Ya know, I kinda agree with the AMA on this one. Childbirth is a very risky procedure. It necessitates a highly skilled, learned individual to assist the mother and baby. A midwife just doesn't cut it. However, I certainly don't think that women who choose homebirth are criminals. That's why I said that I KINDA agree with AMA.

The AMA is too powerful. It is a professional organization that shouldn't be able to make regulatory decisions like this. That should be left to the Government.

Not that our current government is too concerned with protecting anyone these days.

sapien, can you site reasons for why a midwife "doesn't cut it". Certified midwives are highly skilled and trained in their practice. They aren't just any old Jane off the street.

But I digress, the issue is that the AMA, by making this resolution, is telling all women the only "right" place to deliver is in a hospital setting. And any woman who chooses differently (for a miriad of reasons) are ignorant and/or mindfully putting their babies at risk. Just a cursory amount of research tells us homebirth for non-high risk pregnancies is safe and the AMA is dismissive of this fact and womens' choice.

It necessitates a highly skilled, learned individual to assist the mother and baby. A midwife just doesn't cut it.

Care to site any sources or reasons? Midwives are highly skilled and trained in their profession. It's different from an ob/gyn, but not unsafe or unwise to choose a midwife if a woman has a low-risk pregnancy. The AMA is dismissing all the research that shows a homebirth can be and is safe in the majority of cases. And they are advocating taking the right to choose what setting a woman can deliver in.

sapien:

Home birth is perfectly safe. There is plenty of research to back it up. Just like the original post about the AMA resolution, this is not a debate on the safety of home birth. It is safe, that's a fact. If you don't think a midwife "cut[s] it," then don't give birth at home. Your personal preferences are beside the point.

This is about a powerful organization trying take valid and safe choices away from women.

Sapien: Childbirth *can* be a risky procedure, sure, but not always. If a midwife "just doesn't cut it" than why, for low-risk moms, do babies fare just as well as in the hospital and moms actually do better?

And don't knock midwives as a whole - most are very trained and tested. The WHO recommends moving towards a more midwife-centric standard of care like they do in other parts of the world and away from how we do things in the US for a reason.

I don't think I would choose a homebirth myself, but that's my personal choice (I live near a university hospital with a midwifery center, yay!), not because I think the science doesn't support having safe births at home. I was surprised at this the first time I learned about it, but after reading the literature myself I was won over.

Sapien, a midwife IS a highly skilled individual whose training focuses SOLELY on assisting mothers through the natural process of pregnancy and delivery. They have years of training and apprenticeship underneath their belts, as well as having to undergo a certification process. How much more skilled do you want?

The fact is, the modern medical community (AMA and ACOG) want to treat pregnancy as a though it's an affliction or even a disease. They want women in their doors, at their clinics, giving birth in their hospitals they way they want us to. They don't want to allow midwives, doulas, and mothers to treat pregnancy like the natural process that it is. It boils down to this: if women realize they have more choices and start utilizing them, then doctors won't make as much money off pregnant women. They use scare tactics (something might go wrong, you might be in a lot of pain, THE BABY MIGHT DIE) to make damn sure women stay in hospitals.

For most women, pregnancy and birth are uneventful. Midwives are perfectly trained to handle those cases. They've been doing for thousands and thousands of years, and I have to say, the human race seems to have done well so far with them. Some women do prefer doctors and hospital settings, and some high risk pregnancies might necessitate the use of skilled facilities, but for the most part, it's not needed.

Giving birth isn't any riskier if you give birth at home than at a hospital. In fact, you are much less likely to have a c-section or even die. And you're also much likelier to be more satisfied with your care if you you're attended by a midwife.

And I'm gonna take a stab at this...you're not a woman, are you?

Anyway, I hold to my previous opinion on the subject - fuck the AMA and ACOG. They are putting women's health at risk for the chance at more money. Shame on them.

sapien, as Miriam pointed out, the evidence really does not support the idea that a highly medicalized birth environment is in any way safer for low to moderate risk births.

Miriam has written a great deal on this very topic that you should read, but I just ran a quick search on midwifery on Google scholar and pulled up three of the abstracts in the first twenty hits.

1) Turnbull et al. (1996) in Lancet. UK based study.

2) Rowley et al. (1995) in Medical Journal of Australia.

3) MacDorman & Singh (1998) in Journal of Epidemiology and Community Health. US based study.

The UK and Australian studies found that midwifery was as clinically safe and effective as regular care. Both also found higher rates of satisfaction with midwifery. The US study found that midwifery was clinically BETTER than regular care on measures like birth weight and infant mortality. This is especially significant considering that the US has absolutely horrid infant mortality rates compared to other countries.

The ideal would be a situation where midwives could work in tandem with hospitals so that women who do require medical intervention can receive it, but the US medical system is extremely resistant to this idea.

Perhaps women of low-risk do fare the same with a midwife as the do with a doctor and hospital. But, what about high-risk women? Certainly, they would fare better with the doctor. And, I'm not saying that midwifery should be illegal. I'm just saying it's a bad choice. And, there should be an incentive to not do it.

Also, childbirth is not a “procedure.” A c-section is a procedure; childbirth is a normal, natural process that differs from woman to woman (nothing wrong with a c-section per say, but it is major surgery).

I’m not trying to be an ass here, it’s just that referring to childbirth as a “procedure” or other such terms just helps perpetuate the idea that childbirth should be a hospitalized process. When what it really should be is a woman-led, woman-centered process (in other words, the birthing woman dictates and decides how the birthing process proceeds – whether it is at home or in a hospital).

While I'm not at all impressed by the AMA's... overreaction, shall we say, I think there are some serious problems with the way it's been presented here. In particular, the generalized doctor-bashing bothers me a lot. There are some very conscientious, very feminist OB/GYNs, doctors, and nurses out there. (And, incidentally, the ones at hospitals get a salary. They don't get paid per procedure.) The idea that the AMA wants to "ban" home birth is misleading in itself - the AMA isn't a legislative body; it can't ban anything.

There's also the chorus of "home birth is safe," which is true in many cases. But in many other cases, hospital birth is safer, and women are perfectly capable of making the informed and uncoerced choice to have medical staff on hand. The contempt I've been seeing directed toward medically attended birth here and elsewhere on the feminist blogsphere is just as bad as the medical contempt for midwife-attended birth.

Saipen, you are not listening. No one thinks that high-risk women should have home births. That's like saying sick people shouldn't go to the doctor.

Aside from the high-risk pregnancies no one is talking about and personal preference, *who* exactly is it a bad choice for? I would assume that we would judge this by a) how well the baby comes out and b) how the mom fares and homebirth and/or midwifery practices meet both.

Also, some midwives practice in hospitals. I think something like 10% of US births are attended by them. Do you think that's a "bad choice" too?

ShelbyWoo, thank you for pointing out the biggest part of the argument, at least for me: birthing should be a woman-led, woman-centered process.

And Sapien, some women will absolutely choose doctors and hospitals, and that is okay. But to call midwife assisted birth "risky" or a "bad choice" is irresponsible. A woman should be free to choose how and where to give birth. That is all this is about - letting the women who choose to give birth at home the right to do so without being criminalized for it.

Whoops, flubbed that last link. It should go here.

Sapien - As the husband to a woman who was rushed into a completely unnecessary, not clinically recommended C-Section for our first child and then had a completely drug & intervention free VBAC* with a midwife I can authoritatively tell you you have absolutely no idea what you're talking about. You are spouting the typical "common-sense" nonsense that most people who have never bothered to do the actual research tend to.

*VBAC=vaginal birth after cesaerian. I'm going to go out on a limb and guess you probably never heard of the term, because people who view child-birth as you do typically assume such a thing is not possible.

The US study found that midwifery was clinically BETTER than regular care on measures like birth weight and infant mortality. This is especially significant considering that the US has absolutely horrid infant mortality rates compared to other countries.
Actually, let me attack that statistic for the b.s. that it is.

Remember the joke that everyone who has gone to a doctor has been sick, so the way to avoid getting sick is to not go to the doctor? Same thing here.

Midwives are as safe (for both mother and baby) as hospital births for low-risk women. I seem to recall that it's an appropriate option for about 95% of women.

The women who have at-home births are a self-selected group of healthy women with healthy babies. No kidding, they will fare better than their hospital-based counterparts. The real comparison is between healthy, low-risk pregnancies in at-home birthing and hospital births. (At-home birthing still stacks up, but I'm not sure that it's necessarily correlated with a higher birth weight. I find it nearly impossible to believe that giving birth at home would cause the baby to put on a few more ounces in the day before delivery.)

Second, the U.S. is not any worse for infant mortality than any other country. Let me repeat: we are as good, if not better, than any other country.

We just report differently. If an American woman gives birth to a 21-week-old foetus, it will count as a "live birth." When that child dies, inevitably, he will be an "infant mortality" statistic (and a "low birth weight" statistic). I've looked up the numbers before, but, off the top of my head, most countries do not report "live births" for babies that are under 2.5 pounds (almost all of whom will live). We report all of the babies that are born breathing, with an umbilical cord that shows a pulse, or the like.

If you actually compare outcomes of babies by various birth weights, the U.S. does as well as any other country in this world.

Just a quick note to remind everyone that, as SophiaPriskilla suggested, not all doctors share the mindset espoused by the AMA, on this or other issues. Many of us have made a conscious decision NOT to join the AMA because we disagree with them on many things (not the least of which is their lackluster support for universal healthcare over the years). Know that there are many physicians out there, in all different specialties, who reject the old paternalistic model of medicine and who are working hard to change the system!

Sophia:

People are entitled to their opinions about the medical community (I’ve read the comments here and have seen no “doctor-bashing”). Would you have us ignore the 40%+ c-section rate, the incredibly high intervention rate, or the fact that many women do indeed feel coerced or forced into interventions they don’t want just because some of healthcare providers are nice (and, again, no one here has said anything about doctors or nurses, only commented on the AMA and the medical community at large)?

Lobbying how a good majority of the legislation in this country gets introduced and passed in the U.S.; and while the AMA is not a legislative body, they are going to model legislation and lobby for it (they state as much in the resolution). The AMA is a fairly powerful group, especially if you compare them to the groups fighting for home birth as a legal option.

***************

I cannot recommend watching "Business of Being Born" enough. It's a real eye-opener on how our heath care professionals are trained to handle birth. Does that make the nurses or doctors bad people personally? Of course not. It does mean that the medical community needs to make some serious changes in their approach to childbirth.

Saying "What about the high-risk pregnancies?!" is a red herring. No one is saying ALL women should give birth with a midwife at home, nor is anyone saying that choosing a midwife means you MUST have a home birth. Certainly, if you're in a high-risk group, you should be under the care of a doctor. The studies being cited (and there are many, many more) compare groups of low-risk women; it's not junk science. Nor does the fact that you wouldn't want a midwife-assisted birth (whether or not at home) doesn't mean it's unsafe.

It is also not true that the US is as good as other countries in terms of infant mortality. Again, studies have been done correcting for premature infants (you're not seeming to understand the rigors of scientific studies very well) and the United States doesn't fare very well.

Lastly, higher birth weight is not correlated to giving birth at home, but rather with receiving care under a midwifery model. It's not about home birth, it's about the type of care a woman receives throughout her pregnancy.

You can twist the facts as much as you like, but home birth is just as safe as hospital birth for low-risk pregnancies. The end.

ShelbyWoo: Thanks for the reply. I do think we're going to have to agree to disagree on some things. For example, you've read the comments here and have seen no “doctor-bashing”. I see the problem in the statement itself - "The other trouble with the American MDs..." and "Research evidence be damned, the doctors want to mandate you to go to the hospital. They don't want you to have a choice" aren't acceptable to me.

I do agree that, for example, the 40% C-section rate is too high (among other problems). But I would point out also that poor prenatal care and high obesity rates will keep it high in this country - and there will always be some that are medically necessary. Beyond that, we're going into the realm of anecdotes about women we've known or our experiences. In terms of "The Business of Being Born" - it raises some good points, but I don't take it as the gospel truth. It definitely glosses over the fact that there are some really bad home birth experiences, just as there are some really bad hospital ones. Birth under any circumstances is often complicated, messy, and painful. Home birth advocates (like those in the film) are correct that the medicalization of birth has gone way too far in many respects, but I do feel like it's ultimately less interested in helping women make a fully informed and free choice than in pushing or scaring them toward a particular choice, in this case a non-medical route. I also think that one film alone is an inadequate basis of information. You've got a producer and a director - neither one a midwife or a health care professional - deciding what information fits their interests and including that. That's what documentary films generally do, of course. Don't get me wrong, they're often a very good thing, but one documentary film is not an adequate education on an issue. It's just that that film is so often trotted out in these discussions, to the exclusion of other material, that it can become a bit disquieting.

oenophile, that was a bit much.

But I would agree that there is a generalized doctor-bashing, starting with the comment that the AMA and ACOG members somehow make more money when they do c-sections.

TexasMomma is repeating a common misconception here:

"It boils down to this: if women realize they have more choices and start utilizing them, then doctors won't make as much money off pregnant women."

If a doctor is at a hospital, they get a salary that does not change, period, unless they get a raise. If a doctor is in private practice that's another matter, but the old model of single-doctor practices isn't all that common anymore, and it's even less so for surgeons.

I think a lot of us react badly because the feminist blogosphere *is* full of doctor-bashing. Whenever I see a discussion of birthing it's always the doctors as evil representatives of the patriarchy. It doesn't seem to occur to anyone that the behavior of doctors might be the result of systemic conditions that many of those same doctors would just as soon not work under.

The AMA has been lukewarm about universal health care, for instance, but doctors as a whole seem to think it's a good idea. Part of the problem is the cost of a medical education, which in this country is not free by any means, whereas in other countries it is. So the docs have to dance with the insurance companies and mess around in order to get stuff covered. This adds zero to their salaries so there isn't even an economic incentive to do it. (Think long and hard about that the next time you scream at your doc -- s/he probably fought long and hard to get the insurance company to pay up).

But I digress. I think the issue for many physicians is the idea that being a midwife and a woman grants some mystical magical power. It doesn't. A midwife should be trained with a verifiable paper trail and it should be clear that birthing at home is probably for a subset of women who are healthy with no complications. I realize most states have some licensing requirements for midwives, but last time i looked those qualifications were all over the place.

I'm not for banning home births, but I am for thinking carefully about it. I mean, it isn't like modern medicine was pulled out of the air just for the sole purpose of oppressing women. Yet that's the attitude I see a lot of the time around here.

"The real comparison is between healthy, low-risk pregnancies in at-home birthing and hospital births."

The three studies cited above - as well as the majority of studies done since the 1990's - did just that. Read first, criticize next. Additionally, thanks to my institutional access, I have found several studies done in the past 2 years that are done with appropriate controls or case matching that all conclude that outcomes were better for mother and baby at home than at a hospital.

NOW. The only beef I have is...the "better" is usually marginal; usually only signivicant at type II error range of 0.1 (or 90% confidence). BUT, for some things there was a dramatic improvement in outcome, and those were usually for the mother, such as better recovery time and lower incontinence levels due to much lower incidence in things like c-section and episiotomy. Overall, from the available data, I'd conclude that, for baby, outcomes are about the same; for mother, outcomes are usually better, when comparing low-risk births at home with at the hospital.

Jess - You're right - It's not the doctors performing the procedure who stand to lose money.

It's the hospitals themselves; and the administrators are the ones (who do influence the AMA, let's be honest) who stand to lose. Now administrator and doctor are certainly not mutually exclusive. However it is incorrect to place the blame on individual doctors; really it's the medico-industrial complex that deserves the blame.

That was more than a bit much. People have been banned for less than telling another commenter (who was being civil) to eat shit and then calling them a bitch.

Wow, I didn't know you could call someone a bitch and ask them to eat shit and still request to be taken seriously.

I had my first kid at 21 in the hospital with a midwife, and she had to tell the doctor (whom I'd never met before and who had been in my room a total of 17 minutes thru my entire 16 hour delivery) NOT to give me an episiotomy 3 times. While the hospital gave my idiot 21 year old self a false sense of security, I'm glad it was at least a CHOICE I got to make. Next time around though, I'll exercise my CHOICE and have a home birth, thank you very much.

Geeze! I didn't know that my comment would cause such a stir. If I don't get to your comment, please accept my apology, I just read about 30 replies, so I probably just forgot about it.

First, to Texasmomma, you're absolutely correct, I am not a woman. lol. But, does it matter?

Second, I agree with Sophiapriskilla, the level of doctor/ hospital bashing is off the charts here. In fact, this reminds me a lot of the debate of whether alternative medicine is better than regular medicine. The alternative people almost always claim that the medical establishment is corrupt and is negatively affecting the lives of people.

Third, I have never read any studies about at-home-births. But, there are two things that I know for sure. One, the equipment at hospitals has got to be waaaaaaay better than anything a midwife brings with her to a house-call. Second, the training of doctors is waaaaay better than the training of a midwife. Hell, I'll bet the training of a nurse is better than that of a midwife.

Fourth, oenophile, let's keep things civil, shall we?

Fifth, NthnBrazil, I have nothing but sympathy for you and your wife. Obviously, you both went through a very hard time. But, I stand by my initial response to this topic, at-home-births are a bad choice. But also that it should be just that, a choice.

I'm going to back kissmypineapple on this, Saying this to a commenter:

Oh, you little sweetie pie. 160 IQ, engineering degree - eat shit, bitch, is above and beyond a banning offense, especially when Jessica F. DIDN'T EVEN INSULT her and I'm wondering why none of the feministing bloggers have 1)banned her (finally) or 2)called her out on her shit. While this is probably the worst offense I've read from oenophile it's not the first time she's been condescending to a group of women by addressing them as "sweetie" or some other term used to talk down to a person. A while back I think Ann threated to ban her for using inaccurate medical information so it's beyond me why this hasn't just sent her over.

Sophia:
I recommended a film because it’s a surprise in terms of how our health care professionals were trained to attend hospital births. I did not say the film was final word on the subject nor did I claim that it was completely fair and balanced. And, thank you for the lecture, but I think we are all aware that it’s a just a film and, therefore has some biases . That doesn’t have any impact on the reason why I suggested it. . I said eye-opener…as in it makes you think and want to do further research.
Also, please site some studies that link obesity and poor prenatal care with high c-section rates in the U.S.

Normally, I just ignore oenophile, but that comment was too much to ignore, imo. I agree with kmp and UltraMagnus, a ban is long overdue here.

UltraMagnus commented at June 20, 2008 7:59 PM: "...and I'm wondering why none of the feministing bloggers have 1)banned her (finally) or 2)called her out on her shit."

Well, her shit sure doesn't fit in here. Maybe someone else is afraid of being accused of peer pressure by the "it's always better to not fit in!!!" crowd if she doesn't welcome that shit here?

I also want to add my voice to those calling for oeno's banning.

Oenophile, "My IQ is 160 and I have an engineering degree" does not make an argument. A lot of us have engineering and science degrees, some of us with or working at our PhD's.
I know from experience (having observed many an undergraduate), that getting a Bachelor of Science in engineering does not necessarily give someone an understanding of the scientific method. So really cut it out already. Also, you can't call yourself a scientist (as I've seen you do in the past) just because you graduated with a B.S. in engineering.
If you mention studies to back up your claim you need to properly cite them. I was also wondering ... is it due to your deep scientific understanding that you keep claiming (on other threads) that abortion causes breast cancer?

I guess that supreme understanding of science, biology, neurology, and philosophy must also be why she (?) dogmatically asserts that implanted eggs and fetuses unrefutably qualify for personhood...!

(The fact that she (?) believes eggs "being people" would matter at all, at the end of the day, must point to an equally grand understanding of the democratic system and the human rights innate to the concept of personhood!)

/snark

sapien: ("Second, the training of doctors is waaaaay better than the training of a midwife. Hell, I'll bet the training of a nurse is better than that of a midwife.")

The CNMs (certified nurse midwives) who did my prenatal care and attended my son's birth had completed BOTH nursing AND midwifery training, so their training did not exactly pale in comparison to that of non-midwife nurses. Several types of midwives practice in the US and complete various kinds and amounts of training; an intelligent pregnant woman just learns what all those letters after people's names mean, finds out about individual practitioners' levels of experience, learns about the medical and midwifery models of care and about her own body and situation, and makes an informed decision.

It's also important to think about what we mean by "better" training. By my own standards, my midwives' training and immense experience in helping with unmedicated low-risk births like mine far outshone that of most obstetricians. If we're looking at training in, say, cesarean sections, midwives drop out of the picture--but they're certainly good at figuring out whether a c-section (and hospital transfer) may possibly be necessary. More training does not necessarily equal better training, and it makes sense for individual women to ask questions about HOW and FOR WHAT individual birth attendants have been trained.

I love how every entry about homebirths results in an arguement about if homebirths and midwifes are really safe. Whatever happening to the old abortion arguement about trusting women to make their own reproductive decisions? This is not different. Why can't we trust women to make their own decisions about birth?

"Third, I have never read any studies about at-home-births. But, there are two things that I know for sure."

Eeeeeeh (that's a buzzer) full stop! You know this immediately disqualifies your next two statements, right? One cannot claim COMPLETE ignorance on the subject then state "but I do know 2 things about it". No. Complete ignorance is complete ignorance, despite what you think you know, without ANY evidence. Epic fail.

"One, the equipment at hospitals has got to be waaaaaaay better than anything a midwife brings with her to a house-call."

Define better. More technological? Yeah. It has buttons and lights and buzzers! Better? Hardly. I can tell you not a single thing a midwife brings can cause neonatal seizures, however EFM can and does, yet it's used in over 85% of deliveries. Wouldn't "better" be measured by outcome? And isn't outcome the same between the two groups?

"Second, the training of doctors is waaaaay better than the training of a midwife. Hell, I'll bet the training of a nurse is better than that of a midwife." Ignorance rears its ugly head here. How can you claim to know nothing about homebirth then out of the other side of your mouth claim you know that nurse and doctor training is "better" than that of a midwife? And again, define better. Unless you have extensively studdied the two, like the BMJ and AJOG have, you have ZERO basis for this conclusion. (By the way, most midwives train for longer than nurses do, so better can't even be measured by years of schooling) How would you measure the quality of training? Perhaps by outcome? And, according to all the friggin studies already mentioned in this thread, the outcome is the same in low-risk situations. I can tell you, from OB/GYN friends, that they spend less time learning about their specialty than a midwife does. A doctor spends ~3.5 years in general training, and 6-18 months in specialty training (excluding training during fellowships, which occurs after licensure). Midwife training lasts 2-4 years (excluding apprenticeships which can last anywhere from 3 months to 5 years).

Now, you might have an argument that MD EMERGENCY and HIGH RISK training is better, but you're willfully ignorant and arguing something you're willfully ignorant about, so I wouldn't accept even that argument from you. Maybe from someone informed though.

Sorry about coming into this late folks. Oenophile's abusive comment has been deleted and seriously, please refrain from that kind of language or we'll have no problem banning you.

leah commented at June 20, 2008 11:09 PM: "By the way, most midwives train for longer than nurses do, so better can't even be measured by years of schooling"

Nurses don't all train for as long as each other either, right? Also, what about when a midwife is a nurse?

leah commented at June 20, 2008 11:09 PM: "I can tell you, from OB/GYN friends, that they spend less time learning about their specialty than a midwife does."

Just curious, did they mention anything about any OBs opting to go get midwifery training too instead of limiting themselves to what their med schools and hospitals taught them about assisting birth? Maybe someday there will be OBMs as well as CNMs?

"Nurses don't all train for as long as each other either, right? Also, what about when a midwife is a nurse?"

I'd guess at least six years of specialized schooling with additional training and separate licensing. OTOH, one can be a licensed practical nurse (LPN) in the US with as little as one year of training, or be a registered nurse (RN) with as little as two years of training. Back in nursing school, I read 46% of RNs in the US had associate's degrees. Someone with a BSN in the US has three or four years of training. A master's degree can be had in two years on top of that. Despite findings by the ANA (American Nursing Association) leading them to promote a BSN as a minimum for RNs, I believe hands on experience is more important than pure education. I consider nurses with about 30 years experience to be like gods.

"In the United States, a nurse-midwife is an advanced practice nurse who has specialized in the practice of obstetrical and gynecological care of relatively healthy women. Most nurse-midwives have a Master of Science in Nursing in addition to being a Registered Nurse."

http://en.wikipedia.org/wiki/Nurse_midwife

"Currently 2% of nurse-midwives are men."

[I was outside just now wondering how many there were, pondering my situation as a male in nursing. Even this is hard for me to conceive of (I believe men can do it - I couldn't imagine that they would be accepted by peers, employers, and clients. This despite my highly positive experience studying OB nursing and labor and delivery. Only one mother/partner ever gave me a problem. She 18, he 25, with quite interesting ideas on what kind of care they would accept for her or the baby.

"I'll bet the training of a nurse is better than that of a midwife."

Um, no. I have pride as a nurse, but let me tell you as a working, licensed nurse, it continues to disturb me how easy it is to become a nurse (school, licensing, interviews), and what one is allowed to do as a nurse. I've said this before: at my highly respected school known out of state, we were allowed to practice on live, paying human clients in a clinical setting in our 16th week of class. We were taught procedures through demonstration, and approved to practice through return demonstration. People who did not read the text or workbook in preparation for this training received a stern warning, they were not punished. This initial practice is done on non-human models, such as foam rubber arms for injections. Patient transfers and bathing we did on each other. Whoo hoo.

Time and again, I had to confirm with instructors or even the director of the program, that it was really ok (as in legal and ethical) to do what they/we were doing. They insisted it was. If we had been 100% forthcoming, "Hi, my name is Joe. This is my first time ever doing this sort of thing. Can I give you a live virus vaccine? My teacher said you looked like a good opportunity and I should give it a try." people would be horrified. They'd probably threaten to sue if they heard teachers and students talk shop ("I was so nervous. I didn't know what I was doing."), or saw what was contained in the school's locked student discipline files. (In my school, even the director is not in possession of the key.)

Even if it is a teaching hospital or a teaching situation with a staff nurse, doctor, or nurse instructor standing by, don't be afraid to ask questions, and don't be ashamed to politely refuse. It's not as if I'd allow just any shaky or giggly 18 year olds (16 in Japan) to put their hands on my children or myself, either. I'd give them some shit. "What's that for?" "How does it work?" "What are the five (or six) rights of medication administration?" "What are the signs of an adverse reaction?" "What should I look out for after I go home?" "How common are side effects?" "What should I do if it happens?" "I read in TIME magazine that vaccines cause autism." It's your health on the line.

I'll bet nursewives-in-training tag along on a host of cases with certified mentors, before being allowed to do anything that could affect your health.

I can tell you, from OB/GYN friends, that they spend less time learning about their specialty than a midwife does. A doctor spends ~3.5 years in general training, and 6-18 months in specialty training (excluding training during fellowships, which occurs after licensure). Midwife training lasts 2-4 years (excluding apprenticeships which can last anywhere from 3 months to 5 years).

This is wrong. CNMs complete a 2 year masters program in most cases (some are still bachelors). There is no requirement for apprenticeship/residency.

OB/GYN is a 4 year residency program after med school. CNM programs tend to be based at smaller colleges without academic medical centers, where the number of births is low compared to the "baby factories" that tend to exist at OB/GYN residency programs. CNMs in training dont handle the same volume of patients that an OB/GYN resident does. That results in CNMs giving more one on one time with the mom, compared to OBs which tend to run mutiple births simultaneously and dont spend nearly as much time with each patient.

If you want to argue that CNMs are better trained in terms of spending more time with the mom and providing a more "holistic" birth experience, then I agree. But I dont agree with your asssertion that CNMs get "more" training than OB/GYN residents.

Let me make the point again that I made in the other thread. The reason midwives dont deliver more babies in the US has little to do with the evil AMA/patriarchy and more to do with finances.

Midwives follow the money just like doctors do, so lets not pretend like financial motivation is exclusive to those with MDs after their name. A midwife who chooses to do home births has to pay higher malpractice insurance. Furthermore, their overhead costs are much higher and they are much less efficient because of the time driving to various houses, etc.

Its much more efficient to work in a birthing center or hospital. CNMs make more money there than they do with home births, AND their malpractice insurance is a lot lower.

CNMs are allowed to do home births in all 50 states. A few states bar non-CNM midwives, so-called "lay" midwives from home births but it was the nursing associations who pushed those laws as much as the AMA/ACOG.

So CNMs certainly have the option of doing home births and nothing the AMA/ACOG says or does will change that, but the fact is that 90% of CNMs are opting out of homebirths for the financial reasons I mentioned above. They make more money with less overhead and less malpractice insurance when they work in a birthing center or hospital.

"I'll bet the training of a nurse is better than that of a midwife."

And you would be wrong. Seriously, is anyone doing actual research before announcing their biased, ingnorant opinions?

Direct-entry midwives (sometimes called "lay" midwives, although the title is misleading and I don't like to use it) or Certified Professional Midwives attend accredited schools, attend births with qualified instructors, and sit for a national exam. Certified Nurse-Midwives get their BSN and then a Master's degree in nurse-midwifery, an educational process that can take six or more years (usually more--many midwifery master's programs require or "strongly recommend" a year or two of experience in OB nursing, which is not an easy field to get into as a nurse).

A midwife has gone through just as much or more training as a nurse. No one is advocating that a birth be attended by an uneducated layman with an OB/GYN textbook. If you don't want a midwife, fine. Don't have one. But it's unfair to clog up a discussion with opinions you can't base on science or research.

Women should have the choice if they want to have their child at home with a midwife or in a hospital. It is not the goverments place to tell women where they can have their childern. I have known many families that have had their childern at home with a midwife and the birth went fine.

"A midwife just doesn't cut it"

ha-ha, that's the point.
My unwanted c-section was extremely traumatic and totally unnecessary. When they told me I “had” to have one, I cried. The doctor asked me in an annoyed voice: “why are you crying?” I told her “Because you are going to cut me”
I won’t go into the whole ugly detail, but next time, I’m going to a midwife just because they don’t “cut”
Anyway, statistically, you are SAFER giving birth at home with a midwife.
Born in the USA by Marsden Wagner is a great read about this issue. He’s an OBGYN who studies medical outcomes and shows how other developed countries spend less money on maternity care (midwives are cheaper than OBs, by a LOT) and have much better outcomes then we do here in the USA. (less dead babies and mothers)

I've made the choice that at this point in time, I don't want to have children. Honestly, if I got pregnant by accident I would probably choose to have an abortion.

Later, I may change my mind and decide to have children. If that happens, I don't know if I would choose to give birth at home or in a hospital, with a doctor or a midwife. I'm fortunate to live in a city where you can pretty much find every option for any decision you have to make, so I hope that if I ever do choose to give birth I will be able find the options and choose what is best for me.

My point is, look how many times I used the words "choose," "decide," "option" and any derivative thereof. Women should be able to make their own informed choices about their reproduction. Input from partners/husbands/etc is certainly alright, but in the end it is the woman's decision, since she is the owner of the uterus in question.

And to the person who italic-quoted oenophile's nasty comment - thanks. I didn't see the original before it was deleted, and while I already take what s/he says with a grain of salt, it's good to know the mentality in question.