Dispatch: Birth Wars
Who’s really winning the homebirth debate.
by Jennifer Block
August 3, 2009
Mention that you are planning a home birth and it might be as if you had just brought up Sarah Palin or Palestine: brace for family feuds, public denunciations, and offhand remarks that imply you are selfish and stupid, your midwife is a quack, and your unborn child is a victim already in need of social services.
If you've made a documentary that is critical of standard American hospital maternity wards and portrays home birth in a decidedly more flattering light, you might be likened to Nazi propagandists by an obstetrician, as Abby Epstein and Ricki Lake were after they screened their film The Business of Being Born at St. Luke's Roosevelt hospital in New York City. Or if you appear as a pro-home birth guest on a TV show hosted and produced by doctors, perhaps called The Doctors, get ready for opprobrium of this sort: "You don't want to be responsible for the death of your baby or the death of your wife!"
That's also the bad-parent card played by the American College of Obstetricians and Gynecologists, the standard-setting professional organization of doctors for women: a woman who chooses a home birth "puts herself and her baby's health and life at unnecessary risk," says a 2007 statement on the subject. "Choosing to deliver a baby at home . . . is to place the process of giving birth over the goal of having a healthy baby." Ouch.
Such is the pitch of the "home birth debate" in the United States. And yet, the the research evidence suggests a more nuanced conversation. Home birth by choice among healthy women in industrialized countries has been studied for four decades. There have been dozens of studies published. The largest to date, published in April in the British Journal of Obstetrics and Gynecology, looked at more than 500,000 births to healthy women in the Netherlands and found that no more babies died among those who planned to give birth at home than those who chose the hospital. "The opinion that a hospital birth is the best option for every woman is increasingly being challenged," write the study's authors. "These results should strengthen the policies that encourage low-risk women . . . to choose their own place of birth."
A 2005 study of 5,000 planned home births in North America, published in the British Medical Journal, also found that babies were born just as safely at home, and that the mothers did much better than compared to similarly low-risk women who had intended a typical hospital birth — with a C-section rate five times less (4% v. 20%) and with hardly any inductions, episiotomies, epidurals, vacuum extractions, or forceps. (A proportion of women who plan home births transport and deliver in the hospital, mostly for non-emergency reasons, depending on how integrated the system is. In the States the rate is around 12%, in the Netherlands around 30%.) A 2007 review of twenty-eight studies of planned home birth found such optimal outcomes and safety among home births to be true across countries, health systems, and midwife credentialing systems. In other words, the available body of research suggests that for healthy women with access to care, home birth is a low-risk, high-benefit choice.
The British government is now nudging healthy women to stay home.
This body of research evidence has been enough to convince the American Public Health Association: "Recognizing the evidence that births to healthy mothers . . . can occur safely in various settings, including out-of-hospital birth centers and homes," the organization " . . . supports efforts to increase access to out-of-hospital maternity care services." The international consensus is that women should have the option. The Royal College of Obstetricians and Gynecologists, together with the Royal College of Midwives, says that there is "ample evidence" to "support home birth for women with uncomplicated pregnancies." The 2007 joint statement continues: "There is no reason why home birth should not be offered to women at low risk of complications and it may confer considerable benefits for them and their families." The British government, in fact, is now nudging healthy women to stay home. ACOG, meanwhile, likes to pass out a bumper sticker to its members: "Home Deliveries are for Pizza."
©2009 Jennifer Block and Babble
About the Author
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Jennifer Block is the author of Pushed: The Painful Truth About Childbirth and Modern Maternity Care (Da Capo 2007), and the blog Pushedbirth.com. Her articles and op-eds have appeared in the Village Voice, ELLE, The Nation, Mothering, the L.A. Times, and the Guardian. She's based in Brooklyn, NY. |
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