June 20, 2008

Home Birth: Is This the Next ‘Right to Choose’?!

On June 18th the American Medical Association (AMA) issued a resolution in support of the ACOG statement that “the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.” as well as a resolution “to develop model legislation in support of the concept…“.

The statement from ACOG and the subsequent resolutions from the AMA are very likely due at least in part to the increased attention from the media on home birth, brought to the forefront by the film “The Business of Being Born” and its producer Ricki Lake. I have seen the film multiple times and think it is a very responsible, well-done documentary on the subject of home birth. The overall message is that home birth is a safe option for a low-risk woman who has a trained, certified midwife in attendance for medical assistance.

The midwifery model of care is based on the concept that pregnancy and birth are normal life processes – not pathological medical conditions. However midwives are trained medical experts. They monitor the mother and the baby throughout labor with a dopplerscope, come equipped with oxygen and resuscitation skills, and bring Pitocin in the event that it is necessary. They are also at the ready to make a call to transport the woman to a medical facility should she need more advanced medical attention. But unlike many medical professionals within hospital walls, they allow the birthing mother a great deal more choice – for instance the position she wishes to take to birth her baby – with fewer restrictions.

There have been numerous studies demonstrating that a home birth with a trained midwife can be a good choice for low-risk women who want to avoid unnecessary routine interventions. The largest and most rigorous study of home birth internationally to date found that among 5,000 healthy, “low-risk” women, babies were born just as safely at home under a midwife’s care as in the hospital. And not only that, the study, like many before it, found that the women actually fared better at home, with far fewer interventions like labor induction, cesarean section, and episiotomy (taking scissors to the vagina, a practice that according to the research should be obsolete but is still performed on one-third of women who give birth vaginally).

Other eye-opening statistics indicate that though the US has the most expensive births, the maternal and infant mortality rates are on the rise. According to Mother Magazine, US infant mortality rates continue to rank it below 30 other countries. Twenty-two percent of all pregnancies are induced, and most worrisome of all, in the last four years the maternal mortality rate has risen above 10 per 100,000 for the first time since 1977. These statistics can not be blamed on home birth since only 1% of US women are birthing in their homes.

If you look outside the US, many other countries are strong proponents of allowing women the choice to birth at home. The Netherlands with over a third of all births being planned homebirths. The Perinatal Study Group came to this conclusion about the Dutch system of maternity care: “This is an important exception: this country also has one of the lowest mortality rates in the world for both mother and baby. This maternity system is worthy of close evaluation and emulation.” Across the pond, the British OB/GYNS respond with “There is no reason why home birth should not be offered to women at low risk of complications… it may confer considerable benefits for them and their families. There is ample evidence showing that laboring at home increases a woman’s likelihood of a birth that is both satisfying and safe…”

Home birth is not a choice for everyone. Several states in the US have made a home birth attended by a direct-entry midwife illegal. These states include Alabama, North Carolina, Georgia, Hawaii, Illinois, Indiana, Iowa, Kentucky, Maryland, Missouri, South Dakota and Wyoming. One of the concerns of home birth advocates is that the AMA is trying to persuade individual state legislators to see home birth as harmful to the baby, equating it as child abuse, for which the woman may be criminally prosecuted.

How a woman chooses to birth should be based on her needs and what feels right for her and her family. She should be educated about her options and empowered by her choices. Wherever a woman is most comfortable, supported and heard is the best place for her to birth her baby, whether that be at home, a birthing center or a hospital. Throughout history women have fought long and hard for the right to make decisions about their own bodies. Birthing is a natural ability with which women come naturally equipped. Shouldn’t we be able to choose how and where?




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