Because I have witnessed several hospital births, I know that the level of care is not what a woman and her baby deserves. Frequently the doctors arrive at the last minute, and women are often left on their own in the room (except for the partner or family members with her) and only checked on sporadically. Medicinal interventions are encouraged strongly, and a woman is frequently relegated to remaining in the bed for the entire labor. Natural childbirth is not encouraged.

In an out-of-hospital birth (which research has shown is SAFER for mother and baby... just do some research) with a midwife, the woman and baby have the undivided attention of the midwife for the duration. There's someone there encouraging and supporting the woman. And that continual presence means an earlier recognition of something going wrong. NH midwives are mandated to transfer clients in the event of complications, but in the event of an uncomplicated labor and delivery, home or out-of-hospital birth is imminently safer. There's less chance of nosocomial infection and the labor and delivery are not prematurely rushed. A mother and baby have a chance for labor to progress naturally, which is better for both. And the fact that Mom can get up and move around, change positions, and be coached through ways to lessen pain and discomfort, means a more satisfying labor.

I've been researching this issue for years (since I was a teenager), and I'm scheduled to give birth in a few months. I'm working with Jeanne and Kate and I feel better about what it means to give birth than I would if I were working with a group of practitioners to whom I'm just "another patient." I am so grateful that I know who will be there when my baby is born, and that I have had the opportunity to develop rapport with Jeanne and Kate.

I would urge women to educate themselves about their options and to do some real heartfelt research. Don't just go by what a group of doctors say (they're losing money because women aren't using their services as much). Remember... Pregnancy is not a medical emergency. It's something that has been taking place for millenia and without complications, is just another act of nature. Do research and make the decision that is best for you and your baby. I think you'll be surprised... but whatever you choose, please choose in confidence, and respect those who choose differently.

Also... don't be surprised to hear people criticizing or questioning whatever choice you make. You can't please everyone. Do what's best for you and your baby.

I am a well-educated person, including in the medical arena. I am a licensed and practicing naturopathic doctor in New Hampshire, I have attended a 4-year medical school, and I have attended and supported births ranging from beautiful home births to complicated Cesarian sections.

When I found out I was pregnant about 9 months ago, I first began my care with an obstetrical nurse midwife in Southern NH. She practiced under an OB and delivered in-hospital only. After my first few prenatal appointments, I realized that this was not the care that was right for me. On the day of my visits, I would have to block off up to 3 hours in my schedule, because the office was usually running about 1-2 hours late. My actual time with the midwife or OB was never more than 5 minutes. On top of this inconvenience, the hospital they delivered in (in Massachusetts) has a Cesarian section rate of over 40%. I find it hard to believe that almost one in every 2 births is complicated enough to warrant such a higher risk surgical intervention.

I contacted Jeanne Browne at CBWC and my husband and I decided to switch our care over to Jeanne. It has been a wonderful decision and experience. As we take our last few weeks to prepare for our "bundle of joy", we feel very safe, informed, and well cared for.

The term "Doctor" comes from the latin term, "Docere" or "to teach". For each decision that we have had to make, from the birth location to circumcision and even for routine procedures such as vitamin K injections and antibiotic eye ointment, Jeanne and her team have taken the time to explain why those procedures are performed, any pros and cons, and leaves the decision to the parents- explaining any risks they may be taking on by one decision or another. As a medical professional, I knew in advance most of the pros and cons of these procedures and knew where I stood on those choices, but the education was complete and non-judgemental. The education provided by this midwife was more complete than any doctors I had either worked with professionally or seen as a patient.

In addition, my experience working with both OBs and midwives are that their skill sets are relatively different. While OBs clearly have better training and experience to manage high-risk births, midwives have more experience managing normal pregnancies and births and have an innate trust in the process. Midwives have an understanding of what a normal birth looks like and are very happy to transfer care to an obstetrician when a pregnancy or birth is not progressing as it should, of course putting the welfare of the mother and child first. Midwives understand what is within their scope and what should be referred to an OB.

I firmly believe that couples should have the right to choose (within safe boundaries) where they are most comfortable having their child. We are very lucky in NH to have many options available, from a homebirth through an elective Cesarian section. We have great in-between options available as well, as some posters have mentioned places like the Mom's place at the CMC where nurse-midwives are available to help moms through the birth process. A woman with a healthy, normal pregnancy should be able to labor where she feels most comfortable, and we are so blessed to have a variety of options available.

I have counseled many patients through the decision of what type of prenatal care is right for them. There are certainly pros and cons to BOTH giving birth in a hospital AS WELL AS out of a hospital, and to BOTH working with an obstetrician AS WELL AS working with a midwife. No one type of care is right for everyone. But let's take the time to recognize that both can be a safe option, and be thankful that we have the choice.

If any women are considering what type of care to choose for their pregnancy and birth, I'd encourage you to become informed about all of the options that are available. Interview a midwife as well as an OB and ask both the questions you have. Get educated and THEN choose the care that is right for you.

In health,
Dr. Jaclyn Chasse, N.D.

How could you think that a hospital is the "safest place for a baby?" Hospitals are filthy and disease-infested. I personally know two women who contracted deadly staph infections - MRSA - after giving birth in them! One died! If you *really* cared about the safest place for a baby you wouldn't go anywhere near a hospital to give birth!

When you go to a hospital you get hospital care. Midwives at a hospital are nothing more than medwives, and you'll get care that is not much better than an ob. If you want REAL midwifery care (Google "Midwifery Model of Care!) then you have to go to a REAL homebirth midwife. Jeanne Browne is the best there is.

If you are looking for a medical establishment that respects and recognizes the value of midwifery in NH, go the extra miles south from Concord to "The Mom's Place" at Catholic Medical Center in Manchester.

I am a brand new mom who feels very lucky to have found Jeanne Browne in Concord. She and her assistant, Kate, made my pregnancy a time for learning about my body and its amazing capabilities, learning about my baby, and learning about the birthing process. I feel sure I would not have learned half as much from a "team" of OBGYNs (never really forming a trusting relationship with any one of them, being forced to see all eight throughout the pregnancy). I also would not have been so confident about my strength (which helped me labor with bravery and consciousness), my mothering skills, and my choices. With the Concord Birth Center, I was so well-informed about what was happening to me and the baby, and what my choices were (with the pros and cons laid out for me). And while this may not be something statistics calculate, it was very important to my husband and I --- Jeanne and Kate loved our baby throughout this time and we could feel that they always had our family's best interest at the forefront.

I'm so happy your births were satisfying and in the end occured safely. I'm sorry you feel attitude from "other women" about your choices. My guess is they are adament about their choices because they have felt uninformed by the "establishment". Epidurals and other interventions such as inducing a labor for no medical reason, rupturing of the membranes and even just pain medications other than epidurals (nubain, stadol and even therapuetic sleep which I have seen used i.e. morphine injections, CAN have no ill side effects. But to believe they are safe because some occur without any of the possible side effects is dangerous. Again, it's great there were no ill effects from the medications that you chose to avail yourself of. Epidurals don't come by themselves. They come with 100% Electronic Fetal Monitoring, a blood pressure cuff attached to the mother 100% of the time, scheduled to automatically monitor the mother's blood pressure at preset intervals, as one of the side effects of an epidural can be SUDDEN drop in maternal blood pressure which of course can affect the fetal heart rate. If medication administered cannot resolve the problem, an emergency cesarean section is performed. The electronic fetal monitoring is done 100% of the time because the b/p cannot be monitored continuously. The monitor will hopefully pick up any change in the mother's b/p through the fetal heart rate. Epidurals can cause maternal fever. This is a side effect of the medication and doesn't necessarily indicate maternal infection. However, if they wait until the infant's bloodwork to come back ok to administer IV antibiotics to the infant, and it was indeed an infection and not a side effect from the medications, the infant would be very sick. Therefore, if a maternal fever is present a complete work up is performed on the infant involving blood draws and possible IV's. There are times when after receiving an epidural a mother is in need of being catheterized because she cannot get up to use the bathroom. Any time someone is cathererized, there is an increased risk of a UTI. Once the catheter is removed, sometimes a woman has the side effect of urine retention. She is unable to empty her bladder requiring a re-catheterization. Increased risk for infection. This doesn't even address the issue of possible allergic reactions to the cocktail of medications used in an epidural. All of the monitors used during the administration of an epidural don't make the medications safe, the monitors provide information that lets the staff be aware of problems and they can therefore address the problems. IV's are placed before an epidural is placed in an effort to completely hydrate the women in an attempt to prevent the sudden drop in maternal b/p. This is helpful, but doesn't eliminate the risk.

Many times once an epidural is placed it is determined to be as safe as possible, knowing the risks, that in internal electronic fetal monitor is placed. This is done using a plastic tube to guide a wire with a very small corkscrew like electrode at the end. This attached to the presenting fetal head by screwing it into the infants scalp. This way they can be 100% sure the monitor is picking up the infants heart rate accurately. The tube is removed and the wire hangs out of the woman and is connected to a device attached to the mother's leg.

Epidurals frequently slow down if not stop labors (one of the reasons they want you to reach at least 4 cm's before one is administered) therefore pitocin is almost always used in conjunction with the epidural medications. Pitocin has it's own possible risk factors, over stimulation of the uterus causing fetal distress, increased maternal b/p, and excessive bleeding.

We know epidurals carry a large increased risk of problems, or they wouldn't prevent a women from eating or even drinking anything other than water in the event of emergency surgery.

Ask any lactation consultant and they will tell you that epidurals absolutey can effect the nursing infant. Infants whose mothers have had epidurals are more likely to bite down rather than suckle causing possible issues and early termination of breastfeeding. Do all mothers with epidurals have problems nursing, absolutely not. It's just important to have the information before making the choice.

I would be pleased as punch if the consent form for all the possible medications and interventions at a woman's disposal in a hospital birth were handed out prior to going into labor during prenatal visits. To ask a mother who has begged for an epidural if she has any questions about the myriad of risks listed on the consent form, which honestly I have never witnessed a women read, but quickly sign, while she is waiting for the epidural to be placed is not informed consent. Having this information prior to it's necessity, would allow for women to ask about all of the possible risks associated with the procedures and with accurate information make the decisions that work best for her and her birth.

No one should be made to feel badly about their choices. Again, I think the women you refer to have felt betrayed at one point or another about the information they were or were not given which affected their choices.

I think the one thing that's misunderstood about home birth advocates is that we are fighting to have our choices allowed by law in about half of the U.S.

Imagine if suddenly you were told that hospitals are far too dangerous, and OB's were illegal? How would you feel? You might start telling everyone why that's wrong, and why you should be allowed to choose how and where to give birth.

I, for one, cannot legally choose a licensed home birth care provider where I live. So, please don't think I'm telling you what to do. What I am trying to do is (1) prove my choice is a good one (which good scientific evidence shows us), and (2) regain control over my children's births.

telling me what is "best" for me when it comes to having a baby, feeding it, raising it, educating it etc. I have never felt disrepected by my OBs, but have felt much disrespect from other women preaching to me what I should do.

If women choose to have a doula or a midwife, homebirth etc, that's great. Good for them. That's their choice.

However, my choice was and always will be to have an OB and a hospital, with an epidural. That's my choice. I enjoyed the births of my children. My children were born safely, came home safely, and continue to be healthy and happy.

If you think the hospital is the safest place to give birth ask yourself why? Why is the hospital the safest place? Did you credential the nursing staff? Did you find out the infection rate of the hospital? Oh - that's right...NH hospitals are not giving that information out to the public. Yeah, hospital births MUST be safer than at home!!!!!

We had three of our four kids at home. It was a great experience! Comfortable! Safe! And I know that none of my kids left the hospital with an infection! And I know that the Midwife was credentialed and well spoken of before we had our child at home.

I had my baby with Jeannie Browne only 10 weeks ago. After realizing that I didn't actually know anyone who had had a natural, drug free birth, I started researching. Sadly, I also know more women who have had c-sections than I know women who have not. I began my pregnancy with an OBGYN and felt very disconnected from the process of my pregnancy. The practice was so large that I never saw the same doctor twice, the appointments were hurried and not very informative. At my first appointment with Jeannie I learned more about what was happening with my body and my baby than I had in all the appointments combined with the OBGYN. Jeannie was supportive and reassuring throughout my pregnancy, but when it really counted she was my rock. From the moment I got out of the car at the birth center Jeannie was by my side, she helped me to feel safe and strong, she guided my husband in his support of me while I labored. The experience of bringing my daughter into the world was one of the most profound of my life, I can't imagine having done it without Jeannie and Kate, in a different place or in another way.

Over 22 years ago I almost bled to death in the "safe" place (hospital) to have my child. I was the only one in labor that night and the doctor said “I� (he) should get a "good nights sleep". I trusted him (I did not have the time to research) and took the sleeping pill I was given. I did not get any sleep. The next morning he was ready to go and I was loaded up with Pitocin. Unfortunately after 10 hours of Pitocin my labor failed to progress and my blood pressure began to rise. I had an emergency C-section and the doctor came out to tell my family that the baby was fine but I might not make it because I had a “bleeder� they could not find. Three years later for my second child I was determined to deliver naturally. Concord OB-GYN led me to believe that they were on board with the VBAC (vaginal birth after C-section) but at every appointment C-section was mentioned. I dropped them and was lucky to find a doctor that worked with a midwife and was “allowed� to deliver naturally. I understand now that insurance companies and some hospitals will no longer “allow� women to even try. I wish I had a midwife handle the delivery the first time. I am sure my outcome would have been very different.

If it were only about the baby women would not remember their birth stories when they are aged and unable to remember anything else, nor would they share those stories openly and willingly 50 and 60 years after their "baby" has grown up, as if it were only yesterday.
Birth is a moment in a woman's life that alters her being and empowers her to be a mommy in a way nothing else can. Taking away the purity of it is dangerous not only to the mother and the baby, but to society as a whole.

As far as the comment about not calling 911 and an EMT not knowing as the midwife does, I am sure that was taken out of context knowing "Ms. Brown" personally, and being an OOH(Out of Hospital) midwife myself. It is not a demeaning comment, it is a factual comment in the sense that in a moment of panic, due to our conditioning as a society, we tend to believe that calling 911 is the almighty answer. In birth there are times it is not the answer, and can actually make things worse...not that an EMT or paramedic is not well trained and able to do their jobs well, we know they have spent much time in training, as have we, but we are seeing birth only, no other conditions or serious events, so it is important to remind our clients that 911 may not be the best choice. The most common reason for transfer to hospital is exhaustion due to failure to progress. I think this comment was likely blown up to sound like Jeanne is irresponsible and and a chance taker...when she indeed is not, and is a very well trained, experienced midwife. Oh the power of the pen...
I have to add here that in my area of the state we have a fabulous relationship with our EMTs and Paramedicine Professionals as well as our Hospitals. It is critical to the care we provide to have working relationships with those who we count on and who know our level of skills and abilities. But this in not the case in every area, nor in every state.

I am so pleased to read such a well-researched article - thank you for exploring this topic! I am a home birth midwife, and share a common concern for the availability of resources when it comes to consultations and medical transfers.

I have been medically trained, and I have also taught in several medical schools. My students have been touched by the same kind of personal care I take in caring for childbearing women, because they come to understand that there is both a physical element (exam technique), and also an emotional one (sensitivity training). Because I understand these are integral parts of the equation, it is essential to remember that we are all complementary to each other, with the central focus being the women and families we care for.

More than the typical medical patients, home birth clients are well-versed in the safety-of-home-birth debate (and the unanimously agree it has been settled in favor of home birth, or they wouldn't choose this for themselves, right?). They deserve good care wherever they may be - at home in the care of their midwife, en route (emergent via ambulance, or non-emergent in their private cars), or in the hospital where they should be received and welcomed as any other paying customer.

We should all be on the same team, here. No one is the bad guy - we just all have our specialized knowledge and skills. I'm an expert in normal birth and in finding complications before they are emergencies. EMTs are experts in stabilizing and transfer. Physicians/surgeons are experts in disease, pathology, and surgery. If we choose to honor the priorities that called us to enter our respective professions, we would all be collegial with each other, and the woman and her needs would be placed in the center of our care.

1) Home birth with a certified professional midwife (CPM) is at least as safe as in the hospital. Many hospitals don't have the ob or anesthesiologist actually on site 24/7, so it's a myth that "immediate" surgery is available to all American women. (even if your hospital had it; that's not what I'm talking about; I'm talking about what's available in general to American women for childbirth)

2) AMA and other doctors' trade unions lie to the public using very bad, uncontrolled, data to lie to the public. The fact is that when looking at home birth, you have to look only at the births planned to take place at home with a qualified care provider like a CPM (in other words, weed out the unplanned, unattended emergency births since they don't speak to the issue at hand). CDC stats are raw data and do not apply. The "Washington State study" (Pang et al), is uncontrolled. The Australian study included high risk women in extreme rural Australia (doesn't apply to low risk American women).

3) Most so-called birth emergencies occur gradually over time, so a midwife can very effectively take a mom in who's labor fails to progress normally. Emergencies (incl fetal distress and mom hemorrhaging) occur much more frequently in hospitals -- mostly b/c of the drugs or procedures commonly used to manipulate and speed up the birth process (pitocin, epidural anesthesia, having women deliver on their backs, etc)

4) BABIES DO MUCH BETTER (lower risk of problems) when the labor starts on its own, and it left to proceed naturally. (Even iv fluids change the mom's chemistry and screw up the hormonal loop that helps human babies during childbirth.)

5) Horrible infections are caught at higher rates in the hospital, much more than at home.

6) C-sections are much more dangerous for both the mom and baby, which is why it's a public health HAZARD to have a 30+% c-section rate in our country (This is true even if you had a good c-section; it's statistics not what happened to you.)

7) THE REAL PROBLEM is that half of the U.S. fails to license CPMs, so it makes those rare trasports to the hospital difficult to integrate into care. And it also allows uneducated people to claim to be midwives, when the state fails to license the nationally certified, CPM.

8) There's an internet troll called "Dr. Amy" (who isn't licensed anywhere according to people who did some digging) who lies about the studies and misrepresents what they say, or how to analyze birth statistics.

Wow....... thats quite a statement to advise your "clients" that you should NOT call 911, based on your assertion that "if you seen a birth, you are more experienced than the EMT's". What a dangerous and irresponsible statement. In the United States, EMT's recieve approximately 120 hours of classroom in addition to field practical time, Paramedics receive in the area of 6 months to 2 years of classroom and field practical including time with OB/GYN rotations. Granted, not all of NH is covered by Paramedics, but most of it is, and in the areas that Paramedics are not immediately available, the EMTs are usually some of the tops in their field based on their experience with working independently without Advanced Life Support available........... Kind of the same concept of how midwifery originated from!!

I am also troubled by the reference of Ms. Brown taking clients to the hospital herself when things aren't going according to plan......... Isn't that what ambulances are for? How does Ms. Brown care for her "Clients" when she is driving? If she isnt driving........ who is? The worried father? Hope I dont meet that caravan on the road. Talk about distracted driving!!

Also, what services does Ms. Brown offer when the mother delivers a baby that is in extremus? What does she do after she "catches" a newborn that suffers from a serious medical condition? Does EMS get called then?....... and since she doesnt tell the parents what to do....... do the parents have to call EMS? Do they have the "experience" to know what to do with a pulseless infant? How about one with Meconium aspiration?

Dont get me wrong, I think she offers a noble service to clients who desire a more holistic and natural experience with the birth of their children......... but failing to recognize, and even denigrating the abilities of the EMS professionals is short sighted at best. Seems like its that attitude or perception that all of those Institutionalized OBGYN folks (ie - Doctors) seem to be worried about!!

Of course everyone wants a healthy BABY and healthy MOTHER. The issue is about interventions and medications that have become "routine" in the typical, not every, hospital birth. The complications discussed, cord prolapse and excessive bleeding sometimes happen on their very own. The risk of cord prolapse happening is increased when artificial rupture of a woman's amniotic sac when the baby's head may not be fully engaged in the pelvis which can cause the cord to float down before the baby's head, is performed. Not having an amniotomy hook inserted to "break the water" to "speed" things up decreases that risk. Midwives are not typically proponents of this procedure for the very reason I just mentioned. While bleeding can occur without any reason, it can be more likely to happen with medications and procedures that only happen in a hospital setting. There are instances where Pitocin (a manufactured hormone) is necessary to induce a woman's labor for various medical reasons, or to supplement a woman's own (oxytocin) levels to get a labor moving along if there is a medical reason. Use of this medication can lead to a plethera of increased risks, bleeding being one of them. We know there are many increased risks when using this medication. If there weren't many possible risks involved with this medication, the use of electronic fetal monitoring during 100% of the labor wouldn't be required rather than intermittent monitoring. Women wouldn't be told they can no longer eat food because of the increased risk of emergency surgery if there weren't increased risks. When needed, Pitocin is a great tool to have. Women having birth center or homebirths don't have the option of using Pitocin because of these very risks. If they required it's use, their care would be transferred to an OB.

Once the baby is born, and the cord has stopped pulsating, the care provider clamps and cuts the cord and should wait patiently for signs of the placenta detaching. It is important not to pull on the cord to speed up delivery of the placenta as this can cause the severe bleeding spoken about in the article. If a piece of the placenta tears away, the uterus cannot clamp down completely causing the bleeding. When I think about the safety of medications and procedures I think about whether homebirth or birth center midwives are "allowed" to use them. There are, in place, rules and regulations outlining what homebirth and birth center midwives can and cannot use and can and cannot do. Pain medications and induction medications cannot be used by homebirth midwives, because they carry risks and complications with their use that homebirth midwives may not be equipped to deal with. One cannot assume they are completely safe just because hospitals have the medical and surgical means to deal with the complications that can arise with their use.

There are women who only feel safe and comfortable birthing in a hospital setting. Thank goodness we have good docs and hospitals to attend them. There are, however women who through research and knowledge only feel safe birthing with midwives in a birth center or home setting. Thank goodness NH supports their choices as well. My wish would be, like the article mentions, that Obstetricians work at least on a consultation basis with homebirth and birth center midwives so that in the event, through screening of their homebirth clients, or situational changes during the birth process, a homebirth midwife needs to transfer the care of her client to an OB, she can do so with the knowledge that her client will not only receive the medical care she is in need of but also receive the respect she deserves as an informed woman and not be greeted with an "I told you so" attitude or be made to feel that her choices were ignorant.

A healthy baby and healthy mother goes without saying, with the proper skilled care, women can have that with either a midwife or an Obstetrician. After that, the mother's satisfaction with her experience is also very important to her emotional well being as well as her ease in transitioning into the role of becoming a mother. Of course many women have wonderful experiences with OB's and hospitals, it's a testament to the great care we have access to. We cannot assume that there is only one way to birth, one care provider to use, or one setting to birth in for every woman. I have given birth four times and all four were different and by the way in a hospital setting with a Family Practitioner. I am just one woman, and all four were different and required different care. Women should have this safe option without being told she is putting the safety of her baby at risk for her experience. Women who choose this option absolutely believe they are making the safest choice for themselves and their baby. The countries that primarily use midwifery care for normal healthy pregnancies have the best maternal/infant outcomes. To have the attitude that a mother would hold it against her son if he needed to be born in a hospital rather than a rubber pool (and by the way there are whirlpools in hospitals as well, so it's not so ridiculous) is the very attitude women try to avoid.

Janice Mello, CCE, CD
Mother of Four

Anon -
Check out the stats for safest birth locations ... I think you will be unpleasantly surprised. In case you're into the Euro thing, they have greatly shifted birthing back to the home - not a ringing endorsement, I admit, but one worth considering. The most safe practice is likely a hybrid of midwife delivery, with OBGY backup, but sensible solutions are generally rejected out-of-hand.

And in case you were duped into thinking the American College of Obstetricians and Gynecologists is an academic or scientific organization, learn something new, they're effectively a "trade organization." Google is quite effective at rapidly undressing the truth, give or take a few nanoseconds.
- C. dog e. doG

I cannot understand how a mother having just given birth in a hospital could ever fell that she is not respected! The birthing process is to me all about the baby and what is best for him/her, not all about the mother. I would want my baby born in the safest most secure place possible. I wonder if this mother holds it aginst her son because he was born in a hospital and not in a rubber pool!!!