Should homebirth have a black box warning?

The Food and Drug Administration (FDA) created black box warnings to alert physicians and consumers to life threatening risks associated with certain medications. According to

A black box warning is the sternest warning by the U.S. Food and Drug Administration (FDA) that a medication can carry and still remain on the market in the United States.

A black box warning appears on the label of a prescription medication to alert you and your healthcare provider about any important safety concerns, such as serious side effects or life-threatening risks…

The FDA requires a black box warning for one of the following situations:

* The medication can cause serious undesirable effects (such as a fatal, life-threatening or permanently disabling adverse reaction) compared to the potential benefit from the drug…

Unfortunately, the FDA has no jurisdiction over homebirths, but we can imagine what a black box warning about homebirth might look like.


Women contemplating homebirth should know that planned homebirth has nearly triple the neonatal death rate of comparable risk hospital birth.

Since many women are unaware of the two different types of midwives and their drastically different levels of education and training, it would be important to include that in any black box warning.

Trying to capitalize on the success of certified nurse midwives, CPMs have awarded themselves a designation that is bound to create confusion with CNMs. Every effort must be taken to make sure that consumers are aware of the differences in “dose.”

Finally, the Midwives Alliance of North America (MANA), the organization that “manufactures” CPMs is behaving like Big Pharma and refusing to release the results of their own safety studies. Women considering homebirth need to be aware of that fact as well.

If women are to make informed choices about homebirth, they need to be informed. It would be very helpful if we could put a black box warning on homebirth, both to educate women about the risks and to eliminate confusion about what they are actually choosing.