Where are the studies demonstrating institutionalized birth to be a safe place for a healthy mom and baby to birth?

The National Center for Health Statistics reports that Midwife-assisted deliveries are 19% lower in morbidity and mortality rates than Physician-assisted deliveries.

Certainly the American College of Obstetricians & Gynecologists (ACOG) will argue homebirth as an inappropriate birthing environment, as it is a union respresenting obstetricians who almost exclusively attend births within the hospital institution. They even black-ball family physicians by stating women who have had a previous cesarean section should have an obstetrician in-house throughout labor, although no evidence demonstrates this to have improved outcomes. It has however, increased cesarean rates and dependence of childbearing women on obstetricians. They've secured their market.

Ironically, if their argument held any truth, all remote facilities would have their doors closed to maternity care. Their on-call physicians, comfortable in the privacy of their own homes as their clients labor in the hospital, are even less capable of managing an emergency than the Nurse Midwife directly observing, proactively directing, and when necessary, stabalizing mom and baby for transfer. Our Nurse Midwives have sat in the hospital aside transfered clients, awaiting the arrival of the physician from home. The homebirth argument as a site without ability to manage emergencies is ignorant. The issue is securing care for a trained and equipped provider.

Can research end the home birth controversy? Rixa Freeze PhD asks in her 2010 article within Expert Reviews Obstetrics & Gynecology, "Could a series of large, well-designed studies finally heal the rift between advocates and opponents? In other words, is the real problem with home birth simply lack of sound research and evidence?" The answer Dr. Freeze concludes, "No. There is, in fact, already a large and growing body of research about the outcomes of home birth (p 8)."

The safety of home birth for healthy, low-risk women, when attended by skilled midwives and in a system that facilitates collaboration and timely transfer of care, is well supported by the evidence.

"The reaction from medical organizations to these recent studies - especially the studies affirming the safety of home birth for low-risk women - has been a nonreaction: no press releases, no commentaries or critiques and certainly no change in policy towards home birth. Attitudes towards home birth shape which studies a group privileges and which it ignores; additional studies are unlikely to convince an organization that is already ideologically opposed to home birth (Freeze, 2010, p 10)."

"Even though the United States has the most intense and widespread medical management of birth-99% of women give birth in a hospital-we rank near the bottom among industrialized countries in maternal and infant mortality. In spite of our vigilance, preterm births are on the rise, cerebral palsy-thought to be caused by fetal distress-rates have remained stagnant, and in 2002, infant mortality rose for the first time since 1958. According to the World Health Organization, we rank second to last among 33 industrialized countries in this regard and 30th for maternal mortality. Although we are superior in saving the lives of infants born severely premature, women are 70% more likely to die in childbirth in the United States than in Europe. Black women are four times more likely to die than white women (Block, 2007)."

"In the countries with the best maternal and infant outcomes- the Netherlands, Sweden, and Denmark-women and babies benefit from lifelong universal healthcare, but that care is markedly different: obstetricians attend only high-risk pregnancies. The vast majority of laboring women get individual support from a midwife, are free to move about and birth in whatever position feels best, and are rarely induced, anesthetized, or cut. These countries have between a 14% and an 18% cesarean rate, and in the Netherlands some 20% to 30% of births happen at home with virtually no medical intervention at all. Their approach, opposite to that of the United States, is to support physiological birth, allowing labor to begin and progress in its own time, and intervening only when necessary" (Block, 2007)" 

"Are U.S. women less capable of giving birth than their Scandinavian sisters? Is technology being overused at the expense of women and babies? (Block, 2007)"

Pushed: The Painful Truth About Childbirth And Modern Maternity Care by Jennifer Block. (2007).

Our country certainly is in the midst of a centuries' old monopoly over the right to heal.

"The set of healers who became the medical profession was distinguished not so much by its associations with modern science as by its associations with the emerging American business establishment. With all due respect to Pasteur, Koch, and the other great European medical researchers of the nineteenth century, it was the Carnegies and Rockefellers who intervened to secure the final victory of the American medical profession," (Ehrenreich & English in Witches, Midwives & Nurses: A History of Women Healers).

Despite thefact that the United States spends more money on health care than any other country - and more on maternity care than any other type of hospital care - maternal mortality rates are actually increasing for U.S. women rather than decreasing. Maternal mortality rates have doubled since 1987, and the United States ranks 37th in the world in terms of maternal mortality (Amnesty International, 2010). These discrepancies in maternal health outcomes are parallel in time with rising rates of cesarean section, decreased rates of vaginal birth after a previous cesarean section, and an increase in the amount of medical interventions in the "standard" hospital birth.

Watch this informational video, presented by world-reknown experts, regarding the current crisis facing mothers and newborns in America. Certified Nurse Midwives and homebirth can rectify this tragedy.

The complimentary nature of advanced practice nursing (APN) to medical care is a foreign concept for some physicians who view all healthcare as an extension of medical care and APNs as physician extenders. This misunderstanding of APNs underlies physician opposition to independent roles for nurses because they believe APNs want to practice medicine without a license. The fact that nursing has its own knowledge and skills is a novel idea for physicians who see nursing as a subset of medicine.

Autumn Bay caught in water by her big sister on November 22cd, 2010

"The ACOG, AMA, and AAP policies on home birth contain no cited evidence for their conclusions; rather, they rely on consensus opinion and obstetrical beliefs about safety. By contrast, most organizations supportive of home birth supply citations to support their assertion that panned, midwife-attended home birth is a safe, reasonable choice (Freeze, 2010, p 10)."

Dr. Freeze goes on to explain, in her 2010 article, Attitudes towards home birth in the USA, published in Expert REv. Obstet Gyneocol 5(3), "Groups supportive of home birth would argue that this is simply because the evidence is clearly on their side. However, there is a more complex explanation behind this disparity in the use of evidence. Medical organizations are in a relative position of power. Their guidelines are the basis for hospital and insurance policies, and shape clinical practice. The vast majority of pregnant women still see obstetricians for maternity care. In that sense, medical organizations are under less pressure to justify their policies than are other maternity-related organizations, such as midwifery or consumer advocacy groups, which are still struggling for legitimacy and public recognition (p 10)."

"Although physical safety, e.g, avoidance of death or disability, is part of a woman's risk calculus, women who choose home birth describe a broader concept of safety that incorporates the long-term physical and emotional wellbeing of both them and their infants and places a high value on practices that ease and facilitate labor, prevent complications, protect breastfeeding and foster early mother-infant attachment. They believe that planned home birth offers a safety advantage over hospital birth because it allows relationships with care providers that are based on trust, active participation in decision making, and minimal exposure to potentially harmful interventions" (Goer H, Romano A. Personal Communications documented by Rixa Freeze, 2010 in her above sited article).

Candian physician Andrew J Kotaska, Clinical Director of Obstetrics & Gynecology at Stanton Territorial Hospital (Canada), wrote in response to ACOG's 2008 statement on home birth: "Modern ethics does not equivocate: maternal autonomy takes precedence over medical recommendations based on beneficence, whether such recommendations are founded on sound scientific evidence or the pre-historic musings of dinosaurs. In the modern age, the locus of control has, appropriately, shifted to the patient/client in all areas of medicine, it seems, except obstetrics. we do not force patients to have life-saving operations, to receive blood transfusions, or to undergo chemotherapy against their will, even to avoid potential risks a hundred fold higher than any associated with home birth. In obstetrics, however, we routinely coerce women into intervention against their will by not 'offering' VBAC, vaginal breech birth, or homebirth. Informed choice is the gold standard in decision making, and it trumps even the largest, cleanest, [randomized controlled trial]. Science supports homebirth as a reasonably safe option. Even if it didn't, it still would be a woman's choice (Walden, 2008 sited from Freeze, 2010)."