Obstetricians offer care more personalized than that of homebirth midwives


Homebirth midwives often proclaim that they offer more personalized care than obstetricians. The truth is 180 degrees opposite from the claims.

I suppose that if homebirth midwives mean that they have nicer personalities than obstetricians (more personable care) or that they will spend more time discussing intimate details of your life that have nothing to do with birth (inappropriately personal care), they are correct. But when it comes to care based on the precise medical situation of the mother, obstetricians are lightyears ahead of homebirth midwives.

I’ve always known this, but my recent attendance at an “updates in obstetrics” reinforced the point. Over the course of two days, I attended 16 sessions on a variety of obstetric topics and every single session was, in essence, about the discoveries that allow obstetricians to counsel and offer care to women in ways that are ever more personalized. Almost all the sessions involved case scenarios:

Prenatal testing: the mother is under 35 with no family history of Down Syndrome, over 35, with a family history, with a previously affected child, etc. etc.

Premature labor: the mother is white, is African-American, has no history of prematurity, has multiple previous premature births, membranes are intact, membranes are ruptured, etc. etc.

VBAC: previous C-section for a non-repeating cause, for a repeating cause, previous vaginal delivery before or after C-section, no previous vaginal delivery, baby is big, baby is small, mother has normal BMI, mother is obese, etc. etc. etc.

After each session there were questions from participants and almost all of them were case scenarios (almost certainly real cases that the questioners had faced or were facing). Nearly all the questions took the same form: these are the patient characteristics, this is the problem, what shall I tell her about what is likely to happen and what we should do about it?

Homebirth midwifery, in contrast, is one size fits all.

Personal characteristics are irrelevant. Advanced maternal age, maternal obesity, pre-existing maternal disease? It doesn’t matter because the counseling and treatment plan are always the same: you can and should have a homebirth.

Medical history is irrelevant. Had a previous shoulder dystocia, C-section, postpartum hemorrhage? Who care? You can and should have a homebirth.

Complications are irrelevant. Baby is breech, have gestational diabetes, colonized by group B strep? Who cares? You can and should have a homebirth.

Labor complications are irrelevant. Dysfunctional labor, prolonged rupture of membranes, pushing for 4 hours? Who cares? You should still stay home because you can and should have a homebirth.

Why do homebirth midwives have a one size fits all approach to pregnancy and childbirth?

Two reasons: ignorance and dogma.

Homebirth midwives are lay people. They basically acknowledge that fact by calling themselves “experts in normal birth,” since most laypeople could easily deliver a baby in the absence of risk factors and complications.

Homebirth midwives have literally no idea of the breadth of possible complications, the effect of various risk factors, the many variations of abnormal in pregnancy and birth. Moreover, they are not able to deal with risk factors or treat complications. If they acknowledge them, they will have to transfer the patient to the care of an obstetrician and lose the fee and the birth junkie high. Instead they paper over their ignorance by declaring that whatever happens makes no difference at all. It doesn’t matter that they cannot anticipate, diagnose and manage complications when everything is a “variation of normal” and the treatment is always to forge ahead with a homebirth.

Ultimately, though, it comes down to the dogmatic cult-like believe in unmedicated vaginal birth. They appear to be unable to fathom the concept that childbirth is dangerous for both babies and mothers. Just like the flat-earthers maintain that the world is flat because that’s the way it seems to them, homebirth midwives maintain that childbirth is safe because that’s the way it seems to them. It simply never occurs to them that their relentless emphasis on unmedicated vaginal birth can and does kill babies and mothers. They literally cannot accept the evidence that is right in front of their eyes, so they deny it (“some babies are just meant to die” sounds so much more soothing than “we tried so hard for a vaginal birth that we killed the baby”), or, in the case of homebirth midwifery leaders like Melissa Cheyney, they tell bald-faced lies about it, claiming that their own hideous death rates are “safe.”

Women who are contemplating homebirth need to ask themselves whether they value obstetric care, which is personalized to their specific circumstances in this specific pregnancy, or whether they’d prefer a one size fits all approach. Obstetric care is personalized because the goal is a healthy mother and a healthy baby. Homebirth midwifery is one size fits all because the goal is unmedicated vaginal birth; if the baby and mother survive without injury, that’s simply a bonus.