The UK’s National Institute for Health and Clinical Excellence (NICE) released new childbirth guidelines this week that call for more normal births, and more “control” for women in how and where they give birth. Some highlights:

• Women should have continuous labor support from a midwife.
• Interventions such as amniotomy (instrumentally breaking the bag of waters), synthetic oxytocin, and continuous electronic fetal monitoring should not be administered routinely.
• Movement should be encouraged throughout labor and women should adopt whatever positions they find “most comfortable.”
• Laboring in the water is recommended for pain relief; women should be fully informed of the risks and benefits of epidural anesthesia before choosing it.
• Women should be “discouraged” from lying flat or reclining during the pushing stage and should be “encouraged to adopt any other position.”
• Women should have the choice of where to give birth — home, hospital, or midwifery-led clinic.

NICE provides evidence-based, cost-effective guidance for the UK’s National Health Service. Click here for a great summary of the new guidelines, or check out the full report.

Kudos to North Carolina Physicians for Midwives, a group of MDs who recently organized to support the midwifery model of care, which essentially means that women should have hands-on support from midwives for normal, physiological birth and access to obstetricians for medical intervention when necessary. The group’s humble mission is no small feat when you consider that the American College of Obstetricians and Gynecologists opposes both home birth and the licensing of Certified Professional Midwives, who remain illegal in eleven states. NC Physicians for Midwives boldly state:

We recognize a woman’s right to choose a home birth and want the best possible care for these women. Certified Professional Midwives (CPMs) are the national standard for Direct Entry Midwives serving the home birth community and we agree that they should be licensed in North Carolina, as they are in the vast majority of other States. NCPFM recognizes that denying licensure to CPMs restricts patient access to care and degrades communication when a transfer of care is appropriate.

Home birth with a trained attendant is a safe choice for healthy women with uncomplicated pregnancies. What increases risk is when home-birth midwives and families are disconnected from the larger health care system, as they are in “illegal” states. These docs have their priorities straight.

Welsh child classical vocalist turned pop star Charlotte Church started her family young (she’s 21), giving birth to a baby girl last week. Unlike her American peer Britney Spears, though, Church didn’t plan a C-section. She gave birth at home with a midwife, as many UK women do (not just celebs). In fact, earlier this year the British Health Minister announced plans to guarantee every mum a midwife-attended home birth by 2009. “We believe that, given a genuine, properly-supported choice many women would choose a home birth. Part of this strategy is to ensure that a home birth becomes a serious and realistic option.” In Wales, the goal is for 10% of women to birth at home. The health minister there said, “I hope that with guidance and help more mothers will consider home births as [a] preferred option for delivering their babies.”

Things sure are different across the pond!

As we learn from gender scholar Louise Marie Roth in this Huffington Post blog, political moderator Bill Maher has apparently come out as being “Lactate Intolerant.” On a recent episode of Real Time he defended an Applebee’s restaurant for booting a woman who was nursing her babe at the dinner table. I didn’t see Maher’s show, but I read about this “new rule” of his on HBO’s web site. Perhaps he is winking just a little (he is a comedian, after all) when he chides “lactivists” who argue breastfeeding as a human right:

“It’s not fighting for a right. It’s fighting for the spotlight you surely will get when you go all ‘Janet Jackson’ on everyone. And get to drink in the ‘oohs’ and ‘aahs’ from the other customers because ‘You made a baby,’ Something a dog can do.”

But I think Maher is being serious when he says, “But this isn’t really about women taking their breasts out in public, as much as I’d like it to be. It’s about how petty and parochial our causes have become, how activism has become narcissism.”

Breastfeeding is considered nothing less than the most important intervention for newborn survival. And we call this petty? Parochial?

Women are called selfish if they don’t breastfeed, and now selfish if they do…

Certified Professional Midwives in Missouri are in a court battle for legalization — their work is currently considered a felony offense (it’s criminal in 10 other states as well). On the midwives’ side is a republican senator, the republican governor, and the state attorney general; Missouri doctors are on the other side. (For the juicy politics behind this, read my Huffington Post article.)

It turns out that Fox news, never strong on neutrality, is on the midwives’ side as well. In this brief segment, which aired last week, midwife-attended home birth is portrayed as a woman’s right to choose (there’s even a shot of a court protester dressed as a pregnant Statue of Liberty — her tablet prop is titled “Free the Midwives”), and the medical lobby is practically villified as old-school, white-coat paternalists. Watch it on YouTube.

Yes, supposedly the U.S. Department of Health and Human Services hopes you just about lactate when you see this ad, but I can’t decide if it makes me want to go for a hike or reach for an allergy pill. The Washington Post explains: this is a “toned down” version of a public health ad campaign that was initially designed to encourage breastfeeding by making clear that formula has serious health risks.

The original HHS ads, like the inhaler one to the right, were designed just like campaigns against smoking and drunk driving — highlighting the dangers of not following the recommendation — and were visually arresting. (Another scrapped ad features an insulin vial topped with a rubber nipple to represent the increased risk of diabetes. See it here).

Naturally, the formula lobby didn’t take kindly to the negative publicity, hired a few political big wigs to lobby against it (including the former chair of the Republican National Committee), made a few phone calls (one was to the American Academy of Pediatrics), and poof, we get dandelions.

Meanwhile, a recent review of the medical literature by the U.S.’s own Agency for Healthcare Research and Quality found that breastfed infants have “fewer ear and gastrointestinal infections, as well as lower rates of diabetes, leukemia, obesity, asthma and sudden infant death syndrome.” Yet health officials were told by the powers that be to downplay the report.

The Post did a bang up job with this story — read the full article here if you haven’t already.

When the New York Times first reported on the challenges women face in having a VBAC (vaginal birth after cesarean) in 2004, it counted more than 300 hospitals nationwide that had stopped allowing them. Banning VBAC effectively forces women who’ve had a previous cesarean into repeat surgery. Just how many hospitals are still doing this, we don’t know. But perhaps Washington County Hospital, in Hagerstown, Maryland, thought it was compromising when it began telling VBAC seekers that they would only be permitted to give birth vaginally between the hours of 7 am and 3 pm. The hospital denies this was ever official policy, but the Herald Mail reports that the hours of service were made clear to patients, who were told that if their baby “wasn’t born within those hours,” they’d be taken to the operating room. “Three different doctors told me the same thing,” said one woman. Talk about being pushed!

An editorial in the British Medical Journal suggests that docs and midwives end the practice of immediately clamping and cutting a baby’s umbilical cord after he or she is born. This is because blood continues to flow from the placenta even after birth, as evidenced by higher iron stores in babies whose cords are left intact for a few minutes. “Placental transfer of oxygenated blood, nutrients and stem cells continues for several minutes after birth. Physiologic principles suggest that the optimal transition to life outside the womb depends on this transfer,” says a 2006 study from the journal Pediatrics.

So why do we cut? Because once upon a time cutting was thought to prevent hemorrhage in the mother. It was also thought to prevent jaundice in the baby. But editorial author Andrew Weeks, MD, says both of these assumptions turn out to be false. “There is now considerable evidence that early cord clamping does not benefit mothers or babies and may even be harmful.” Weeks recommends holding off for three minutes.

He’s of course not the first to suggest it. Also calling for a delay (a big one) are the lotus birthers, who pack up the placenta like a pillow next to the baby and wait for the cord to fall off naturally.

It being Sunday, let’s indulge in a little celebrity gossip, shall we? The tremendous actor Naomi Watts, who gave birth to a baby boy this summer (the father is the also tremendous actor Liev Schreiber), plays a biker midwife in the forthcoming David Cronenberg film Eastern Promises. Watts found out she was pregnant while filming, and told Good Morning America that the professional education served her personally as well. “I was doing all this research of midwifery and turning up at hospitals and watching live births…And there I was, pregnant all that time!” (Watch the clip here). She hasn’t gone public with too much detail, but it sounds like she had a physiological birth: “…the whole birth thing is such a physical and dramatic experience. You’re so in your body that it’s almost an out-of-body experience,” she told Canwest News Service. “I keep replaying the birth in my mind because it was so powerful.”

Several studies have shown that healthy women can give birth just as safely in midwife-run birthing centers as in hospitals, including this new one out of the University of New South Wales in Sydney, Australia. Researchers looked at one million births total, 20,000 of which occurred in birth centers. (That’s a huge cohort.) You’d expect hospitals to have a higher newborn death rate because they handle more “high-risk” cases, but when researchers looked at only babies born to “low-risk” first-time mothers at either site, there were still slightly fewer perinatal deaths among those born in birth centers (1.4/1000 v. 1.9/1000). The difference held true for low-risk women who’d had children before as well (0.6/1000 v. 1.6/1000). The study is published in this month’s issue of the journal Birth.