Midwives say doctors and nurses at OHSU have filed baseless complaints to the licensing agency meant to thwart competition … The threatened lawsuit spurred a passionate online debate among supporters and critics of home birth.

Conflicts between midwives and doctors run deep. One of the biggest problems: Many physicians deal with midwives only when a laboring mother experiences difficulties during a home birth and requires transport to a hospital, sometime urgently.

“It’s an extremely tension-fraught encounter,” according to Melissa Cheyney, an Oregon State University assistant professor and practicing midwife who studied the interactions of midwives and doctors in Jackson County last year. Nearly every physician interviewed by Cheyney and her graduate student expressed the view that births must take place in a hospital to be “safe.”

Studies including higher-risk pregnancies have found that fetal deaths are more likely in home births. But in low-risk pregnancies, most research shows no significant difference in risk to the baby, while home-birth mothers experience fewer complications. In a study in British Columbia last year, women giving birth at home suffered fewer than half as many serious perineal tears, and about a third less postpartum bleeding.

By choosing a hospital birth, women substantially increase the risk of having a surgical delivery. More than 29 percent of hospital births in Oregon resulted in a cesarean during the years 2006-2008. Less than 4 percent of home births ended with a cesarean in a 2005 study of 5,400 births attended by midwives in the U.S. and Canada.

Women who choose home birth often cite the desire to keep birth free of medical intervention. Heather Hermans … transferred to the care of a midwife because she wanted to try a vaginal delivery rather than schedule a cesarean section, as her obstetrician-gynecologist recommended.

Conflicts aren’t inevitable. Cheyney is working with midwives in Lane County and a Eugene obstetrician, Dr. Paul Qualtere-Burcher, on guidelines for smoother, more collaborative relations. Qualtere-Burcher and his colleagues have agreed to help midwives get access to laboratory testing and ultrasound screening for their clients. Midwives are referring higher-risk home birth clients to the physicians for assessment and another perspective.

“We’d like them to come in and see us before it becomes a big issue during labor,” Qualtere-Burcher said. “I think it’s been very successful.”

Home birth by the numbers

Planned home births in Oregon last year: 877 out of 47,675 total births, or 1.8 percent.

Chances of giving birth without medical intervention: 78 percent with a home-birth midwife versus 54 percent in hospitals, according to the 2009 British study.

A women’s chances of having cesarean section when giving birth in an Oregon hospital, 2006-2008: 29 percent.

Fetal deaths in births attended by licensed midwives in Oregon, 2001-2007: 4 in 2,906 births, about 0.1 percent.

Complaints lodged against licensed midwives, 1999-2007: 40.

Disciplinary actions imposed by the Board of Direct Entry Midwifery, 2000-2004: 12

Midwife guide

…

Direct Entry Midwife – A general term for practitioners who train directly into midwifery without a nursing or medical background, and attend births outside of hospitals. Oregon law allows direct entry midwives to practice with no licensure.

Certified Professional Midwife — Direct entry midwives certified by the North American Registry of Midwives, which requires written and practical examinations and practical experience attending 40 births.

Licensed Direct Entry Midwife — Direct entry midwives who obtain a license in Oregon are authorized to use some prescription drugs and medical devices. They must pass a national examination, demonstrate experience in attending births, and complete continuing education every three years. They are licensed by the Oregon Board Direct Entry Midwifery and subject to disciplinary actions if they violate professional standards.

VBAC is known to increase the risk that the scar left in the womb from a previous cesarean will tear during labor, leading to massive bleeding that can threaten the baby’s life. That has led to previous guidelines urging caution for women who have had cesarean sections.

But recent research shows so-called uterine rupture occurs in less than one percent of women who opt for vaginal birth, and that between 60 and 80 percent of VBACs are completed successfully.

While the new guidelines from the American College of Obstetricians and Gynecologists (ACOG) still say a full surgical team should be present in case an emergency cesarean is required, they now put a bigger emphasis on the woman’s decision.

“Respect for patient autonomy supports that patients should be allowed to accept increased levels of risk; however, patients should be clearly informed of such potential increase in risk and management alternatives,” they say.

“For most women with a previous cesarean delivery, a trial of labor is a safe and appropriate option,” …

… Even women who’ve had two prior cesareans might be good candidates for vaginal birth …

… Today, about nine in 10 pregnant women … end up with a repeat cesarean if they’ve already had one. By comparison about a third of all women who give birth have cesareans.

What happened is this: In my 39th week, I am induced because of high blood pressure. At the hospital, I am given Pitocin, a synthetic form of the labor-inducing hormone oxytocin, and Cervidil, a vaginal insert used to dilate the cervix. Within two hours, my contractions are one minute apart. I had lasted as long as I could without an epidural because I had read that they sometimes slow dilation. That’s the last thing I need: I’m at a pathetic 2 centimeters. My doctor comes up with a solution for the pain: a syringe full of a narcotic called Stadol.

“I have a history of anxiety,” I tell the nurse who has brought in the syringe, as I always warn any medical professional who wants to give me drugs. “Is this drug OK for me?” “It sure is,” she says.

It is not. Within 10 seconds, I begin hallucinating. For five hours, I hallucinate that I’m on a swing that’s soaring too high, that houses are flying at my face. My husband has fallen asleep on the cot next to me, and I’m convinced that if awakened, he will turn into a monster — literally. I’m aware this notion is irrational, that these images are hallucinations. But they are terrifying. I buzz the nurse. “Sometimes that happens,” she says …

By noon the next day, 24 hours after I had arrived, I am only 3 centimeters dilated. The new nurse, a nice lady, tells me the induction isn’t working. “Your blood pressure isn’t even high anymore,” she says. “Tell the doctor you want to go home.”

When my OB comes in, I say, “I’d like to stop this induction, if that’s possible. I’m worn out. I hallucinated all night … I just don’t think this is working out.”

“OK,” he says. “Let me examine you. If you’re still not dilating, we’ll talk about going home.”

My previous dilation exams had been quick and painless, if not entirely pleasant. This one takes a long time. Suddenly, it hurts. “What are you doing?” I scream. “Why does it hurt?”

No answer.

“He’s not examining me,” I scream at my husband. “He’s doing something!” My husband grips my hand, frozen, unsure.

I scream to the nurse, the nice one who had suggested I go home. “What is he doing?” She doesn’t answer me, either. I writhe under the doctor’s grasp. The pain is excruciating.

The first sound I hear is the doctor’s directive to the nurse, in a low voice: “Get me the hook.”

I know the hook is for breaking my water, to speed my delivery by force. I scream, “Get off of me!” He looks up at me, as if annoyed that the specimen is talking. I imagine him thinking of the cadavers he worked on in medical school, how they didn’t scream, how they let him do whatever he wanted.

“You’re not going anywhere,” he says. He breaks my water and leaves. The nurse never looks me in the eye again.

Eleven more futile hours of labor later, I am exhausted and terrified when the doctor comes in and claps his hands together. “Time for a C-section,” he says. I consider not signing the consent form, ripping off these tubes and monitors, and running. But the epidural I’d finally gotten won’t allow me to stand up.

It’s nearly midnight when I hear a cry. My first emotion is surprise; I had almost forgotten I was there to have a baby.

I was desperate to find someone who could tell me what had happened to me was normal. To say, “You hallucinated? Oh, me, too.” Or “My doctor broke my water when I wasn’t looking. Isn’t that the worst?” Nothing …

Now, I’d never loved my doctor … I’d found him patronizing — “Normal!” he’d shout at me, when I asked a question — I thought his assuredness might be a good antidote to my anxiousness. It seemed to work, until it didn’t.

… I also didn’t have a birth plan … Sure, I had a plan for the birth: Have a baby using whatever breathing method I’d learned in the hospital’s birth-preparedness class, maybe get an epidural. But I didn’t have the piece of paper that so many of my friends have brought to the hospital with them … in my opinion, the very act of creating such a contract was to ignore what labor is: something unpredictable that you are in no way qualified to dictate.

… people who hear my story ask … Did I consider a home birth? A midwife instead of an obstetrician? … The answer is no. I am not holistically minded. My philosophy was simple: Everyone I know has been born. It can’t be that complicated.

The women who ask me about my preparations for my first son’s birth — who imply with these questions that I could have prevented what happened to me if I’d been more diligent — are part of an informal movement of women who are trying to “take back” their birth — take it back from the hospital, the insurers and anyone else who thinks he can call the shots.

But hospitals aren’t so interested in giving women back their birth … stipulations dealing with labor and delivery (“I want only one medical professional in the room at a time”) garner barely a glance. University OB/GYN in Provo, Utah, even has a sign that reads, “…we will not participate in: a ‘Birth Contract’, a Doulah [sic] Assisted, or a Bradley Method delivery. For those patients who are interested in such methods, please notify the nurse so we may arrange transfer of your care.”

… This question of whether I could have prevented my trauma has lingered in my mind since that day; now that I am pregnant again, it has become deafening. I have a chance to do it all over. Would I benefit from thinking more holistically? Should I bother taking back my birth?

During my pregnancies, friends gave me two books; their spines are still barely cracked. The first is called “Ina May’s Guide to Childbirth.” … The other book is “Your Best Birth” by Ricki Lake and Abby Epstein; it’s an offshoot of their 2008 documentary, “The Business of Being Born.” Their urgent message is that women who want to deliver vaginally can do so if no one intervenes. Instead, doctors and hospitals are doing all they can to “help” the laboring woman along … and failing. Inductions like mine, epidurals given early in labor, continuous fetal-heart monitoring — all of them have been associated with a higher risk for cesarean section. The result is an epidemic — 32 percent of U.S. births were C-sections at last count, the highest rate in our history. Individual surgeries may be medically necessary, but as a matter of public health, the best outcomes for mothers and babies come with a rate of no more than 15 percent, according to the World Health Organization.

Sam … was five months pregnant when watching “The Business of Being Born” convinced her that hospitals could be dangerous and a home birth would be more meaningful. She and her husband found a midwife … and spent the rest of the pregnancy preparing.

After 24 hours of labor, Sam’s contractions were two or three minutes apart, yet when her midwife examined her, she was only 3 centimeters dilated. The midwife gently told her that she was nowhere close to delivering, despite her contractions, exhaustion and pain. Sam asked to be taken to the hospital.

The change of scenery did her good. “At that point, I had been in labor for 40 hours,” she says. “I entered the relaxed zone. The epidural took the edge off … It was a sacred space.”

After her son’s delivery, Sam passed out, having lost 50 percent of her blood volume in a postpartum hemorrhage. Needless to say, she was relieved that she was in a place where blood transfusions were readily available … she believes she will want midwife care at a hospital next time.

… Bialik’s first birth didn’t go the way she wanted. After three days of labor at home, she stalled at 9 centimeters, one short of the goal. Her midwife suggested they go to the hospital, where after a natural childbirth, Bialik’s son spent four days in the neonatal intensive-care unit. “My son was born with a low temperature and low blood sugar, which isn’t unusual in light of the fact that I had gestational diabetes,” she explains. “I understand doctors need to err on the side of caution, but there was nothing wrong with my child. All of our plans for bed sharing, nursing on demand, bathing him — gone.”

The experience was scarring. “I felt a sense of failure that I had to call my parents from the hospital,” Bialik continues. “Yes, I know vaginal birth in the hospital is the next best thing to a home birth.” …

I point out that natural childbirth in the hospital — her “failure” — was my best-case scenario. But I also understand when she says, “Everyone is allowed her own sense of loss.” She realized her vision when her second son was born at home.

The second time around
I don’t consider myself a candidate for a home birth. The risk of uterine rupture from an attempt at vaginal birth after cesarean (VBAC) makes it unthinkable … I’m also not really interested in a home birth … But I’m also not interested in another C-section …

So I’d like to attempt a VBAC, but I know that it doesn’t always succeed. I have a new doctor — the 10th I interviewed following my son’s birth — at a new hospital, and he has agreed to help me try. But my primary goal is more modest: not to be retraumatized. Even now, my heart pounds at the sight of hospital receiving blankets, the antiseptic smell of the maternity ward.

The common thread in Bialik’s and Sam’s stories that impressed me was how supported and safe they felt with their midwife …

In an e-mail Bialik sends after our meeting, she goes back to my idea that some women weren’t meant to have babies the holistic way. “There are those among us who believe that if the baby can’t survive a home labor, it is OK for it to pass peacefully,” she writes. “I do not subscribe to this, but I know that some feel that … if a baby cannot make it through birth, it is not favored evolutionarily.”

I think about my appendectomy, back in 2003. Had I not made it to the hospital in time, I would be dead. What would it be like to refuse medical intervention? I’d call my family, say my good-byes. “I’m sorry,” I’d say. “But I’m not evolutionarily favored. It’s time for me to go.”

This attitude, that everything was better back when there were no doctors, seems strange to me. C-sections, although certainly done too often, can save lives. Orthodox Jews still say the same prayer after childbirth that those who have been in near-death experiences say — and with good reason. A birth that leaves mother and child healthy may be commonplace, but it’s also a miracle every time.

As the weeks pass and my belly grows, I can’t stop thinking about Sam. Her pregnancy was a sacred time, and she had truly looked forward to labor. Is that what I should try for — a meaningful birth, as well as an untraumatic one? At what point had people like Sam and me learned to feel entitled to a meaningful birth?

“I think that birth should be a beautiful experience,” says obstetrician Kimberly D. Gregory, M.D. She’s the vice chair of women’s health care quality and performance improvement at Cedars-Sinai Medical Center in L.A. “It should be exactly the way you want it, and doctors should intervene only to preserve the health or life of you or your baby.”

Naturally, one would assume that Dr. Gregory advocates birth plans. When I ask her this, she laughs. “We always say, ‘If you show up with a birth plan, just get the C-section room ready,’” she says. “You get everything on that list that you don’t want. It’s like a self-fulfilling prophecy.” Dr. Gregory led an unpublished study that compared women who took traditional hospital birth classes with those who employed Bradley-like training and a birth plan. The birth-plan group trended toward a higher C-section rate and more interventions. “There’s a certain personality type that tends to be more anxious. Maybe the anxiety hormones themselves put them at risk,” Dr. Gregory theorizes. “It seems that being open and honest and choosing the right doctor is probably a better option than writing everything down. Walking in with this list appears to set up an antagonistic relationship.” …

… In the past three weeks, I’ve had the same dream. I’m in a field (I believe at Ina May Gaskin’s Farm), and women in braids are dancing around me as my baby is born, painlessly, joyously. As I reach down, I notice my C-section scar is gone.

I wake up upset. Am I truly under the impression, subconscious though it may be, that taking back this birth will undo the damage of the last one?

“I don’t understand this phrase ‘take back your birth,’” nurse-midwife Pam England, creator of “Birthing From Within,” … tells me. “Who took it? What would a woman tell herself it meant about her if she failed to meet the criteria she made up for ‘taking back’ her birth? I am concerned that this phrase, meant to generate action and a feeling of empowerment, may actually be generated by or feeding the victim part of her.”

England is right: Having a childbirth that I deem successful this time will not change what I haven’t overcome from the first. I try to find a way to make what my doctor and nurses did to me OK, but my mind rebels. I feel loss — no, theft — of an opportunity for me to have a baby the way so many other women do: a carefree pregnancy, a labor that could still go any way.

Maybe I’m not so different from the women I spoke with, after all. Bialik had a successful natural childbirth but felt like a failure because it was in the hospital. Women who had a C-section also used words like failure. Perhaps part of the problem is that our generation of women is so ambitious, so driven, that we don’t know how to do anything without quantifying it as a success or failure.

According to Dr. Gregory, women are now requesting a C-section for their first birth, even without indication. “A lot of people are uncomfortable with the unknown,” she says. Plenty of people are wary of C-sections by choice, from holistic moms to obstetricians. But isn’t this, too, taking back your birth? Refusing to be out of control seems to me the epitome of taking it back. You don’t have to have an unattended birth in the woods to be considered a real woman.

Deciding that you can’t control the uncontrollable — and committing to that decision when you are, in fact, out of control — is also taking back your birth. It’s what your grandmothers did. It’s what their grandmothers did.

With this, I realize that I have already taken back my birth, but not as part of any movement. I have stopped judging women who take extra precautions as defensive and started to understand that everyone has to find her way.

I don’t know how this story ends. I’m still not convinced my body was made to deliver vaginally. But here’s what I do know: I will insist on kindness. I will insist on care. And I hope I will be open to being treated kindly. It’s harder than it seems.

I don’t know who is familiar with it, but if you look at the medical model of maternity care and the midwifery model, you’ll see that the outcomes of both models are drastically different, with the midwifery model being the more positive of the two.

Why is having a baby today less safe than it was two decades ago? Two studies … make suggestions for addressing the crisis …

… vaginal birth after cesarean is “a reasonable choice for the majority of women.” … although both elective repeat cesarean section and VBAC are highly safe, maternal death was higher for elective repeat Cesarean sections (0.013% versus 0.004% for a trial of labor). The rates of hysterectomy, hemorrhage and transfusions did not differ between the two groups. Uterine rupture — the complication that is usually given for discouraging VBACs — was rare but higher in the trial of labor group (0.47% compared with 0.03% in the repeat C-section group). Infant death was higher in the trial of labor group (0.13% compared with 0.05% in the repeat C-section group).

About one-third of all births today in the U.S. are cesareans, and the most common reason for needing a C-section is that the mother has already had one. But recent studies show that two or more cesareans increase the risk of dangerous complications of the placenta that may be contributing to the increase in maternal deaths in recent years. That complication may prove to be more significant than the risk of uterine rupture in a woman attempting a VBAC …

“[It] … was a very traumatic experience,” … “So when we decided to get pregnant again, I knew that I wanted to have a vaginal birth.”

The issue remains a subject of a hot debate between women who don’t feel they should be forced into surgery and doctors and hospitals that say the risks of VBACs – including uterine scar rupture during labor – outweigh those of repeat C-sections.

“We certainly support the concept of people having choice and are happy to have people undergo a trial of labor, but I think also we want to convey to them what the risks and benefits are in their individual circumstances,” …

Yet critics argue … the high success birth rates of VBACs … between 60 and 80 percent … [and] the extremely low risk of uterine scar rupture, which … occurs in less than 1 percent of women.

Some health care professionals believe key risks involve legal as well as medical issues.

“It has to start with tort reform, that’s the bottom line. Until that happens, I will recommend every doctor not to do vaginal birth after cesarean, only because it’s going to put them in more jeopardy [of being sued if it goes badly],” said Dr. Mayer Eisenstein, a physician and home birth doctor in Rolling Meadows. “In our society today, there’s no tolerance. If something bad happens, someone has to pay for it.”

A CLASH OF VALUES

… “[My doctor] wasn’t going to support … my VBAC,” she said. “I saw myself going back down this road where I was just going to end up with another C-section and I knew that I had to get myself informed and get myself a really good support system.”

… Crosley-Corcoran … hoped to give birth at home to avoid unnecessary hostilities at the hospital. But when her contractions started … she … took a taxi to … hospital.

“The minute I got there it was kind of a battle,” she said. “… a lot of doctors don’t get why birth is important to women.” …

Crosley-Corcoran said she fought throughout her 38-hour labor with doctors and nurses who said she needed another C-section.

… “To me, the most inappropriate behavior was the scare tactics.”

COMMON PRACTICE

Dr. Melissa Dugan-Kim, an OB-GYN … said in the last five years she has done nearly 300 C-sections and 200 vaginal deliveries.

Jamie Grumet knew having a baby would be painful and even stressful. But she didn’t realize how hard it would really be …

“He said that my uterus … ‘just might not work,’ so I needed to have a C-section,” … “He said I’d had enough time and my ‘trial of labor’ had failed. He said it was a case of ‘failure to progress,’ at which point I shot back, ‘No! It’s a failure to WAIT.’”

Crosley-Corcoran continued to resist.

A TANGLED WEB

Situations like Crosley-Corcoran’s stem from a complex web of causes.

“I think it speaks to the many different pressures in our health care system,” … “It has to do with regionalization of health care. It has to do with, probably, to some degree, the professional liability climate. It has to do with societal attitudes toward cesarean and vaginal delivery.”

… “It’s not that those hospitals are being mean, per say, but they’re constrained by guidelines and circumstances. In that sense it’s not really necessarily their fault,” he said. “It’s really system-wide change that people need to make … if people feel this is an important thing.”

… “Unfortunately, lawyers have characterized doctors as just out to hurt people and do bad things,” said Eisenstein, who also has a law degree. “I don’t buy that for a second. I’m as big a critic of medicine and doctors as can be, but I can tell you, left unconstrained, doctors will do the right thing 999 times out of 1,000.”

PLAYING THE CARD THAT’S DEALT

… Crosley-Corcoran’s experience turned out differently. She said eventually her doctor told her Jules’ heart rate was fine and she could continue to labor. Crosley-Corcoran took responsibility for whatever happened. For her, the struggle was completely worth it.

The ban aims to close the loop on what is already a stringent policy on VBACs in Florida. To have a non-surgical birth after a C-section, women are compelled to go to hospitals that permit it (which are not accessible throughout the state), or, if a physician signs off on the procedure, they can have one at home with the guidance of a licensed midwife. VBACs currently don’t occur in Florida birthing centers because of what is being a called a “de facto ban” due to outdated language in the state regulations. The language, which will be updated this week, will turn the ban from de facto to explicit—making VBACs illegal in all of Florida licensed birthing facilities.

Miriam Pearson-Martinez, a licensed midwife who serves on the Pushing for VBAC committee of BirthGirlz, said that the organization has hired an attorney and will file a legal challenge to the ban when the AHCA moves to amend its regulatory language.

“We believe that the role of our law, and the agency’s duty, is to provide access to birth centers, not limit access, and that this ban is outside the scope of its role,” Pearson-Martinez said.

She noted that licensed Florida midwives are legally permitted to oversee VBACs, so long as a physician signs off on it, and that not all birth centers are owned by midwives—marking the ban as a move that conflicts with legal activities.

The AHCA contends that this week’s adjustment is merely cleaning up its language, rather than an attempt to make any new restrictions on VBACs, birthing centers, or midwives …

“I might be able to believe that, but at the same time … the AHCA intends to reduce the maximum number of births a woman can have before she is allowed to use a birth center. While before a woman who had seven births can have her eighth child at a birth center, she now will not be able to do so if she’s had more than five births.

… the ban is troubling, especially given recent statistics that reveal a 12% chance of something going wrong with a VBAC in a hospital setting, compared to a 4% chance in a birth center.

“There’s not a single statistic that justifies this (ban),” …by restricting women’s ability to give birth where she chooses, the Florida policy will lead to dangerous consequences—including women having unassisted births at home or the prosecution of licensed midwives.

“Throughout history, the traditional medical field has frowned upon midwives, and this (ban) seems to be taking another step to maintain the power of their industry,” … “It seems like a ploy for doctors to say this is one more thing midwives can’t do, one more thing to have control over.”

Nationally, VBAC rates have declined since 1996, while the delivery rates for cesareans are increasing … cesarean deliveries in 2005 are at the fourth highest rate of the world’s developed nations, behind Italy, Mexico, and Korea. This rate is exacerbated by the American College of Obstetricians and Gynecologists 2004 recommendation that women not attempt a normal birth after a C-section if a hospital does not have round-the-clock obstetrics and anesthesia backup. Likewise, medical practitioners’ fear of being sued if something goes wrong with the procedure has also discouraged VBACs.

… about 45% of hospitals in the United States formally ban VBACs either explicitly or through unsupportive policies and procedures.

… the rate of C-sections has been increasing out of proportion to their need. In 1965, when the C-section rate of delivery was first measured, it weighed in at 4.5 percent; in 1996, the rate was 20.7 percent, and the provisional 2006 rate was 31.1 percent of all births – representing a 50 percent increase over fifty years. Meanwhile, VBACs have declined by 72 percent in less than a decade – 28 percent in 1996 to eight percent in 2005.

The World Health Organization recommends that … cesarean rates … above 15 percent are likely to do more harm than good.

… While the deadliest risks of VBAC, including uterine rupture, are possible, the risk is limited—impacting less than one percent of patients. Seventy-four percent of VBACs are successful …

“… VBAC is a reasonable option for most women. Over 75% of women who attempt VBAC will be successful,” “Currently less than 10% of women who have had previous cesareans deliver vaginally in subsequent pregnancies, leading to significant and preventable illness and death.”

… the NIH panel urged ACOG to reassess its guidelines on VBACs, noting that large swaths of the nation don’t have the resources for hospitals with obstetrics and anesthetics back-up teams.

Jane Peterson, a certified professional midwife in Wisconsin and a member of the Big Push for Midwives, said that while there are health risks in VBACs, as there is in any birthing experience, it has been shown that the risk increases with more labor interventions, such as induction.

“Births in birth centers under the midwifery model of care don’t have interventions, and so they have a greater opportunity for success,” Peterson said.

She added that birth centers screen very carefully for VBACs, ensuring that candidates are healthy. They also make plans to move to traditional facilities if anything occurs that is not reassuring.

Peterson said she advocates for “complete informed consent” from mothers about the risks and benefits of VBACs—a conversation that is most likely to happen outside a hectic hospital setting.

“The fix (for poor maternity care in the United States) is to increase access to midwives, not decrease them,” Peterson said …