They miss the obvious here: Some women are giving birth at home because they don't have health insurance and can't afford to pay cash up front for a delivery. That was true back in the 1970s, when I apprenticed as a lay midwife, and it's even
May 20, 2011

They miss the obvious here: Some women are giving birth at home because they don't have health insurance and can't afford to pay cash up front for a delivery. That was true back in the 1970s, when I apprenticed as a lay midwife, and it's even more true now.

There's no question that home delivery is much cheaper, and in low-risk births, just as safe when you have a qualified midwife. (For one thing, you don't pick up those antibiotic-resistant superbugs in your own home.) The medical restraints of hospital births can trigger a cascade of complications and interventions that might account for the U.S.'s disgraceful 32 percent C-section rate. The standard line is that American doctors are jumping the gun to avoid legal liabilities, but I think there's more to it than that: C-sections have become so commonly used that most medical students don't ever learn non-surgical alternatives to managing a complication, and thus don't know any other way to treat them.

The argument against home birth is the risk. But why are our infant and mortality rates so bad? We have the worst statistics in the developed world. You can't blame that on home delivery.

The other factor in choosing home delivery is that the quality of prenatal care is usually much higher, since midwives are famously reluctant to chance a high-risk home delivery.

Consider the typical profit-driven OB-GYN "assembly line" visit of 20 minutes or so. My visit with my lay midwife was more likely to last a couple of hours, including detailed questions about my protein intake, any unusual symptoms that might indicate nutritional deficiencies, blood pressure sitting and standing, and internal and external examinations. Midwives also recommend positions to encourage a breech baby to flip. (My midwife diagnosed twins in the last trimester that the woman's OB-GYN had missed. Just sayin'!)

So instead of moaning and wringing their hands as they've been doing for decades now, it might make more sense for ACOG to offer more affordable - and safe - alternatives to women. In England, it used to be that a low-risk woman in labor was provided with a midwife or doctor to attend her (the UK has since moved toward the American model of technology-controlled birth) with an ambulance on call outside her home.

Oh, and by the way? Any kind of universal health care should include supported home birth as an option, because it helps control costs. Hospital-based maternity services are a very lucrative revenue stream.

ATLANTA - Home births rose 20 percent over four years, government figures show, reflecting what experts say is a small subculture among white women toward natural birth.

Fewer than 1 percent of U.S. births occur at home. But the proportion is clearly going up, study by researchers at the Centers for Disease Control and Prevention found. The new figures are for 2004 to 2008. Home births had been declining from 1990 to 2004.

The increase was driven by white women — 1 in 98 had their babies at home in 2008, the most recent year for which the statistics were available.

[...] The increase is notable because doctors groups have been increasingly vocal about opposing home births, The American College of Obstetricians and Gynecologists has for years warned against home births, arguing they can be unsafe, especially if the mother has high-risk medical conditions, if the attendant is inadequately trained or if there's no quick way to get mother and child to a hospital if something goes awry.

Doctor participation in home births declined by 38 percent from 2004 to 2008. The percentage of home births attended by certified midwives and nurse-midwives grew, meanwhile.

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