Every once in awhile, I find myself on a home birth blog or Facebook group where someone posts a question like this one:*
"Looking for some advice from my fellow HB mamas - I'm 34 weeks pregnant with breech twins. Recently I started bleeding, and a trip to the back-up OB confirmed that I have a slight placental abruption. Also, I tested positive for GBS (did I mention I have gestational diabetes?) I really, really wanted my VBAC home birth, but now I'm not so sure. What do you guys think? Has anyone ever had a successful VBAC/twin/breech/GBS positive/gestational diabetes home birth with placental abruption?"
Posts like this one frighten me on so many levels. First, why are you trying to get medical advice from a blog? Second, why are you even considering a home birth? Even more appalling are the responses, which can often be downright encouraging of home births in high-risk situations. Just because one person had a successful VBAC-twin-breech home birth doesn't mean that you should.
Let me be clear. I'm not saying that a VBAC automatically disqualifies you from a home birth. Or twins. Or any one of those risk factors on their own. What I'm trying to confront is this increasingly narrow definition of "high risk" that leads many otherwise poor candidates for home birth to believe that home birth would be safe for them. Yes, you might have a perfectly fine birth in your living room. But if you have risk factors, why take the chance?
The research shows that home birth is as safe as a hospital birth only in low-risk situations. We should be grateful that we live in a society with state-of-the-art hospitals that enable high-risk women to deliver healthy babies. As much as I love home birth - and I firmly and strongly believe that women should have unlimited support and access to home birth - I wouldn't chance a risky labor in my house. There's just too much riding on it.
And here's why I worry. The American Medical Association and the American College of Obstetricians and Gynecologists are just itching to give a big "I told you so" every time a home birth goes wrong. If more and more high-risk women choose home birth and those births result in disastrous outcomes, there could be a serious push against home birth. And that's going to ruin it for everyone.
This is why we need qualified and licensed midwives, why these midwives need to be conservative in their approach, and why home birthers need to trust in their midwives - even if they recommend a hospital birth - and ignore Facebook comments.
Because in the end, it's not just about a single birth. It's about all of us finding support for home birth from a society generally hostile to the idea, and we need all the help we can get.
*It has to be said that this is not an actual post, just a spoof - thank goodness!
"This is why we need qualified and licensed midwives, why these midwives need to be conservative in their approach, and why home birthers need to trust in their midwives - even if they recommend a hospital birth - and ignore Facebook comments."
ReplyDeleteA friend had a very successful vaginal birth with twins in the hospital. Every home birth advocate I talked to told me that she would end up with a c-section and never get what she wanted. The fear mongering on the part of the home birth community is crazy! It is possible for high risk pregnancy moms to have a natural birth in a hospital.
Thanks for a great article! If out of hospital midwives in the U.S. had the type of education required in Canada, for example... a university degree and a license, they'd be educated enough to know when homebirth is safe and when it's not and be able to refer higher risk patients to a higher level of care. Also, Canadian midwives can work in or out of a hospital, transferring care seamlessly, because they're already part of the care system, not fighting against it as so many lay/dem/out of hospital midwives are in the U.S. The REASON they are "fighting" in the U.S. for recognition is that their education level is so low that it's not recognizable to U.S. medical professionals or hospitals. We already have a perfectly good credential, it's called the CNM, certified nurse midwife, and yes, some of them do practice out of hospital birth. But they can also practice IN the hospital when it's needed, and refer to other care providers appropriately, and procure needed tests and prescriptions for mothers and babies and much more. Lay midwives aren't able to do this because they don't start out with the basics of higher education. Instead, they have a made up credential, the CPM, which is not recognized in U.S. hospitals or most insurance plans or amongst other, real, educated medical care providers. If homebirth is to be a mainstream choice and not a hippy, fringe movement that will never grow much beyond the 1%, then we need more CNM's, not more CPM's. Low income women are cut out of the homebirth scene because they can't shell out $2500 in cash to pay an out of hospital lay midwife. The current "hip" movement of a natural peaceful homebirth is limited to the white upper middle class and the rich or celebrities, who can pay out of pocket. I've talked to many many medicade mothers who "wanted a homebirth but couldn't afford it" and birthed in the hospital instead. Providing doulas for women in hospital, and providing safe and educated CNM's for out or in hospital birth is what anyone should be "Pushing" for!
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