Planned Home Birth is actually a 2-part “PLAN” that ONLY applies to healthy pregnant women at the term of pregnancy

by faithgibson on September 26, 2013

in Contemporary Childbirth Politics

A good portion of the posts on this website have to do with vital statistics research, published studies and meta-analysis on the topic of place-of-birth, in particular the relative safety btw hospitals as high medical-intervention setting, and so-called “planned” home birth as a low (in frequency and it technology) medical-intervention setting.

As used in research, such a term as assumes that any childbearing woman “planning” to give birth at home would first be in labor at home under the care of a professional birth attendant, must usually a midwife. 

While I have in other places defined the Planned Home Birth (PHB) plan” to include a part A and part B, I haven’t included my definition on this website.  I am rectifying that in this post.

PLANNED HOME BIRTH — whose plan and how its defined:

I’d like everyone to note that the professional “PLAN” by midwives to attend an OOH birth actually is the ‘plan/intentition’ to attend an OOH labor. This is ALWAYS a two-part equation and ONLY comes into play after a healthy woman with a normal pregnancy has completed 37 weeks of pregnancy.

Prior to that any significant medical, obstetrical or perinatal issue by mother or baby — a complication, or the need to evaluate the mother or unborn baby for a complication — will be reason for the midwife herself to consult with a physician, or refer the mother-to-be to a physician. Midwives don’t ever PLAN to attend pre-term labors or ones in which the mother-to-be (or fetus) has already been identified as having a serious medical complication.

Assuming that both mother and baby get to the magic 37 completed-weeks of pregnancy in perfect health (85% of pregnancies in the US), only then does the PLAN for an OOH labor comes into play. That mother will ONLY give birth at home  if labor progresses normally and mom and babe remain OK.

This issue would be far more accurately discussed and researched as the midwife’s plan to attend-a-labor-at-home (quite different that the issue of a family ‘choice of a “home” birth’, which is preference, not actually a ‘plan’, since it must be preceded by a normal and progressive labor, which is outside of the ability of anyone to ‘intend’.

But in the public discourse about intended place-of-birth, we instead conflate the parent’s preference for OOH care with that of the midwife’s intention to give care according to professional guidelines. While ACOG would like you to believe that the  “plan” of midwives that their clients give birth at home, come heaven, hell and/or high water.

Wrong, wrong, wrong!

From the midwife’s perspective  the actual “PLAN” relative to home birth is a Part A and Part B PLAN that goes like this:

PHB-Part A is providing care to healthy woman at the term of her pregnancy who has a spontaneous onset of labor that progresses ‘normally’ (fast or slow, but always moving forward) and always factors in whether or not the mother and/or baby are able to tolerate this normal but still painful and stressful biological process.

PHB-Part B is equally clear — at any time that:

  • the mother’s labor is no longer progressing normally
  • unborn baby gives evidence of not tolerating labor
  •  either mother or baby develop a medical issue or complication
  • the mother simply asks to be transferred to hospital care

PLAN B goes into effect — off to the hospital!

Any type of research on the comparative safety of OOH birth that doesn’t take this PLAN’s part A/part B into account is not responsibly configured and therefore cannot definitively  determine the issue of comparative safety for low medical-intervention settings (birth centers and family home).

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