Home birth, unassisted birth

Here is a long article from the Baltimore City Paper entitled “Home Made: Inside  Baltimore’s Home-Birth Underground.” Although I didn’t read all the article — as I said, it was very long — I did read the first several paragraphs, and skimmed the rest. It seemed like a fair, well-balanced article discussing home-birth with or without a midwife, as well as hospital birth.

It also made me think about a couple of points that are more common to home birth than are typical among women who give birth at a hospital.

First, many states do not have legal home-based midwifery. While most states technically allow certified nurse-midwives (CNMs) to attend home births, most of the time they are restricted by what their back-up OB will allow. Some states require CNMs to “risk out” all but the very lowest-risk women; many times these women refuse to go to a hospital, preferring instead to give birth without any attendant other than their families. Some midwives are technically free to attend home births, but it is made very clear to them that if they do, they will lose hospital privileges where they work. For women in these states who would very much like to have a legal home-birthing midwife but cannot find one, their choices are limited to having a hospital birth, having a home birth with an illegal midwife, or having an unassisted childbirth (UC). Even in states that allow and have legal home-birthing midwives, many times if a transfer is necessary, hospitals treat the women poorly for having planned a home birth.

When midwifery is illegal, women still seek it; but there is no “safety net” in a lot of ways. First, if the midwife is incompetent, there is no revocation of her license, because she wasn’t licensed in the first place. Second, if a transfer becomes necessary, many midwives are not allowed to continue to attend the women in the hospital. Sometimes midwives show up with women at a hospital as merely a doula, so that they can continue to serve the woman who chose them as the birth attendant. Sometimes midwives might resist the idea of a transfer, even when it is obviously necessary. This may be due to fear of prosecution.

But women who choose home births tend to make the decisions instead of “oh, whatever you say, doctor.” Some women refuse a transfer even when the midwife strongly suggests it. What should the midwife do then? Should she stay and attend the birth, even knowing that the birth has moved out of her realm of knowledge and expertise? Should she leave, to show her level of disagreement with the laboring woman? If she leaves, it will be said by anti-homebirth people that she “abandoned her client when things got out of hand.” If she stays, it will be said by the same crowd that she “didn’t transfer when she should have.” Talk about a rock and a hard place!

The above-mentioned article also talks about how that statistics are grouped into fairly large categories. For example, some stats have all out-of-hospital births in one category — whether the birth was a planned out-of-hospital birth or not, regardless of who attended the birth (midwife, father, construction worker on the side of the road, taxi driver, EMT). It also said that in many states where certified professional midwives (CPMs) are not legal, the births are recorded as unassisted “to keep the midwife off the bureaucratic radar.”

Here is the paragraph in which the mother featured in the article explained her decision to have an unassisted home birth:

“The first two times there were a few issues with both my care and the baby’s care,” she says wryly. While in labor with Joseph, Alana says she was given pitocin (a synthetic hormone that speeds up contractions) without her knowledge or permission, and another drug caused her to hallucinate. During Keira’s birth at a now-defunct birth center, each time Alana’s labor plan diverged from birth-center policy the staff threatened to transfer her to the hospital for a cesarean section; even worse, immediately after Keira was born, they took action that potentially endangered the neonate. There was meconium stain–feces passed by the baby in utero, which happens in approximately 13 percent of births–when Keira was born, and, as Alana explains, “studies show that if the baby is alert and crying, suctioning in the presence of meconium will do more damage than good–it can cause pneumonia. I repeatedly told them not to do it, and even gave them the reference number of the article, but they just did it anyway. It was maddening.” [emphases mine]

While Dr. Amy of course had to weigh in (the comments after the article are quite lengthy as well!) trying to scare everyone out of giving birth at home, it made me think, “If some people are concerned about women choosing home birth, I suggest that the better way to deal with the situation is to see why women choose home birth, and to see what they can do at hospitals to make them more attractive than home for birthing. Instead of legislating away a woman’s choices, they should actually **listen** to women and respect them enough to be accommodating to their desires, instead of just ignoring them like second-class citizens, whose desires and wishes are unimportant, compared to doctors and hospitals and protocols.”

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