Home Birth Consensus Summit: Making History and Moving Forward

Last week Congresswoman Lucille Roybal-Allard spoke in the House of Representatives applauding the consensus document produced by the Home Birth Consensus Summit in Warrenton, Va. in October. The document was read into the Congressional Record.   Congresswoman Roybal-Allard noted that history had been made. It certainly has.

Two years of hard work went into the planning of the meeting. The system-wide, and very serious problems related to safety net, consultation, collaboration and referral necessary for safe home births provided the stimulus for the Consensus Summit. Dr. Saras Vedam’s energy, commitment, and relentless conviction that the time was right to bring together stakeholders and leaders with an interest in home birth, provided the momentum that kept the planning committee working, and ultimately convinced an incredibly diverse and committed group of midwives, physicians, nurses, childbirth educators, consumers, lawyers, policy makers, educators, researchers, administrators, and insurance representatives to participate in the Summit. The Summit was not a forum for reviewing, interpreting or debating the research. The Summit did not address the rightness or wrongness of home birth but accepted the reality that home birth is a choice more women are making in the U.S.  There were no papers or presentations. The goal of the Consensus Summit was to find common ground so that home birth is safe and a positive experience for mothers and babies. We had no idea where we were headed except all of us hoped that some common ground could be found.

The invited delegates were in positions to inform and influence a change process, and/or commit to measurable steps within their stakeholder groups. The delegates did not represent any organization but rather attended as individuals. Reading the bios of the delegates provides insight into just how influential this group is and has the potential to be.

Part of the planning involved choosing a setting that would foster collaboration and make the hard work of moving beyond disparate ideas and beliefs easier.  We were invited to set aside our own agendas, and be open to finding common ground. Careful attention was paid to the details. The setting, in rural Virginia, was perfect. The weather was glorious. Excellent food and conversation were shared together at breakfast, lunch and dinner. We got to know each other better over drinks and stories in the pub. We talked into the wee hours on the porch enjoying the cold fall weather, the stars, and the rocking chairs. The distraction of cell phones and email was amazingly minimal!

What was truly historic was not just that people with divergent opinions and beliefs met in the same space but that these remarkable people listened to each other with respect and appreciation of the challenges we all face.  It is easy to be collaborative when everyone is on the same page. But to value each other’s contribution and knowledge when you don’t see eye to eye is much more difficult.  I was humbled by everyone’s willingness to be honest, to listen, and, ultimately, to find common ground.

The reward for the hard work of the two-plus days are nine common ground statements. This is a brief version of the statements. To read the full statements go here.

  • We uphold the autonomy of all childbearing women
  • We believe that collaboration within and integrated maternity care system is essential for optimal mother-baby outcomes. All women and families planning a home or birth center birth have a right to respectful, safe, and seamless consultation, referral, transport and transfer of care when necessary. When ongoing inter-professional dialogue and cooperation occur, everyone benefits.
  •  We are committed to an equitable maternity care system without disparities in access, delivery of care, or outcomes. This system provides culturally appropriate and affordable care in all settings, in a manner that is acceptable to all communities.
  •  It is our goal that all health professionals who provide maternity care in home and birth center settings have a license that is based on national certification that includes defined competencies and standards for education and practice.
  • We believe that increased participation by consumers in multi-disciplinary stakeholder initiatives is essential to improving maternity care, including the development of high quality home birth services within an integrated maternity care system.
  • Effective communication and collaboration across all disciplines caring for mothers and babies are essential for optimal outcomes across all settings.
  •  We are committed to improving the current medical liability system, which fails to justly serve society, families, and health care providers.
  • We envision a compulsory process for the collection of patient (individual) level data on key process and outcome measures in all birth settings.
  • We recognize and affirm the value of physiologic birth for women, babies, families and society and the value of appropriate interventions based on the best available evidence to achieve optimal outcomes for mothers and babies.

These common ground statements are just the beginning.  Those who oppose the option of home birth have been busy blogging. Those who support the value of home birth have too.  And those of us who were there are starting to work with our colleagues, including all of you, to achieve what is set out in the common ground statements. There is a tremendous amount of work to do. Lamaze Board member Betsy Armstrong and I worked on the common ground statement affirming the value of physiologic birth for women, their babies, families and society. We, with our team, are developing action items related to the statement. Valuing physiologic birth has been the foundation for the vision and hard work of Lamaze International for over 50 years. Childbirth educators can contribute in important ways to helping women and their families value physiologic birth and develop confidence in their ability to give birth. Childbirth educators are in an important position to help women know that they have a right to autonomy in making maternity care decisions, and then to provide the knowledge and support women need as they make decisions not only about place of birth and provider but all maternity care decisions. We need to work tirelessly to make all nine common ground statements “come true.” Keep the momentum going!

Being part of this historic event leaves me wondering if there isn’t a lesson to be learned.  Much about birth is controversial, not just place of birth and provider. Issues like induction, epidural, routine interventions and cesarean surgery are important and controversial. I wonder if finding common ground in these areas would move us beyond differences in thinking and interpretation related to evidence, risk, benefit, liability and “expecting trouble”? What if one common ground statement related to epidural was insuring that women have available a full range of comfort measures to cope with labor? Would finding common ground related to all these issues provide a foundation for finding solutions that make birth safer no matter where it takes place?

Keep checking the home birth summit website for updates on the action plans moving forward.  Jump on the bandwagon and think about ways you can advance these common ground statements.

Saras Vedham

Saras Vedam looking at  the “mind map” created by the group to identify all the forces that impact home birth. It was part of the process that eventually led to the common ground statements.

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