For women who choose to go through pregnancy and childbirth, the freedom to choose where and with whom to birth is not always immediately accessible. Before childbirth in hospitals became the norm, women birthed at home, under the care of a midwife. It wasn’t until the 1950s that childbirth care shifted significantly from midwives and homebirth to physicians and hospital birth. However, birth for healthy mothers and their babies does not necessarily have to be medicalized. And because it was becoming increasingly clear that birth was drifting, quickly, from the hearts and hands of women to the more medicalized, economic model put forth by hospitals, women’s health advocates interested in natural birth created a movement.
There is nothing inherently wrong with hospital birthing, of course (written from the heart of a mother who birthed two beautiful children in a hospital birthing center). It is the focus on economics, while having lost our sense of what birth is all about by straying far away from trusting women and women’s bodies, that is the “wrong.” We now have a cesarean section rate in this country of 30 percent – one out of every three births in this country is via c-section – that dangerously exceeds the World Health Organization’s recommended rate of 5 to 10 percent of all births. With a cesarean rate of over 15 percent, the WHO says, we’re in the realm of doing “more harm than good.”
We are not providing women with the optimal enivornments for birthing, or giving women the chance to choose where they wish to birth and with whom. There are of course many reasons for this, not the least of which is access. Women who have no health insurance are not in a position to “choose.” Pregnant women who live in a small town with one hospital that forces c-sections upon women who have had a previous c-section are not in a position to “choose.” Women who live in a state where midwifery, essentially homebirth, is illegal are not in a position to “choose.”
This cannot be what our mothers want or what we want for our mothers.
Things are looking up. According to a new report by the Centers for Disease Control (CDC) released this week, more women in the United States are opting to birth at home or out-of-hospital, when they are able, mostly out of a desire for a low-intervention birth or because of cultural or religious reasons, and sometimes because of lack of transportation.
The report also identifies reduced costs associated with out-of-hospital maternity care as a factor in the increased demand.
Over the last five years, out-of-hospital births (which includes home birth and birthing at a free-standing birth center) rose 3 percent and home births rose 5 percent after having sharply declined between 1940 and 1969 and then remaining static over the last few decades.
Approximately 17 percent of these home births recorded were unplanned – either because of transportation issues for women who live in rural areas or emergency scenarios.
The report acknowledges that home births were “less likely than hospital births to be preterm, low birthweight, or multiple deliveries.”
Out-of-hospital birthing, particularly home birthing, has been treated with more than a raised eyebrow by the media as well as some professional medical associations (specifically the American Medical Association (AMA) and American Congress of Obstetricians and Gynecologists (ACOG)) over the last few years.
The AMA passed a resolution in opposition to home birth stating that hospital births are the safest route for mothers and babies.
In a poorly reported segment on The Today Show a few months ago home birth was treated as a perilous fad spurred on by celebrities who birth at home with hordes of pregnant women clamoring to “do what Ricki Lake did.”
However, the report makes a point to note that in contrast to the AMA and ACOG, the organizations that represent physicians who facilitate birth in hospitals, “the World Health Organization, the American College of Nurse Midwives, and the American Public Health Association all support home and out-of-hospital birth options for low-risk women.”
As for midwives who attend home births and birth center births around the country?
The Big Push for Midwives Campaign Manager, Katie Prown, says, “Those of us who have been advocating for increased access to Certified Professional Midwives and out-of-hospital maternity care have long known that the research shows that AMA and ACOG statements about the safety of home birth and the reasons why women choose out-of-hospital delivery have no basis in the evidence,“ said Prown. “It’s great to be able to cite even more research on the safety of out-of-hospital birth and to be able to point to data showing that women in the United States do not, in fact, make decisions about where to have their babies for frivolous, selfish, or trendy reasons.”