Last week, midwives and clients of Andaluz Waterbirth Center in Portland announced plans to file a federal lawsuit to "cease intimidation and threats against midwives" by the Oregon Health Licensing Agency and Oregon Health & Science University.
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.
"My ob-gyn didn't remember me from appointment to appointment," Hermans said. "I was treated like pregnant cow No. 45."
Many women will choose midwifery care to receive personalised care where they can develop a relationship with the midwife who will attend their birth.
Hermans experienced complications during labor and took an ambulance to OHSU, where a surgeon delivered her healthy baby boy by emergency C-section. The surgeon filed a complaint about Hermans' midwife to the state ... Roy Haber, an attorney hired by the midwives, said the Oregon Health Licensing Agency withdrew all six investigations after he challenged them.
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.
Risk of baby dying in a midiwife-attended home birth: 1.7 percent versus 0.6 percent in hospitals, based on a 2009 British study including women with breech births, twins, or attempting a vaginal birth after a previous cesarean (VBAC).
I'd be interested to see what these stats are when high risk homebirths are removed from the data set, or to analyse the risk of each "risk factor" in isolation to determine the riskier "high risk" situations, for example, is HBAC less risky than twin homebirth?
Risk of baby dying in a midwife-attended home birth when comparing only low-risk mothers: 0.5 percent versus 0.3 percent in hospitals.
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.
Fetal deaths in births attended by physicians in Oregon, 2001-2007: 1,455 in 274,278 births, about 0.5 percent.
This would account for the fact that midwives mostly manage uncomplicated pregnancies and births, while doctors are referred higher risk women and babies.
Number of home birth midwives who are licensed in Oregon: 64, up from 54 in 2008.
Complaints lodged against licensed midwives, 1999-2007: 40.
Disciplinary actions imposed by the Board of Direct Entry Midwifery, 2000-2004: 12
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.
Certified Nurse Midwife – Registered nurses who go on to complete an accredited nurse-midwifery program. Oregon requires certified nurse midwives to obtain a Masters degree. CNMs are the only midwives that practice in hospitals. They are licensed by the Oregon State Board of Nursing.