Birth Story

A fight worth watching is shaping up in the New York State Legislature, where a bill that would ease restrictions on the practice of midwifery has attracted opposition from the American Congress of Obstetricians and Gynecologists, the new political arm of the 59-year-old organization that represents physicians who specialize in caring for women.

The bill, dubbed the Midwifery Modernization Act by its supporters, would give midwives the right to attend pregnant women without first obtaining a written practice agreement from a medical doctor.

On June 17, ACOG held a press conference in Albany to warn that the bill could compromise the safety of mothers and babies by exposing them to the risk of delivering without medical backup in the event of an emergency.

Midwives say that they sometimes have a hard time finding a doctor, say, in rural areas, willing and able provide a written practice agreement. And, they say, the problem is not confined to the boondocks.

After St. Vincent's Hospital in New York City closed last April, seven midwives who attend home births found themselves without a practice agreement, according to a story in the New York Times. St. Vincent's, a Catholic hospital, reportedly was uncommonly sympathetic to home births.

New York has as many as 900 midwives, more than any other state, according to Laura Sheperis, president of the New York Association of Licensed Midwives, in a separate story. Fifteen states so far do not require written practice agreements, which Sheperis has characterized as a "cumbersome and unnecessary barrier to health care and provider choice."

The bill would not prohibit doctors and midwives from creating written practice agreements; it would remove the requirement for them.

ACOG came out swinging against home births (along with the American Medical Association) in 2008 in response to "The Business of Being Born," a film that featured the home birth experience of actress/former talk-show host Ricki Lake.

"...Monitoring of both the woman and the fetus during labor and delivery in a hospital or accredited birthing center is essential because complications can arise with little or no warning even among women with low-risk pregnancies," ACOG stated in 2008.

Obstetricians deliver about 70 percent of American babies, while midwives, mostly nurse-midwives, handled roughly 8 percent of births in 2004. Family physicians attend about 20 percent of American births.

"Pregnant Graffiti" by Petteri Sulonen

“Driving under those conditions is obviously a bad idea," said David Teator of Amanda Norgaard McBride's incredible feat of delivering a baby while driving 70 miles an hour. Teator is senior director of transportation strategies and initiatives for the National Safety Council and an expert on distracted driving, Paul Stenquist reported on the New York Times' "Wheels" blog last week.

The Bemidji (Minn.) Pioneer reported that McBride , 29, who was in labor, and Joseph Phillips, 33, of Bagley, Minn., were on their way to North Country Hospital in Bemidji to deliver their baby when McBride's water broke. McBride was driving; Phillips was not able to drive because of a medical condition.

Phillips thought they should pull over but McBride was anxious to get to the hospital.

Phillips steered while McBride operated the pedals of their 2005 Chevy Cobalt — and delivered the baby, their first child together (each has two other children). Joseph Dominick Phillips was born at 12:20 a.m., weighing 8 pounds. Once the family reached the hospital, McBride and little Joseph were taken into the emergency room area to finish up the birth process, Bethany Wesley reported in the Pioneer. Both mother and baby appeared to be doing well.

Chevrolet announced that it was giving the family a stroller, a safety seat, a year's supply of diapers and other baby gear to celebrate the role of the family's Cobalt in getting everyone safely to the hospital.

I have seen a couple of blog posts lately grousing that the "mainstream media" is choosing not to cover this or that event or development, as if to suggest that a conspiracy is afoot to keep people in the dark on a particular topic.

As a staff writer for the Chicago Sun-Times, I am a member of the mainstream media, and I wonder if people have a good sense of what's happening in our industry. Ad revenues have been dropping, mostly as a result of services available on the Internet, and hordes of writers and editors have been bought out or laid off in recent years.

Fewer bodies mean less time per project -- less time to learn about a new topic, and often no time to take on a tough topic.

Just for example, I have seen complaints that many important aspects of childbirth, the topic I address here in Birth Story, don't get the attention they deserve in the media. I couldn't agree more, but I also know that a good airing of the issues would require a depth on the bench that simply isn't there at most media outlets right now.

The Tuesday Science section of the New York Times is one of the rare dedicated sections left that cover science and health. Natalie Angier, a Pulitzer Prize-winning writer for the Times, said she has noticed that that section addresses health topics more than science ones these days, in a story posted by Mallary Jean Tenore on the Poynter Institute's website.

Readers appear to want stories that relate directly to their own lives, said Angier, who has written a number of science books, including Woman: An Intimate Geography. Her latest is The Canon: A Whirligig Tour of the Beautiful Basics of Science.

"One of the things I try to do when writing about science is make it seem like it's part of your life already by making things into characters and protagonists, even if they're just molecules," she said.

Charles Petit, chief tracker for the Knight Science Journalism Tracker, agrees that strong articles on science topics are becoming scarce.

While such issues as stem cell research and global warming still appear on newspapers' front pages, they are less likely to be written by reporters who have a solid understanding of those topics. So the stories are superficial, and readers don't get what they need to understand them, Petit told Tenore.

Even scientists are worried about this trend. In a Pew Research Center study published last year, nearly half of scientists polled said oversimplification of scientific findings in the media is a major problem. A whopping 85% of scientists said that the public’s lack of scientific knowledge is a major problem for science.

Let's interrupt our Women's History Month programming to consider the news. The National Institutes of Health today begins a three-day session on vaginal birth after Caesarean, a hot topic, given that this practice, which was commonplace 15 years ago, has become scarce in the United States, at the same time that the Caesarean section accounts for nearly one-third of American births.

The VBAC has some passionate champions. While it isn't for everyone, it can work for many mothers, enabling them to avoid major surgery, and perhaps also to enjoy birth as they have always imagined it. The VBAC's decline has attended a steady rise in reliance on the Caesarean section, in part because the VBAC does carry a risk of rupture to the uterus, which can be life-threatening.

So it will be exciting to see what comes out of this conference, which aims to bring the best research available to bear on determining the safety and efficacy of the practice.

The VBAC is also one subject of an article by Denise Grady in the New York Times on Sunday, about a hospital in Tuba City, Ariz., where 32 percent of women who previously had Caesarean sections delivered vaginally, compared with a national average of less than 10 percent.

The rate of Caesarean births at the Tuba City Regional Health Care Corp., where about 500 babies are born a year, is 13.5 percent, less than half the national rate of 31.8 percent. The hospital is run by the Navajo Nation and is partially funded by the Indian Health Service, and it largely serves a Native American population.

What I love about Grady's account is how well this small, poor hospital appears to be doing in addressing one of the major tensions in the modern birth story -- how to keep the blissful experience of childbirth from being swamped by the technology that has been developed to keep it safe.

Canada's full-bore pursuit of gold at the Olympics the country is hosting in Vancouver, B.C., has attracted much comment, mostly about how out-of-character overt ambition supposedly is for Canadians.

Writing in the New York Times last week, Charles McGrath quoted the Canadian writer George Woodcock on the subject: “Canadians do not like heroes, and so they do not have them. They do not even have great men in the accepted sense of the word.”

Here's one for the books, then -- William Osler, the so-called "father of modern medicine," a great man if ever there was one, born in Bond Head, Ont., in 1849.

Dr. William Osler

Osler received his medical degree from McGill University in Montreal in 1872 but, critically, then went abroad to study in London, Berlin and Vienna before returning to join the McGill faculty. By 1883, he was one of two Canadian fellows of the British Royal College of Physicians. The next year, he accepted a post as professor of clinical medicine at the University of Pennsylvania in Philadelphia.

It was as a founding faculty member of Johns Hopkins School of Medicine in Baltimore, where he went in 1888, that Osler had the opportunity to put the innovations he had seen in Europe to work.

Osler insisted that the patient could teach medical students nearly everything they needed to know -- that the study of medicine was properly conducted at the bedside -- and that hands-on laboratory research must also be part of medical training.  He also introduced the German model of post-graduate training, a one-year internship followed by several years of full-time residency.

These innovations began a profound change in American medical education, which up to this point had been largely a matter of learning from lectures.

Osler was able to implement his ideas because he was an excellent doctor. In 1905 he moved to England to take up a prestigious post as professor of medicine at the University of Oxford. His book, The Principles and Practice of Medicine, was a major work in medicine for nearly half a century.

Osler died in England in 1919, of the Spanish flu.

Canadians might say that Osler's absconding to the United States and England rules him out as a national hero, but it says something when a boy from Bond Head can hit the heights of world medicine.