Is birth a normal physiological process that goes well most of the time if left undisturbed, or is it a risky medical challenge that can only be termed “normal” in hindsight? Attitude and beliefs about birth are central to the controversies about “management” of birth in this country and in many other countries. Three years ago, the U.S. National Institutes of Health held a controversial state-of-the-science conference on maternal-request cesarean. One of the most alarming moments of that conference was when an obstetrician described a “typical” vaginal birth in her community hospital – a woman confined to bed with IV fluids, continuous EFM, Pitocin, and epidural analgesia on board. Long hours of poor labor progress, probable forceps or vacuum delivery requiring episiotomy. Maybe choosing a cesarean isn’t such a bad idea?
Despite the evidence that most medical interventions routinely used during labor and birth do not provide benefit and sometimes cause harm, many healthcare providers hold on to the belief that birth is not “safe” without interventions such as continuous EFM, restrictions on eating and drinking, routine IV fluids. I think that this is why the idea of home birth is so frightening to many providers – it challenges their belief that birth can only be “managed” safely with medical intervention.
Studies looking at home birth in the past have often had methodological problems. A new study published in the CMAJ is without such problems. It is an excellent study, clearly showing that planned home birth is at least as safe as planned hospital birth and results in fewer complications. Amy Romano, in the Lamaze Sense and Sensibility blog, has done an excellent job of analyzing this study. This study is important not only to support those women who choose home birth with a trained attendant and transfer plan in case complications occur; but it is also important to challenge the way that labor and birth is “managed” in the hospital. Why can’t we reproduce many of the benefits of home birth in the hospital where the majority of women give birth? In a time where our nation is ferociously debating our health care system, why can’t we get anyone in our government to focus on the billions of dollars wasted on unnecessary cesarean surgeries and NICU admissions caused by unnecessary medical interventions? By promoting the home birth option for low-risk women, by supporting out-of-hospital birth centers, by re-looking at how birth is “managed” in our hospitals, we could go a long way towards freeing up health care dollars that are needed elsewhere. And, importantly, we can give babies, mothers, and families the best possible start in an environment that reduces complications, keeps mothers and babies together and promotes breastfeeding – policies that can have life-long consequences. We all have a lot to think about and a lot to learn from home birth.