Posted by: Ticktock | September 18, 2008

Dr. Phil & ‘The Doctors’ Vs. Home Birth

Dr. Phil must have an agenda against mothers who choose to do home birth.  First, he solicits submissions from mothers who regret their home birth, and then his spin-off program ‘The Doctors‘ presents an unfair, inaccurate, and biased pro-hospital argument to a couple considering home birth.

Regular readers will know that my wife chose to do a drug-free “natural” birth.  I specifically requested that the birth be done at a hospital because I didn’t want to take any chances.  I think everyone can agree that the instinctual concern about the health and safety of mother and child is normal, but just because I had worries about birthing at home doesn’t mean I had all the facts.  Licensed midwives are trained to take care of serious situations, they know when a birth requires medical attention, and they are professionals.  But, you wouldn’t know that it if you relied on the bad facts from the CBS hit piece “The Doctors”.

Read a midwife’s detailed response to the “home birth” episode of “The Doctors” here.  She does a great job disputing their bad information and obvious biased propaganda.  If anyone would like to challenge the corrections provided by this midwife, I will happy to host the debate.  I’m not an expert or scholar on home vs. hospital birth, but I can see that CBS did not present a balanced view on the subject.  I understand that sticking up for home birth is not the skeptical thing to do, but I also think that skeptics should defend truthful arguments, whether they fit modern traditions or not.  I welcome true balance on this divisive issue; if any doctors or scientists have an informed opinion, please let us know in the comments section.

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Responses

  1. I’ll start by saying that I don’t have a horse in this race, as I really don’t care one way or the other. As long as the midwives are licensed, and expectant mothers are consulting medical doctors as well, the decision can only be their own. Also, I didn’t watch the episode of the Doctors, so can’t really comment on that.

    But, as for the “sticking up for home birth is not the skeptical thing to do,” you have to remember that it is the proponents of home-birth who are making a claim, and therefore the burden of evidence must fall on them. In her response, the mid-wife makes the following claim: “for low-risk women with normal healthy pregnancies, there is no more risk at home than there is in the hospital.” She supports this claim with a single study. (The other studies cited support her statistics and her other arguments, not this claim.) One study is really not enough to make a general conclusion. There may be other studies that support this same conclusion, but she doesn’t mention them, except as “many, many.”

    More importantly, though, are her adjectives: “low-risk,” “healthy,” and “normal.” These words raise red flags. Who determines what these mean, and then who decides if the mother and/or pregnancy fit these definitions? There is a lot of grey amid those adjectives.

    Then she makes other unsupported claims, such as “they are afraid of hospitals and doctors who try to manipulate them and strip them of their identity… they don’t want themselves or their newborn babies to be exposed to super-bacteria.” Super-bacteria? Who is doing the manipulating in that sentence?

    She also employs a straw-man fallacy: “They don’t feel that pregnancy and birth is a sickness that needs to be managed in the hospital.” No, pregnancy is not an “illness,” and I don’t know of any doctor who treats it as such. Pregnancy is a medical condition, one that used to be quite dangerous. As modern medicine progressed, it became less dangerous to both mother and baby (source).

    Again, I genuinely do not have an opinion about this, one way or the other, and am not at all informed on the subject. I am not saying that home-birth is a bad idea, nor that hospital births are the only way to go. But, proponents of home-birth are advocating a return to the way it used to be, before the advent of maternity wards and modern medicine, and they need to back up their assertions if they want to be accepted by the mainstream medical community.

  2. First, let me thank you Colin for your comments about my post on The Doctors forum. And Blake, I appreciate your thoughtful response here, and I would like to take the opportunity to address your concerns.

    I commend you for acknowledging that one study does not constitute a body of literature. If only more seemingly-intelligent people would realize that! The BMJ study that I cited is the most current study on homebirth with midwives, and because it is a prospective study using a database about planned homebirths, it is much more useful than a retrospective study using, let’s say, birth certificate data in a state (such as, let’s say, Washington) where the birth certificate does not distinguish critical data (such as whether a home birth was planned or accidental) for a study that analyzes the safety of “planned” homebirth (Pang et al, Outcomes of Planned Home Births in Washington State: 1989-1996, Obstet Gyn, 2002, Vol 100(2).)

    Other research on the safety of homebirth includes:
    Murphy PA, Fullerton J. Outcomes of Intended Home Births in Nurse-Midwifery Practice: A Prospective Descriptive Study. Obstet Gyn, 1998, Vol 92 (3).
    Conclusion: Home birth can be accomplished with good outcomes under the care of qualified practitioners and within a system that facilitates transfer to hospital care when necessary.

    Janssen et al. Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia. CMAJ, 2002 Vol 166(3).
    Interpretation: There was no increased maternal or neonatal risk associated with planned home birth under the care of a regulated midwife.

    Olsen O. Meta-analysis of the Safety of Home Birth. Birth, 1997, Vol 24(1).
    Conclusion: Home birth is an acceptable alternative to hospital confinement for selected pregnant women, and leads to reduced medical interventions.” [FYI, a meta-analysis reviews the pooled data from several of the best studies to determine any differences that might not be seen unless there was a very large number of subjects.]

    I’m going to suggest a website for a more thorough listing of literature on the safety of home birth:
    http://www.changesurfer.com/Hlth/homebirth.html

    Regarding your concern about the subjectivity of the terms “low risk”, “healthy” and “normal”, these is very well laid out, in great detail, by the licensing laws in the states where licensure is available. For example, in Oregon where I practice, the administrative rules specify exactly when a woman is no longer considered to be a good candidate for home birth, mandating when the midwife must consult with an obstetrician or perinatologist and when the client’s care should be transferred. These conditions can appear in the prenatal period, during labor, or in the postpartum period for mother or baby, and midwives are trained to assess for these conditions throughout all phases of care. I invite you to check out Oregon’s Risk Assessment Criteria here:
    http://www.oregon.gov/OHLA/DEM/docs/DEMRISK.pdf

    In states where licensure is not available, not only are midwives not held accountable to these standards of care, but they are also not allowed to legally carry medications and equipment that would make homebirth as safe as it should be. For this reason, it baffles me that there are states in which licensure is being actively opposed — and by the medical community, no less. It absolutely makes one question whether it is really safety for mothers and babies that is at the top of their list of concerns. I can assure you that homebirth still happens in states where midwives are not legally allowed to practice; it just happens a lot less safely.

    The claims that I made about why women choose midwives and home birth are not unsupported. I urge you to simply read through the posts in The Doctors forum from the dozens of women who tell stories of exactly these issues. Also, several years of research has been done on the topic of maternal satisfaction with obstetric care providers, the most compelling of which are the “Listening to Mothers” surveys which I referenced in my post. Take a look for yourself about the kind of care that pregnant and laboring women are getting. I will confess that I used the term “super-bacteria” instead of “methicillin-resistant staphylococcus aureus” or even “drug-resistant bacteria” or “superbugs”. Perhaps I was considering my audience. My point is this: these bacteria are created and reside exclusively in hospitals, not in people’s homes.

    The “straw-man fallacy” that you refer to was not mine: the guests on the show quoted this as their main reason for considering a home birth (that they didn’t feel that pregnancy is a sickness that needs to be managed in the hospital). And sadly, it is not a fallacy, either — again, I urge you to read the stories of the women on the forums who were treated as if they were ticking time bombs. And yes, pregnancy was quite dangerous once upon a time, and still is in some under-developed countries where there are not enough care providers to reach all women. The World Health Organization estimates that there is a midwife shortage on the order of 330,000 midwives, and blames the deaths of tens of thousands of mothers and babies worldwide on this midwife shortage. Antibiotics and modern technology have absolutely made birth safer in the US in the last 100 years — and thank goodness for Semmelweiss who discovered that doctors were actually making pregnant women very sick when they went from autopsy to vagina without washing their hands!

    Hospitals absolutely have their place in obstetrics today; no one is trying to say that every woman should have a home birth. Nor is anyone saying that we should all “return to the way it used to be, before the advent of maternity wards and modern medicine.” We need obstetricians to manage the high-risk pregnancies. We need surgeons to perform necessary cesareans in the safest way possible. I would encourage you to educate yourself about the skills, medications and safety equipment that licensed midwives have when they attend births in the home.

    In most other developed countries of the world, midwives care for the low-risk women, and physicians handle the high-risk cases. Home birth is not pushed to the margins in Canada, Great Britain, the Netherlands, Australia, New Zealand… it is embraced as a real option for low-risk women, and in a country that is in such an obstetric crisis as ours, one would think that all safe options would be taken advantage of. Instead, ACOG has made it their #2 priority for 2008 to eradicate homebirth midwifery in the US. Higher priority than doing something about the skyrocketing cesarean rates, the rising prematurity rates, the rising maternal mortality rates, the tremendous racial disparities in maternal and neonatal outcomes… It just baffles the mind.

    I thank you again for your comments and the opportunity to respond.

    Sincerely,
    Wendy Gordon, CPM, LM
    Certified Professional Midwife
    Licensed Midwife

  3. Home birth vs hospital birth is no longer a debate. It is comparing apples to oranges. The issue today is hospital birth, birth center or home birth. Each mother to choose based on her personal comfort level and knowledge.

    The real fight now is between drug and drug free births. We have 100% of our resources go to women choosing the least healthy choice in birth and no resources going to women choosing the most healthy and least expensive birth options. Best wishes, Gail J. Dahl, National Bestselling Author of Pregnancy & Childbirth Secrets. web.mac.com/pregnancysecrets

  4. Wendy-

    Thanks for taking the time to respond to my post in such detail.

    As I said, as long as the midwives are licensed, and medical doctors are consulted during pregnancy, I have no problem with someone deciding to give birth at home. Especially in Oregon, where I know about the licensing requirements, and am aware of the outstanding midwife program at OHSU.

    And, I apologize for mischaracterizing your claim. I did not mean to say that you were advocating for all births to be taken out of maternity wards, for I certainly do not think that is what you believe. I believe you want to make it safe and legal for women to have CPM-assisted homebirths, if they choose. As a skeptic, I was stating merely that you must prove it can be safe, and your response has certainly gone a ways towards doing that.

    As for the strawman, I understand that you were just repeating this assertion, but it is still a strawman, and one I have heard often from many advocates of more”natural” childbirth. Illnesses are treated in a way as to make them go away. If pregnancy were really treated as an illness, OB’s would merely be terminating pregnancies as the quickest means of treating the illness.

    OB’s treat pregnancy as a medical condition, which it most surely is. The rhetoric of that statement, “treating pregnancy like an illness/sickness,” is much higher than its accuracy. I think it would serve everyone better to eliminate such hyperbole from this debate.

    I also whole-heartedly support licensing requirements for midwives. I think the concern in those states where licensure is not available is more of a chicken/egg thing. Medical professionals see the problems with unlicensed midwives, think it applies to all midwives, and therefore are opposed to licensure. I think this is also why Colin believes it might be unskeptical to support home-births, as most “skeptic opposition” to this issue seems to be focused on these states as well.

    Thanks again for your response!

  5. Thanks Wendy and Blake for the responses.

    I also think home birth is not traditionally cool with the skeptics because many people make that choice out of an irrational fear of doctors, “big pharma”, and the hospital system.

    Speaking as someone who has two daughters born “naturally” in hospitals in two different cities, there are hospitals and doctors that will respect a couple’s birth plan. But, I do believe that the method and place of delivery should be a choice, as long as both are made in a “safe” environment under the guidance of professionals.

  6. If homebirth is so great, why did SkepticDad insist on his children being born in the hospital? Maybe because it is scary stuff when things happen, it’s not so great to be five minutes, ten minutes, half-hour away from a hospital. My own OB has stopped delivering babies because the hospital he practiced out of built it’s emergency unit *across the street* from the L&D area. He thought that the distance was too great to effectively treat a woman or baby under extreme circumstances, however, rare they might be.

    And there is nothing unhealthy about choosing an epidural. It is a humane option during a very painful process. If you’re birth wasn’t painful or all you felt were surges, you were just lucky, that’s all.

  7. I insisted on a hospital birth out of fear and emotion, not on any facts. It doesn’t really matter because it was my preference at the time. Everyone has different reasons for choosing options for labor and delivery, and mine were my own. However, I don’t think it’s right for a television show to stretch the truth (lie) in an effort to ram their opinion down the throats of the viewer.

    There are plenty of factual things you can say against a home birth that don’t require manipulation. For instance, it does happen that there are instances like the baby being turned the wrong way where a c-section is sometimes critical. Why not cut out the middle man and pick a midwife friendly hospital rather than take the chance of having to travel to the hospital in the middle of labor? Such an example happened to the producer of The Business of Being Born in Rikki Lake’s documentary, and I felt that it really watered down Rikki’s argument. I guess it can be said that the event was an example of how home birthing midwives know when to draw the line for a safe delivery, but it was still a reminder of why hospital births are a practical and easier option. Maybe not a cheaper option, though. Insurance companies should probably pay women for saving them money… just like energy companies do for solar panel users.

  8. But see, it wasn’t out of fear and emotion that I picked a hospital. It’s because of reports like this: http://www.msnbc.msn.com/id/26792990/ and having the good sense to understand that it’s because of obstetrical care that maternal and infant mortality have gone way down. Notice that hemorrhaging is one of the biggest causes of maternal death in developing countries. This is not a circumstance handled well at home and why would anyone want to lose seconds, nevermind minutes because they were not in proximity to emergency care?

    I agree with your middle ground approach, because what harm could that possibly cause, but I feel that it is more geared toward this ‘birthing experience’ zeitgeist than actual practicalities of how do we care for this crazy process that could go south in a heartbeat. There is a lot of ideology around home birthing/unmedicated birthing and not a lot of sense. I first became aware of this at the birthing class I took. The teacher was unbelievably biased in the direction of natural childbirth (at a hospital class, not Bradley or whatever) and really shut down the people in the class who were not in lock step with her line of thinking. She was really down on epidurals and she showed this video of a pretty good epidural birth (because it was required) but she cautioned that it wasn’t the whole story. Oh horrors! Guess what I had a pretty darn good epidural birth, too, that’s the whole story.

    I also don’t think homebirth is cheaper. I have spent enough time on places like Babycenter to see that the transfer is often done using EMTs (expensive) not the family car and that now the solution to the crisis is emergency surgery (expensive) and long hospital stays for either mother or baby or both. Rather than paying mothers back for the difference in cost for a successful, non-eventful homebirth, insurance companies should put that money in the kitty to pay for the care in one of these scary (often avoidable) instances.

  9. WonderingWilla, the article that you posted has to do with women dying in childbirth because no one is available to attend their births. There is a vast, vast different between their situation and homebirth in the United States with licensed midwives. Again, I will reiterate that licensed homebirth midwives are trained to handle postpartum hemorrhage and carry and administer the exact same medications that are available in the hospital setting for this situation. I would encourage you to educate yourself about this and advocate for licensure of midwives in all 50 states so that all midwives are able to legally carry these important medications and provide even safer care.

    Also, it’s true that maternal and infant mortality have declined dramatically over the last 100 years, but despite our modern technology and ready use of it, the US is nowhere near the top of the list on either account, and maternal mortality has actually begin to increase, largely due to the rising cesarean rates. Here’s that link again:
    http://www.medicalnewstoday.com/articles/80743.php

    I’m sorry to hear about your childbirth education instructor, but I think it’s unfair to paint the whole home birthing/ unmedicated birthing movement as having “a lot of ideology… and not a lot of sense” because of one person’s views. Again, I invite you to educate yourself about midwives and homebirth in states where midwives have the option to become licensed. I’ve posted links to some homebirth research as well as Oregon’s risk assessment criteria for out-of-hospital birth in my previous post above. You can easily Google information about midwives in your state. I think it’s important for all of us to truly understand what we’re talking about, as there are some very common misperceptions about this.

    Wendy Gordon, CPM, LM
    Certified Professional Midwife
    Licensed Midwife

  10. […] Look at Lotus Birth Recently, some good friends of mine had a drug-free home birth.  I support a family’s right to deliver their baby at home (as long as it’s attended by a […]

  11. […] Birth Better? – It’s been debated before, most recently on an episode of The Doctors, but another study has shown that a low risk home birth […]


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