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Re: gional Physician Backup for Homebirths
From: jwang,MD (anonymous@obgyn.net)
Mon, 31 Jul 2000 17:02:33 -0500 (CDT)
I personally do not agree with home births. One statement Jennifer made
that the midwife found the "few times" she needed ER care were too
abusive points to the risk home birth without ob backup. If in fact
homebirths are so safe, why, then is backup necessary? One- out of how
many home births did there need to be the "few" emergency room
treatments and two how severe or ill were the Mom's/babies? While there
are adament supporters of home birth who feel that iatrogenic infections
are rampant in hospitals, most ob's and in fact most midwives find the
hospital setting much safer.
My underlying question is always how would you feel if something went
wrong and the few extra minutes it took to get an ambulance/ride to
hospital resulted in a bad outcome for Mom, baby, or both. While the
vast majority of labors and deliveries happen without a problem,
unexpected complications can occur in an instant.
At Mon, 31 Jul 2000, Tonja wrote:
>
>Jennifer, your statement, "doctors will not take any part of backing up
>a midwife" is a pretty bold and global one! If that were truly the case,
>midwifery as a profession would be nearly obsolete, as most qualified
>midwives insist on being affiliated and/or under the directive of an
>obstetrician in the event a transport in indicated.
>
>Certainly, there are some OBs who don't believe in homebirth as a safe
>and/or viable method of childbirth, but I have yet to hear of a hospital
>transport where a woman who was attempting to birth at home presented in
>a hospital emergency room with a surprise prolapsed cord and was refused
>treatment because the hospital/staff in question "didn't support
>homebirth."
>
>For the record, I completely understand your position and personally, I
>fully support homebirth under responsible circumstances (i.e. transport
>plans, solid midwife affiliations with OBs in the event of a transport,
>education on the part of the birthing mother, etc.). We as women are
>passionate about the childbirth choices we make and we look for support
>from all angles to validate our choices. I do agree that there are
>*some* doctors who are vehemently opposed to homebirth, just as there
>are many women who feel the same about hospital births and the
>"unnecessary interventions" that often accompany them. And just as you
>will find it challenging to change the minds and philosophies of women
>who are pro-homebirth, you'll find equal challenges with the opposite.
>It may be true that in your specific area, there is a gross lack of
>medical support to midwives who support birthing at home, and that is
>very unfortunate, particularly given the fact that homebirth is your
>childbirth choice. I do feel for you. But try not to condemn the
>entire medical community for the circumstances that surround your
>specific community. There are wonderful OBs all over the world who work
>with, and provide medical support to women who birth at home and
>midwives who care for them.
>
>I disagree wholeheartedly about the "competition" theory - it could be
>that the OBs who are "against" homebirth have witnessed one too many
>tragedies in a transport situation that they feel could have been
>avoided had immediate medical technology been available. You can't
>really blame anyone for coming to a personal conclusion under those
>kinds of tragic circumstances.
>
>--
>Tonja
>
>At Mon, 31 Jul 2000, Jennifer wrote:
>>
>>The lack of medical support for homebirths is specific to my community,
>>not to the one and only midwife in my community. She happens to be a
>>registered nurse and a certified midwife. I have done extensive
>>research and doctors will not take any part of backing up a midwife. The
>>way I see it it is because the only thing that they have to gain is
>>liability. The client only goes to the doctor in the event of an
>>emergency. I believe many doctors see these midwifes as competition to
>>their business.
>>
>>I believe doctors can make homebirths more safe by making themselves
>>available in the event of an emergency. I live 5 minutes from a
>>hospital. It would be nice to know that a doctor in the hospital would
>>be available for an emergency transport.
>>
>>Unfortunately the only midwife that performs homebirths will be retiring
>>because the local medical community refuses backup.
>>
>>>I am not a professional, and I may be totally off base here, but here's
>>>my 2 cents:
>>>
>>>It seems to me that it should be the midwife's job to have physician
>>>backup that she works with on a regular basis. It would make me very
>>>suspicious of any midwife that did not have solid contacts in the
>>>medical community. In my opinion, no midwife should be doing a
>>>homebirth without a standing relationship with the nearest hospital and
>>>a doctor. Maybe there is a legitimate reason that the ER docs have been
>>>hostile to her? She may have a reputation for bad judgement or waiting
>>>too long to get help (I'm just hypothesizing here -- I don't know a
>>>single thing about your midwife).
>>>
>>>It is unfortunate that your options are limited simply because of
>>>geography. There are plenty of communities where homebirth midwives
>>>have some sort of support from area doctors. Quite frankly, I don't
>>>know what doctors can be doing to make home births safer. The problem
>>>of home births is the fact that some of the unexpected catastrophe's
>>>that can occur during childbirth can not be appropriately treated
>>>outside a hospital setting, regardless of the attendant's skill. These
>>>problems are incredibly rare, but you probably won't care how rare it is
>>>if it is your uterus that ruptures.
>>>
>>>Good luck, and I hope you can find a satisfying solution to your
>>>dilemma.
>>>
>>>Andrea
>>>
>>>At Wed, 26 Jul 2000, Jennifer wrote:
>>>>
>>>>I am looking for information on gaining community support for a
>>>>homebirth. I have done my homework and feel very strongly about having
>>>>my second baby at home. The only midwife in my area will only take
>>>>clients who can find a physician backup for the event of an emergency
>>>>hospital transport. Her few experiences with local emergency rooms have
>>>>been too abusive for her to continue without the support of a doctor.
>>>>The OB's that I have contacted are adomandtly against homebirths. Does
>>>>anyone have any regional information on potential doctors, in Charleston
>>>>County, South Carolina, that may be willing to back up a homebirth. Also
>>>>any ideas on how to pursuade the profession that although complications
>>>>can occur childbirth is a natural process of the body. When
>>>>complications occur and medicine is necessary it should be available
>>>>without losing the option of a homebirth. I could not find the
>>>>necessary recourses for my first birth and would be forever grateful to
>>>>have all of the options for my second birth. It seems if doctors really
>>>>belive that there is potential danger in homebirths they would take the
>>>>responsibility to make them safe.
>>>>
>>>>Jennifer
>
--
J Wang, M.D
Assitant Clinical Prof.
Tufts University School of Medicine
>**Note: Opinions expressed here are for educational purposes only
>and, as such, do not constitute a physician-patient relationship.
>This information is not intended to supplant the need for you to
>consult with your physician prior to choosing therapeutic options
>and/or interventions.>
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