"Ask not what your country can do for you, but ask what you can do for your country."

Or something like from John F. Kennedy.

Why? Why? Why? So many whys and questions I have and have posed this week. What can we do together for our country and for our people?

They all boil down to why does the United States not have A “standard of care” in obstetrics -- like every other industrialized nation?? Followed up, by why is there no standard of care when assessing maternal and infant safety and mortality when clearly the significant findings across the board in all research from the thirties to the present are that DE and CPM attended births are safer for the mother and baby when:

1) The training of the professional is the key factor in safety and homebirth is shown over and over to be safer because of the lack of disruption to the natural process of birth.

2) Planning and having access to respectful hospital care in the event of an unforeseen emergency.

Even in the US in states where homebirth is illegal the research has always shown that homebirth, planned, and with adequately trained professional is as safe as the hospital. A study was conducted of 4,054 Missouri home births occurring from 1978 through 1984. For planned home births attended by physicians, certified nurse-midwives, or Missouri Midwife Association recognized midwives, there was little difference between observed and expected deaths (5 observed vs. 3.92 expected). Maternal planning and preparation for every aspect of labor and homebirth is what makes birth safer wherever it is. Too often, women today plan to turn their body, mind, and heart over to professionals who will take care of everything. Beginning with non-medically necessary induction, they lay passive on the conveyor belt towards cesarean surgical birth.

In hospital birth in the US, most women are cared for by nurses throughout labor and the physician is in the hospital only seventy percent of time (and not with the laboring mother.) Nurses typically "manage labor" via phone contact with a doctor until he or she arrives in time to "deliver the baby." Research shows that if a woman is within twenty to 30 minutes of the hospital (as the physician also is) she is AS safe at home as she is in the hospital. Hey, have I mentioned HomeFirst in Chicago!?!? --- a family practice directed homebirth practice directed by a family physician and with a team of midwives and nurses and mobile equipment units?

No one in the countries with the low mortality rates debates the research findings that a well-trained professional is the key element. Like a broken record, another blogger denying the research from other countries and the statistics of mortality rates for seventy years, insists that babies are at risk for death at homebirth because of the risk of meconium and the inability of the midwife to do newborn resuscitation. (This alone is another article and guest posters are welcome!) It appears logical, rational, scientific, and ethical, given the safety of homebirth in other countries with trained midwives, that this claim that babies will be more likely to die because of the inability of a midwife to resuscitate at home is merely an opinion stated in an argument. We also know now that babies born in American hospitals are routinely resuscitated on an “in case of” status (for liability reasons, not the need of the baby) – even though the act of resuscitation is extremely physically and psychologically traumatizing even when done for life saving reasons.

But, let’s say it is true -- with proven data on how we can improve neonatal death rates in both home and hospital births in the US – that meconium is the main concern in homebirth. So, what is the logical action of the greatest country in the world with the greatest technology and access to care? Ah, why not just train midwives and EMT’s and provide equipment and respectful climate and access to medical emergency care? And, why isn’t this part of every local, state, and national Homeland Security Plan – the care of woman as they gestate, labor, and birth their babies (as well as for infants and children) in the event of a catastrophic event? If it is true that the babies in the US are resuscitated more, is it really because of meconium? And, is it possible it is because of being in the hospital? STRESS?? From induction, narcotics, and cesarean surgery? Why are physicians and hospitals so insistent on maintaining power and control when women and babies' lives are at stake? Why does the US lag behind every industrialized nation?

What America needs is an evidence-based plan and protocols that are consistent from state-to-state, hospital-to-hospital, doctor-to-doctor, nurse-to-nurse, and not based on personal choices, biases, needs, and time tables of the medical caregiver.

Sooooo, given the historical data and current scientific findings, the logical answer appears to me to be:

1) Collective action from grassroots to take the issue of maternal and neonatal health care to the federal level.
2) Collaborative participation with medical establishment and politicians locally and at the state level.
3) Insure the science-based adequate training of midwives.
4) Establish standards of care like the other industrialized nations with low infant and maternal mortality have done --- SINCE THE THIRTIES!!
5) Citizen and scientific community oversight of obstetrics
6) Stop holding physicians alone disproportionately responsive for birth outcomes. Put money spent to treat the symptoms of poor quality births into prenatal parenting and human baby development.

My idea for a national model is at: http://www.safebabyresolution.blogspot.com/

Janel Martin-Miranda