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I think lasonadr below is misinformed:

There may be higher rates of ceseareans in women with diabetes or preeclampsia but that the majority of women who develop these common complications have vaginal births. It is absolutely not the standard of care for hospital midwives, ob gyns or family doctors to automatically perform a cesarean when these complicatoins develop.

posted 4 years, 1 month ago
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Just remember that the CPM will ultimately be caring for the lowest risk women so the cesarean rate is lower because of a pre-selected population.

Also- there is NO hospital setting I'm aware of that would give a woman an epidural without an informed consent. If a woman asks for an epidural she then goes through a process that takes a while where she discusses her choice with an anesthesiologist. If she "blurts out" epidural but then reconsiders there is no way that she would be forced to have one: that would legally be considered assault.

posted 4 years, 1 month ago
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I am a family physician (MD) who does maternity care including birth and newborn care. My practice philosopy is to provide women with excellent and wide ranging information in order to allow them to make well informed choices. I have read good quality studies on home birth as it is practiced in other countries such as the UK and the Netherlands where there tends to be a more seamless relationship and transition between in hospital care and birth center and home care for laboring and birthing women. Women who are candidates for home birth in these settings are low risk and they are appropriately screened during their pregnancies for common complications. These studies show that home birth can be very safe. It also seems like an ideal situation for pregnant women as they are less likely to have a traumatic experience during transport, they have increased continuity of care, and a functioning health care team that communicates well together and is generally on the same page about goals of care.

I am the primary care physician for women who choose to have home births. I will often continue to see them during their pregnancies for issues that come up that are either out of the scope of practice of their midwifes or unrelated to pregnancy. In discussions with my patients it is clear that they ARE having informed consent conversations with their maternity care providers but the risks and benefits discussed are VERY different than what I am familiar with.  I'm not always confident that my patients are given all the information they need in order to make choices that are right for them. For me its not about not wanting to "give up my power over women"- if a patient of mine would prefer no interventions at 2-3 weeks past her due date I would be a worried about some increase in risk for her (the main risk being a risk of cesarean with a small increase in sudden fetal death...) but if I felt that she really understood how the risks/benefits balanced out in such a situation and was making a clear minded choice, I would support that. I worry that some home birth clients have the risks minimized or the risks are not well explained or well understood by their providers.

posted 4 years, 1 month ago
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