New York Times Examines Increase In Home Births Despite Warnings From Medical Associations

Main Category: Pregnancy / Obstetrics
Also Included In: Caregivers / Homecare;  Nursing / Midwifery
Article Date: 14 Nov 2008 - 5:00 PST

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The New York Times on Thursday examined the growing number of women who choose to give birth at home despite opposition from the American College of Obstetricians and Gynecologists and the American Medical Association. According to the Times, which focused on New York City, although births in city hospitals "still vastly outnumber those in its homes," many local midwives report that their normal workloads of two to four deliveries per month have increased to as many as 10. Several certified nurse midwives who conduct home births exclusively said they have received so many requests in recent months that they have begun referring pregnant women to midwives in areas outside the city.

The Times reports that a significant factor in the rise in home births is a documentary by former television talk show host Ricki Lake that examines the current maternity care system and at-home childbirth. According to the Times, the film -- titled "The Business of Being Born" -- argues that "women's bodies are perfectly well equipped to give birth at home and that the occasion need not be a medical event." In addition, many women have become wary of hospital births, both because of what they feel is a patient's limited control over the process and because of the recent increase in caesarean sections. C-sections increased by 50% from 1996 to 2006, to nearly one in three births, according to the National Center for Health Statistics. Elan McAllister, founder of Choices in Childbirth, said Lake's documentary seems to offer an alternative and "is putting home births on the map in a way that makes women feel like it's a really legitimate option." McAllister added, "In your home, you're able to move around and be in the tub or in the shower. You're able to eat and behave in a natural, more normal way. If you believe birth is not a medical emergency, it is the ideal place because it's the place you can really let go and follow what your body wants you to do." Although the film was released in few theaters, it "has become an underground hit among expectant parents since coming out on DVD," the Times reports.

Despite the vast amount of preparations that go into a typical home birth, the Times reports that home births do not always go as planned and that most home birth specialists have a relationship with a hospital or physicians in case of an emergency. Home birth specialists also have discussions with their clients in advance to prepare them for the possibility of a hospital transfer. According to the Times, the "best study of North American home births available cites an average transfer rate of about 12%." ACOG has officially opposed home births since 1975, and this year it convinced AMA to adopt a similar policy. Erin Tracy, an obstetrician and a public health expert at Massachusetts General Hospital, said, "Many low-risk pregnancies become high-risk with no warning and can become urgent within minutes." Tracy -- an ACOG representative who helped petition AMA to adopt the statement against home births -- added, "In a home, even with a quality provider, you don't have access to surgeries or blood transfusions or lifesaving medications you would have in a hospital. The literature does say the majority of normal deliveries can be done at home. But I think, and others think, the stakes are too high."

The Times profiled a Queens couple who had a home water birth earlier this month (Scelfo, New York Times, 11/13). In addition, the Times' "Well" blog on Thursday included a post on home births (Parker-Pope, nytimes.com, 11/12).

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