Another anti-home birth article was published in this months American Journal of Ob/Gyn. I want to stress that this is an
OPINION piece and not a study. I have already seen many news articles that refer to a new "study" out against the safety of home birth. I cannot link it directly but I am certain it will continue to get lots of play from home birth detractors. This one is specifically written to assist obstetricians in developing arguments and reasons not to support the option of home birth.
Planned home birth: the professional responsibility response. Chervenak, et al.
AJOG Clinical Opinion November 2012
The positions and arguments presented there are worthy of point by point review in the proper forum. For now, here are some of my quick insights:
This is nothing new from Dr. Chervenak. In my opinion he gets lost in his own glow on this subject into which he has put an inordinate amount of time and effort. I am still confused how he places fetal rights above those of the mother in todays society. While I agree that the fetus has rights it would seem the abortion without restriction argument has won the day in the recent election cycle making that argument questionable at best. He cherry picks much of his data and suggests a model of professional responsibility ethics that fits his purpose while excluding the beneficence model he has supported in the past. He still relies on the disputed Wax paper and a lot of data from Southern Australia. I know nothing about southern Australia but I highly doubt it is as filled with proximate medical centers as is Los Angeles County or other large urban areas in America. Quoted rates of transfer from the Netherlands study seem high relative to my own 26 years of experience working with home birth midwives. Nonetheless, a nonemergent transfer, as most of them are, is not a reason to deny a woman the option. I read some of his data and examples and anecdotes and come to completely different conclusions as to the decision process. Clearly, we both have a bias. Chervenak is a bright man who considers his opinions to be truth and unassailable. I do agree with his recommendation that doctors and hospitals become more friendly and nurturing to women and offer a full course of options. Until that day comes, however, there is no place like home as a legitimate choice for some women. Dr. F
I am really pleased to see your response to this article. Thank you for clarifying that it is opinion and not fact.
ReplyDeleteHello Dr F
ReplyDeleteI have just come across your blog, and appreciate your wisdom.
I am an independent midwife in Melbourne (Australia).
We are experiencing growth in interest in vaginal breech birth in major public maternity hospitals.
The deskilling of midwives and doctors in vbb is not going to be easily reversed. Breech vaginal birth should be a competence of every midwife. Obstetricians need skill in vbb too, as well as surgical births, but the nonsense that happens again and again is that women are told they can't have a vbb because the hospital can't guarantee that a suitably skilled obstetrician is present, and of course spontaneous onset of labour means that birth happens at most inconvenient times.
One of the major questions in the exam I sat in 1973, when I studied midwifery, was on spontaneous breech birth. I do encourage all midwives to upskill for breech births.
Thanks, Joy. Retraining will be a major hurdle in U.S. residency programs but advocating for that is necessary and urgent before the skill is lost. Spreading the word about the safety of selected breech delivery is a good start.
DeleteI feel the same. I am an OB/Gyn resident. When I have a baby, I would like the option to give birth at home.
ReplyDelete