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Controversy Over Home Birth Safety: What Is Really the Problem?

By HERWriter
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Controversy Over Home Birth Safety: What Is the  Real Problem? Halfpoint/Fotolia

Dr. Amy Tuteur published an article in the Opinion section of the New York Times on April 30, 2016, decrying the practice of home birth in the United States.

Tuteur was an OB/GYN for several years before becoming a writer. She is no longer a practicing physician, but manages a blog called Skeptical OB where she discusses birth practices, parenting choices and medical care.

In her recent article, Tuteur asserts that “childbirth is inherently dangerous.”

Her opinion is directly in contrast with much of the recent research published surrounding birth, including statements and statistics published by the CDC promoting midwife-attended, minimal intervention births. The CDC says that such birthing situations result in the best health outcomes for both infants and mothers. (3,4)

According to the CDC, midwife-attended, minimal intervention births can have better results than highly medicalized approaches based on the assumption that birth is an unnatural pathological event .(3,4)

The CDC reported that “in 2009, there were 29,650 home births in the United States (representing 0.72% of births), the highest level since data on this item began to be collected in 1989.It is estimated that 1 in every 90 births is done at home, mostly to non hispanic white women. (4)

In her editorial, Tuteur makes the case that home birth in the United States is unsafe. She reviewed infant mortality outcomes for various health providers and birth settings. She evaluated nurse-midwives and direct entry-midwives in a home or in the hospital.

Direct entry-midwives are also called lay midwives. They are birth professionals who typically receive their credentials and experience through apprenticeships and independent studies.

According to her research, infant death rate for home deliveries is about seven times higher than that of a hospital birth with a midwife.

She blames this disparity on incompetency of lay midwives. Lay midwives are the professionals who attend a majority of home births across the nation

Tuteur calls for an abolition of lay midwife participation as a solution to this problem.

1) Original article by Amy Tuteur- “Why is American Home Birth So Dangerous.” New York Times. Website accessed: 5/2/16.

2) “Home birth with midwife just as safe as hospital.” The Star. Website accessed: 5/10/16.

3) “Midwife-led continuity models vs. other models of care for childbearing women.” Cochrane Database of Systematic Reviews. Website accessed: 5/10/16.

4) “Home Births in the US, 1990-2009.” National Center for Health Statistics. CDC. Website accessed: 5/10/16.

5) “Outcomes of Care for 16,924 Planned Home Births in the United States.” Journal of Midwifery and Women’s Health. Website accessed: 5/11/16.

6) “Study ties home births to higher infant death rates.” Web MD: Health and Pregnancy News. Website accessed: 5/11/16.

7) “Joint Statement of Practice Relations Between Obstetrician-Gynecologists and Certified Nurse-Midwives/Certified Midwives.” ACOG and ACNM. Website Accessed 5/20/16.

Add a Comment2 Comments

EmpowHER Guest

Yes, it is true that the leading causes of preventable bad birth outcomes are poverty and lack of access to care. However, the women in the USA who choose home birth tend to be relatively privileged! Approximately 90% of women who deliver at home with a midwife are white and approximately 90% are married, as per CDC figures. They are also less likely to have serious preexisting health problems, because women with known issues usually choose hospital care.

However, despite the fact that women who birth at home are healthier beforehand, they have worse outcomes. Much worse. The only possible explanation is that lay midwives do not provide good care.

Women deserve real health care, not lies. Poor health care is the opposite of empowering.

May 27, 2016 - 1:51pm
EmpowHER Guest

"Instead, we should be building a health care system that encourages ALL professionals to obtain certification that meets high-quality standards and practice evidence-based care."
So, you agree with doctor Dr. Amy. CPM's do not, by any measures , meet high-quality standards. Rather than saying essentially the same thing, but with a hug attached, how about forwarding pathways for lay midwives to obtain the certifications that lead to high-quality care? Nobody thinks these women are un-teachable or uninterested in the well being of mothers...a critique of competency is not a critique of character. Keep it simple: If these women want to support healthy birth in alternative settings, earn the nessesary credentails.

May 27, 2016 - 1:36pm
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