Tuesday, May 1, 1979
University Daily Kansan
5
Local opinions of home childbirth diverse
By SHIRLEY SHOUP
Staff Reporter
Neah was born on the dining room floor.
bambar father and grandmother and several friends were there to greet his arrival. His big brother, 9-year-old Joshua, was there, too. The other two members of the room, a little bored by the whole affair,
But the response to home birth by its opponents and advocates is anything but.
On one side stand many doctors and the American College of Obstetricians and Gynecologists. They strictly oppose home birth.
On the other side are couples who want more control over how their baby is born. With them are such groups as the Lawrence Association of Parents and Professionals for Safe Alternative childbirth, an auxiliary of a national organization.
HENRY BUCK, a Lawrence obstetrician,
said he vehemently opposed home birth,
and cited ACOG infant mortality rates to prove
his point.
"In Kansas there were 31 babies lost out of hospitals in the last five years that would otherwise have been healthy babies," he said.
In 1976 the Kansas paranatal mortality rate, which includes stillborn babies or those that die within 28 days of birth, was 0.32. In 1980, in all hospitals, and 105.7 for each 1,000 out of hospitals.
But Chris Petr, LAPPSac president, said those figures are misleading.
"They show all out-of-hospital deaths, not just those from home births," he said.
"The figures show that all miscarriages are called home births when they aren't planned home births," he said. "We are only advocating trained help for childbirth."
But even under those constraints Buck and the ACOG oppose home birth.
"The problem is that if they had well-trained people, the risk might be lower," he said, "but there still are going to be significantly higher mortality figures."
"THINGS HAPPEN that you just can't
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Because they feel so strongly about the dangers of home birth, Buck and most Lawrence doctors refuse to give pre-natal women who plan to have their babies at home.
Steve Bruner, a Lawrence doctor who specializes in family practice, will not refuse pre-natal care to those women, but he said, "I'm not enthusiastic about it."
I think we've lectured about it that we have driven most of them off," he said of me. "The rest were good."
Lawrence women go to other towns for pre-natal care when they want a home birth. Elaine Brewer, Noah's mother, went to a female doctor in Toneka.
"You need good pre-natal care," she said.
"If you plan to have a home birth, you need
a nurse."
"OUR DOCTOR didn't say home birth was unsafe. You just have to search out a doctor who has the same philosophical outlook as you do."
But why do women want a home delivery when obstetricians are so concerned?
"It's a belief that it's the best thing for the baby," Petra said. "Women don't choose to have home births unless they think that is the best thing."
Advocates of birth also are opposed to many of the rules and procedures used in maternity care.
Petr's wife, Tami, who is a nurse and a certified wife outside Kansas, said, "Some people think it is crazy. And some are now outraged because they found out later all the things that were done at birth weren't necessary."
HOME BIRTH advocates say fetal monitors, tubing inserted through the infant's windpipe to clear any blockage, and epistiomies are not always necessary. Episiotomies are surgical incisions made to widen the passage for the baby's delivery.
Pet said, "Doctors are trained to think of pregnancy as a disease. But it's only the high risk pregnancies that need all that technical apparatus.
"About 10 percent need the technical facilities of a hospital but they treat all births."
John Brewer, Noah's father, agreed.
"Dectors must expect the worst, but they're needed only when the worst happens."
Brewer said "Doctors and hospitals have this peer pressure to use all their equip-
'Hospitals and doctors can give you the subtle message that you aren't competent to take care of your own health.
He said professional ego and peer pressure also were reasons doctors opposed
Brewer, whose father and brother were doctors, said, "They fear a deterioration of the health."
"BUT IT'S FOOLISH to generalize about hospital care. You just have to answer the question of whether the doctor's expertise is so great that you always have to defer to
Home birth advocates also oppose the set procedures some hospitals follow.
When Noah was born, his mother was living on her side.
"GIVING BIRTH on your back is the number to have a baby, she said. The birth was the birthday of her."
Although, she said, some people have had bad experiences with hospital births, that was not the case when Joshua was born in a hospital five years ago.
"It was OK for me, but I didn't like being separated from him for four hours after he left."
Petr and his wife also think the first few hours after birth are important to the process of bonding between the mother and infant.
"It is interesting that research on animals
County refuses radio plan
A offer from Motorola Communication
and Electronics, 19077 Granada Lane,
Overland Park, to upgrade a radio com-
munication system was rejected yesterday
on Friday.
The system, which was designed to serve as a link between Lawrence Memorial Hospital and ambulance teams throughout the county, is also able to reach all areas of the county.
The water tower's elevation, nearly 300 feet higher than the hospital roof, would cure the system's problems, according to Motorola.
The offer rejected by the commission included moving the radio base station and its antenna from the roof of the hospital to the top of a water tower near campus, on Stratford Road, at a cost of between $2,500 and $3,000.
Motorola agreed to cover the cost of relocating the antenna and base station as well as paying the leasing costs of the phone lines for the first year of use. At current prices, the phone lines would cost $540 a year.
However, the system, which was installed by Motorola in September, does not reach
But the commission decided that $31,664,
the contracted price for the system and
installation, was the total cost of the project.
The on-going cost of leasing the phone lines
should be paid by Motorola, according to
the commission.
However, two phone lines from the emergency room at the hospital to the water tower would be necessary to operate the radio system.
shows that when a newborn is taken away there will be trouble," Tami said. "People are animals, too. Hospitals deny this natural tendency."
An alternative to traditional hospital labor and delivery rooms that has been tried in some hospitals and clinics is the birthing room.
Unlike traditional hospital methods, a birthing room usually allows labor and birth take place in the room or on the particular hospital or clinic, will allow family members to be present at the birth. The atmosphere of birthing rooms is also usually warmer and cooler than normal.
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Mrs. Brewer said she had told a friend that she planned to have her baby at home when she was 50 years old.
But Mrs. Petr said even a birthing room has its faults.
Mrs. Brewer said a birthing room in one of the Topeka hospitals would have been her second choice if she had decided against a borne birth.
'We wanted someone here who could catch the trouble if there was any,' she said.
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getting someone to help. There is no guarantee now that you could find a midwife
"In birthing rooms childbirth would be more subject to intervention than at home. Just being in a hospital puts you in the atmosphere of being sick."
But in spite of that possibility, the Brewers wanted to have Noah at home.
And how about Joshua and Noah?
Home birth advocates would like to see midwifery legalized, but they want the midwife to have a doctor backering her up and transportation waiting in case it is needed.
Brewer said, "Once through those doors, whether it is good or bad, you are under pressure."
Advocate of home birth see this as the first step in providing training assistance for home births, and they would like to see midwives with less training licensed.
Bruner said midwives should not practice independently.
"I had the feeling that if I don't do this at
home, despite the problems, I will regret it.
But Buck says the nurse practitioners would have to practice under the direct supervision of trained health care people going out into the home because they still would not be able to
Although he said he was not opposed to midwife, he would not want to work as the backup doctor for a midwife because, "I've got enough problems of my own."
There does not seem to be any way to resolve the philosophical schism between the advocates and opponents of home birth safety. It could be a way to make home birth safer in Kansas.
In the long run, she said, it will have a good effect on Joshun. Maybe he won't be so traumatized by birth as are many men, she said.
MIDWIFERY IS illegal in the state now, but the Kansas Board of Nursing is establishing rules so nurse practitioners would also be allowed to act as midwives.
As for Noah, he looks like a normal 2-month-old baby.
RIGHT NOW home birth is a do-it-yourself proposition or a matter of luck in finding someone with experience in midwifery to assist.
"They want to stop being midwives legally, someone else would step in and assist," she said.
The Peters and the midwives in Douglas County are just friends helping other families.
Buck said in the current nurse practitioner program hospitals granted doctors the license to practice.
with them at the hospital. The doctor is still responsible, not the nurse, he said.
Brewer said. "It was a matter of luck in
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If the Brewers decide to have a third child, they if it probably would be at home, even though Mr. Brewer said, "It was courageous in a courageous thing I decided to do in my life."
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Kansas considering making midwifery legal
Rv SHIRLEY SHOUP
Staff Reporter
According to the Kansas Attorney General, midwifery constitutes the practice of medicine, and is therefore, practicing medicine without a license.
Midwifery is illegal in Kansas Midwifery is 19 states
The opinion was prompted when a mid-wife-assisted birth in Douglas County last week resulted in the death of her baby.
It is legal in 48 states.
But Kansas could join the majority of states by the end of the year if the Kansas State Board of Nursing has completed guidelines for nurse-midwives by then.
Ray Shawalter, executive director of the board, said no final action would be taken until the new board took office in July. But Shawalter said that decisions would be filled before the end of the year.
Such action would make Kansas the 29th state to allow nurse-midwives to practice. Twenty other states, many of which have been previously allowed to practice although 11 of those states require licensing.
Showalter said the Kansas nursing board was onoosed to lay midwifery.
"THE BOARD THAT midwife should have training as a nurse and build the skills of her staff."
The American College of Obstetricians and Gynecologists and the American College of Pediatrics
that only certified nurse-midwives or doctors have sufficient training and skill to be able to handle unforeseen complications at childbirth.
However, in many remote parts of the country, a lay midwife is the only assistance available, and some doctors say lay midwifery is better than nothing.
Henry Buck, a Lawrence obstetrician,
opposes any form of midwifery that would
allow the midwife to work independently
of a doctor.
But Steve Bruner, a Lawrence family practitioner, said, "The ObJgyn guys think they're more qualified than I am, and I think I'm more qualified than a midwife. But really, most of what we do could be done by someone else."
The cost of doctor and hospital care is another factor that drives some women to midwives. Although costs vary across the country, the ACGO estimates a delivery attended by a physician would be $800. A delivery by a midwife could be less expensive if that failure
A PRACTICING lay midwife in Texas charges fees on a sliding scale from $150 to $400 for complete care during pregnancy, delivery and after birth.
Because they say women in Kansas want the option of midwifery, several state legislatures have worked on a midwifery bill.
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But so far in Kansas it is still in the House Committee on Public Health and Welfare.
State Rep. Geneva Anderson, D-Mulvane, one of the bill's sponsors, said the bill would provide for both lay and nurse-midwives. One year of training beyond nurse's training probably would be required for nurse-midwives, she said, and without a two or three years of training probably would be required for a baby midwife.
"I want a bill that will have safeguards in it where the midwife will have training so she can detect problems. I think we'll be able to show consumers that it will help them."
Cribs, whose mother and sister were midwives, said, "I lived among it all my life."
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