Christian Science Monitor Examines Debate Surrounding Home Births

Main Category: Pregnancy / Obstetrics
Also Included In: Nursing / Midwifery
Article Date: 24 Jul 2008 - 7:00 PDT

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The Christian Science Monitor on Tuesday examined the debate over whether "childbirth is a natural bodily function or a medical event necessitating hospitalization." The Monitor profiled the case of midwife Diane Goslin, who practices in an Amish area of Lancaster County, Pa. Goslin was ordered last fall by the Pennsylvania Board of Medicine to stop assisting pregnant women during childbirth. The board said Goslin was "practicing medicine and nurse midwifery without the appropriate licensure" (McCauley, Christian Science Monitor, 7/22).

The Pennsylvania Commonwealth Court in May ruled that Goslin was not practicing medicine without a license by assisting at home births. State officials initially charged Goslin because she is a lay midwife and not a nurse midwife. Only people who have nursing degrees can be licensed to practice midwifery in the state, but Pennsylvania law does not prohibit the practice of lay midwifery -- usually defined as midwives trained through apprenticeship. The court did not address whether it is necessary to be certified as a nurse-midwife to practice midwifery in the state (Daily Women's Health Policy Report, 5/28).

According to the Monitor, the order arose because an infant delivered by Goslin died one day after birth. The death was not considered her fault, nor has there been any suggestion that her rates of death or complications are unusual. The case was the third time Goslin had charges dropped against her for allegedly violating licensing regulations in 18 years of practicing midwifery. Although Goslin has been cleared and continues to deliver infants, her work remains "under a legal question mark" because Pennsylvania recognizes only nurse midwives.

According to the Monitor, the home birth debate recently has been joined by such participants as former talk show host Ricki Lake -- whose documentary,"The Business of Being Born," looks at the current maternity care system and at-home childbirth -- as well as the American College of Obstetricians and Gynecologists, which recently reiterated its opposition to home birth, according to the Monitor.

Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, said, "The (issue of) the medicalization of childbirth has been around for a long time now," adding, "There will always be (people like) the Amish, who want no technology," and those who will refuse to have an infant unless they can deliver at a hospital. Caplan said debate on the issue should be "removed from the ideological push and pull" and instead be driven by safety data specific to a woman's age and risk factors, as well as the availability of emergency backup care. However, such data are always changing and debatable, the Monitor reports.

The Midwives Alliance of North America said research suggests that safety rates of home births are equal to or better than those of hospital births among women who have low-risk pregnancies. According to the Monitor, such comparisons are "difficult" to make because the 40,000 to 45,000 infants born at home represent about 1% of all U.S. births annually (Christian Science Monitor, 7/22).

Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

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