Can we please stop framing homebirth as a turf issue?

In the past month or so I’ve given a number of interviews and it’s been a rather discouraging experience.

Of course, I welcome every opportunity to expound upon my favorite subject: accurately informing women about the increased risk of neonatal death at homebirth. And I’ve enjoyed speaking with a variety of thoughtful, intelligent reporters. I’m discouraged, though, because I always have the impression that the article has basically been written according to a script before anyone is called for quotes. The script goes like this:

Meet Jane Doe and her newborn baby. Jane had a blissful, empowering homebirth. (See picture of Jane and baby).

According to the CDC, more women are making the same choice as Jane.

But doctors and midwives disagree about whether homebirth is a safe option. Doctors site the Wax study [insert quote from George Macones, MD of ACOG].

Midwives cite the Johnson and Daviss study [insert quote from local homebirth midwife] and claim that doctors oppose homebirth because they are afraid of losing business.

There are different kinds of midwives. Not all are legal, but some people think that all midwives should be legal [Insert quote from Katie Prown of The Big Push for Midwives.]

Is homebirth safe? We have no idea.

The article, Growing number of women choose to give birth at home, produced by the Washington Post in collaboration with Kaiser Health News and syndicated across the country is a perfect example.

There are a variety of serious problems with this approach, not surprisingly, since it is not an accurate representation either of the issue or of the state of the scientific literature and available statistics. Basically, it frames the issue in the way that homebirth midwives frame the issue, as a turf war.

Framing the issue as one of “turf” has important advantages for homebirth advocates. At a deep (possibly unconscious) level, most homebirth advocates suspect that homebirth may be risky for babies. The few professional homebirth advocates who are familiar with the literature and statistics KNOW that homebirth increases the risk of neonatal death. Moreover, the idea that being far from emergency personnel and equipment in the event of an emergency defies common sense. Therefore, they’ve chosen to frame the argument as doctors bullying midwives over “turf.”

It’s not an issue of turf, it is an issue of safety, but the script does not allow for exploration of the real issue. What would such an exploration involve?

1. A review of all the relevant literature beyond two opposing studies, both of which are poor. The literature includes the Malloy study that shows that homebirth with a CNM has double the risk of neonatal death as comparable risk hospital birth, the BMJ study that shows that low risk birth with Dutch midwives (home or hospital) has a higher rate of perinatal death than high risk hospital birth with an obstetrician, and the recently released Birthplace study that showed that even when the eligibility criteria are extraordinarily strict, homebirth still has an increased risk of adverse outcome.

2. A review of the most recent national and state statistics. The latest CDC statistics show that homebirth with a non-nurse midwives has a neonatal mortality rate more than 600% higher than comparable risk hospital birth. Statistics on planned homebirths attended by licensed midwives in California, Colorado and Oregon exceed death rates for comparable risk hospital birth.

3. Interviews with pediatricians and neonatologists since they are the people who actually care for newborns. This is the best way to break out of the “turf” frame because pediatricians and neonatologists have no economic interest at stake. Moreover, they are the people forced try desperately to resuscitate the babies deprived of oxygen at homebirth.

4. A comparison of American homebirth midwives (CPMs) with midwives from all other first world countries to highlight the lack of education and training of CPMs.

These are just the most important of the issues that ought to be addressed.

I implore reporters contemplating writing about homebirth to stop writing the same articles over and over again and break out of the script. In 2012, there is copious evidence in the scientific literature and in state and national statistics that shows that homebirth increases the risk of perinatal and neonatal death. That evidence ought to be reported and analyzed.

Step back and consider that there are other people who actually care for babies, pediatricians and neonatologists. Ask them whether homebirth is safe and what their personal experience is with homebirth tragedies.

The bottom line is that the only people who think homebirth is safe are homebirth advocates. Everyone who reads and analyzes the scientific literature, everyone who follows state and national statistics, and everyone who cares for newborn babies knows that homebirth increases the risk of neonatal death.

Please report that.

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