States that allow homebirths
Ben Warner
Can someone please provide a list of the states that
allow homebirths, esp. attended by midwives?
Please e-mail the list to:
Important information as we look at relocation...
Malcolm Griffiths
In article <smm$961227...@cony.gsf.de>, Ben Warner
<bdwa...@southeast.net> writes
>Can someone please provide a list of the states that
>allow homebirths, esp. attended by midwives?
>
I am unaware of anywhere else that imposes these restrictions !
--
Malcolm Griffiths MD,MRCOG,MFFP,Cert.Mgmnt
Obstetrician & Gynaecologist Luton & Dunstable Hosp.,UK.
Tel: 01582-497459 (office)
01525-222849 (home)
Fax: 01582-497424
email: Mal...@mgriff22.demon.co.uk
"It is dangerous to be right on a subject on which the established authorities
are wrong." (Voltaire)
Todd Gastaldo
British physician Malcolm Griffiths wrote of homebirth restrictions in
the U.S.:
<<<<I am unaware of anywhere else that imposes these restrictions !>>>>
Dr. Griffiths might have a look in his own backyard...
Heather Rothwell, Staff Midwife, East Glamorgan General Hospital,
Pontypridd, East Glamorgan, UK., argues that publication of "Changing
Childbirth" by the British Department of Health should have finally
granted British women the option of homebirth - but because of ongoing
medical propaganda, British women effectively don’t yet have the
homebirth option:
"Institutional care is still the norm...99% of mothers give birth in
hospital...I do not argue that all women, given a real choice, will opt
for home births; but that there are some women, who would like to give
birth at home, who do not know that it is ‘allowed’...who do not like to
ask because it will cause a fuss or make them appear awkward or
unco-operative...It is the structure of the service which prevents more
people from giving birth at home, and the structure is dictated by the
obstetricians, who want 100% hospital confinement...The propaganda
required to maintain compliance with the present routines compromises
the ethical credibility of both doctors and midwives, and the autonomy
of mothers...The dissonance between the recommendations of "Changing
Childbirth" and what health professionals can actually do, given the
resources available, only serves to emphasize the ethical credibility
gap in the maternity services." [Rothwell H. Changing childbirth:
changing nothing. Midwives (Nov)1996;109(1306):291-94]
Ms. Rothwell noted in her article that after "Changing Childbirth" was
published, "the RCOG protested that any increase in the number of
home[births]...would be unsafe."
Recently, by telephone, Ms. Rothwell indicated that this sentence from
her article alluded to the fact that publication of "Changing
Childbirth" initially elicited from RCOG a letter to RCOG obstetricians
further libeling homebirth as unsafe. [Nov. 26, 1996 personal
communication, Heather Rothwell]
I pointed out to Ms. Rothwell that she had rather generously neglected
to mention in her article the fact (paraphrasing Cronk and Flint's
Community Midwifery [1989]) that there is "now no evidence to support
the previously held view that all births should take place in hospital."
I noted further that in future articles on the subject, Ms. Rothwell
should state outright that RCOG libeled homebirth and homebirth midwives
even after the British government had published authoritative evidence
(the Winterton Report and "Changing Childbirth) that there was never any
evidence for the obstetricians’ homebirth is unsafe libel in the first
place.
I am reminded of British research statistician Marjorie Tew's conclusion
that the British maternity system is run by obstetricians who "withhold
and pervert knowledge in order to maintain public ignorance and
delusion." [Tew M. Safer childbirth? A critical history of maternity
care. London: Chapman and Hall, 1990.]
Of course, British obstetricians - like their American cousins - are
perverting knowledge for profit.
I note in this regard Ms. Rothwell's statement that, to effect change,
"midwives will need access to accounts so that they know how money is
distributed..."
Excellent advice for midwives everywhere.
Here in the U.S., I would like to start by opening the books of
malpractice liability insurers.
Attorney/physician Harvey Wachsman [Lethal Medicine NY: Henry Holt 1993]
offers some staggering figures to show that malpractice liability
insurers are making an obscene killing writing insurance for
obstetricians.
Obstetricians appear to be getting something quite valuable in return -
the ability to tell homebirth midwives that their malpractice liability
insurance companies simply won't let them support homebirth....
In effect, the malpractice liability insurers thus insure that all
maternity care business is routed to obstetricians and hospitals. The
obstetricians then have plenty of money for their malpractice liability
insurance premiums - and a seemingly legitimate gripe at-the-ready for
when they are asked why they are refusing to back-up homebirth midwives.
It's all very tidy. In California, most if not all the malpractice
liability insurers are physician-owned.
The only catch is that there are no actuarial data to show that
homebirth malpractice liability risk is any greater than hospital birth
malpractice liability risk.
At a March 1, 1994 California Medical Board meeting, a homebirth
midiwife challenged a retired appellate court judge to back up his claim
of higher liability. He could not. (The retired judge works as a
lobbiest for a malpractice liability insurance company.)
At that same meeting, I requested that the Medical Board not spend any
of the $70,000 taxpayer loan authorized for implementation of
California's 1993 midwifery statute - until the Medical Board could find
the homebirth physician supervisors that medical lobbyists had insisted
upon in the statute "so as not to issue an invitation to homebirths."
[Ob.Gyn.News Sept.15, 1993]
Exactly three years later, Ob.Gyn.News ran an article noting that the
three homebirth midwives then licensed couldn't seem to find homebirth
physician supervisors because of the malpractice liability insurance
situation. [Ob.Gyn.News Sept.15, 1996]
The following month, about 35 more homebirth midwives were licensed -
and there is now a report that ONE homebirth physician supervisor has
stepped forward. By law he can supervise only four midwives total and
he doesn't have to be present at any of the births they attend.
I personally hope that MANY homebirth physician supervisors step forward
in California.
A few token homebirth physician supervisors will not stop a lawsuit
against California obstetricians for subverting the 1993 midwifery
statute in advance by insisting on physician supervision "rather than a
more collegial relationshiop...so as not to issue an invitation to
homebirths." [Ob.Gyn.News Sept.15, 1993]
The master key to the whole charade may be what Wachsman calls "the myth
of the vanishing obstetrician," which, he says, is believed at the
highest levels of government.
Todd D. Gastaldo, D.C.
--
IMPORTANT NOTE: I am not currently practicing chiropractic - except
insofar as the practice of chiropractic includes freedom of speech.
While in Oregon doing library research I have voluntarily forfeited my
California chiropractic license so as not to have to pay the annual
licensing fee. (Under California law, any licensed D.C. may voluntarily
forfeit his/her license, and may, at any time, reactivate said license
by providing the Board of Examiners with "twice the annual amount of
the renewal fee...[He or she]...shall not be required to submit to an
examination for the reissuance of the certificate." [Section 12, Act
Regulating the Practice of Chiropractic...Issued by the Board of
Chiropractic Examiners...Act Includes Amendments Through October 1993]
Malcolm Griffiths
In article <smm$961228...@cony.gsf.de>, Malcolm Griffiths
<Mal...@mgriff22.demon.co.uk> writes
>In article <smm$961227...@cony.gsf.de>, Ben Warner
><bdwa...@southeast.net> writes
>>Can someone please provide a list of the states that
>>allow homebirths, esp. attended by midwives?
>>
>Have you thought of relocating to anywhere outside the United States ?
>
I received this Email off-list. It seemed likely that the author hadn't
gone to all this effort to try to reply personally so I'm posting it to
the group. Even if he didn't I hope he won't mind. Ive replied at the
same time.
In message <32C61F...@gte.net>, Todd Gastaldo <gast...@gte.net>
writes
Todd's bits are in ( single) quotation marks.
'British physician Malcolm Griffiths wrote of homebirth restrictions in
the U.S.:'
I'm actually an obstetrician !
'I am unaware of anywhere else that imposes these restrictions !'
'Dr. Griffiths might have a look in his own backyard...'
I work in a part of the UK where there is a very favourable attitude
towards home birth. I am ( locally ) well-known for my positive views on
home births ( neither I nor my siblings were hospital births ! ). I will
be lecturing next month on the role of the consultant obstetrician in
home births. The meeting is organised by the "Changing Childbirth
Implementation Team" - which arose as a result of the Changing
Childbirth Report. That tea are passionately in favour of women's choice
on manner and place of birth and have done a n amazing amount of work to
"get the message across".
'Heather Rothwell, Staff Midwife, East Glamorgan General Hospital,
Pontypridd, East Glamorgan, UK., argues that publication of "Changing
Childbirth" by the British Department of Health should have finally
granted British women the option of homebirth - but because of ongoing
medical propaganda, British women effectively dont yet have the
homebirth option: '
I don't know Heather, nor the unit she works in, nor have I seen her
article.
British women have always had a right to home birth. Home birth was the
norm for all deliveries until the later 1950's. There had been the Peel
report ( ?1947 ), when the RCOG had mis-guidedly influenced government
policy towards encouraging institutional delivery. This was politically
and and self-interestedly motivated.
>From about 1960, hospital ( or more often midwife run maternity home )
delivery was the norm for first births and later became the norm for
subsequent births. Thoughout all that time women have been able to chose
home birth. It is a statutary responsibility that community midwives
will attend ( when requested ) a home birth. Similarly it is a
requirement of managers of maternity care to provide midwifery cover for
home birth requests. It is a criminal offence for any one other than the
mother to plan to deliver the child without the attendance of a midwife
or doctor. What has happened ( to varying degrees - in different
localities and at different times ) has been institutional obstacles
have been placed in their way and they have been given discouraging
advice. Home birth though should not have been refused ( admittedly made
very difficult to achieve for some women ).
The whole British midwifery and obstetric professions now view home
birth with differing degrees of positivity.
'Institutional care is still the norm...99% of mothers give birth in'
Reliable figures for home births are difficult to obtain. What we're
talking about her is planned home births, there are also unplanned home
births ( where labour progresses very quickly and delivery occurs
without attendants and support - sometimes with poor outcomes ).
Statistics have always been collected by place of birth, rather than
intended place of birth ( this has allowed some massaging of statistics
to suggest home births are less safe ). Most recent estimates suggest
planned home births account for 2% of all UK births, another 1% are
unplanned. SOme areas have much higher figures.
'hospital...I do not argue that all women, given a real choice, will opt
for home births; but that there are some women, who would like to give
birth at home, who do not know that it is allowed...who do not like to
ask because it will cause a fuss or make them appear awkward or
unco-operative...'
Talking to UK women ( as I do all day every day ) suggests that the vast
majority of women don't want home birth - in fact I'm disappointed by
how few do ! Whilst out shopping in the supermarket today I met two
friends ( he and she are both GPs - family doctors ), they had with them
there three children - all born at home !
'It is the structure of the service which prevents more
people from giving birth at home, and the structure is dictated by the
obstetricians, who want 100% hospital confinement...The propaganda
required to maintain compliance with the present routines compromises
the ethical credibility of both doctors and midwives, and the autonomy
of mothers...The dissonance between the recommendations of "Changing
Childbirth" and what health professionals can actually do, given the
resources available, only serves to emphasize the ethical credibility
gap in the maternity services." [Rothwell H. Changing childbirth:
changing nothing. Midwives (Nov)1996;109(1306):291-94]'
It sounds very sad. I don't recognise this picture of UK maternity care.
Perhaps Heather should get in touch with the Changing Childbirth
Implementation Team, who have run sever Home Birth Workshops for
professionals.
'Ms. Rothwell noted in her article that after "Changing Childbirth" was
published, "the RCOG protested that any increase in the number of
home[births]...would be unsafe." '
When the report came out there were major ( political ) upheavals
already occuring at the RCOG. The inital resposes were from dinosaurs.
Since then the RCOG convened a study group of professional bodies and
consumers. This led to a very positive meeting and publication. RCOG
policy is not anti-home births.
The two obstetric advisors to the Changing Childbirth Report were a
former senior vice-president of the RCOG and one of the editors of the
RCOG publication - Br.J.Obstet.Gynaecol.
'Recently, by telephone, Ms. Rothwell indicated that this sentence from
her article alluded to the fact that publication of "Changing
Childbirth" initially elicited from RCOG a letter to RCOG obstetricians
further libeling homebirth as unsafe. [Nov. 26, 1996 personal
communication, Heather Rothwell] '
'I pointed out to Ms. Rothwell that she had rather generously neglected
to mention in her article the fact (paraphrasing Cronk and Flint's
Community Midwifery [1989]) that there is "now no evidence to support
the previously held view that all births should take place in
hospital." '
'I noted further that in future articles on the subject, Ms. Rothwell
should state outright that RCOG libeled homebirth and homebirth
midwives'
I'm uncertain about the use of the word libel here. But assure you this
is a quite incorrect description of the RCOG position.
'even after the British government had published authoritative evidence
(the Winterton Report and "Changing Childbirth) that there was never
any evidence for the obstetricians homebirth is unsafe libel in the
first
place. '
'I am reminded of British research statistician Marjorie Tew's
conclusion that the British maternity system is run by obstetricians who
"withhold
and pervert knowledge in order to maintain public ignorance and
delusion." [Tew M. Safer childbirth? A critical history of maternity
care. London: Chapman and Hall, 1990.]'
The findings from Marjorie Tew's research are widely accepted over here.
'Of course, British obstetricians - like their American cousins - are
perverting knowledge for profit. '
This unfortunately demonstrates a misunderstanding of UK medicine.
Private ( for profit ) obstetric care is the exception in the UK. It
accounts for far fewer births than even home births !
What motivated 1940's UK ob/gyn's was establishing a professional
position for themselves. Until that time medical involvement in
maternity care was not at a specialist level. Currently a large chunk of
UK ob/gyn's are rather more interested in gynaecological practice (
which largely happens in office hours ) and not maternity care ( most of
which happens at times beyond our control ).
'I note in this regard Ms. Rothwell's statement that, to effect change,
"midwives will need access to accounts so that they know how money is
distributed..." '
I don't know what Ms Rothwell means by this but she should take it up
with her manager.
'Excellent advice for midwives everywhere.'
'Here in the U.S., I would like to start by opening the books of
malpractice liability insurers.'
Here Todd I must admit I'm not terribly knowledgeable about US
insurance. I hope you are better informed about it thanh you seem to be
about UK maternity care.
'Attorney/physician Harvey Wachsman [Lethal Medicine NY: Henry Holt
highest levels of government.'
Malcolm Griffiths MD,MRCOG,MFFP,Cert.Mgmnt
Obstetrician & Gynaecologist Luton & Dunstable Hosp.,UK.
Tel: 01582-497459 (office) Fax: 01582-497424
01525-222849 (home) email: Mal...@mgriff22.demon.co.uk
http://www.obgyn.net/board/griffith.htm
"It is dangerous to be right on a subject on which the established authorities
are wrong." (Voltaire) "But sometimes it's fun :-)" (Griffiths)
Todd Gastaldo
Malcolm Griffiths, M.D. wrote:
<<<<I don't recognise [British midwife Heather Rothwell's] picture of UK
maternity care.>>>>
Dr. Griffiths' statement came in response to an excerpt from British
midwife Heather Rothwell's article, "Changing childbirth: changing
nothing." [Midwives (Nov)1996;109(1306):291-94]
Whereas Dr. Griffiths claims,
<<<<British women have always had a right to home birth...>>>>
According to the British government, British women have been DENIED the
homebirth option.
According to the 1992 Winterton Report of the House of Commons Select
Health Committee - as quoted by the British Department of Health
(emphasis added):
"[We] must draw the conclusion that THE POLICY OF ENCOURAGING ALL WOMEN
TO GIVE BIRTH IN HOSPITALS CANNOT BE JUSTIFIED ON GROUNDS OF
SAFETY...[I]t is no longer acceptable that the pattern of maternity care
provision should be driven by presumptions about the applicability of a
medical model of care based upon unproven assertions...Hospitals are not
the appropriate place to care for healthy women...We recommend that the
Department of Health vigorously pursue the establishment of best
practice models of team midwifery care..."
"[A] ‘medical model of care’ should no longer drive the maternity
service and WOMEN SHOULD BE GIVEN UNBIASED INFORMATION...INCLUDING THE
OPTION, PREVIOUSLY DENIED TO THEM, OF HAVING THEIR BABIES AT HOME..."
[House of Commons Select Health Committee, Second Report 1992. Quoted in
Department of Health (Britain). Changing Childbirth HMSO Publications
Centre, P.O. Box 276, London, SW8 5DT. Thanks to Trudy Saunders
(071-972-2000 ext. 4155), Assistant to Baroness Julia Cumberlidge,
Parliamentary Under Secretary of State for Health, in the office of
Virginia Bottomley, Parliamentary Secretary of State for Health,
Wellington House, 133-155 Waterloo Road, London SE1 8UG.]
Dr. Griffiths blithely states:
<<<<it is a requirement of managers of maternity care to provide
midwifery cover for home birth requests.>>>>
This seems to be the rub - and it appears to be an artificially
(medico-politically) created rub at that.
Ms. Rothwell notes that the Winterton Report clearly stated a basic
premise - an important PREREQUISITE - which was politically rejected by
the British Government's Changing Childbirth effort.
Ms. Rothwell notes that those who authored the Changing Childbirth
report somehow received a "remit" that did not include meeting the
Winterton prerequisite, which is as follows:
"Pronouncements about the need to provide women with choice, continuity
of care and control are wanting in purpose unless the inequalities in
health between different groups of women are acknowledged and addressed.
This is a PREREQUISITE to placing women at the centre of the planning
and provision of maternity care." (emphasis added)
Ms. Rothwell notes that as a result of Changing Childbirth's failure to
meet the Winterton prerequisite, Changing Childbirth only "SEEMS to
support midwifery." (emphasis added) She says further that there is
considerable "dissonance between the recommendations of 'Changing
Childbirth' and what health professionals can actually do, given the
resources available..."
Based on Mrs. Tew's observation that the British maternity system is run
by obstetricians who pervert knowledge to delude the public (an
observation curiously not disputed by Dr. Griffiths; see below), my
suspicion is that British obstetricians engineered the gutting of the
Winterton Report described by Ms. Rothwell.
I further suspect that the gutting was engineered in the "very positive
meeting" at RCOG which occurred soon after Dr. Griffiths' RCOG
"dinosaurs" libeled homebirth immediately following publication of the
Winterton Report. See below.
While British obstetricians have now published a beautiful position
STATEMENT (in support of homebirth; see below), they may still be quite
fundamentally opposed to homebirth. (As noted at the end of this post,
something very similar appears to be happening in both Oregon and
California in the U.S.)
<<<<I will be lecturing next month on the role of the consultant
obstetrician in home births. The meeting is organised by the "Changing
Childbirth Implementation Team" - which arose as a result of the
Changing Childbirth Report. That tea are passionately in favour of
women's choice on manner and place of birth and have done an amazing
amount of work to "get the message across".>>>>
Why on earth would the Changing Childbirth message require this "amazing
amount of work?"
Could this "amazing amount of work" have anything to do with RCOG's
"politically and self-interestedly motivated" long term denial of
homebirths, based on "unproven assertions?"
<<<<[In] the later 1950's...RCOG...mis-guidedly influenced government
policy towards encouraging institutional delivery. This was politically
and and self-interestedly motivated.>>>>
<<<<institutional obstacles have been placed in their way and they have
been given discouraging advice. Home birth though should not have been
refused ( admittedly made very difficult to achieve for some women
).>>>>
Again, homebirth was DENIED to British women - and this denial was based
upon "unproven assertions" - according to a two year study by a British
House of Commons Select Committee.
Homebirth is STILL effectively being denied to British women, according
to Ms. Rothwell's article.
<<<<<the vast majority of women don't want home birth...>>>>
Ms. Rothwell wrote: "I do not argue that all women, given a real
choice, will opt for home births; but that there are some women, who
would like to give birth at home, who do not know that it is
allowed...who do not like to ask because it will cause a fuss or make
them appear awkward or unco-operative..."
Ms. Rothwell believes that "the numbers of homebirths can be expected to
increase" when the fundamentally medicalized structure of maternity care
finally changes.
<<<<When the [Winterton] report came out there were major ( political )
upheavals already occuring at the RCOG. The inital resposes were from
dinosaurs. Since then the RCOG convened a study group of professional
bodies and consumers. This led to a very positive meeting and
publication. RCOG policy is not anti-home births.>>>>
No doubt RCOG "dinosaurs" knew in advance what the Winterton report
would say.
With all due respect to real dinosaurs (may they rest in peace) I
suspect that the obstetric "dinosaurs" to which Dr. Griffiths refers did
not have the good manners to die off - or at least change their BEHAVIOR
regarding homebirth - during the "major (political) upheavals" at RCOG.
<<<<I'm uncertain about the use of the word libel here.>>>>
Then let me be more precise: When obstetric "dinosaurs" can't prove
their authoritative assertion that homebirth is unsafe - when they
persist in authoritatively asserting that homebirth is unsafe - they are
libeling homebirth. It's really quite simple.
<<<<But [I] assure you...[libel]...is a quite incorrect description of
the RCOG position.>>>>
Libel is indeed a "quite incorrect" description of the RCOG position
STATEMENT - the one that magically appeared following the "very positive
[RCOG] meeting" that occurred soon after RCOG obstetric "dinosaurs"
reacted to the Winterton Report by further libeling homebirth as unsafe.
Of COURSE obstetric "dinosaurs" are going to craft a pro-homebirth
STATEMENT. Libel is illegal.
When powerful cultural authorities libel a practice location (the home)
as unsafe, they are ILLEGALLY gaining an unfair competitive advantage
over practioners who practice in the home. Many of these home
practitioners must switch to hospital practice and adopt medical habits
just to survive financially. Others just go out of business.
Some people at RCOG might have said, "HEY RCOG DINOSAURS - THIS IS
REALLY TOO BLATANT. WE CAN'T KEEP THIS LIBEL THING GOING WITHOUT
EVENTUALLY GETTING SUED. WE'D BETTER CRAFT A PRO-HOMEBIRTH STATEMENT."
Perhaps the "upheaval" started because the RCOG dinosaurs pointed out in
reply that everyone KNOWS that obstetric dinosaurs have been doing what
they damn well please for decades...
Perhaps the "upheaval" only ended when RCOG "dinosaurs" and
"moderates(?)" hit upon a plan to gut the Winterton Report... See below.
British research statistician Marjorie Tew concluded that the British
maternity system is run by obstetricians who "withhold and pervert
knowledge in order to maintain public ignorance and delusion." [Tew M.
Safer childbirth? A critical history of maternity care. London: Chapman
and Hall, 1990.]
Upon reading this quote from Mrs. Tew's book, Dr. Griffith's response
was:
<<<<The findings from Marjorie Tew's research are widely accepted over
here.>>>>
In reponse to my claim that, "Of course, British obstetricians - like
their American cousins - are perverting knowledge for profit"...
Dr. Griffiths wrote:
<<<<This unfortunately demonstrates a misunderstanding of UK medicine.
Private ( for profit ) obstetric care is the exception in the UK. It
accounts for far fewer births than even home births !>>>>
There is no misunderstanding. Public obstetric care in the UK results
in salaries paid to "expensive consultant obstetricians" (Ms. Rothwell's
phraseology).
British obstetricians do NOT work for free. More importantly, like
their American obstetrician cousins, they know the value of having a job
- even if it means putting homebirth midwives out of a job - illegally -
by libeling home-based practice as unsafe.
<<<<What motivated 1940's UK ob/gyn's was establsihing a professional
position for themselves...>>>>
Yes! This is *exactly* what motivated 1940's *US* ob/gyn's; though
their homebirth is unsafe libel continues - in the form of an
experimentally unsubstantiated "hospitals are safest" boast - and in the
form of persistent "homebirth is child abuse" undercurrents. (ACOG's
"homebirth is child abuse" libel first appeared publicly in Ob.Gyn.News
Oct.1, 1977. It resurfaced again in the 1990s according to homebirth
proponent Marsden Wagner, M.D., in his 1994 book "Pursuing the Birth
Machine," as quoted in an interview with Ina May Gaskin in Birth
Gazette.)
I suspect that obstetric "dinosaurs" in Britain were only attempting to
MAINTAIN their illegally established professional positions when in 1992
they persisted in libeling homebirth as unsafe upon release of the
Winterton Report.
We love our cultural authorities - and we believe in some of the
strangest things they tell us - but only to a point of disbelief...
When cultural authorities belatedly realize that the point of disbelief
has been reached, they hurriedly issue forth with beautiful STATEMENTS
which fortunately sometimes precede behavioral changes.
While I appreciate Dr. Griffiths' input - and his public profession of
support for homebirth - I am still inclined to believe Ms. Rothwell when
she writes: "It is the structure of the service which prevents more
people from giving birth at home, and the structure is dictated by the
obstetricians, who want 100% hospital confinement..."
Barbara Troutt, a community midwife in Manchester wrote:
"Why is there such a deafening silence on the results of research that
proves that obstetric intervention can actually cause the neonatal
mortality and morbidity it aims to prevent?...
"I can only assume that...powerful vested interests are involved...
"[T]o 'fully inform' the public...would remove the need for most of the
powerful obstetric industry that has grown up since 1970 and return
childbirth to its rightful place as a normal life event within the
family." [Troutt B. Changing Childbirth: the best-kept secret ever.
Midwives. 1996;109(1303):235]
Whereas Ms. Troutt seems to be innocently calling for more publicity for
Changing Childbirth ("It would be so easy for the Department of Health
to spread the word"); Ms. Rothwell is publicizing the fact that Changing
Childbirth only SEEMS midwife/homebirth-friendly - because the
Government (at RCOG's behest?) intentionally left out the Winterton
prerequisite. See above.
Ms. Rothwell says that midwives are left trying to effect the changes
recommended in Changing Childbirth - without adequate resources - "and
without the support of obstetricians and GPs."
If Ms. Rothwell is to be believed, there are not very many
homebirth-friendly OBs in Britain.
Perhaps Dr. Griffiths will recognize "the picture" when he reads Ms.
Rothwell's midwifery article in its entirety.
Interesting endnote: A member of RCOG, E. Paul Kirk, M.D., happens to
be chairman of the obstetrics department at Oregon's only health science
university.
RCOG member Kirk chaired (until Dec 1996) the Oregon Health Services
Commission which established the Prioritized List for the Oregon Health
Plan, Oregon's innovative Medicaid program.
Formerly a British subject, now a U.S. citizen, Dr. Kirk, too, professes
support for homebirth.
Oddly, though, OHSU obstetrics chair Kirk has yet to install a homebirth
program at Oregon Health Sciences University (OHSU) - even though it is
official Oregon State policy (stipulated in law) that homebirths are
"safe deliveries at lower cost" - and even though it is Oregon State
policy (stipulated in law) that Oregon's homebirth midwives are to be
"acknowledged" for offering Oregonians the safe, lower cost homebirth
option. [ORS 442.600 Maternity Care Access Plan]
Interestingly, Dr. Kirk, who worked in Britain’s health system from 1961
to 1975 [BMJ 1991;302:1020], has criticized the U.S. Food and Drug
Administration (FDA) for being "unwilling to accept experience from
Europe" in regard to an abortion drug. [Kirk quoted in The Oregonian
(Sep9)1995:A14]
"[A]mazed and embarrassed by the politicians of this nation" (when they
attacked surgeon general nominee Dr. Henry Foster, Jr. for having
performed abortions), Dr. Kirk said, "Abortion is legal. Abortion is
something women choose. It’s the responsibility of my profession to
make it safe." [Kirk quoted in Oregonian (Feb10)1995:C6]
HOMEBIRTH is something women choose; and the nice thing about homebirth
is that it’s ALREADY safe [ORS 442.600 plan] - no medical intervention
necessary.
On Feb. 16, 1995, Dr. Kirk told The Oregonian (p. A12) that OHSU does
not require abortion training - "However," he said, "and the however is
very important, the majority of our residents do choose to learn the
skill..."
Regardless of whether OHSU obstetrics residents want to learn the
homebirth skill, OHSU residents should at least be offered the
opportunity to practice alongside homebirth midwives who for years have
demonstrated their skill in offering "safe deliveries at lower cost."
[ORS 442.600 plan]
My guess is that homebirth will come to OHSU - via the American College
of Nurse Midwives (ACNM) - which recently did homebirth midwives the
favor of "assuming responsibility" for the education of existing and
future homebirth midwives.
My own preference would be for CNMwives to handle HOSPITAL midwifery at
OHSU and let experienced licensed homebirth midwives handle OHSU's
coming homebirth midwifery program - AS IS - no CNM training necessary.
These non-medically-trained experienced homebirth midwives should also
be given hospital privileges at OHSU so that nurse-midwifery and medical
students could learn from them right in the hospital - as they offer
Oregonians their non-interventive skills in a hospital environment.
It's not the birth location that is important - it's the philosophy of
the provider.
Obstetrician Kirk’s public comments about abortion interest me greatly
because, incredibly, birth was essentially equated with abortion by a
California Supreme Court bent on concluding (erroneously) that the
Medical Practice Act didn't really state that midwifery was not the
practice of medicine - when it actually did (and still does).
The California Supreme Court’s bizarre "abortion equals birth" logic may
be summarized as follows: Since women can’t even hire M.D.s to ABORT
their babies at term, California women can’t hire unlicensed non-medical
midwives to DELIVER their babies at term:
"[T]he right of privacy has never been interpreted so broadly as to
protect a woman's choice of the manner and circumstances in which her
baby is born. Indeed Roe, supra, appears specifically to exclude the
right to make such choices...In Roe, the United States Supreme Court
held expressly that the state may proscribe the performance of an
abortion...by a person who is not a licensed physician." Bowland v.
Municipal Court (1976) Sup.134 Cal. Rptr. 630
"More significantly...at the point of viability of the fetus, the
state's interest in the life of the unborn child supersedes the woman's
own privacy right, and at that point (the beginning of the third
trimester) abortion may be prohibited...For the same policy reasons for
which the Legislature may prohibit [licensed physicians from aborting]
unborn children it may require that those who assist in childbirth have
valid licenses." Bowland at 638)
The catch to the State of California requiring "valid licenses" is that
the 1974 nurse-midwifery licensing law in California required "physician
supervision" - which meant, after obstetricians created their
malpractice insurance crisis hoax [Wachsman Lethal Medicine NY: Holt
1993], that California women couldn’t have homebirths because
nurse-midwives couldn’t find homebirth physician supervisors willing to
risk losing all of their malpractice liability insurance coverage.
As I noted in my previous post, a token homebirth physician supervisor
finally (reportedly) appeared in California - three years after medical
lobbyists held out for "physician supervision" in the 1993 midwifery
statute "so as not to issue an invitation to homebirths." [Ob.Gyn.News
Sept. 15, 1993]
Whereas British physicians libeled homebirth - and PERHAPS engineered
the obvious (thanks to Ms. Rothwell's article) subversion of the
Winterton Report - California physicians libeled homebirth as they
DEFINITELY attempted to subvert in advance the 1993 midwifery statute.
A little known fact about the 1993 California midwifery statute is that
it repealed the existing INDEPENDENT midwifery practice statute - the
one that the California Supreme Court so dishonestly attempted to change
with its preposterous abortion-equals-birth Bowland decision.
Some awfully illegal things have been happening on both sides of the
Atlantic in the name of illegitimate obstetric authority.
Israel Gale
Malcolm Griffiths <Mal...@mgriff22.demon.co.uk> writes:
> I received this Email off-list. It seemed likely that the author hadn't
> gone to all this effort to try to reply personally so I'm posting it to
> the group. Even if he didn't I hope he won't mind. Ive replied at the
> same time.
In general, it's considered very bad netiquette to publicly post someone's
private e-mail without their explicit permission.
You may not be aware that full-text searchable databases of everything
posted on Usenet are now freely available to the public. Posting
something on Usenet is akin to entering it into the card catalogue of every
public library in the world, or taking out an ad in every newspaper.
Just hoping to save you any future ill-will or flame attacks.
-Israel Gale
ga...@hpc.pko.dec.com
Malcolm Griffiths
In article <smm$96123...@cony.gsf.de>, Todd Gastaldo
<gast...@gte.net> writes
>Malcolm Griffiths, M.D. wrote:
>
><<<<I don't recognise [British midwife Heather Rothwell's] picture of UK
>maternity care.>>>>
>
>Dr. Griffiths' statement came in response to an excerpt from British
>midwife Heather Rothwell's article, "Changing childbirth: changing
>nothing." [Midwives (Nov)1996;109(1306):291-94]
>
You obviously feel strongly about this issue. I feel equally stronglky
about this issue too. You're attacking the wrong person.
Sadly you are waging a war against UK obstetricians ( and me in
particular ) which has largely been won already though it sounds like
there are a few mnor skirmishes to be won in parts of South Wales.
It is a fact that women in UK have always had a legal right to DEMAND
home birth. It is obviously the case that some women who would have or
now would like to chose homebirth are put off by mis-informed doctors or
midwives. My case is that anyone who insists cannot be denied. A midwife
( or a manager of community midwives ) who refused to attend a home
birth would be in serious shit - deregistered !
My personal estimate is that no more than 5% of all women would wish to
chose homebirth - therefore the 2% figure previously quoted is an
indicator that we're doing well, but could do better.
Next month I shall be attending my third "home births workshop" the
Changing Childbirth Implementation have organised a number of others, as
have other groups. Practitioners in the UK are going to great lengths to
facilitate women's choice in childbirth - supported by the Departmetn of
Health.
No-one over here would argue we'd got things perfect, but I think we're
doing very well.
Try hopping over to Hull ( East Coast ) on 10th Feb for one of the
workshops. You could learn about what's being done, maybe you could take
it back to the USA, where you'd be hard pushed to find many
obstetricians too positive about home births and no-one funding them out
of public money.
Todd Gastaldo
Malcolm Griffiths, M.D. wrote:
<<<<Practitioners in the UK are going to great lengths to facilitate
women's choice in childbirth - supported by the Departmetn of Health...
Todd Gastaldo, D.C. remarks:
Practitioners in the UK may well be going to "great lengths" to
facilitate women's choice in childbirth; but as midwife Heather Rothwell
points out, according to the Winterton Report, such efforts are "wanting
in purpose" because they ignore, by design the crucial Winterton
prerequisite:
"Pronouncements about the need to provide women with choice, continuity
of care and control are wanting in purpose unless the inequalities in
health between different groups of women are acknowledged and addressed.
This is a PREREQUISITE to placing women at the centre of the planning
and provision of maternity care." (emphasis added)
Quite simply, Dr. Griffiths' lofty pronouncement ("Practitioners in the
UK are going to great lengths to facilitate women's choice in
childbirth") - is "wanting in purpose" - this according to the very
experts who started the task.
As I read Ms. Rothwell's article, with the Winterton Report gutted as it
is, poor women and children lose - and UK obstetricians win - as does
the medical model of care.
According to Ms. Rothwell, midwifery is being "forced into the
straitjacket of the hospital-based consultant unit"; and as a result,
midwives end up serving the medical model instead of serving the
COMMUNITY (with the midwifery model). Meanwhile, the real causes of
most maternity morbidity and mortality go unacknowledged and
unaddressed...
Re-stating the Winterton prerequisite:
FIRST acknowledge and adress "the inequalities in health between
different groups of women" - and THEN (and only then) can you begin to
meet "the need to provide women with choice, continuity of care and
control..."
Dr. Griffiths claims on his web page that he is "currently involved in
the following initiatives...<snip, snip>...responding to 'Changing
Childbirth', developing other patterns of maternity care."
Furthermore, he says on his web page that he is aware of "pitfalls" in
the Changing Childbirth report, because he helped develop a scheme for
midwifery care:
"...develop[ing] a scheme for midwife or GP/midwife administered ante-,
intra- and post-partum care...has given me an insight into the
attractions and pitfalls of some aspects of the recent reports of the
parliamentary health committee and of Baroness Cumberledge. I
am now involved locally in similar developments..."
Was ignoring the Winterton prerequisite an INTENTIONAL pitfall -
introduced at the behest of RCOG and welcomed by Conservatives who
originally intended the Winterton report, quoting Ms. Rothwell, "as an
instrument of the Government's policy of reducing public spending?"
<<<<Sadly you are waging a war against UK obstetricians ( and me in
particular ) which has largely been won already though it sounds like
there are a few mnor skirmishes to be won in parts of South Wales.>>>>
I was disappointed to see Dr. Griffiths accuse ME of "waging war"
(against UK obstetricians) - even as he failed to address my point that
*UK obstetricians* had waged a war - an ILLEGAL war of libel - against
homebirth and homebirth practitioners.
Dr. Griffiths also failed to address my point that as a result of past
anti-homebirth libel, UK obstetricians are now ILLEGALLY positioned in
the health care marketplace. (Dr. Griffiths, of course, is an innocent
beneficiary of past RCOG anti-homebirth libel.)
Community midwife Barbara Troutt of Manchester recently wrote that she
is often asked regarding homebirth, "Oh, is that still allowed? I
thought that was stopped years ago." [Midwives 1996;109(1303):235]
Strangely, Dr. Griffiths publicly professes his commitment to homebirth
here in the sci.med.midwifery newsgroup; but he utterly fails to
emphasize his commitment to homebirth on his web page:
"I am pleased to have achieved one of my career aims of a consultant
post in Obstetrics and Gynaecology in a busy district general hospital,
maintaining wide ranging interests AND A COMMITMENT TO LABOUR WARD
PRACTICE..." (emphasis added)
Commitment to labour ward practice is fine - so are "wide ranging
interests" - but given past RCOG libel (in effect admitted by Dr.
Griffiths; see below), a few explicit words about commitment to
homebirth would seem to be in order on his homepage.
Midwives all over Britain could give out Dr. Griffith's web address to
British mothers-to-be wondering whether homebirth is really allowed.
They could say to these women, "See for yourself, things ARE changing -
here is an OB who openly supports homebirth. He admits it was
anti-scientific the way RCOG got rid of homebirth."
Perhaps RCOG has a web page. Perhaps Dr. Griffiths could persuade RCOG
to offer information about past RCOG libel of homebirth.
Research statistician Marjorie Tew observed that the British maternity
system is run by obstetricians who pervert knowledge to delude the
public. Mrs. Tew's observation STILL has not been disputed by Dr.
Griffiths; hence my ongoing suspicion that British obstetricians
engineered the gutting of the Winterton Report described by Ms.
Rothwell.
<<<<....A midwife ( or a manager of community midwives ) who refused to
attend a home birth would be in serious shit - deregistered !>>>>
A Department of Health which by design makes an attempt at Changing
Childbirth without heeding the Winterton prerequisite might also be "in
serious shit" - by which I mean (if I am reading Ms. Rothwell's article
correctly), poor British women might already be suffering "serious shit"
- senselessly.
Ms. Rothwell states that the midwifery profession "unwittingly colluded
in the [Changing Childbirth] report's deliberate dismissal of the plight
of the poorest women"; and she suggests that "midwives could now help to
remedy this mistake by demonstrating the deficiencies of 'Changing
Childbirth' and of the resources for implementing its recommendations."
Dr. Griffiths could do the same on his web page - so that anyone with a
computer and a link to the internet could verify that at least one RCOG
member is up to speed on the obvious gutting of the Winterton
prerequisite.
Instead of accusing Gastaldo of "waging a war against UK obstetricians"
(a war which Gastaldo believes cannot be said to have been won until
lucrative RCOG-induced public anti-homebirth sentiment is erased from
the public consciousness) - why does not Dr. Griffiths state in his home
page that he is committed to actively engaging RCOG members in the
compensation of the British public for the ongoing deleterious
(financial/social) effects of past RCOG wars against homebirth?
Do I hear scoffs from RCOG "dinosaurs" - the guys who libeled homebirth
yet again after the Winterton Report came out?
When people have been damaged through negligence - they are to be made
whole. When they have been brainwashed by obstetric "science" into
thinking that homebirth is dangerous and against the law - is not a
legal remedy in order?
Is not the British public entitled to financial recompense for its
RCOG-induced addiction to expensive and dangerous hospital
interventions?
According to his web page, Dr. Griffiths has "long been interested in
the legal process and in medico-legal issues." In fact, he is "planning
to attend the University of Glasgow's residential school for the
Certificate in Medical Law later this year."
Dr. Griffiths also notes on his web page, "I won the prize for the most
effective expert witness in a series of mock trials"; and he notes
further that his interest in law, "has the potential to benefit
patients..."
Fortunately, according to his web page, Dr. Griffiths has taken a
seminar entitled, "How to handle birth trauma litigation," from
International Business Communications Ltd. (31/1/96)
MASSIVE birth trauma has occurred in Britain. It has occurred wherever
obstetric "science" has flourished. Labouring women have been quite
literally dislocated from their homes. While it is true that many
welcomed this dislocation, most did so because obstetrics was promising
science at a time when obstetrics was actually engaged in anti-science.
One aspect of RCOGs anti-science was its anti-homebirth libel, the
unfortunate effects of which forced Marjorie Tew to go to the
Netherlands to study independent midwives:
In 1991, British research statistician Tew teamed up with Dutch
physician Sonya Damstra-Wijmenga, M.D. to publish statistics
demonstrating that independent, non-nurse Dutch midwives, using their
own methods, and practicing in homes and hospitals, were associated with
10 times fewer perinatal deaths than Dutch obstetricians. Tew and
Damstra-Wijmenga noted that high risk patient selection bias could only
account for a small part of the obstetricians' ten-fold greater
perinatal mortality rate:
"Though unlikely, excess risk might conceivably have been high enough to
account for threefold or, at a stretch a fourfold discrepancy between
obstetricians' and midwives' perinatal mortality rates; it could not
have been nearly high enough to account for the ten fold discrepancy
actually experienced...[The obstetricians'] higher perinatal mortality
rates at all identified grades of predicted risk...support
the...hypothesis...that obstetricians' care actually provokes and adds
to the dangers." [Tew M, Damstra-Wijmenga SMI. Safest birth attendants:
recent Dutch evidence. Midwifery 1991;7:55-65. SMI Damstra-Wijmenga,
M.D., van Ketwich Verschuurlaan 5, 9721SB Groningen, HOLLAND; Marjorie
Tew, 121 Bramcote Ln, Wollaton, Nottingham NG8 2NJ]
Quite simply, it is not enough for RCOG to come out with a pro-homebirth
position statement with such widespread evidence of past anti-homebirth
libel still in the air. In effect, RCOG will have begun to admit defeat
in its war against homebirth only when the Winterton prerequisite is
met. Re-educating the public about RCOG's anti-science and
anti-homebirth libel is only PART of meeting the Winterton
prerequisite. I wonder, is the Changing Childbirth Team praised by Dr.
Griffiths openly acknowledging RCOG's sordid past and responsibility for
the virtual elimination of homebirth from Great Britain?
I think it monumental arrogance for Dr. Griffiths to arbitrarily decide
for the newsgroup on Jan. 1 that "no more than 5%" of women will choose
homebirth - after telling the newsgroup on Dec. 31 that homebirth was
"the norm for all deliveries...[until]...the RCOG...mis-guidedly
influenced government policy towards encouraging institutional delivery.
This was politically and and self-interestedly motivated."
Dr. Griffiths has in effect admitted that libel occurred.
The RCOG "dinosaurs" did it, he says.
I say these RCOG "dinosaurs" ought to be busted down from their cushy
consultant posts to make room for younger more open-minded obstetricians
who openly favor homebirth.
These RCOG "dinosaurs" ought to literally PAY for their post-Winterton
anti-homebirth libel. (Perhaps some of them could be assigned to doing
free maintenance on the cars which some British midwives are required to
maintain at their own expense.)
A public spectacle should be made of the RCOG "dinosaurs."
No more than 5% of women will choose homebirth? To me, this sounds
rather much like what might be expected from an RCOG "dinosaur."
Is not the homebirth rate 30% in Holland (and falling)? Why does not
Dr. Griffiths put his arbitrary home-initiated birth rate cap at 30% (or
higher) and work toward THAT figure?
Why do not obstetricians world-wide tell the full truth about the risks
of their interventions?
Or, as British midwife Barbara Troutt puts it, "Why is there such a
deafening silence on the results of research that proves that obstetric
intervention can actually cause the neonatal mortality and morbidity it
aims to prevent?" [Midwives 1996;109(1303):235]
I would add (thanks to Ms. Rothwell's article): Why is there such a
deafening silence about the fact that the Winterton prerequisite is
being ignored? Why would RCOG ignore the advice of experts who found
evidence of RCOG anti-homebirth libel? Why would RCOG put poor women at
risk by ignoring PREVENTION of maternal and child morbidity and
mortality?
Rich or poor, why aren't obstetricians fully informing the women they
anesthetize and operate upon?
According to Dr. Dermot McDonald of Ireland, if physicians fully
divulged the risk of cesarean section (which they aren’t doing), women
might start having their babies under trees:
"...[M]edicolegal pressure to perform a cesarean may abate only when
mothers begin suing physicians for assault, alleging that they were not
given fully informed consent...
"'If one went to the extreme of giving the patient the full details of
mortality and morbidity related to cesarean section, most of them would
get up and go out and have their baby under a tree,' [Dr. McDonald]
said." [Neel J. Medicolegal pressure, MDs' lack of patience cited in
cesarean 'epidemic.' Ob.Gyn. News Vol 22 No 10]
Though I am sure that midwives have assisted in many births under many
trees down through the centuries; no one needs to run out and have a
baby under a tree...
MANY women - more than 5% even - might decide to have their babies under
their own roofs - with a community midwife - were all the risks of
modern "scientific" obstetrics divulged.
<<<<[I]n the USA...you'd be hard pushed to find many obstetricians too
positive about home births and no-one funding them out of public
money.>>>>
Perhaps *I* have been monumentally arrogant to so roundly criticize a
British consultant obstetrician. I am not even a British subject.
Actually, the State of Oregon is funding a few homebirths out of public
money - though it is true that most women on welfare in Oregon who want
homebirths cannot have them unless they live outside of areas served by
medically directed managed care organizations.
Still, I suspect that Oregon's homebirth climate is much like Britain's
- perhaps a little better.
Dr. Griffiths, the "war" you say I am waging against UK obstetricians -
and you in particular - is really quite civil compared to the war that
was waged against homebirth practitioners by UK and US obstetricians.
Even with your glowing reports otherwise, I say the obstetricians' war
against homebirth practitioners is ongoing - even in the UK. It's just
under the table now - with a nice RCOG pro-homebirth STATEMENT - and a
gutted Winterton Report called Changing Childbirth.
Please prove me wrong.
One last thing...
I have wondered since 1992 why obstetricians routinely jam tailbones up
to 4 cm into fetal skulls. (For biomechanical mechanism and clinical
and radiographic references, see Gastaldo Birth 1992;19:230.)
With evidence that 4.6% of infants suffer unexplained brain bleeds, and
with recent reports that up to 10% of infants suffer neonatal
encephalopathy - and with anecdotal reports that some fetuses
unexpectedly die right before birth - it seems kind of dumb (legally
indefensible) for obstetricians to keep jamming tailbones into fetal
skulls.
As you might imagine, I was pleased when, at my request, the authors of
Williams Obstetrics [1993] acknowledged, in effect, that if a woman is
placed on her sacrum at delivery her sacrum is indeed jammed into her
baby's skull.
I was also pleased when Williams Obstetrics [1993] stated that the
McRoberts maneuver for shoulder dystocia DOES increase the pelvic
dimensions. The original papers on the McRoberts maneuver - and all
other texts I have found - clearly state that McRoberts does not
increase pelvic dimensions. Indeed, Williams Obstetrics states that
McRoberts does not increase the dimensions - in the same 1993 edition
that says it does!
I'm thinking if there is something to go to war about - it's senseless
fetal skull squashing. Even if it just causes fetal headaches, isn't it
about time it ended worldwide?
A British-trained American professor of midwifery, Mary Ann Levine,
mentioned my interest in this subject in the same issue of Midwives in
which Ms. Rothwell's article appeared.
Prof. Levine asked for feedback from the midwifery profession. I am
asking for feedback from the obstetric profession - you in particular.
If I seem "war"-like, it is only because of all those unexplained brain
bleeds, etc.
Mary Owens
Dr. Griffith,
I for one appreciate your support of homebirth in the UK. I would hope
that more US doctors were supportive. IMO, what would help is if doctors
would inform women about the benefits of homebirth (for those women who
don't have high-risk factors), and help educate them about this option.
Then, for those high-risk moms who need to go to the hospital, I would
like to see a more woman-centered, empowering approach given to women.
Mary Owens
CB educator, advocate of natural birth and alternatives in birth, and
mother of three beautiful children (2 VBAC's)
>>
--
Mary Owens