You have no idea what you are talking about. Midwives are the best for birth.

Birth is not about "medicine". My wife and I had a "medical" birth that was horrible -- unnecessary interventions leading to c-section. Since then we have had two wonderful midwife births. This article is ridiculous.

This is the stupidest article ever. This guy doesn't know what he is talking about. Lawyers making birth recommendation? What next? I give it a big "S" for S-T-U-P-I-D!.

This article is so ignorant and erroneous it's a little astonishing. I expect this kind of off the cuff generalization from opinion to "fact" with no basis from the freshmen students I teach, not legal professionals.

Homebirth is as safe as hospital birth with far fewer risky interventions. Period.

Midwives are trained and competent professionals. Period.

Homebirths are happening in America, regardless of the author's approval. States are seeking licensure so that women who make this choice can have the reassurance of professional standards and a grievance procedure.

How about you do your homework and then write an article about this issue?

Home birth with CPMs has been shown to be safe in a large, well-designed study published by the British Medical Journal.

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Your comments above reflect the typical and poorly-founded bias of medical practitioners. The bottom line is that homebirth consumers are among the most well-educated and well-informed of all consumers of health services. They have a right to be attended by the practitioner of their choice.

The right to give birth at home with a midwife is an important aspect of women's reproductive freedom. Virginia women are right to demand it.

Wow. Worried about your pocketbook much?

My choice to use a midwife had nothing to do with money and all to do with getting the birth experience I wanted. OBs couldn't do that for me. It is not about money. It is about women taking birth into their own hands where it is safer.

Please let consumers and practitioners comment about hospital vs. in home birth. A lawyer has no place making such blanket statements until he/she has done some research. Right now, in this state, midwife care can be the best option for many low-risk women who otherwise find themselves pushed through the factory-like, fearful of litigation, one-size-fits-all mentality of the hospitals across this state.

Wow, what a breathtakingly ignorant article. And written by a lawyer, no less, OBVIOUSLY someone with LOTS of expertise in medical issues. Note that this appears on InjuryBoard.com, which has as its motto "Promoting safety, protecting rights." Whose rights are being protected here? Obviously not the right of MOTHERS to CHOOSE for themselves (being adults, you know) the safest birth for their babies.

Note at the bottom of this page that this group includes "attorneys, media professionals, safety industry experts, and local activists". Not a single doctor or medical specialist among them! And obviously no midwife. I think all this guy knows about midwifery is what he's seen on TV shows about the 1400s! I guess he doesn't know that countries who use midwives as the first points of care for childbirth have lower maternal and infant mortality and morbidity rates than does the U.S., with its obsession with medicalized birth. I guess he doesn't know that midwives can assist mothers whose babies get the umbilical cord wrapped around their necks or are "too big" (much rarer than is generally believed). I guess he also doesn't realize that, even in the hospital, an "emergency" c-section is not instantaneous, that the room still has to be prepped, the doctor has to be summoned, the anaesthesiologist has to be summoned, the patient still needs the spinal... it takes time. Taking an ambulance to the hospital from home in an emergency doesn't take much more time.

The scenarios he's talking about just don't happen, or are very, very rare. And, for his info., women choose midwives because they are EDUCATED and know that a midwife-assisted birth is more likely to be a healthy, normal one than an in-hospital, physician-assisted birth with its hospital rules and interventions. They don't do it because birth is expensive in a hospital.

For my next birth, I am CHOOSING to do an in-home birth even if I have to pay OUT OF POCKET because my in-hospital, eventual c-section birth was lousy, even if it was fully paid for by my insurance.

"Virginians deserve better medical care...it's not a mystery people....its medicine!"

Are physicians gods? Is that how there is no mystery in physician-attended birth? Is that why physicians have great birth outcomes? Because they are gods?

The real and obvious, although unstated, issue for Mr. Frith is the loss of income for injury lawyers when consumers inform themselves and take responsibility for their own health and for their birth choices.

Your article is poorly written and poorly supported by any factual evidence what so ever. The statement "I see many complicated deliveries where a fetus becomes entangled in the umbilical cord or caught in the birth canal due to the large size of the fetus or the smallness of the mother's pelvis" is ridiculous. As a lawyer, not a doctor or midwife for that matter, you don't see any births at all, either normal, or births in need of assistance.

Midwives, like other medical professionals are trained to deal with birth as a normal part of the life cycle. Women are screen *before* they give birth for risk factors and other anomalies. If they are healthy and low-risk, as are most women, there is no reason why they should not give birth under the compassionate care of a midwife.

Please go back to studying the law, and leave your personal opinions out of it.

Wow!

Thanks to all of you readers for the passionate, constructive, and smart feedback on this subject. It is of interest to me both personally and professionally.

My wife just gave birth to our first child (two weeks ago). After talking with someone who had opted for a home birth, and reading about it in the baby books my wife assigned to me, I raised the possibility of having a home (and drug-free) birth with my wife during the pregnancy.

She declined both, and it was her decision to make. She has a medical background and her father is a physician, so (aside from the fact that it is her body) she was in a far better position to make this decision than I.

In our case, I think it was the right one. We later learned we had a rare (and ultimately minor) complication which may have upped our risk, and I am glad we were in the hospital for the birth.

We narrowly avoided a c-section, and I am very grateful to the wonderful labor and delivery nurses who helped keep my wife out of the operating room that day. I assume that these nurses have experience similar to that which would be provided by a seasoned mid-wife (correct me if I am wrong on that).

That's not to say I don't believe it's a reasonable option for mothers and babies who are at low risk, and who have reasonable access to more advanced medical care if they need it.

I believe home birth with a midwife is a safe alternative for many mothers based on the little bit of research I have done (I did a little more reading today and found lots of books and articles which reference a great number of studies indicating it is reasonably safe, most of which are coming out of countries where tens of thousands of home births have taken place). At the end of the day, we were able to reproduce through thousands (millions?) of years of evolution without the advances of modern medicine - certainly it has to be safe for a great many mothers and babies (I am aware that "died in childbirth" used to be a more common cause of death in years past).

I am of the opinion that despite the incredible scientific and technological advancements found in the modern US healthcare system, Americans are not receiving the most efficient, safe or effective care on average. I don't think hospitals are as safe as I once did, probably because of my experience with InjuryBoard and the many news stories and stories of victims (maybe an unpopular word - but I am referring to those who've had wrong limbs amputated, been given wrong medications, contracted MRSA, etc. in hospitals). This, I feel is also supported by other expert analyses:
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With so many Americans without health insurance, and with many hospitals claiming they don't have enough beds, nurses, resources, etc., to serve everyone (meaning it isn't profitable for them, usually), shouldn't we be considering safer alternatives for procedures like birthing?

I am glad to see such passionate and learned debate on this issues.

To answer some of your suggestions above, however, I can assure you that Dan Frith, whom I know personally cares deeply about the safety of mothers and children - a lot more than he does about some potential loss of income. He also has a very good reputation as an attorney knowledgeable and skilled in medical malpractice matters - hopefully matters you and I will never have the misfortune of facing.

InjuryBoard is, as you say, dedicated to promoting safety and protecting rights. That's exactly why we've gone to great lengths (and considerable investment) to establish a forum for this kind of constructive debate and discussion.

If using a midwife for a home birth is a medically safe option (as I believe it is), then let's ask some reasonable questions:

1) How do we establish standards in determining which pregnancies qualify as "safe" for home birth?

2) How do we educate, train, license, monitor, and regulate the midwife profession (off topic question - are men who do this job also "midwives?" I want to make sure I am using the correct terminology.)

3) How do we establish best practices for this procedure? Certainly not all homes are close enough to a hospital in the event of an intervention, and I imagine there a lot of homes that simply aren't clean enough or safe enough for someone to give birth in).

4) Are midwives held accountable and required to be insured in the event there is a mistake? How many mistakes are too many before someone is no longer qualified?

5) How far can midwives currently go to provide more complicated medical procedures (episiotomies, sewing up lacerations, attending to emeergency situations, etc.)?

I am sure there are a lot more questions to ask and that I've displayed some ignorance as to this subject, but I've also learned a lot more about it thanks to all the commenters. That's one of the main objectives of InjuryBoard.

I have received far fewer injuries from the midwives that attended and assisted my homebirths than I did from the OB who attended my first birth, lied to me, and convinced me to have a c-section so he could go home for dinner. Ever since that fateful labor and "delivery" I have had to fight for the right to use my body as it was intended. There was no good reason for me to be cut open, other than for the convenience of the doctor. Give me a midwife who will sit with me in my home for hours, attending to me constantly, over an OB who pops in for a moment here and there until he gets tired of me and pulls out the scalpel to get things over with.

Wow - an article demonstrating vast ignorance. My first baby - 13 weeks premature because a completely incompetent OB didn't know the signs of premature labor. Fairfax Hospital was a four day nightmare from the moment I entered the triage. Nurses claimed I was lying about how much I was bleeding. My OB took three hours to arrive. No working sonogram machine in the triage so that she could have a visual of what was wrong and from where the bleeding originated. Surgery not terrible, but followed by a reaction to the morphine and NO doctors in the hospital to stop the drip or prescribe benedryl. Nor any doctors on staff at night or on the weekends to continue the order for the benedryl. It was like being tortured. My first roommate smoked in the room - according to the Maternity ward nurses she was allowed to because she didn't speak English. The second roommate's family smoked pot in the bathroom. Again, allowed because they didn't speak English and Fairfax Hospital's smoking ban only applies to English speakers. The result? Mutilated abdomen combined with other problems caused by the c-section with which I will have to live for the rest of my life because insurance doesn't cover repairing abdominal damage caused by cesareans: "It's cosmetic". Life-saving surgery? Yes. Necessary had I had good, attentive care? Probably not.

Following that horrible experience, I did not want another cesarean again, unless it was LIFE SAVING again. Unfortunately, in Northern Virginia, VBAC is not a birth option provided by OBs. All they would offer was a two hour "trial of labor" with labor induced at 36 weeks (AKA premature baby) which would increase my risk of uterine rupture from 1 in 7000 to 1 in 100 and labor augmented by pitocin, further increasing the risk of catastrophic uterine rupture to 1 in 25. As far as I am concerned, such "best obstetric practices" are nothing but institutionalized deliberate malpractice. The ONLY option I had which would allow a safe, intervention-free birth, was homebirth with a lay midwife.

My midwife provided far more comprehensive, detailed care than that provided by either OB. She detailed the risks of VBAC, provided studies from the New England Journal of Medicine and medical text books so that I could make a truly informed decision about the comparative risks of homebirth, VBAC and unnecessary repeat cesarean. After duly comparing the risks, I knew that a VBAC was far safer and lower risk than a repeat cesarean, and homebirth was my only option.

My midwife was wonderful. She came to my house and spent at least two hours with me at each appointment (using the same schedule as my OB had). She did the same tests, but then went far beyond any OB appointment, discussing proper diet, labor preparation and general health at each appointment.

When I went into labor, she was with me throughout the labor, constantly checking me and the baby's heartbeat. Because she had provided such personal, detailed care throughout my pregnancy, she knew exactly how I and my baby were doing. I had a perfect birth with her. It was a long labor, stalled for many hours (which she finally relieved by suggesting a touch of benedryl with a sip of wine so I could sleep and relax). At the end of eighteen long hours, I had a perfect, healthy baby and was up and about two hours after the birth.

My third birth was also a home birth because once a cesarean, always a cesarean in Northern Virginia. Again it was a great pregnancy with the same wonderful midwife. I had another wonderful birth, though in three hours the third time.

If I got pregnant again, I would use the same midwife again; if she were not available I would find another lay midwife. The standard of care was so much higher, the care itself so much more thorough and comprehensive. The births, free of questionable and scientifically proven dangerous interventions.

If women wish to birth with an OB, then do not stand in their way. It is their personal choice. Far too many of them suffer dreadful consequences because of their choices. But, women are actually intelligent humans capable of making informed choices. You have NO right to treat us like a sub-humans, or like children, incapable of making thoughtful decisions about health care. I far prefer evidence-based care from a midwife and I deserve the freedom of choice; it is my free will.

Please THOROUGHLY research midwifery care and talk to those of us who have experienced both before embarrassing yourself hacking out ignorant, ill-informed rants.

I agree that this guy is ignorant about childbirth, as most of us have been at one time. He's just speaking according to stereotypes he hasn't examined. Birth IS a mystery, to hospital-based practitioners more than to CPMs. Hospitals don't know anything beyond epidurals, episiotomies and c-sections. They get freaked out when they hear a woman making real labor sounds and remaining upright like a normal human being during labor.

This article is a good example of the almost total ignorance of midwifery and home births that permeates the United States. So sad, that someone who may be interested in a home birth with a midwife might read this and actually take some of this misinformation seriously.

The greatest regret of my life is the fact that I did not know more about midwives when I was having babies in the 60s and 70s. I wanted very much to have a baby at home but just did not know where to go for help.

Years later one of my daughters came home and had her baby with a lay midwife. It was perfect. So much more relaxed, so much more loving, so much less frightening than a hospital birth. It completely changed my ideas about home birth. Birth is NOT medicine, and should really not be done anywhere near a hospital, if one considers the germs running rampant in todays medical facilities.

It seems that the word mystery disturbed the lawyer who wrote this article. Well....in spite of all we know....in spite of how modern we are...in spite of anything this lawyer thinks he knows...birth is a mystery and a wonderful one at that. There is something horrible about trying to erase that mystery. Hospitals really try hard to do that, too.

My advice to any woman contemplating using a midwife for a home birth is to read everything she can, talk to midwives and women who have birthed at home. Also try talking to some of the women who have NOT used a midwife. Listen carefully to what they say. You will not hear much about mystery, or love, or peace, or privacy, or respecting the woman's wishes in those hospital birth stories.

Also, and this is very sad to say, doctors have a way of trying to convince women that without THEM, there would have been a serious threat to the baby, or sometimes the mother. They seem to thrive on using fear and intimidation to force mothers to give birth according to hospital policy. Birth does not happen according to ANY policy. A lot about birthing involves WAITING for nature to take it's course.

The idea that delivering an unconscious woman of her baby, SLAPPING it's bottom to make it breath and then taking the baby to a nursery to cry alone was the correct way for babies to be born in this country for fifty years was an abomination. It is little better today. One has to wonder what impact that practice might have had on several generations of people who are living today.

Unfortunately many women are deceived into using hospitals by "birthing suites" with pretty wall paper and more "home like" furniture. They think they will get individual care and a nurturing environment in these places. Wrong. It is just window dressing unless the birthing suite also provides a midwife and has no rules about eating food, birthing positions, length of labor, or who can come and go....what about the family dog....(just kidding, sort of). Many hospitals refuse to allow filming of births now, because they fear the film can be used as proof of malpractice later. (and they are right to fear this) Doctors do not always use the best practices that they say they will when they want to hurry a birth along.

Can you tell that I am passionate about this subject? But Please, Dan Frith, if you really care about mothers and their babies as your friend says above, then go talk to some midwives. Talk to mothers who have used them. Listen with an open mind. Most doctors have NEVER seen a normal birth. They have NEVER attended a home birth. Home birth is normal, while it is birthing in a hospital that it is NOT. Once you have seen a home birth, it is very hard to argue against them.

There is a lot of fear of birth because of media misinformation, movies that portray birth as a catastrophe and just plain wrong ideas. Birth is NOT fearful. It is not dangerous either. Has anyone ever compared auto fatalities to birth? I wonder if it isn't more dangerous to drive to the hospital than it is to have the baby at home? (But I admit I have NOT done the research on this, and do not know the outcomes)

Thanks for writing an article that was so outrageously irritating that it got a lot of us to answer it. Now I need to spend time thinking about what we can do to stop people from having such a lack of facts about midwives and home births. Good for YOU!

First of all, CONGRATULATIONS on the birth of your first child. I'm sure this is a very exciting time for your new family, and I'll bet the scary hospital birth you experienced was fresh in your mind when you responded to the comments about this article. We all want to make the best decisions for our babies when we give birth, so I'm sure your comments were well-intentioned. I'm not, however so sure of the author's intentions. It seems to me that the intent of the article was to build fear, and that the author is not knowledgeable about normal birth nor about midwifery.

You'll find the midwifery consumers in Virginia are very well-informed. Many of us choose to give birth at home because we are so well-informed. We decide to give birth at home because we know that true informed choice does not exist in hospital birth. After all, when you're given the same cookie-cutter "care" as every other woman in the hospital, there are no choices that are your own. From wearing the hospital gown to having the IV ("just in case") to continuous electronic fetal monitoring (despite the fact that it doesn't improve outcomes -- it just increases the c-section rate) to being forced to have a repeat c-section because your hospital doesn't "allow" VBACs, there are very few choices at a hospital birth. Pitocin induction/augmentation happens in almost every birth, forcing most moms to opt for epidurals and leading to what can only be described as an obscene cesarean rate in Virginia. Some hospitals, I'm told, have a nearly 75% c-section rate in the Northern Virginia area.

Physicians cause most of the "problems" at births. Why is it that when our babies have problems the physicians create, the physicians are seen as super-heroes for "saving" our babies' lives? It is because we super-value technology in this country. We feel that the more technology we throw at birth, the safer it is. The truth is, however, that birth is about as safe as life gets. When we throw technology at birth, we add complexity to a simple physiological process and interfere with something that happens best when left alone.

Certified Professional Midwives are the only birth practitioners with an internationally-recognized credential requiring experience in out of hospital birth. They are experienced at seeing normal birth in the home setting. They are trained to be watchful observers, much like a lifeguard at a pool. Through their experience, they are able to identify situations when medical intervention might be necessary and will transfer care if it is appropriate to do so.

Homebirth isn't for everyone. The woman has to be willing to take responsibility for her own care and be willing to work in partnership with her midwife. This is a whole paradigm shift from male-oriented hospital-based obstetrical care. There is an emphasis on prevention, rather than on fixing problems. Because midwives attend healthy, low-risk women at home, the women are highly motivated to do all that they can to remain low risk so they can continue care at home, and the midwives do all that they can to help their clients meet that goal.

Here are my answers to some of your questions:

1) How do we establish standards in determining which pregnancies qualify as "safe" for home birth?

As for standards, midwives use evidence-based standards to help advise the women they serve. Women, ultimately, choose where and with whom to give birth. I think in any discussion about who might or might not be "allowed" to give birth at home, it is important to show women the respect they deserve for the ability and desire they have to make the best possible choices for themselves and for the babies they are carrying. Midwives are self-selected by the women they serve. Midwives spend a lot of time helping women become informed about the choices they make with their care. If we first make the assumption that the midwife, as well as the woman she serves, both want the best possible outcome for the pregnancy, we have to assume that they will seek medical management if it is in the best interest of the woman and/or baby's health.


2) How do we educate, train, license, monitor, and regulate the midwife profession (off topic question - are men who do this job also "midwives?" I want to make sure I am using the correct terminology.)

NARM (The North American Registry of Midwives) provides standards for midwifery accreditation. If you want to learn more about this, you can look on their website at More ...

Midwives are licensed by the states in which they practice.

I have not met a male midwife, but I believe there are a few. Personally, I have always seen midwifery as women helping women.

3) How do we establish best practices for this procedure? Certainly not all homes are close enough to a hospital in the event of an intervention, and I imagine there a lot of homes that simply aren't clean enough or safe enough for someone to give birth in).

There are certain standards of practice, supported by evidence, that midwives use to guide their practice. CPMs are required to have practice guidelines and participate in peer review. They are also required to have continuing education as well. They stay up-to-date on research and participate in study groups to keep continually building their knowledge and skills.

As for cleanliness... hospitals are full of sick people! So many people encounter MRSA infections and other diseases when they spend time at a hospital. I would never want to have my newborn baby exposed to those germs. The germs in my home are MY germs. During the course of a woman's pregnancy, she produces antibodies to the germs she encounters, and she passes those antibodies to her baby in utero, as well as through her breast milk.

4) Are midwives held accountable and required to be insured in the event there is a mistake? How many mistakes are too many before someone is no longer qualified?

Midwives in Virginia are held accountable to the Virginia Board of Medicine, as well as to NARM. Their clients are required by law to be given information as to how to file a complaint with both the BOM and NARM. This is something no other profession has to do in Virginia. CPMs do not carry malpractice insurance. They are required to inform their clients of this fact as well. The BOM has the authority to provide disciplinary action against midwives.

5) How far can midwives currently go to provide more complicated medical procedures (episiotomies, sewing up lacerations, attending to emeergency situations, etc.)?

Midwives are trained to perform episiotomies (rarely needed), suture lacerations, perform neonatal resuscitation, perform CPR, administer life-saving medications (prohibited by VA law, but required knowledge for the CPM credential).

I hope that answers your questions.

Sincerely,

Kim Pekin
Student Midwife
Purcellville, VA

We are all allowed freedom of speech in this country...but in my opinion the author of this post is quite ignorant of the facts and the practice. He is obviously speaking from a financially self-serving perspective. Perhaps bad publicity is better than none?

For those of you interested, Dan just made a follow-up post...

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Wow! I'm astonished that the folks who run this board would even allow such an under-educated posting. Where are your facts Mr. Frith?

Just curious how many law suits you have ever seen against midwives...

There isn't much I can say that hasn't already been said, but I would highly recommend you educate yourself. You speak as if a midwife just bops in at the end and catches a baby. Midwifery is about being there for the pregnant mother and educating her on her pregnancy, while monitoring her and ensuring that she has a healthy pregnancy that results in a healthy baby.

Babies getting stuck in the birth canal? What sort of nonsense is that? The reason babies are "too big" are usually attributed to things like poor diet during pregnancy or gestational diabetes, all things that can be identified prior to delivery. And if you want to talk about stuck babies, the primary culprit for that is the epidural which causes a women to lose the sensations she needs to have in order to push properly.

If you're not willing to do some PROPER research before you vomit your bilge onto the internet, take a few hours and watch two films:

The Business of Being Born
and
Pregnant in America.

Both are chocked full of unbiased research, and something your article is highly deficient in...FACTS!

hmm....Midwives a bad idea?

Interesting that research shows that there are FEWER complications when babies are delivered BY midwives in the home setting than when delivered in the hospital. Infant and mother mortality is LOWER with midwives as well.

The common assumption is that midwives are NOT medically competent...when in reality..they are. When emergency situations arise...they are generally able to call them sooner than most labor nurses (the doctor doesn't sit in there anyway) and are able to get the help needed for the mother and child sooner as well.

"Home birth with CPMs has been shown to be safe in a large, well-designed study published by the British Medical Journal.

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This study, like most, shows that home births had death rates three times the control (and they got to pick the control any way they wanted, mind you).

The article clearly shows this. They did what midwives always do to show "safety". They drop deaths by making excuses.

The excluded stillbirths. This is where midwifery death rates are concentrated, because they are so bad that the babies don't make it to birth alive.

They always claim they have "fatal anomalies". The problem is the rates of these anomalies in the US population is a known quantity. For these midwives to have so many in their relatively small sample? The chances are absolutely astronomical. The bottom line? The baby doesn't breath at birth (10% don't), the midwife really doesn't know how to use that intubation equipement she brings as a prop, she lies and tells the mother it was a fatal heart defect. The parents have had friends and family tell them for 9 months not to do this at home. They can feel guilty and stupid or they can swallow the midwife lie and believe going to a hospital wouldn't have made a difference.

Lastly, this data was all self-reported. Many midwives run out the back door when the ambulance pulls up and make it look like an unassisted birth.

Midwives kill for money.

OK, how many of you were alerted to this post by a midwife (doula) or midwifery (doula) organization?

Creating the false impression of concensus on message boards is yet another of midwifery's prime skill -- deception of moms.

PS Your victims don't have a listserve.

Wow you should really look up more information before you go on spouting out like that. If you look at the research you would find midwives only do low risk births and actually have better outcomes than medical doctors. More ...