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| Posted By |
n/a on 7/8/2008 3:13:55 AM |
| Subject: |
RE: two questions |
| Message: |
I am a general surgeon in California currently working as mother. I had
my now five year old by cesarean for breech and asystole with an attempted
external version with my obstetrician friend. I had my now three year old
in water at home with a midwife with my obstetrician friend as my
backup.
I think studies can be interpreted in different ways. I
was merely pointing out the data. The reason you were not sure which
side I was one is because I am not on the home birth or the hospital
birth side. I am on the mother’s side.
Some events that happen
during labor and birth are not resolved immediately after birth.
Sometimes babies survive for weeks or months on life support only to
die later. Researchers have different time periods (infant, neonatal,
intrapartum, perinatal mortalities) because they are trying to answer
different questions, and sometimes they disagree on which time period
to use. Sometimes there is no right answer.
Prenatal care and
its effectiveness or ineffectiveness have been studied. Studies are
inconsistent in part because the purpose of prenatal care is not
consistent. Is the goal a lower maternal/ neonatal mortality rate? Or
breastfeeding success? Or avoiding repeat cesarean sections? See the
Cochrane database at:
http://www.ncbi.nlm.nih.gov/pubmed/17636711?ordinalpos=9&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
Although
you may not perceive any difference in monitoring between a home and a
hospital, those who feel they “do it better” have very strong beliefs
about how intrapartum and neonatal mortality is affected by location of
birth and birth attendant. For some, being ten minutes from the hospital is too far. For others, an hour is close enough.
As far as a general consensus, I don’t know of one.
Perhaps obstetricians believe that the advantage of a hospital birth is
that they are there, along with all the equipment and personnel with
which they are comfortable. In fact, most people have some element of
this. If you plan a home birth, is your backup plan to go to the most
rural hospital without a neonatal intensive care unit? Or is it to go
to the hospital with a perinatologist on call 24/ 7? Are you more likely to take the words of
an obstetrician or a mother more seriously? Is
not having a continuous fetal monitor only ok if you have a Doppler? Or
is a fetoscope enough? All of us participate in the idea that doctors
know more than us and that technology and science make things safer.
Some less than others. Robbie Davis-Floyd says it best in her book
Birth as an American Rite of Passage with her discussion of our
societal values of paternalism and technocracy.
http://www.amazon.com/Birth-as-American-Rite-Passage/dp/0520229320/ref=sr_1_3?ie=UTF8&s=books&qid=1215502269&sr=1-3
Tienchin
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