Home Birth Debate Heats Up

I’ve been meaning to write about this for awhile now.  The debate about home birth, usually relegated to the side-lines in the larger debate about birth, has hit the big time recently (well, back in June) as some of our nation’s top female journalists waded into it full force.  First, Michelle Goldberg at the Daily Beast wrote the following post: Home Birth: Increasingly Popular, But Dangerous.  This was answered by Jennifer Block on Slate (who’s also author of the book Pushed: The Painful Truth About Childbirth and Modern Maternity Care) in her article How To Scare Women. Michelle Goldberg then went on to write a response to Jennifer Block’s critiques.  But the two articles that really got me excited were the following commentaries on the back-and-forth between Goldberg and Block: Smart Women Debate Home Birth by Ceridwen Morris, and Can We Have a Civil Debate Over Home Births? by KJ Della’Antonia at the NY Times, because these were both less polarized takes on the debate which advocate the middle option, which is what I agree with.

There’s something wrong with a system that has so colossally failed women that for some, in response to this, the only answer is to go to the extreme of having an unassisted home birth, where no medically trained person is in attendance.  While I can certainly sympathize with the views of women who choose unassisted childbirth, for myself, I’ve worked in obstetrics long enough to know that sometimes, even when everything is going right, there are still plenty of terrifying emergencies which can happen in the blink of an eye, and which need a very swift response by a medically trained person (not that these emergencies happen often, but they DO happen).  But then, I am a midwife, and this is my job, so naturally I would advocate for a midwife to be in attendance at  every home birth.  That said, given how variable the training system and educational pathways are for midwives in this country, there is no single standard for midwifery education, which means that even if you do elect to have a midwife at your home birth, there can still be a huge difference between the skills and knowledge of your attendant, and many of the tragic mistakes you hear about on website’s like Dr. Amy Tuteur’s Hurt By Home Birth site reflect these discrepancies.   But I think the biggest problem we face with home birth lies in the fact that there is no integration in our health care system between home and hospital, and this is what I would advocate for more than anything else (the middle way, I would argue…and I’m certainly not alone in pushing for this!). When you look at other countries with the highest number of successful home births, like the Netherlands and England, each of those countries has a systematic approach to home birth. Women who choose home birth are not seen as wackos who’re going outside the healthcare system–they’re still very much a part of the system, and they receive care similar to their hospital-birthing contemporaries.  And when something happens which deviates from the low-risk standards which have been established for home birth, they’re transferred to the hospital without any judgements or accusations, simply an escalation to the next level of care that’s needed, end of story, and lo and behold, they have MUCH better outcomes than we do.

I’m currently in England for the summer, and I went out for lunch a few weeks ago with a British midwifery student, and we got to talking about babies and birth (go figure).  At one of the hospitals she’s training at (King’s College Hospital), which has a very successful home birth rate, pregnant couples are presented the option of home birth right alongside their other options at the start of their prenatal care (just look at the link above, it says it right there in the hospital info page: “You can choose to give birth in the Nightingale Birth Centre at King’s or, if you live in the King’s catchment area, at home with the help of our community-based midwives.”), and if they choose to have a home birth, they receive prenatal care from a collection of community midwives who work for the hospital, and who will attend their birth. If everything goes to plan, they deliver at home. But if there are any deviations from normal (and I’m sure they have a very clear policy on what’s normal and what’s not), they’re transferred to the hospital, and they give birth at Kings with the technology they need, and with attendants who don’t view the transfer as a train wreck, but as an appropriate response to their individual situation.  Which means that rather than receiving unnecessary intervention, they’re receiving the exact appropriate level of intervention they need on a case-by-case basis.  What a breath of fresh air compared to the U.S. system, where finding a back-up physician is next to impossible for many hone birth midwives, which means when they have to transfer a client to the hospital, they have no rights or recognition as a midwife at the hospital they transfer to, and they’re not transferring to a specific attendant whom they work with and who supports their client, but instead are at the mercy of whomever happens to be working that day (usually an OB resident), who will know nothing about the client before she comes in, and will probably view the transfer as another “home birth train wreck” which needs cleaning up.  Not exactly ideal, right?  But then, we live in a country where the idea that healthcare is a fundamental, universal right which every human being deserves is still being hotly contested.

In any case, it’s nice to see home birth in the national news. We can only hope that with the debate taken to a whole new level like this, awareness will spread, and perhaps increased awareness will lead to increased demand, which will lead to changes in our system which is currently failing so many women, and perhaps even lead to a more integrated system down the road.  One can certainly hope, at any rate. (Or move to England).

This entry was posted in Choice, Complications, Homebirth, Hospitals, Issues, Labor and Birth, Midwifery. Bookmark the permalink. Trackbacks are closed, but you can post a comment.

4 Comments

  1. Simply Logic
    Posted September 1, 2012 at 8:06 am | Permalink

    Netherlands should not be looked at as a “good” example of safe homebirth.

    http://www.bmj.com/content/341/bmj.c5639.full

    Conclusions Infants of pregnant women at low risk whose labour started in primary care under the supervision of a midwife in the Netherlands had a higher risk of delivery related perinatal death and the same risk of admission to the NICU compared with infants of pregnant women at high risk whose labour started in secondary care under the supervision of an obstetrician. An important limitation of the study is that aggregated data of a large birth registry database were used and adjustment for confounders and clustering was not possible. However, the findingsu are unexpected and the obstetric care system of the Netherlands needs further evaluation.

    http://www.ranzcog.edu.au/publications/oandg-magazine/doc_view/762-16-trouble-in-paradise.html

    In addition to this, an editorial about USA homebirth states…
    http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Safe-at-home-Probably-not/ArticleStandard/Article/detail/751425

  2. Simply Logic
    Posted September 1, 2012 at 8:15 am | Permalink

    BOBB celebrity homebirth midwife Cara Muhlhahn already settled $950,000 for a homebirth permanently damaged baby and is being sued for a 3 day Manhattan homebirth death…

    http://articles.nydailynews.com/2009-10-22/local/17934735_1_midwife-baby-birth

    BOBB’s Ricki Lake and Abby Epstein’s “Mr Wonderful” Dr Biter has had a run of malpractice in which he was found guilty of in May 2012, but still managed to have a homebirth loss in June 2012…

    http://m.nbcsandiego.com/nbcsandiego/pm_107837/contentdetail.htm?contentguid=96jT3aHY

  3. Posted September 2, 2012 at 9:17 am | Permalink

    I am glad to see you here….more birth stories from both client and care provider…..thank you!

  4. The Midwife
    Posted September 4, 2012 at 5:22 pm | Permalink

    Simply Logic:

    I will have to look into this new study from the Netherlands in more detail. Thank you for sharing it.

    Your other link from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists didn’t work, since I don’t subscribe to Ranzcog and couldn’t access the article. Is it available somewhere else?

    The article from Modern Medicine.com is actually a reprint from an article in Contemporary OB/ Gyn, and you’ll have to forgive me if I take it with a grain of salt. Contemporary OB/ GYN is an ACOG publication, and ACOG has been notoriously anti-home birth for years now. To quote from this article: “Specifically, they should be informed that although the absolute risk may be low, planned home birth is associated with a twofold to threefold increased risk of neonatal death when compared with planned hospital birth.” The data they are basing this on comes from the Wax home birth study, and many, MANY researchers, doctors, midwives and journalists have questioned those findings, not just me:

    http://www.bellytales.com/2011/10/09/wax-study-revisited/

    And unfortunately, if you delve into the sticky underbelly of obstetrics, you will discover that nearly every provider, be they obstetrician or midwife, will most likely be sued for a bad outcome *at least* once in their career (and possibly more than that). Using examples of tragic outcomes for individual home birth providers doesn’t necessarily mean that home birth is unsafe, only that bad outcomes happen (to everyone who works in this field, and in fact, to plenty of doctors delivering babies in hospitals, too). For every tragic home birth story you give me, I could probably find an equally tragic hospital story to match it. I have worked in this profession for over 8 years now in a hospital, and in that time I have seen 2 mothers die, and personally delivered 3 stillbirths myself, and all of these have occurred with the very best of medical technology at our disposal. The sad, sad truth is that women and babies still die during childbirth; there will always be tragic stories. The harder thing to assess is the actual risk involved. Home birth deaths tend to make the headlines much more frequently, though, since there is always an element of blame attached to it.

    Jennifer Block addresses this in her Salon article above: “Is it responsible journalism to construct a story around the rare outcome? And is it logical for us, as readers, to take away from the anecdotes that home birth is dangerous?”

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