The American Association of Pediatricians (AAP) recently released a policy statement on home birth outlining safety recommendations for planned home birth, including the presence of two skilled caregivers, with one specifically trained in neonatal resuscitation.
To me, the AAP statement reviews common sense guidelines. However, the final paragraph seems to convey a not so subtle disapproval of home birth. The AAP concluded it agrees with the American College of Obstetricians and Gynecologists (ACOG) that, “hospitals and birthing centers are the safest settings for birth in the United States, while respecting the right of women to make a medically informed decision about delivery.”
Planned home birth, though still very uncommon in the United States today, have become more popular in recent years. Tired of unnecessary interventions and the medical model of care, many women are opting for unmedicated home birth with a midwife, or rarely a physician. But a stigma still exists around home birth among the obstetric community.
Personally, I have never attended a home birth. I have friends who are home birth midwives, and friends who have had their babies at home. I believe it is a wonderful choice for a low-risk mom. The videos I’ve watched of home births seem more peaceful and intimate than even the best hospital or birth center birth.
Last fall, I started watching a new British television show on PBS, “Call the Midwife.” The series is based on the real-life experiences of the late Jennifer Worth, a midwife who practiced out of a clinic alongside medically trained nuns in the slums of London’s East End in the 1950s.
Heartwarming, yet bittersweet, this show is by far the best and most accurate depiction of labor and birth on television to date. Most of the birth scenes occur in homes, not in the hospital, as was routine during this era. It is refreshing, yet almost startling, to see birth portrayed so honestly and to see home birth — often attended by only a midwife, or a midwife and a nun — as the norm.
For centuries home birth was the norm both around the world and right here in the United States. Women did not want to leave the comfort of their homes and families to go to a cold and strange environment, often germ-infested, to have their babies. It was not until the 1940s that hospital birth became more common than homebirth in the United States. Even today in the Netherlands, a third of women choose to birth at home.
Limited quality studies have examined the safety of modern homebirth. Although some show an increased risk of neonatal death with planned home birth compared with hospital birth, this risk is still very low. All birth, no matter where it occurs, involves risk. There will be bad outcomes regardless of place of delivery.
I applaud the AAP, as well as ACOG, for their hesitant support of low-risk, safely planned home birth, and their willingness to respect the right of women to make informed choices. And I will continue to watch “Call the Midwife” with a sense of wonder and awe, and hope that maybe someday we will again recognize birth as a natural event, not a medical event. I will continue to dream that maybe someday, among low-risk women home birth will again become the norm.
Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.