Discuss Jennifer Block's Dec. 24 Op-Ed article.

CPM education does engage in modern research and training can be (if you get it from somewhere reputable) QUITE adequate. Why do you think midwives see fewer deaths, interventions and complications than doctors do? CPM's can detect illnesses such as pre-eclampsia well in time to refer a high risk patient to an OB/GYN for care. Birth needs to be taken out of the hospital and put back into the hands of women who are more than capable of delivering them. Amen to this article, indeed! Say goodbye to the fear-mongering that has lead women to resent birth and flock to hospitals in "need" of drugs and interventions!

Robbin @ 1:47 PM PST, Dec 24, 2008

"Obstetrician" cites the inclusion of high risk prematures as invalidating comparisons with perinatal mortality rates of other countries, yet an increasing proportion of these preterm (especially late preterm) births have iatrogenic origins: "elective" labor inductions and scheduled cesareans, including cesareans for twins and breeches that elsewhere are born vaginally: and these interventions carry risks of their own. A recent study found: that late preterm babies “are more than three times as likely to be diagnosed with cerebral palsy than full-term babies, and have an increased risk for developmental delay or mental retardation.”

Prenatal/perinatal researcher @ 1:46 PM PST, Dec 24, 2008

"Concerned Physician" is regurgitating old, tired and invalid arguments that have been offered by obstetricians and OB-wanna-be's among family physicians for at least a century. The fact remains that countries in which midwives and/or family physicians are the primary caregivers with OB care only for high-risk and emergent problems outcomes are better (and women are more empowered in their birthing experiences). It is unfortunate that the U.S. is almost unique in the adversarial relationship between OBs and midwives (and even with family physicians) where elsewhere these relationships are far more collaborative and mutually supportive.

Prenatal/perinatal researcher @ 1:36 PM PST, Dec 24, 2008

Thanks for the fantastic article! I am looking forward to having a home birth with a CPM this August. I feel very confident in her level of training and experience. Post bachelor's degree, she attended a 3 year midwifery program and attended over 100 births BEFORE receiving her license and certification. I know I will be much more comfortable with this level of experience and expertise dealing with normal and natural childbirth, than I would be at a hospital where interventions are regularly recommended. Of course, a hospital will be close by if for some reason medical intervention becomes necessary.

Marie @ 1:20 PM PST, Dec 24, 2008

Unfortunately, conditions will probably have to get worse before they get better. For the sake of the women of this country, I hope not. Great article, Ms. Block.

Unnecesarean @ 12:57 PM PST, Dec 24, 2008

Unmedicated "natural"childbirth is not for everyone. Just because a woman opts for medicine to assist her or delivers via c-section doesn't mean the childbirth experience is any less meaningful to her! Sometimes the choices we make are in the best interest of the child and the mother. I'm a little tired of people's attitude that unless you deliver "their" way, you didn't do it right. Tell me, does that mean that unless you conceive "naturally" it's not right either?

C-Section Mom @ 12:57 PM PST, Dec 24, 2008

I'm getting really tired of the pompous way in which obstetricians scoff at the experience of CPM's. Have they ever heard of a midwife named Ina May Gaskin? Have they ever used the Gaskin Maneuver? The difference is that midwives are experienced in normal birth and OB's are experienced in TREATING birth, so they rarely EXPERIENCE what normal birth should be like. Here is a story of a local CPM and her journey to becoming an excellent midwife. You tell me what OB resident has more hands on experience than this with as much success as this midwife had. Here is the link:http://www.casamidwifery.com/interns/13.htm

Stephanie @ 12:46 PM PST, Dec 24, 2008

The education of the CPM has been evaluated as excellent by the states that license CPMs. These states have overseen the practice of licensed CPMs for many years, and are satisfied that the CPM can recognizing and handle emergencies. Research quoted by the physician groups also inclues unplanned and unattended births out of the hospital. Research regarding outcomes for out-of-hospital births planned and attended by CPMs proves the safety of this option with far fewer cesareans and inductions.

Concerned CPM @ 12:36 PM PST, Dec 24, 2008

The bottom line is that we have decades of solid medical literature supporting the safety and cost-effectiveness of skilled midwife attended births at home, which CPMS are. When discussing "evidence-based care" let's not overlook the clear double standard. Obstetricians are not required to adhere to evidence-based practices, and in general, they do not. All one has to do is look at the trends in obstetrical practice over the years, culminating with today's indefensible cesarean rates.

Erin Ellis @ 12:01 PM PST, Dec 24, 2008

An ad campaign about "optimal" birth? What condescending, sexist garbage. We're already given about a gazillion messages a day about all the various ways our bodies can be a failure unless we anxiously do a ton of difficult and energy-sapping things. So while it's very trendy now to extend this language of personal failure-avoidance to childbirth -- if you're a middle-class white woman -- but it's also very sexist. As is the notion that women's health is a good thing to save money on because, hey, they're just women, right? They like to suffer.

Trixie Mae @ 11:54 AM PST, Dec 24, 2008

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