Thinking a bit more about the North Carolina tragedy…
The bad outcomes that happen in states where home birth is illegal (or poorly supported) strike me as classic self-fulfilling prophecies… kind of like the outcome of the U.S.’s 50+ year economic embargo of Cuba. That may sound like a stretch (sorry, I just love analogies), but bear with me.
When Castro took over Cuba and embraced communism in the early 1960s, U.S. officials predicted that the Castro government would soon fail, as socialism/communism was an infinitely inferior economic system compared to capitalism. And, lo and behold, here in 2011 Cuba is one of the poorest nations in the western hemisphere. So the prediction of economic failure was accurate from the start…right?
Well, not entirely. The U.S.-versus-Cuba struggle has never been been a fair, level-playing-field test of economic philosophies. The U.S. government made sure of that in 1960 when it imposed a total economic embargo on Cuba. A classic self-fulfilling prophecy ensued: barred from trading with the world’s largest consumer nation (us), Cuba’s economy predictably floundered.
Back to North Carolina and home birth. In a state where home birth is illegal or poorly supported, bad things will inevitably happen as a result of poor communication and collaboration in times of emergency. And when those bad things happen, critics will inevitably point to home birth itself as the problem, rather than the many hurdles to success thrown in its path. This in turn leads to calls for ever-more draconian laws and restrictions, which in turn leads to potentially more bad outcomes. (Actually, that sounds like a combination of a self-fulfilling prophecy and a vicious circle…)
Home birth can only thrive in a system in which it is integrated with the larger OB community, so that all providers are well-educated and trained, and emergency care–especially transfer from home to hospital–is quick and seamless. Anything less simply invites more tragedy.
So judging home birth per se to be unsafe based on outcomes arising from a system stacked against it is a bit like our history with Cuba: when you work really hard to make something fail, it likely will.