intervention (an artificially induced birth) leads to another (an epidural and fetal monitoring) to another (forceps delivery or an emergency C-section).

When mothers are lucky, they and the baby emerge with their physical health intact, although emotionally they may be scarred for weeks, months, or years. They are often told, "You have a healthy baby and that is all that matters."

Of course, everyone wants this happy outcome; but I also value a more "high-touch, low-tech" approach that seeks to provide real emotional support to the laboring mother, a philosophy of birth that is often found by seeking care from a midwife rather than an obstetrician.

Infant mortality rates for home birth are not "more than double that of hospital-born babies." That "statistic" was extracted from a highly flawed study out of Washington state that was not reflective of planned home birth with midwifery care. Indeed, the most recent reputable study on home birth by the British Medical Journal concluded that: "Planned home birth for low-risk women in North America using certified professional [i.e. lay] midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low-risk hospital births in the United States." That is, for the majority of women who experience low-risk pregnancies, choosing to birth at home allows them to better control the experience, with no greater risk to their babies.

Unfortunately, having a baby in a hospital is no guarantee of a trouble-free birth either. The U.S. is ranked 36th in the world for infant mortality. This is awfully far down the list when you think about it, especially when you take into account the vast amount of money and technology that is employed at the typical hospital birth.

Interestingly, in many of the countries where it is safer to have a baby, midwifery is the standard of care with obstetricians handling only high-risk pregnancies.

Despite the tragic story of Kelly Moscarella, home birth is statistically speaking as safe as, if not safer than, hospital birth. So, why does Scene choose to portray lay midwives as witch doctors and women who want home birth as just plain crazy?

Melissa Gonzalez

Sensationalizing difficult births ["Midwife Crisis," June 28] is not new to Scene. A 2002 article ["The Forceps Affair," November 13, 2002] demonized difficult hospital births and forceps deliveries at University Hospital. To demonize home birth is wrong. Birth can be risky no matter where it occurs, as you have demonstrated.

Today, midwives all over the world handle births. University-trained nurse midwives are legal in all states and in Ohio do not work "under physician supervision" but collaboratively with physicians. Our expertise is in normal pregnancy and birth while the obstetricians are surgeon experts in problems. In 2003, there were 310,000 babies delivered by nurse midwives in the U.S. (about 10 percent of the vaginal births nationally). In many highly regarded studies nurse-midwife birth outcomes for the same population are as good or are better than physicians'.

The birth in this article was unfortunate -- anyone would agree. The woman was high-risk and not a good candidate for home birth. That the baby was born when the woman was moved to the ambulance was likely because when she moved her pelvis, more space was created. An amazing procedure called the Gaskin Maneuver involves creating space by intentionally moving the pelvis and usually dislodging the stuck baby. This is a procedure familiar to most nurse midwives and not so many doctors or to the midwife featured in this article.

Do the community a service and sensationalize normal birth and safe, sound midwifery care. It occurs very often and is honestly sensational.

Susan Greene
Cleveland Heights

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