The Homebirth Midwife said What??!!

1. 10 Astounding Claims Made by Homebirth Midwives Amy Tuteur, MD The Skeptical OB The Homebirth Midwife said What??!!

2. At the conclusion of this course, participants will be able to: • Describe the different types of midwives in the US, their education and training • Summarize the literature on homebirth • Explain the origin of the natural childbirth movement • Anticipate the most common claims of homebirth midwives • Debunk the most common claims of homebirth midwives

3. Commercial Affiliation: NONE

4. 1. I’m just like the midwives in the Netherlands

5. No other country has a 2nd class of midwife • Less education than ALL other midwives • Less training that ALL other midwives • Not eligible for licensing in the UK, the Netherlands, Canada, Australia of ANY other first world country 1. I’m just like the midwives in the Netherlands

6. 2. Homebirth is as safe as Hospital birth

7. All the existing literature shows that homebirth increases the risk of perinatal death • CDC statistics: homebirth with a non-nurse midwife increases death rate 3-7X • Birthplace Study: homebirth increases the risk of poor outcomes • Oregon licensed midwives: death rate 9X higher than comparable risk hospital birth • Homebirth increases the risk of a 5 minute Apgar of 0 by 1000%. 2. Homebirth is as safe as Hospital birth

8. CDC Wonder Linked Birth/Infant Death File. http://wonder.cdc.gov/lbd.html

9. Rooks, Judith. Testimony before Oregon Legislature; March 15, 2013. https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeMeetingDocument/8585.

10. Grünebaum, et al. Apgar Score of Zero at Five Minutes and Neonatal Seizures or Serious Neurologic Dysfunction in Relation to Birth Setting, in press, published online, http://www.ajog.org/article/S0002-9378%2813%2900641-8/abstract

11. 3. Primitive women have painless childbirth

12. Grantly Dick-Read made that up • A eugenicist worried about “race suicide” • “ The mother is the factory.” 3. Primitive women have painless childbirth

13. 4. countries with high homebirth rates have low mortality rates

14. The Netherlands has high perinatal mortality • Low risk midwife birth has higher mortality than high risk obstetrician birth • Irrelevant since homebirth only small % of births in most developed countries 4. countries with high homebirth rates have low mortality rates

15. 5. Childbirth is inherently safe

16. Childbirth is inherently dangerous • 7% neonatal mortality • 1% perinatal mortality 5. Childbirth is inherently safe

17. 6. Waterbirth is safe; babies won’t inhale underwater

18. No primates deliver in water • Dive reflex occurs in cold water • Multiple deaths due to aspiration • Multiple deaths due to hyponatremia 6. Waterbirth is safe; babies won’t inhale underwater

19. 7. Pre-eclampsia can be prevented & treated with diet

20. Brewer diet • No evidence to support it 7. Pre-eclampsia can be prevented & treated with diet

21. 8. Babies aren’t library books, due on a certain day

22. Library books don’t self-destruct • Stillbirth rate rises 8. Babies aren’t library books, due on a certain day

23. 9. No abx for Group B strep; put garlic in your vagina

24. Or wash vagina with chlorhexidine • No evidence for effectiveness • Multiple GBS deaths at homebirth 9. No abx for Group B strep; put garlic in your vagina

25. 10. Breech, twins, VBAC are just variations of normal

26. “Normal” is anything a midwife can do • Midwives reclassify everything as variations of normal 10. Breech, twins, VBAC are just variations of normal

28. Bibliography Birthplace in England Collaborative Group. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ 2011;343:d7400. De Jonge A, van der Goes BY, Ravelli AC, Amelink-Verburg MP, Mol BW, Nijhuis JG, et al. Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births. BJOG2009;116:1177-84. Evers AC, Brouwers HA, Hukkelhoven CW, Nikkels PG, Boon J, van Egmond-Linden A, et al. Perinatal mortality and severe morbidity in low and high risk term pregnancies in the Netherlands: prospective cohort study. BMJ 2010;341:c5639. Amos Grünebaum, M.D., Laurence B. McCullough, Ph.D., Katherine J. Sapra, M.P.H., Robert L. Brent, M.D., Ph.D., DSc (Hon), Malcolm I. Levene, M.D., FRCP, FRCPH, F Med Sc, Birgit Arabin, M.D., Frank A. Chervenak, M.D. Apgar Score of Zero at Five Minutes and Neonatal Seizures or Serious Neurologic Dysfunction in Relation to Birth Setting, in press, published online, http://www.ajog.org/article/S0002-9378%2813%2900641-8/abstract Jacoba van derKooy, MD, JashvantPoeran, MD, Johanna P. de Graaf, MSc, Erwin Birnie, PhD, SemihaDenktas¸, PhD, Eric A. P. Steegers, MD, PhD, and Gouke J. Bonsel, MD, PhD. Planned Home Compared With Planned Hospital Births in The Netherlands; Intrapartum and Early Neonatal Death in Low-Risk Pregnancies. ObstetGynecol 2011;118:1037–46. Rooks, Judith. Testimony before Oregon Legislature; March 15, 2013. https://olis.leg.state.or.us/liz/2013R1/Downloads/CommitteeMeetingDocument/8585. Wax JR, Lucas FL, Lamont M, Pinette MG, Cartin A, Blackstone J. Maternal and newborn outcomes in planned home birth vs planned hospital births: a meta-analysis. Am J Obstet Gynecol2010;203:243.e1-8.