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Re: ChoicesFrom: ainsron (ainsron@sbcglobal.net)Fri Mar 19 10:01:07 2004
If you have access to Williams Obstetrics, look at p.4, infant mortality (first year of life) rates from 1915 to 1995 dropped from 100/1000 live births to less than 10. Maternal mortality in 1900 was 850/100,000 live births, from 1980 to 1997 it dropped to 8.4/100,000 live births. Those improvements are not because of midwifery care. They are because of movement of birth into the hospital setting and availability of blood, anesthesia, antibiotics and self-serving as it might seem to say, good medical care. Ronald E. Ainsworth -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Heidi Sent: Friday, March 19, 2004 7:52 AM To: Multiple recipients of list OB-GYN-L Subject: Re: Choices
>Larry R. Glazerman, MD wrote: Can you provide any reference whatsoever to support the claim the 30-50% of women and/or babies died due to childbirth related causes? Despite misconceptions that abound regarding the odds of 'dying in childbirth' it is patently false that hospital "delivery" has had much, if any, contribution to decreasing overall maternal/infant morbidity and mortality. In fact, antibiotics and blood transfusions alone account for the vast improvement in perinatal mortality rates in the past 50 years, NOT "high tech" obstetric management or cesarean section. The leading causes of death due to childbirth related causes, even in undeveloped nations, still remain and have always been sepsis and hemorrhage. not "dystocia" or "failure to progress." I'm not talking about VLBW babies or the advances in fertility treatments that have produced high-order multiples who require skilled medical expertise. Home "deliveries" may be for pizzas, however, home *births* are no more dangerous for mothers and babies than those that take place in a hospital when *matched cohorts* are used. Claiming that home birth is only safe when you exclude all the cases of transfer is ridiculous. This would be akin to claiming that everyone should eat in the hospital in case they were to choke or have an acute allergic reaction, and that eating is "only safe outside of the hospital if you don't count all the people who require emergency medical attention for choking or anaphylactic reactions." The entire point of having a trained and qualified attendant present in a home birth situation is *specifically* to recognize and treat any complications that may arise, and this includes recognizing a need for transfer of care to a qualified surgeon in rare cases. Not 25% of cases. Not 50% of cases. Many out-of-hospital providers maintain excellent safety records with transfer rates under 15%. A trained attendant is also qualified to provide acute care when needed, such as in the case of postpartum hemorrhage or neonatal resuscitation. This care is provided in the interim while emergent transfer is being arranged- just as acute care is provided in a delivery room while a surgical suite is prepared and the anesthesiologist located in a hospital situation. While I can respect that those of you who are trained as surgeons (seeing complications in high-risk pregnancies that we could never even begin to appreciate as homebirth attendants) may never be convinced of the safety of out-of-hospital birth, it would at least be worthwhile to discuss it with realistic statistics and less rhetorhic and disrespect. Sincerely, Heidi Streufert Formerly CNM student at UF, Gainesville (quit due to state of nurse midwifery and lack of evidence-based care in hospital obstetrics) Now apprenticing for certification as a CPM
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