Pediatricians on Home Births: Ugh, Fine

The American Academy of Pediatrics said today that it respects the decision of women to give birth at home -- on the following conditions.

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Midwife Brynne Potter evaluates Gabrielle Kaufmann using a fetoscope while her son Taliesin looks on during a home visit. (AP /Andrew Shurtleff)

While some parents-to-be do worry that if they have a baby at a hospital, it could get mixed in with the veritable pile of other babies and get infected, stolen, or mixed up and mislabeled, the wider appeal of "low-tech" home birth comes down to more practical matters. Most home-birth parents do not own VW microbuses. The decision may be a matter of saving money or retaining a semblance of control and normal during an oft-surreal experience -- part of the culture increasingly focused on minimizing stress and accepting holistic approaches to health -- getting back to unprocessed caveman diets and minimally interventional lifestyles. Compelling research on the negative effects of maternal stress on fetal health is accumulating, such that even data-minded medical bodies do well not to ignore home births as a potential nidus of comfort with tangible health benefits.

Still fewer than one percent of all U.S. births take place at home -- but that number is increasing. With it, medical bodies are charged to address the trend. Today, the American Academy of Pediatrics took an official position.

SHARK300200.jpgWax JR, et al. Maternal and newborn outcomes in planned home birth versus planned hospital births--a meta-analysis. American Journal of Obstetrics and Gynecology

It essentially sided with the American College of Obstetricians and Gynecologists, which recently said it was okay with home births as long as the mother was aware that the risk of complications (cited at right, per their report) was higher than an in-hospital delivery. Both bodies are clear to state that the birth must be overseen by a certified midwife, nurse, or physician.

In terms of a certified midwife, that comes via the American Midwifery Certification Board. The pediatricians add that there should be at least one person present whose job is specifically to attend to the infant -- so, two caretakers, "at least one of whom has the appropriate training, skills and equipment to perform a full resuscitation of the infant."

Now, from the consensus perspectives of the mothers' doctors and the infants' doctors, the official position is that "hospitals and birthing centers are the safest settings for birth in the United States, while respecting the right of women to make a medically informed decision about delivery." The pediatricians' statement reads less like an endorsement of the practice, though, than as a talk with a teenager of the "Don't have sex, but here are condoms" sort.

The condoms in this case are explicit instructions about how to go about getting universal newborn screening, vaccination, feeding assessments, and transitional care after a home birth. These things still have to happen, regardless of where the placenta lands. The instructions are written in medical jargon in a medical journal because, again, this is all to remain in the hands of professionals. There is an element of control over the experience that comes with being in one's own home, but there is ultimately a limit to that autonomy in any environment. Even in a birthing pool, no woman is a reproductive island. As my colleague Dr. Alice Dreger's doula Libby Bogdan-Lovis put it to her: "Birthing a baby requires the same relinquishing of control as does sex -- abandoning oneself to the overwhelming sensation and doing so in a protective and supportive environment."

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It's great to see mainstream medicine addressing alternative and non-traditional trends (although, in this case home births and midwives are like quintessentially traditional -- see Exodus, chapter one). The discussion is akin to last week's article on the five-year-old Internet "cinnamon challenge" meme in the same medical journal, Pediatrics. It was similarly late to the game, but a nonetheless heartening gesture of seriously addressing widespread practices that might traditionally be simply shunned.

Despite these positions from official medical bodies, some pediatricians and obstetricians doubtless remain convinced that home births are a perilous decision. People are going to keep having them, though, so it's best to accommodate everyone's perspectives, decisions, and autonomy in the safest way possible.