The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS,
a homebirth midwife in Mountain View, CA
The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS,
a homebirth midwife in Mountain View, CA
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An interactive resource for moms on easy steps they can take to reduce exposure to chemical toxins during pregnancy. Other excellent resources about avoiding toxins during pregnancy These are easy to read and understand and are beautifully presented. |
This discussion of legal and political issues is unusual for this homebirth list. If you're here to learn about setting up tubs for waterbirth and about siblings at birth and about talking with friends and family, stick around. For now, I'm afraid you'll just need to exercise that delete key.
Or, you could learn about the issues that might or might not affect your ability to choose homebirth in the future and wade through all this dry stuff.
OK, What I really like is the way the UK handles this. There, there are protocols that say that only healthy women with healthy babies are good candidates for homebirth. If a woman insists on a homebirth despite the fact that she does not meet the safe criteria, midwives are obliged to attend her. BUT, they do not carry legal responsibility for the outcome - she does. So, if the midwives have said earlier "you do not meet the criteria" and she insists and something bad happens, she can be charged with criminal neglect.How amazing. Here, the hospitals will get a court order to have the woman forcibly hauled into the hospital to have the baby surgically removed if that's what they consider "best for the baby". Or . . . best for their "risk containment", i.e. reducing exposure to lawsuits.
OTOH, if a midwife gives false/bad info and the woman takes bad decisions based on it, the midwife can be charged with malpractice and may face criminal prosecution as well as losing her license to practice. So, everyone has a duty to be informed, and to give information and CAN BE HELD RESPONSIBLE for doing so.Hmm, I suspect that it is really only those who choose homebirth who are held responsible for their decisions. There are babies who have problems in the hospital that they would not have had at home. Are the parents of those babies held responsible for the bad decision they made?
To answer your more specific points:
Good for whom? The woman whose religious beliefs prohibit any and all medical care?Yes, around here there are Christian Scientists and some Fundamentalist Christians who will not go to the hospital for a birth, end of discussion.I cannot think of any religion that disallows all medical care. Even the JW's who disallow blood transfusion allow the use of saline etc. Anyway, should the woman be allowed to extend her beliefs to her baby? (This is a toughie, I'm a Christian and believe strongly that my daughter is part of the Christian community and that the state doesn't have the right to challenge that, but I hope that if I ever did anything to endanger her well being, they would intervene to stop me.)
And the question of whether the woman should be allowed to control what happens to her body, even though it affects her baby, is a big question. In most cases, moms would gladly sacrifice their own body for their baby's safety, but they have instincts about what is best for their particular baby that may run counter to standard medico-legal advice. In the very rare cases where a mom isn't interested in her baby's welfare, I think she still has a right to say what is done to her body. Once the baby's born, of course, there's still lots of room for argument about the state's authority regarding non-vaccination, homeschooling, religious education, sex education, discipline, etc.
The woman with severe chemical sensitivities, for whom a hospital environment might actually be life threatening?Yes, it's often called Chronic Fatigue Syndrome, and it affects hundreds of thousands of people. Search the Web to find more info.Does this really exist ? I've never heard of this.
Over the years, I have developed an extreme sensitivity to chemicals, to the point where a theater seat next to someone wearing perfume will make me ill. Hospitals have the most severe effect of any place I've been. My face, arms and hands turn bright red with the toxic overload that my liver can't handle. (This is only one reason I prefer homebirth.)
This kind of a reaction would be devastating to a woman in labor - it would sap her strength and harm her in other ways; probably raise blood pressure, certainly increase anxiety.
The woman who was sexually abused and fears loss of control over who touches her and how?Would you want someone else making this decision for you if you were in that circumstance? Would you want to risk something that might cause you to re-experience the abuse? Would you want to risk the experience triggering a psychosis? What kind of mother would you be if you had to be institutionalized right after the birth?OK this is a toughie - but ought she be allowed to endanger her baby over this? (supposing her baby is in danger)
The baby who dies from a GBS infection acquired in the nursery?Yes, and, on balance, homebirth is safer than hospital birth for all risk factors.But here you have to balance the other risk factors.
If you really believe that there should be restrictions favoring the safest birth circumstance, then you would be saying that the state should have restrictions against hospital birth unless very specifically indicated. And women who choose hospital birth against these restrictions should be help legally responsible for any negative results.
And, of course, there are the women who have done their homework and believe the research shows that they are still safer at home, even with these "complications"? Why do you think it's good to restrict their choices?You might be surprised. There's a book called Guide to Effective Care in Pregnancy and Childbirth (Enkin, et al.) that summarizes current research and shows that a number of common practices are done counter to research results. Episiotomy is one of the biggest in this country. Here's what they have to say about breech - "The place of elective caesarean section for breech presentation at term is still unclear. . . . The use of caesarean section for breech delivery in the belief that it is safer may become a self-fulfilling prophecy as attendants become less skilled at breech delivery."I think you need a consensus of what is safe and what isn't. If the Royal College of Midwifery, or the Conseil des Sages-Femmes, do not regard something as safe, I think they are likely right - they are not part of Some Evil Conspiracy To Hurt Women, they are professional midwives taking decisions based on over a century of experience and research.
By the way, this book is printed by Oxford University Press, is Winner of the 1995 British Medical Association Book Competition in the category of Primary Health Care, and favorably reviewed by MIDIRS (a British midwifery journal?).
And there is lots of data showing that the concept of "gestational diabetes" has no basis in scientific fact.
But some things just get started and become "standard of care" in one place and either turn out to be more convenient for the practitioners, or people are just too scared to deviate from the local "standard of care" and then everybody's doing it everywhere.
If my next baby is breech, or twins, or too early, or too late I will respect my midwife's advice and go to hospital.And aren't you glad that's your choice? How would you feel if they suddenly changed their policy and restrictions to require homebirth for breech or twins?
If she is endangering her child, I think the state has a duty to ensure that she acts in its best interest. If she ignores all the medical advice and insists on a homebirth, and the child dies, I think she (not her medical attendants) should be held responsible and there should be a full criminal investigation - which might or might not end in prosecution. Babies are living human beings, not possessions, and they should be cared for as such, before and after the birth.There are many who would say that babies will be cared for much more as human beings at a homebirth than in a hospital birth. You might be interested to read some of the URLs on birth trauma to understand why some women would choose homebirth even in high risk situations - they value their child's spiritual and emotional well being as well as their baby's physical well-being. [Related Web Sites]
I also think that the medical personnel involved have a duty to assess whether the woman is capable of making informed choices - for example, are her reasons for wanting to avoid hospital good and valid ones (like some of the ones you mentioned above) or not.You know, I think most women choose hospital birth because they're afraid of the pain. Does this seem like a good reason for denying their baby the increased safety of homebirth? Avoiding pain certainly doesn't seem like a "good and valid" reason to me. It seems like a very selfish reason for endangering the baby's well-being. Those epidurals don't do the babies any good at all.
Who is qualified to specify the circumstances? The professional bodies - they Royal College of Midwifery in the UK, the Conseil des Sages-Femmes in France, and so on.Are these bodies truly independent or are they "supervised" by medical personnel, i.e. MDs, physicians, doctors, whatever you call them?
In any case, they make mistakes. If they had figured out a set of protocols for always getting from "healthy mom and baby before labor" to "healthy mom and baby after birth", I'm sure I would have heard about it. As it is, they make mistakes. And they freely admit this every time they revise their protocols. In this country, that's as often as every three months for GBS.
Do you think women should have to choose between going to the hospital and an unattended homebirth?Yes, homebirth midwives are particularly sparse in those states where it's specifically illegal.No, that's why I support the availability of trained competent midwives. And I think it's sad that the US doesn't seem to have them everywhere.
And do you understand that there are many circumstances where there are very competent midwives who are legally prevented from attending homebirth because of "restrictions"? Although the laws are worded to prevent the midwife from attending the birth, they implicitly prevent the woman from having an attended homebirth; thus the birthing woman's only choices are hospital birth or unattended homebirth.
It sounds as if you place a great deal of trust in the medical establishment. You might enjoy Silent Knife or Open Season" to read about women who once held that belief and felt they were betrayed and grossly mistreated. Or subscribe to the ICAN list - International Cesarean Awareness Network. Many of these are women who followed all the guidelines and had experiences that they felt were the worst of their life.
These are some of the influences that caused me to change my mind from
"hospitals know best" to "informed mothers know best".
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