Home Birth: A Right or a Must?
I wasn’t surprised to read Melanie Reid’s assumption that home birthing moms are all sandal-wearing hippie freaks (OK, I added that last part). It’s the way a lot of people look at women who decided to deliver a baby at home. That’s not to say I agreed with her.
But even with her narrow description of the type of woman who decides to give birth at home, Reid’s piece in the Times of London this week hit upon some pretty shocking numbers: home birthing is on the rise after decades of decline, but so too are the numbers of people pushing to make home birth THE way to give birth.
And that, I have to admit, I’m not kosher with.
Because for all the wonderful things that home birth offers, and all the reasons I think it should be available to any mother who wants to try it, the one thing I have heard from most moms who have actually given birth at home is that what empowered them to do it was knowing the hospital was just a phone call – and an ambulance ride – away should they need it.
I’m not sure if Reid has met your average home birther, to be honest. She calls the countries where home birthing rates are low as the “sensible” ones, and calls hospitals”the only intelligent, progressive, logical place to give birth.” Ask your average home birthing advocate, and she will actually tell you hospitals ARE progressive, intelligent, logical places to give birth – if you need them. The truly sensible home birthers decided to make the choice based on medical assessments, which you very well might call progressive – considering back in the day there was no doctor checking for fetal distress before a woman on the prairie gave birth in her house. If the hospital becomes necessary, the sensible homebirthers say OK, and get there . . . pronto.
As our own home birthing Strollerderby writer Madeline Holler pointed out in her Babble essay on the topic, when she asked her midwife all the what ifs, the dangerous ones pointed to a trip to the hospital – no matter what:
What if the cord slips out before the baby? (We go
straight to the hospital.) Bleeding? (Hospital.) Premature labor?
(Hospital.)
But, as Reid explains, there’s a difference between helping women to realize their dreams of a homebirth and actively advocating we all head in that direction. Wales actually put out a target of having at least ten percent of women
give birth at home (this was in 2002, and their target year was 2007 -
they’re two years past and nowhere near it).
Why?
Because for all its advantages (and there are plenty – read Madeline’s essay, she’s been there, done that, and can explain them much better than a hospital birther like me), the hospital birth remains its back up because it has something a home can’t have: the means to deal with complications. Midwives have modern medical training and are fantastic for your average birth, but outside of a hospital setting, if something DOES go wrong, where do they send you? You got it.
Which means pushing women to have a homebirth, rather than simply accommodating those who want to give it a go, does indeed put us back toward the dark ages. It means putting more women at risk, more babies at risk. The reason a select few women give birth at home in countries like the U.K. and the U.S. is not only because, as Reid claims “We’re squeamish. We are hardwired to go to hospital and have our babies there. It’s what we do. It’s in our modern DNA.”
It’s because that’s a better option for a lot of women. Not all. But a lot. Women like me who had to have pitocin adminstered because my daughter just WOULD NOT come out. Or women like my friend whose son had been improperly measured by her midwife and came out with shoulder distortion because he was just too darn big for her tiny frame. It’s better for women with pre-existing conditions, babies with elevated heart rates.
Pushing for the opposite, pushing women to return to their homes, to take away their access to the modern advances of technology heightens the risks for women, gives insurance companies the excuse NOT to cover services and demeans the needs many women experience during labor and delivery. So some women can do just fine in a birthing pool at home. So some women make it through balancing on a ball in their bedroom. Not all of us can.
Very simply: it’s one thing to chose a home birth. It’s another to get the most out of home birth.
Image: TrueBirth
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I haven’t read all comments, so sorry if this is a repeat.
What’s more important than shooting for a certain percentage is educating women on what home birth really is like, which may up the percentage (or maybe not!).
I was shocked at common responses I got when telling people I was having a home birth:
“Do you know that things can go wrong during birth?”
“Does your midwife have a backup plan?”
“Is your midwife trained?”
“Has your midwife ever delivered a baby before?”
“Does your midwife know that you can bleed a lot after the baby is born?”
I’m not kidding on any of those questions. I was slightly offended that some people (who know me well) assumed I had no idea what happens in the birth process, or that my midwife had no training, experience, or education. But then I realized that midwifery is not so common and many people have no experience whatsoever about home birth and just don’t know what to think. Or they think that a midwife is some witch-like old lady chanting incantations while I try in vain to deliver a stuck baby, etc.
Lula, you are right about malpractice insurance being a major problem. I used to work with physicians/hospitals, and you cannot imagine what some people will sue for and win. In Europe (at least in France) people are just not as sue-happy. In the US, if you get the right lawyer and jury, you can win almost anything. Usually the doctor/practitioner will just settle to avoid legal fees, even if the lawsuit is frivolous.
I’m really at a loss as to how that is going to change. Maybe if there is a universal health care system, lawsuits could be limited.
Thank you, Voice of Reason, for being… you know, a voice of reason. And a British one, at that.
Right now, the US healthcare system is still heavily profit-driven, and childbirth care in particular is overshadowed by malpractice fears and the need to carry high-premium malpractice insurance in case a practitioner should be sued. My understanding is that the malpractice insurance issue is a big reason why we’re seeing so many freestanding birth centers close here in the US… non-interventive care doesn’t generate income the way high-intervention care does, so the birth centers weren’t making enough $$ to cover the costs of the providers’ malpractice insurance. Of course, the closing of the birth centers eliminates them as a choice for the women who want this happy-compromise option between home and hospital care, which sucks.
As you know, Americans either have private health insurance (usually paid for by their employer), public-aid coverage (not easy to obtain, and subject to state as well as federal regulation. I believe Medicaid is the program that applies to pregnant women), or go uninsured and hope they suffer no health problems. Pregnancy qualifies uninsured women for Medicaid through the birth of their child, and then I think most state programs provide coverage for the child for a year or more — that may vary from state to state, and I’m not sure how it works myself. What I do know for sure is that women’s choices for pregnancy and birth care are limited by their insurance coverage. Not all practices are required to take all insurance plans, and as I mentioned earlier, my own state’s Medicaid program currently only reimburses for hospital births.
I think this article is shedding light on an underlying fear about pending healthcare reform under the Obama Administration — namely that a national health plan would somehow force women into unwanted homebirths based solely on the fact that homebirth care costs less to provide than hospital-based care. We’ve been conditioned for over a century to believe that hospital-based care is better and safer than homebirth care, so I think some folks are also feeling challenged by this research study confirming what’s already been known for a long time in (developed) countries that never lost homebirth as a component of care: namely, that homebirth is as safe as hospital birth for low-risk women. That’s not a value judgment; it’s just science-based research. No one’s saying women who give birth at home are Better or More Womanly — they’re just saying they’re having healthy births and healthy babies at home, the same way many women have healthy births and babies in hospital.
I think people are afraid that this research will be used by policymakers who are only concerned with cost-effectiveness to deny the choice of hospital birth to women who want it. And I think the chances of that happening in the US, where the American Medical Association still regularly hates on homebirth, are nil. I honestly cannot see a day in the near future where homebirth will be the norm in the US, not even to the extent that it currently is the UK.
All *I* want is for it to be a viable choice for the women who want it, and for the public to stop equating it with child abuse and impending disaster. If decent information dissemination and public education on the safety of homebirth increase the number of healthy women who WANT it, rock on. Like you said, that’s not coercive in the slightest — that’s increasing access to a healthy choice for healthy women. I am not remotely concerned about it supplanting hospital birth, no matter what happens with nationalizing healthcare or how much money it would save. If you’re not seeing it in the UK, I’m not worried we’ll see it here.
Lula, I am a midwife on maternity leave and a regular reader of the strollerderby. Thank you for saying all the things I never have the time or energy to say when a homebirth article comes up and the comments roll in.
I also have to say thanks Lula, your well-informed comments are refreshing.
I’d just like to point out that I had both my babies in the UK and both times, home birth was offered as a choice (as were hospital births and birthing centres).
I cannot emphasize strongly enough that it’s is absolutely nothing other than a choice.
Perhaps Babble readers are feeling confused by the fact that they have goals and measure percentages, but that’s just they way they do things in the National Health Service. They set a goal and measure its success by monitoring percentages. No forceful tactics would ever take place because there’s no incentive to do so. The mission of the NHS is to provide a quality universal health care service, not to make a profit. They are measured against their health results far more than their financial results. They have no shareholders.
There’s been a growing demand for homebirthing services in the UK, so my understanding is that a goal was established in response to that demand and then their success is monitored against that goal. (They also have goals related to the offer being made, but obviously that’s more difficult to monitor without recording every appointment every pregnant woman has with a midwife or a GP.)
By monitoring the total percentages of babies delivered at home, it’s possible to deduce that women are having exactly what they demanded: a choice. (And yes, there’s no doubt that the NHS was prompted to create this policy for financial reasons as well and I’m perfectly okay with that because no one’s being coerced.)
Home birth is definitely what I would call mainstream in the UK, although not a majority of women are choosing it and of those who do choose it, their health status or that of their pregnancies precludes them from being able actually deliver at home. (If it would be dangerous, then the NHS midwives, consumate professionals that they are, would never allow it.)
I don’t really understand how the system of healthcare works in the US so I really can’t comment as to whether offering homebirth as an option would work in the mainstream, but it really is not the hippy-chick stereotype being perpetuated by certain Babble poster.
Also, in the UK you don’t have to do your own post-delivery laundry. They take away and clean all the mess. It’s all part of the service.
And for the record, I did NOT have homebirths.
How is a goal of 10% homebirthing making homebirth “the norm” instead of a viable choice? I still don’t see where you’re getting this message that advocates of homebirth want to abolish hospital birth for the vast majority who will continue to feel more emotionally safe giving birth there than at home. I don’t see that argument in the London Times article, and I certainly don’t hear anyone proposing it as part of US healthcare policy reform.
Again, Lula, I point to the fact that mental state is not considered by health insurance companies or indeed many health practitioners to hold weight over physical condition.
By making home birth the norm rather than simply advocating that it be a choice available to any mom who wants to take it, you are potentially pushing a lot of women into something that they will not be able to handle. Nor should they have to.
I’m all for homebirth, if that is what you want to do….
But I’m all for the hospital thing, and if that is what I want, why not??? I’m sorry, but I want and need to make sure enough people with nametags and uniforms are surrounding me making sure my baby is ok.
My children were all born before 38 weeks anyway, so I wouldn’t be a homebirther, but I know my personality and I’d much rather give birth in a hospital.
Why not just advocate a choice??? Instead of the “my choice is so much better than your choice” mentality.
Oops, forgot a couple –
Alice: A serious and sudden emergency complication like a placental abruption often ends poorly when it takes place in the hospital, too. One of the OBs involved in my training (note: I’m not a CPM; I trained for a year but didn’t finish the full 3-year course) took great pains to point that out to us — and this OB practiced solely in hospital. Sometimes, no matter where you are, babies or mothers are injured or die during the birth process.
However, this does not mean that homebirth practitioners are not equipped to manage emergencies in home and during transport. Homebirth practitioners carry anti-hemmorhagics, oxygen tanks, and resuscitation equipment — and they know how to use them, same as EMTs. Since homebirth practitioners also observe a great many more naturally-progressing births than do those who practice solely in hospital settings, they are often quick to note when a labor is deviating from “healthy & normal” and are therefore able to transport *before* a serious emergency presents.
All of this is why the Dutch research that spawned the original London Times article says what it says: “… (I)n the largest study of its kind undertaken, researchers have revealed that women in the
Jeanne: As I’ve already pointed out at least twice, women who are scared of giving birth at home are not suitable candidates for homebirth. Ask any homebirth practitioner or advocate, and they’ll tell you the same thing. Can we agree to agree on that now?
ChiLaura: Homefirst exists and provides homebirth services to northern IL. Whether or not I’m a fan of Homefirst as a practice… well, let’s just keep that a mystery for now (though I will say this: When the very few practitioners available to you advocate eating neonatal feces, I am all for increasing the homebirth provider pool in a big bad way. I am also for suggesting that practitioners retire or switch professions if they’re spouting weirdness like that, if for no other reason than to give the fearmongers one less reason to diss on homebirth).
Laure: Thanks for the dialogue!
I do want to add one more thing that I think gets lost in these types of conversations. When we say we have poor outcomes in this country (infant mortality, etc.), it is always much worse in poor areas (especially the rural south and inner-cities) than in wealthy areas where more people have insurance. The real tragedy is that there are people in this country with no insurance and no access to good health care. Until we have a universal health care system, we will continue to have poor outcomes, and people who are limited in their choices.
Lula – although I agree with a lot of what you said, what bothers me is the notion that every woman who has no medical need for intervention would be better off giving birth at home. What about women who are just plain scared of doing so?
Let’s look at how this country especially, and our healthcare system, approaches mental health needs – and I would say that a shift toward sending a majority of women back into their homes to give birth would have severe mental consequences even when the physical ones were not an issue.
Again, I am a supporter of women who want to give birth at home having that option. I agree that that should be opened up to MORE women, and that the concept of the law keeping them from do so is silly (to say the least). But I would caution against suggesting that there is only a physical need for hospitals in the birthing process.
Lula, thanks for your point of view about people from other cultures wanting home births. I agree that poor communities have poor access to any healthcare, and your clinic having such great outcomes is a big achievement.
I have to admit, here in California, home birth is viewed as something mainly requested by middle- to upper-middle-class white women. I am not a midwife, but I have spoken to several who have told me very few minorities or immigrants seek out their services. But maybe there are other reasons for this. (I am not sure how home births are covered financially here, and these midwives were not working with non-profit groups, like it sounds like you were.)
Lula, I’m guessing from your comments that the parts of Mexico and Central America where homebirth is much more normal are impoverished. Maybe a number of these women would prefer a homebirth anyway, but it seems to me that most women in most developed countries prefer a hospital birth “just in case.” There is no time to treat some medical emergencies, which can appear in an otherwise healthy pregnancy. Maybe so many of these women give birth at home because they have no other realistic option.
And Homefirst in Chicago? One of the doctors there told my friend to eat her baby’s FECES in order to build immunity against whatever bug her child was carrying, so that it would be passed on thru the breastmilk. Granted, one doctor does not a practice make, but no thanks.
Lula, I just wanted to thank you for taking the time to post such intelligent, well-documented, interesting, myth-dispelling feedback about homebirths.
Lula – I can get behind there being more great birthing centers with qualified personel and less medical, more natural alternatives available. Not sure I’d go that way, but I’m sure that would be pretty dang safe.
All of my grandparents were born at home. I bet all of yours were too. This is not a new thing. But if you do bleed out there is no time to get to a hospital. By the time the ambulance arrive either the mom is dead, baby dead or baby brain damaged. Most women in the world still have babies at home because they are too poor to receive medical care. It is nice that our society is so rich that we can choose. I really think this is another issue, like breastfeeding and c-sections that divide women and prevent a cohesive women’s empowerment movement. The reason the Civil Rights movement was so successful was they were united together against oppression. Women can never do that.
(And yes, I know the original article is from the UK. But clearly Americans are wondering if/when such talk will start here as well.)
Also, now that I re-read… why was the jump made from “Wales advocates for a 10% homebirth rate” to “People are advocating that WE ALL give birth at home” made in the first place? A national rate of 10% homebirthing among those women who are healthy and low-risk enough for homebirthing would be just that: 10%. The other 90% of birthing women would presumably fall into the (very large, vast majority) category of women for whom homebirth may be a medically-appropriate option, but who DON’T WANT to give birth at home. Let’s not get alarmist just because American policymakers *may* start to speak realistically and favorably about homebirth and work to make it more widely available to those who DO want it!
Laure: Homebirth is still the norm in many parts of Mexico and Central America, which are the countries I was thinking of when I wrote that post. It’s also the norm for certain groups of Native/Indigenous Americans in the US and Canada, many devout Muslim women, and also not a few American fundamentalist Christian communities. My personal experience with homebirth comes mainly out of the Latino communities, as I worked for a couple years with a medical clinic in the Pilsen neighborhood of Chicago that primarily served families recently arrived from Mexico, Guatemala, Nicaragua, and El Salvador. Check online to see if you can find any articles on the homebirth figures for Chicago Community Midwives, especially from the 1990s when Alivio Medical Center operated a very popular homebirth program that boasted amazingly good maternal and neonatal outcomes with families that were often living in serious poverty and otherwise experiencing factors that contribute to low birthrate, prematurity, and other ills. It was truly a privilege to work with this program, and to see the positive impact that providing high quality and culturally appropriate homebirth care had on this high-risk community.
Unfortunately the program closed in 2000 or 2001 — not at all due to a decrease in consumer demand, but because of statewide changes to Medicaid (Medicare?) billing that would no longer allow for homebirth reimbursement. This change also shut down a popular prenatal practice on Chicago’s north side that was affiliated with Illinois Masonic Hospital, which at that time operated an excellent non-interventive “alternative birthing center” (ABC). The IL-Masonic ABC still exists, but I hear it is much changed from the way it operated in the late 90s, when the prenatal program I speak of was partnered with it.
During that same time period, we lost at least five skilled homebirth practitioners who provided great homebirth care throughout northern IL. Some of that was due to the billing changes, and some was due to a statewide legal crackdown on homebirth practitioners who were Certified Professional Midwives (CPMs), but not Certified Nurse Midwives (CMNs). Each state sets it’s own rules about what credentials are needed in order to legally practice midwifery, and though IL has never exactly been CPM-friendly, no one was paying much attention to these practitioners until the early 2000s. Again, it was not a reduction in consumer demand OR poor outcomes that led to active harrassment of these CPMs — but the result was that most of them left IL and went to practice in states like OR and NM, where the CPM license is recognized and CPM-provider homebirth is promoted as a desirable option for healthy women who are experiencing normal pregnancies.
Illinois residents who want a homebirth are now served only by a couple of practices, including Homefirst and CNM Sarah Simmons… I think one of the CNMs from the West Suburban Midwives practice that staffs the ABC at West Suburan Hospital in Oak Park is in the process of opening a homebirth practice now, but that’s still only 3 providers that I can list off the top of my head. And none of them work south of Kankakee, so homebirth in IL is really only an option for those who live in the Chicago metro area counties of Cook, Lake, McHenry, and a few other counties beginning with “D” (Dupage? DeKalb? I never remember them). That’s a major hardship for everyone else in IL who already wants to give birth at home OR who would want to if they were better educated on the safety of the option, and it’s the result of policy decisions made deliberately at the state level for reasons that don’t have anything to do with protecting the health of women and babies.
As you can tell, I’m very much down with your goal of “making sure homebirth is legal for every woman in the US and making sure every woman has the resources to be armed with the knowledge to make a decision that is best for her and her family”. It’s my personal experience that leads me to believe that the common public-health practice of setting specific percentage-increase goals would help make your goal a reality. Maybe I’m wrong, but maybe I’m not. At the end of the day, I’m all for whatever will bring about the changes necessary to ensure that everyone who wants or would stand to benefit from homebirth has access to it.
And I do very much believe that a lot of Americans (primarily Anglo-Americans) are *not* intellectually, emotionally, or culturally open to it no matter how medically appropriate it may be. I wrote that as a neutral fact, not an insult. I can’t account for any other reason why there’s still so much misinformation and fear of homebirth in the general/Anglo public, when there’s plenty of writing and research to demonstrate otherwise, and cultural bias plays a large role in how any group of people conceptualizes and accesses healthcare. If Americans as a group were seriously dedicated to the best science has to offer pregnant and birthing women, there’s no way on Earth we’d stand for our current systems! We’d have rioted long ago against a national C-section rate of 30% and the way malpractice fears dictate the way hospital birthcare is managed — or rather, we’d never have allowed our current systems to come into existence in the first place.
Okay, I agree that homebirth is not for everyone, but referring to it as something from the dark ages, is a little over the top, don’t you think?
I have known several people who’s birthed their babies at home, myself included, who have had wonderuful experiences.I had an uncomplicated pregnancy which allowed me to birth my daughter at home, and I am so grateful for that. In the off-chance that something might go wrong, I was grateful to have the hosptial as an option. Hospital births have too many interuptions and you have no control.
Also, I really do not agree that, by putting in a goal (5-10%), the necessary laws/education would be put into place. Look at No Child Left Behind. This is just one example of our government demanding a certain result without first putting in the necessary elements to make it happen in a real, meaningful way.
What we should be doing is making sure homebirth is legal for every woman in the US and making sure every woman has the resources to be armed with the knowledge to make a decision that is best for her and her family.
I really don’t think the reason most American women do not choose homebirth is because we “are not intellectually, emotionally, or culturally open to it no matter how medically appropriate it may be”. It really depends on each person. Someone may be very open-minded, but still feel more comfortable in a hospital/birthing center. For some women, even a 1% chance of something adverse occurring may be too much, and would rather be in a hospital. For others, they are more comfortable in their homes.
“But there are also whole communities in the US who come from countries and cultural mindsets that welcome homebirth as the preferred norm for healthy women.”
What are these countries? My father is French and my mother is Iranian, and I know that in these cultures homebirth is not the preferred norm. (In France, they very often have midwives attend the birth, but always in a hospital. And for Iranians? The more technology, the better.) Even in England, homebirth is still not the norm, although it is more accepted than in the US.
I am all for homebirth being available, but I hear these general comments and I’m not sure this is really true. I live in a city with many immigrants/races, but the only people I have met who have had homebirths are white Americans. When I have brought up the subject of homebirths to anyone who is not a white American, they look at me like I was insane, and are completely against it.
If the percentage correlates with the percentage of women who receive unnecessary medical interventions during labor and birth than it would make sense to me. We clearly need to stop hospitalizing every pregnant woman and treating her as if she has a medical condition. Birth is a totally natural experience, and we have allowed ourselves to forget that. Complications are not the rule, they are the exception, and that exception is what the hospital is for. No one is ever going to stop a real medical emergency during birth from going to the hospital; but the majority of women do not need to be there. Home births do not put us back in the dark ages. They put us exactly where we need to be, as women who can handle giving birth, because that is what our bodies are built for, the ability to give birth is at the very essence of what makes us women. Pregnancy is not a medical condition, it is not an illness or a disease, it is not something that needs to be treated. If we just treated complications when they arised we would be much better off. You wouldn’t go to the hospital with the prediction that you might have a heart attack, you would go if you actually had a heart attack. It does not make sense to go to the hospital to give birth, and I can’t understand how women have been convinced that they are completely not capable of the very thing their body was meant to do.
You really, really need to read this article:
http://www.newyorker.com/archive/2006/10/09/061009fa_fact
But that kind of goal setting is standard for public health promotion, which I feel this is. Since homebirth *is* safe for a large percentage of women, and the very option of homebirth is currently so restricted here in the US, it makes sense to me for public health officials to set a goal of educating and making available this option to the women and families who may very well decide they want it once they hear honest information about the benefits and availability. Setting a goal # for homebirths also necessitates setting a goal # for increasing the number of practitioners who are free to provide homebirths, which would help repeal the unnecessary insurance coverage and legal roadblocks to homebirth practice that exist right now in not a few states. Given the difficulty of getting homebirth in the US, I’m all for goal-setting at 5-10% if it’s going to be effective in increasing the ability of women who *want* a homebirth to access that option. Once the safety and benefits of homebirth are known and homebirth practitioners are free to practice and bill for their services, I wouldn’t be surprised to see 5-10% of American women freely choose homebirth and be very satisfied with that choice.
It’s unlikely that a majority of American women are ever going to want to give birth at home, since so many of us are not intellectually, emotionally, or culturally open to it no matter how medically appropriate it may be for healthy women experiencing normal pregnancies and births. But there are also whole communities in the US who come from countries and cultural mindsets that welcome homebirth as the preferred norm for healthy women, and who are effectively barred from receiving that model of care because it’s not covered by Medicaid or many private insurance plans, or because there’s no homebirth practice serving their area. That’s a problem in serious need of a fix.
In short, I really don’t see a need for concern re: forceful tactics being used to meet the goal, if such a goal were set. Quite the opposite, in fact — I believe setting such a goal would help make homebirth accessible to the percentage of women and families who already want it, and who are unfortunately current forced into hospital birth by the financial and/or logisitical tactics that were implemented in the last century specifically to move birth out of the home and into the hospital. By setting a very modest goal to increase the accessibility of homebirths, I honestly think we’d be setting right something that went wrong a long time ago.
Lula, I think the issue is with setting a goal to have a certain percentage of births to be home births. Why can’t we just say we need to better inform all pregnant women of their options? Setting a percentage can lead to people feeling pressure to meet that number, which might lead to forceful tactics.
I’ve had two healthy pregnancies, with uncomplicated vaginal deliveries and am now pregnant with my third. I’ve thought of home-birth, especially because I have (so far had) VERY fast labors; I’m a bit scared that #3 is going to fall out of me! However, my husband is totally uncomfortable with a home birth because of the “what if”. I’m a bit more relaxed about it than he, but still. I’d much rather be in a setting where access to emergency medicine is IMMEDIATELY available. This is why we choose a midwife in a hospital setting (which, I realize, is an option not all women have!). She’s qualified, is there through the whole birth (not just catching the baby), and advocates for a no-(or low-)intervention labor, but we feel much better knowing that emergency care is right down the hall. I also think that aiming for a target number (as someone mentioned above) is arbitrary and thoughtless. If insurance companies are trying to reduce costs, can we look at another way to do so? Transferring home sooner and being checked on by a nurse? There must be other ways.
Birth in countries without hospitals or established healthcare infrastructures *is* dangerous, I agree. Those are places where high-risk care and emergency care can’t be easily accessed when needed, which of course contributes to high maternal and infant morbidity and mortality rates. But the US *does* have healthcare infrastructure and emergency-care access, except for extremely rural counties where the nearest NICU or high-risk obstetric hospital might be several counties over. But even those areas are generally served by helicopters that airlift to the nearest appropriate hospital, which is not an option in countries like Uganda and Guatemala.
As for American women who are having babies later in life — again, high-risk care would be standard for high-risk pregnancies and births even if the US system deemed non-interventive care and homebirth as the norm for low-risk pregnancies and births. If a mother’s age or some other physical condition made it unsafe for her to give birth at home, she would be risked out for homebirth under any responsible healtcare policy. Homebirth/non-interventive care in developed countries is safe because it *is* conservative care, appropriate for a lot of women but not for all. A shift toward non-interventive care as the norm wouldn’t be pushing women who should receive interventive care into receiving anything less — it would just be avoiding inappropriate (and wastefully expensive) high-intervention care for women who *don’t* need it.
I think a lot of people confuse “homebirth” with “no medical care”. This isn’t true. Homebirth OBs and midwives strive to provide excellent prenatal care as well as excellent care during labor and birth, and also generally address the much-neglected need for postpartum care better than hospital-based practices do. It may be a slightly different care philosophy, but it’s quality care. Part of that quality care is screening out the people who are experiencing problems or who are demonstrating a higher likelihood of having problems during the birth itself, such as a history of postpartum hemorrhage. No homebirth practitioner wants a woman giving birth at home if that’s not the safest option for her. I’m not sure where the notion of forcing women who need high-risk care into receiving anything less is coming from, just because people are talking about more actively promoting homebirth for those who *would* be safely served by it.
And if homebirth itself is too much of a leap for the majority of American women, there’s no reason why we can’t be creating more low-intervention birthing centers, both in-hospital and freestanding (not actually in a hospital, but within close proximity in case a transfer is needed). Those are a happy medium, and one that would fulfill the purpose of providing more appropriate and better quality care to low-risk women and babies without necessitating homebirth.
I agree that women who don’t feel emotionally safe giving birth at home have no reason doing so. But right now, I see a lot more women who would be better served by low-intervention and homebirth care unable to receive it — or even to get accurate information about it, to counter all the myths that have contributed to largely confining American pregnancy and birth care to high-intervention hospital practice. If we really do want to be receiving best-practice care in the US, we do need to change our current delivery system. If homebirth is too Woo-Woo for Americans, there’s still a lot we could be doing around birth centers and midwifery-model care.
For those who don’t know what this “Midwifery Model of Care” business is, I give you a handy journal article:
http://download.journals.elsevierhealth.com/pdfs/journals/0091-2182/PIIS0091218299000609.pdf
I agree with making it a viable option for women w/o reason to think there may be complications. However, with American women having babies later in life, and birth in places w/o hospitals having such a high mortality rate – I don’t think making it the default is a great idea. I think the default should be medical assessment and freedom of choice.
Jeanne, countries that have kept homebirth and midwifery-model care as key aspects of their maternal/child healthcare practices (such as the Netherlands) don’t force women to stay at home if complications develop during the course of labor. They transfer to hospital if pitocin augmentation is needed, or if there’s fetal distress, or for any of the other reasons why it becomes safer for a mother and baby for the birth to take place in hospital and under a doctor’s care. These countries also consistently have better maternal/child health outcomes than countries like the US, where normal healthy pregnancies and deliveries are generally managed under a very medically and technologically intense practice orientation regardless of whether that’s really the best-practice options of care for mothers and babies.
Since everyone agrees that hospitals are where births *should* take place if the pregnancy and/or delivery is high-risk, or if a problem develops during the course of an otherwise normal pregnancy or birth…. well, why the fear of homebirth and midwifery-model care becoming the standard for the vast majority of pregnancies and births that ARE proceeding normally and in optimal health?
Non-interventive care has been demonstrated to result in optimal maternal and child health outcomes for such pregnancies and births. If we truly want to be providing American families with best-practice standards of care, why *wouldn’t* we want to see a shift towards, say, how pregnancy and birth care is provided in the Netherlands? They’re not “living in the Dark Ages” there, despite a much higher incidence of homebirth and much lower rates of C-section — no reason to believe American women wouldn’t fare just as well if American practice switched over to the Dutch model.
Even if Americans are unable or unwilling to make a paradigm shift toward homebirth as the best option for those experiencing a healthy pregnancy and uncomplicated labor, we could do a lot more to provide best-practice care in birthing centers or even in hospitals. This resource here is a good summary of what kind of practices result in the most optimal maternal/child health outcomes:
http://www.childbirthconnection.org/article.asp?ck=10092
Homebirth aside for the moment, American women and babies would still be healthier if we had two systems of care in operation — non-interventive midwifery-model care for the normal & uncomplicated cases, and specialized medical-model care for the truly complicated & high-risk cases. Right now, very few of the women who would benefit from non-interventive care have access to it, regardless of where they want to give birth. I’m all for policies that will increase access to best-practice care, since no one’s talking about advancing best-practice care at the expense of maintaining specialized care for those who truly need it.
I heard something about this from a British friend of mine. She said that the main reason they were pushing for more home births is because it is so much cheaper, and with their universal health care system, the government is trying to cut costs.
Whether this is the case or not, pushing for a certain percentage is ridiculous. There should be options for everyone, but why push somebody into something they don’t want. I feel the same way about how we are trying to lower the c-section rate. I am OK with identifying certain issues that may cause unnecessary c-section and lowering those, but just saying that we need to lower the rate to such-and-such a percentage does not make sense to me.
Also in the hospital, you don’t have to do more laundry after wards.