Heather Michon

Heather Michon
Location
Virginia,
Birthday
June 25
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Editor’s Pick
JULY 5, 2012 1:57PM

What We Miss When We Talk About Home Birth

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 "Mindy Bizzell decided to have her second son at home partly because of money and partly because of faith...."


This is the start of all home birth horror stories: pseudo-hippy or upper-class white mom-to-be wants to have an orgasmic birth experience and maybe save a little cash in the process. She labors with a midwife and a doula and patchouli candles aglow. Something goes horribly wrong. She regrets her selfish choice. The end.

This is also the start to Michelle Goldberg's Daily Beast/Newsweek story, Home Birth: Increasingly Popular, But Dangerous and it's just the latest salvo in the war between home birth advocates and critics.

In the last two years, there have been over 270,000 stories in English-language publications on home birth - some positive, some negative, but almost all falling into the same basic pattern of a religious conversion tale. Critics highlight the stories where women sin by choosing homebirth and are punished with a painful, scary or even deadly experience; advocates highlight the come-to-Gaia stories where women embrace their physical and spiritual power.
Neither side can cleanly "win" the argument, because it can't really be studied in a rigorously scientific way. The available statistics can be read to support either position.

Even if there was a clear scientific consensus the battle would continue, because it transcends science or health or safety. Instead, it's become a war over our perception of pregnant women and the nature of pregnancy. Is it a potentially deadly medical condition requiring massive intervention to produce a "good outcome" or is it a beautiful, natural moment of bonding between human souls? How you answer that question says as much about how you view the world as how you view childbirth.   

What are we missing when we obsess on this philosophical question? Perspective, for starters.

In her story, Michelle Goldberg cites CDC statistics of 29,650 home births reported in 2009 and notes that this was an an increase of 29% from 2004 figures. What she does not mention that that even with that growth, home births still make up just 0.72% of of the whole. While figures have fluctuated over the years, it's accurate to say that around 99% of all American births each year since 1969 have taken place in a hospital.

A blistering 2010 Amnesty International report illustrated dozens of ways American women are being denied quality prenatal, birthing and postpartum care. The short version: we're behind just about every industrialized nation on the planet. The longer version: if you are poor, if you are black, if you are Native American, if you are Hispanic, if you are on public assistance, if you live in a rural area, if you don't speak English, your chances of walking away from a pregnancy, much less walking away with a healthy baby go down. . .and go down dramatically.

Here are some more CDC statistics to ponder: pregnancy-related maternal deaths in the United States bottomed out at 7.2 per 100,000 live births in 1987 and by 2003 more than doubled to 16.8 per 100,000. In 2010, the mortality rate for white women was 9.5 per 100,000; for African-American women, it was 32.7 per 100,000. (All these figures may be much higher. Reporting requirements vary from state to state, and most only look at maternal deaths that occur within around 40 days of birth.)

American women are not dying of strange and exotic afflictions. The Amnesty International report found that 75% of reported maternal deaths were attributed to embolism, hemorrhage, pre-eclampsia and eclampsia, infection, and cardiomyopathy. These are the same things that have been killing women since the dawn of humanity. They aren't always survivable, but survivability would increase if more women were educated on the warning signs of common postpartum killers.

Part of the problem is a shortfall in medical professionals who can impart information. High malpractice insurance rates and low government reimbursement rates are driving health care providers away from those that need them most, or even out of the field. A 2009 American College of Obstetricians and Gynecologists study found that 21% of their membership reported reducing the number of high-risk patients they would accept, 10% reported reducing the number of births that they attend, and 6.5% had stopped practicing obstetrics altogether. Understaffing of both doctors and nurses, particularly in lower-income areas, is a serious and growing problem, and we have the lowest number of midwives in the industrialized world.

Then there is the ubiquity of the Cesarean section in U.S. hospitals. The World Health Organization argues the C-section rate should be, at most, 15% in any given country. Last year, the United States rate topped 33% of all births are by Cesarean, with rates of almost 40% in Louisiana, New York and New Jersey. (In 1965, by comparison, it was 4.5%) It's the most common major surgery performed in the United States today, and it is major surgery. . .with all the risks that a go along with it.

A C-section will, in most cases, result in a live baby, but we're hardly setting world records in infant mortality, either. A 2007 CDC survey found a infant mortality rate - defined as death before the first birthday - at 6.75 per 1,000 live births overall. Again, where you are who you are make a huge difference. In Utah, the infant mortality rate was 4.5 per 1,000 in 2008. In Mississippi, it was 11.4 per 1,000.

Every single one of these issues affects some four million American women, and their babies, each and every year. Is this in the headlines each and every day? Nope. Hospitals are the safest place to have a baby and all American receive equal care. We love babies. (They are people, after all, from the moment of conception.) No need to discuss those that get culled from the herd. Call it God's will, call it poor lifestyle choices. Just don't call it malpractice, because that just raises our insurance rates.  

It's much easier to focus about the 30,000 or so women who opt out of the system and the handful of them who lose their babies, or their lives, as a result of that choice. After all, they got what they deserved.

But the question is still there, even if we don't want to ask it: what do the rest of us deserve?

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Comments

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Really good take on this, Heather. Talk about your first world problems.

Is it a potentially deadly medical condition requiring massive intervention to produce a "good outcome" or is it a beautiful, natural moment of bonding between human souls?

It's neither and it's both - it's more and it's less. But that's a subject for a very, very long piece I, at least, have neither the interest in nor the time for!
Glad to see this on the cover, Heather. ~r
I delivered my second child at home with a midwife. I do not remember the experience except the "crowning". I forget almost all my life due to a TBI but do not believe it was not a religious reason.
Men don't want to pay a garage to fix the brakes on their car. The money they saved by doing it themselves ends up being spent on their funerals.

Having a baby is not a "natural, beautiful" process. Nothing on Earth is a "natural, beautiful" process. It is a mine field.
Thank you for setting the priorities straight. As far as home birth goes, it would be safer in a better world, one not polluted with toxins and the stress of of class, race and gender oppression.
This is really well reported and interesting. I delivered both of my children with midwives in a large hospital. I liked the idea that I could have the granola experience with the safety net of doctors outside my door if I needed them. Both of my labors were long: 34 hours and 29. If I had chosen an MD to deliver my baby, I would have had c-sections because they ran over 24 hours with my water broken. The midwives took my temp, kept and eye on me, and let it run its course. My kids were delivered with no mishaps and I recovered so much quicker than EVERY SINGLE ONE OF MY FRIENDS - they ALL had c-sections. And all delivered with MDs. We're the NY statistic. R
Excellent article. I've seen this problem from both sides: as a father of two girls who elected to have home births, one for neo-hippy - natural is always better - reasons and both for reasons of low income; and as a now retired physician. The neo-hippy is a doula. She is had a well attended pregnancy by a mid-wife and a good delivery. Her daughter, unfortunately was born with small poorly functioning kidneys and now lives with a kidney transplant. Being followed and delivered by an obstetrician would not have changed that. The other daughter developed pre-eclampsia which went unrecognized that resulted in a Cesarian section and a small for dates baby. The baby had problems with low glucose levels and was in NICU for a few days.
When I first studied medicine in the 60's - before good anesthesia for Cesarian Section - the indications for C-section were few; prolapsed cord, complete placenta preavia, and few other conditions that had a high incidence of fetal and/or maternal death. There were other conditions like double footling breech that had a high incidence of complications compared with a normal vaginal delivery and as soon as safe obstetrical anesthetics became available the C-section rate went up.
Because this I went to school before poor people were covered by Medicaid many poor, mostly black, women were attended by "Granny midwives". I saw cases of neonatal tetanus resulting from cleaning the umbilical cord stump with dirty rags and a host of other complications of 'natural' delivery.
Malpractice insurance for me, a pathologist, was $500.00/yr when I started practice in 1975. It was higher for obstetricians, but not so much higher. When I retired my medical liability insurance was ~ $20,000/yr. Obstetrician's insurance was about 5X that. Some of my colleagues in OB/Gyn quit practice or restricted their practice to Gynecology. Our little town had a large number of young women on crack cocaine and delivering them resulted in a lot of increased liability with little financial return.
This long comment, which could be much longer, is only intended to say that what we missed with the Affordable Healthcare Act was a chance for a government run, Universal healthcare program with tort reform. Those two things would have taken two huge costs out of medicine; malpractice insurance costs, and administrative costs. Medicare has an administrative cost of 4%. At last count the administrative costs of hospitals and private insurance companies were about 30%.
Attendant to Universal Healthcare would have to be an objective look at the way care is delivered (or not) under our present system with reform.
France, rated by the WHO as having the best healthcare system in the world has no trouble attracting young men and women to go into nursing and medicine. This eagerness to be in one of those professions is not related to a high income, but to the fact that the system works well and professionals don't have to spend time with the headaches of ineffectual paperwork and administration. R
I wish we could edit our comments for grammatical errors ;)
This was superb Heather. I had two home births, my third daughter with a nurse midwife in Manhattan, my fourth with a family physician in Bangor, Maine. Both had hospital admitting privileges, but the births went very well. There was an active home birth movement in the late 70s and early 80s. I don't think it is any easier to find a nurse midwife than it was then. I would not have had a home birth for my first or second child. I had bad experiences in 2 different hospitals and was separated from the baby for 12 hours following their births because "it was hospital policy." I had chosen both hospitals because they promised 24-hour rooming in.

Both my midwife and my doctor stayed with me for the entire labor. I hardly saw my obstetrician when my first daughter was born and was attended by a resident and a labor nurse who jeered at me for wanting drug-free childbirth. The second one would have been born in a cab if we had tried to go up Eighth Avenue rather than Tenth. When Michelle wants something, she wants it now.

Women deliver babies. Doctors and midwives catch them.

Home birth is not exactly new. My husband, my mom, my dad, all my uncles and aunts were born at home. Nurse midwives have more experience with normal deliveries than young doctors do.
"Instead, it's become a war over our perception of pregnant women and the nature of pregnancy."

This is the absolute core of the issue in my opinion. I almost did not read your post because I get so viscerally angry over this issue. I'm glad I did. Nothing like the facts of this matter to illuminate how off our whole approach to birth and maternity are in this country. Thank you for this post.
Excellent article! I had wanted a natural, homestyle birth (even if it was in a hospital) but I lived in a rural area when my child was born so that went right out the window. I ended up having a C-section, because as you laid out here, the delivery went over 24 hours.

I honestly believe that people may care about children (particularly their own) but legislatively and politically speaking, the opposite is true.

Thanks for this
As I read this I have been drawn to think about the one and only personal experience with home birth in my 59 years (excluding my grandparents and mother).
For the first time I have realized these numbers have another statistic:
Home births where
1. complications BECAUSE of the home birth
2. complications that would have occured either way.
I think that would change the statistics.

This one experience I state was in 1977, the mother gave birth to a child with spina bifida.

The child survived and was immediately taken to the hospital. The doctors said he would have issues, but none of them from the birthing experience.
Excellent piece Heather. I am glad to see it on the cover.