Thursday, February 6th, 2014
Giving birth at a hospital–even under the care of a midwife–is less likely to result in infant death than giving birth at home, according to new research conducted using data from the Centers for Disease Control and Prevention. The take-away from the study is not that women should avoid holistic care options like midwives and doulas, but that they should think twice about giving birth at home. More from Time.com:
A new study from researchers at New York-Presbyterian/Weill Cornell Medical Center presented at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting, in New Orleans, found a growing rate of newborn deaths associated with home births.
That’s disturbing because the practice is becoming more popular in the U.S. In 2012, the CDC reported that after declining from 1990 to 2004, the rate of home births has increased by almost 30% from 2004 to 2009 (the latest years for which numbers are available).
Using CDC data collected from 14 million infant births and deaths, the research team learned that the rate of newborn deaths was greater for home births delivered by midwives (12.6/10,000 births) compared to births delivered by midwives in a hospital (3.2/10,000 births). The death rates were even greater for first-time mothers having a midwife delivery at home (21.9/10,000 births). Births in a hospital–even if delivered by a midwife, were still safer than home deliveries.
Taken together, there were about 18 to 19 additional newborn deaths from midwife home deliveries compared to midwife hospital deliveries. If home births by midwives continue to increase at the current rate, the researchers suspect that newborn mortality could almost double from 2009 to 2016.
Based on these findings, the scientists say that expectant parents should be aware of the risks of home births, and doctors should strongly encourage women who want to use midwives to deliver at a hospital. Many families choose home births because they believe that having their baby at home is more comfortable for both mom and baby; to accommodate them, hospitals could make their birthing experiences more welcoming and relaxing for mothers.
Image: Woman laboring at a hospital, via Shutterstock
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Friday, December 6th, 2013
Though they are far from typical, male doulas–professionals who help women through pregnancy and with labor and delivery–are seen more and more at hospitals across the country, The New York Times reports:
Meet David Goldman of Bellingham, Wash., the … “dude-la”? Mr. Goldman was certified as a doula last year by DONA International, the largest accrediting body of doulas worldwide. Although the group doesn’t track how many men have completed the training, officials there are aware of just a handful of male doulas among the 8,500 birth attendants it has certified since launching two decades ago.
The scarcity of men reflects a widespread perception that the role of a doula is seen as women’s work, even among many who wouldn’t hesitate to champion egalitarianism elsewhere in the workplace. Indeed, the topic of male doulas frequently draws skepticism — and sometimes biting criticism — in online discussion groups.
Some women say the presence of another male in the delivery room would just stress them, or their husbands, out. Others say that only women who have gone through the birth experience themselves can properly serve as birth assistants. Women are also typically seen as more nurturing than men, and thus better able to fulfill the emotional requirements of a doula’s job description.
A recent thread about male doulas on the DONA Facebook page showcased the sensitivity around this issue, drawing some uncharacteristic “disrespectful commentary,” said Sunday Tortelli, the group’s president and a doula in Cleveland, with many commenters saying it just didn’t “feel right.”
But Sharon Muza, who has instructed three men in the nearly eight years she’s been training doulas, among them Mr. Goldman (the other two men went on to become midwives), said that “men can be nurturing and caring and loving and bring every quality I would want in a doula.” She also noted that men may have a physical advantage. “They’re really strong and can apply counterpressure to a woman’s back or support someone who needs to be held up. That’s a wonderful bonus.”
Image: Male nurse, holding newborn, via Shutterstock
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Thursday, August 22nd, 2013
A new research review finds that women who receive consistent care from midwives during pregnancy have better outcomes than those who see family doctors or obstetricians. This review, conducted by the Cochrane Library, found that moms who saw midwives were less likely to need medical interventions or to give birth prematurely.
More from The Huffington Post:
The reviewers looked at 13 trials of more than 16,000 women who saw a small team of midwives throughout their pregnancy, or one primary midwife. Eight of the trials included women who were at low-risk for complications during pregnancy and birth, while five included higher-risk women. All of the midwives were licensed in their respective countries, and none of the trials looked at home births.
On the whole, women who saw midwives throughout their pregnancy were less likely to have an epidural painkiller, an episiotomy (an incision made from the vagina to anus during delivery), or a delivery using instruments, such as a vacuum or forceps. There were no differences in Cesarean birth rates.
Women who received continuous care from midwives also were less likely to have a baby before 37 weeks of gestation, or to lose their babies before 24 weeks.
Notably, higher-risk women who saw a midwife as their point-person did not have worse outcomes than low-risk women — a discovery the researchers interpreted with cautious optimism.
“This is an important finding, because it means that midwives have something to offer women who are not low-risk, when they are coordinating care with a primary care physician or an OBGYN,” argued review author Jane Sandall, with the division of women’s health at Kings College, London.
For now, the researchers can only guess why continuous midwife care seems to confer important benefits.
“Having someone who is there for you, who you know is going to be there at your birth is important to women,” said Sandall. “Because women know their midwives, and they’re often easier to get in touch with them, the midwives are picking up any problems sooner and helping women get the right specialist input as early as possible.”
Image: Newborn baby and mom, via Shutterstock
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Monday, June 25th, 2012
A new study from the Centers for Disease Control and Prevention is reporting that nurse midwives are more popular among pregnant women than ever before, with 8.1 percent of all the births in 2009 being attended by a midwife. Thirty-nine states have seen an increase in the number of midwife-attended births, according to the study, which was published in the journal Journal of Midwifery & Women’s Health (JMWH).
“The growing number of midwife-attended vaginal births in the United States may be a reflection of the increasing recognition of midwives’ expertise in the management of labor in vaginal births. As many mothers express their concern with the high cesarean rate in the United States, it is likely the demand for midwives will continue to rise,” said the JMWH report’s author, Eugene Declercq, PhD, Assistant Dean for DrPH Education at the Boston University School of Public Health. “While still far below the rates of midwife-attended births in other industrialized countries, this is nonetheless good news for those mothers who want the choice of a midwife as their prenatal care provider and birth attendant.”
Image: Midwife with pregnant woman, via Shutterstock.
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Monday, June 18th, 2012
A feature in The New York Times tells the story of midwifery in New York City, once relatively uncommon but now bone fide “status symbols” on par with trendy preschools and high fashion. From the Times:
Are midwives becoming trendy, like juice cleanses and Tom’s shoes? It seems that way, at least among certain well-dressed pockets of New York society, where midwifery is no longer seen as a weird, fringe practice favored by crunchy types, but as an enlightened, more natural choice for the famous and fashionable. “The perception of midwives has completely shifted,” said Dr. Jacques Moritz, director of the gynecology division at St. Luke’s-Roosevelt and a consulting obstetrician for three midwife practices. “It used to be just the hippies who wanted to go to midwives. Now it’s the women in the red-bottom shoes.”
And like any status symbol, a pecking order has emerged. Just as getting your toddler into the right preschool requires social maneuvering, getting into a boutique midwifery clinic has become competitive.
“We constantly have to turn women away,” said Sylvie Blaustein, the founder of Midwifery of Manhattan, a practice on West 58th Street that has its share of well-heeled clients. Opened in 2003, the practice now has six midwives on staff. “Because of the quality of care, we can only deliver about 20 babies a month.”
“It sounds bizarre,” Ms. Blaustein added, “but midwifery has become quote-unquote trendy.”
Image: Pregnant woman, via Shutterstock.
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