In last month’s “Gray Journal” (aka American Journal of Obstetrician & Gynecologists), Dr. Frank Chevernak and colleagues wrote a response entitled “Planned Home Birth: The Professional Responsibility Response” that was troubling. The authors recommended that an obstetrician not backup midwives when they performed planned home births but “still provide excellent and compassionate emergency obstetrical care to women transported from planned home birth.” Well, there are assumptions that the authors need to clarify. First, they’re assuming that homebirths will require emergency care and that obstetricians should provide “excellent and compassionate” care once these patients arrive. So, if we, as obstetricians anticipate a problem, is it ethical to take a “hands off” approach until it plops on our door step?
I am not an advocate for home births because of my concern for patient safety but as, Chevernak points out, the rate of women who give birth at home as increased by 29 percent which is significant. Instead of addressing the root cause of the problem, these “thought leaders” take a very paternalistic approach which will not solve the problem and as a woman, I find offensive. The attitude is reminiscent of a certain political party who thought they spoke for the values of Americans until the infamous “47 percent” showed up at the polls and proved them wrong.
I wish homebirth moms would deliver in birthing centers if they want to avoid a hospital because of its immediate access to emergency care. A C-Section cannot be done in someone’s home nor can the baby be properly resuscitated. However, our hospitals also have some “housekeeping” to do such appropriately staffing their overworked labor and delivery nurses and making family practice physicians and midwives contact a back-up obstetrician when a baby is having decelerations on a fetal strip rather than waiting until the 11th hour when it’s often too late.
We need to take a more intelligent approach to this issue and have a dialogue with patients, physicians and midwives such as Ina Mae Gaskins, an expert who has a track record of homebirth safety. We need to start thinking outside of the box and use technology and innovation rather than paternalism and fear.
In the words of the great Marianne Williamson: “Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness that most frightens us.”