Home Birth Consensus Summit: Heading to Virginia

Not exactly home birth: 1957

I’ve been invited to attend this week’s Home Birth Consensus Summit in Warrenton, Virginia (October 20-22). As you’ll read on their website, the purpose of the Summit is to “bring a cross-section of the maternity care system into one room to discuss improved integration of services for all women and families in the US across birth sites.”

I may seem like an unlikely invitee at first glance, as I’m a primary care pediatrician (the only one attending the Summit), and none of the more than 3,000 births I’ve attended in my career happened anywhere but in a hospital.

The only home births I encountered were in the neonatal intensive care unit, where over the years I cared for a very small number of babies whose home births had gone wrong. Those experiences formed my then-opinion of home birth–it just wasn’t safe. Like a lot of the doctors and nurses I worked with, I concluded that you’d have to be nuts to birth your baby at home.

Well, I’m nothing if not flexible. My you’ve-gotta-be-nuts opinion has been changing in the last few years, a shift that accelerated in May when I spoke in Vancouver at Turning the Tide: Balancing Birth Experience and Intervention for Best Outcomes about the worrisome effects of cesarean birth on the newborn immune system (see my posts in the “Cesareans” category).

I listened as other speakers talked about planned home birth in British Columbia and elsewhere in Canada. They showed that having a baby at home can be safe for low-risk mothers when such births are attended by well-trained midwives, and are well-integrated with the larger health care system.

The problems they do encounter tend to stem from riskier home births–women with chronic diseases, bleeding during pregnancy, or who were pre- or post-dates, for example, or who lived far from a hospital when complications arose. And poorly planned or unplanned home births are the riskiest of all.

In other words, at least in BC, bad outcomes for mother or baby were no more likely to occur in a home than hospital birth for low-risk women (and many outcomes are actually better at home), but higher-risk home births were, well, riskier.

Can home birth become an accepted part of the American way of birth? It’s possible, but there are enormous obstacles. As with just about every issue that touches on childbirth, the opposing sides are well-entrenched and often not speaking to one another, or at least not speaking the same language.

The American College of Obstetricians and Gynecologists only recently pulled back a bit from condemning home birth outright, though it continues to insist (on the basis of some questionable studies) that a baby is three times more likely to die in a home birth than a hospital birth. On the other hand, some home birth advocates paint the hospital as a place of unmitigated evil, and are too willing to encourage a woman with significant pregnancy-related health issues to attempt a birth at home, ignoring the real risks this can pose to her baby.

That’s why the pediatrician in me is still a wee bit cautious, though tilting toward home birth. My job is to advocate for babies and children, and though there are still many questions to be answered it’s hard for me to ignore the fact that, when done well, home birth is a safe option for many women and babies. Maybe even safer than a hospital birth when you factor in long-term health issues for children.

I’ll be taking a lot of notes at the Summit this week. I’ll write more about it soon.

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5 Comments

Filed under Cesareans, Home birth

5 responses to “Home Birth Consensus Summit: Heading to Virginia

  1. I had hybrid births: home births in the hospital. For the first one, my OB let my midwife “catch” the baby. #2 baby pretty shot out on his own while the nurse was running to get the doc. No drugs or interventions but they were nearby, which made me feel safe. I recommend it!

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  2. Christine

    I have had 3 homebirths (attended by qualified midwives, although the third, only after I caught the baby) after having been a doula for years and having seen both sides. Recently, my hematologist (I have Gestational Thrombocytopenia) said that I would be SAFER in a homebirth because I would be more relaxed and less likely to be subjected to interventions that could be risky for me or my baby. It is also the only place I would be allowed according to Ontario hospital policy to have a lotus birth (where the cord is not cut and the placenta falls off three or four days later, leaving no open “wound” or cut), which means that if my baby is born with low platelets she will be able to get all of her blood volume and will also have a much lesser chance to bleed. I am thrilled that you are keeping an open mind and hope that you have the opportunity to attend a home birth as an observer to see how different and wonderful they really can be!

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  3. Meghan

    Thank you for keeping an open mind. As someone who has had one baby in a hospital with a top-notch NICU, one in a freestanding midwife-staffed birth center, and one at home with a direct-entry midwife, I have a unique perspective on the pros and cons of each. If I have any more children, I would not hesitate to go to the hospital if anything abnormal arose during my pregnancy or birth, but I would unquestionably plan a home birth again, as I think for a healthy woman having a healthy pregnancy who wishes to avoid intervention, the balance is in favor of homebirth as a plan A.

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  4. I am so happy to see that more and more families are choosing to raise their children naturally. As adults we need to be setting the example for what is a healthy lifestyle so if our children see us doing it they will pick it up. It feels good to know my child will have the best life she can because of my families choices:) Also by following the idea of attached parenting my daughter is happier and easier to calm when upset. She is never not with me.

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  5. I’m in favor of everyone talking together. As a nurse educator, former NICU nurse and one who’s witnessed home birth, I can’t encourage you enough to stand up for moms and babies. Too often the medical profession stands on the omnipotent pedestal and proclaims all “non MD” views as “not relevant”. Please bring your colleagues into this discussion. Home birth is not going away. The interest of safety for families is all about respect and working together. Midwifery should be supported, families should have access to medical care at any stage of birth without condemnation. Home birth can be safe, when the forces are coordinated. I’m looking forward to your post on the conference

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