Home birth, a controversial subject in the world of maternity will gain even greater controversy based on the recent death of 36 year old Carol Lovell, an Australian home birth advocate who collapsed and died after the birth of her second daughter. Lovell was rushed to the hospital after she developed symptoms of heart failure during labor and ultimately died.
Despite warnings from the American College of Obstetricians and Gynecologists (ACOG), homebirths in the U.S. has increased by 29% from 2004 to 2009, according to Bloomberg Business Week. Caucasian women over 35 with previous children are more likely to have homebirths and over 60 percent of them are attended by midwives, 5 percent by physicians and 33 percent by “others.” Admittedly, twenty years ago, the thought of having a homebirth seemed farfetched. However, when patients lost their freedom of choice regarding hospital selections based on managed care restrictions and healthcare became more focused on profit as opposed to quality healthcare, the landscape changed dramatically.
Women opt to give birth at home for a multitude of reasons. Some want minimum interventions such as the I.V., meds and fetal monitoring. Others prefer to deliver in the comfort of their home based on its familiarity and then of course, there’s the issue of cost. It is much cheaper to deliver a baby at home rather than in a birth center or hospital. But here’s the dilemma: obstetrics is a specialty of the unexpected and a low risk pregnancy can transform into a high risk condition abruptly with little warning. Unfortunately, when a complication occurs during homebirth, the babies will die 2 to 3 times faster than if they were born in the hospital. Why? Because of the advantage of life-saving neonatal technology that is used in most hospitals. If a mother has a difficult birth in a hospital, the pediatricians and neonatal specialists are in the delivery room at the time of birth. The baby is whisked away to the neonatal intensive care unit where life-saving procedures are performed. A home birth does not offer this advantage.
Although ACOG does not support homebirth, they make the following recommendations:
- Have standard prenatal care, including Group B Strep screening
- Work with a certified midwife, certified nurse midwife or physician that practices in an integrated or regulated health system
- Be able to obtain professional consultations from obstetricians or specialists quickly
- Have a plan for safe and quick transportation to a nearby hospital in the event of an emergency
- Be a low risk patient
- Do not have a home birth if you are beyond 42 weeks
It is also time for ACOG to meet these women halfway. We know that the numbers of homebirths are steadily increasing. ACOG needs to devise new methods and innovations of improving patient safety. Homebirths are here to stay, whether we like it or not.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.