Home Birth….yeh or nay???

I follow many parenting blogs and commentaries. Over the past few weeks there has been much chatter about “home births”

“No surprises here. ACOG looked over the scientific evidence once again and found that it still shows that homebirth increases the risk of neonatal death.

The ACOG practice bulletin, Committee Opinion No. 476: Planned Home Birth appears in the February issue of Obstetrics and Gynecology. The Committee notes that many of the existing scientific papers are of poor quality, and almost all are observational:”

via The Skeptical OB: New ACOG opinion on planned homebirth.

As a masters prepared mother baby nurse and a licensed clinical social worker, I have shared in many of these discussions over the years and I have definite opinions.

It was my fortune to work with very competent obstetricians during my work in Labor and Delivery. They were willing to teach me what they knew and helped to make me a skilled practitioner. I relied on them for their expertise and they relied on me for mine. Of course many times our experience overlapped and that was expected and respected. I was not a physician and they were not nurses.

My early practice was mainly in New York City in the 70’s and La Maze was a popular childbirth preparation…it was even taught by Elizabeth Bing herself. She was the guru of “natural childbirth” in those days. Elizabeth was a physical therapist by practice and she was extremely enthusiastic about her practice and adamant that women should be able to be in control of their labor and delivery. I took classes with her become a La Maze instructor. There were no prerequisites to becoming an instructor except desire. What I noticed was most of the women in the class had delivered successfully with the La Maze method. It was a very skewed population who were learning to be instructors…these were women whose only experience with childbirth was their own. For me, this was not a good thing. Every childbirth that I have attended has been different and I have attended many. My feeling was that when I stopped seeing each birth as an individual unique event that was the time for me to retire from what I was doing.

At the time home births were somewhat popular in NYC but there was a birthing center available…”Maternity Center Association” where women could deliver in a more homey atmosphere. Maternity Center had a hospital connection and guidelines for the patients that delivered there. No high risk were accepted. I had no relationship with this birthing center and do not pretend to know any statistics of their outcomes.

Maternity Center Association

1975

Established The Childbearing Center, a project in New York City to demonstrate out-of-hospital, family-centered maternity care, which was approved by the New York State Department of Health and operated from September 1975 through June 1996.

“1979

Developed innovative classes to prepare children for the birth of a sibling.

1983

Established the National Association of Childbearing Centers, a professional association for out-of-hospital birth centers.

1985

Established the Commission for the Accreditation of Freestanding Birth Centers to ensure high standards of operation for out-of-hospital birth centers across the United States.

1988

Opened the Childbearing Center of Morris Heights, a neighborhood-based birth center in the South Bronx serving low-income families.

1989

Results of the 84-site National Birth Center Study of outcomes of care in out-of-hospital birth centers were published in the New England Journal of Medicine, with funding secured by Maternity Center Association; the study concluded that care in birth centers was safe, satisfying, and cost effective.”

Childbirth remains a “natural” occurrence but when complications set in they can occur very rapidly. These complications can have disasterous results. I am only one practitioner and have seen a maternal death and other extremely serious complications for mother and baby. I can surely say without reservation if these particular patients were not in a hospital they would not have survived. They needed expert care, and immediate intervention not available in the home.

Nurses and physicians are educated and trained extensively. Their goal is a healthy outcome for mother and baby. We are not in opposition to each other we are each others colleagues. If home birth is to continue and be as safe as it can be there must continue to be extensive training for the nurse-midwives and there must be a collegial partnership with the medical community.

Any one who is considering a home birth should discuss their wishes with a Board Certified Obstetrician and weigh the pros and cons of carefully. This is a decision that could seriously impact you and your family for the rest of your life. Your obstetrician should not be considered your enemy he/she is your advocate…if you do not feel this way find one that is.

http://blogs.babble.com/being-pregnant/2010/12/21/pregnancy-related-deaths-rising/?utm_source=Babble&utm_cam

http://parenting.blogs.nytimes.com/2011/01/04/debating-home-birth/?scp=10&sq=motherlode&st=cse

http://parenting.blogs.nytimes.com/2008/11/20/guest-blogger-a-birthing-story/

About lorettelavine

Wife, mother, grandmother, registered nurse, licensed clinical social worker, blogger. Parent and child advocate, involved in life.
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2 Responses to Home Birth….yeh or nay???

  1. Mary Poole says:

    While I agree with you about most things, this is one topic that I too have strong feelings, and they are different from yours. Seven years ago, my daughter became pregnant, and she told me she was going to deliver her baby at a birthing center, with a certified licensed midwife. I was appalled, and did everything in my power to dissuade her. I was not successful.
    Now, I have watched three children born at the same birthing center with a licensed midwife, and my opinions have significantly changed. With healthy low risk women, births accompanied by licensed certified midwives have as positive outcomes for mother and baby as hospital births. And, the experience is more woman, family affirming, and amazingly inexpensive. I can provide you with citations to support this.
    My daughter’s prenatal, birth and postnatal cost was only $3500.
    The WHO reports that the United States is 32 internationally in infant and maternal mortality. Thirty one countries have less maternal and infant mortality per capita, and we are behind most of the developed world. Many of the countries with better outcomes consistently use midwives in their low risk deliveries. Scandinavian countries are good examples of this.
    I agree that each birth should be looked upon as unique. However, our current medicalized model of birth has not been that successful. And, obstetricians and hospitals present a point of view that is my experience is prejudiced against non-hospital births. At least in Florida, in order to be licensed as a midwife, you are required to attend a strenuous multi-year training, and are adept at reading for complications, and if problems emerge, midwives can resolve many of them. They are also must be within a certain time limit of a major hospital.
    Births at free standing birth centers or at home accompanied by a midwife is a good alternative for healthy women who choose this option. It isn’t for everyone, but if you want a birthing environment that is supportive, drug free and affirming, then a birthing center is a good option.

    • I do agree that Birthing Centers do offer a much needed option and that certified midwives do provide the low risk mother with the care that she needs. It is a birthing option that should be carefully considered, along with the credentials and experience of the nurse midwife. I would give the same advice to a mom-to-be with regard to delivering at a hospital. Carefully choose your physician and your hospital in the same way. It is a partnership with mutual respect for each other.
      I agree that obstetricians are prejudice against non-hospital births but I believe that this is due to their experiences during their residencies and fellowships (approx. 5-6 years) that skew their views in this area…they often have to deal with “bad outcomes and complications that get transferred to the teaching hospitals from outlying hospitals. It is definitely not a perfect system.
      The stats from other countries from my understanding are pretty good due to the high standards that are required for birthing centers and midwives in those countries. Something we could learn from. Now “home births” are another separate discussion all together.

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