The Business of Being Born - #76297

[pillowy]

Going along with the other thread about labor positions/pain management during labor, I want to talk about this recent board question where someone asked about the documentary "The Business of Being Born."

I think Ozymandias gave a great little reply when they said:

Though I haven't seen the actual film, you would be correct in assuming that it is one-sided. Simply the description on IMDB already gives a hint of bias: "Compelled to find answers after a disappointing birth experience with her first child, actress Ricki Lake recruits filmmaker Abby Epstein to explore the maternity care system in America." When a film-maker is specifically looking for something, they can typically find enough material to make a movie.

"The Business of Being Born" is, most definitely, one-sided. Home birth in the United States has increased 20% since the film came out, largely in part due to its influence. Unfortunately, "The Business of Being Born" is so slanted and leaves out so much information that I feel like I can call it propaganda without exaggeration.

You know how in my last post in the "Labor Positions" thread that I said that I'm tired of hearing babies die of preventable deaths due to the fear and misinformation spread by the leaders of the natural birth movement? Well, the whole film "The Business of Being Born" is a perfect example of that fear and misinformation.

First of all, the fear that I'm talking about that "natural childbirth advocates" perpetuate is a fear of hospitals and everyone who works in them (doctors, nurses, anesthesiologists). Most people don't have any fear of those things before watching "The Business of Being Born." After watching the movie, which is filled mistruths, lies-by-omission, and emotional quotes played over scary hospital scenes, women feel like to have any sort of peaceful, happy birth, they will have to fight the doctor and the hospital every step of the way. They become afraid of the normal hospital process, and have been told that the normal interventions are (at best) unnecessary and (at worse) dangerous.

This simply isn't true! Doctors aren't out to get you. Hospitals aren't out to get you. The routine "interventions" during labor (electronic fetal monitor, IV fluids, etc.) have been shown to lower maternal and neonatal mortality rates. Many, many, many women have great, happy, peaceful births at the hospital.

And the misinformation - holy cow, the whole show is full of misinformation and half-truths. (One of the half-truths, about the US having a high infant mortality rate, was already addressed by a commenter in response to Ozymandias's answer. Infant mortality measures deaths up to one year of age is a measure of pediatric care; neonatal mortality is the measure of obstetrical care {it measures death up to 28 days of age} and the US has one of the best neonatal mortality rates in the world.) The first thing you see when the movie starts is a scene about midwives, and you see a midwife drive up to a woman's house. On top of this comes the quote, "Midwives attend 70% of the births in Europe and Japan. In the US they attend less than 8%." This is true. What it doesn't tell you is that there are two types of midwives in the US - Certified Nurse Midwives (CNMs) and Certified Professional (lay) Midwives (CPMs). CNMs are "real" midwives - they have education and training that exceeds that of all other midwives in the world. However, the huge majority of out-of-hospital births are not attended by CNMs. They are attended by CPMs, who do not have the education or training required by midwives in ALL other first world countries. CPMs would not qualify for licensure in ANY other first world country. One ob explains: "In the UK, the Netherlands, Canada, Australia, etc., you need a university level degree to practice midwifery. In the US, you need a master’s degree in midwifery. In contrast, the requirements of the CPM were 'strengthened' in September 2012 to require a high school diploma." And these are the people attending the huge majority of out-of-hospital births.

In addition to leaving out the fact that the majority of midwives attending out-of-hospital births could not be credentialed in any other first world country because of their lack of education and training, "The Business of Being Born" also fails to address the huge differences between the US's health care system and those in Europe in Japan. In places like the UK, Canada, and the Netherlands, home birth is officially integrated within the medical system. There are strict "risking-out" criteria to make sure only the lowest risk women attempt home birth, and well set-up transfer systems so that women are more smoothly transferred to the hospital if complications arise during labor. In some of the countries the transfer rate to the hospital exceeds 40%. And even with those precautions, studies in places like the Netherlands have shown that the perinatal mortality rate (number of stillbirths and deaths in the first week of life) is higher for LOW risk women under the care of midwives than HIGH risk women under the care of obstetricians.

The authors of this study, Perinatal mortality and severe morbidity in low and high risk term pregnancies in the Netherlands concluded:

We found that delivery related perinatal death was significantly higher among low risk pregnancies in midwife supervised primary care than among high risk pregnancies in obstetrician supervised secondary care. This difference was even greater among the cases that were referred from primary to secondary care during labour...

In summary, the Dutch obstetric care system is based on the assumptions that pregnant women and women in labour can be divided into a low risk group and a high risk group, that the first group of women can be supervised by a midwife (primary care) and the second group by an obstetrician (secondary care), and that women in the primary care group can deliver at home or in hospital with their own midwife. When complications occur or risk factors arise antenatally, during labour, or in the puerperium in primary care, the women is referred to secondary care. We found that the perinatal death rate of normal term infants was higher in the low risk group than in the high risk group, so the Dutch system of risk selection in relation to perinatal death at term is not as effective as was once thought. This also implies that the high perinatal death rate in the Netherlands compared with other European countries may be caused by the obstetric care system itself, among other factors. A critical evaluation of the obstetric care system in the Netherlands is thus urgently needed.

The Netherlands is often touted as an ideal country by home birth advocates because of its high home birth rate, but in reality is a stunning indictment of the idea that "low risk" women can be cared for just as safely by a midwife as an obstetrician.

So the opening quote of "The Business of Being Born," that less than 8% of US births are attended by midwives? Great. We're probably saving a lot of babies that way.

There is so much more to say about this subject, but I feel like I'm making my post too long again.

For a great breakdown on several of the quotes from the BOBB, check out this post on "What Ifs & Fears Are Welcome": The Business of Being Misled

Or this article: "What Ricki Lake Doesn't Tell You About Homebirth"

Or this series of posts: Debunking the Business of Being Born

Annnnd I should probably stop there because this is already tl;dr.

[Whistler]

I haven't watched The Business of Being Born, but fantasizing about a better birth experience has gone on for a long time. I recently read _Birth in Three Countries_, which admittedly, is a bit hippie-ish and outdated (it was published in the 1970s). But even now I hear stories of nurses/doctors focusing on what the fetal monitor says rather than what the woman says she is experiencing. It also mentioned a study where women had better birth outcomes when there was a silent observer in the room (the results are even better when the person is supportive). Hospitals allow room for support people now, but it seems like that took longer than it should have.

I'd like to think that most women don't birth at home over a movie. Most of the women I've heard from who gave birth at home did so after having a really unsatisfactory hospital birth. I agree with you for the most part that birth at a hospital is safer (although IV fluids have very little impact on infant mortality). But I think hospitals need to look at what they could change.

[pillowy]

What do you think hospitals could change?

[Yellow]

It seems to me that hospitals are, due to the litigious environment today, very risk averse. This means taking precautions that may not really be warranted, just because of a remote possibility of something going wrong that could lead to a lawsuit.

For example, with Dragon Baby, the hospital said she could have any solid foods once she was admitted. This was because if she happened to need anesthesia, and happened to have a reaction to the anesthesia, she might vomit and then might aspirate her own vomit. This meant that Dragon Lady had to go through labor (a very intense process) without having eaten any solid foods for 24 hours. She was *dying* for some real food. It would have helped her have more energy to get through labor. But because of the remote possibility of something bad happening, she had to go through it in a weaker state.

Of course, aspirating your vomit would be a bad thing. But how likely is that? Is it worth making every woman have a more difficult labor due to lack of energy? Financially, it makes sense for the hospital. But does it make sense for the mother?

[pillowy]

Yes, I think that it does make sense for the mother, for the very reason you said - if something happened and she happened to need anesthesia, the risk would be lower to her. And the "if something happened" is unpredictable - you almost never know you're going to have an emergency before you have one.

However, I do think it should be the mother's choice. If the hospital explained the (very small) risks of eating during labor, and Dragon Lady accepted them and signed some sort of waiver saying she wouldn't sue the hospital, she should have been able to eat.

[pillowy]

I think IV fluids are another thing that fall under this category - as Whistler pointed out, those are also mostly to prevent vomiting. Another of the uses of being hooked up to an IV is that medical staff can immediately administer various medicines if necessary. I have heard of women who did not want the IV fluids administered, but had a hep-lock in their arm in case medicine needed to be given in an emergency. This seems a good compromise - they're informed and aware of the (small) risks of not having an iV, choose not to have the fluids, and yet still have the hep-lock in case of an emergency.

[Whistler]

yes, I would like better informed consent for rules like eating. Even if the woman needs a c-section, it's really likely that they wouldn't have to put her all the way under these days.

Another problem I hear a lot of people complaining about is how "failure to progress" is the reason most women are given c-sections. (see http://evidencebasedbirth.com/friedmans ... -sections/ which I realize is pretty biased, but it does cite studies, which is better than a lot of other stuff out there). I'd like doctors/hospitals to make a new Friedman's curve that mirrors today's birthing populations, and to inform women that they could still be in early labor, but that they can have a c-section if they really want one, instead of insisting that it's necessary.

I haven't gone through labor myself, so I can't really say, but anecdotal evidence from family/friends suggests that a more relaxing environment provides a better birth experience for the mother (and if there isn't increased risk to the baby, why not?). For my mother, she fondly remembers her last birth where they turned down the lights, her doctor was a woman who had given birth before and didn't pressure her (it probably also helped that my mother had given birth before and knew what to expect from her own body).

This is going to sound weird, but I think giving birth and having sex probably have some similarities. Being relaxed and feeling like you have some say in the situation go a long way to making the process less physically painful. And it's really hard for a woman who felt violated by a doctor/hospital/system of rules to believe that same feeling of violation won't happen again. Basically, the subjective experience matters a lot, which could explain why many mothers feel frustrated with a hospital system that puts a premium on quantifiable data (but if a likert-type satisfaction survey is what it takes for them to change I am all for it).

[pillowy]

Okay, so I want to write out my thoughts on c-sections/"failure to progress," but before I do I just wanted to write a quick side note about the website "Evidence Based Birth." When I first started learning about all of this stuff (about a year ago) Evidence Based Birth was one of the first websites I found and I thought I could trust it, because, you know, the name. Evidence-based. Sounds pretty reliable. But, it turns out that the author of the site is a natural birth advocate (who tries to hide it) who has no training or experience in obstetrics, midwifery, or obstetric nursing. She's the same author of this misleading article on "Sense and Sensibility" about oligohrydamnios (low amniotic fluid).

Just take a look at the post on electronic fetal monitoring. She says:

"In summary, evidence clearly demonstrates that the best option for most women and babies is intermittent auscultation. Continuous EFM increases the risk of C-section and vacuum delivery and does not improve neonatal outcomes. Routine use of continuous EFM and “admission strip” EFM is not supported by best medical evidence."

Yeah, continuous EFM does increase the chance of C-section and vacuum delivery. It also increases the chances that you'll have a live baby. Those extra c-sections and instrumental deliveries save lives and brain function. Her conclusion that intermittent auscultation is the best option is true if your main goal is avoiding a c-section. If, however, your main goal is to have a live, non-brain-damaged baby, EMF is your best option.

(I know I already cited these two articles in the "Labor Positions" thread, but here are two articles on EMF. This one explains what information you get from EMF that you cannot get from intermittent auscultation: Electronic Fetal Monitoring Give Much More Information. And this report published by the American Journal of Obstetrics and Gynecology shows that EMF cuts early neonatal mortality in half: Electronic fetal heart rate monitoring and its relationship
to neonatal and infant mortality in the United States.)

So if her website lies about this very simple, easy-to-verify-is-wrong thing, what else does it lie about and present biased viewpoints on?

[Dragon Lady]

I'd like to think that most women don't birth at home over a movie. Most of the women I've heard from who gave birth at home did so after having a really unsatisfactory hospital birth. I agree with you for the most part that birth at a hospital is safer (although IV fluids have very little impact on infant mortality). But I think hospitals need to look at what they could change.

That's my story. I had an OB with Dragon Baby, did *not* feel comfortable with him (not because he's an OB, but because he was... weird.) and started, for the first time, to educate myself about labor. I ended up switching to CNM midwives that deliver in the Timp and AF hospitals. I liked the care I received from them for the most part. Prenatal care was great. But I happened to have my appointments on Fridays (which I will never do again if I go the hospital route... because they often turn birth into a routine medical procedure, as was my experience) and I wasn't growing like they thought I should be (I have really small pregnant bellies, despite my 6-8 pound babies and my short torso... not sure how that works, logically) so they did a non-stress test and an ultrasound to measure my amniotic fluid levels. The non-stress test came back just fine and the amniotic levels came back on the low end of normal. (With the knowledge that the results of that test usually come back lower than reality, because of how they measure it.)

After consulting with the OB on duty that they work under, they induced me that night. Two weeks before my due date. "Normally we'd have you just go home and drink lots of water and test you again the next day, but where it's Friday... we don't want anything bad to happen over the weekend. Let's induce you tonight." It took 22 hours in the hospital of Cytotec (to soften the cervix), then Pitocin (to force contractions), and stripping my membranes and all of them working really well for a few hours, then completely dying off in effectiveness before we decided to break my water. The midwife on duty at this point completely scoffed at them inducing me and gave me the option to go home and try again on Monday. I really liked her.

But at that point I'd been 22 hours on a clear-liquid diet (oh sure, sodium-laden beef broth and sugar-filled popsicles along with ice chips are going to give me the energy I need for the most energy-intensive thing I've ever done after 22 hours of not eating... uh-huh) and I was completely exhausted and was terrified that I'd come back on Monday and they'd make me do the whole thing over again. I didn't think I could handle that. So I made my decision, terrified, and in tears (literally. I think I scared my midwife at that point.) to let them break my water and hit the point of no return.. This had better work, or I'm having a c-section. (The best news is that I couldn't feel the contractions At All up to this point. Even when they were hard and strong according to the monitor.) And then they broke my water and I went from feeling nothing to hard and strong labor. No transition period. (Though, turns out, that's just how I labor, apparently. I did the same thing with Niffler Baby, even though her water broke spontaneously.) Oh, and I had more than 3x the amount of amniotic fluid than they said I did. There ended up being no medical reason for me to be induced. Except that it was a Friday.

2 hours of intense pain later (I remember biting the mattress on the bed at one point), Dragon Baby was born. And instead of falling in love with my baby, I felt an overwhelming relief that I was done. And then they reminded me that I had a baby. And I was slightly resentful that I was expected to just turn around and love on that baby. I wanted to focus on me. Not a baby. I felt guilty at the time, and I still feel a little guilt over that. But it took me months to really bond with her.

So within the next few months I knew I needed something different if I wanted to ever give birth again, so I started researching and educating myself even more, found a birthing center that I felt so incredibly right about that I stopped looking and even stuck with my decision when I moved and had to drive 20-25 mins to get there. (45 minutes for a few months, while our house was being built.) And partway through my next pregnancy I decided to home birth for various reasons, most prominent among them being that after much prayer, it's what felt *right* for me. I'll spare you the birth story (this is long enough) but I spent my active labor (2.5 hours this time), in a dim room with candles and soft music, kneeling in a birthing tub in warm water, with people putting cold washcloths on my head and neck, and massaging different parts of my body and focusing completely on my comfort. And above all, I was excited instead of terrified. When Niffler Baby was born I wasn't exhausted. I had eaten a full meal just a few hours before. I had been comfortable (instead of on that horrid hospital bed that left my tailbone sore for days). When they put her in my arms, I felt an immediate, powerful bond. I was exhilarated and confident and had an immense sense of accomplishment that left me on a high for days. Even though I tore worse with NB, I was able to get up and walk almost immediately, where with DB it took me three days to be able to walk without help. And then, after changing into dry clothes, I was able to lay on my bed and not get out again until morning. Only waking up when she was hungry. Not every few hours because they wanted to take my blood pressure All Night Long. I was able to rest completely.

My two birth stories are so night and day for me. They represent different mentalities in my head. My first represents modern medicine trying make birth a routine procedure—a medical event. My second represents birth being a normal, natural event, surrounded by love. I ended up with mild post partum depression after DB. I never had that with NB, even when sleeping and nursing were hard.

I didn't home birth because of a movie. (I've never even seen it, though I've heard much about it.) I home birthed because of a traumatic hospital experience (which is nothing compared to some horror stories. It's actually a relatively normal story... which is part of why it makes me angry.) and educating myself. I knew the risks. I discussed them and backup plans with my midwives. I had hard conversations about the "what ifs". And despite all of that, I still chose to home birth because, for that birth, it's what I needed. I needed it for my self-esteem. I needed it for my emotional state. I needed it to have faith in childbirth and in my body. I needed it to body with my baby. I needed it for the sense of community and love I felt. And I'm willing to change how I do it in future births. If I feel I need to be in a hospital, I will. I'm planning on a home birth this time, but if at any point I feel like I need change, I will. I'm open to that. I don't hate doctors. I don't hate hospitals. I have *so many* reasons to be grateful for modern medicine. And if a hospital near me offered a more natural-based option, like many hospitals around the nation do. One where I could labor in a tub, with lights down, with anyone there that I wanted, where I could eat and move around as needed. Where I could use natural induction methods such as massage, and oils and herbs before turning to medicinal options. With a doctor/midwife who would be willing to do a test over a weekend if needed. Who cared more about the health and safety of me and my baby instead of money, convenience, and get'er in; get'er out mentality. Then sure, I would be much more willing to labor there. It's nice being able to just be home and not have to travel after birth, but it's also nice to have that peace of mind that if something goes wrong, I'm in a hospital.

But where I don't have that option, I opt not to live my life for the worst case scenario. Instead I choose to trust my body and to rely on my relationship with the Spirit for guidance.

[Dragon Lady]

And now with that said, I'm not going to debate this. I've been avoiding debate/conflict on the boardboard for awhile now and I've found that even with this topic that I'm so very passionate about, I simply don't have the energy nor desire to argue about it. I just don't.

My position stands: every woman should be educated about her body and her birth in order to make whatever decision she chooses. And whatever decision she makes, between her and her husband, is their decision. And no one has the right to judge them on it. Period. Just be educated first. Don't be bullied into making decisions because you don't know any better. (But also pick a doctor/midwife that you trust their judgement, so if an emergency does come up, you can trust their opinion.)

[Portia]

I'm nowhere near being pregnant (Insha'Allah) but considering how high-risk I was as a baby, I'd be surprised if a homebirth weren't contraindicated.

[Portia]

It just seems like this isn't really a viable option for lots of women out there, because of money, high-risk conditions, and culture (for instance, as many women get pregnant without a husband as with). I'm more attracted to the French system (very low cost, hospital stays and prenatal care completely covered for all, good Pre-K education) than either American option.

[Yarjka]

I did see the movie and it really opened up a new perspective for me that I really appreciate having. I think it does a good job of showing some of the issues that arise when you treat birth as a de facto medical procedure rather than a naturally occurring event.

My wife and I still chose to go the hospital route since we felt safer that way and it helped ease our anxieties. But the documentary led us to look into hypnobirthing classes leading up to the birth, which helped us relax and get into a natural birthing mindset, even if we did decide to opt for the epidural and 'clinical' birthing method in the end.

Just because the documentary is one-sided doesn't mean it isn't valuable. I for one had no idea other options than the hospital even existed, and I had no ideas of some of the issues that come up in a hospital setting. It was very nice to have an idea of how things can happen in order to take some control over the birth. I didn't find it made me hate or fear doctors, but it did make me ask them questions rather than take their word for everything, which helped engage me in the process and feel more in control.

I think the movie is very empowering and I recommend it very highly. You get the doctor/hospital perspective anytime you go in for a checkup, so there's a need to give the other perspective as well. For some, home birth is absolutely the right option, but I've never seen any pamphlets at the hospital outlining the ways to have a natural home birth; it's just not included in the discussion at all, which is a shame.

[Dragon Lady]

To clarify: as far as money goes, I have a $7500 deductible for maternity. If I go the hospital route, it's going to be completely out of pocket. Going with my midwife is $2400 for pre and post natal checkups, as well as birth. So monetarily, for me, it's a better option. (Birth center would be even cheaper.) With insurance I paid the same amount with DB in the hospital as I paid for NB at home.

I agree that home and birth center should not be considered for high-risk pregnancies. Absolutely I'm only talking about low-risk pregnancies.

[pillowy]

So, my thoughts on c-sections/"failure to progress"/adjusting the Friedman curve: most doctors have already adjusted their timelines/expectations about the length of labor, especially when it comes to epidurals. Most also don't worry about the speed of the labor until after 4cm, as early labor can take a very long time indeed. So when labors are labeled "failure to progress" and eventually go in to c-sections, I think that most of the time it's for a pretty good reason. If all of these labors had progressed unassisted, would most of them have turned out okay? Yes, probably. But that's something you can only see in hindsight, or by letting the labor progress until it becomes a true emergency with a crash c-section.

My sister and my sister-in-law both gave birth recently. My sister reached 10 cm relatively quickly (within about 10 hours), but then was encouraged by her midwife (coincidentally, Dragon Lady, a midwife at Timpanogos Regional Hospital)(maybe a common theme of these stories is, don't choose those midwives or deliver at those specific hospitals) to push for 4 1/2 hours. This is way outside the limits of normal. Finally, a doctor was consulted, who recommended immediate forceps delivery, and, if that failed, a c-section. My sister agreed. The doctor immediately (with forceps) delivered my nephew, who was blue and not breathing. His first Apgar score was 3. They were able to resuscitate him, though, and everything is okay now. But it was quite scary and traumatizing for my sister and her husband.

So which category would people put my sister in? Did she need a c-section? Technically, no. Her baby did eventually come out vaginally and they are currently alive and well. So if she had had a c-section hours earlier, having been labeled "failure to progress" after two hours of pushing (the 95% percentile for amount of time it takes for first time mothers with an epidural), would it have been "unnecessary?" No. But people might have seen it as such. My nephew would have come out pink and breathing with no ill effects, and my sister might have been told, "Oh, you didn't really need a c-section. Your baby was doing fine." My nephew could have died. He didn't, but he could have. A c-section could have spared him the trauma he suffered during hours of unnecessary battering during labor. But if they had had a c-section earlier, they wouldn't have known how bad it would actually get. It's something that can only been seen after the fact. Does that make sense?

My sister-in-law went into labor in the morning and stopped dilating any further than 7 cm in the early evening. They did everything they could (gave her pitocin, etc.), but her cervix would just not dilate further. After a couple more hours, the baby's heart rate started to drop. It was at that point that multiple doctors consulted each other and after individually reviewing her labor, its progress, and the baby's stats, recommended a c-section. She had one a few hours later, and their baby boy was born healthy and with no problems. Again - was this a "necessary" c-section or an "unnecessary" c-section?

It's a tricky topic, because the only way to truly tell would be to offer no c-sections at all, and see which women and children made it.

[pillowy]

Dragon Lady, your story sounds like it was an awful experience. I can completely see why you would want to avoid what you had the first time. I can't believe they induced you just because it was a Friday; that's just ridiculous and way out of line. I don't know how long ago DB was born, but most hospitals now also have a really strict no-induction-before-39-weeks rule, so it's crazy that they did it to you at 38 weeks. I'm sorry.

I think you're completely right that whatever decision someone makes about where they give birth, that is their decision and their right and no one should judge them on it.

I do think that the home birth system needs to be completely revised in the US. The CPM "credential" should be abolished. DEMs (direct entry midwives) and LMs (lay midwives) should not be allowed to practice. All midwives should be required to carry malpractice insurance. As it stands at the moment, if something goes wrong at a homebirth there is almost no recourse for the parents to take and nothing can be done if the midwife has done something wrong. There are almost no legal regulations on home birth midwives, and so matters cannot be pursued as a criminal matter. And they don't carry malpractice insurance, so matters can't be pursued financially. If something goes wrong, and it's the midwife's fault, there's nothing to be done.

It would also be much better (though very hard to incorporate in our current system) for the midwives to work directly with doctors and hospitals. Stricter risking-out criteria, higher transfer rates - things they have in the other countries where home birth is more integrated - those would be a lot better than what we have now.

[Whistler]

pillowy thanks for sharing your perspective on this topic. I'd love to find out what kind of criteria doctors are "really" using; maybe increased transparency can be on my want-list for Things Hospitals Could Change.

As it is, I'm planning to give birth in the hospital in Provo, and I hear they have jet tubs for women in labor (you bet I am asking about that at my prenatal class). I hope that I'm able to use multiple positions in my labor and that I have the assertiveness to ask questions if I don't understand things. It's a little anxiety-provoking though, because I know that once I'm in labor I probably won't be my most rational self. ;;

[Dragon Lady]

I hope that I'm able to use multiple positions in my labor and that I have the assertiveness to ask questions if I don't understand things. It's a little anxiety-provoking though, because I know that once I'm in labor I probably won't be my most rational self. ;;

That's why you take your husband along and make sure he's as knowledgeable about what you want and why as you are. It would also be a great idea to hire a doula who can help remind you of what you want when you aren't as rational.

[Dragon Lady]

pillowy, DB was born 4.5 years ago. 38 weeks is considered full term, so they didn't have any problem inducing me then. I don't know if that's changed at all in the last 4.5 years, though. I haven't even thought to look into it.

The problem with licensed midwives, at least in Utah, is that it greatly limits what they can do. Utah is *not* friendly to midwives. From what I understand (and I this is hearsay from a friend who went to a different class than me at a birthing conference this fall), licensed midwives aren't allowed to do breech or twin births. They're limited in what natural methods they scan use in labor. Becoming licensed limits and hurts the midwife instead of helping them. When I was interviewing midwives this time around, I met one who was fully qualified to to be licensed, but chose not to because it hurt what she was able to do. It boggles my mind that Utah of all places is so unfriendly to midwives. Midwifery used to be a calling in the church. And again, I don't know the details. Perhaps I should look into that sometime. But I've heard from several sources that Utah law is simply not friendly to licensed midwives.

That said, my midwife is licensed and recently added a CNM to her practice. So now that birthing center is a lot more robust in what they can do during birth. They've recently added Nitrous as an option during labor. It's basically laughing gas. Apparently it relaxes moms and allows them to birth without being tense and fighting against it. It's the first I've heard of it. They can also use Pitocin. They don't use it to induce labor, but have it in case of hemorrhaging. They can also do pap smears and well woman checks, etc. The addition on the CNM is one reason I decided to use them again, despite the distance to appointments. It adds one more level of security and peace to my birth.

To add one more argument to my decision to home birth... I have *really* fast labors. With NB, I had no idea I was in labor. Just under 39 weeks I went in for a routine appointment and found I was dilated to a 6, 100% effaced and baby was at a +1. I had no idea. A few days later my water broke spontaneously and I still didn't feel any contractions for a half hour. Once they came, though, they were hard and fast. I couldn't take more than a few steps without having to stop and breathe through them for a few minutes. I can't even fathom what I would have done had I been planning a hospital, or even birth center birth. I wouldn't have been able to find a babysitter that quickly, or even be able to drive by myself. Had Yellow been at work (at the time, a 45 minute commute in the afternoons), and had he been able to come home immediately, then drive me to the hospital (20 mins away), I would have only had an hour left. That's assuming he could pull in the drive, then pull out. It would have required me packing kids stuff by myself, walking up and down stairs, getting my stuff together... all while in *hard* labor. I honestly can't even fathom it. And riding 20 mins in a car like that? Yipes. As it was, I was able to just relax at my house, let everyone come to me, and I could focus solely on labor and breathing. For which I am grateful.

But then again, I do not labor normally. I know full well that I'm an exception. And because of it, I'll probably labor for 36 hours this time, and be 3 weeks late. Just to spite my early, short labors.

[thatonemom]

Dragon Lady, I wonder if we had the same midwife. Thatonekid is nearly 5, but I went to those midwives too and I think she was still practicing with them for maybe a year or so after I had him. She also had me on cytotec (my water broke at 39 weeks and I didn't go into labor on my own. I went to the hospital 5 hours after it broke and I had no contractions and was at a 1. I think a different practitioner might have gone with a different method)