The Chicago Tribune today reports on an “underground network of midwives” who flout bans in Missouri, Illinois, Indiana, and other states. Critics often brand these midwives as “lay” or untrained — and unqualified to attend birth, they argue — but certified professional midwives, who are included in the bans, “are nationally certified through the Midwives Registry in a highly selective process that takes three to five years of study, including one year of clinic practice and an eight-hour written exam.” In Missouri, CPMs who practice are committing a Class C felony. “Can you imagine that?” Jessica Kerr, a new mother told the Tribune. “I make the personal choice to have my baby at home, assisted by a midwife of my choosing, and that is illegal?” Read the full article here.

*Note: the graphic above is illustrative but slightly outdated and not entirely accurate. Alaska doesn’t belong in the pink, and New York and Rhode Island honor the “certified midwife” credential. There are also states in the green zone where CPMs have been prosecuted, such as Pennsylvania, even though they were thought to be legal by default. Click here for a map showing exactly which states recognize certified midwives.

First read this piece in the Houston Chronicle about how “Physicians at West Houston Medical Center will meet this week to decide whether to continue offering the procedure, called vaginal birth after Caesarean, or VBAC.” Even better, read the letters that came in response, like this one by local cesarean awareness activists Pam Udy and Angela Baehr (I’ve excerpted a bit; killer quotes are in bold):

VBAC bans illogical

The article on West Houston Medical Center’s possible ban on vaginal birth after Caesarean (VBAC) exaggerated the relative risks of VBAC, underrepresented the potentially lethal complications associated with Caesareans, and completely failed to inform women that, even if WHMC passes a ban, all patients have the right to consent to or decline medical care, including unnecessary surgery.

VBAC bans are unethical and unenforceable and only have power because women believe they have power.

Further, the article failed to examine the illogic of VBAC bans… if WHMC or any other hospital bans VBAC because they cannot handle a childbirth emergency, then is the hospital really safe for any mother?

When a hospital bans VBAC, they are advertising either that the hospital is unsafe, or that the hospital is willing to trample the rights of patients for the sake of convenience and money. Either way, women deserve better care than that.

Click here for the Pushed take on VBAC.

Here’s more reason to be wary of scheduling birth: a study published in this month’s Journal of Pediatrics found that babies born even slightly premature, at 34-36 weeks, are six times more likely to not survive the first week of life than those born at “term” (after 37 weeks). They are also more likely to have respiratory and feeding problems, body temperature irregularities, jaundice, and brain development issues. According to national data (see below), one in eight babies are born premature in the United States.

Maybe you’ve already heard about Ricki Lake’s “awesome” vagina — she included the waterbirth of her second child in the fantastic documentary The Business of Being Born (Lake produced it, Abby Epstein directed it). But now, six months after the film’s premiere, on the other side of the globe, Lake’s movie is being taken a bit more seriously: it’s being likened to Al Gore’s Inconvenient Truth.

With an election weeks away, Australia’s What Women Want party is calling for maternity care reform to be as big of an issue as global warming, and party leaders have enlisted Ms. Lake as their celebrity spokeswoman. Like in the U.S., nearly a third of Australian women give birth by major surgery, and the government is not promoting home birth as an alternative. Lake says she’s calling for more choice.

Want to see the film? Click here for a list of sneak previews being held around the country. I’ll be speaking at one in Des Moines tomorrow, November 6.

Researchers with the World Health Organization published a huge study this week in the British Medical Journal finding that women are twice as likely to suffer serious complications or death if they give birth by cesarean section, even if it is planned prior to labor, and they are five times more likely to have a postpartum infection. Babies, too, are more likely to die or to be so sick that they require a week-long stay in intensive care if they are not born vaginally.

The study of nearly 100,000 births excluded women or infants with underlying health complications or distress during labor so that the outcomes are associated with the method of delivery alone. Researchers found that for women undergoing cesareans, “compared with vaginal deliveries, the risk was three to five times higher for maternal death, four times higher for hysterectomy, and twice as high for being admitted to intensive care and hospital stay more than seven days.” Researchers found that infant death shortly following birth was also more likely among cesarean babies, except those who were breech* (presenting bottom-first rather than head-first).

*Of breech babies, the researchers conclude, “It is clear that these babies, regardless of gestational age, should be delivered by planned caesarean.” This statement will no doubt be challenged by researchers who have demonstrated the safety of breech birth when attended by a provider with expertise (vaginal breech birth requires special knowledge and skills). This study did not account for the qualifications of the birth attendant.