Home Birth: The rest of the story

September 11th, 2009 by avatar

As most readers of this blog are probably already aware, The Today Show ran an inflammatory piece about home birth this morning that parroted ACOG’s long-standing scare tactics and anti-midwife rhetoric.

Since I just wrote a post on the safety of home birth, I thought that rather than repeating the same old story that home birth is safe for healthy women with qualified attendants and access to referral, I would share with readers some other thoughts, culled from this blog, the rest of Lamaze.org, and other trustworthy resources.

One of the first posts I wrote for Science & Sensibility (actually written as a guest post at the Giving Birth with Confidence Blog while this site was getting up and running) was titled, “Why the Largest Study of Planned Home Births Won’t Sway ACOG.” ACOG prefers to hold home birth to a standard of evidence to which hospital birth was never held.  Even while actively compiling the lowest form of evidence on the supposed “perils” of home birth in a membership survey, ACOG repeatedly calls for a randomized controlled trial comparing perinatal death rates in the two settings, fully aware that such a trial is literally guaranteed never to happen. I discuss some of the reasons why in my post, concluding that we face much more urgent research priorities for the study of planned home birth than a full-scale clinical trial.

We need more and better research on home birth. We can use data from the Netherlands to determine the safety of home birth in systems that support and integrate home birth midwifery. After all, it is the only place left with a maternity care system that lends itself to home birth safety research, and national registers to conduct that research soundly. In the U.S., we must study how we can reform our maternity care system to provide access to midwife-led care in all settings, and best practices for caring for the women who rightly and inevitably will continue to desire birth at home.

Why exactly do women desire to birth at home? It’s is not because they are hedonistic or selfish, as ACOG likes to suggest. Judith Lothian, PhD, RN, LCCE, wrote recently about the qualitative research she will present at next month’s Lamaze Conference. (Rixa Freeze, PhD, Lamaze International’s 2009 Media Award recipient, has conducted similar research.) Judith asked women themselves why they planned to give birth at home, and then observed them doing so. Their responses describe motivations far from reckless desire and hedonism. She writes:

I was surprised that all of the women described themselves as “mainstream”. They all wanted a natural birth. All the women came to believe that “intervention intensive” maternity care increased risk for them and their babies. They valued the personal relationship with their midwife and believed that this relationship increased safety. They believed they could manage the work of labor more easily and more safely in their own homes. They all expressed confidence that a hospital and skilled physician care were available if needed. ‘Being Safe’ emerged as the theme that captured the essence of women’s decision to plan a home birth. In stark contrast to the current thinking, that birth is safer in hospitals under the care of an obstetrician, these women believe that giving birth at home is safer for them and their babies.

It seems likely that women believe that home birth is safer than hospital birth because word is getting out that hospitals routinely deprive women of the style of care that is proven to produce the safest, healthiest outcomes. Just last week, Lamaze released the third revision of the Healthy Birth Practice Papers, a collection of evidence-based articles about the care practices that ease and facilitate labor, prevent complications, and protect breastfeeding and early mother-infant attachment:

1. Let labor begin on its own

2. Walk, move around, and change positions throughout labor

3. Bring a loved one, friend, or doula for continuous support

4. Avoid interventions that are not medically necessary

5. Avoid giving birth on the back and follow the body’s urges to push

6. Keep mother and baby together – it’s best for mother, baby, and breastfeeding

The 2006 U.S. Listening to Mothers II Survey revealed what anyone who advocates for home birth could tell you even without the data: almost no one who births in a hospital actually experiences these care practices. The survey found that fewer than 2% of women had all 5 of the care practices that the survey measured. (The practice they were unable to measure was “no routine interventions”. Since interventions are routine and rampant in hospitals, this likely means that the proportion of hospital birthing women who experienced all six care practices was effectively zero.)  Instead, the authors of the survey tell us what is happening in current, hospital-based maternity care:

The data show many mothers and babies experienced inappropriate care that does not reflect the best evidence, as well as other undesirable circumstances and adverse outcomes. This sounds alarm bells…Few healthy, low-risk mothers require technology-intensive care when given good support for physiologic labor. Yet, the survey shows that the typical childbirth experience has been transformed into a morass of wires, tubes, machines and medications that leave healthy women immobilized, vulnerable to high levels of surgery and burdened with physical and emotional health concerns while caring for their newborns.
– Maureen Corry, Executive Director of Childbirth Connection.

In fact, ACOG themselves acknowledged in a press release today that the current style of obstetric practice (high-tech defensive medicine) “ultimately hurts patients“.

I continue to believe that if hospitals provided the Six Healthy Birth Practices as the standard of care and offered evidence-based treatments for women and babies experiencing complications, hospital birth would be safer and so would home birth. That’s because midwives would initiate transfers with more confidence that it would improve the outcome, women would transfer more willingly, and care at the receiving facility would be safe and effective. What’s not to like about that plan, ACOG? Now, let’s make it happen!

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  1. | #1

    What makes me really mad is that I have been receiving comments from midwives who feel so disheartened by their jobs because of stories like these from the Today Show. I would be disheartened also if I worked so hard (and it is very hard work) laboring with patients, providing great care with good outcomes, and then bam!, a stupid news story comes out profiling the “dangers” of midwifery because of one bad outcome. I am still mad a day later.

  2. | #2

    Excellent job breaking it down. Thank you.

    Are we inundating the Today Show with letters, including links to this and other great blog responses to this terrible piece of “journalism”? Is there any chance we could get a piece in response? It’s not outside the realm of possibility.

  3. | #3

    Amy, BRAVO! You always do such an amazing job at breaking this down.

  4. | #4

    Many thanks, Amy, for once again bringing sanity and truth to bear on harmful nonsense, and especially for making these important points about maternity care at home and in hospitals, and ACOG’s cynical calls for impossible and useless RCTs.
    We at the Big Push for Midwives Campaign enjoy reading your blog and will pass it on widely around the internet. Thanks, too, for mentioning our expose of ACOG’s unscientific survey.

  5. | #5

    Great conclusion–I agree!

    I am still shaking my head about all those hedonistic homebirthers lounging at the spa…

  6. | #6

    I wrote a letter to NBC, and have posted it on my blog as well. You can read it here: http://laundryandlullabies.blogspot.com/2009/09/open-letter-to-nbc.html

    I encourage everyone to write! If enough of us take the time to complain about it, they might just pay attention.

  7. avatar
    | #7

    Anybody else think it’s an odd coincidence that The Today Show ran their piece the same day as ACOG released a pretty damning press release?

  8. avatar
    Carol Van Der Woude
    | #8

    I began my career as a hospital based labor/delivery nurse in 1972. I taught Lamaze classes for many years but was frustrated when women were caught up by the hospital practices. In 2000 I began working for a group of doctors that attended home births. I attended 62 safe home births that resulted in healthy babies. I participated in the transfer of six women to the hospital–they gave birth safely in the hospital. For me, the complex issue is the gateway to the hospital. A few women will need transfer to the hospital. Because some hospital staffs are hostile to home birth, women (or their care giver) may delay going to the hospital. The problem is compounded when they arrive in the hospital in crisis. I have been on both ends of this situation. I have written more about my experience at: http://www.carolvanderwoude.authorweblog.com

  9. avatar
    | #9

    It’s interesting that countries like the UK, and Canada have health care systems which support and advocate for home birth, based on evidence. Even Australia has recently backed down from policies which would restrict home birth access. The US is really alone here, and attention is being diverted AWAY from the clinicians and locations where most maternal mortality and morbidity occurs — trying to make it seem as if the 1% of women who give birth at home with qualified, trained midwives are causing some sort of public health crisis. very strange.

  10. | #10

    I have just started educating myself on midwifes, birth centers and home births. After doing research and drawing my own conclusions I find the Today Show’s unbalanced coverage of one family’s very tragic experience appalling. I found the ACNM’s letter to the Today show very well written. http://www.midwife.org/documents/TodayShowResponse.pdf
    You can find my own thoughts about midwifes and non-hospital births at http://www.cyclekore.com Before I did research I was against midwifes. Not now!

  11. | #11

    So, did anyone contact Today with this? What did they say?

    Heroic post, Amy.

  12. avatar
    Elise Nolan
    | #12

    As a mother of four children, who has given birth naturally (drug-free, no cesearean) with all four children, I would like to encourage you to not make blanket statements, such as “almost no one who births in a hospital actually experiences these care practices.” I think it is inflammatory and may lead women to fear-based decisions. My last three births have been attended by a certified nurse-midwife in a hospital, and my first pregnancy was a planned homebirth but resulted in a hospital setting due to PRM at 36 weeks. In discouraging physician-attended hospital births, you seem to be indirectly disqualifying the possibility of a gentle birth in midwife-attended hospital births. The statement that you made is not fair, because I can attest and so can at least 4 other women that I know, that a midwife-attended hospital birth does result in the Healthy Birth Practices which Lamaze encourages. (As a side note, the hospital staff and facilities were also very supportive of natural childbirth and breastfeeding. One hospital did not even have a well-baby nursery so baby never left my side, and they asked me if I wanted my child to have any vaccinations or Vitamin K. Perfect! Giving the mother the choice to decide what is best for her and the baby!)

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