Navigation Links
Study reveals conflict between doctors, midwives over homebirth
Date:5/11/2009

CORVALLIS, Ore. Two Oregon State University researchers have uncovered a pattern of distrust and sometimes outright antagonism among physicians at hospitals and midwives who are transporting their home-birth clients to the hospital because of complications.

Oregon State University assistant professor Melissa Cheyney and doctoral student Courtney Everson said their work revealed an ongoing conflict between physicians and midwives that is reflective of discord across the country.

The pair recently examined birth records in Oregon's Jackson County from 1998 through 2003, a period when that county saw higher-than-expected rates of prematurity and low birth weight in some populations. The researchers wanted to assess whether those rates were linked to midwife-attended homebirths.

The findings revealed that assisted homebirths did not appear to be contributing to the lower-than-average health outcomes and, in fact, that the homebirths documented all had successful outcomes. But even more importantly to Cheyney, discussions with doctors and midwives uncovered a deep gulf between the two groups of birthing providers, with doctors expressing the firm belief that only hospital births are safe, while midwives felt marginalized, mocked and put on the defensive when in contact with physicians.

"We've been getting insight into their world view, and it's been quite illuminating," Cheyney said.

Cheyney, who is a practicing midwife in addition to being an assistant professor of medical anthropology and reproductive biology, said she was surprised that physicians, when presented with scientifically conducted research that indicates homebirths do not increase infant mortality rates, still refuse to believe that births outside of the hospital are safe.

"Medicine is a social construct, and it's heavily politicized," she said.

Last year the American Medical Association passed Resolution 205, which states: "the safest setting for labor, delivery and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex" The resolution was passed in direct response to media attention on home births, the AMA stated.

What is interesting, Cheyney points out, is that 99 percent of American births occur in the hospital, but the United States has one of the highest infant mortality rates of any developed country, with 6.3 deaths per 1,000 babies born. Meanwhile, the Netherlands, where a third of deliveries occur in the home with the assistance of midwives, has a lower rate of 4.73 deaths per 1,000.

One of the biggest problems Cheyney sees is that physicians only come into contact with midwives when something has gone wrong with the homebirth, and the patient has been transported to the hospital for care. There are a number of reasons why this interaction often is tension-filled and unpleasant for both sides, she says.

First is the assumption that homebirth must be dangerous, because the patient they're seeing has had to be transported to the hospital. Secondly, the physician is now taking on the risk of caring for a patient who is unknown to them, and who has a medical chart provided by a midwife which may not include the kind of information the physician is used to receiving.

And because the midwife is often feeling defensive and upset, Cheyney said, the contact between her and the physician can often be tense and unproductive. Meanwhile, the patient, whose intention was not to have a hospital birth, is already feeling upset at the change in birth plan, and is now watching her care provider come into conflict with the stranger who is about to deliver her baby.

"It's an extremely tension-fraught encounter," Cheyney said, "and something needs to be done to address it." As homebirths increase in popularity, she added, these encounters are bound to increase and a plan needs to be in place so that doctors and midwives know what protocol to follow.

She is working with Lane County obstetrician Dr. Paul Qualtere-Burcher to draft guidelines that would help midwives and their clients decide when they need to seek medical help, based in large part on Cheyney's research, and another that would ask physicians to recognize midwives as legitimate caregivers.

Qualtere-Burcher said creating an open channel of communication isn't easy.

"I do get some pushback from physician friends who say that I'm too open and too supportive," he said. "My answer, to quote (President) Obama, is that dialogue is always a good idea."

Qualtere-Burcher said he believes that if midwives felt more comfortable contacting physicians with medical questions or concerns, there would be a greater chance that women would get medical help when they needed it.

"Treat (midwives) with respect, as colleagues, and they'll not be afraid to call," he said.

Qualtere-Burcher doesn't expect immediate buy-in, but hopes that if a small group on each side agrees to the plan, it will provide more evidence that a stronger relationship between physicians and midwives will lead to better outcomes for mothers and infants.

"We're having a meeting in early May to propose a draft for a model of collaborative care that might be the first of its kind in the United States," Cheyney said.

Cheyney is also pushing to get hospitals and the state records division to better track homebirths. The department of vital records had no way to indicate whether a birth occurred at home until 2008, and without being able to pull data, Cheyney said it's hard to explore the nature of home birth in Oregon.

She's also working on education programs for midwives in rural areas, including a cultural competency piece as demographics in Oregon continue to change.


'/>"/>

Contact: Melissa Cheyney
cheyneym@onid.orst.edu
541-737-3895
Oregon State University
Source:Eurekalert

Related biology news :

1. UNC study identifies genetic cause of most common form of breast cancer
2. Comprehensive genetic study paves way for new blood-pressure medicines
3. Study finds novel genetic risk factors for kidney disease
4. New study: Home energy savings are made in the shade
5. Study finds homicidal poisoning rising, more likely in infants and elderly
6. OHSU researchers study the idling brain
7. Study finds childrens activity levels not influenced by more PE time in school
8. Study finds link between hot flashes and lower bone density in women
9. Songbird study from CSHL, CCNY provides concrete measure of biologys impact on culture
10. Genetic study confirms the immune systems role in narcolepsy
11. U of Minnesota study finds high school teachers influence student views of evolution & creationism
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/26/2017)...  Securus Technologies, a leading provider of civil ... investigation, corrections and monitoring, announces the appointment of ... "Too often, too many offenders return to jail ... trying to tackle this ongoing problem and improve ... members. While significant steps are underway, Securus continues to ...
(Date:2/21/2017)... PORTLAND, Ore. , Feb. 22, 2017 /PRNewswire/ ... of Companies (Avamere Health Services, Infinity Rehab, Signature Hospice, ... study that will apply the power of IBM cognitive ... and health centers. By analyzing data streaming from sensors ... into physical and environmental conditions, and obtain deeper learnings ...
(Date:2/14/2017)... WINSTON-SALEM, N.C. , Feb. 14, 2017  Wake ... FRY-shlog), M.D., as its new chief executive officer (CEO). ... succeeds CEO John D. McConnell , M.D., who ... new position at the Medical Center, after leading it ... oversee the full scope of Wake Forest Baptist,s academic ...
Breaking Biology News(10 mins):
(Date:3/22/2017)...  Ascendis Pharma A/S (Nasdaq: ASND), a biopharmaceutical ... address significant unmet medical needs in rare diseases, ... ended December 31, 2016. "2016 ... we broadened our pipeline and pursued our vision ... with an initial focus on endocrinology," said ...
(Date:3/22/2017)... New York , March 22, 2017 ... is largely fragmented, states a research report by Transparency ... S.A., Pfizer Inc., Amgen Inc., and AbbVie Inc., accounted ... in 2015. The prominent players in this market are ... expand their product portfolio, which is likely to lead ...
(Date:3/22/2017)... ... March 21, 2017 , ... Premier executive recruitment firm, Slone Partners, is proud ... Hunt Scanlon Media. , Hunt Scanlon Media is one of the most ... news source in the human capital sector. , “It is a great honor for ...
(Date:3/22/2017)... ... March 21, 2017 , ... The Conference Forum has announced the ... be held on May 10-11, 2017, at the Colonnade Hotel in Boston, MA. The ... Medical Officer peer-to-peer learning, benchmarking and support. , “The Chief Medical Officer faces a ...
Breaking Biology Technology: