Reply to Evelyn Muhlhan - another homebirth midwife bites the dust?

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[quote=Anonymous][quote=Anonymous]"I've been musing about what I would do if I were to go into preterm labor. The answer is obvious if the baby were 30 weeks: go to a hospital with a good NICU. My own cutoff for an out-of-hospital birth would be around 36-37 weeks, depending on the particular situation, access to oxygen and a midwife skilled at recognizing signs of respiratory distress or other prematurity-related complications."

"But what about 28 weeks? 26? 24? 22? At what point would I allow the baby to pass on peacefully, rather than attempting heroic efforts at resuscitation with a small chance of survival and high likelihood of major disabilities if the baby were to live? My own gray area is between 24-28 weeks. By time a baby hits 26 weeks gestation, survival rates are between 80-90%, and about 15% of those surviving babies will have major disabilities as a result of prematurity. I think this would be the earliest point at which I would consider intervening."

"Still, survival rates and even major disability rates are not the only practical or moral considerations that I would have to account for. Having a very premature baby, in my own family setting, would mean I would have to commute to a hospital with an advanced enough NICU: probably 40 minutes away and most likely an hour or more. The stresses on our family, the realities of trying to spend my time in a NICU while caring for a nursing toddler, and the emotional and financial drains that an extremely premature baby would entail are all things I'd have to carefully think about."  -From a natural birth blogger

Late to the conversation here. I started my pregnancy under the care of very good CNM and then was transferred to OB/hospital care when my pregnancy got very complicated.  I'm very sympathetic to natural birth and I believe strongly in a woman's right to choose or decline her own medical care.  I'm also the mom of a 29w preemie who is everything to me.  When I read the quote above on a blog it just made me sick to my stomach that someone (and someone who obviously loves and want children) would consider withholding care from a 28w preemie.  I don't quite know where I'm going with this-I guess I do believe in the right of women to choose their own standard of care, but I'm also personally pretty horrified by what some of hose choices look like.[/quote]

I dunno, I don't really have a problem with the piece you quoted. I read her blog fairly regularly, and she's very involved in the birth community. This is obviously something that she's thinking about, both personally but also philosophically. I think that it is all to the good for women to really evaluate their choices and values, the options before them and potential situations they might find themselves in, rather than just assuming that everything will be fine and not examining the consequences for any of the situations that arise.

I personally had never considered how I would react to, feel about and deal with pre-term labor until just now. I was an incredibly overconfident first time mom. I skimmed over the chapters about complications and emergencies.  It never occurred to me that I would ever need any interventions or that I would have any complications. I think that partially, my confidence was what helped me to have a natural birth free of complications, but I can only say that from this side of it - I can only say that because it worked out. I am the first to admit that if things had gone south, I would have been completely unprepared to deal with it and it would probably have been a lot scarier as a result. I think that it's good to consider all options and outcomes - because whether it's sickening to you or not, it is this woman's choice whether to intervene or not.  I think often thinking through all the options a situation presents helps us to refine our preferences and feelings if and when that situation presents itself. Obviously you, PP, made the choice that I probably would also make. I suspect that the woman whose blog you quoted, ultimately, would make the same choice, though I have to say having read her blog for a while that she definitely makes choices I would not make. That said, unlike some of the other naive fringe natural birthers, she is very educated, very scientific and has a very complete understanding of the issues at play, and out of that whole fringe, I think I respect her choices more than others as a result.[/quote]

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