THE HOMEBIRTH MIDWIFE SAID WHAT??!!

Amy Tuteur, MDThe Skeptical OB

10 Astounding Claims Made by Homebirth Midwives

At the conclusion of this course, participants will be able to:Describe the different types of midwives in the US, their education and trainingSummarize the literature on homebirthExplain the origin of the natural childbirth movementAnticipate the most common claims of homebirth midwivesDebunk the most common claims of homebirth midwives

Commercial Affiliation:

NONE

1. I’M JUST LIKE THE MIDWIVES IN THE NETHERLANDS

1. I’M JUST LIKE THE MIDWIVES IN THE NETHERLANDS

No other country has a 2nd class of midwife

Less education than ALL other midwives

Less training that ALL other midwives Not eligible for licensing in the UK, the

Netherlands, Canada, Australia of ANY other first world country

2. HOMEBIRTH IS AS SAFE AS HOSPITAL BIRTH

2. HOMEBIRTH IS AS SAFE AS HOSPITAL BIRTH

All the existing literature shows that homebirth increases the risk of perinatal death

CDC statistics: homebirth with a non-nurse midwife increases death rate 3-7X

Birthplace Study: homebirth increases the risk of poor outcomes

Oregon licensed midwives: death rate 9X higher than comparable risk hospital birth

Homebirth increases the risk of a 5 minute Apgar of 0 by 1000%.

CDC Wonder Linked Birth/Infant Death File. http://wonder.cdc.gov/lbd.html

Rooks, Judith. Testimony before Oregon Legislature; March 15, 2013. https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeMeetingDocument/8585.

Grünebaum, et al. Apgar Score of Zero at Five Minutes and Neonatal Seizures or Serious Neurologic Dysfunction in Relation to Birth Setting, in press, published online, http://www.ajog.org/article/S0002-9378%2813%2900641-8/abstract

3. PRIMITIVE WOMEN HAVE PAINLESS CHILDBIRTH

3. PRIMITIVE WOMEN HAVE PAINLESS CHILDBIRTH

Grantly Dick-Read made that up A eugenicist worried about “race

suicide” “ The mother is the factory.”

4. COUNTRIES WITH HIGH HOMEBIRTH RATES HAVE LOW MORTALITY RATES

4. COUNTRIES WITH HIGH HOMEBIRTH RATES HAVE LOW MORTALITY RATES

The Netherlands has high perinatal mortality

Low risk midwife birth has higher mortality than high risk obstetrician birth

Irrelevant since homebirth only small % of births in most developed countries

5. CHILDBIRTH IS INHERENTLY SAFE

5. CHILDBIRTH IS INHERENTLY SAFE Childbirth is inherently dangerous 7% neonatal mortality 1% perinatal mortality

6. WATERBIRTH IS SAFE; BABIES WON’T INHALE UNDERWATER

6. WATERBIRTH IS SAFE; BABIES WON’T INHALE UNDERWATER

No primates deliver in water Dive reflex occurs in cold water Multiple deaths due to aspiration Multiple deaths due to hyponatremia

7. PRE-ECLAMPSIA CAN BE PREVENTED & TREATED WITH DIET

7. PRE-ECLAMPSIA CAN BE PREVENTED & TREATED WITH DIET

Brewer diet No evidence to support it

8. BABIES AREN’T LIBRARY BOOKS, DUE ON A CERTAIN DAY

8. BABIES AREN’T LIBRARY BOOKS, DUE ON A CERTAIN DAY

Library books don’t self-destruct Stillbirth rate rises

9. NO ABX FOR GROUP B STREP; PUT GARLIC IN YOUR VAGINA

9. NO ABX FOR GROUP B STREP; PUT GARLIC IN YOUR VAGINA

Or wash vagina with chlorhexidine No evidence for effectiveness Multiple GBS deaths at homebirth

10. BREECH, TWINS, VBAC ARE JUST VARIATIONS OF NORMAL

10. BREECH, TWINS, VBAC ARE JUST VARIATIONS OF NORMAL

“Normal” is anything a midwife can do Midwives reclassify everything as

variations of normal

BibliographyBirthplace in England Collaborative Group. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ 2011;343:d7400. De Jonge A, van der Goes BY, Ravelli AC, Amelink-Verburg MP, Mol BW, Nijhuis JG, et al. Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births. BJOG2009;116:1177-84. Evers AC, Brouwers HA, Hukkelhoven CW, Nikkels PG, Boon J, van Egmond-Linden A, et al. Perinatal mortality and severe morbidity in low and high risk term pregnancies in the Netherlands: prospective cohort study. BMJ 2010;341:c5639.

Amos Grünebaum, M.D., Laurence B. McCullough, Ph.D., Katherine J. Sapra, M.P.H., Robert L. Brent, M.D., Ph.D., DSc (Hon), Malcolm I. Levene, M.D., FRCP, FRCPH, F Med Sc, Birgit Arabin, M.D., Frank A. Chervenak, M.D. Apgar Score of Zero at Five Minutes and Neonatal Seizures or Serious Neurologic Dysfunction in Relation to Birth Setting, in press, published online, http://www.ajog.org/article/S0002-9378%2813%2900641-8/abstract

Jacoba van der Kooy, MD, Jashvant Poeran, MD, Johanna P. de Graaf, MSc, Erwin Birnie, PhD,Semiha Denktas¸, PhD, Eric A. P. Steegers, MD, PhD, and Gouke J. Bonsel, MD, PhD. Planned Home Compared With Planned Hospital Births in The Netherlands; Intrapartum and Early Neonatal Death in Low-Risk Pregnancies. Obstet Gynecol 2011;118:1037–46. Rooks, Judith. Testimony before Oregon Legislature; March 15, 2013. https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeMeetingDocument/8585. Wax JR, Lucas FL, Lamont M, Pinette MG, Cartin A, Blackstone J. Maternal and newborn outcomes in planned home birth vs planned hospital births: a meta-analysis. Am J Obstet Gynecol2010;203:243.e1-8.