Home Birth “Common Ground”?

Amie Newman

In a less well-known but no less controversial effort to find "common ground" a Home Birth Consensus summit seeks to bridge a divide between those who support and those who oppose expanded access to homebirth.

It may be less well-known than the effort to find common ground between the pro-choice and anti-choice movements but it’s no less controversial, it seems.

The growing childbirth advocacy movement has highlighted the divide between those who would like to see expanded access to safe, state-regulated out-of-hospital birth and midwifery for women and those who oppose access to these options.

However, a new effort, nearly three years in the making, to bridge the divide is underway. According to the American College of Nurse-Midwives, a Home Birth Consensus Summit is being convened in 2011 and will bring both camps to the table in an effort to find areas of agreement with the ultimate goal of improving maternity care for pregnant, birthing and postpartum women and their babies.

In a statement about the summit, ACNM notes that the meeting will be facilitated by “the Future Search Network, a nonprofit organization that is internationally known for brokering lasting agreements and shared initiatives in highly volatile and polarized settings, around issues related to poverty, health care access, regional and ethnic conflict, and education. Future Search meetings produce a “Common Ground Agenda,” which articulates a shared vision and direction.”

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It’s likely not shocking that this issue is considered “highly volatile,”  if you’re a regular reader of Rewire or have ever been a part of the maternity care system as patient or provider in this country. Despite a steady stream of peer-reviewed, published, scientific studies on the safety of planned home birth and the widespread use of midwives in other countries as credible maternity care providers, mainstream medical associations like the American Medical Association (AMA) and the American College of Obstetrics and Gynecologists (ACOG) are fiercely opposed to any home birth options – licensed and regulated or not. Whereas a host of public health associations, nurses groups, nurse-midwifery organizations, certified professional midwifery advocates and even many individual MDs are working hard, daily, to pass state laws legalizing home birth and certified professional midwifery.

Progress is happening, though. ACOG recently revised its official position on hospital policies regarding the availability of VBACs (vaginal birth after cesarean section), after an immense grassroots advocacy effort by birth advocates and an agreement about the safety of VBACs from an NIH Consensus Development Conference on the issue. The issue is central to home birth access since many women interested in out-of-hospital birth desire less – or no – unnecessary medical interventions and most hospitals have banned even allowing a woman to attempt a vaginal birth, after having had a cesarean section for previous births.

The Home Birth Consensus Summit is hopefully the next step in this journey towards progress. That there is funding for it at all, is the first step in consensus building. The Transforming Birth Fund awarded a grant for the summit to an impressively diverse array of groups to convene the conference in 2011. According to ACNM, the grant proposal was spearheaded by ACNM’s Home Birth Section Chair, Saraswathi Vedam, and includes the Midwives Alliance of North American (MANA), the American College of Obstetrics and Gynecology (ACOG), the American Pediatric Association (APA), Association of Women’s Health, Obstetric and Neonatal Nurses (AWHON), Lamaze and more.

Home birth and certified professional midwifery are topics lighting some serious fires around the web, amongst not only mothers and providers, but seemingly anyone with an opinion on our health care system right now.

Hop on over to the New York Times Parenting blog, Motherlode, and you’ll find a recent post (and polarized discussions in the commenting section) on the fiery debate that’s been happening on yet another parenting site, Babble.com, over home birth access. As with abortion access, there is a contigent of those who do not want women to be allowed to access care. In this case, licensed, regulated home birth with a certified professional midwife – despite the fact that 27 states already have deemed this legal and safe. The discussion seems to devolve into whether or not women should trust doctors, whether or not women should automatically defer to hospital policies when it comes to hospital birth (ie, if the policy is to strap a fetal heartrate monitor on every woman, then it must mean it’s the right thing to do so don’t question it) , and why we can’t just put ‘newborn lives ahead of our own desire for a certain type of birth.’

But these claims seriously overlook the central issues for home birth and CPM advocates. Desiring and advocating for planned home birth options with a CPM is precisely about newborn health and the experience babies have during birth. Or, at least it is for many women. There are women, with healthy pregnancies, who desire a birth experience that is not automatically medical in nature because they know that evidence – medical evidence – points to the detriment unnecessary medical interventions may (though don’t always) impose upon a newborn’s health both in-utero and once he or she is born. As well, some women do see birthing at home, with a midwife, as an optimal birth experience – far from the bright lights and antiseptic environment some hospitals (though not all) provide. For women who wish to plan a birth at home, or at a birthing center, it’s not about a distrust of physicians so much as it is about a choice not to make it about physician-oriented care at all. Midwives are not medical doctors but they are care providers and care givers.

Motherlode writer Lisa Belkin writes,

Isn’t the obvious answer somewhere in the middle — a recognition that birth should be treated as a natural event, until it isn’t. And that it should happen in a homelike environment within a hospital, because when things go wrong they go wrong quickly?

However, finding common ground when it comes to maternity care isn’t that simple. Women in the US are more likely to die of complications resulting from pregnancy or childbirth than women in 49 other countries, including South Korea, Kuwait, and Bulgaria, yet we spend more on health care than any other country in the world, according to Cristina Finch writing on Rewire. Simply creating a “homelike environment” in hospitals isn’t what will save women’s health and lives. We need to find the common ground that all women can stand on – women who desire a planned home birth, with a licensed, regulated professional midwife; women who desire to birth at a birthing center, without intrusive, unnecesseary medical interventions; and women who need the medical care provided by physicians and surgeons should their birth experience require it; finally, we need to create a common ground that respects the knowledge of both midwife and physician, the distinct models of care which both provide, and the desires and knowledge of our pregnant and birthing mothers who have a right to care which is, by state regulation and evidence-based research, deemed safe and legal. The Home Birth Consensus Summit is banking on finding that common ground, to save the health and lives of our mothers and babies.

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