Who to believe: Ricki Lake or the American Academy of Pediatrics?

How safe could homebirth and waterbirth be when pediatricians, those who know the most about the health and safety of babies, are opposed?

It is an article faith among homebirth advocates that homebirth is as safe or safer than hospital birth. It is an article of faith among many of them that waterbirth is a safe and gentle method of entering the world. It is an article of faith among natural childbirth advocates that NCB is better for babies. It’s all rather astounding when you consider that pediatricians have gone on record that birth in a hospital or an associated birth center is the SAFEST place of birth.

The Guidelines for Perinatal Care published by the American Academy of Pediatrics (AAP) and American Congress of Obstericians and Gynecologists (ACOG) state that:

the hospital, including a birthing center within the hospital complex, or a freestanding birthing center, provides the safest setting for labor, delivery, and the postpartum period. The use of other settings is not encouraged. Further, any facility providing obstetrical care should have the services listed as essential components for a level I hospital. This includes the availability of blood and fresh-frozen plasma for transfusion; anesthesia, radiology, ultrasound, electronic fetal heart rate monitoring and laboratory services available on a 24-hour basis; resuscitation and stabilization of all inborn neonates; nursery; and other services that are not available in the home setting.

It’s difficult to be clearer than that. There is no hedging or equivocation. Pediatricians insist that hospital is the SAFEST SETTING and that homebirths should be discouraged. Why? Because safety demands electronic fetal heart rate monitoring, personnel and equipment for neonatal resuscitation and a nursery staffed by nurses who can monitor even well babies.

The AAP is, if it is possible, even more strongly oppoesed to water birth. The American Academy of Pediatrics Committee on the Fetus and Newborn released a comprehensive report in 2005 that waterbirth is not safe for babies. The report, Underwater Births, states:

The safety and efficacy of underwater birth for the newborn has not been established. There is no convincing evidence of benefit to the neonate but some concern for serious harm. Therefore, underwater birth should be considered an experimental procedure that should not be performed except within the context of an appropriately designed RCT [randomized controlled trial] after informed parental consent.

So pediatricians are OPPOSED to homebirth and especially to waterbirth on the grounds that they are unsafe. What about natural childbirth?

With the exception of fringe professionals like the Drs. Sears, pediatricians find no particular benefit to natural childbirth. It’s not safer, healthier or better in any way for babies. That’s because there is no evidence that pain relief in labor is harmful to babies, no evidence that electronic fetal monitoring is harmful to babies, and no evidence that vaginal delivery is safer for babies. In fact, the bulk of the existing evidence suggests that C-section is unequivocally the safest method of birth for babies.

It’s a trifecta! Pediatricians oppose homebirth, they oppose waterbirth, and they can find no benefit to natural childbirth.

But, hey, who are you going to believe when it comes to the safety and well being of babies? Pediatricians, whose sole concern is the safety and wellbeing of children, or Ricki Lake, Henci Goer, Jennifer Block and Barbara Harper, women who lack basic educations (or, in some cases, ANY education) in science, statistics or pediatrics whose sole concern selling DVDs, books, courses and anything else that will generate a profit?

It’s difficult to be more definitive than that: there is no evidence of benefits and the possibility of serious harm.