Natural Birth

Tara - posted on 10/18/2011 ( 270 moms have responded )

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http://www.ottawacitizen.com/technology/...

While having a baby at home and live online may seem wacky, it draws attention to how rare natural childbirth has become, writes Elizabeth Payne.

Nancy Salgueiro is not crazy. She is tired, very busy and extremely happy, like most new mothers.

But the Barrhaven woman's decision to live-stream her home birth, which took place early Sunday morning without a hitch, while unconventional, was not irrational.

In fact, doctors, nurses, medical students, health policy-makers and prospective parents would do well to watch the recording of baby Oziah's birth, which is available at Salgueiro's website yourbirthcoach.com. It might be one of the few chances they ever get to see a baby born without medical intervention, which is a sad comment on modern health care.

The fact that normal has become the wacky exception when it comes to birth is a problem that gets too little attention. If Salgueiro's decision to bring her baby's birth to a world audience was provocative, that is a good thing. It might just provoke a conversation that is needed about how natural childbirth became something so rare that few people even know what it looks like, including the very people whose jobs it should be to promote and encourage it.

That is why she decided to take the unusual step of welcoming the world into her living room to watch her give birth. An estimated 2,500 people, who had registered beforehand, watched from countries including Brazil, Afghanistan and Australia.

"I want people to realize that birth is not the crisis that (movies and television shows) make it out to be. Birth is just a normal part of life."

Salgueiro, 32, who is a chiropractor and birth educator, says there is a great deal of unnecessary fear surrounding birth. "We are the population with the least faith in our ability to (give birth naturally). Women are totally capable of it, it doesn't need to be managed."

It is a long way from the giant tub Salgueiro and her husband Mike Carreira placed in their Barrhaven living room for last weekend's birth to the operating rooms where growing numbers of Canadian babies are delivered. If there is a lesson to be learned from Salgueiro's live-streamed birth, it is not that everyone should be having babies in their living rooms, but that there has to be a safer, more rational middle ground that swings the pendulum away from the operating rooms and medically intensive births back to something that is both safe and more natural. Salgueiro is right: Women can do it. They just need a little more support from the health system.

And that is often where things fall down, but not for a lack of good intentions.

The Society of Obstetricians and Gynecologists of Canada has actively campaigned for fewer C-sections and more natural births. In the last few years it has rewritten policy guidelines, including one that said doctors should automatically perform C-sections in cases of breech birth.

"The safest way to deliver has always been the natural way," said Dr. André Lalonde, executive vice-president of the SOGC. "Vaginal birth is the preferred method of having a baby because a C-section in itself has complications."

The problem with the SOGC's new guidelines, which said doctors should not automatically rule out vaginal births for breech babies, was that a whole generation of doctors had never been trained regarding - or even seen - a breech baby (about three to four per cent of term births) delivered any other way than by C-section. They needed training (in some Ottawa cases, with the help of a midwife who had experience) to gain the necessary confidence. And likewise, many doctors have never witnessed a natural birth at home.

While C-sections can save lives, they can also cause problems. The World Health Organization has said no more than 15 per cent of babies should be delivered by C-section. In some parts of Canada the rate is double that, and rising.

What is the solution? While it has been popular of late to blame mothers for the pressure to deliver more babies by C-section, some research has debunked that and suggested a number of systemic factors within the hospital and health system contribute to mothers feeling pressured to agree to C-sections.

Not only is the increasing reliance on medical interventions in birth costly (one estimate says the country's health system would save $25 million if the rate of first-time C-sections was reduced to the amount recommended by the WHO), but they are risky. Compared to vaginal delivery, C-sections bring with them greater risk of cardiac arrest, hysterectomy, infection, fever, pneumonia, clotting and hemorrhaging than vaginal births. There are also more risks to the baby.

And yet, too many needless C-sections and other medical interventions continue to be the new normal for birth in Canada.

Who sounds crazy now?

Elizabeth Payne is a member of the Citizen's editorial board.
© Copyright (c) The Ottawa Citizen

Do you think there should be a shift in the medical field towards a more natural attitude about birth?
How were you talked to about natural birth? Were you planning on natural birth?
Personally I am thankful that here in Canada there is always room for dialogue, for discussion and a review of the way things work, and that the focus is on the health of baby and mom.

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Mary - posted on 10/24/2011

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"Wait, so the dr caused your baby's heartrate to drop dangerously low three times and then did a c section and you think it's a wonderful doctor?

You do know that being induced *causes* baby's heartrates to drop. So the dr caused a problem then fixed it."




Lauralei, that is a rather big assumption on your part, and honestly, this statement only displays your ignorance of obstetrics. Read as much as you want to in books or on the web - it still won't make you an expert on labor or inductions.



Being induced does not automatically equate to fetal distress. That's simply an absurd statement. If it were even remotely true, no one would ever be induced, particularly here in the US, where lawsuits are abundant.



There are a number of things that can cause a drop in the baby's heart rate - fetal position, poor oxygen reserves (from a multitude of issues, either fetal or placental), position of the cord (i.e. a nuchal cord) - hyperstimulation of the uterus from induction is just one of the possible causes. It should also be noted that hyperstim can occur "naturally" as well.



Here's a scenario that I am sure you may not have considered, but is just as possible as your assumption that a lack of interventions would have resulted in uncomplicated vaginal birth without any fetal distress or compromise:



Katherine is not induced, but rather, waits until she spontaneously goes into labor at 42 3/7. She labors for hours, but it's not until around the 18th hour that they really become strong enough to make any cervical change, or lower the baby down. At which point, the heart rate does begin to drop with each contraction, and takes longer and longer to recover...why? Because even without pitocin, that cord is still wrapped around baby's neck, and it's oxygen reserves are low; weeks of steadily increasing maternal pressures, and advanced gestational age have led to highly calcified placenta, with poor perfusion to the fetus. Bottom line? With or without pitocin, that baby did not have the necessary reserves to tolerate contractions adequate enough to get him out of her body. Allowing labor to continue "naturally" would only further compromise that baby, and increase the odds of brain damage. (And that's assuming this baby "fit", which there is no way to know until the very end).



I am by no means against intervention-free births. However, I get really annoyed with those of you who persist in this fantastical belief that everyone's body is capable of this without problems. Sometimes, there are "natural consequences" to allowing nature to proceed without intervention...and they can be just as, if not more catastrophic that a section. Sometimes, allowing the body to "do it's thing" or what it was meant to means a women goes into labor at 28 weeks, or that her water breaks at 32 weeks. Sometimes, it means her blood pressure sky rockets, and she seizes. Sometimes, it means she never goes into labor at all, and ends up with a dead baby at 43+ weeks (and yes, I've seen this, and it is NOT pretty).



Both the humans that work in medicine AS WELL AS nature are fallible. There are times when both work perfectly, and times when both make mistakes. Obviously, the key is finding a balance between the two.

Mary - posted on 10/24/2011

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And again, I feel the need to contradict you...."... they aren't required to know how to deliver breech vaginally. If they do their own research they might but it's not something doctors are taught here, they are simply told breech requires surgery."

Doctors as recently as the mid-late nineties did perform vaginal breeches regularly, particularly on multiparous women. What changed that? Lawsuits. I know this, because I have been a part of more than a few vaginal breech deliveries in the hospital setting. For a patient who was well-informed, and willing to assume the risk of head entrapment, many an OB would be willing to do it. Admittedly, any of them who had experienced head entrapment were loathe to do it again, and some did flat out refuse it after witnessing it, and having a dead baby. That, however, was a personal call, and not one forced by the profession as a whole. What drastically changed that was the fact that it became absolutely indefensible in court when an OB participated in a vaginal breech, and there was a bad outcome. It didn't matter how informed the patient (now the party bringing suit) was, and how willing they were to assume those risks before delivery, or that it was the mother's choice to have a vaginal breech. Any type of bad outcome, and that doctor could pretty much kiss the profession goodbye, since they would lose their malpractice insurance after that settlement.

In the US, many women rail about being informed partners in their obstetrical care, and being in control of all decisions. I think they should...but then they also need to accept the consequences of those choices. Problem is, when they outcome is less than perfect those same women will turn around and sue the hell out of everyone even remotely involved. The even bigger problem is that even when no one was at fault, and no mistakes were made, our society will, without question, side with the women whose informed choice it was. And in the process, ruin the doctor's life who honored his patient's wishes.

Perhaps I am more well versed in this than some, having been an active, working member of the medical community when this subtle, yet devastating change in medicine occurred. Society forced doctors and hospitals into the unenviable position of having to practice defensive medicine in order to remain practicing. This is true in all fields, but more so in obstetrics than in any other. Our society punishes those who fail to intervene...so really what choice do they have?

In the case of a vaginal breech, an OB can be the most skilled and experienced of practitioners. They can do absolutely everything right, and yet, the head becomes entrapped, and the baby suffers either irreversible brain damage, or dies. Even if it is clearly documented that the mother and her partner were well advised of the risks, and that despite the OB's advice to the contrary, she choose a vaginal delivery over a section, she can still bring suit...and have a 99.9% chance of winning.

Yes, women should have a choice and a say in how they birth their babies. But they need to carry some of the accountability for their choices as well

Mary - posted on 10/24/2011

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"I don't care what women choose, I care when myths or lies spread as facts out of doctors or hospitals and women get convinced that their body doesn't work."

Here's the thing - that is a two way street. Just as you cannot tolerate "lies", neither can I. I simply cannot abide those who proclaim that all medical professionals are dishonest, self-centered, or all practice in a certain fashion. Whether you realize it or not, physicians and hospital staff are just as human as you are - and the vast majority of them are individuals who truly care about their patients. As a nurse who cares deeply, I find your slanderous generalizations not only unfounded and inaccurate, but highly offensive.

Another little fact...not all women's bodies "work" in quite the same fashion. Some don't "work" at all. Although you have no personal understanding of this, some of us actually are "broken". Some of us cannot carry an infant to term; out body tries to expel it well before it can survive on it's own. Some of us cannot do it without becoming deathly ill ourselves. Some of us do not have have a big enough pelvis, or have a funny shape to it, and our babies get stuck. Some of us can't get even get pregnant without intervention, if at all.

And believe it or not, some of us could give a rat's ass about our "birth experience", and do not need an unmedicated birth to feel empowered, or blissful over the birth of our child. Just hearing that first cry, even if it is hours later, because we had to get general anesthesia, is enough overwhelm us with joy, and make us grateful that our bodies were good enough to produce this tiny miracle, even if we didn't push them out on our own.

I m happy that you were able to derive such pleasure out of your home birth. I am even more glad that both you and your baby had no issues that required any type of intervention. However, that does not mean that your experience or circumstances are the standard for every pregnant woman out there, nor are their desires or priorities the same as yours.

Ez - posted on 10/21/2011

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There is a difference between having an interest in the availability of natural birth, and caring whether or not Jane across the street has one. I absolutely believe in a women's right to access pain relief or intervention if she wishes. What I have a problem with is that becoming the norm and being written into hospital protocol and government legislation.

Most women do not want a home birth (numbers are around 1% in the US and even less here in Aus), but that doesn't mean it should not be available and accessible to those who do. It certainly doesn't mean it should become a political issue.

Many women are perfectly happy to have an IV upon admission at the hospital, have a c-section for breech or have a repeat c-section instead of trial of labour for VBAC. But that doesn't mean women shouldn't be offered the alternative if appropriate resources are available.

That is why I am passionate about natural birth, and birth rights in general. Not because I care whether so and so has an epidural or c/s, but because I care about women having choices. And mainstream medicalised birth can sometimes take those choices away. It is insane that VBACs are outlawed and homebirths are illegal in some states. It is ridiculous that a woman can't find a doctor who is experienced and skilled in breech vaginal deliveries. I'm not saying anyone should necessarily go that route, but the choice should be there.

Minnie - posted on 10/24/2011

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I do agree. Laurelai I know how passionate you are about natural and home birth since you had yours- I am too. But only for -me-. I would love that medical professionals in general be much more educated on normal birth and accepting of out of hospital births. I know all too well from my personal experience that OBs are not as knowledgeable or supporting of natural birth as they could be. And its SO frustrating, and I know the feeling of wanting to crusade and change things!



Women need freedom of choice. I want home birth to be legal in every state. I want mothers to be able to birth wherever the choose, however they choose and with whomever they choose. And that includes repeat elective cesareans if a mother so wishes. :)



It's like breast vs. bottle. We hear of so many mothers who said something went wrong, so they switched to bottle feeding and we think "if only she had done this! She would have the beautiful experience I had!" And it's commendable to wish that a woman would share our experiences and hope that she would enjoy it too. But maybe she wouldn't!



It's hard to step back and feel that a mother could have had a different outcome if she had made such and such a choice. But you know that we can't know that. So we can only look back on our own personal experiences and own our personal feelings and make our future choices based on that, for us.

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Merry - posted on 10/26/2011

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Interestingly though the midwife who delivered my second is now retired and I was worried who I would find to delive our future third baby but the first midwife I had is now getting herself going as a home birth midwife!
It's pretty cool! I think she will even have privileges at a hospital so maybe even if I need a transfer I wouldn't have to be stuck with random joe obgyn in the er

Merry - posted on 10/26/2011

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I was born at home with a midwife in 1988 in Wisconsin so I'm sure it's not illegal here!

Becky, yes there are midwives who will deliver at hospitals. I had a midwife that I saw for the first 7 months of my first pregnancy and she was covered by my insurance but out of nowhere the team of obgyns that they were teamed with cut off their funds or something and they all lost their jobs essentially. So I went to an obgyn since there were no other midwives in my area that my insurance allowed" at the time I hadn't learned about the one who delivered my second because she wasn't affiliated with any hospital. There's a great team of midwives just in the next county ut my insurance wouldn't cover me since I was in another county.

♥♪Megan♫♥ - posted on 10/26/2011

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Erin thanks, I read some of it on Wiki. My friend had one I guess because her 7 year old's father is like my 7 year old's father. I don't know if her mom was in the room with her or not. But she said that having one helped.

Sherri - posted on 10/26/2011

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Yuppers Tara now you know why some of us are so shocked at the numbers of midwives used elsewhere as most Americans will go a lifetime and most likely never even hear about or encounter a midwife practice.

Tara - posted on 10/26/2011

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Thanks Sherri, I already found the stats, that's why I removed the post.
That's an astounding number of births, and so few midwife assisted, whether at home or in hospital. Probably one of the highest if not the highest numbers in the world of hospital, doctor, often specialist led births....

Tara - posted on 10/26/2011

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www.midwife.org has lots of current news for those interested in midwifery care in the US and how there are ongoing changes being made and policies implemented to allow for further and broader education, training and regulation of certified nurse midwives and certified midwives.

edited to add a missing word.

Ez - posted on 10/26/2011

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Meggy, doulas are not midwives. They are a support person and advocate for the labouring woman. They have no medical training, and no medical responsibility.

The problem I see with midwives in the US is that there is no consistency in training. You can have an CNM, who is an RN with graduate training in midwifery. This qualification is equal to midwives here in Aus. Then you have CPMs, who are not required to have a university education and get their licences from various private colleges (some even online!). Then there are DEMs or LMs, who gain their knowledge through apprenticing with an experienced midwife.

This is why so many Americans balk at the idea of a midwife attended birth. You can literally have someone who hasn't finished high school delivering babies and calling themselves 'midwife'.

So while I whole-heartedly believe in the midwife-led maternity care system we have here (and in the UK), I do understand why it would not be possible or well received in the US unless there is reform. There needs to be standardised education and training among student midwives if that is going to happen.

Becky - posted on 10/25/2011

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Laura, can midwives not deliver in the hospital where you live? I am having a midwife assisted hospital birth because my husband is freaked out by the idea of a home birth. We haven't gone over the specifics yet because it's still a ways off, but my understanding is that the only people who will be in the room are my midwife and her partner, and my support people. No other nurses and no doctor, unless an emergency arises and then one would be called in. So I won't have to fight any hospital policies or doctor's preferences regarding birth. The only hospital policy I may have to abide by is their policy on how many support people you are allowed to have in the room (only 2, including your spouse.) I'm hoping it doesn't apply with a midwife birth because my little sister, who is a nursing student, would like to be in the room too. But if it does, it's something I can live with at least. My births are generally over pretty quickly!

Tina - posted on 10/25/2011

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I had full intention of having a natural birth with no painkiller but I had a very long labour with complications. Ended up having an emergency C section. My second I had a c section it broke my heart to make that decision but i had to do what was best for my baby. Really where I live midwives are a bigger part of the birth than the doctor they really come in once in a while to see how you're doing. There are physical reasons why people can and can't have natural births but support is a big thing too. Natural birth is very much encouarage where I live they give information on it and on breathing, videos and birthing classes. My caesar was only done as a last resort.

♥♪Megan♫♥ - posted on 10/25/2011

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Non nurse trained midwives were illegal. Not all midwives,

Minnie - posted on 10/25/2011

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Ahh, the date is 2000. Yes, I *think* it was illegal then. Thankfully things have changed!

Minnie - posted on 10/25/2011

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Yeah, it's totally legal in NY. Ask April, she's trying her hardest to search for one in her area. Plenty on the eastern side of the state.

♥♪Megan♫♥ - posted on 10/25/2011

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Sherri I don't know if it's because I'm in Canada, but the link doesn't work.

Sherri - posted on 10/25/2011

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I don't know Lisa got this from http://www.nurseweek.com/news/00-10/1031... Here is says that they are illegal in NY????



I knew they were in NH because I knew you had used one. Just had no clue where they are. Since they are in Concord and Milford I can see why I have never seen them around. I don't visit Concord often and never go to Milford.

♥♪Megan♫♥ - posted on 10/25/2011

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Maybe they're illegal in certain counties? Those areas are from the Capital down to the NY/NJ boarder. I'm from Monroe County on the Western part of NYS.



I read that a doula is more like a support team, they can be medically trained though.

Sherri - posted on 10/25/2011

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Possibly not everywhere in the US Meggy but since they are illegal in 15 states and not common in others I am willing to bet in a lot of states they are virtually impossible to find.

Currently, it is illegal to practice midwifery in the District of Columbia and 15 states: Alabama, Delaware, Georgia, Hawaii, Indiana, Iowa, Kentucky, Maryland, Mississippi, New Jersey, New York, North Carolina, Rhode Island, Virginia and Wisconsin.

In some states, statutes require midwives to have nursing degrees in order to practice, while in others, licensure is unavailable, indirectly preventing midwives from practicing legally

♥♪Megan♫♥ - posted on 10/25/2011

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I don't think midwives are that uncommon in the US or Canada. I'm just wondering if they're anything like a doula. Because a friend of mine in New York had one when she delivered her baby.

Sherri - posted on 10/25/2011

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I wouldn't even know the first place to even look for a midwife here?? I have never seen an office or even heard of one around. I know they must be here somewhere but where no clue.

I am pretty sure they are relatively rare here in the US as well as home births as home births only acct for 0.67% of the 4.2 million births annually in the US.

Merry - posted on 10/25/2011

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I'm not anti hospital. I would choose a hospital birth if I thought I could get the birth the way I want it unless there's an emergency. I don't necessarily want to be home, the minuscule risks do concern me, but with my insurance my choice of obgyns is small and choice of hospitals is even smaller and I know I'd be fighting hospital policy left and right and ehile I'm not opposed to fighting for what I want, when I'm in labor I don't need to be fighting.
If I could get the same birth in a hospital as I had at hme I'd do it there. But unless I argue many policies I couldn't get it so home is my best option.

Mary - posted on 10/25/2011

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Tara, your post does emphasize the difference that occurs in different areas. In my region, GP's simply do not do prenatal care or deliveries. That falls solely into the realm of OB's. As well, I can attest to the fact that there are plenty of OB's in my area who have delivered many a baby "naturally" - meaning sans intervention, with only intermittent fetal heart checks - if that is what the patient wants, and there are no risk factors or issues.



Without question, OB's are more experienced, and have done more deliveries than the CNM's; they have four years of residency, compared to the two years of graduate level education that a CNM receives (after she has obtained a BSN). The number of deliveries required for completion according to the program, but is somewhere around 40. So in the beginning of their careers, I would hardly describe any of them as experienced, unless they also spent years and years as an L&D nurse first - and even then, it's not quite the same.



I'm not, by any means, knocking midwives. I have had the privilege of working with some truly outstanding ones. However, I have also worked with more than a few outstanding OB's, who are, without question, more experienced, and are very open to unmedicated births, with freedom of movement. IN fact, the birthing tub in my former hospital was paid for out of pocket by one of the perinatologists on staff.

Elfrieda - posted on 10/25/2011

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Oh, just wanted to add (just in case my post wasn't long enough!) that I did have some other "medical intervention". Not long after I delivered the placenta, Mojgan told me that I was bleeding "more heavily than she liked" and asked for my permission to give me a shot of oxytocin (I think) to shrink my uterus faster.



Well, I didn't know! I asked her, "Do you think I need it?" and she said, "Well, it's not an emergency, but I'd prefer to do it now so you don't become weak from losing so much blood. But if you don't want to we can wait for a few minutes and see if the bleeding slows." I opted for the jab.



I think it was the right thing, because in all the "happy family" pictures we took right afterwards, I had a beautiful pale complexion, instead of the bright pink cheeks I usually have. I think that means there was a lot less blood in my body than it's used to.

Elfrieda - posted on 10/25/2011

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Just looking at all the nitty-gritty details of midwife care in the different countries, I'm so thankful to live where I do. (ON, Canada) One midwife stays with you for the labour part, and she calls the other one to come when she thinks it's likely that the pushing will start, so that there is one midwife for the baby and one for the mom. They are trained in a standardized way, and have transfer priviledges at one or more hospitals. I had to pre-register at the small hospital near us, and also at the bigger, higher-tech hospital 35 minutes away, just in case.



I just wish there were more midwives around here. I almost didn't get one which would have meant no home birth, I was on the waiting list until I was 7 months pregnant. My family doctor was about to force me to choose an OB/GYN (he doesn't do births, he says he used to and that's why he has white hair... okay, dude, whatever.) because it was getting to that time, when my mom pulled some strings (thanks, mom!) and I got accepted into one of the two midwife associations that are within an hour's radius from my home.



The midwives are divided into teams of three women each, so I had one primary care-giver, but there was no guarantee that she would be the one to help me, because she might be off or be helping another woman. If she wasn't able to, one of the other two would. If all their preggos went into labour at the same time, I would have had to go to the hospital so that they could tend to more than one person at the same time. (boo)



But it didn't happen. I got my primary midwife (yay!) and she came over at 9 Sunday morning, and at 3 or so she called her partners for one of them to come and help with the baby, but they were all busy! So she called another of her colleagues (from another 3-person team) and she rushed over. That was kind of strange to be all naked with somebody I just barely met, but at that point I just wanted to push the baby out and didn't really care. She was very nice, and actually was the primary midwife for my sister-in-law's home birth, so there was a connection there.



After the baby was born, Jackie watched the baby as I held him, while Mojgan numbed me (ow, it's like a dentist needle but DOWN THERE!) and gave me some stitches. Jackie weighed him and gave him Vitamin K, and then my husband held him while the two midwives helped me walk to the shower (I was instructed to pee while in there, which was funny) but I closed the door on them because I was tired of people watching me and I felt fine anyway. They turned on the shower for me and stripped and remade the bed (without the crinkly plastic this time). I felt very cared for.



After that, my baby and I hung out in the bed while the midwives and my husband brought me tea and supper and took care of the mess, and my parents dropped by with food for us, not even knowing that we'd had the baby already! So they got to hold their first grandchild when he was only 20 minutes old. The midwives left me and told me that someone would be by tomorrow. My husband got on the phone to all our friends and relations and we grinned at each other for a long time and chose a name for our baby. Then I went to sleep, because I was tired. :)

Tara - posted on 10/25/2011

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In Ontario you may have a homebirth without an ultrasound, many Amish women do so all the time. These births are still attended to by a certified midwife. The idea being that the midwifery care available here is based on the concept of "informed choice" meaning that the midwives provide all the info that is available to their clients about all procedures, tests etc. etc. so that each woman can make an informed choice about their own care.
Only women who are considered to be high risk will not be able to have a board certified midwife attend her homebirth, she can however still have a hospital birth in most cases, attended to by a midwife with an Ob/Gyn consult first, and sometimes they will do shared care, where a potentially high risk client is seen by a specialist as well as having the midwife attend as a support and advocate and to care for the newborn or mom post natal. So even if you have a hospital birth attended to by a OB/Gyn you still maintain your midwife for all post natal check ups, etc.
Midwives, at least mine, clean up all "mess" that is left from a homebirth, they also fed my kids breakfast, dinner for one, they return to my home at day 1, 3, 5 and 7 to check in and see how things are going, they did some dishes, held the babe while I showered etc.
I love midwifery care in Ontario!
Oh and our midwives receive far more training (years more) than your average GP does regarding prenatal care, women, labour and delivery.
They are often the only people who know what a natural birth really looks like.
My BF is a RN, she has worked both for the midwives as their infant support person at homebirths and at a hospital with all sorts of deliveries. She can attest to the fact that almost all doctors she works with GP and otherwise have never actually seen a natural delivery.
It's sad but true.

Merry - posted on 10/25/2011

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I envy uk system for home births! Here it's so hard to find a midwife, half aren't even nurse midwives, and almost none have any agreement with a hospital at all! I only had one midwife for ferns birth, her apprentice was out of the country but I had expected them both to be there. But with my aunt here I knew they were a good team.

Mary - posted on 10/25/2011

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Cathy, what you describe seems like an ideal situation for home births. It ensures that a set of safety guidelines are followed, and I absolutely love the fact that there are two certified midwives in attendance, as opposed to one. Often times, a crisis in childbirth is unexpected, and time is of the essence. Waiting for help to arrive can have a hugely negative impact on the outcome. As well, it just makes sense to have two trained professionals present, since there are two patients that could potentially require immediate assistance. If a baby comes out requiring some type of resus, and the mother is hemorrhaging, one person is not enough - and one of those patients will suffer for it.



I also think your mistrust of a midwife willing to do a home birth with a women who fell outside of the NHS criteria is well-founded. It makes me wonder exactly what that midwife's motivation is that she thinks it reasonable to be a part of birth that has a higher risk of complications, and to do so unassisted. Is there a reason this midwife is not employed by the NHS? Or, is it some militant birth nazi, so consumed with her ideals, that she is willing to compromise safety to prove a point, and be "right"? Whatever - it seems like only the most foolhardy of women would do this in your country, with the system designed the way that it is.

Merry - posted on 10/25/2011

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Our midwife fee would have been the same even if we transferred to a hospital. So no worry about money controlling her! She would turn into a doula essentially if I needed to go to the hospital. I didn't have a ultrasound to determine presentation, only one scan at 18 weeks.

Frances - posted on 10/25/2011

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From what Cathy said, it sounds like in the UK that unless you are willing to have an ultrasound, you are not allowed to have a home birth.

Minnie - posted on 10/25/2011

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Cathy, that 10% seems like such a high number comapared to the US! Here home births count for only 1% of all births.

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Midwives are often better than doctors particularly in low risk pregnancies as birth doesn't need to be a medical thing, here if you have a home birth the midwives can carry gas and air and can stitch tears and know when to transfer to the hospital for further help. They have specialist knowledge about pregnancy, labour and newborns that doctors don't always get the chance to have. Which isn't to say that doctors aren't needed, they are needed for people like me who have high risk pregnancies and need medical care. But not everyone needs medical care! Midwives are experts at their profession here!

Merry - posted on 10/24/2011

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Aww Lisa you sure know how to word it :)
Ditto what Lisa said as it applies to my 2.5yr old son nursing too :) except he nurses a lot longer then a few minutes if I let him! But he sort of understands he has to leave some milk for his sister :)

Minnie - posted on 10/24/2011

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It definitely can be surprising seeing a preschooler nursing- they're so -big- compared to a little baby. But like you, I set goals that I thought we could attain. And each time we met them I saw how much she needed to nurse still and surprising to me, she still was my little baby. They only grow a teensy bit each day- and since we enjoyed nursing yesterday, we have enjoyed it today, I suspect we will tomorrow. :)



I can see her decreasing in her need to nurse ever so gradually. It's been such a gentle process that I truly and honestly couldn't tell you when she went longer than an hour without nursing. I have only a very slight idea of how often she nurses during the day- it's so mundane, it hardly crosses my mind. Perhaps five or six times, for about five minutes each. It will become less and less.



So to answer your question, will I let her nurse as a five year old? I can't tell you that. We'll nurse for however long we both are comfortable. I don't know what will happen a year from now. Perhaps she'll be done, perhaps it will be only at bed time, who knows?

Minnie - posted on 10/24/2011

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It depends on the midwife. I had a nurse midwife, and she is able to administer medications. Midwives apprentice for years under more experienced midwives. They're trained to handle emergency situations, trained to forsee possible complications. They do have medical knowledge and do carry equipment and pitocin.



No, they can't do surgery, but they can repair tears. When you choose an out of hospital birth you need to pretty much be low to no risk. To minimize possible complications that may occur in a home birth.

Katherine - posted on 10/24/2011

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But correct me if i'm wrong, a midwife isn't as medically trained as a doctor/obgyn correct?? As in, she can't administer medications, cant do emergency operations, she's just trained to be like a nurse, there to oversee and encourage the mom along and to deliver the baby???

I see, now, I planned on nursing my son and set small goals to reach, and I reached several but not nearly as much as I had intended. But will you allow her to continue nursing when she's in school? grade school??

Minnie - posted on 10/24/2011

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Katherine, in most home births there is a midwife present- she is a medical professional.



I don't plan on actively weaning my daughter. I'm still comfortable with her growing out of her need within her own time. :)

Katherine - posted on 10/24/2011

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There will always been fantastic doctors who will go above and beyond, there will be those who are just ok and there will always be those who suck at whay they do!!!

It's up to us as mothers, strong women to stand up for ourselves and find the doctors we feel are right for us and allow us to do as we want.

Not everyone wants a home/water birth, personally I would not forgive myself and most likely harm myself if something happened to my child if i had a home birth and it went wrong. I'm so glad I was in the hospital. I had amazing doctors and nurses, they were very understanding, the communication was great, and even though I didn't have my regular obgyn the one who induced me was reffered by my obgyn and he was great, even when doing my c-section.

I feel empowered just by being able to carry my son to term and deliver him healthily the way I did!!! I would be very upset and sue if I carried a healthy baby to term only to have a lack of oxygen by his cord and brain damage after birth!!!

My choice of c-section was offered, the reasons were persented to us and thats what we agreed on with the doctor.

My obgyn never pushed anything on me at any time, she gave me the facts, the risks, the pros the cons and allowed my hubby and I to make our own decisions, about birth, about circumcisions everything. My birthing experience was different from what we planned but as with life we need to be flexible and be able to change things as we go. My sons birth was amazing, I feel empowered to just be a mama to a healthy wonderfully smart little boy!!!

IMO I don't feel it's safe to have a home birth, so many things could happen and there is no medical professional there to intervene as needed. You could die, baby could die, baby could have brain damage, just so many things could happen that I would never want to happen.

@lisa, your seriously nursing a 3 year old.......when do you plan on weening??? Sorry, I've just never seen anyone nursing a child of that age

Merry - posted on 10/24/2011

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My home birth midwife wouldn't even deliver a breech baby. And she has attended 1700 births!

Merry - posted on 10/24/2011

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I know that Mary, I know the drs are just trying to be careful and not get sued, which s why the mothers have to inform themselves and yell the dr no to unnecessary precautionary stuff.
And as Lisa said, once you see something horrible come out of your trusted doctors mouth it's hard to know which dr you can trust. So, I just take all medical advise with out blind faith and do my best with second opinions if needed as well as common sense and personal research.

Minnie - posted on 10/24/2011

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Oh I know.



I was responding to the generalized comment about doctors being worth their degree, basically. All too often I see mothers doing something "because my doctor told me to." And I've been in the same boat.



It's tough when you're in a position of trusting someone because they're supposed to have all this knowledge. It can really be scary considering that if a doctor is giving out one tidbit of misinformation then what else might be wrong?



All around I've just managed to have really bad luck with them. Until our last trip to the ER. So I'm jaded, naturally. Where I'm left standing is: how do you -know- the doctor is competent?

Sara - posted on 10/24/2011

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And that's exactly what I meant, Sarah. I realize that there are bad doctors as well as good doctors (and nurses, and midwives), but I think most of the time, the information your doctor gives you should carry more weight than internet websites or other people you know who are self-educated. I think it's great to self educate, don't get me wrong, I know I do, but I also know that I don't have the experience or training of a medical professional. And I chose doctors who I think are competent.

Sarah - posted on 10/24/2011

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As you say Lisa, there's "good" and there's "bad"......your personal experiences have led you to be cautious which is understandable, but you do realise that all doctors are that way........so you can't tar them all with the same brush.

I'm not saying that we shouldn't arm ourselves with knowledge, nor that doctors are infallible. I'm just saying that in *most* cases, doctors are highly trained and that it's probably worth listening to them rather than listening to Jane down the road.....or Dr. Google.

Sherri - posted on 10/24/2011

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Lisa you are right a doctor isn't good because of the degree they are great when they do and believe in the same kind of care as you do and has a lot of the same beliefs as you do. That is what makes a great doctor for each individual person and why there are so many to choose from so we can pick the best one for us.

That is why I am in love with my OB he listens to everything I say doesn't blow me off but truly listens and truly is the best doctor for me and to deliver my children. I would honestly trust nobody else.

Minnie - posted on 10/24/2011

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Many DO know what they're talking about, but many don't, either. My mother was an L & D nurse for years and she'll agree.

No, I don't think that doctors are evil. I had a wonderful experience with the medical staff in the ER just last week when Evelyn came down with pneumonia. They were supremely sensitive to her feelings, and mine, asking me to come with her for her chest x-rays.

But I'm not lying when my OB decided to induce me with cytotec, contraindicated against for inductions by the FDA, without informing me of the risks. I was not high-risk, there was no reason for me to be induced. She just said, "we could induce you now, you're a day before your due date, why don't we get that baby out of you!"

She pushed colored pamphlets about circumcision on me, saying that a circumcised penis is "cleaner' and "less likely to get penile cancer." This was just five years ago.

Can you see why I don't put a lot of stock in her medical education? Maybe it was good and she chooses to forget it for money. Who knows.

I hear just as many stories about wonderful OBs. And I believe them. But I don't trust a doctor just because they have a degree. I did that, it bit me in the rear.

Sarah - posted on 10/24/2011

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Just because you've heard a few experiences where the doctors were ill informed, doesn't mean that ALL doctors are that way.



I bet for every experience like that, there's a hundred other stories where everything was hunky dory and the woman in question had no complaints about her doctor.

Merry - posted on 10/24/2011

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That's what's used to think! But if you see how many stories come through here about horribly ill-informed people in the medical community I started to be more cautious about what advise I believe without backup.
My obgyn said if I didn't clamp Eric's cord instantly at birth I'd have to have him held underneath me or risk his blood circulating back into me and causing an infection.
So, yeah, they're humans and they can make mistakes and they aren't required to know how to deliver breech vaginally. If they do their own research they might but it's not something doctors are taught here, they are simply told breech requires surgery

Sara - posted on 10/24/2011

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I just want to add that it's not like having a medical degree or a BSN is a technical degree. They may only be trained in certain ways, but it doesn't mean they aren't educated in natural birth or breech birth or any of the other things that natural birth advocates seem to insist the medical establish do not know enough about. At the end of the day, you can do all the research you want online and in books, but you don't have either of those degrees. You pay doctors and nurses for their education and experience, which I personally put a lot of stock in. In the end, in most scenarios, the final decision is up to you, but it's not as if they don't know what their talking about.

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