Homebirth Summit consensus statements: much ado about nothing

Organizers of the Home Birth Consensus Summit are trumpeting the nine statements of common ground that emerged from the meeting. According to the press release:

Although many of the participants represented stakeholders who have long been on opposite sides of the fence when it comes to the practice of delivering at home or in a freestanding birth center, the group was able to reach agreement on core sets of principles and to forge a shared commitment to quality maternity care for women and their babies in all birth settings.

Frankly, it is much ado about nothing.

Here are the statements statements:

  1. We uphold the autonomy of all childbearing women…
  2. We believe that collaboration within an integrated maternity care system is essential for optimal mother-baby outcomes…
  3. We are committed to an equitable maternity care system without disparities in access, delivery of care, or outcomes…
  4. .. [A]ll health professionals who provide maternity care in home and birth center settings have a license that is based on national certification that includes defined competencies and standards for education and practice…
  5. We believe that increased participation by consumers … is essential to improving maternity care…
  6. Effective communication and collaboration across all disciplines caring for mothers and babies are essential for optimal outcomes across all settings…
  7. We are committed to improving the current medical liability system …
  8. We envision a compulsory process for the collection of patient … data on key … outcome measures in all birth settings….
  9. We … affirm the value of physiologic birth … and the value of appropriate interventions based on the best available evidence to achieve optimal outcomes for mothers and babies…

The are so banal as to be nearly meaningless, and everyone agreed with them prior to the Summit. It put me in mind of a summit between two bitterly warring countries that is declared a great success because everyone agrees that … peace is good. There’s nothing substantive here and the most critical issues are not addressed.

I was interviewed by a reporter for Medscape about by impressions of the Summit results:

“On any substantive issues there was no agreement: The idea that women should have autonomy…that there should be some sort of standard,…everyone agreed on that beforehand as no-brainers.”

Dr. Tuteur takes exception to the summit’s wishes “not to examine, debate, or form a consensus statement regarding the evidence published regarding safety or maternal–newborn outcomes of planned home birth.”

“One of the things that I found most disturbing about the summit was that one issue was off the table from the get-go: there would be no discussion of whether home birth is safe, and that’s really the key issue,” …

I commented on the fact that the existing scientific evidence and state and national statistics show that American homebirth has triple the death rate of hospital birth for comparable risk women. The problem is so serious that MANA refuses to release the death rates for homebirth midwives.

“It does not take a rocket scientist to surmise that [the Midwives Alliance of North America’s] own data show that homebirth with an American homebirth midwife is not safe,” Dr. Tuteur noted. “Withholding that information from patients is both unethical and immoral.”

And, of course, I mentioned the inadequacy of the CPM credential:

“One thing that most Americans don’t realize is that American homebirth midwives have a pretend credential they give themselves, called ‘Certified Professional Midwife,’ and any similarity to Certified Nurse Midwife is confusing and deliberate, … There is no possible way that a high school graduate with a mail-order certificate is qualified to take care of anyone,” …

I am no diplomat (that’s no surprise to anyone who reads this blog regularly), so perhaps in the world of diplomacy it is a great achievement to hold a conference and announce you agree on a bunch of things that everyone already knew you agreed upon, while simultaneously refusing to address critical substantive issues. But it seems to me that this Summit was nothing more than a public relations ploy to elevate the status of homebirth midwives, giving the impression that they were “invited to the table” by the expedient of creating the table and issuing all the invitations.

The two principle issues in American homebirth did not produce consensus, and one was off the table from the start. The two critical issues, threshold issues on which everything else is based, are these: American homebirth increases the risk of perinatal death, and the CPM credential does not meet the standards of any other first world country. If homebirth advocates refuse to acknowledge or even discuss these issues, the results of any consensus summit are meaningless.


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