Is Homebirth Safe?
This used to be the most common question people asked me.
The answer is: it depends. Homebirth safety depends largely on the degree to which state and local agencies collaborate with homebirthing women and midwives. Can midwives access trainings, labs, medications and equipment necess ary for safe preventive care? Can mothers and midwives access strong bridges to hospital and medical resources when needed?
I have witnessed an evolution surrounding homebirth. In 2000, when I began attending births at home, the most common questions were, “Is that legal?” and “What's a midwife?” Today, the most common question is, “Does insurance cover it?”
Homebirth in Wisconsin has moved from the brink of extinction to universal licensing and regulation of midwives, acceptance of all midwives as Medicaid providers, and supportive and collaborative public health departments and physicians. At Community Midwives, hospital-based medical professionals make up a significant portion of the client population.
This degree of systemic integration is the number one reason why birth at home for healthy women in the Madison area is as safe as birth can be, anywhere.
Hour-long prenatal visits concentrate on informed decision-making around nutrition, immunity-building, and other physical and mental health choices in prevention of illness and complication. Alll women are offered all standard recommended tests, screens and procedures, including newborn screens and procedures. Lab tests are processed at SSM Health Laboratory Services in Madison and the WI State Laboratory of Hygiene. Ultrasounds are ordered at hospital outpatient perinatal clinics.
At labor, standard first-line response equipment is available. This includes IV equipment and fluids, IV antibiotics, anti-hemorrhagic medications, sutures and needles, lidocaine, oxygen adn equipment to deliver oxygen to mother and baby, a pulse oximeter, blood pressure cuff, doppler ultrasound to assess fetal heart tones, and newborn cardiac, metabolic, bilirubin and hearing screening equipment.
Two licensed midwives attend every birth. Typically, a third midwife in training lends extra skilled support. All three are certified in Neonatal Resuscitation and Adult and Infant CPR.
Madison midwives enjoy well-established systems of medical collaboration and transfer with first responders, paramedics, nurses, hospital-based midwives and physicians. In the rare event that transfer to hospital is necessary, it is typically by car and very smooth. The receiving staff is provided with complete verbal and written reports and primary care is transferred to the attending hospital midwife or physician. Homebirth midwives assume a supportive role in hospital.
Whether at home or in hospital after birth, a healthy, Madison-area woman who plans to birth at home with a midwife ensures continuity of skilled and trusted care, as well as certainty that she is doing everything within her power to minimize risk and needless interventions.
In contrast to most of the world, the United States reports a rising maternal mortality rate. We are number 38 in infant mortality, far below western nations with higher rates of homebirth. Clearly, at just over 1% of all births in America, homebirth is not a driver in these tragic trends.
Could midwives and homebirth play a part in systemic efforts at reversing them?
The United States Agency for International Development, World Health Organization, Royal College of Obstetricians and Gynecologists, American Public Health Association and many other evidence-based bodies and agencies support birth in all settings with a qualified midwife within systems of collaboration.
“Midwives are essential to providing quality, respectful maternal and newborn care. They are able to prevent and manage many complications of pregnancy and birth and play a crucial role in ending preventable child and maternal deaths. USAID is committed to supporting and empowering their important role on the frontlines of health systems.”
-Dr Ariel Pablos-Méndez, Assistant Administrator for Global Health and Child and Maternal Survival Coordinator, USAID, October 2016.
“It's time to recognize the pivotal role midwives play in keeping mothers and newborns alive.Their voices have gone unheard for too long, and too often they have been denied a seat at the decision-making table.”
-Dr Anthony Costello, Director of Maternal, Children's and Adolescents’ Health, WHO, October 2016.
“There is a...need and demand for care that is close to where and how people live, close to their birthing culture, and at the same time safe. The World Health Report 2005 states that ‘There is a value in the rituals surrounding birth, and in keeping these as a central feature of family life. The setting for birth may therefore be the woman’s home, a local health facility or, if medical or surgical care is likely to be needed, a hospital.’ Furthermore a recent (2010) European court judgement declared that the choice of home birth is a European human right.”
-International Confederation of Midwives, Position Statement on Homebirth, 2011. (See full statment here)
“Overall, the literature shows that women have less pain at home and use less pharmacological pain relief, have lower levels of intervention, more autonomy and increased satisfaction. The studied interventions included induction, augmentation, perineal trauma and episiotomy, instrumental delivery and caesarean section. These are not insignificant interventions and may have considerable impact on a womans long-term health and emergent relationship with her baby, as well as her satisfaction with her birth experience.”
-The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG), April 2007. (View full text here)
“Recognizing the evidence that births to healthy mothers, who are not considered at medical risk after comprehensive screening by trained professionals, can occur safely in various settings, including out-of-hospital birth centers and homes...APHA supports efforts to increase access to out-of-hospital maternity care services.”
-American Public Health Association, American Journal of Public Health, Vol 92, No. 3, March 2002.