A student doctor recently blogged about home birth. The post was full of the common misconceptions about home birth and she asked for clarification from anyone who had ever attended a home birth. She got some thoughtful comments, including a personal invitation from Elizabeth Allemann, M.D. to visit the birth center and some home births and was very gracious and appreciative of all of the feedback.
Several of her commenters mentioned ?evidence-based medicine,? and she replied with the following:
I would have to disagree with your statement that no one has taught about evidence based medicine much less evidence based OB. On the contrary I consider evidence based medicine daily. However I also consider the standards put forth by authorities like the American College of Gynecologists to be important. I realize an appeal to authority is a logical fallacy but as aforementioned by deviating from practice guidelines I put myself at risk for litigation. Right or wrong I am made to follow those guidelines. I obviously wasn’t taught about “physiological birth” because generally that does not involve a doctor. Why would a doctor be taught a process that they are actively excluded from? Think about it.
You cannot expect to condemn medical standards & cut doctors out of the care of a patient then expect them to know what’s going on.
So I did ?think about it.? And I?m a little bit confused. Physiological birth is an expression used to describe birth with no unnecessary intervention. In Pushed, Jennifer Block interviews Vancouver physician Andrew Kotaska, who states, ?An unmedicated birth in an environment where a woman feels comfortable, where she?s adequately supported, where she has a degree of privacy that allows her brain and her uterus to do the dance that we understand very poorly called labor, is physiological birth.?
Doctors should still be learning how a normal birth unfolds in the absence of medication, regardless of whether they are ?actively excluded? from it. What really sat with me, besides seeing the seeds of the ?I must obey or I will be sued? mindset and the repeated mentioning of pelvic inadequacy was that this student doctor attended her tenth birth ever recently. The attending didn?t show up on time and she flew solo with just one nurse at her side. It was her tenth birth ever and she was alone.
Granted, it was an error that she was alone, but if hospitals are being billed as the gold standard of safety and there isn?t even another physician nearby to back her up, something is amiss. My midwife, a home birth midwife, has attended almost 900 births. The midwife at the birth center where I gave birth has attended more than 3,000. Their care is generally regarded as unsafe but anyone walking into a hospital in labor assumes that they are getting the very best.
So who is catching your baby? Do you know?