Writer Responds

Thank you for your letter. Your more specific information about the training and philosophy of nurse-midwives was interesting adn appreciated.

The work you are doing in the Detroit area helps to fill a huge gap in the health care system. I commend your struggle. Although you did not specifically state it in your letter, it sounds as if you help women birth in a birthing center. Because there are no birthing centers in Ann Arbor, Renee Rutz (my co-author) and I didn't focus on them in our article. We decided to focus instead on what is available locally for women interested in homebirth.

When Renee and I wrote about the "medical model," we were not discussing the philosophy of midwifery as you do in your letter. We were discussing the fact that if a woman births in a hospital, she must follow certain rules to help protect the hospital from malpractice claims. This is true regardless of the personal philosophy of the attending nurse midwife. We suggest that women must become informed and educated about what is available to them and what restrictions apply to them when they choose their birth situation.

The feedback renee and I have received from women about our alternative health care series gave us the impression that many women in the area know very little about the home birth experience. We both feel strongly about the politics and legal issues of all alternative health care, including homebirth, and feel that it does deserve attention. We decided, however, at the beginning of the series to focus on giving information about what is available locally in order to assist people in selecting the care they might need.

Lisa Gottlieb-Clark