Agreeing to disagree on homebirth is like agreeing to disagree on seatbelts: deadly and wrong.

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Dr. Whitney You, a maternal fetal medicine specialist, writing on the Huffington Post suggests: Maybe We Should Agree to Disagree: A Perspective on Homebirth.

It’s not that she thinks homebirth is safe; she doesn’t.

I am not in favor of home birth. I believe the safest place for a laboring woman is in a hospital or birthing center. Labor and the associated complications are not predictable. When potentially life-saving interventions are delayed because a woman is laboring outside a hospital setting, the consequences can be catastrophic…

She wonders whether agreeing to disagree on homebirth can be beneficial by maintaining the relationship between doctor and patient, thereby maintaining the potential that the doctors may influence the patient to make safer choices.

In an era where patients are seeking information beyond the advice of a medical provider and are vying for control of their medical care, medical professionals need to learn how to enter conversations where their recommendations may not be followed. Attempting to dissuade a convinced patient can be alienating, pushing the patient further away, and driving a chasm between the patient and provider ultimately benefiting no one. It is still the job of the medical community to offer information and voice a recommendation. Sometimes coming along side patients in shared decision-making, even when it goes against medical advice, may offer a chance for the best possible outcome.

But if we’ve learned anything from the vaccine debacle, it’s that agreeing to disagree is both ineffective and dangerous.

Why? Because homebirth, like anti-vaccine advocacy is not about science, it’s about an unmerited sense of maternal superiority.

Homebirth, like anti-vax advocacy, is about privilege. Nothing screams “privilege” louder than rejecting the hospital obstetric care that the majority of women around the world are literally dying to have. The “empowerment” of homebirth reinscribes the privilege of the Western, white, well off women who choose it in the most obvious possible way. The entire homebirth movement is premised on the privilege of having a fully equipped and staffed hospital nearby to rescue your baby when you’ve screwed up by choosing homebirth.

Homebirth, like anti-vax advocacy, is based on the delusion of women who believe they have “done their research” and pose as “educated” despite the fact that they are astoundingly ignorant on the subject of childbirth. Homebirth advocates are no more educated about childbirth than creationists are educated about evolution. Neither group has done research; they’ve simply read propaganda, and both groups need to be disabused of their delusions.

Homebirth advocates need to understand that they have been hoodwinked by an alternate world that bears no relationship to what science actually shows. Just about every premise of homebirth advocacy — that childbirth is inherently safe, that interventions are dangerous, that interventions interfere with breastfeeding and bonding, and that obstetric emergencies always allow for enough time to get to the hospital — are utter lies.

Obstetricians MUST explain to homebirth advocates that their fundamental assumptions are fabrication by the homebirth movement and that the only people who claim homebirth is safe are those who profit from it. I’ve corresponded with all too many women who have lost babies at homebirth, and if there is one common theme it is that these mothers never realized the massive gulf between what they were told and the actual scientific evidence. Obstetricians MUST explain what the scientific evidence really shows, and MUST encourage women to view homebirth advocacy with the same skepticism they would view any industry promoting its products.

Homebirth, like anti-vax advocacy, is a matter of life and death. Agreeing to disagree with homebirth advocates sends the WRONG message: that their claims have merit. Would we agree to disagree about carseats for infants? Would we agree to disagree about bicycle helmets for children? No, we wouldn’t because we recognize that children’s lives depend on parents understanding the deadly risks. The fact is that choosing homebirth is more deadly than forgoing a carseat, or letting children ride bicycles without helmets.

Finally, though every patient deserves to be treated with respect, every idea does NOT deserve to be treated with respect. Homebirth, like any other choice that places children at risk of death, is unworthy of respect. That’s why we must not agree to disagree on homebirth.

  • Daleth

    I just came across this gem of an essay by a New York first time mom who hired a midwife for her home birth. Guess what happened? Thankfully no one was hurt, but get this:

    “Two weeks later, I gave birth at home, after a 13-hour posterior, or back-to-back, labour, which the long-practising, well-respected midwife did not bother to attend. Frankly, it felt like staring death in the face, by which I mean an altogether normal and intense physiological process that has nothing to do with the ordinariness of daily life. Throughout, my husband and doula repeatedly called and texted the midwife, whom we had found privately. She told us it was “probably” early labour. From inside the grip of what turned out to be very active labour, I managed to flat-out demand that she join us, speaking at the phone while the doula held it to my ear. The midwife sounded annoyed, vaguely put-upon. It was another three hours before she arrived.”
    http://www.theguardian.com/lifeandstyle/2015/mar/14/my-friend-breastfed-my-baby-elisa-albert

    • Daleth

      PS Almost the same thing happened to my mom, who hired a CNM for my home birth. The CNM went home around midnight to get some sleep, saying I wouldn’t arrive until dawn or later… which in her book apparently meant it was fine for her, as a professional licensed midwife, to leave a first-time mother in labor with nobody there but her husband (himself a first-time father). And of course she was wrong; I arrived well before dawn.

      • demodocus’ spouse

        *Shudder* Obviously, it worked out for you and your mom, but the possibilities!

  • Lion

    Hmmm. I don’t know. I know someone who is a bit hippyish. She went off to one OB and said she wanted him to be a back up doctor for her home birth (hypno birth, kiddy pool the works). He yelled at her about how irresponsible she was. She found another OB, he listened to what she had to say, told her he didn’t feel it was safe, gave her the reasons, said he knew he couldn’t do much more than give her information and encourage her to be influenced by the information, and that if she did have a home birth and needed emergency care at the hospital, he would happily be there for her. She went back in the third trimester and he encouraged her to bring her midwife with, she went with, at the scan it was discovered that baby was breech. He talked to both midwife and my friend and she went in for a planned c-section with him. He is the same doctor that spoke to her so nicely at her child’s six week check up that she decided to vaccinate her child (and the second one too – who he delivered by VBAC). I know not every doctor has the time to sit and talk like that, and she wasn’t mad, she was open to hearing what he had to say, but it did make a difference. He took an agree to disagree approach and at least one of his patients came around to agreeing. Just one story I know, but niceness has its place.

    • Lion

      I don’t use mad in the American sense of angry but in the South African sense of being somewhat off centre in one’s thoughts.

    • Francesca Violi

      I also think that many times niceness can go a longer
      way than shaming, scolding etc, but niceness has nothign to do with validating a patient’s unsafe choice… In your story the second OB told the woman that HB was not safe and provided her with information in the attempt to make her change her mind. In other words, he openly disagreed with the patient’s choice and tried to dissuade her; even more so when they found the baby was breech. He did not agree to disagree on Homebirth, it seems to me… just disagreed, though in a very nice and effective way.

    • Amazed

      Frankly, I think it’s incredibly arrogant of mothers to barge into a random OB’s office and ask them to be a back up OB. So I am not your first plan, huh? Not good enough to trust me with the process but good enough to drag you from the steaming pile of shit, literally? You want to give your trust and money elsewhere but I should be on standby in case Your Highess needs emergency care? You don’t trust me enough to become my patient but you want me to be your servant in case your chosen provider isn’t capable of performing adequately. And then I should possibly spend the next 18 years of my life waiting for a lawsuit because I couldn’t be the superhero you envisioned when the steaming pile emerged? Just how arrogant should one be?

      I am not saying that any of this should take place in the conversation. I don’t think so. But niceness is a two way street. Your friend wasn’t nice in putting such a demand in the first place. Now, politeness is a must.

      On the other hand, perhaps the doctor has recently been nice to another mother and it didn’t end well – not for the sacred birth plan but the health of both patients?

      I wonder what the OB who agreed to be the back up would have done if your friend had insisited on homebirth. Perhaps waiting with a bated breath and praying that she’d not be rushed to the hospital with an ambulance. Or perhaps he was like Dr Sears who so caringly lets his patients’ parents not vaccinate. If I remember correctly, a little girl became very ill but her well-off, well educated parents didn’t want antibiotics and being the nice doctor he is, he didn’t push for such a treatment. The kid became sicker. But hey, he’s all nice!

      Niceness is overrated. Politeness is a must.

  • Dr Kitty
    • araikwao

      Shared this. Will probably offend some people, but hey, maybe it means a couple of strung-out parents might not buy their kids homeopathic teething remedies or something. Edzard Ernst is so great!

  • Young CC Prof

    This is so timely. I attended (heckled) a quack nutritionist’s speech today, and, after proving within the first ten minutes that said quack didn’t know a thing about biology or chemistry, the audience was angry at me. For pointing out that the person there to scam them had no relevant knowledge or qualifications.

    Example: “…So you need to look out for pesticides and toxins.”

    “Which ones?”

    “What?”

    “Which pesticides are most dangerous, and why?”

    “Oh, um, I don’t know.”

    Well, maybe some of them listened. At the very least, I may have discouraged them from hiring her by making it clear that she was an amateur.

    • Beh. Unfortunately, they’ve already convinced themselves of the danger of TOXINNNS! and logic doesn’t beat fear when it comes to pseudoscience.

      I fucking LOVE that you shut them down, though. I wish more people did that.

    • lilin

      I’ve found frequently that one of the best techniques ever is asking questions. “Why? Which ones? How does that work? Exactly what is it made of?”

      A real expert won’t even realize you’re “heckling” (if that’s what you are doing). They’re used to being asked questions and often the challenge for them when making a speech is figuring out how to condense and select the information that will guide laypeople through a concept. Elaborating on a concept when asked about it is nothing.

      • Young CC Prof

        Afterward, I asked myself, how would I feel if a ringer snuck into my classroom and asked me questions designed to make me look ignorant? And I concluded that such a person would probably fail, and if he or she succeeded, I’d deserve it.

        Besides, I’ve already taught highly gifted teenagers. If they couldn’t make a fool of me…

        • Sue

          Paradoxically, people who really are up on their specialist area and are confident in their competence generally aren’t thrown by being asked curly questions, or admitting that they dont know.

          It’s the ones on shaky ground who get defensive when challenged.

          • lilin

            Yes, experts are also happy to admit when they don’t know something, and will either throw out a few ideas (specifying that they’re just ideas), or tell you where you can find more information on the subject, or tell you that, currently, no one knows.

            It’s possible to ask questions in such a way as to ruin a person’s presentation and try to make them look stupid, but just plain questions asking for more specification or examples or the mechanism of an effect? If someone has put in the work, that doesn’t phase them at all.

        • Dr Kitty

          I teach medical students occasionally- if we have extra time I ask them if they have any burning questions about anything at all- more than happy to try and answer them, or find out the answer for them next time if I don’t know off the top of my head (which does happen!). TBH they’re usually a bit terrified to be put on the spot, but often come up with some really interesting things to ask.

          It amazes me that anyone who considers themselves to be a professional would find that threatening.

        • Ceridwen

          I’m not sure about you, but every time I teach a class, even when it’s for the 8th time, I get asked questions I’ve never been asked before. Sometimes I know the answer without looking it up, and sometimes I tell them I’m not sure but I’ll find out the answer. I’ve never felt a fool though, because I don’t act like I know the answer when I don’t. That’s when you get into trouble. If you don’t pretend to know things you don’t there isn’t any shame in telling someone that you’ll look up the answer and get back to them. The quacks pretend to know it all. It’s what makes it so easy to out them as morons.

      • Montserrat Blanco

        When I do a presentation I try to make things as easy as possible and leave time for questions. I LOVE answering questions and I think it is better if the audience can choose what are they really interested in and so they ask about that. If you only talk about something you really know, as it should be, it is usually easy to answer the questions.

      • Medwife

        An expert’s response would be more like, “woohoo, a chance to geek out!”

    • The Bofa on the Sofa

      Example: “…So you need to look out for pesticides and toxins.”

      “Which ones?”

      “What?”

      “Which pesticides are most dangerous, and why?”

      “Oh, um, I don’t know.”

      The difference between real expertise and blowing smoke.

      When I give talks, I will sometimes be vague or general in some statements. In these situations, sometimes there will be people who ask for specifics. And in those cases, my response is to tell them about it in all the gory detail.

      The reason I can do that is because I am actually talking about stuff I know, and I stick with stuff I know. The person described above is sharing platitudes, not knowledge.

    • Alcharisi

      I shudder to ask–what sort of position was she up for?

      • Young CC Prof

        No, she was giving a “free” public lecture to recruit for her business.

        • Alcharisi

          Aha. You had me seriously worried that she was up for a job in higher ed somehow.

  • Dr Kitty

    OT
    http://m.bbc.co.uk/news/uk-scotland-glasgow-west-31831591
    An appeal court in the UK has awarded almost £6million to a young man who suffered a birth injury.

    His mother is a type 1 diabetic, the risk of macrosomia and shoulder dystocia were never discussed with her and she was not offered an elective CS.
    She went on to have a severe Shoulder dystocia that took 12 minutes to resolve, causing catastrophic damage to her son.

    The appeal court has decided that even though it would have been accepted practice at the time not to discuss the risks of VB and offer CS, she still had a right to know and would have been likely to choose a CS had she been so advised.

    It’s a landmark ruling, at least as I understand it.

    • theadequatemother

      Hey DrKitty how are you feeling? Better i hope.

      • Dr Kitty

        Yup, definitely getting there!
        Weaning off the Zofran, still on Cyclizine. Actually gained a little weight.

        • Montserrat Blanco

          Great! I am really glad to hear it!

        • Amazed

          You rock! All the good to you!

        • Mishimoo

          Awesome!! So glad to hear that things are getting better for you!

        • Ceridwen

          Glad to hear! I’ve been wondering about you as I go through my own pregnancy sickness hell. I made my first attempt at weaning off Zofran this week. It was a failure. Maybe next week. Still down 4lbs but starting to be able to eat enough that I suspect it will be back soon.

          Hope you’re able to be off meds soon!

    • Roadstergal

      Dr Kitty – just trying to understand the system there better. Was she seeing an OB instead of a midwife because she’s automatically high-risk as a T1D?

      • Dr Kitty

        Yes. But an OB who clearly thought that CS was less good for women than VB.

  • Amazed

    He’s there! He commented on the article! His Awesomeness, in all his glory, in person! *rushing to take my Amos Grunebaum Number 1 fan out to go worship at his feet*

    Without mincing words, he latched onto Dr You’s warped perception of “not a nuisance on society, so it’s all roses and peaches”.

    I adore this guy.

  • mostlyclueless

    Also OT: can we expect a post about the new ACOG consensus guidelines? I’m really interested in hearing what ACOG plans to do about OB’s tee times if OBs start letting women labor longer. That is what ACOG is REALLY concerned about, right?

    http://www.acog.org/Resources_And_Publications/Obstetric_Care_Consensus_Series/Safe_Prevention_of_the_Primary_Cesarean_Delivery

  • OT: I’m annoyed…yesterday I had a twitter exchange with a dyed-in-the-wool homebirth advocate who was convinced the evidence was clear homebirth was safe or safer than hospital birth. Her qualification: BA in anthropology. I bolstered my information with links to blogs written by doctors (Dr. Amy, The Adequate Mother, Doula Dani, etc.) with references to the peer reviewed literature on the “evidence”. She refused to look at the blogs – and told me that “I should do my research”, go straight to the academic journals, and watch “The Business of Being Born”…. ARRRRGGGGHHH!!!! This is how we got here – where the word of midwives and Ricky Lake somehow trumps that of someone trained to actually read the scientfic literature and form an opinion on it. In other news Soo Downe’s UBC lecture on “normalizing” birth seems to have been welcomed with nothing but acclaims.

  • Amy Tuteur, MD
    • Amy M

      Huh–it seems to show that people (at least those who don’t know each other well) in small groups, are inclined to equality bias. I agree that all patients need to be respected, but not all opinions do, and we’ve seen plenty of times where people in NCB world conflate the two. Suggesting that something is a bad idea is equivalent to saying the person who thought it is stupid, in their world. Then we see the echo chambers, “supportive comments only, ” “no bashing, ” etc….

      While the article is about giving equal weight where its not warranted (anti-vaccine, climate change denial), which is a little different, some of the reasons are the same: no hurt feelings allowed. Its nice that people don’t want to hurt each other’s feelings, but when there is a possibility of harm done, feelings can’t/shouldn’t be the top priority.

      • Bugsy

        “but when there is a possibility of harm done, feelings can’t/shouldn’t be the top priority.”

        Yes. It’s interesting to me how in the NCB world, the possibility of emotional harm is more concerning than that of physical harm.

        • Lizzie Dee

          I think there is a far amount of emotional harm in finding out the hard way that “Low Risk” is a very provisional assessment.

          • Bugsy

            I would agree, but think that for many/most of the NCBers, there’s a belief that something bad generally won’t apply to them. If you believe hard enough in your body and maintain a positive enough outlook, you can overcome birth hardships.

            (I don’t believe it for a second, just paraphrasing the sense I’ve gotten from online discussions.)

      • Michele

        “Suggesting that something is a bad idea is equivalent to saying the person who thought it is stupid, in their world.”
        Currently watching something similar happening on a forum I belong to that has agree/disagree voting buttons on posts. It’s not uncommon for people to conflate “disagree” with “dislike” (which is not a voting button option) and to complain they feel attacked when others vote disagree on their post. It’s not enough that there’s an option on the forum to hide the disagree button (so that you don’t see whether people have clicked disagree), some people want to ban it entirely to keep others from even having the option to vote disagree.

      • Roadstergal

        That, to me, is the critical part of a science education. Learning to take questioning of your ideas as a _good_ thing, and that being open to changing your mind makes you a better person. How on earth can you expect that all of your ideas are good ideas, and that they will remain good ideas for all time?

        • Froggggggg

          Yes! It’s all become too personal – “I’m entitled to my opinion” seems to be the be all and end all, and if you disagree, even with facts on your side and in a respectful, non-personal manner, you’re the bad guy. It’s an attitude I’ve never understood (I generally don’t mind admitting when I’m wrong, either… and boy, have I been wrong about a number of things!)… Of course we all have opinions, whether they are backed up by facts or not, but why would you want to close yourself off to learning more? People who do that are missing out.

          • anh

            agree times ten. I remember people calling me a “bully” when I very vehemently disagreed with a girl who claimed the HIV rate was higher in the US than it was in Sub-Saharan Africa. The kept saying “but she is entitled to her opinion!!”

          • MegaMechaMeg

            I remember this one time I saw a picture on the internet of a white and gold dress and my friend was insisting that it was blue and black. I asked him what shade of blue he saw and he accused me of bullying. Weird day.

          • The Bofa on the Sofa

            Other person: “Marijuana is illegal. ‘Nuff said”
            Me: “Actually, marijuana is legal for medical usage in some parts of the country, so it’s not so obvious”
            Others: “Stop with the unfair personal attacks”

          • Dr Kitty

            Asking WHY marijuana is illegal, when tobacco and alcohol are legal, is a much more interesting conversation.

            Legal doesn’t always equal “less harmful”, just as illegal doesn’t necessarily mean “more harmful”

          • The Bofa on the Sofa

            This was a discussion about marijuana for morning sickness. In that case, the comment that it is allowed for medical usage is even more poignant.

            Shoot, it’s not like I even was supporting it (mj use), I was just pointing out that “it’s illegal” is factually questionable.

            But that was a personal attack.

          • Young CC Prof

            Even if it was still 100% illegal in all states, “It’s illegal” is a perfectly good reason not to do something right now. It’s not a reason to stop talking about it. Otherwise, how could we ever change laws?

          • Oh yes! I’ve just started flippantly responding with “you are entitled to your opinion, but not your own facts. If you can back up your opinion with actual facts, we can talk. Otherwise, you’re just believing something because you want to, and I don’t want to talk to you about this because you aren’t anchored in reality on it and I’m just going to make you mad if we keep talking about it.”

        • KeeperOfTheBooks

          Honestly, it seems to me to be a crucial part of education, period. I’m a pretty conservative Catholic, and I’ve learned more about my faith and its history through discussing (and researching in order to discuss) theology, philosophy, ethics, morality and so on with my atheist/agnostic friends than through any other channels. Sure, we disagree at the end of the day, sometimes strongly so, but we’re also very well-informed about that which we disagree.
          None of us really understand this whiny “you disagree with me, therefore you must be attacking me personallyyyyyyy!” nonsense.

  • attitude devant

    Dr. You, call me sometime. I’ve been at this longer than you, and I HAVE seen it all. The message your patient is going to take away from all of this is that you think her homebirth and her undertrained caregiver are just fine, and that the hospital is waiting there if she needs it. I kid you not.

    We had in my area a big homebirth meeting with the midwives to try and encourage them to follow evidence based risk guidelines and to call us before things got dire. In return they asked us to standardize our intake of their emergency transfers, and to meet with them outside the patient’s room before doing our assessments. Good, right? NOPE, because the midwives turned around and told their patients that we were backing them up, thereby using our goodwill to legitimize their practices and give their clients a (very) false sense of security.

    • Goal: Harm reduction.
      Result: Increased risk taking.
      Sorry to hear this.

      • Young CC Prof

        This seems to happen a lot with the woo. You try to control it, to make it safer, and that just drives more people into it.

    • CrownedMedwife

      I’m curious how a meeting between OBs and HB midwives was arranged and the tone of the meeting. Was there followup communication to clarify that the intent of the meeting was to discuss risk guidelines and improve transfer procedures to mitigate the risk of Homebirth attempts and NOT to condone Homebirth or imply backup?

  • Emily

    After my 5th consecutive pregnancy loss I had a consultation with a reproductive endocrinologist. I asked about the Beer’s protocol and specifically about Ivig therapy. He told me that Beers was a quack, that he never published his research, that ivig won’t prevent recurrent loss and that those blood products are needed for seriously I’ll people. He respected my intellect enough to protect me. He agreed that desperate times can feel like cause for desperate measures but did not want to see me flying to the east coast for a very expensive treatment that had been proven not to work. OBs should have the same concern and candor when discussing home birth.

  • Trixie

    You hit the nail on the head with this one, Dr. Amy.

  • Stacy48918

    “Finally, though every patient deserves to be treated with respect, every idea does NOT deserve to be treated with respect.”

    THIS x 100000000000000000.

  • Julie Ann

    You know how you hear “babies die in the hospital too”? But do they? Working as an L&D nurse for 17 years (now retired) of course we saw babies who had died, fetal demises, preterm, congenital defects, ect. Rarely did a baby who was healthy on admission die. I can think of only one. It was a huge event for all of us even if we hadn’t taken care of the patient personally.

    • Sue

      IN particular, babies who start the exit process well very rarely die INTRA-PARTUM in hospital.

  • Anonymous

    I’ve had this exchange a lot:

    “I’ve done my research and I’m not convinced that vaccines are safe.”
    “I see, and what was the topic of your dissertation?”
    “My dissertation?”
    “I’m assuming you have a PhD in Pharmacology, or Immunology or, baring that, an MD or DO right?”
    “No, well, I’ve read some books.”
    “Ah so my graduate, undergraduate, and field training are trumped by that then?”

    This is usually where they shut down.

    OT, but did anyone notice the subtle dig at homebirth on Family Guy?

    • Roadstergal

      The one where Stewie got pregnant? If there was anything subtle in that ep, I missed it…!

      “Call my doula!”

      “What’s a doula?”

    • Bugsy

      Sometimes I wonder how many books they’ve read on the topic. Usually they’ve read a bunch of anecdotes and blogs from the internet in forming their anti-vax mentality…

      • Sue

        Also, people who have “read lots of books” generally mean populist books written for lay people, not text books, and certainly not high quality research articles in their fully detailed format.

        • Amazed

          Of course it isn’t “high quality research”. They – well, we – wouldn’t understand it since they – well, we – don’t have the background.

          Anti-vaxxers claim of having read lots of books is worse than reading one of those cute de-aged adaptations of the Illiad and think you’ve read Homer. At least pseudo-Homer won’t kill anyone. And at least those who read it don’t think they know better than those who actually TEACH said literature.

  • What if, every homebirth incurred a fee for having the hospital be “on-standby” in case of an emergency? I mean they expect the hospital will be there, ready and waiting – what if they were required to pay for that “ready and waiting” status. Then the relative financial benefit of homebirth would be reduced and the likelihood of choosing it for that reason would be lessened.

    • Inmara

      There should be affordable hospital care available in the first place. I have read some bloggers who had homebirth not because they believe in underlying ideology (OK, they most probably believe and trust their midwives but they were not birthing at home for the sake of “being natural”) but because that’s what they could afford without going into debt. That’s sad and that should be fixed before implying higher costs for homebirths.

      • Guesteleh

        I find it hard to believe that people choose homebirth because of cost. Medicaid pays for 40% of the births in the U.S. For the people who don’t income qualify for Medicaid they can work out a payment plan with the hospital or frankly just walk away from the bill, which happens a lot. I don’t know a single poor woman who has had a homebirth with the exception of a woman who had her first baby at home in Guatemala. Baby died and she had the next one in the hospital. Here in the U.S. a hospital birth is an option for everyone despite what the homebirth propaganda machine tells you.

        • The Bofa on the Sofa

          Seriously, they can afford to drop $4K on a homebirth, but can’t afford health insurance? Something doesn’t add up.

          • Kelly

            And somehow they have that money upfront. We are having our third a bit earlier than expected and I am already on a payment plan with my OB. I will again be on a payment plan for all the other bills once we have the kid. I can’t afford to just drop four or five thousand and we are doing pretty good financially.

          • Liz Leyden

            If you live in a state that opted out of Medicaid expansion, and you make too much to qualify for Medicaid or a subsidized private plan, and you have no access to a plan through your job, or you employer’s plan does not include maternity care, a home birth could be cheaper than a hospital birth.

        • Inmara

          Well, I for sure can’t judge their options and situation as I’m not familiar with U.S. healthcare system and insurance, but that’s what they said. Maybe they didn’t evaluate all options fully before jumping into homebirth wagon.

          • The Bofa on the Sofa

            Maybe they didn’t evaluate all options fully before jumping into homebirth wagon.

            Or maybe they were using cost to rationalize their decision.

      • Young CC Prof

        Definitely, access and affordability are issues. ACA has improved matters somewhat, although not 100%.

      • moto_librarian

        There is a major flaw in the affordability argument, though. Homebirth is ONLY cheaper if you don’t transfer, and studies show that for it to be reasonably safe, there should be a relatively robust rate of transfer for complications. Anybody remember Ruth Fowler Iorio? She was absolutely livid that her transfer to the hospital for a pph so severe that she required blood products was $20,000. Having a home birth is a pretty significant financial gamble.

        • Inmara

          Living in EU country, I simply can not imagine situation where people are charged for _emergency_ medical assistance. I’m really sorry for all families who have to deal with that especially if they don’t have access to affordable insurance plan and emergency occurs not because of bad choices (like homebirth) but just because it’s, you know, emergency.

          We have the exact opposite scenario – homebirth is for fee (government doesn’t subsidize it and I guess most insurance companies doesn’t cover it too) whereas emergency care is free of charge. That gives kind of false security for homebirthers and quite annoys hospitals because they have to deal with such cases without warning. Due to small population, professional midwifes and prenatal care, and very small fraction of births at home we haven’t had any fatalities yet in assisted homebirths but I guess it’s only matter of time and dumb luck.

          • The Bofa on the Sofa

            Emergency medical service cannot be refused for inability to pay.

            It might bankrupt you, but you can’t be refused.

          • Francesca Violi

            Here in Italy it’s the same, meaning, delivery in hospital is free for everyone, homebirth costs around 2.-3000 euros, only in some regions you can get a partial refund. I’ve just read the guidelines of a HB midwives association here, and they seem very stern in pre-selecting eligible homebirthers, and dictating when you have to transfer to hospital. Actually in their website they push on the birth is not a disease pedal, but going through the detailed guidelines meant for midwives themselves I realized that in each and every stage of labour, delivery, and postpartum there is plenty of things that can go wrong so you have to transfer… I mean, not only the obvious things like stalled labour, foetal distress or PPH, also smaller deviations from safe ranges, like palcenta failing to come out within a certain time, or lacerations too big for being sutured at home. It seems to me that if HB is performed within reasonable safety standards, there must be a very high rate of transfer. So I think that’s why in Italy it is not such a common thing, it’s expensive and you have a good chance you will end up in hospital anyway. And having to transfer during labour or shortly after delivery seems much more stressful than going to hospital in the first place.

          • moto_librarian

            I wholeheartedly agree that people should not be denied emergency medical treatment due to cost. No one is denied care at the point of need. As Bofa said below, you may well be expected to pay for it, which I also think is barbaric, but it will not be denied.

    • Therese

      As long as hospitals actually took steps to be “ready and waiting” for homebirth transfers. Otherwise, I’m sure it would lead to them being sued and the parents would have a much stronger case if they had paid the hospital to be ready for their transfer and the hospital wasn’t.

      • The Bofa on the Sofa

        As long as hospitals actually took steps to be “ready and waiting” for homebirth transfers.

        The problem with “being ready” for homebirth transfers is that it requires things like preliminary exams and communication, before the activity is even started. So the hospital has to have things like bloodwork taken care of and even pre-registration. Otherwise, what could they be doing to be “ready and waiting” that isn’t already part and parcel of the ED? Having an ambulance in the house’s driveway? Yeah, get a HBer to agree to that.

        • attitude devant

          ‘Ready and waiting’ essentially works out to not turning away a pregnant woman in an emergency. Seriously, it’s really hard to do intake on a midwife patient. They often don’t have the records, and when they do, the records may be fanciful or falsified, and the most essential stuff is bound to me missing. And THEN you have a patient who doesn’t want IVs, doesn’t want monitoring, doesn’t want labs…. It can be a nightmare.

          • Criminal sanctions: failure to keep medical records, falsifying medical records, etc.

  • Roadstergal

    Looking forward to the Seatbeltplace study, where the risks of driving without a seatbelt on residential suburban US streets in the middle of a sunny Sunday are not statistically different from driving with a seatbelt under those conditions, and all of the social media moms crow that driving without a seatbelt is always safer than with. And really, seatbelts restrict your ability to move around, and interfere with bonding.

    Anyway, it’s an apt comparison – if I had been driving without my seatbelt all this time, I could point to tens if not hundreds of thousands of automobile trips I took that turned out just fine seatbeltless.

    • ModerateMom

      I think of that all the time. My current car has 100,000 miles on it, the vast majority driven by me, and most with my kids in the car. Never once were the seatbelts or car seats actually needed to prevent injury…and if we had been in an accident, in most cases a hospital was no more than 10 minutes away! We would have been so much happier and more comfortable without them, and they aren’t even necessary.

      • Inmara

        Unfortunately seatbelt analogy is very true in the sense of small risks versus big risks. I know more than few people who dismiss seatbelts because they have heard that cousin’s wife’s nephew’s friend survived in accident because of not wearing seatbelt whereas other people in the car died. Yeah, that happens (though rarely) but risk of being injured or dead because of NOT wearing seatbelt is much higher. Yet no evidence and statistics will convince these people. They are deliberately taking high risk (i.e. not wearing seatbelt or birthing at home) to avoid extremely low risk (i.e. injuries because of seatbelts of some infection catched in hospital).

        • Roadstergal

          Yes, this, exactly. And there are indeed advancements in place that make surviving an accident without a seatbelt more possible (crumple zones, airbags, better communication for more rapid first response), but it doesn’t change the fact that just wearing the seatbelt is a simple way to head it all off in the first place – much like all of the advancements in emergency obstetric care make a disaster much more survivable, but avoiding the disaster in the first place by being in the hospital and intervening rationally should be preferable.

          • Cobalt

            Also the unpredictability of accidents, even if you do everything “right”. You can be a safe, sane, sober driver, but that doesn’t guarantee anything. Brakes fail, other people miss signs, etc. A few years ago there was a semi accident near where my sister lives. The semi driver had a heart attack and the truck flipped over on an overpass, with ensuing additional wrecks and chaos.

            Shit happens. It’s not about ‘if’, it’s are you ready for ‘when’ and ‘how bad’.