Obstetric trade union threatened by homebirth

[An opinion piece I recently sent to a local newspaper]

With Ricki Lake’s new film, “The Business of Being Born,” giving homebirth a high-profile legitimacy, the American College of Obstetricians and Gynecologists had to do something. As if their monopoly on maternity care in the U.S. wasn’t extensive enough, they felt a need to, once again, stake out their turf. On February 6, the ACOG issued a press release outlining their strong opposition to homebirth. They claim to be concerned for the well being of women and infants. Given the state of maternity care in this country, I find the ACOG’s supposed concern highly questionable.

The ACOG press release criticized mothers who choose homebirth for placing “the process of giving birth over the goal of having a healthy baby.” Women choosing homebirth are often accused in this way. How could they put their own comfort before the health of their baby? The problem with that accusation is that it should really be turned the other way. How can obstetricians put their comfort before the health of the baby?

Many prevalent hospital birth interventions including labor induction for non-medical reasons, elective cesarean section, continuous electronic fetal monitoring, routine use of IVs, early amniotomy (artificial breaking of water), episiotomy, and withholding of food and liquids have not been shown to improve outcomes and, in many cases, lead to other harmful complications for both infants and mothers (click here for more info). These interventions are warranted in rare cases, but they are being used excessively. When many of the most common birth interventions used by obstetricians in hospitals cause unnecessary harm, it is hard to believe that the ACOG’s concern for the well being of mothers and infants is at all genuine. Interestingly enough, most of these interventions reduce the amount of time doctors must spend attending a laboring mother and protect them from possible malpractice lawsuits. It is obstetricians that are putting babies and mothers at unnecessary risk for their own ease and comfort, not homebirth mothers.

The ACOG press release also erroneously claims that there are no scientifically rigorous studies demonstrating the safety of homebirth. There are, in fact, many reputable studies demonstrating that a midwife-attended homebirth is just as safe as a hospital birth for healthy women with normal pregnancies, and with much lower intervention and c-section rates. The most recent and largest of these studies was published in the British Medical Journal in 2005 (“Outcomes of planned home births with certified professional midwives: large prospective study in North America.” Kenneth C Johnson and Betty-Anne Daviss).

The United States is unique among developed nations in its obstetric-heavy maternity care system. The developed nations with the best birth outcomes, the lowest c-section rates, and the lowest rates of maternal and infant death have the majority of women attended by midwives and a significant portion of them giving birth at home. The United States trails behind 27 other developed countries in terms of maternal death and 35 other countries in terms of neonatal deaths.

Homebirth is not “trendy” as the ACOG would have you believe. Women have been giving birth in their homes for thousands of years. Being induced early or opting for an elective c-section are the truly dangerous trends. Women who choose homebirth do so after much research and soul-searching. They deserve our admiration and respect for their courageous choice to avoid the complications stemming from medical intervention and follow their birthing instincts. It is these informed women who will stem the tide of obstetric abuse. As Marsden Wagner, Director of Women’s and Children’s Health for the World Health Organization for 15 years, pointed out, “In every country where I have seen real progress in maternity care, it was women's groups working together with midwives that made the difference.”