First, I love reading your blog and would definitely enjoy any of those stories. Second, have you head about the blog: The Skeptical OB? I think a few of these questions you are raising are well throughout there. And she sometimes posts guests writers. I don't know anything about how it works, but thought it might be of interest. Keep up the good work, both with the blog as well as with being an excellent OB.
Congratulations on passing your boards! I think I would yell too.
I have quite a lot of information and perspective on how home birth works in the U.S. I used to be an aerospace engineer and am in the midst of a career change to a lactation consultant and possibly a CNM or MD after that. My first child was a planned home birth that resulted in a non-emergency hospital transfer. My second child was also a planned home birth who also was born in the hospital after we suspected IUGR at 37 weeks and I was then induced. A couple of things to clear up. Who is doing home births varies significantly state by state; just as physicians are, midwives are licensed (or not) by each state. Some states, including California where I live, license CNMs for home births and there are a significant number of CNMs here who have home birth practices. Most states also have some provision for licensing "direct entry" midwives. These midwifes are also referred to as "LMs - licensed midwives" or "CPMs - certified professional midwives". They have had years of formal training both in terms of coursework and apprenticeships before they take a licensing exam and are licensed to practice. "Lay" midwives generally refer to midwives without any formal training and are not licensed anywhere. Most midwives doing home birth in the U.S. are licensed midwives. You are right in that the U.S. healthcare system is not set up well for home birth. However, successful continuity of care and patient safety can be achieved under the current system if the providers and patients work at it. For example, my two hospital births went seamlessly because I had worked with both my midwife and my OB beforehand to set it up that way. My OB was initially very skeptical of home birth but agreed that she would be my "back up" doctor if anything went awry (she had never done so before). I saw my midwife for all the prenatal visits plus the OB for ultrasounds and a several prenatal visits. I pre-registered at the hospital even though I didn't plan to give birth there. When it came time for me to transfer to the hospital (nothing emergent - just after 26 hours of laboring at home I was exhausted and needed an epidural) the transfer was seamless. OB took over my care and midwife stayed with me as a "doula". Things worked similarly with my second baby. Baby started showing growth issues around 35 weeks. I started seeing the OB and midwife weekly and, at my 37 week appointment it was clear that it was time for baby to come out. I was induced in the hospital, had the (small but healthy) baby in the hospital with my OB delivering, and Baby and I went home 8 hours later. Third baby, didn't need the OB, baby was born, and texted her a few hours after the baby was born while eating cinnamon rolls in my bed and nursing the baby to let her know all went well. And now that OB who was skeptical of home births is the official back up doctor for a CNM home birth/birth center practice. Pretty awesome!
Please shoot me an email if you want any information or my perspective.
Have you read Michael Chabon's Telegraph Avenue? Not a factual account of home births but an interesting cultural portrait that includes them prominently.
I'd love to read any of those articles. Am particularly interested because the only OB I've read on home birth and c-sections is Amy Tuteur aka Skeptical OB, and she's such an ideological polemicist that I don't trust a word she says. I had two babies in a CNM-operated birth center and it went really well.
Congratulations on the boards! C-section article first please.
On that piece, have you thought about the changing cultural attitudes toward c-section?-- In the 3 year difference between my two babies, I have noticed a marked cultural difference in my demographic toward tolerating/supporting breastfeeding, an improvement in my opinion, where women who do not breastfeed for whatever reason are supported and not shamed about formula use. This is great! Unfortunately the trend seems to be in the opposite direction for c-sections, with other moms being much more judge-y about that. It's like formula feeding was 3 years ago, is what I am trying to say.
I would love to see the piece on necessary c sections. I'm a layperson but had one of my babies as a necessary c section in a hospital where the c section rate is FOUR PERCENT. Baby needed to be born that way... But the judgment I received? It's been something else.
Anote vote for the post on necessary C-sections. (And as an aside: I made the mistake of following the link to The Skeptical OB. Oh dear. Some crazy, vicious people on both sides).
First, I love reading your blog and would definitely enjoy any of those stories. Second, have you head about the blog: The Skeptical OB? I think a few of these questions you are raising are well throughout there. And she sometimes posts guests writers. I don't know anything about how it works, but thought it might be of interest. Keep up the good work, both with the blog as well as with being an excellent OB.
ReplyDeleteCongratulations on passing your boards! I think I would yell too.
ReplyDeleteI have quite a lot of information and perspective on how home birth works in the U.S. I used to be an aerospace engineer and am in the midst of a career change to a lactation consultant and possibly a CNM or MD after that. My first child was a planned home birth that resulted in a non-emergency hospital transfer. My second child was also a planned home birth who also was born in the hospital after we suspected IUGR at 37 weeks and I was then induced. A couple of things to clear up. Who is doing home births varies significantly state by state; just as physicians are, midwives are licensed (or not) by each state. Some states, including California where I live, license CNMs for home births and there are a significant number of CNMs here who have home birth practices. Most states also have some provision for licensing "direct entry" midwives. These midwifes are also referred to as "LMs - licensed midwives" or "CPMs - certified professional midwives". They have had years of formal training both in terms of coursework and apprenticeships before they take a licensing exam and are licensed to practice. "Lay" midwives generally refer to midwives without any formal training and are not licensed anywhere. Most midwives doing home birth in the U.S. are licensed midwives. You are right in that the U.S. healthcare system is not set up well for home birth. However, successful continuity of care and patient safety can be achieved under the current system if the providers and patients work at it. For example, my two hospital births went seamlessly because I had worked with both my midwife and my OB beforehand to set it up that way. My OB was initially very skeptical of home birth but agreed that she would be my "back up" doctor if anything went awry (she had never done so before). I saw my midwife for all the prenatal visits plus the OB for ultrasounds and a several prenatal visits. I pre-registered at the hospital even though I didn't plan to give birth there. When it came time for me to transfer to the hospital (nothing emergent - just after 26 hours of laboring at home I was exhausted and needed an epidural) the transfer was seamless. OB took over my care and midwife stayed with me as a "doula". Things worked similarly with my second baby. Baby started showing growth issues around 35 weeks. I started seeing the OB and midwife weekly and, at my 37 week appointment it was clear that it was time for baby to come out. I was induced in the hospital, had the (small but healthy) baby in the hospital with my OB delivering, and Baby and I went home 8 hours later. Third baby, didn't need the OB, baby was born, and texted her a few hours after the baby was born while eating cinnamon rolls in my bed and nursing the baby to let her know all went well. And now that OB who was skeptical of home births is the official back up doctor for a CNM home birth/birth center practice. Pretty awesome!
Please shoot me an email if you want any information or my perspective.
Have you read Michael Chabon's Telegraph Avenue? Not a factual account of home births but an interesting cultural portrait that includes them prominently.
ReplyDeleteI definitely want to read all of those! Particularly the home birth one! And the c-section one! And the mean doctor one! Okay, just all of them.
ReplyDeleteI'd love to read any of those articles. Am particularly interested because the only OB I've read on home birth and c-sections is Amy Tuteur aka Skeptical OB, and she's such an ideological polemicist that I don't trust a word she says. I had two babies in a CNM-operated birth center and it went really well.
ReplyDeleteThey all sound absolutely fascinating. Please share!
ReplyDeleteCongratulations on the boards! C-section article first please.
ReplyDeleteOn that piece, have you thought about the changing cultural attitudes toward c-section?-- In the 3 year difference between my two babies, I have noticed a marked cultural difference in my demographic toward tolerating/supporting breastfeeding, an improvement in my opinion, where women who do not breastfeed for whatever reason are supported and not shamed about formula use. This is great! Unfortunately the trend seems to be in the opposite direction for c-sections, with other moms being much more judge-y about that. It's like formula feeding was 3 years ago, is what I am trying to say.
Oh oops, that should be "tolerating/supporting NOT breastfeeding." Sorry, I'm tired this morning.
ReplyDeleteI would love to see the piece on necessary c sections. I'm a layperson but had one of my babies as a necessary c section in a hospital where the c section rate is FOUR PERCENT. Baby needed to be born that way... But the judgment I received? It's been something else.
ReplyDeleteAnote vote for the post on necessary C-sections.
ReplyDelete(And as an aside: I made the mistake of following the link to The Skeptical OB. Oh dear. Some crazy, vicious people on both sides).