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.