Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
15 Oct

The High-Tech, High-Risk State of Maternity Care

1155117271 917c0baaa3I’ve been known to critique various elements of the medical establishment now and then, it’s true. (Anyone for a good Big Pharma rout?) But I’ll admit I’m venturing into new and weighty territory today. (My Y chromosome and I will tread lightly and respectfully, I promise.) It’s been a while since my own (indirect) experience in the obstetrics arena, but a new report came across my radar last week that led my mind back to the maternity ward.

It’s the Evidence-Based Maternity Care report (PDF), a collaborative effort of the Childbirth Connection non-profit organization, the Reforming States Group, and the Milbank Memorial Fund. The report was picked up by a modest number of news organizations, but it was reviewed by dozens of top physicians and policy makers across the U.S.

The findings are enough to make anyone wince. Despite paying the most for our maternity medical care, the U.S. has fallen increasingly behind (as low as 36th in the world) in certain negative markers such as low birth weight, premature delivery, and maternal and fetal/infant death. Between 1981 and 2006, the U.S. saw a 36% rise in pre-term birth. Low birth weight numbers during that time period increased 22%. Since the 1990s, the U.S. caesarean rate has risen dramatically and is expected to account for 1/3 of births this year. (The World Health Organization suggests a statistical guide of 5-10% caesarean rate.) Labor induction doubled between 1990 and 2005. What’s going on here?

The report points to a “specialist orientation care” for both pregnancy and labor. While the vast majority of women have “low risk” medical profiles, “pathology- and surgery-oriented obstetric specialists” are the primary care providers in 79% of pregnancies. The study’s authors also discuss the “optimism bias” in maternity care – a bias rooted in the research itself. Obstetrics studies, the report says, distinctly emphasize potential benefit in tested procedures and surgical/pharmaceutical interventions while they give little attention to “harm” data. Many studies’ designs don’t even include sufficient time for adverse effects (to mother or especially baby) to become apparent.

In the U.S. alone, we can expect more than 4.3 million children to be born this year, and the costs are accordingly substantial. The report explains that with the overwhelming predominance of hospital birth in the U.S., the cost of hospitalization alone for annual births approached $80 billion in 2005 (higher than those “for any other condition”). Caesarean sections are now the “most common operating room procedure in the country.” Compared to an average of about $7000 for an “uncomplicated vaginal (non C-section) birth,” in a hospital, the average bill jumps to a whopping $16,000 for C-section births. (Rare and little-used “out-of-hospital” birth centers, the reports says, charge on average about ¼ of what hospitals do for uncomplicated, vaginal births.)

And what do we get for these exorbitant bills? Not higher quality care, the report authors (and the aforementioned comparative statistics) suggest. The study’s authors evoke the “‘perinatal paradox: doing more and accomplishing less.'” Not only does our “procedure-intensive” approach cost patients and insurers more money in the U.S., it results in higher medical risks and death rates, and it leaves women less satisfied with their experiences. Almost 10% of women who have given birth report stress symptoms clinically indicative of post-traumatic stress disorder. Not surprisingly, women who described symptoms in line with PTSD, “had a higher rate of medical intervention.”

Why are there more interventions in the U.S. than other developed countries? What’s behind these medical trends? Some critics direct attention to a consumer culture that expects more convenience and intensive, cutting edge intervention in maternity as in general medical care. I believe they have a point, but it’s also all in the “patients”/society’s education. What information is out there? What approaches and limits are dictated? What “preferences” are encouraged by the care providers themselves? It’s clear that the high tech hobby horse is the medical community’s (as a whole) before (and likely more) than anyone else’s. Just as we have an intervention, pharmaceutical based mentality in health care at large, does it come as much of a surprise that this mindset also drives many care providers in the obstetrics arena?

Yet, some experts say that there are even more suspicious motivations behind the high tech trends. In an interview with U.S.A. Today following the report’s release, Douglas Laube, former president of the American College of Obstetricians and Gynecologists and reviewer of the report, said he believes there are “‘very significant external forces’ for the overuse of expensive technologies in maternity care.”

He goes on to explain, “‘I don’t like to admit it, but there are economic incentives’ for doctors and hospitals to use the procedures.” Examples of these profitable procedures, he says, include unnecessary labor inductions and C-sections. Laube also adds that doctors often perform unwarranted tests and procedures for legal liability sake. (A whole other ball of wax – and post – all together.)

And there’s another issue not directly covered by the report but worth mentioning here. In addition to the routine use of procedural and narcotic interventions, we’re seeing more common use of “off label” pharmaceutical treatment used in labor and delivery. Cytotec, a medication prescribed for the treatment of ulcers, is increasingly used for labor induction as a cervical ripening agent. Critics claim that the drug, when used in this manner, can increase the risk for uterine rupture and shock. Again, it seems to me like another example of favoring benefit versus harm analysis, choosing loose consensus opinion over hard evidence.

The report (PDF) ultimately comes out in favor of many common sense, safe, and evidence-based practices for facilitating labor such as: “continuous support throughout labor,” comfort measures like warm baths and sterile water injections, and “upright and side-lying” positioning for labor. It also shows that family physicians and especially midwives tend to use non-invasive, evidence-based practices more often and medical intervention more conservatively than their higher paid counterparts in the OB circuit. The report authors note that shifting low-risk maternity care to these groups can result in substantial cost savings. The report also commends the “excellent outcomes” and “very high levels of satisfaction” observed in studies of free-standing birth centers, which serve low-risk pregnancies and deliveries.

Their goals, the report authors explain, include sharing and expanding upon research in the area of successful, evidence-based maternity care. Beyond the issue of intervention-focused culture (“willingness,” I’ll venture to say), there’s a legitimate lack of training and preparation in evidence-based, non-invasive techniques. In some cases, physicians don’t know enough about complementary medical techniques (such as acupuncture to turn a breech baby or to induce labor when necessary) to recommend them. In some other cases, we assume, women aren’t told because the doctors are motivated by profit. In either case, I have to ask as I’ve asked before: what are you paying for? What is our health care system paying for? And how many people have paid a price beyond dollars for unnecessary and even unsubstantiated medical interventions? The authors’ intentions don’t end with education. They hope their findings and subsequent research will initiate a “reform” of the “reimbursement system” to provide less monetary incentive for unnecessary high tech intervention and more incentive for evidence-based, non-invasive care. (Now that proposal is almost worth a cigar.)

Finally, I just want to recommend checking out the full report. (Truth be told, after reading the report, I could go on for days.) And while you’re at it, take a turn through the Childbirth Connection’s website for more information on maternity care research and resources for both health care providers and expectant parents/interested individuals.

Now it’s your game. I’d love to hear your thoughts from all sides of the issue (parents, medical professions, taxpayers, concerned citizens, etc.). Though the report focuses on maternity care in the U.S, I hope our Apples from overseas and over the borders feel free to share their insights as well. Thanks for reading.

morgantepsic Flickr Photo (CC)

Further Reading:

Deconstructing Healthcare in America – A Modest Proposal

The Beginning of the End: Statins for Children

NNT (Number Needed to Treat)

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. I have a problem with doctors being seemingly controlled by the insurance companies and threated by patients with malpractice lawsuits. Both my children were born by c-section. My first birth experience was not fun. My daughter was born 56 hours after my water broke. I didn’t go into labor until it was induced and never fully dialated. My child and I both wound up with beta-strep. Naturally, we were both given antibiotics to cure it. Same thing with my second, but my new doctor didn’t wait long given my history. Again, we both had beta-strep. Again, we were given antibiotics to cure it. I think doctors are caught in the middle, between insurance companies and some demanding patients, and this causes them to have to document every step so they can get paid and not sued.

    Cynthia wrote on October 15th, 2008
  2. Just a thought, but do you think that any of our issues with prenatal problems are related to diet? If the typical American, high grain, high sugar diet isn’t good for you, then I can’t imagine it is good for your baby either! Point of reference: My wife was born in the Phillipenes with her mother eating a traditional diet high in coconut, fats, fruit and veggies. Her brother and sister were born here in the states with my mother in law adopting a much more American diet. My wife is a comparative beacon of health compared to her siblings. Not only was she healthier at birth, but even now, she is very healthy while one of her siblings has a brain tumor and thyroid issues and the other has severe immune disorder issues.

    Son of Grok wrote on October 15th, 2008
  3. Son of Grok, I believe you are right. When I was born, both my mother and I caught staff infection. The antibiotic I got was later linked to yellowed permanent teeth. Lucky me. I was also raised on soy formula and had radiation on my thyroid at 18 months because it was a little fast, a great-aunt had a goiter, and I was an active child. Oh, and I was a fussy eater. I wouldn’t eat baby food without some real food mixed in. I am also short and narrow, but have a large frame. And yes, I was “good” and faithfully ate a high grain diet, drank milk (which I hate) and gave up my coffee while I was pregnant. The only thing I gave into was a craving for steak almost every night. I am now trying to help my kids develop healthy eating habits and lifestyles in a hope to get our family, present and future, on the right track.

    Cynthia wrote on October 15th, 2008
  4. Thank you for discussing this here. It’s a subject I’m very interested in.

    My first child was born in a military hospital, but an amazingly natural birth given the circumstances. Maybe it was because I was so young, or ill-informed, or maybe I just got lucky and had low-intervention doctors, I don’t know.

    With my next child, 8 years later, I became better informed. He was born at a freestanding birth center, and his younger brother was born at home, 2 years later. Barring any major complications, I would not give birth in a hospital again.

    The problems are many, and feed on each other. Yes, there is the problem of diet, overweight and poor health. These contribute to complications, make c-sections more likely, and cause other problems.

    But, more than that (I believe) is the medical culture that wants to throw a pill or surgery at everything and doesn’t want to take any responsibility for themselves. How many women (and men, for that matter)go into pregnancy and birth not really knowing anything about what to expect or how to help create the best possible outcome? How many just blindly trust their doctors to do what is best, without really understanding what “best” is or might be? How many women except medical pain relief at the first opportunity without really understanding potential side effects and complications and how one medical intervention can lead to another?

    The doctors are at fault for wanting to cover themselves from the risk of lawsuit, the mothers and fathers are at fault for not taking better care of themselves and then not being better informed (reading “What to Expect” does not make you well-informed), and the whole culture is responsible for contributing to this.

    And one last thing: Think about how birth is portrayed in the media. More often than not, there is a crisis involving the birth (mom or baby’s life in danger, emergency c-section must be performed immediately), or the mother is suffering so horribly with the labor that it looks like some form of torture. Most women, under ideal circumstances, could deliver their babies on their own without problems if they knew how to do it, and labor is not the excruciating, agonizing torture so many people believe it to be. But to watch it on TV or in the movies, you would never believe it to be so.

    Judy wrote on October 15th, 2008
  5. “doctors often perform unwarranted tests and procedures for legal liability sake.”

    A patient has 18 years from delivery date to sue her obstetrician for malpractice. These days avoiding liability is almost as important in the medical field as treating patients.

    Amy wrote on October 15th, 2008
  6. Amy, I’m pretty clueless about the laws wrt malpractice. Can a patient sue a doctor for having performed an unnecessary c-section? Or not having informed her of the risks of an epidural? Should she be able to?

    Your comment was kind of vague (or maybe I’m just not reading it right), so I’m not sure what your position is. Do you think it’s right that a doctor perform procedures to avoid liability? Or should the laws be changed to make malpractice suits harder – or easier? Just curious.

    Judy wrote on October 15th, 2008
  7. Judy –
    I think your points about medical culture dictating quickly jumping to pills and surgeries, parents being uninformed, and people blindly following their doctors are good ones and can be applied across the map of medicine – even down to a simple cold…

    How often do people visit their doctors when they have a cold and ask for antibiotics/medicine? Do they realize, or do the doctors ever inform them, that if taken too often the antibiotics will stop working. Then, if something more severe comes along, more drastic measures might have to be taken – rather than being able to simply take the medicine that should have worked in the first place.

    So often more extreme measures are taken than necessary, filling people’s bodies with increasingly more foreign products. That is not to say that sometimes a surgery isn’t necessary, or sometimes a prescription isn’t necessary. But wouldn’t it be better (for one’s health, for cost-effectiveness, to reduce the risk of lawsuits, etc)to try natural cures first and then move on?

    Holly wrote on October 15th, 2008
  8. And I have to add that after an appointment with an ob/gyn yesterday (routine exam), I remember why I loved my midwives so much. I waited a solid hour before I saw the doctor, a good half of that time covered from the waist down in nothing but a paper sheet, and then the doctor was in my room a good long 7 minutes, tops. He was literally opening the door to leave as I was asking questions, as if I had no right to ask questions about my medical care and when to expect results. He didn’t remember (and apparently it was too difficult to look in my chart to find out) how long I had been taking my birth control, asking if I was in the first pack (I’ve been using them for a year and a half).

    Yes, I know, I should switch doctors, but I can’t find a midwife in this area, and everyone I ask for a recommendation seems less than enthused about their own doctor.

    Judy wrote on October 15th, 2008
  9. I wouldn’t say that patients (can we call them “consumers”) aren’t uninformed as much as misinformed. And not necessarily by doctors. My wife will tell you, but most women who have had children will probably back me up on this: It doesn’t matter who my wife’s talking to, whether her friends at church, relatives, the plumber, or the barista at Starbucks. As soon as she mentions she’s pregnant, she’s bombarded with advice on what to do for a safe pregnancy. We’ve heard everything, do yoga, don’t do yoga, play Beethoven, don’t play Beethoven, stay off your feet, get exercise, shake salt on your tummy. The list just goes on and on. And most of it, frankly, sounds ridiculous!

    Bob G. wrote on October 15th, 2008
  10. Holly, so true, and I think it’s been talked about here before (I always read, but don’t comment much). So many people just don’t want to do anything on their own that requires any effort to help themselves and their health. High cholesterol? So what that diet and exercise could help a lot – here’s a pill. Diabetes? My aunt’s doctor told her (someone who had a triple bypass at age 36, a stroke 10 years later, and too many other complications to list) not to give up the “goodies” and let herself feel deprived, but just to up her insulin if she wanted that chocolate cake. Depression? Exercise and diet (hey, those are sounding like magic cures for everything), again, can do wonders for most people with mild-to-moderate depression, but isn’t easier to take a pill (which causes side effects, for which you take another pill, which causes more side effects …).

    And it’s the same with birth. It’s easier to get an induction than wait for spontaneous labor, easier to get an epidural than use natural pain-management, easier to have a c-section than to have to push the baby out yourself, easier then to give the baby a bottle of formula than nurse the baby at your breast. To heck with which way is better, safer, healthier, let’s go with which way is easier!

    Judy wrote on October 15th, 2008
  11. Judy,
    Unfortunately there’s no easy answer. A good doctor puts care before liability. I would argue the good doctor puts care before cost as well, though as is the case with this study, more expensive doesn’t necessarily mean better.

    As to what you can sue for, in a nutshell: anything (providing you have a good enough lawyer). This is where the ultimate problem is, not specifically with doctors, patients, or even insurance companies, but with the litigious society our current medical system is built on. Without using too much hyperbole, patients view a trip to the hospital like run at the lottery, one small mishap and it’s time for a million dollar lawsuit. And conversely, a hospital is more concerned with dotting all the i’s and crossing the T’s on the paperwork to avoid lawsuits without regard to whether or not the patient is cared for.

    Of course, that’s an illustration at its extreme worst. Despite all the liability clauses, there are still good hospitals, good doctors, good patients, and in a few years perhaps even good insurance companies.

    Amy wrote on October 15th, 2008
  12. One of my good friends, a well-respected OB/GYN in LA, had to leave the field entirely a few years ago when her med-malpractice insurance premiums ($300,000 per year) nearly exceeded her net income. She does fine doing fee-for-service non-insurance anti-aging medicine now, but misses delivering babies. Crazy.

    Mark Sisson wrote on October 15th, 2008
  13. I agree that the influences behind the “high tech” culture are numerous. It’s amazing to me how casually many women (and their partners) talk about scheduled C-sections, epidurals off the bat, and whatever else their OBs and friends tell them they should do.
    I’m lucky enough to live in a fairly sizeable city with several respected certified nurse midwife groups as well as a large number of home birth midwives and doulas. My husband and I worked with a CN Midwife and a private doula when we had our daughter, and we’re doing the same again this time around. It’s amazing the culture of care and preparation we enjoy compared to our friends who go the OB route. I’m absolutely convinced I would’ve ended up with a C-section had I been with an OB.

    I’d also like to put in a plug for good birthing classes. Bradley and Birthing From Within both offer amazing support for mother and partner. Our midwife group started offering alternative classes last year that take a different approach from the typical hospital class, but I know that’s a rare thing.

    Jen wrote on October 15th, 2008
  14. I am an army soldier’s wife stationed in Germany. I learned some german, and attended a german pregnancy support group my last trimester. They handed out a copy of a segment from Ina May’s Guide to Childbirth translated in german. I ran home and ordered the book online. You can go to Amazon and read segments of the book, plus I’ve seen sections quoted on various websites. It changed my life. I gave birth at a german birthing center at a total cost of under 2k(paid for happily by the US Army) and had an amazing amazing experience. My husband and I both still get emotional talking about it. Immediately after giving birth I nursed our baby, and then while my husband helped to take his weight I took a shower and then ate some hot soup the midwives had prepared for me. We left the birthing center 2.5 hours after I gave birth. The medical establishment and the fear it markets takes that experience away from women in America today.

    g wrote on October 15th, 2008
  15. ..and i have to add: 9 hours of labor, and both of my midwives & a doctor who was called just in case told me i would’ve absolutely had a C-section if i’d delivered in a hospital.

    g wrote on October 15th, 2008
  16. g: I’m pretty sure at least one of my sons would have been a c-section in a hospital. My first son was over 9 pounds, and at one point my labor stalled for a couple hours – no progress at all. I think, with his size, many doctors would have tried a scheduled c-section, telling me his was too big and scaring me that I might tear. He wasn’t too big, there was no tearing, and I used no drugs. He was just a little big!

    My second son was born with the cord wrapped around his neck. Yes, his heart started slowing, and my midwives told me I needed to push the baby out fast (I understood what was going on, and he was out the next push), but the apprentice midwife just unwrapped the cord and it was no big deal. If that had shown up on an ultrasound, I think they would have done a scheduled c-section there, too, which proved to be unnecessary.

    I LOVE Ina May Gaskin’s book. Mine is loaned out to a pregnant friend right now!

    Judy wrote on October 15th, 2008
  17. judy: ha! my book is loaned out too!! my labor was one big “stall”: nearly 8 hours. the midwives kept tabs on the baby’s heartrate and had me “breathe for him”. as soon as i gave up trying to control the progression of the birth, our son was born. I had no tearing but ours was 6 lbs 7 oz – still normal, but small like me. Birth is such an empowering experience for a woman, and such a core bonding experience for a family.

    g wrote on October 15th, 2008
  18. I had 4 babies naturally. The first was in a free standing birth center with a midwife (he’s 13 years old now) and the rest were at home with a midwife. My SMALLEST baby was 10 pounds and my largest was 11 pounds, so clearly I would have been a high risk patient in a hospital, yet all of my babies were born without complications. I did not tear, I was not cut with a pair of scissors like a package of frozen food. The midwives knew how to handle normal situations in a healthy way. Their idea of helping a birthing mother remain intact is not to cut them with scissors. Brilliant! Their idea of helping a mother have a smooth labor is to let her have control of her environment, to eat when she is hungry, to move around in any way she chooses, to relax. Brilliant!
    Birth is a natural process, not a disease. Sick people belong in a hospital, not healthy people going through a natural process. Our bodies know more about birthing babies than any doctor could ever know. We seem to be addicted to fear in this country. That addiction has not led us to safety but to the opposite…a more dangerous place for babies to be born.

    Jessica wrote on October 15th, 2008
  19. Thanks for this post! I am a student midwife and a member of Citizens for Midwifery, a GREAT organization aimed at educating consumers about their choices in birth. Without getting into a big rant (I could go on for hours about why every woman should have a midwife, not to mention the fact that the countries that have the lowest maternal/neonatal mortality and c-section rates all have midwives as the standard care for a normal, healthy pregnancy (O.B’s are trained for emergencies and should be utilized only if such an occasion arises)…anyway, here’s a great book if you are interested on the topic: Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First by Marsden Wagner (he is the former director of Women’s and Children’s Health at the World Health Organization).
    And of course, anything by Ina May! She is my hero ;o)

    Spindelicious wrote on October 15th, 2008
  20. Great discussion going on here! As a mother of five children I’m always interested in this topic.

    I agree that most stories that come from hospital birth experiences are nightmarish. Sometimes the parents don’t even realize how bad their experience was because they have no idea that it could have been much better. Rarely do I hear anything positive. There is a great need for improvement, both on the professional medical side as well as with individuals taking responsibility for their own education and care.

    However, I consider myself greatly blessed to be able to say that four out of five of my birthing experiences were fabulous hospital experiences and that my physician is to be credited (at least in part) with making them that way. I had 9 and 10 pound babies and 15-24 hour labours, never a drug, or a stitch, healthy babies all breast-fed for over a year.

    I know that my story is a rarity, but I just had to say that it CAN be done. There ARE good doctors out there still.

    Now, I have four teen daughters to educate. They know my birth stories, both the not-so-good one where I was strapped down and my husband wasn’t allowed to touch me as well as the following four that were wonderful. I am ensuring that they are well educated and motivated to take responsibility for this event, should they ever have children. It is what I CAN do to make a difference.

    We should all talk about this (and other topics that we are enlightened about) more freely so that the younger people might stand a chance at having a positive birthing (life) experience.

    new_me wrote on October 15th, 2008
  21. My kids were born 20 yrs and 17 yrs ago at my home with a midwife.

    EVERYONE…friends and family (except for my husband)…tried to talk me out of it. “Aren’t you afraid something will go wrong? What if something happens?”

    My births went perfectly, whereas many of the women in my birth prep classes had horrible hospital experiences…induced labor, caesarean sections, staff infections, the trauma of having the baby taken away for hours at a time…

    Now, Mark, the next topic to tackle is circumcision!

    dragonmamma wrote on October 15th, 2008
  22. lol! Dragonmamma you are awesome.

    Spindelicious wrote on October 15th, 2008
  23. “Now, Mark, the next topic to tackle is circumcision!”

    8) That should get the men talking! (or maybe not!)

    new_me wrote on October 15th, 2008
  24. My daughter gave birth nearly 5 months ago in my bed at home. She was gonna birth in her home country in Jerusalem, Israel but was so turned off by the hospital she decided to come back to the US for her first birth!

    It was a beautiful experience with 2 midwives present and I got to cut my gorgeous granddaughter’s cord too!!

    sarena wrote on October 15th, 2008
  25. (giggle) I had to laugh when I read “staff infections” as it should be “STAPH” (if you meant the bacteria). It conjured up images of an endless stream of hospital staff relentlessly intruding and being invasive and pesty and offering relatively little assistance. Yea, that’s a common ‘infection’ found in hospitals. ;)

    new_me wrote on October 15th, 2008
  26. Ack, eye can’t believe eye did that; I really due no that it’s short for staphylococcus! Maybe it was a Freudian slip.

    dragonmamma wrote on October 15th, 2008
  27. I am all for the topic of circumcision… well with 2 minor problems. 1st.. we all know where Grok was on this one and 2nd, Its too late to matter for any of us men here!

    Son of Grok wrote on October 15th, 2008
  28. But it’s not too late for the sons of Grok!

    dragonmamma wrote on October 16th, 2008
  29. Both my siter and I were born at home. (now 45 and 41)
    No mid wife, just the family doctor.

    Marc

    Marc wrote on October 16th, 2008
  30. My wife recently gave birth to our child at our home with the help of a midwife. It cost $1800 and was an incredible experience.

    Most of our friends had bad experiences with their hospital births and paid 4-7x as much money for the privilege.

    Pregnancy and childbirth are not illnesses and rarely benefit from intervention.

    bp wrote on October 17th, 2008
  31. Thank you Mark for another thoughtful entry packed with scientific proof for natural choices. I have given birth on both sides of the ocean and I must enter my vote for the midwife care and natural delivery in Denmark. The maternity ward has two wings here, the doctor’s side and the midwife’s side. As I was low-risk, experienced, and confident I opted for the midwife’s ward. The prenatal care is entirely the responsibility of the midwives here. My labor was very rapid (45 minutes) but the pain relief options here include acupuncture and warm bath. Ahhhh…. I must also comment on the manner of the midwife and the atmosphere in general. Dim lighting, a large window facing the river, quiet voice of the midwife, and gentle suggestions. No hustle and bustle, no coming and going, just us welcoming our child. I am so grateful.

    Dana wrote on October 18th, 2008
  32. Thanks for bringing up these topics. I have always found it very interesting that whenever a report comes out that shows the quality of healthcare in the U.S. dropping in the world rankings – the AMA is quick to blame the poor, the un-insured & the under utilization of allopathic medicine. However, if you follow the money, it paints a completely different picture. The more money we throw at traditional allopathic healthcare the less healthy we become (medicine is the 3rd leading cause of death in the U.S.). There is a time and a place for everything – but when it comes to the birthing process & medicine – Less is More!!

    Dr. Jay wrote on October 18th, 2008
  33. I was fortunate to be at my friend’s on Friday while she was homebirthing, although I missed the birth by about 30 minutes!! She had an awesome midwife and doula there, she was making great birthing sounds, squatted thru contractions, wa sin and out of the tub and bed and gave birth finally on a birthing stool.

    Her 18 month old was in the other room with a babysitter and Dad was there helping her with pushing!!

    And this was her first natural birth as the older child was a C-section for the doctor’s convenience. What a shame Mom wasn’t as well informed then and was “talked into” an unnatural situation.

    Kudos to her for going ahead and switching birthing practitioners this time around!

    sarena wrote on October 19th, 2008
  34. Mark, you have an excellent site. It’s so well written and based on sound research. We have very similar viewpoints with regards to health and wellness and particularly, the pharmaceutical industry. Thanks so much for your and Carrie’s willingness to share your healthy lifestyle and inspire others through this blog.
    In health,
    Lisa Benton

    Dr. Lisa Benton wrote on January 22nd, 2009
  35. Another homebirthing mama here. Our son was born in January, 2008…first pregnancy, beautiful birth. :)

    I’m game for a circumcision chat, as well. :)

    Lindsey wrote on June 16th, 2009
  36. Home births are often less problematic and stressful than the hospital. I had planned to have a home birth, but so far, I’ve had 4 early miscarriages. Maybe someday.

    Elizabeth Colon wrote on July 17th, 2009
  37. I am a birth doula and birth assistant. I planned a home birth with my first child but transferred appropriately prior to labor and had a normal delivery with a CNM in the hospital. My second child was born at home with a CPM and what a difference! I will avoid giving birth in the hospital again if at all possible.
    Check out my blog for lots of great info on pregnancy and childbirth!

    Naomi wrote on August 5th, 2009
  38. When I was pregnant with my first child 40+ years ago, I was really interested in natural birth, but didn’t know how to find supportive care where I was living (Florida). I ended up with a very conventional doctor and hospital, being drugged into insensibility by deception, and being very upset by the experience. With my second baby, I was at least allowed to be awake, with demerol and a spinal. With the third baby, I was living in Oregon,and was able to find a midwife and deliver at home. Of course it was a happier, much more fulfilling experience, and I’m grateful to have finally had it.

    Maxine Humpherys wrote on November 19th, 2009
  39. My birth is my own war story. My pregnancy went great. My labor was a disaster. My doctor left me in various stages of labor for 6, yes, 6 days. $ nights were spent sleeping for minutes at a time in between contraction in a warm bath. 3 trips to the doctors office, 3 trips to the hospital finally yielded the idiot doctors I had to step in and move things along. Out of the 7 to 8 different doctors I saw not a single one figured out my son was in the posterior position. By the time they FINALLY admitted me to the hospital my blood pressure was out of control, too much protein in my urine and I was peeing blood. My doctors were ignoring my body’s signals that my son needed to come out, instead I got the response this is your first child it takes a while and you aren’t due for a week. No matter how much complaining, crying, telling them something wasn’t right they kept shoving me out the door with the same response. Ultimately I ended up with a C-section and I firmly believe my doctors were on a path to almost killing me and my son. There is modern birthing in a nutshell. I don’t think most OBGYNs know how to deliver a baby the old fashioned way.

    Kara wrote on February 8th, 2011
  40. I have great respect for midwives and wanted to use them with my first pregnancy, but then found out we were having twins. The midwives in my area do not deliver twins (it’s considered hgh risk), which I understood, but was a little sad about. Despite this, I LOVE LOVE LOVE my OB! He (yes HE) was amazing. He cared about delivering babies safely. He cared about my questions and took time to answer them- even the silly ones. He was kind and reassured me when I had to have a c-section (the “bottom” baby wouldn’t flip down and I never went into labor). My babies were born at 39.5 weeks weighing 7-14 and 6-9! They are healthy, and IF I have more children, I’ll be going back to him!

    Jessica wrote on March 12th, 2013

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