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The Homebirth Summit: Providing Much-Needed Multi-Stakeholder Collaboration

With the recent Homebirth Summit that took place in Warrenton, VA October 20-22, our country has witnessed increased attention on the state and incidence of this birthing option in the United States.  The Summit organizers have published the outcomes of the event, including Consensus Statements which can be viewed here.  Additionally, you can read comments about the Summit from attendees on various blog sites like Rixa Freeze’s Stand and Deliver, pediatrician Mark Sloan’s blog site (part one and part two) and Childbirth Connection’s Transforming Maternity Care blog site—written by former S&S editor, Amy Romano.

When flipping through the fall issue of the peer-reviewed journal Birth, I landed on the study, United States Home Births Increase 20 percent from 2004 to 2008 (MacDorman, Declerq and Mathews, 2011).  This 20 percent increase isn’t really surprising to me—there is so much momentum in the taking back childbirth renaissance.  The opening paragraph of the article reminds us how much birth location has changed over the past ~ 100 years:

 

Major changes in United States childbearing patterns have occurred over the past century. At the beginning of the last century, almost all United States births took place outside a hospital, the vast majority at home. However, by 1940, only 44 percent of births occurred outside a hospital, and by 1969 this percentage had declined to about 1 percent, where it has remained relatively stable for several decades.”

 

When looking at the Trends by State section of the article, I was interested to find the state in which I live, Montana, boasts the highest homebirth rate (2.18%).  That’s compared to the country’s over-all current homebirth rate of 0.67% in 2008 (most recent data).  While this trend feels significant (especially to homebirth advocates here in the Big Sky state) philosophical dichotomies still exist.

As a part of an email conversation I had with a friend the other day, I was yet again reminded of the age-old  riff between hospital-based and home-based birth providers or, more accurately, the cracks birthing women fall into when attempting to traverse the chasm between these two models of care.

This friend of mine, a doula whose family recently relocated to a very small northeastern Montana town, is pregnant with her second child.  Her first birth was successfully attended by a midwife at a birthing center in the town from which they recently moved.  Desiring the same level of skilled, attentive, compassionate maternity care, my friend began her search for a midwife who would look after her throughout her current pregnancy, labor, delivery and postpartum care.  And yet, due to their rather remote location, she found a lack of midwifery care in her exact locale.  Hoping to piece together her prenatal care from readily available care providers (a local obstetrics clinic) and the philosophical maternity care she truly desires, she hoped to attend regular prenatal care appointments with an OB who was willing to co-supervise the pregnancy with a more distant midwife.  We’re talking true, interdisciplinary collaboration, here.  However, when the OB clinic got wind of this plan, they flat-out refused to work in conjunction with a midwife, or to provide my friend with prenatal care if she chose to also work with a midwife.  So, for now, my friend is tending to her own prenatal care, punctuated with telephone calls and intermittent visits with the midwife she has hired (who lives 270 miles away).

If this story is at all reflective of the state of maternity care collaboration in our country, then the multi-stakeholder conversations that took place at the Homebirth Summit are more important than ever.

 

What are your thoughts on the Homebirth Summit?

 

 

Posted by:  Kimmelin Hull, PA, LCCE, FACCE

 

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  1. November 15th, 2011 at 10:55 | #1

    While the intentions may have been good, I think it is a sad time in the United States that we need a “summit” to discuss homebirth and it’s safety. Humankind has been in existance for hundreds of thousands of years, and birth only moved out of home and into the hospital in the middle part of the last century. We are all here today, because hundreds (if not thousands) of our ancestors gave birth at home (and I’m certain the homes of our ancestors were even less well-equipped than ours are today).

    I would encourage anyone, particularly these stakeholders, to attend a handful of homebirths with a qualified homebirth attendant. What an enlightening experience for someone who has never witnessed a homebirth. I’m certain it would redefine the quality of maternity care in the United States.

    I still affirm it’s about the lack of education in our society.

    What an awful experience your friend is forced to go through. How is not providing shared care less of a liability than providing no care? Seems like the powers that be need to have some pressure put on them.

  2. November 16th, 2011 at 12:34 | #2

    I think it’s wonderful that all the different stakeholders are talking. I hope they (we) keep talking. I don’t have any high hopes that that will affect care in the short term, but understanding each other is really the first step.

  3. avatar
    Jill Herendeen
    November 16th, 2011 at 18:14 | #3

    The OB’s clinic was probably responding to the doc’s malpractice insurance carrier than to the OB’s personal whim. The fact is, health “care” in the US is a for-profit business, and “health” is incidental (health might come in first for doctors & other clinicians, but for hospitals, insurance companies, malpractice insurance companies, possibly even med schools, absolutely not!). Doctors have to follow protocols; they’re not free agents. Countries which have single-payer, universal health care, where profits aren’t allowed and where optimal care SAVES money, have the lowest c-section rates, the lowest infant & maternal mortality rates, and independent midwives collaborating with OBs. The most constructive conversation is going to be the one about how the U.S. is going to get single-payer health CARE, and when.

  4. November 16th, 2011 at 20:32 | #4

    I think it was a necessary and important step forward. I look forward to seeing the action that comes from it and am sure the relationships that were forged will be helpful as we move forward towards better outcomes for maternal health in our country.

  5. avatar
    JMT
    December 14th, 2011 at 14:24 | #5

    I’m concerned that you include a link to an anti-vacc website under that video. Science and Sensibility is supposed to be a evidence-based website.

  6. December 14th, 2011 at 14:58 | #6

    @JMT:

    Yikes!
    I’m glad you found this and pointed it out. We have been having some very peculiar problems with our WordPress platform lately. When I originally posted this, it linked to One World Birth’s own website. You will find the link is restored to its original location.
    Thank you.

  7. avatar
    JMT
    December 14th, 2011 at 16:54 | #7

    Thanks for the responsiveness!

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