Clashing Over Home Births

New opposition may limit women’s choices.

Eager to avoid medical interventions such as an induction or a Cesarean section, more women are choosing to give birth at home, often with the help of a midwife. Champions of the practice—including actress Ricki Lake, who documented her own home birth in the 2008 film The Business of Being Born—argue that for many healthy women at low risk for delivery complications, it’s a smart choice. “A comfortable, familiar place with a competent care provider and other people you love and trust is an ideal setup for an easy, normal birth,” says certified nurse-midwife Mairi Breen Rothman, C.N.M.
However, last June, the American Medical Association passed two resolutions that may make home births harder to achieve. “Deliveries are completely unpredictable,” says Boston obstetrician Erin Tracy, M.D., author of the resolutions. “Often, when something goes wrong, there’s only a matter of minutes to really affect the outcome, and that’s precious time wasted driving to a hospital.” Citing such safety risks, the American College of Obstetricians and Gynecologists (ACOG) also opposes home births.
One of the factors triggering the AMA’s action was a trend among states to license certified professional midwives (formerly known as “lay midwives”), who learn via apprenticeship rather than formal education. ACOG and the American College of Nurse Midwives (ACNM) recognize only certified nurse-midwives and certified midwives as having adequate training.

The case for staying home
Midwives contend that their constant monitoring of women in labor means that potential problems are spotted sooner, almost always with ample time to get to a hospital. In the Netherlands, where the newborn mortality rate is slightly lower than in the U.S., about 30 percent of women give birth at home. While research on the safety of U.S. home births is limited, a study published in the British Medical Journal in 2005 found that midwife-attended North American home births had an infant mortality rate similar to that of low-risk hospital births.
With doctors’ groups opposed, however, women who want a home birth may face a tougher time having one. Aetna Health recently announced it will stop covering home births, and many midwives have difficulty getting malpractice insurance, says ACNM president Kitty Ernst, C.P.M. “Other countries, including Canada and Great Britain, have worked out a way for hospitals, doctors and midwives to work together, save money and help women have babies at home safely,” Ernst says. “It’s time we stopped blaming people and worked together to fix the system in the United States.” To learn more, go to mymidwife.org and click on “Get Involved.” 

December/January 2009