Friday, July 13, 2012

Take on Home Birth, Part II

I just want to quickly mention a few things.....

1. I don't think every woman has had a perfect hospital experience. I know some women have had some downright horrible experiences in hospitals. I don't mean to gloss over those. But for the same reason that we can't assume that every baby at a home birth will die, we can't assume that every hospital experience will be horrible. Not every midwife practices negligently, not every OB pushes interventions. There is no black or white. All I can base my opinion of hospital births on is my own experience, now that I've had one.

Watching the movie Business of Being Born scared me. Talk about trying to instill some fear in women! I had never given birth in a hospital before so when I saw that, I thought, "YIKES! That's how it happens in majority of the hospitals in the US? I don't want that!!" It was pretty much all I knew of hospital birth at that time until I had my own.

After our birth, my opinion changed. It changed based on my own personal experience.

No one bases their decision to have a home birth on experience alone (or, at least, I hope they don't). I, personally, no longer had "fear of hospital birth experience" on my list of reasons for wanting a home birth. So I continued on down my list..... I took into consideration as much as I possibly could. If I missed anything, please tell me. Honestly, what else can I consider? I am not basing my decision solely on a desired experience, or solely on anecdotes, or solely on any one thing... I can't imagine that any woman does... I am basing my decision taking into account everything I knew to consider. 

2. I'm not suggesting that home birth all of a sudden become illegal in all 50 states. But what I think we should all be striving for is for regulation of home birth midwifery in the US to ensure it is being practiced as safely as possible. If people want to continue to compare the US to other first world countries to show how we are failing with childbirth and they are thriving with childbirth b/c they have more home births with midwives than we do, then the US should have a home birth midwifery system that is somewhat comparable to those other countries - but we don't at all. Our home birth midwifery system in the US is flawed.

I think it would be wonderful if we had a home birth midwifery system like they do in the Netherlands, where home birth is an option for low-risk pregnant women and the home birth midwives are an integrated part of the hospitals.

Some things I think that could help:
  • That the title "CPM" not include such a wide range of education and training. As it is now, you could have a CPM that never received a high school diploma or you could have a CPM that has her masters in a health-related field. You could have a CPM that apprenticed for 2 years or one that apprenticed for 5 years. And etc. Perhaps CPMs don't want hospital privileges, I don't know... but for the sake of consistency of care for their clients who need to transfer in labor, I would think it would be something they would like. Why not set the standards for education and training so that they can have hospital privileges?
  • Mandatory reporting of records and outcomes to the state, signed off by the parents (to ensure accuracy).
  • Mandatory malpractice insurance - if they want to be considered health care professionals, why would they be an exception to this?
As I mentioned in one of my comments, perhaps if midwifery were more regulated, then more states would legalize it and maybe even more insurance companies would provide coverage for it... therefore, giving more women the option of having a home birth. 

While I don't see myself ever seriously considering home birth again, I am not trying to take away that option from anyone who wants it. I am just advocating for a safer home birth midwifery system here in our country.

3. Why didn't I add neonatal death rates? Because, just like infant mortality, neonatal mortality does not include stillbirths. Regardless, I didn't leave them out on purpose - I simply did not look up the most recent ones. If anyone would like to add them in the comments, please feel free. Even if we considered neonatal statistics, what would it tell us about home birth safety in the US? Nothing. Perinatal mortality rates, neonatal mortality rates and infant mortality rates of the US vs other first world countries tells us nothing about the safety of home birth in the US. Even if the US was #1 for safety for each of those rates, would that mean every woman would want to give birth in a hospital? No.

Until we have some accurate data of home birth outcomes in the US, we're never going to know how safe or not safe it is.

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