I’m doing something one shouldn’t probably do as a blogger…responding emotionally to another piece circulating on the internet. Recently there have been several stories that have classed midwife attended births as “trendy” or “chic” or even a “status symbol” (case in point the recent NY Times Style piece). Today a friend linked to this Daily Beast piece disparaging homebirth as “dangerous.” And recently my home state of North Carolina has taken steps to halt legal homebirths altogether in the midst of a campaign to legalize CPMs (currently only CNMs are legally allowed to attend homebirths in NC; recent actions by the state medical board forced the physician providing “supervision” for 7 NC homebirth CNMs to break his association with those providers).
While I have not personally chosen homebirth for myself, I have many friends and acquaintances who have made an informed choice to birth at home and I fully support homebirth as a safe and responsible birth choice. I’m a huge advocate for the midwifery model of care and chose a midwife attended delivery (one in a hospital setting; the other at a birth center) for both of my children. I could present here dozens of peer reviewed studies that demonstrate the efficacy of the midwifery model and support homebirth for low risk, healthy pregnancies. But right now I want to address briefly why the articles linked above are so problematic…and even irresponsible.
Michelle Goldberg, author of the Daily Beast piece, really should be ashamed to call herself a journalist. Sensationalist tabloid writer might be more appropriate. Way to present a one sided story and oversimplify the issue. Certainly bad things can happen during a homebirth (although it is important to remember that those bad things could have and in many cases do happen in hospitals – and outcomes may be just the same). But you know what? I could write an equally scary story …based in fact…about why hospital births are “dangerous.” And of course that would be a biased, slanted, and un-journalistic piece – just like Goldberg’s. The families she profiles did have tragic outcomes – and this is in no way intended to minimize that fact. But they were also victims of subpar medical care (if the story as she presents it is true). That bad care wasn’t a result of choosing homebirth; it was the result of bad care. There are subpar members of every profession; to pretend that those cases are representative of the entire profession is insulting.
Of course it isn’t acceptable to have subpar professionals responsible for any aspect of medical care, much less birth. Which is one reason why instead of making homebirths difficult or even illegal, states should work to make sure that licensed midwives can safely practice without jumping through a bunch of hoops. They should be subject to the same sort of rigorous standards that obstetricians or hospital based midwives are – and I don’t think you’ll find any competent homebirth midwives who would complain about that. When homebirth midwives can’t practice legally, the risk of shoddy practices spikes dramatically as people go “underground” to receive care.
It’s also important that parents-to-be considering homebirth know what to look for and what questions to ask – so they can spot “red flags” in advance. This is no different than what parents choosing obstetric care for a pregnancy would/should do. For this to happen we have to stop sensationalizing homebirth – whether it’s to say “it’s so dangerous!” or “wow, all these cool models are doing it so you should too!” Women and their partners should have access to UNBIASED information about all birth choices – everything from what should risk one out of choosing homebirth to the risks of a cesarian section (and, yes, there are plenty of risks there too). There is no such thing as risk free birth; any expecting mother should know and understand all the choices in order to make the most informed and best choice possible for her and her child. Writing biased “scare” pieces doesn’t do anything to make homebirth (or any birth) safer; level-headed education does.
Midwives, homebirth or otherwise, aren’t status symbols or trend setters. They are practicing a time-honored model of care, a model that has been enhanced over time by both our improved understanding of medical science and centuries of experience and observation. Smart midwives – like the ones I know – blend both of these effortlessly in a way that provides truly patient centered care.