An open letter to expectant mothers on the safety of homebirth

Dear Mama,

You may have read an opinion piece in the New York Times by a non-practicing obstetrician who typically saves her rants for Twitter fights against homebirth, midwives, breastfeeding and even certain parenting practices. Perhaps you were as surprised as I was to read her views in a respected mainstream publication at a time when:

• The governments of many developed countries (such as the UK) are doing more to promote homebirth as a safe option for low-risk women
• Harvard-trained practicing OBs are talking about the faults and dangers in our current hospital maternity system
• And although they are still a small number, home births have doubled over the last decade.

The number of women giving birth at home is less than 2 percent of the 4 million or so annual births in the U.S.  And yet, according to the Lancet, America is only one of eight countries in the world where the maternal death rate is increasing, nearly doubling since 1987.  These awful numbers are rising for a few reasons-- including that hospital births have become so medicalized that they often introduce complications into what is otherwise an unchanged ancient physiologic process -- not because home birth has taken off like a rocket.

All of the gains our healthcare system made throughout the 20th century to fight infection, perfect anesthesia and cesareans, and provide better prenatal care are being eroded because doctors are introducing complications that don’t need to exist. To be clear, I’m not here to bash doctors. They mean well and often practice in an environment of fear where the saying goes like this: you get sued for the c-sections you don’t do, not the ones you do.  So the system is skewed toward intervention, which is now so common, it is one the key reasons why more American women are choosing to stay home! Oh, the irony. Another reason more moms are choosing to stay home is because the data shows it is safe, especially for low-risk mothers, and even for those who have had a cesarean.

Instead of focusing on what hospitals and OBs could do to lower their complications in birth -- beginning with reducing the outrageous national cesarean rate in the double digits that is as high as 50 percent in some hospitals -- the author of this confusing out-of-the-blue-except-that-she-is-promoting-a-book diatribe against homebirth instead chose to turn her sights on midwives who attend home births.

That angle makes me even more angry.

In the late 19th century, the all-male medical profession began launching campaigns to eradicate midwives. Massachusetts was at the forefront of this movement as we churned out doctors seeking to claim market share in childbirth. These campaigns portrayed midwives as illiterate, often because the women were immigrants who spoke languages other than English. And yet these midwives carried generations of wisdom and decades of hands-on practice that gave them the ability to gently ease breeches into the world or guide a mother into a position to minimize shoulder dystocia. As home birth midwives were pushed to the brink of professional extinction, this knowledge also faded. How has that helped women?

In the Netherlands and other countries that recognize the value of integrating home birth midwives into the maternal health care system, families have access to physician consult when needed, and smooth transfers from planned home births to the hospital during the small percentage (about 10 percent) of births where additional care is needed. In the U.S., this integration fluctuates widely. In some areas, physicians and midwives collaborate and transfers occur seamlessly, ensuring families receive the appropriate level of care when complications arise. In other communities, physicians refuse to consult with midwifery clients or families describe hostile treatment when they transfer to the hospital.

The bottom line is, the debate around home birth statistics as it has been portrayed in the mainstream media is only serving to confuse expectant parents trying to decide what is safest for their family. The headlines have focused on research highlighting the relative risk rather than the absolute risk, which is still quite small.

Continuing to blame midwives of any stripe for the lack of safety in the U.S. maternity care system is an utter farce. It is not the path to making birth safer. Women need more options, and more ways to integrate midwifery into mainstream care. Right now, midwifery lives in the realm of women who can pay for it like the luxury item that it is. That is also wrong. Expanding access to midwifery care -- whether at home or in the hospital -- benefits all of us.