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Should midwives take on risky deliveries?

Should midwives be allowed to care for women giving birth to twin, breech and VBAC babies? Or is home birth in these cases simply too risky?

An interesting article in The Oregonian describes dueling legal actions that seek to resolve that question, with Oregon Health & Science University on one side and five midwives from Portland's Andaluz Waterbirth Center on the other. OHSU maintains the midwives are violating professional standards; an attorney for the midwives has filed a lawsuit on the premise the allegations are harassment.

While Oregon law gives midwives a broad "scope of practice," safety "remains a matter of fierce debate," Joe Rojas-Burke reports:

Standards of practice vary widely from state to state, and studies are contradictory. In a report in February, University of Texas researchers who analyzed U.S. birth records from 2000 to 2004 concluded that the risk of infant death was twice as high in home birth compared with hospital birth.

But in two large Canadian studies last year, in Ontario and British Columbia, infants born at home fared just as well as those born in the hospital. Significantly, home-birth mothers experienced fewer complications. In the Ontario study, the rate of emergency c-sections was 5 percent among women who planned home births compared with 8 percent among those who started in the hospital. In the British Columbia study, women giving birth at home suffered less than half as many serious perineal tears, and about a third less postpartum hemorrhaging.

Of course, whether or not water births are safe is another question. Recent research hasn't looked too kindly on the practice.

Photo by a4gpa

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