Putting the hospital vs. home birth turf war aside

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Whenever someone finds out that I'm a midwife they inevitably ask if I deliver babies at home. I find this humorous, since only about 1% of babies born in the United States are delivered in an out-of-hospital setting. 

I do not attend home births as part of my midwifery practice, but more and more women have been choosing this birthing option the past few years.

In 2008, both the American College of Obstetricians and Gynecologists (ACOG) and the American Medical Association (AMA) discussed developing legislature that would make planned home birth almost impossible. 

In 2011 the ACOG revised it's position, releasing a slightly more relaxed statement on the topic that acknowledged a woman's right to make an informed decision regarding where she gives birth. Currently, the American College of Nurse Midwives (ACNM) supports planned home birth and offers guidelines to provide the safest outcomes.

Women have been birthing at home long before the modern hospital came into existence, so why the controversy? Safety, comfort and avoiding unnecessary medical interventions are the top reasons women cite for choosing home birth.

These women feel that birth is not a medical event, and have a deep belief in their bodies and the birthing process. Many have had negative experiences in the hospital setting or distrust the medical system. If a woman wants to give birth in the comfort of her own home, why should the ACOG or the AMA stop her?

Some have suggested that the medical community may feel threatened by planned home births and the midwifery profession in general. The ACOG's position is founded on data that show a significant increase in newborn death with home birth. But this research is inherently flawed, as it does not differentiate between planned and unplanned home births.

In its position statement supporting home birth, the ACNM cites separate research that demonstrates excellent outcomes and a decrease in risky medical interventions.

Personally, I support a woman's right to choose where and how she labors and births, as long as a skilled birth attendant is present. These attendants should provide appropriate and thorough prenatal care, and develop a safe and responsible birth plan. This should include an alternative transport plan in case complications arise. The risks and benefits of each potential birth setting should also be thoroughly discussed throughout pregnancy. 

The goal among all obstetric providers and expectant parents should be the safety of both the mom and baby. Let's back away from these turf wars and work collaboratively to provide the best care possible, regardless of where a woman chooses to birth. 

Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.


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