It is on my Netflix list, but won't ship until Feb 8 I think.

"the medical industry has turned childbirth...into a business"

Definitely!

Even the practice of women delivering babies on their backs in hospitals is done for the convenience of the doctors, this isn't the best position for women to be in for delivery... and don't even get me started on the drugs they give, although they absolutely help manage the pain they also slow down the birthing process and take the control away from the woman (she is less able to push and to regulate the speed of the delivery).

Ahh man, I really want to see that movie. A good friend of my boyfriend's is expecting her second child and she told me that at the hospital where she delivered the first child, the doctor told her 80% of women were induced to suit the doctor's convenience. I was enraged and disgusted by this, but my boyfriend thought it was ok because of high demands on doctors. I really want to watch this movie with him! Also, kudos to NH. Women have been delivering babies with the help of midwives for millennia at home and it's great that women now have that (much cheaper) option covered by insurance.

I cannot remember what group was sponsoring it, but I saw "The Business of Being Born" at the University of South Carolina back in November. The film was very well done, and it really did open my eyes in so many ways. There was a panel discussion that followed that included a Certified Nurse Midwife, a law professor, a Women's Studies professor, a woman who had a vaginal birth after cesarean, a woman who has had home births after cesarean, and someone else, but I cannot remember who the other person was. Quite a compelling film really, and I know I spent a lot of time after thinking about how we should all be more proactive when it comes to our medical care and given more choices, be it when going through childbirth or other issues.

So, as I've commented before, I have very strong feelings about this. If there is no certification for midwives, insurance companies should NOT have to cover them. I would support this measure if it applies to midwives who have been certified, accredited, whatever. While many are skilled professionals, there are also people who have no clue what they're doing. Sadly, a family friend's daughter lost a full-term, perfectly healthy baby because the midwife did allowed the woman, a first-time mother, to be in labor for 36 hours with an 11-lb baby. The infant was so beat up during the birth that he was died.

While I certainly support women's reproductive choices at every step along the way and recognize that birth has been going on for, uh, tens of thousands of years, I think it is so freaking naive to say it's "not a condition that needs to be treated". Until the last 60 years or so birth was a major cause of death everywhere in the world. Now it's only a major cause of death in the developing world. Arguing about how horrible hospitals and doctors are is a first-world problem - millions in developing nations are dying because they don't have the same access we do.

From the linked article: "Supporters noted that the federal government reimburses women for home delivery under the Medicaid program."

Did not know that. Very cool. And I would totally support this bill.

I think that every time a bill is introduced to give women more options when it comes to childbirth it's a great thing. I recently found out that my province has started covering the hiring of midwives with our provincial health insurance. Now women here can have a midwife assisted birth paid for through their taxes, just like they can with a physician assisted birth.

Haven't seen the movie, although I will look into it now :)

I've had two children born with my midwife, but both were in the hospital. The second one was without an epidural (go me!)... but even if I decide to have another, I'm not sure that I can see doing it at home. I would like not having nurses and equipment hovering around, but I also like the "safety net" in case anything does go drastically wrong and surgical intervention is necessary.

But, whether it's a home or hospital birth, I can't recommend midwives enough. The OBGYN at the hospital was pushing for me to get a cesarean when my first labor reached 36 hours (it took 4 more for my daughter to arrive) and the midwife told him he was being ridiculous. I don't know if I could have made an informed decision at that point, with the pain I was in -- she stepped in, represented my interests, and kept me out of surgery. And she was completely right.

My significant other and I live in NYC, and the options for natural birth are limited. A lot of the midwife centers are closing down. We ended up choosing the one hospital in town that has a 'birthing center' where the practice is natural, wait-and-see, and non-interventionist. But it was tough.

Haven't seen the movie, but Naomi Wolfe's Misconceptions makes a lot of the same points. It's a chilling but necessary read for anyone considering having a baby.

@MyBabyPanda: I agree that there should be basic certification. My midwife was a CNM (certified nurse midwife), and personally I can not imagine using somebody who did not have medical training. I do not feel that pregnancy should be seen as a disease or something to be gotten over as quickly as possible; however, there are hundreds of dangers for mother and child which SHOULD be monitored by medical professionals. Luckily there is a middle ground between "old granny in the village who is also a midwife" and "full-fledged doctor/surgeon"...

This is so sad. The same goes for breastfeeding. So many women are given the wrong information leading them to think they can't breastfeed. All for the profit of some huge corporation.

Here in Germany, where I delivered my twins, having a birth without midwives is unthinkable. In fact, there was not one doctor around the entire time I was in labour until my twins absolutely had to be delivered by c-section due to wrong positions.

Also, the -government paid- health insurance pays for your midwive to come to your home and take care of you before and after delivery.

This is so sad. The same goes for breastfeeding. So many women are given the wrong information leading them to think they can't breastfeed. All for the profit of some huge corporation.

Here in Germany, where I delivered my twins, having a birth without midwives is unthinkable. In fact, there was not one doctor around the entire time I was in labour until my twins absolutely had to be delivered by c-section due to wrong positions.

Also, the -government paid- health insurance pays for your midwive to come to your home and take care of you before and after delivery.

I just wanted to point out that there is no significant difference between the track record of direct-entry midwives and CNMs. Their route to midwifery is different, but direct-entry midwives are no less professional then their CNM counterparts.

Erica B -

Agreed. I think midwives also need to know when they do need to get a doctor, and women planning for a home birth need to discuss with their midwives a plan for if something goes wrong. Where to go, who to see, etc.

Birthing centers adjacent to a hospital or actually within a hospital make me far more comfortable, because medical help is right there if the woman or the baby needs it.

While birth doesn't need to be unnecessarily medicalized, I don't think we should romanticize it either and forget that it can cost women and/or babies their lives.

Thanks for posting this news Vanessa! It's really exciting.

The Business of Being Born is a great movie (you can see more about my thoughts on www.radicaldoula.com) and this a big step for homebirth midwives.

It's a little absurd how agencies in the US have not caught on to the midwife secret. All over Europe and even in Japan midwives deliver the majority (over 70%) of babies. It's cheaper, safer and better for moms and babies.

To clarify re: certifications, "lay" midwives, etc. There are three basic paths to midwife practice in the U.S.:

1. CNM: Certified Nurse Midwife; nursing degree plus midwife degree. Seems optimum, but is very expensive/time consuming to get both degrees; also CNMs are under the control of OBs; in most places, they cannot practice without a designated OB backup--so if the OB is anti-VBAC or anti-homebirth (as most are), the CNM cannot attend those births. Usually seen in hospital/birth center settings; may or may not be all that supportive of "natural" births.

2. CPM: Certified Professional Midwife; requires extensive schooling in an accredited program plus a long apprenticeship under another midwife(ves) plus passing a certification exam and keeping license current. Not legal to attend births in all states, about 37 at the moment I think. Not req'd to have OB backup, so usually the ones who attend home birth, sometimes have birth centers/spaces in their own offices. Training includes CPR (duh), basic triage management, some medication administration (Pitocin to slow down postpartum bleeding)and a very thorough knowledge of when a birth is not going well/transfer to hospital is needed. (NY State has a special designation CM: Certified Midwife that is very similar to CPM).

3. Lay midwife: may have schooling or simply apprenticeship experience, or both; not licensed, but, depending on their training, not necessarily less skilled or knowledgeable than a CNM or CPM. I would point out that it was lay midwives who preserved what knowledge current midwives possess of natural birthing techniques; however much we value training and certification (and I do) we should honor their role in keeping midwifery alive for most of the 20th century.

Thanks for posting this news Vanessa! It's really exciting.

The Business of Being Born is a great movie (you can see more about my thoughts on www.radicaldoula.com) and this a big step for homebirth midwives.

It's a little absurd how agencies in the US have not caught on to the midwife secret. All over Europe and even in Japan midwives deliver the majority (over 70%) of babies. It's cheaper, safer and better for moms and babies.

I work at a hospital and here midwives deliver over 60 percent of births-- but we're very unique, and a real exception to the norm. Midwifery should be encouraged and celebrated.

Annajcook, direct entry midwives can be awesome, but I'm skeptical of unlicensed midwifery-- to be a CNM you have to uphold certain standards, you have to keep your nursing license, etc. Is there a way of licensing direct entry midwives? I can't remember, but if there isn't there should be.

I remember thinking about home birth when I was pregnant and deciding that, considering where I lived (half an hour from medical treatment if something went wrong) it wasn't practical. Then, of course, I went into preterm labor, lost all my choices, and had, generally, a bitch of a time. (Highlight: fighting over not wanting an epistiotomy with both the resident delivering the baby AND the chief resident, who both seemed to think I was an idiot for not wanting to be sliced open. Later, I had almost no tearing at all. Did they apologize? Oh hell no.)

Hospitals really can treat women like pieces of meat and problems waiting to be solved. But there are good ones out there too. I think if I could make the world better, I'd have women deliver at hospitals-- but good hospitals that respect women's choices and don't see every deviation as a pathology.

CUNY Law's Advocates for Students with Kids is screening of "The Business of Being Born" on Jan. 31 2008 with a panel of childbirth experts and activists to follow.

The film starts at 6:30PM in the Auditorium at CUNY Law, 65-21 Main St. Flushing, NY

($10 suggested donation to benefit student efforts to establish infant care on campus)
Open to the public! Families welcome! We will have snacks for sale.

This screening is dedicated to the question of how to bring the fruits of childbirth activism within the reach of underprivileged populations. Panelists to include:

Maria Barroso, NYC Chapter Co-Founder, International Caesarean Awareness Network
Haya Brant, NYC Chapter Co-Founder, International Caesarean Awareness Network
Joan Bryson, CNM, Homebirth Midwife
Jennifer Dohrn, CNM, Director of Midwifery Services, Childbearing Center of Morris Heights
Allison Guttu, JD, Equal Justice Works Fellow, National Advocates for Pregnant Women

I wonder, could the US's high infant mortality rate be partially correlated with hospital births?

@fiery_lil'_redhead -- I do know that some countries count infant mortality differently; for example including (or excluding) stillbirths as infant deaths. So that screws up the statistics a little bit and makes comparison more difficult.

Beyond that, however, I have not looked at the numbers recently and can't make a more informed comment :)

MyBabyPanda- This is a huge pet peeve of mine. As others have stated, midwives are licensed and regulated. They are also well educated and trained to o what they do, which is to take care of healthy pregnant women. Those without training do not represent the profession. I have seen plenty of births gone bad with OBGYNs, bad outcome (even death) for babies, mothers being sliced open for no good reason, and yet, no one will condemn the medical profession. Yet you know of one bad (actually, pretty fucking horrible) outcome with ONE midwife, and our ready to write off the whole profession.

MyBabyPanda- This is a huge pet peeve of mine. As others have stated, midwives are licensed and regulated. They are also well educated and trained to o what they do, which is to take care of healthy pregnant women. Those without training do not represent the profession. I have seen plenty of births gone bad with OBGYNs, bad outcome (even death) for babies, mothers being sliced open for no good reason, and yet, no one will condemn the medical profession. Yet you know of one bad (actually, pretty fucking horrible) outcome with ONE midwife, and you're ready to write off the whole profession.

Firey 'lil redhead, I believe our infant mortality rate is embarrassingly high, but not our stillbirth rate-- infants, IIRC, being children under 1 year of age.

I think it's really cool the CUNY students are doing the showing and using the donation to pay for child care. Yay!

Homebirths delivered by midwives are required to be covered by insurance and Medicaid in Florida. So are out of hospital births in birthing centers attended by midwives.

I have heard the Ricki Lake movie is fantastic. I have yet to see it, but it is way up on my list. Med school is sucking up most of my screen time.

One of my hopes as a doctor is to be able to do homebirths without jeopardizing my license or insurance.

MyPandaBaby:
No, criticism of technocratic birth is not a first-world issue. For example, Brazil has some of the highest rates of C-section in the world (like 95% in many hospitals) and a correspondingly high maternal mortality rate. Certainly human childbirth has risks, but the question is what really reduces them. Evidence suggests that pretty simple, low-tech methods will radically reduce maternal mortality. Trained midwives are both the most effective way to reduce risks to women and the cheapest--which is crucial in poor countries.
Fiery lil redhead: yup, there's convincing evidence that hospital births, and especially our C-section rates, play an important role in the U.S.'s rising maternal mortality rate. The Netherlands, with a C-section rate under 10% and a home birth rate of 30%, has among the lowest maternal death rates in the world, and according to Marsden Wagner, formerly of the WHO, every European country with a lower infant mortality than the U.S. uses midwives as the only attendants for at least 70% of births.

MyPandaBaby:
No, criticism of technocratic birth is not a first-world issue. For example, Brazil has some of the highest rates of C-section in the world (like 95% in many hospitals) and a correspondingly high maternal mortality rate. Certainly human childbirth has risks, but the question is what really reduces them. Evidence suggests that pretty simple, low-tech methods will radically reduce maternal mortality. Trained midwives are both the most effective way to reduce risks to women and the cheapest--which is crucial in poor countries.
Fiery lil redhead: yup, there's convincing evidence that hospital births, and especially our C-section rates, play an important role in the U.S.'s rising maternal mortality rate. The Netherlands, with a C-section rate under 10% and a home birth rate of 30%, has among the lowest maternal death rates in the world, and according to Marsden Wagner, formerly of the WHO, every European country with a lower infant mortality than the U.S. uses midwives as the only attendants for at least 70% of births.

MyPandaBaby:
No, criticism of technocratic birth is not a first-world issue. For example, Brazil has some of the highest rates of C-section in the world (like 95% in many hospitals) and a correspondingly high maternal mortality rate. Certainly human childbirth has risks, but the question is what really reduces them. Evidence suggests that pretty simple, low-tech methods will radically reduce maternal mortality. Trained midwives are both the most effective way to reduce risks to women and the cheapest--which is crucial in poor countries.
Fiery lil redhead: yup, there's convincing evidence that hospital births, and especially our C-section rates, play an important role in the U.S.'s rising maternal mortality rate. The Netherlands, with a C-section rate under 10% and a home birth rate of 30%, has among the lowest maternal death rates in the world, and according to Marsden Wagner, formerly of the WHO, every European country with a lower infant mortality than the U.S. uses midwives as the only attendants for at least 70% of births.

MyPandaBaby:
No, criticism of technocratic birth is not a first-world issue. For example, Brazil has some of the highest rates of C-section in the world (like 95% in many hospitals) and a correspondingly high maternal mortality rate. Certainly human childbirth has risks, but the question is what really reduces them. Evidence suggests that pretty simple, low-tech methods will radically reduce maternal mortality. Trained midwives are both the most effective way to reduce risks to women and the cheapest--which is crucial in poor countries.
Fiery lil redhead: yup, there's convincing evidence that hospital births, and especially our C-section rates, play an important role in the U.S.'s rising maternal mortality rate. The Netherlands, with a C-section rate under 10% and a home birth rate of 30%, has among the lowest maternal death rates in the world, and according to Marsden Wagner, formerly of the WHO, every European country with a lower infant mortality than the U.S. uses midwives as the only attendants for at least 70% of births.

My sister in law is about to become a certified midwife and wants to do home births. She highly recommended The Business of Being Born.

I had my daughter in a hospital birth last fall, and it went about as well as you could expect a birth to go. I'm thinking about going with a midwife the next time around, though (if there is one). It was kind of strange to go through such a significant life event and to have little to no control over what happened to me. I think I might like to have some more control (if more pain) next time around.

After going through the hospital birth, though, I really think that having a 'natural' childbirth at a hospital would require an absolute will of steel. I couldn't have done it - just knowing that the OB and anesthesiologist were there made it easy to make the decision to let them take over. And if I had wanted to go without pain medications, I was in such a vulnerable position while in labor that I think it would've been impossible to turn down the temptation of an epidural. So I'm thinking about hitting up a birth center next time around.

I had a hospital birth with my first daughter...the birth itself went ok, it was the aftercare that nearly killed her. All in the name of 'good insurance' my daughter was over medicated, over tested & taken away from me to be 'monitored'...during this she was fed formula against my written wishes and left on her back unattended...she vomited and choked, stopped breathing & had to be resuscitated. To top it off, the nurses did not tell me this happened, I had to read it on her chart.
In the end they didn't find anything wrong with her excluding a slightly elevated billirubin level. I think they were trying to find a way to keep her to watch for aspiration pneumonia, but since they never fessed up to the incident, they couldn't just come out & tell me that.

I think the saddest part...I contacted a lawyer to see if there was anything to be done about the 'killing my child & not telling me part' and he said that because she ended up being ok, there was no lawsuit there...he said i was lucky LUCKY! **CRY**

I had a hospital birth with my first daughter...the birth itself went ok, it was the aftercare that nearly killed her. All in the name of 'good insurance' my daughter was over medicated, over tested & taken away from me to be 'monitored'...during this she was fed formula against my written wishes and left on her back unattended...she vomited and choked, stopped breathing & had to be resuscitated. To top it off, the nurses did not tell me this happened, I had to read it on her chart.
In the end they didn't find anything wrong with her excluding a slightly elevated billirubin level. I think they were trying to find a way to keep her to watch for aspiration pneumonia, but since they never fessed up to the incident, they couldn't just come out & tell me that.

I think the saddest part...I contacted a lawyer to see if there was anything to be done about the 'killing my child & not telling me part' and he said that because she ended up being ok, there was no lawsuit there...he said i was lucky LUCKY! **CRY**

MyPandaBaby:
No, criticism of technocratic birth is not a first-world issue. For example, Brazil has some of the highest rates of C-section in the world (like 95% in many hospitals) and a correspondingly high maternal mortality rate. Certainly human childbirth has risks, but the question is what really reduces them. Evidence suggests that pretty simple, low-tech methods will radically reduce maternal mortality. Trained midwives are both the most effective way to reduce risks to women and the cheapest--which is crucial in poor countries.
Fiery lil redhead: yup, there's convincing evidence that hospital births, and especially our C-section rates, play an important role in the U.S.'s rising maternal mortality rate. The Netherlands, with a C-section rate under 10% and a home birth rate of 30%, has among the lowest maternal death rates in the world, and according to Marsden Wagner, formerly of the WHO, every European country with a lower infant mortality than the U.S. uses midwives as the only attendants for at least 70% of births.

I wonder, could the US's high infant mortality rate be partially correlated with hospital births?

Yep. Check out Marsden Wagner's Born in the USA and Jennifer Block's Pushed. The outcomes for mothers and infants in American have been going steadily UP in recent years, and both of these authors (one of whom worked for the World Health Organization, the other an author for Our Bodies, Ourselves) are convinced that it's due in large part to the over-medicalization of childbirth and maternity care.

Ok CarolynMcC I get it! Just kidding I know the comments get messed up.

I'm not "writing off the whole profession". As you'll see, I said that I feel a lot more comfortable with certification and training, and being close to a hospital or even annexed to one. I think midwifery can be a great choice to keep costs down and keep the birth process simple.

I think what is a first world mentality is the notion that birth is natural, its safe, has been going on since the dawn of time, etc. I feel that the decline in infant/maternal mortality BECAUSE of Western medicine has lulled us into thinking that birth is like, risk-free, when in reality it has been and continues to be a major cause of death. "Natural" doesn't mean safe, risk free, etc.

Midwife isn't for me. If I have a baby I want an epidural if I have vaginal birth, no epistiotomy and I'm undecided on C-section. My mother is a physician and works damn hard, so I do come from a different perspective than many here. I guess if I could get an epidural and have a midwife attendant and a doctor in the building, I'd be pleased with that. But fuck, I don't even know if I want a kid so whatever.

Yay!!!! Wooohoooo, New Hampshire! Way to go!

Women have the right to the kind of care we prefer. We have the right to pharmeceutical pain relief if we want it -- but we also have the right to turn our backs on the male-designed system that so deftly puts women's on their backs and out of control. We have the right to float, to squat, to push, to breathe, or to scream "Get your hands off of me!" and have everyone in the room instantly comply.

Homebirth is an excellent option for women who are healthy and desire it. Studies show that homebirths outcomes are better than hospital outcomes.

After 3 homebirths, I cannot imagine exposing my child to staph or to staff. Hands off my baby!

I'd bet my retirement that fully half of all complications are iatrogenic. But doctors don't say this. They don't tell you when they screw up. If the baby's heart rate drops, they don't say, "Wow, must be all those narcotics we're pumping in your spine." No, they call it distress, up the epidural and slice open the woman.

The field of childbirth is a whole new playing field for institutionalized misogyny.

"@MyBabyPanda: I agree that there should be basic certification. My midwife was a CNM (certified nurse midwife), and personally I can not imagine using somebody who did not have medical training. I do not feel that pregnancy should be seen as a disease or something to be gotten over as quickly as possible; however, there are hundreds of dangers for mother and child which SHOULD be monitored by medical professionals. Luckily there is a middle ground between 'old granny in the village who is also a midwife' and 'full-fledged doctor/surgeon'..."

Yeah, good points.

Also, you might find this discussion on birth options interesting:

http://blog.washingtonpost.com/onbalance/2008/01/birth_business.html

It includes one point I haven't seen in other coverage:

"a few extreme views I disagree with...

"...and that women who have babies without 'intervention' love their infants more profoundly, a judgment I found not merely untrue, but also insulting to mothers with high risk pregnancies and adoptive parents."

For that matter, what about fathers, stepmothers, women who donate ova so their wives/partners can give birth, etc.?

"Women have the right to the kind of care we prefer. We have the right to pharmeceutical pain relief if we want it -- but we also have the right to turn our backs on the male-designed system that so deftly puts women's on their backs and out of control. We have the right to float, to squat, to push, to breathe, or to scream 'Get your hands off of me!' and have everyone in the room instantly comply."

Right on!

"The field of childbirth is a whole new playing field for institutionalized misogyny."

Isn't it an *old* playing field for institutionalized misogyny? For an example: a woman might be infected in the maternity ward, after an obstetrician ignored her requests in a clinical institution. For another example: a girl might get obstetric fistula at home, after a man raped and impregnated her in the institution of marriage.

the medical industry has turned childbirth not only into a business, but pregnancy into a medical condition that needs to be "treated."

Oh yeah. Very much so. There's been a lot of interest in the first part of that, but I find the latter part more interesting. That pregnancy is an illness to be treated. I found that in a very big way when I was pregnant with my second child. I started with a doctor, and felt so medicalized, so 'sick', that I switched to a midwife (ultimately a HUGE mistake. She was a CNM, but a ridiculously bad one. I'd still recommend a midwife though. Just not her.)

I had a set schedule of when I had to come in. I had to pee in a cup EVERY time. I had scheduled blood work for this that and the other. I was sent for NSTs. Ultrasounds. Genetic work if I wanted it. Fingers in the vag OFTEN. Why? NEVER, until I switched to the Evil Midwife, did I feel like I had a choice in those tests. These things were just done this way. The Evil Midwife at least kept her fingers to herself, and 'let' me pee on the test strip, and do my own strep b swab.

That's another thing, these swabs. Why on God's green earth can women not be trusted to do swabs ourselves and hand the swab over? I'll give that to the Evil Midwife, she did that one thing right.

I tell you, if I have another (somewhat unlikely), the next pregnancy will be very different. I will be with a doctor because I'll need another c-section, but I *so* am refusing to do all that testing. It's more stressful than useful. IMO, anyway.

the medical industry has turned childbirth not only into a business, but pregnancy into a medical condition that needs to be "treated."

Oh yeah. Very much so. There's been a lot of interest in the first part of that, but I find the latter part more interesting. That pregnancy is an illness to be treated. I found that in a very big way when I was pregnant with my second child. I started with a doctor, and felt so medicalized, so 'sick', that I switched to a midwife (ultimately a HUGE mistake. She was a CNM, but a ridiculously bad one. I'd still recommend a midwife though. Just not her.)

I had a set schedule of when I had to come in. I had to pee in a cup EVERY time. I had scheduled blood work for this that and the other. I was sent for NSTs. Ultrasounds. Genetic work if I wanted it. Fingers in the vag OFTEN. Why? NEVER, until I switched to the Evil Midwife, did I feel like I had a choice in those tests. These things were just done this way. The Evil Midwife at least kept her fingers to herself, and 'let' me pee on the test strip, and do my own strep b swab.

That's another thing, these swabs. Why on God's green earth can women not be trusted to do swabs ourselves and hand the swab over? I'll give that to the Evil Midwife, she did that one thing right.

I tell you, if I have another (somewhat unlikely), the next pregnancy will be very different. I will be with a doctor because I'll need another c-section, but I *so* am refusing to do all that testing. It's more stressful than useful. IMO, anyway.

I had a hospital birth with a midwife and a epidural. I wanted an at home birth but I did not receve confirmation from medicad about being insured until after my pregnancy and delivery. However, I also feel like I need to point out the other side of the issue, which is that women on medicad who may want to see an OB instead of a midwife are not always given that option. During my pregnancy I was seen by midwives at my local clinic because they had a policy that only high risk pregnant women needed to see a doctor during their check up appointments. I was also turned away from an appointment less then a week before my due date by nurses for being late because of traffic. Medicad only pays doctors and hospitals a standard fee for delivery pushing many OB doctors away from taking care of medicad patients, because they are not paid for taking longer hours or doing c-sections meaning they have to absorb that cost. Another issues with prenatal care currently is a lack of locations and some hospitals being unwilling to take women without insurance. I lived less then a mile away from a hospital with prenatal services during my pregnancy, but they refused to even see me because I was uninsured, despite being labeled as a "clinic" for just about everything else. Prenatal services and deliveries are being bundled up in hospitals that are still willing to take the risks and the costs and many women are losing out and getting further away from the care they need because of it. While I think midwifery is awesome for women seeking the alternative in care, their options may be very limited by current healthcare system and I feel like poor and uninsured women are being pushed into "natural" births that are natural only in the sense that they are being given the cheapest and least amount of care possible, not being seen one on one by midwives like in a typical home birth or birth center delivery and medical appointments.

Here is another issue that is all about CHOICE. Give women the choices and the information they need to choose from among the choices, and then stand back and let her make her own decisions. This is a no brainer.

So, kudos to NH for providing yet another choice.

Now, for a personal story about a smart woman who wasn't given the choice she wanted. Me. With my first pregnancy I researched birthing options and chose what I wanted: a birthing center attached to or down the street from a hospital. Then I looked around my university town for the local version of my choice. Didn't exist. It was a two-hour drive away.

Okay, that kind of pissed me off but I could deal. I got a good recommendation for a group of CNM's (certified nurse midwives) that worked under (and, yeah, it's a hierarchy thing) the hospital-based OB-GYN's. It was only half an hour away in the next town. That's right. No CNM's in my ultra-liberal west coast university town.

I had two babies over three years with this group of CNM's. The first experience was pretty good. No drugs, pretty easy birth AND the midwife completely surprised me by having me pull my baby out myself after his shoulders were born. Talk about an empowering experience. I felt like a superhero.

Second birth was same place (hospital), but a different midwife was on call that weekend. It was a less than satisfactory experience. The midwife didn't give me all the information I asked for, and we just didn't communicate well overall.

Third and last baby comes along by surprise. I have two young children at home, one with autism, and I just feel like I can't make the drive to the next town as frequently as they want you to go for prenatel care. I decide to check out the local OB-GYN's. God, talk about culture shock. I walked in and they immediately began to tell me how my birth was going to be. It was clear that laboring in the tub wasn't something they supported, even though it is my preferred method of pain management. When I told them I wanted to use the tub instead of drugs they laughed at me. Then I told them I had done so twice before. They stopped laughing but didn't stop with the eye-rolling. Prior to me they had never had another woman in their practice who hadn't wanted an epidural. Okay. This wasn't looking good. But I was still thinking that my powers of standing up for myself would get me through this birth doing only want I wanted to do. I would not be bullied.

I took the hospital tour with my husband. I was so busy drinking in the gorgeous mountain views I would have to look at while I walked around during the early part of labor I almost missed the fact that these delivery room nurses were also laughing at my "idea" of giving birth without drugs.

I walked out so angry I was, as granny used to say, ready to chew nails and spit battleships. There is a part of birth that is a head game. I really needed to be able to float my boat of tranquility through labor, and anger-inducing nurses and doctors were *not* going to facilitate that. So I gave up and did what I always swore I would never do.

I went to see a homebirth midwife.

In Oregon there is an accreditation program for midwives who provide homebirth. Also, her assistant is a RN (turned out her husband is my husband's physician, small world). Anyway, to wrap this up. I had a home birth. It went well. The hospital was 8 miles away, but I didn't need it. I certainly didn't miss it with all it's needles and everyone wanted to peek inside my vagina every hour.

It's a weird feeling to do something you said you would never do, and then have to defend your choices to friends and family who question them. When it comes to birth and babies, women, if you choose anything other than tradition people will call you to account for it.

As a birth doula, I second the recommendation of Marsden Wagner's book Born in the U.S.A.

I also highly recommend Henci Goer's The Thinking Woman's Guide to a Better Birth, which supports the fact that obstetrics is the least evidence-based branch of medicine.

Truly, the evidence suggests that, for a healthy, low-risk pregnancy, we should be more scared of biomedical birth than dependent on it. Ob's are surgeons; they are best used for high-risk circumstances, which are most often predictable in advance. Sometimes certified nurse-midwives are too caught up in the medical model as well; which overly relies on technology, technology that often creates more problems than it solves. The countries where midwives (of all kinds) are standard have the lowest infant mortality rates. I could go on and on with the research; check out these books!

As a birth doula, I second the recommendation of Marsden Wagner's book Born in the U.S.A.

I also highly recommend Henci Goer's The Thinking Woman's Guide to a Better Birth, which supports the fact that obstetrics is the least evidence-based branch of medicine.

Truly, the evidence suggests that, for a healthy, low-risk pregnancy, we should be more scared of biomedical birth than dependent on it. Ob's are surgeons; they are best used for high-risk circumstances, which are most often predictable in advance. Sometimes certified nurse-midwives are too caught up in the medical model as well; which overly relies on technology, technology that often creates more problems than it solves. The countries where midwives (of all kinds) are standard have the lowest infant mortality rates. I could go on and on with the research; check out these books!

Two anecdotes --
(1) in re treating pregnancy as an "illness," I had to pass up one job offer because my wife was pregnant, and the insurance carrier for the new job refused to cover the pregnancy, even though it was covered under the old insurance, because it was considered a "pre-existing condition."

(2) -- when we had our second boy, we used a midwife. She had an office in southern Massachusetts, and had patients/clients in Rhode Island who had to travel to her office because use of a midwife was *illegal* in RI at the time. I pointedly did not ask what she would do if a woman went into labor and was not able to get to her office in time.

Two anecdotes --
(1) in re treating pregnancy as an "illness," I had to pass up one job offer because my wife was pregnant, and the insurance carrier for the new job refused to cover the pregnancy, even though it was covered under the old insurance, because it was considered a "pre-existing condition."

(2) -- when we had our second boy, we used a midwife. She had an office in southern Massachusetts, and had patients/clients in Rhode Island who had to travel to her office because use of a midwife was *illegal* in RI at the time. I pointedly did not ask what she would do if a woman went into labor and was not able to get to her office in time.