LA Times chimes in on rise in Home Birth

July 11, 2011: Writer Olga Khazan highlights the usual pros and cons of home vs. hospital birthing. Some of the usual suspects appear, including some quotes from me.

http://www.latimes.com/health/la-he-home-births-20110711,0,7182324.story?page=1

I did comment to the writer on the story as follows:

Olga, I saw your article today. I think it was objective but there are some clear disputes to some of the statements and facts presented. Risk of uterine rupture is 0.5 % and of those only a small fraction actually end up as disasters. This risk is similar to the risk of requiring an emergency in any mother having her 1st baby according to the NIH study. I am not sure why someone thinks that over 35 is a risk factor for home birth. Your 2 pro-hospital experts continue to espouse the anti-CPM biased position of ACOG but I do not know where else the USC doctor gets his information. As for Dr. Tuteur, did you actually check out her current credentials or did she just tell you her background? I do not believe she is a Fellow of ACOG nor is she practicing. When was the last time she was actually seeing patients? What do you really know about her? She has her web following but is a provocateur who oftens throws vitriol publically at home birth parents and advocates. I have had many encounters with her and have asked her on several occasions to debate. She has never responded even when asked through an academic intermediary. You quote her as saying "all the existing scientific evidence...that home birth increases the risk of death" but then go on to point out a major study that does not. Also, even if you accept ACOGs conclusion of a 2-3 fold increase risk of neonatal death it is still far less than 1 in 1000! You also point out a single tragic outcome from a homebirth but fail to describe multiple similar tragedies occuring in hospitals despite all that technology and often caused by the interventions that push the uterus and baby beyond normal. After our discussions about these issues I am disappointed that you decided to use an anecdote as something against home birth when clearly these things happen in hospitals as well. Just ask my partner. I know you are limited by the number of words you can write so I do understand your position. I hope you understand mine. Maybe someday you can sponsor a public forum where Drs. Ouzounian and I can debate. All the best to you, Dr. Fischbein

I think the recent increase in stories and publicity about home birth is a sign that the public interest is rising. Watch for those opposed to raise the canard of safety and push back with fear based rhetoric. Dr.F

On Informed Consent by Dr. Fogelson

Another good essay by my friend and colleague, Nick Fogelson, MD on the pitfalls of the current surgical informed consent process. I encourage you to check it out at:

http://academicobgyn.com/2011/06/20/on-the-surgical-consent-process/#comment-2850

Bottom line: Doctors and patients should maintain a good professional relationship which, much to the chagrine of the "boundary" fanatics, must cross into the realm of personal insomuch as trust and nurturing and a sense that there is real caring are the best legal protection against an unforseen outcome. As you know, I believe that the continued march toward shift medicine, hospitalists and electronic medicine will only magnify the inevitable errors that will occur and there will be no face of responsibility. Sadly, the "impersonal" model is a much better formula for patient dissatisfaction and inevitable law suit. Until some miracle happens I will continue to preach the path to government endorsed managed healthcare is bad for patients and health care providers but good for lawyers. I do hope I am wrong. Dr. F

HBAC in Water

June 16, 2011: Her first birth story was a nightmare filled with fear, unprofessionalism and coldness that is one I hear all to often. Ending in an "emergency" c/section in the pushing phase with little humanity or respect for family wishes was not what this woman had envisioned. What a difference from the events of today. Desirous of a nurturing environment for her VBAC and with a trust in the process that comes from education and faith, this marvelous woman delivered at home in water in her own living room held and surrounded by husband, family and the Birthing Instincts birth team.
www.birthinginstincts.com

There is another way to give birth that respects both woman and process. Individual demand is the catalyst that will lead to a change in the system. It has to be. Congratulations to all who witnessed this blessed event. It was an honor to be accepted as a part of your family. Dr. F

SOGC Understands

In celebration of the International Day of the Midwife on May 4th, 2011, the Society of Obstetrics & Gynecology of Canada (SOGC) has put out a news release calling for more collaborative care for pregnant women. The president of SOGC has this to say:

“The SOGC acknowledges that it is the mother’s decision to decide where she would like to give birth,” stated Dr. André Lalonde, executive vice-president of the SOGC. “Most babies are born without serious complications. As ob/gyns, our specialized training allows us to address the unique requirements of high-risk situations. What matters is that all professions acknowledge each other’s competencies and work together to provide mother and baby with the quality care they need, when they need it, where they want it.”

See the entire press release at:

http://www.sogc.org/documents/medInternationalDayOfTheMidwifeENG110504%20(2).pdf

Long Distance VBAC

On June 4th, just after sunrise, I was honored to particpate in the birth of a beautiful baby boy to a delighted couple who traveled down from Oregon to have their baby at the Sanctuary Birth Suite. Mom had a c/section with her first child and when it was difficult to bring the baby through a low transverse incision her physician had to "T" the incision to accomplish the delivery. Because of this incision her operative report stated that a repeat c/section should be recommended. She had a midwife in Oregon but could find no doctor willing to back up her desire for a VBAC. The couple researched her options and found me through the internet. After corresponding for a bit they decided to travel down and meet the team. We all hit it off and upon reviewing the records I did not see a reason she should be forced to have a repeat c/section and felt an attempt at VBAC was reasonable. In my training we often allowed women with low vertical c/sections to have a trial of labor with good success. This is not the same as a classical c/section. At 36 weeks she moved the family down to Los Angeles and just 2 days after her due date went into labor. Less than 12 hours later she gave birth to an 8 pound, 7 ounce baby brother.

We were honored that she chose to educate herself in the risks and benefits of all her birth options. This is a right that belongs to all pregnant women. That there was no one she could find in the entire state of Oregon to support her is tragic. This is a trend that I hope can be reversed by truth and example and loud word of mouth. Dr. F

You must watch this!

Andrew Laming, MP attacks Labor's sneaky attempt to snuff out home births in Australia. The liberal party in Australia wants to outlaw home birth. Yes, the liberal party. The one that favors abortion rights but decries home birth rights. Three cheers for Mr. Laming who makes a compelling argument for choice.

http://www.youtube.com/watch?v=zNJA4k-2OkI&feature=share

How headlines are often deceiving!

In the April 2011 edition of the American Journal of OB/GYN Dr. Wax responds to many of his critics in the letters to the editor section. Hope you can find it at www.AJOG.org

My comments to this were part of a conversation I had with my colleague Nick Fogelson in South Carolina and were as follows:

So much to say but will summarize. Everyone has bias. I do feel comfortable, however, with Wax's contention that he had none when setting out to do his study. His last point, that most criticism comes from birth choice advocates, is a bit silly as not much criticism would be expected from hospital birth advocates in a paper that is not critical of hospital births. That Wax concludes there is an increased risk of neonatal mortality of 1 in 1,333 in home vs. hospital birthing does not seem worthy of all the hullabaloo. Most people would not consider this number to be a reason to or not to have a home birth. So, even if we were to accept his paper as flawless, is this number so substantial as to base an entire ACOG committee opinion on? Not being adept in statistics I cannot comment on the science of his calculations. But if we give Wax credit for being truthful we do have to put some credence in the knowledge and science of those authors of some of the papers he uses who disagree with him as well.
When a headline says a 2-3 fold increase in neonatal death it looks scary. When you see the increased risk is really less than 1 in 1000 its not so bad to many. when I counsel patients on interpreting statistics I often use the example of disease X. Say it has a frequency of 1:1,000,000 last year and this year there were 2 cases or 1:500.000. Both very small numbers. However, advocates for funding of research into disease X can say the rate doubled. Very misleading.
Do you agree that the increased risk is still very small and, if so, why do you think organized medicine is so vehemently against informed choice? The risk of c/section in hospitals surpasses 1 in 3 and yet does not draw close to this much finger pointing from ACOG.

I thought it very important to point out the manipulation of statistics by ACOG to make a point and another way to look at the numbers it deems so impressive in its argument against home birth. Lies, damn lies and statistics! Dr. F