Interesting post & cross-talk from NY Times “Opinion Pages ~ Room for Debate” topic: Is Home Birth Ever Safe?

by faithgibson on February 27, 2015

in Contemporary Childbirth Politics

Hospitals Carry Their Own Risks

Marinah Valenzuela Farrell, a certified professional midwife, is the president of the Midwives Alliance of North America.

UPDATED FEBRUARY 24, 2015, 10:39 AM

Welcoming a healthy baby into the arms of a healthy mother is the primary concern of this debate. But most families who choose home birth do so because midwifery’s view of safety includes the psychological and social well being of the new family, with individualized prenatal care, education and counseling.

Families who choose home birth know that all birth settings carry risk. But a growing body of research demonstrates that, for women with low-risk pregnancies and access to medical back-up if needed, home birth with a skilled provider is a safe option.

Certified professional midwives and certified nurse midwives should be licensed to practice independently in all 50 states.
Hospitals carry their own risk. For example, the cesarean rate in the United States is over 30 percent, but a recent study on home birth in the U.S. found a primary C-section rate of about five percent.

Cesareans carry significantly increased risk in current and subsequent pregnancies and can result in elevated maternal mortality, amniotic fluid embolism and placental abnormalities for the mother. For babies, risks include neonatal laceration and respiratory morbidity. The rise in C-sections in the U.S. has not been associated with improved outcomes for mothers or babies, suggesting that many are unnecessary.

Some health conditions pose higher risks. But sometimes there is not a single “red flag” but a series of smaller “pink flags” that may suggest a family is not a candidate for home birth. Assessing these potential risks and consulting with or referring to other health professionals as needed is critical to safety in all settings. This is why risk assessment is a core skill taught to certified professional midwives in clinical training.

When complications arise — about 11 percent of the time — midwives transfer new mothers to a hospital for access to additional technology. But the vast majority of transfers are non-emergent: most are for long labors that require medication or for an exhausted mother in need of pharmaceutical pain relief. MANA has worked with the Home Birth Summit to disseminate best practice transfer guidelines, whose wide adoption could better align the U.S. health care system with those in the U.K. and the Netherlands.

Ensuring access to skilled providers is critical for home birth safety. That’s why certified professional midwives and certified nurse midwives should be licensed to practice independently in all 50 states. That would allow greater access to various birth care and improved professional collaboration.

But, finally, should women be encouraged to have home births? We firmly believe that all women should be actively encouraged to explore the place of birth that is right for their family and risk profile.


KSM, Chicago
The doctors here are claiming hospital births are safer, but they’re not addressing problems caused by overuse of interventions and C-sections. What would it take to change U.S. hospital practice, so births were truly supported, and medical intervention used only as a backup?

Many moms labor at hospitals, lying in bed mostly alone or with a spouse, hooked up to a monitor and IV. This is not optimal care. In contrast, midwives provide knowledgeable, calm, caring, continuous support throughout labor and delivery. That’s why some women choose midwifery service at birthing centers or home births. (Also why British NHS recommends home births for low-risk, second baby or later.)

But why can’t the same good-quality service be offered in hospitals? We set up this system, we can change it. Expectant parents should educate themselves and search for good service. Insurance companies should push back on unnecessary and unhealthy levels of intervention. And the whole OB/GYN model needs to change…

Some hospitals assign OBs to shifts, and find that C-section rates fall due to reduced time pressures. OB/GYNs don’t have to run from their office practice to emergency deliveries, they don’t need to plan c-sections to fit their schedules, and they don’t have to end labor to get back to work or take a break. A hospitalist is always there.

Relying on doulas and midwives , and using hospitalists as backup, would improve care.

Joy, new york

“What would it take to change US hospital practice…?” Tort reform. Take lawyers out of the equation. Those of us that have been involved in the US hospital system (as an L&D nurse 10 years, a home birth CNM 15 years) know this with unquestioning certainty. How can the women of the US settle for lawyers dictating to their hospital caregivers how to take care of them? This is the main reason you will see that many hospital OB’s and midwives do not follow the current recommendations from valid research–it doesn’t follow the recommendation of defensive medicine suggested by the lawyers. Get lawyers out of health care (or limit their powers) and you will see compassion and healthCARE return to the hospital.

Erin, North Carolina Yesterday

I strongly believe that home birth should be an option. Despite this, I plan to give birth to my second child in a hospital, mostly due to my risk of pre-term delivery and the fact that I do like being right as close as possible to emergency medical services, should anything go wrong. I choose a hospital and doctor/midwife practice very carefully because of all the problems with hospital deliveries, such as overuse of c-sections and medical interventions.

That said, I still have serious fears about my hospital delivery. The problem is that while my doctor/midwife team is well educated and up to date on all the medical science, not all the hospital nurses and hospital rules/policies are. Many out-dated hospital rules can potentially put baby and mom at risk. I was reassured at my last OBGYN appointment, but I still have nightmares about mean nurses stealing my food and trying to force me into medical interventions. Perhaps the best course of action is to improve hospital policies/rules, increase nurse training, especially with regard to un-medicated births and alternative pushing positions, and welcome midwives to hospitals more aggressively. Why can’t we have the best of both worlds?

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