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Voices From The Nursing School By Joanna Sullivan In one scene in The Business of Being Born, the recent documentary produced by Ricki Lake, a woman gives birth squatting in her living room, her midwife slowly guiding the baby out. The baby is greeted in darkness, with blinds drawn, and the grandmother is called over to witness the new child. The new mother sits down and picks up her baby, surrounded by her husband, doula, mother, and midwife. The scene is that of a home birth, a topic currently generating substantial controversy in the American medical community. In the wake of positive press response and wide theatrical release of the documentary, the American College of Obstetricians and Gynecologists released an unsolicited statement vehemently opposing home birth, calling it “trendy” and stating that studies of home birth haven’t “been scientifically rigorous.” Conversely, the American College on Nurse Midwives and the American Public Health Association, amongst others, support home birth with a trained Certified Midwife or Certified Nurse Midwife as a viable and safe alternative to hospital birth. Contrary to ACOG’s statement, there have been a number of rigorous studies, most notably the landmark study, “Outcomes of planned home births with certified professional midwives: large prospective study in North America,” published in the British Medical Journal in 2005. The study, which followed over 5,000 intended home births with trained midwives, found maternal, intrapartum and neonatal mortality rates to be statistically similar to those in hospitals, with far fewer medical and surgical interventions as well as complications. While ACOG recognizes birth as a “normal physiological process” in their statement, obstetricians in this country are routinely performing cesarean sections on over 25 percent of their low-risk patients, while both Certified Nurse Midwives and Certified Professional Midwives referred fewer than 5 percent of mothers for cesarean sections when attending births outside the hospital. Despite the fact that 99 percent of births in the United States happen within the hospital, our rankings in maternal and perinatal mortality rank very low when compared to other developed countries. When we look at the five countries with the best outcomes for mothers and babies (Japan, Singapore, Sweden, Finland and Norway), we find one main difference from the United States, the use of midwives as the primary birth attendant at over 70 percent of births. In the Netherlands, where there is an official home birth system, 30 percent of births take place at home. The incidence of home birth differs between regions, and one study of perinatal mortality showed that there was no correlation between hospitalization at delivery and regional perinatal mortality. Another study conducted in the province of Gelderland, compared the “obstetric result” of home births versus hospital births. The results suggested that for first time mothers with a low-risk pregnancy, a home birth was as safe as a hospital birth. For low-risk women who had given birth previously, the safety of a home birth was significantly better than that of a hospital birth. So what’s the disconnect? Why are so many obstetricians so afraid of home birth? One of the reasons is simple; very few obstetricians have witnessed a home birth or know what it entails. Marsden Wagner, M.D., former Director of Women’s and Children’s Health for the World Health Organization, likens obstetricians to early explorers that confidently described uncharted territories before actually seeing them. We have reached a crisis in childbirth in the United States, and declaring that home birth is not viable option for women is not the way to solve it. While the statement that “a seemingly normal labor and delivery can quickly become life-threatening for both the mother and baby” is true, careful monitoring and timely intervention by a properly trained midwife can manage complications until transfer to the hospital. What cannot be denied however, is that the bulk of women admitted to the hospital will undergo routine medical interventions, which can lead to cesarean section, vacuum extractions, episiotomy and the use of forceps, all of which carry potential long-term negative effects on the birthing mother. These are not benign interventions and it is time that the public knows that. Essentially condemning home birth as an alternative choice is not productive nor is it honest when quality evidence points to its safety and efficacy. Joanna Sullivan is a MEPN student in the School of Nursing
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