Missourians finally free to give birth at home

Finally, women in Missouri have the right to a midwife-attended home birth. By a 5-2 decision, the state supreme court rejected an effort by doctors to abolish a recent law legalizing the practice.

Until recently, Missouri was the only state where having a home birth attended by a certified midwife was actually a felony. A group of doctors sought to return women in Missouri to that benighted situation, claiming they had standing to sue by virtue of speaking for their patients. That is, seeking to speak on behalf of women who might foolishly try to have home births if they weren’t prevented, and therefore can't be trusted to speak for themselves. As Susan Jenkins, legal counsel for the National Birth Policy Coalition and a consultant to the Missouri midwives, stated:

“This case confirms the message that’s been reverberating loud and clear in both the mainstream media and the blogosphere ever since the American Medical Association launched its attacks against midwives and home birth last week—physicians do not have the right to speak for patients when it comes to deciding who delivers their babies.”

Our Bodies Ourselves notes how weirdly the concept of choice is being used by the medical establishment when it comes to reproduction and childbirth. At the same time that the AMA and American College of Obstetricians pushes the acceptability of “elective” C-sections, it is making VBACS harder and harder to have and opposes the expansion of women's choices in caregivers and birthing places.

AMA seeks to outlaw home birth

Not content with discouraging and disapproving of home birth, the American Medical Association at its annual meeting last weekend passed a resolution to press for the outlawing of home birth. Given the skyrocketing c-section rate, the spiraling cost of birth, and the nothing-to-be-proud-of U.S. maternal and infant mortality rates (our newborn mortality rate is the second worst in the developed world), this move seems, well, a little insecure. Fact is, studies have found home births to be as safe or safer than hospital care for low-risk births and they cost two-thirds less. Chalk this one up as just one more episode in the sorry history of the AMA.

RH Reality Check rightly places this as part of broader attempts to criminalize motherhood, having “at their core coercive control over pregnancy and childbirth.”

"It's unclear what penalties the AMA will seek to impose on women who choose to give birth at home, either for religious, cultural or financial reasons-or just because they didn't make it to the hospital in time," said Susan Jenkins, Legal Counsel for The Big Push for Midwives 2008 campaign. "What we do know, however, is that any state that enacts such a law will immediately find itself in court, since a law dictating where a woman must give birth would be a clear violation of fundamental rights to privacy and other freedoms currently protected by the U.S. Constitution."

Docs gets defensive on home birth

Right on schedule, the American College of Obstetricians and Gynecologists has issued another pronouncement against home birth. It repeats the usual baseless charges that home birth isn’t safe (more on that below)—yawn. Same old racket the docs have been pushing for over a century. Can you blame a guild for defending its turf?

What’s more interesting is what’s new. For the first time, ACOG has altered its stance to accept as safe “accredited freestanding birthing centers.” This is a significant retreat, in the face of what I surmise must have been rising pressure from birth centers. I guess this means these entities are growing in influence and economic power. Midwives attending home births will have this kind of influence when hell freezes over, so the retreat doesn’t suggest it’s likely ACOG will surrender its last stand against home birth any time soon. Still, this retreat makes ACOG’s anti-home-birth stance even more threadbare, as freestanding birth centers offer nothing significant beyond what midwives practicing in the home can offer.

The other interesting new tidbit is this weirdly defensive and downright sneering line: "Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre. "

“Fashionable”? “Trendy”? A “cause celebre”? Are we talking about home birth, practiced since the dawn of humanity but holding steady at about 1 percent of American births for many decades? People who choose home birth do so in the face of widespread hostility, because of deeply held beliefs, often religious ones. Go tell the Amish they’re being “trendy.” It seems hard to believe big bad ACOG has been scared by Ricki Lake’s new film, “The Business of Being Born.” The movie’s hot in my circles, but has yet to be released in theaters in most of America. A more plausible (and more fashionable) bogey is the favorable mention home birth got in Vogue a few months ago.

ACOG is also defensive about the soaring C-section rate, which it mentions home birth advocates cite as a justification for promoting home births. ACOG states vacuously that it’s “committed to reducing C-section rates," but “there is no scientific way to recommend an 'ideal' national cesarean rate as a target goal." Actually, after thorough review of the scientific literature, the World Health organization has set 15 percent as the upper limit of what C-section rates should be and under 12 percent as a better goal (the U.S.'s rate is currently over 30 percent). The European countries with the lowest infant and maternal mortality rates in the world have C-section rates under 10 percent. These seem like pretty obvious science-based goals.

Among ACOG’s reasons for claiming home birth is unsafe: “a seemingly normal labor and delivery can quickly become life-threatening for both the mother and baby.” In fact, fast-moving emergencies in childbirth are exceedingly rare, and in those cases when they do occur, you’re not much better off in a hospital. Few hospitals have surgeons and anesthesiologists on duty 24-7, and the typical time between the decision to do an emergency C-section and the first cut is thirty minutes—it takes time for on-call docs to arrive at the hospital and scrub up and for equipment to be readied. If you live within 30 minutes of a hospital, you’re just as well off at home—and perhaps better, since, if you have a midwife at home, you have one-on-one attention and the problem may be recognized faster.

Indeed, all well-designed studies have found that a midwife-attended home birth is as safe for low-risk births as hospital birth, and perhaps even safer. See Johnson et al in the British Medical Journal, Janssen et al in Birth, etc, etc. etc.

And get a load of ACOG’s snide and dishonest whack at midwives who attend home births: It refers to “lay or other midwives attending to home births.” “Other” must refer to the highly trained and licensed certified professional midwives who attend most planned home births—nothing lay about it.