Not At Home

April 27, 2012 1:43 PM

Hungarian mid-wife, Dr Ágnes Géreb, is headed for jail after nearly 18 months of house arrest, for 'neglient malpractice'. This follows her sentence being increased after an unsuccessful appeal. The Royal College of Midwives has called for her release and the BBC's Central European correspondant Nick Thorpe, whose five children were delivered by Dr Géreb, has written extensively on the case. More information is available at http://www.freeagnesgereb.com/.
posted by vac2003 (37 comments total)

an excellent use of government resources, particularly when there are no other pressing police matters in Hungary.
posted by leotrotsky at 1:48 PM on April 27, 2012

Wow. Seriously fucked up shit. I had no idea. Thanks for posting.
posted by mrgrimm at 1:53 PM on April 27, 2012

At least in my skimming of the linked articles, nothing indicates that she not break the law as-written in Hungary. In fact, the Guardian article and the Royal Colleges of Midwives both implicitly acknowledge she was breaking the law in Hungary. It should not be a surprise when someone is arrested for openly violating the law. If the law is objectionable, the law should be changed.
posted by saeculorum at 1:58 PM on April 27, 2012 [1 favorite]

Saeculorum: I believe that by continuing to practice, and by proving that home birth can be safe, she is actually fighting to change the law.
posted by SLC Mom at 2:03 PM on April 27, 2012 [4 favorites]

An excerpt from the article, because the post doesn't really explain the situation:

Géreb's crime is to have spent the past 17 years quietly resisting Hungary's attempts to criminalise home births. Against a background of escalating police harassment and abuse, Géreb helped deliver 3,500 babies at home, one of whom died some 14 months after a difficult labour, another as a result of shoulder dystocia (when the head has been born but one of the shoulders becomes stuck behind the mother's pelvic bone). A third infant died seven months after suffering a lack of oxygen at birth.

According to the World Health Organisation, Hungary's early neonatal mortality rate (babies aged 0-6 days) is five deaths in every 1,000 live births. By this measure, Géreb could have expected to see 17 or 18 babies – not three – die during her almost two decades as an independent midwife.

But because the government refuses to regulate independent midwives in Hungary, these cases triggered a criminal investigation and Géreb was found guilty of manslaughter, negligent malpractice and two other charges involving common obstetric occurrences.
posted by Pruitt-Igoe at 2:07 PM on April 27, 2012 [1 favorite]

It should not be a surprise when someone is arrested for openly violating the law. If the law is objectionable, the law should be changed.

But the increase of sentence upon appeal does suggest that vengeance and a desire to retain control might make changing the law a wee bit difficult. Let's not pretend this is a simple matter. The right to control where and with who you birth is something a great many women are determined to fight for. Hungary's stance that it should be able to deny them that right seems more than a little archaic and brutal.
posted by emjaybee at 2:09 PM on April 27, 2012 [7 favorites]

Hungry is messed up in many ways and I can't help but feel that this does seem to represent a continued unpleasant repression.

OTOH, perhaps because it's so filled with dangerous practitioners of woo here in the USA, I'm ambivalent about the whole midwife thing.

On the gripping hand, I can't really argue that women should be able to birth however they choose, it is their pregnancy after all.
posted by sotonohito at 2:17 PM on April 27, 2012 [1 favorite]

sotonohito: "OTOH, perhaps because it's so filled with dangerous practitioners of woo here in the USA, I'm ambivalent about the whole midwife thing. "

Midwives are a standard part of most European health systems. In Denmark, it's a 3½ year long higher education programme and most are employed by the national health service, though there are also some private practitioners. In Germany it's 3 years.

(Interestingly, the Hungarian-language Wikipedia doesn't seem to have an article on midwifery.)
posted by brokkr at 2:28 PM on April 27, 2012 [2 favorites]

"OTOH, perhaps because it's so filled with dangerous practitioners of woo here in the USA, I'm ambivalent about the whole midwife thing. "

That was my first thought when I saw this, but in a couple of articles it mentions that she is a obstetrician, which makes me much more sympathetic to her cause. I'm not sure why there is not more emphasis on that fact in most of the links.
posted by TedW at 2:34 PM on April 27, 2012 [2 favorites]

For all those up in arms about this "archaic", "brutal" and "repressive" policy in Hungary, it appears that the law was already changed in 2011 due to an ECHR ruling. I don't know whether homebirth is now widely available, but the prosecution of Géreb predates the change. It seems as though the policy was a hangover from communist times, and demedicalization has been a slow process. I could be wrong, and would welcome somebody well informed to speak on the matter.

But you know, everybody is free to keep throwing words around if they want.
posted by Jehan at 2:37 PM on April 27, 2012

According to the World Health Organisation, Hungary's early neonatal mortality rate (babies aged 0-6 days) is five deaths in every 1,000 live births. By this measure, Géreb could have expected to see 17 or 18 babies – not three – die during her almost two decades as an independent midwife.

This is not a particularly meaningful stat without much more detailed study. Early neonatal deaths are far more likely to result from premature births, births to mothers who did not receive prenatal care, birth defects and congenital illness, drug and alcohol exposure, and a myriad of other causes. The vast majority of these complex cases aren't going to be home births performed by Dr. Géreb. Presumably, her home births are primarily uncomplicated cases where the mother has received extensive prenatal care and screening, while more dangerous situations are referred to the hospital.

I have absolutely no idea how safe her practice is, but it would really only be meaningful to compare her outcomes to those of like populations of mothers and babies.
posted by zachlipton at 2:38 PM on April 27, 2012 [17 favorites]

If you think about it, it's weird that doctors handle all diseases (except teeth) and normal, un-complicated childbirth. Like pregnancy is an illness or something. The midwife system makes way more sense.
posted by miyabo at 2:38 PM on April 27, 2012 [2 favorites]

This thread is in imminent danger of turning into a knock-down shout-down about midwifery and homebirth. One thing that makes this discussion extremely difficult in almost any setting is the way both advocates and opponents cherry pick the research to support their own views.

For example, here is a post about pretty compelling research-based arguments for the safety of homebirth. (And another positive study, and another.) But here's ACOG coming out against homebirth based on (their own) meta-analysis. But look, here's that meta-analysis being critiqued!

Let me tell you, I've read all the studies, or at least skimmed them, and the bulk of the research points to homebirth being slightly safer than hospital birth, and a few studies show it as slightly less safe, if you measure safe solely by survival - all studies will show fewer medical interventions at home, many of which have their own associated morbidity.

For me, as someone who had a home birth, it comes down to choice. I have at least basic familiarity with every damned study there is. I understand that there are a few rare cases where the fact that I was 15 minutes from a C section rather than, in a best-case scenario, 5 meant that my kid could have died at home for reasons she would be slightly less likely to die in a hospital. I knew it but thank goodness I had the right to choose for myself whether a statistically tiny chance of death was for me worth taking. We all make similar choices daily actually, about where we live, how we get around, what we eat or smoke or drink or what medicines we take or don't take. We're dealing with unknowns, and believe me, there is tons of non-research based crap that goes on in delivery rooms (did you know there is no evidence that fetal monitoring improves survival? Yet it is done in every labor and delivery room in the USA). I had the right to make my own informed decision, and I think every woman and every family should have that right.
posted by latkes at 2:41 PM on April 27, 2012 [11 favorites]

If you think about it, it's weird that doctors handle all diseases (except teeth) and normal, un-complicated childbirth. Like pregnancy is an illness or something. The midwife system makes way more sense.

Childbirth is normal and uncomplicated...until it's not, and the baby is bleeding or not getting oxygen or mom is hemorrhaging or...

Pregnancy is not an illness but it can be dangerous. It can kill, injure, or maim the mother and the child. Ignoring that reality leads to substandard care for women and babies.
posted by the young rope-rider at 3:43 PM on April 27, 2012 [14 favorites]

did you know there is no evidence that fetal monitoring improves survival? Yet it is done in every labor and delivery room in the USA

IIRC there is no evidence that CONTINUOUS fetal monitoring improves survival. Intermittent monitoring is helpful and necessary to detect various potentially fatal conditions. Of course, I am biased because monitoring and quick thinking on the part of an OB nurse saved my baby's brain function (if not necessarily his life).
posted by the young rope-rider at 3:46 PM on April 27, 2012 [5 favorites]

The fetal monitor saved my life and my son's life. So, yeah they can be useful.
posted by dejah420 at 5:23 PM on April 27, 2012 [2 favorites]

That said, I.have participated in home births, most planned, one accidental. Obviously women have been giving birth since the dawn of man w/o the benefits of surgeons and carts of drugs. Young, healthy, non-complicated births seem to me to be a viable choice for those who want that. By the same token, there are people, like myself, that should be steered away from that and towards a modality when intervention is seamless and fast.

The case of this doctor, however seems not to hinge on best practice, but on protecting a medical cartel that wants all women to have mo choice about how/where they give birth, and I hope either the new president pardons her, or the world court takes the case.
posted by dejah420 at 6:44 PM on April 27, 2012

The problem with the "x saved my/my baby's life" thing, although I know it has a lot of personal meaning to people, is that there is actually no way to know if that is true, and often, it isn't.

Firstly, you can't know what would have happened in any different set of circumstances than the one you actually had. There is no control group for yourself.

There are a few situations where someone with a fair amount of medical experience can say fairly confidently that x saved so-and-so's life, for example, if you were bleeding uncontrollably after birth, and lost 10 cups of blood, and then had an emergency hysterectomy to stop the bleeding, you can pretty well say that the procedure very likely saved your life.

However, something like fetal monitoring can almost never be so clear. So maybe fetal monitoring revealed a heart rhythm associated with bad outcomes - there is no way to know if those rhythms would have resolved on their own, with position changes, or with other interventions besides whichever interventions you had. Unless the heart stopped beating altogether, there is no way to know if the baby would have been fine without intervention. The research actually seems to show that higher levels of intervention based on fetal monitoring do not lead to better brain function/fewer disabilities/complications. But of course this works both ways, and we don't know if any one individual baby is/was better off because of early intervention based on monitoring. However, I think the best thing we have at this point in medicine, and the direction all areas of medicine are moving now, is toward basing practice on the available evidence. I think most obstetricians would actually agree with that statement, although if there's one here who would like to refute me feel free to speak up.

Medicine involves an enormous amount of subjectivity, particularly pregnancy and birth medicine for reasons revealed in this thread: because the stakes are so high, we as a culture are inclined toward conservative action. Why take a chance, right? Even if the statistics and evidence tend to indicate that less intervention, less monitoring, etc are just as safe if not safer. It's a highly emotional issue and that's a big part of why it's tough to have rational conversations about it.
posted by latkes at 8:51 PM on April 27, 2012

In the hysterectomy example, you would have already had to have tried other methods: medications, compression, etc. and had each other method fail before being fairly certain that the final action taken was the one that, probably, saved the woman's life, or more precicesly, before you can say that the final action was the only thing that could have been done to save the woman's life. This added layer of trying every other known intervention before you can really be sure shows how hard it is to know in any given anecdote or experience whether what the doctors or nurses did "saved your life" or at least was the only thing that could have saved your life.
posted by latkes at 9:19 PM on April 27, 2012

The immediate intervention that I had was a position change, in addition to oxygen. We ended up having to do other things later due to my weird contraction pattern and his continued heart rate issues, but it never got that bad again.

Changing position is something that I would not have known to do unless I was being monitored; I felt great and thought everything with my baby was perfect. Had I been off the monitor I would have continued laboring in the same position with a baby whose heart rate was low and non-variable for quite a while. A few hours of that would almost certainly have been damaging to him. Unless you're claiming that a low fetal heart rate with no variation is not indicative of a lack of oxygen? I'd like to see some kind of citation for that if so.

I'm not sure what you mean by saying that fetal monitoring can almost never be so clear--do you think that low non-variable heart rates are likely to resolve on their own or again, that they're not indicative of danger?

The research actually seems to show that higher levels of intervention based on fetal monitoring do not lead to better brain function/fewer disabilities/complications.

It would be great if you could cite something there because it goes directly against what I understand, which is, as I mentioned above, that continuous monitoring does not help when compared to intermittent monitoring but intermittent monitoring is beneficial. Even home birth midwives certainly carry dopplers with them to monitor the fetal heart rate.

There are also two different outcomes: the maternal outcome and the fetal/baby's outcome. Focusing on one over the other might lead to different decisions about what interventions are beneficial.

Then there are variables like what pregnancy it is--repeated c-sections end up pretty hard/risky on the mother so someone who wants a large family might be more willing to take a risk that could end with a brain-injured or dead baby (and to be clear, I think that is absolutely her right, although I think it is a bit jerkish to create a new being and then not accommodate them to the best of your ability...but I digress).

So weighing these risks is complicated. However, I think that unless you are really getting into "how do we know anything" territory, that yes, you can sometimes say that a certain intervention saved a baby's life (or brain function). It might not have been the only thing, but that doesn't mean it didn't have that effect.

On a more general level, you can correlate certain things with certain outcomes. Active management of the third stage of labor is correlated with better maternal outcomes, for example. You can say that you won't know unless you let every woman hemorrhage until she stops and maybe that's true on a theoretical level, but you can get a pretty damn good guess in, which is what is ultimately important.

However, I think the best thing we have at this point in medicine, and the direction all areas of medicine are moving now, is toward basing practice on the available evidence. I think most obstetricians would actually agree with that statement, although if there's one here who would like to refute me feel free to speak up.

I think those OBs who aren't sociopaths want to do what is best for the mother and baby. They might not agree with you about what that is, but that doesn't mean that they don't believe in evidence-based medicine. My OB and the academic hospital where I delivered had evidence-based practices in place.

That said, there are some shitty hospitals and there are definitely some sociopathic OBs out there. I wish the focus of birth reform movement in the US would be more focused on informed consent, education, higher reimbursements for OBs and longer appointments, continuous care for laboring women (like doulas), and robust complaint mechanisms for OB misconduct. Instead it seems to be focused on avoiding interventions, without allowances for those interventions being varied and sometimes useful, which is what the evidence suggests.
posted by the young rope-rider at 9:53 PM on April 27, 2012 [2 favorites]

continuous monitoring does not help when compared to intermittent monitoring but intermittent monitoring is beneficial.

As far as I know, there is no study of intermitted monitoring as compared to zero monitoring. Would be very interested to see one though. In practice in US hospitals, all women are continuously monitored. Or at minimum are monitored for 20 minutes on arrival, then once an hour for 20 minutes, then continuously during 2nd stage. Which amounts to continuous. As you mention, continuous monitoring appears to offer no benefit as compared to intermitted monitoring, which, again, isn't an option for the vast majority of laboring women.

Active management of the third stage of labor is correlated with better maternal outcomes, for example.

Agreed! This is something which research has shown. My point is that there is a ton in obstetrics which is not research based though. Again, I feel that the mainstream obstetrics community cherry picks their research in order to support their ideology (or because it's just what's done, or for some other reason I don't fully understand). (And again, I believe that homebirth activists tend to cherry pick research too - and gloss over negative evidence about homebirth or positive evidence about interventions.)

I think those OBs who aren't sociopaths want to do what is best for the mother and baby. They might not agree with you about what that is, but that doesn't mean that they don't believe in evidence-based medicine. My OB and the academic hospital where I delivered had evidence-based practices in place.

Agree 100% that the vast majority of OBs want to do what's best for mom and baby. I would suggest though that more often than not, they are basing their idea of "what's best" on what we euphemistically call "clinical experience" which tends to mean tradition, or what their teachers did, or what the majority do, not on what the actual available rigorous scientific research indicates. For example, take continuous fetal monitoring as mentioned above: the actual research says it does not improve outcomes, and instead leads to significantly higher rates of potentially harmful interventions (C-sections being the obvious one), yet almost every obstetrician in this country is onboard with routine fetal monitoring for all women. That is not evidence based, it is tradition based, or conjecture based, or something else.

Instead it seems to be focused on avoiding interventions, without allowances for those interventions being varied and sometimes useful, which is what the evidence suggests.

I'd like to see two things out of the medical community on this issue: 1) more honesty, and honest self-evalation, about which interventions are actually supported by evidence, and 2) the right to make my own informed choices about my own care. I don't have an agenda about how much intervention any other informed person chooses and I don't think most birth reform types do either.
posted by latkes at 10:44 PM on April 27, 2012

Midwifery is not necessarily about avoiding interventions, or even just about home birth. Lots of midwives also have hospital privileges and deliver babies in hospital, where mothers have access to stuff like epidurals and continuous fetal monitoring, whether they are under a midwife's or a doctor's care.

A Bachelors of Science in Midwifery is a 4 year university program here in Canada--or in the US, the standard in many states is a nursing qualification plus a Masters to be a Certified Nurse Midwife; direct-entry training is pretty varied from what I understand. A big part of any midwifery training is screening for risk. Midwives do normal childbirth, and they refer all high risk cases to obstetricians. Of course, there will always be some unpredictable complicated births.... But midwives are also trained to deal with that eventuality, or to transfer early to hospital. The WHO is a big supporter of trained midwives; and there are lots of statistics that say midwives provide better outcomes for both women and babies.

Speaking of potentially harmful interventions, here are two examples of things that were done routinely by obstetricians as recently as the 1970s, but which are now less common, partially because of the birth reform movement. High forceps delivery, which can leave babies with nerve and tissue damage, or even brain damage, is no longer performed at all. And episiotomy, which is obviously sometimes still necessary (and by the way, midwives can do it) is no longer routine.

Sometimes, avoiding interventions is important. I think all well-trained midwives support the use of a variety of interventions, and in probably more cases than you would think, midwives can do the interventions themselves. There are definitely some purveyors of woo in midwifery... but the same is true of doctors, or any other profession.

I hope Dr Géreb will get some good news one of these days. It sounds like she's doing great work.
posted by snorkmaiden at 11:40 PM on April 27, 2012

Hey, latkes, I don't have time to read and substantively reply to your comment right now (although I may find time later, I hope so) but I did want to apologize for conflating your comment with some other people who are relatively extreme advocates of no-interventions-ever. Your comment was completely reasonable and it was unintentional, simply poor writing on my part. Sorry about that.
posted by the young rope-rider at 6:28 AM on April 28, 2012

What is happening in much of Central and Eastern Europe with regards to women's choices is downright scary.

Uzbekistan is sterilizing women without prior consent, for example.

Regardless of how people feel about a women's choice to birth in any particular environment, I think many people would agree it should be her choice. When choice is lost, it's bad for everyone.

And it wouldn't surprise me if this isn't one small part of much, much larger issues regarding Hungarian women and their various rights or not to choose as they see fit for themselves --- whether related to contraception, abortion, or birth.

Controlling any or all of the above is one means by which to control and oppress women.
posted by zizzle at 6:30 AM on April 28, 2012

One more short thing--and a genuine question and not a rhetorical gambit--do governments have the right to regulate health practitioners if it reduces choice for women? I would argue that they do, but I completely see what you're saying about it being a means to control women and I agree that it has that effect.
posted by the young rope-rider at 6:44 AM on April 28, 2012

No problem rope-rider! Trying to keep it mellow on this end too!
posted by latkes at 6:52 AM on April 28, 2012

do governments have the right to regulate health practitioners if it reduces choice for women?

How do you mean?

Regulating that OBs can't perform abortions? I happen to think that is bad.

Regulating how many pharmacies can carry birth control pills? I happen to that is bad.

It can be a slippery slope. Too slippery for my taste. The VA ultrasound law is on this slope -- that's government regulation. And it is bad.

I don't think governments should go beyond licensing for competency when it comes to patient choice -- whether the choice belongs to men or women, which is why even though I think not vaccinating is one of the dumbest ideas ever, I don't oppose people's right to make that choice for their own kids.

It's not as simple as reducing choice for women. It can easily lead into reducing choices for PEOPLE and women happen to be people.
posted by zizzle at 6:52 AM on April 28, 2012

Zizzle's link on Uzbekistan is terrifying. Sterilizing young women, without their permission, many of them not even k owing until they have complications from having their uteruses removed.

That's barbaric.

In the case of Agnes Gereb, It's obvious Yugoslavia is really punishing the midwife for bringing to light how badly they were failing pregnant women in their country before she came along. They wouldn't let men attend their partners, so women had no advocates in the hospitals to speak for them, until she forced them to allow men (which they now take credit for). She's been trained as a doctor and a midwife and worked to draw attention to a system badly in need of change. Women have benefited from her efforts on their behalf.

She had a child die, yes. That gave the government an excuse to go after her. They see her as this disobedient women whose refusal to obey the law makes them look bad. What they ought to be concerned about is the flawed system that led her to do this in the first place, which is what ACTUALLY makes them look bad.

I can absolutely understand why she felt it necessary to break the law, too. If you feel strongly that the only way women can get proper care during childbirth is by attending to them personally (because you've trained as a doctor AND a midwife) and there are all of these women who want to give birth at home because their husbands can't be with them in the hospital, you want to help them. And then, of course, when things go well, those women want you to attend their births the next time they get pregnant, and they've their friends about you, too.

Pretty soon the hospitals start to notice. Instrad of changing their practices, they just want to shut you down. They make it illegal for professionals to attend women at home.

So now what do you do? Can you really just walk away from all these women? What if they say they are going to give birth at home, with or without you, because they just can't go through a hospital birth again? What about that Hippocratic Oath to "do no harm"?

Yes, I can see why you might continue your practice, in direct opposition to the law.

So I see how it all started, and how it got out of hand, and I am 99% behind this woman.

But 1% is bothered by some things. Apparently, after that first infant death, when two more infants died, public opinion turned against her. I am a little concerned that those deaths might have been prevented--the child with the shoulder lodged in the woman's pelvis, might have been saved with hospital intervention. The death from lack of oxygen might have been prevented, too. In the recent BBC article says she's attended over 3500 births, while one from last year puts it over 5500...

I'm a little concerned that perhaps, at 58, she is not as together as she once was, that she might be slipping a little bit. Which is only understandable, but it makes this whole situation more complicated.

Yugoslavia is already silencing an influential voice in the fight for women's healthcare rights by imprisoning Agnes Gereb. If they can discredit her as well, all these advances she has championed may well be rolled back, especially if there is no one stepping up to take her place.
posted by misha at 2:43 PM on April 28, 2012

It's hard to say with the stuck shoulder (shoulder dystocia). It strikes fear into the heart of even OBs in the most modern, high-tech hospitals because it is unpredictable and unpreventable (although there are some risk factors like big, big babies--and I think that has driven some of the c-section rate, but I digress).

The things you do to get a baby out quickly in that situation if you're in a hospital can get extremely brutal. At home with adequate assistance you can do most of the same maneuvers but sometimes it takes something like pushing the baby back into the uterus and doing an emergency c-section, and that simply can't be done quickly enough from home to prevent damage to a baby. It doesn't take malpractice, it is just a limitation of the location. One of the reasons why good hospital birth will always, in my opinion, be safer than good home birth. Unfortunately good hospital birth is not available to many and in those cases it is not so clear-cut.
posted by the young rope-rider at 6:03 PM on April 28, 2012 [1 favorite]

"Yugoslavia"? Is that what they're calling Hungary these days?
posted by brokkr at 2:20 AM on April 29, 2012

Piffle. My apologies. HUNGARY, of course.
posted by misha at 7:00 PM on April 29, 2012

Actually, most obstetricians have never done, and will never do the Zavanelli maneuver. The procedure has only been recorded to have been done 103 times! This is something tried in the rarest of rare circumstances, by the rarest of rare doctors. There is much more clinical experience with the relatively complication-free Gaskin maneuver, ie: hands and knees position, for distocia - the technique many homebirth midwives will go to first.

good hospital birth will always, in my opinion, be safer than good home birth.

The thing is, "safer" is not really a matter of opinion! Most research says home is as safe or safer than the hospital. Not to say one or the other option is better for you, but just that it strikes me as odd to sometimes use the available medical evidence to support an opinion, and other times just ignore it.
posted by latkes at 7:47 PM on April 29, 2012

I don't think the evidence is conclusive that home birth is safer. I just don't. I think the studies aren't there yet.

That said, I wasn't talking about hospital birth as it stands. Good hospital birth should have almost all the benefits that home birth currently has with the additional benefits that can come with being in a hospital (like trained pediatric staff, for instance, or quick access to blood). It is a testament to the shit show that is our current OB-hospital system that it isn't demonstrably safer.

I mean, just logically, what would be the mechanism whereby a home birth would be safer than an good (as in clean, evidence-based, appropriately staffed, etc) hospital birth? How would the lack of pediatric staff help if a baby were born having difficulty breathing? How would the lack of an OR and blood help if a mother had a severe hemorrhage? Isn't more access to technology, medication, and trained professionals inherently safer?

(As long as you can keep those professionals from fucking things up, which oftentimes you can't, but we're being theoretical here.)
posted by the young rope-rider at 8:12 PM on April 29, 2012

Also, my bad writing (and possibly some bad thinking!) again. I don't actually think the zavanelli maneuver is particularly safe for the mother anyway. It is one of those situations where the mother's well being really goes up against the baby's well being and in that case I generally think the mother should win (or at least get to decide, but how do you decide in that case? Very confusing and sad.) Happy to hear that it is rare.

I do think a shoulder dystocia is safer in a good hospital where they can do all the same maneuvers as a midwife plus have a pediatric team standing by to treat the infant. Again, why would it be less safe? Are OBs unable to do the gaskin maneuver?

And finally, I do think safer can be a matter of opinion when you're weighing things like morbidity vs mortality and the infant vs the mother, but that's neither here nor there because I don't think we have the stats to say one way or the other.
posted by the young rope-rider at 8:20 PM on April 29, 2012

Okay.

I am a huge supporter of homebirths, as has been made clear many, many, many times.

That said, I don't think a strict homebirth vs hospital birth debate should be going on in this thread. Most of us are coming from an American experience, and that just doesn't hold up to other countries at the moment. There's a lot more variability in midwife training in the US than there is in other countries, for starters, but even then -- I don't think THIS particular matter is remotely tied to being about homebirth. I think it's about a terribly broken system that is controlling and harming women -- and possibly, in general, harming patients in other medical practices.

The person this thread is focusing on IS ALSO A TRAINED OBSTETRICIAN! She was a doctor before she was a midwife. Care in Hungary must have been pretty darn awful for her to want to go through all that additional training. The fact that she got in trouble for smuggling HUSBANDS into the labor room to be with their LABORING WIVES when she was a DOCTOR suggests the system there is, at best, lacking and at worst, abusive and manipulative to such a general degree that Gereb protested in part by turning to midwifery.

There's a lot more worth discussing here than simple home vs hospital, and I think we're missing the trees for the forest here ---- in this case, the arrest was never really about homebirths, per se. It was about a doctor, a woman, fighting against a broken system. I really don't think that this case is solely about birth --- I imagine it's more about a medical system that is likely in other ways harmful to patients. But this is the most pronounced way of bringing attention to the entire system.
posted by zizzle at 6:42 AM on April 30, 2012 [1 favorite]

Isn't more access to technology, medication, and trained professionals inherently safer?

Nope, for two reasons. Sometimes all the technology and medication and professionals in the world are not more able to create a better outcome than doing nothing at all would have produced, and because in reality, the more of this stuff there is, the more that gets used, whether it is needed or not. And that is probably because there is no way to know in the moment, if the baby's heart tones get a little slow, or the shoulder gets stuck for a few seconds, what would happen if you just waited it out, so the vast majority of doctors (and humans) will use whatever tools they have to respond to the situation. And unfortunately there are negative health consequences (to speak nothing of emotional consequences) to most drugs and medical procedures.
posted by latkes at 6:44 AM on April 30, 2012 [1 favorite]

Good point zizzle!
posted by latkes at 6:45 AM on April 30, 2012