In a post yesterday entitled “Home births: No drugs, no doctors, lots of controversy”, CNN discussed the rising home birth rate. Having remained fairly constant for a number of years, the home birth rate in 2005 (the most recent year for which data was reported) rose by 5% from the year before.
Citing the recent editorial in Lancet, and Dr. Erin Tracy, a delegate for the American Congress of Obstetricians and Gynecologists (ACOG), journalist Madison Park argued that home births can be risky. The position of the American Medical Association (AMA) and ACOG is that hospitals and birthing centers are the safest place for childbirth to occur.
Dr. Tracy stressed that medical emergencies are rare during childbirth, but can result in “catastrophic outcomes” when a surgical team and medical resources are not immediately available.
Let’s think this through from a common-sense approach. The AMA and ACOG both say that birth in a licensed freestanding birth center is safe:
Resolution 205 (1) that our American Medical Association support the recent American College of Obstetricians and Gynecologists (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”; and (2) that our AMA develop model legislation in support of the concept 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 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.”¹
Do freestanding birth centers have a surgical team immediately available? For that matter, does every US hospital that performs deliveries have a surgical team immediately available? As a labor nurse and then a midwife with 25 years of experience, I can assure you that even when the team is immediately available, it often takes up to 30 minutes or more to begin surgery. Many hospitals I have worked in did not have a surgical team in the hospital all night long; they had to be called in from their homes. Although a surgical team could mobilize quickly, a laboring mother who needs to transfer to the hospital can arrive just as quickly, unless her home is an excessive distance from the hospital.
Dr. Tracy also states that birth with a midwife inside the hospital is safe, while birth at home is not, because a hospital midwife coordinates with an obstetrician to appear only in the case of an emergency.
Let’s consider this. Do you suppose that emergency OB provider is sitting at the nurse’s station, or even in the physician lounge, waiting to be summoned, every time a midwife attends a birth in a hospital? No way! They have to be called from home. In the hospital where I work, physicians must live within 30 minutes of the hospital. If it takes them 30 minutes to arrive once they are called for an emergency, then they need to scrub, gown, and glove, how quickly do you think your emergency is going to be handled?
In large teaching hospitals, residents are available 24/7 and emergency help can be mobilized more quickly. However, teaching hospitals are also known for having more doctor-caused accidents and more interventions, because much care is performed by students who are learning must practice interventions they will need to use one day in order to become skilled.
Most women I know who have chosen home birth have done so to avoid a 33% c-section rate (or more); a high rate of routine interventions, such as IV fluids, not being allowed to eat or drink, automatic breaking of the bag of waters, internal monitoring, and being confined to a bed; and a higher rate of episiotomies, vacuum or forceps, need for drugs during labor, serious lacerations, infection, and neonatal intensive care admissions. Who wouldn’t want to avoid that?
Amy Tuteur, MD, also was interviewed for the CNN article. She spoke of the distrust many women have for doctors, and a belief that “smart, empowered people don’t listen to their doctors”.
Actually, I think the truth is the other way around. Doctors aren’t listening to their patients. Over and over again, I hear physicians say that women choose home birth because they are placing “experience” over safety. A couple decades ago, hospitals bought into this idea. They remodeled their labor wards, designed them to look like home, or better yet, a four-star hotel, and named them “Family Birth Centers”. They believed that all women wanted was a nice environment/experience and they would flock to the hospital now that the rooms no longer looked like a labor ward. Had they really listened to mothers who were choosing birth centers and home birth, they would have understood that few make this choice based on the experience alone. Most make this choice after atrocious treatment in the hospital, or out of a conviction that they and their babies are safest at home as long as things progress normally.
Now, suddenly, the home birth rate has jumped 5%. What’s going on? Our hopsital settings are lovely. We allow fathers and family to be in the birthing room. We have the best technology! Why don’t you want to birth at the hospital?
Home birth opponents, it’s time to start listening. Only then will you begin to understand the issues that pull women away from the “safety” of the hospital to the safety of their own homes.
1. Retrieved 8/9/10 from: http://www.ama-assn.org/ama1/pub/upload/mm/471/205.doc