|Articles of Interest to Midwives|
|Comments by family physicians on
safety of home-based midwifery care,
evidence-based medicine and a simple definition of the scope of midwifery
Date: Tue, 30 Sep 97 12:07:53 CDT
Subject: Studies supportive of Home Birth
Safety of Homebirth - abstracts of medical studies done:
In all these studies there is a bias in evidence that reflects a no-longer-needed defensive posture on the part of midwives. That is, they all refer to the fact that birthing at home is as safe as birthing in the hospital.
Given the state of the evidence, we should now challenge the hospitalists to prove that hospital deliveries can match the results of home deliveries. The statistics are interesting when applied in the reverse direction. Also, showing that midwives at home do as well as physicians in the hospital is an entirely different matter than challenging physicians with all their expense and operative intervention to prove that their methods offer some advantages.
When studies are done showing that indeed the hospital-medical-model offers no advantages, payors, be they third-party or be they private, will refuse to keep going along with the joke.
Modern obstetrics needs to be ..... replaced with a cooperative science that complements the midwifery model. Farces don't usually respond to debate but to humour.
Proverbs 26:4 Do not answer a fool according to his folly, Lest you also be like him.
26:5 Answer a fool as his folly deserves, Lest he be wise in his own eyes.
Date: Thu, 23 Oct 97 16:17:26 CDT
Subject: Scope of midwifery
I would say that the scope of our practice isn't ob at all, but rather midwifery. ...... midwifery is the identification of and management of varients of normal.....
Richard L. Garrison, M.D., Assistant Professor, Department of Family Practice and Community Medicine, University of Texas, Houston Health Science Center
Date: Sat, 27 Sep 1997 19:42:58 -0400 (EDT)
To: falcao@CS.Stanford.EDU, email@example.com
Excerpts from a post by a family physician on the topic of home birth/midwifery research:
I have never reviewed carefully the evidence of home vs. hospital birth.
Let's assume a hypothetical: that if I reviewed it, I would agree that there is no convincing evidence of substantial benefit to low-risk women to deliver in the hospital. Would I then offer the option of home birth to my patients?
I've never pondered the question until this very moment. But I don't think I would. Because I've never had a patient ask about that option, I assume that most are, in coming to me, assuming or requesting a hospital delivery.
Would I *do* a home birth if asked to? Again, I haven't considered it. My offhand answer is no, and the reason is that the tools I am trained to use are either impossible or unweildy to use in a home birth. Put another way, it makes sense to me to match the training/intervention skills to the setting; if they want a home birth, then they can be attended more sensibly by somebody who is used to that setting, was trained in it, and habitually carries around the variety of stuff that one might want on hand.
But if a patient wanted a home birth, I wouldn't put up a fuss about it and tell her that she was putting her and her baby's life in danger, or anything like that. ... I'd probably even be willing to share prenatal care with a home-birth midwife if the patient wanted to do it that way, to have somebody known to her in case hospitalization became necessary.
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