Home Birth

Before I begin, let me say that I'm absolutely not against OBs or hospital births - OBs provide a valuable service and hospitals are sometimes necessary for birth.  If a woman wants to give birth in a hospital, she should be able to do so.  I simply do not think OBs should be the first person to go to for a normal pregnancy and birth, though they are definitely needed for high-risk pregnancies and deliveries.

Having had a home birth with my second child, I can definitely say that I want to give birth at home with my future children, assuming a healthy pregnancy and such.  I've even gone so far as to tell my husband I really don't want to live somewhere that isn't home birth-friendly (I know he doesn't have complete control over that one, so it's not like I'd tell him to refuse a position he wanted if it was in a state that didn't support home births).  I have to say, then, that I get rather sad and irritated when I read ACOG's statement about home births.  This has been parsed over at The Unnecessarian, but I'd like to add some of my own thoughts to it.  I do suggest checking out her thoughts, too, though.

So, let's start at the beginning.

ACOG acknowledges a woman's right to make informed decisions regarding her delivery and to have a choice in choosing her health care provider, but ACOG does not support programs that advocate for, or individuals who provide, home births.

Hmm, contradictory, isn't it?  Giving a person the chance to make a truly informed choice means giving them all the information, even if it means they might not choose what you want them to choose.  If ACOG doesn't support programmes that advocate for home birth, or individuals who provide home births, then women don't truly have all the information to make a real informed choice.  Not only that, but it can make home birth more dangerous if the woman doesn't have access to the necessary information and medical personelle if she choose a home birth anyway but doesn't have all the information.  Then it becomes a self-fulfilling prophecy whereby ACOG can continue to claim that home birth isn't safe, despite studies in Europe showing that it is safe for women with normal, healthy pregnancies who spontaneously go into labour at full term.  Of course, those European countries where home birth is more common also have well-trained midwives who can work with the hospital should an emergency arise, something that isn't always possible in the US, sadly.

Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre

OK, this sentence is just infuriating.  I know quite a few women who've chosen home birth, and none of them have chosen that because it's the "in" thing or because some celebrity did it.  Instead, these women chose it after researching the options, the risks and benefits, and making an informed choice that it would be best for them.  I know I chose it for many reasons.  For one, I knew my first labour was rather quick, and knew the second was likely to be quicker, and therefore thought it prudent to plan for a home birth.  I wanted to make sure I had a supportive, experienced midwife, and knew that was more likely at home.  I cannot have an epidural (allergic and low blood pressure) and did not want narcotics, so I didn't need any medications the midwives wouldn't have on hand.  I wanted to avoid any unnecessary interventions.  I wanted to birth in a place where I wouldn't be stressed and could move about as wanted/needed and choose a position that was comfortable for me.  I didn't want the stress of being away from my son.  And if an emergency arose, I live only 4 miles from the hospital and I had a hospital bag packed just in case a transfer became necessary.  At no time did I decide to have a home birth because friends were doing it or because some celebrity did it.  To suggest that women make their birth decisions so frivolously is insulting.

Unless a woman is in a hospital, an accredited freestanding birthing center, or a birthing center within a hospital complex, with physicians ready to intervene quickly if necessary, she puts herself and her baby's health and life at unnecessary risk.

If this is the case, then hospitals and birth centres had better have OBs and anaesthetists on site at all times, but I highly doubt this is the case except for perhaps in some very large hospitals.  I did have an OB called in for my first birth, because the midwife assigned to me evidently wasn't experienced with ventouse.  However, a ventouse delivery probably wouldn't have even been necessary had she worked with me and realised I was in transition when I was (part of the reason for the ventouse was because I'd consented to the pethidine at transition, which made me a bit too sleepy/loopy to get off my back and push effectively; another reason was that I was on my back, which had caused K to turn posterior - he'd been in the correct position until then as far as I'm aware).   The OB was very nice and did her job well, but I'm not convinced her presence was absolutely necessary, or rather that her presence would've been necessary had I had a supportive, experienced midwife and had I known more about labour and birth at that time.

It should be emphasized that studies comparing the safety and outcome of births in hospitals with those occurring in other settings in the US are limited and have not been scientifically rigorous. Moreover, lay or other midwives attending to home births are unable to perform live-saving emergency cesarean deliveries and other surgical and medical procedures that would best safeguard the mother and child 

OK, I won't argue too much with that, except to say that a better solution to this is to support midwives and create rigorous training programmes for them through the universities and to have OBs and midwives work in partnership.

The main goal should be a healthy and safe outcome for both mother and baby. Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby.

Sorry, but I don't subscribe to the "all that matters is a healthy baby" line.  Don't get me wrong, that's of absolute, utmost importance, but it doesn't mean that the mother's psychological health can be ignored in the process of that.  While I know my first birth isn't anywhere near being considered traumatic by most standards, it still hurts me to think of the way I was treated, of the unnecessary fear, of the insults to me during labour.  Yes, I'm very glad K was born healthy, but I wish it had been more peaceful, and that we'd gotten to have the delayed cord clamping and that he'd been able to be delivered directly onto my chest instead of whisked away first (the initial checks could've been performed with him on my chest).  Yes, I wanted a better experience, though I was not sacrificing mine or my daughter's well-being in asking for that.  I was satisfied that the community midwives would take care of my daughter and me, and that they'd get me to the hospital if it became necessary.  So it's not an either/or situation - women should have the opportunity to have the birth they want, safely.

I'll end with giving the summary of RCOG's statement on home birth:

The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) support home birth for women with uncomplicated pregnancies. There is no reason why home birth should not be offered to women at low risk of complications and it may confer considerable benefits for them and their families. There is ample evidence showing that labouring at home increases a woman's likelihood of a birth that is both satisfying and safe, with implications for her health and that of her baby.1-3 

Update: check out this post by Mama Birth