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Tensions high in debate over safety of home births


Home birth has been much in the news this summer, especially following the July publication of a study concluding the practice triples the risk of infant death. A debate over the appropriate role of midwives is playing out not only on the national level, but at the local level as well - and it sheds some interesting light on regional character.

In Portland, Ore., last week, an article on conflict between a waterbirth group and a few Oregon Health & Science University physicians sparked a particularly lively chain of (more than 130) reader responses. Many featured personal pregnancy stories; some couldn't praise enough the homebirth/waterbirth crew; others dismissed that community as cultish and quackish.

Yesterday, in response to the ongoing conversation, author Joe Rojas-Burke published a more conciliatory piece on doctor-midwife relations. Notably, he seems to suggest that simple lack of communication and collaboration - not midwifery or hospital care alone - is to blame for bad outcomes. He reports:

Conflicts aren't inevitable. [Melissa Cheyney, an Oregon State University assistant professor and practicing midwife] is working with midwives in Lane County and a Eugene obstetrician, Dr. Paul Qualtere-Burcher, on guidelines for smoother, more collaborative relations. Qualtere-Burcher and his colleagues have agreed to help midwives get access to laboratory testing and ultrasound screening for their clients. Midwives are referring higher-risk home birth clients to the physicians for assessment and another perspective.

"We'd like them to come in and see us before it becomes a big issue during labor," Qualtere-Burcher said. "I think it's been very successful."

The concept of collaboration is nice (particularly given Portland's predilection for natural medicine), but if the American College of Obstetricians and Gynecologists gets its way, it doesn't seem like there will be much room for it. That organization asserts:

The safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, the Joint Commission, or the American Association of Birth Centers.

Photo by rumpleteaser

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