I felt extremely honored to have been so graciously received here. By design, Sparrow Hospital was the first stop on my 100 Hospital National Tour – promoting “Positive Pregnancy, Positive Birth”. The reason I am doing the tour is to bring awareness that all across the country, women are choosing to give birth “as they desire” in comfortable, supportive, and safe places. Birth centers and hospitals are indeed the safest place to give birth. There is simply no counter argument to the fact that “most of the time, things go well… but when they don’t, they don’t very quickly”.

There has been much celebrity promotion of home birth recently and as I professionally sorted out why this was, it became clear to me that the appeal of home birth, to many, is the inherent fear that a hospital birth cannot, or will not be intimate and personal.

I was received warmly at Sparrow and was hosted by John Lux, the Director of Communications. I spent the better part of an entire day with nurses, physicians, residents, and administrators, as well as meeting the CEO and President of the hospital. What I found at Sparrow was an exceptionally progressive facility with the best of the best in options for women. Options ranging from natural labor to epidurals, VBAC’s (vaginal birth after cesarean), vaginal twin delivery in the labor rooms, rooming in with the baby and exclusive breast-feeding.

Sparrow has a Level 3 Neonatal Intensive Care Nursery (NICU) and is at the forefront of the most current research-driven, evidence – based practice. It is also a Magnet hospital, which means that it has been awarded a status of excellence in nursing care, professionalism and a leadership system that promotes advance practice nursing and nursing satisfaction. This creates a high level of patient satisfaction.

I wish to openly thank all of the people I met at Sparrow for taking time out of their day to meet with me. I have heard repeatedly from those who argue that hospital birth in America today is less optimal than home birth, that because my practice is in a major urban center on the west coast, that my opinions are skewed and that “the rest of the country is not like California”.

I am certainly not naive and know (and will discuss) that not every community offers every option in birth choices. However, clearly in mid-Michigan, women can expect a wonderfully positive pregnancy and birth experience.

They are an advocacy group that strives to provide information on cesarean statistics, as well as how to advocate for a VBAC (vaginal birth after cesarean).

Yes, yes, yes- we should be screaming that our C/section rate in the U.S.  is out of control. But it is not only in the U.S., it is worldwide. The increase is based on a couple of things. Not only is the increase in women having their first baby, but also is significantly increased in women who have had a prior C/section.

In the 1990’s – VBAC’s were highly encouraged. Insurance companies would not authorize payment of a c/section for many situations, prior to a trial of labor. And physicians solidly encouraged women to VBAC. In my experience, depending on the reasons for the first c/section, the successful VBAC rate was about 70% , at that time.

In the late 90’s, studies were released that showed that 1/200 women who attempted a VBAC, had a uterine rupture. This is a life-threatening situation for both mom and baby and it was at that time that standards began to shift. Although, still unlikely, the risk was great enough for many physicians to become more comfortable with scheduling repeat c/sections.

As time went on, insurance companies began paying for repeat c/sections and the push for VBAC’s decreased. Today, there are hospitals and physicians who refuse to do VBAC’s. This is primarily in less urban areas and the chief reason is lack of 24 hr. anesthesia coverage at the birth hospital.

The larger issue today is with scheduled cesarean sections with a first baby, for either  “quasi” medical reasons, or electively, for no medical reason. I work at a hospital that has a “first-baby” cesarean section rate of 17%, which is below the national average. But we can do better. And we cannot forget that a cesarean section is a vital, life-saving surgery that should be reserved for the times when it is medically indicated.

She prides herself in not having dedicated physician or hospital back up because she doesn’t want to be constrained by the directives those relationships would entail. She blatantly exceeds her scope of practice and offhandedly discusses her work with women who clearly do not fall under the “low-risk” category – twins, VBAC (vaginal birth after cesarean) and breech birth. It is almost as though she considers a potentially difficult birth to be a challenge of sorts. She appears to hold herself separate from professional accountability.

I have watched The Business of Being Born several times and during one birth, Cara Mulhullan delivers a baby in a tub without the use of gloves, a basic and vital aspect of infection prevention and protection for both the mother and the care-provider. She lightly refers to herself as a renegade. Yet, she appears to be celebrated as the panacea of homebirth practitioners.

This should be, to any rational person, frightening at the very least. In countries that actively practice home-birth, these are all situations in which a woman would not be considered to be a candidate for safely giving birth at home. These are circumstances that a woman planning to give birth in a birth center or with a nurse-midwife here in the U.S., would be under the care of an obstetrician in a hospital. It is completely logical, ethical and absolutely essential to ask “whose best interests are at hand with this sort of sense of self”. As Ms. Mulhullan and other home birth midwives enjoy the increase in their practices due to Ms. Lake’s film, I can only hope that they fully acknowledges that their skills are limited, as are all practitioners based on their level of knowledge, training, and experience.

I know, have worked with and fully respect several, amazing, home-birth midwives. Every one of them has a physician back them up in case of an emergency or complication (both can and do happen with “low-risk” moms) and they are very clear about their criteria for a birth at home. If it were true that the process of birth could always be “trusted”, half a million women around the world would not die each year from a likely preventable pregnancy or birth related complication. Birth is not merely an “experience” – the health, the very lives, of two (or more) people are in the hands of the practitioner. Let’s not ever forget that.