Smart Women Debate Home Birth

In my eight years of blogging about birth, I’ve witnessed and been embroiled in many flame wars over home birth. The arguments are about many things, including feminism, medicine, midwifery, and choice, but beneath those themes are some more visceral ones. Home birth debates are really about blood, wounds, and death. Both sides point to the other for negligence that can lead to horrible consequences for both mother and child.

Then there are the statistics. The data on the safety of home birth is tricky and as is often the case when people sling studies around, the conclusions seem to negate each other in cycles. But both sides trot out the best numbers they can find to defend a point of view.

Over the past couple of weeks this fight has been taking place at high levels of journalism. Two women whose writing and research and opinions I respect have published strong arguments for and against home birth.

The first came from Michelle Goldberg, in The Daily Beast, who argued quite uncompromisingly that home birth is not a safe option. Two days ago, Jennifer Block, author of Pushed: The Painful Truth About Childbirth and Modern Maternity Care responded to Goldberg’s piece arguing, among other things, that Goldberg relied too heavily on the opinions of Amy Tuteur, one extremist, anti-home birth activist. Today Goldberg fights back, defending her use of Amy Tuteur and critiquing Block’s tactics.

Like many of the hastily written, sometimes logically chaotic threads on this topic all over the Internet, this debate is getting back to two things: Death and lack of good data. Still, I have enjoyed reading these two smart journalists take this on.

Some thoughts:

Some women who choose home birth are extremely well educated (about home birth and other things) and maybe call themselves “feminist” or maybe think that the “feminist choice” about birthplace has less to do with where and more to do with the right to choose at all. There are doctors, scientists, lawyers and academics who turn to home birth. The skepticism about hospital births is based on a very real, very troubling situation. Hospital practices and policies can be driven as much by the phrasing of malpractice laws or financial pressures as by peer-reviewed medical studies, and concerns about hospital-mediated infections are valid.

But when you move into an anti-establishment terrain you’re going to cast a wide net. There are women who don’t go to hospitals and don’t believe in sonograms or testing for religious reasons. And there are those who take alternative medicine to such great lengths it starts to look as ridiculously ill informed and cynical as some of the medical practices these very women are fleeing. The alternative birth movement, with its general interest in the mind-body connection, nutrition and natural therapies, has so much to offer but sometimes leads very sick people away from good medicine. (Just as the medical complex can exploit patients, so can the alternative health movement, which is rife with scams and bogus claims.) Recently there have been terrible stories out of Australia about badly managed home births by passionate home birth advocates. Amy Tuteur’s stereotype about ignorant home-birthers starts to sounds pretty accurate when you read these tragic stories.

But then, when Goldberg writes that women are “being bombarded with misinformation, some of it in the guise of feminist empowerment,” I take pause. I get what she says about a “naturalist ideology” going too far and wish the so-called home birth movement didn’t include so many alterna-quacks. But there are too many clever women — feminists?– questioning the status quo in American hospitals. And we need to get back to those complaints. It’s too easy to dismiss or even attack the radicals on both sides of this debate — for every ill-informed, ignorant home-birther, there are literally dozens of ill-informed, ignorant hospital birthers, and there are also poor practitioners among the OBs, not just among the home-birth midwives. Both Goldberg and Block make this abundantly clear in this most recent public debate.

Many women who turn to home birth have been “radicalized” by what is happening in hospitals today. Maybe their choice to go home is not always the best one, but we have to look at what their actual choices are to understand what is propelling them there in the first place. Jennifer Block makes this point in Pushed: Women who choose home birth and women who opt for elective c-sections actually have something in common. They are both terrified by/fed up with/mystified by/not buying the standard hospital birth and its attendant questionable interventions and lack of informed consent. Of course, hospital births can be wonderful and respectful and I’m sure there are people reading this who can attest to that.

The real problem in the US right now is that birth has become too polarized. Women should not have to choose between lying in a hospital bed tethered to machines with doctors terrified of malpractice claims and too overwhelmed with work due to soaring insurance premiums, to the point that they skip informed consent and hope their patients are too ignorant to notice on the one hand, or a home birth with an inadequately trained midwife and no back-up medical care because midwives and “natural birth” has been forced underground on the other hand.

We talk so much about the word “choice” when it comes to what is or what is not “feminist.” Right now, in many parts of America, women just don’t have that many good or real choices when it comes to birth. We need more well-trained midwives for low-risk births in birthing centers that are adequately close to and supported by a hospital and obstetricians. We need to have more options for pain relief in hospitals and improved fetal-monitoring methods — ambient (wireless) monitoring is an option in Europe. In the US, we have these silly, old machines that women have to be strapped to. We need tubs in all birthing rooms to help with the pain in labor. We need fewer inductions. We need the c-section rate to edge closer to 15-20% (at most) and not 33% where it is now. We need patients who understand that they are the decision makers in their own care, and who are taught how to ask questions so that their care providers help them through the process, and we need doctors who never forget that they can’t “do” something to the patient without explaining it, offering all the alternatives and discussing a plan of action.

Right now, many first-time pregnant women read about the joys of physiological birth (how normal it is, how powerful it can be, really good stuff) but then they show up to the hospital where this kind of process is not supported. It’s like you get Ina May Gaskin all through pregnancy, and then you’re greeted by Amy Tuteur at the hospital. It’s a terrible situation, and too often women blame themselves or feel like failures.

There is a third way here, but it may take some time before we can achieve it. These debates derail the process when they don’t move beyond the state of opposition. But when smart writers like Goldberg and Block engage, there is a chance some good old fashioned synthesis might emerge, and childbirth in America can move beyond this damned-if-you-do/damned-if-you-don’t predicament.
photo: Chris and Jenni/Flickr


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