Home HealthHospital Administration

Economist Highlights the Home Birth Debate

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The latest issue of the Economist highlights the debate about home births (Is there no place like home?) and notes the charged atmosphere that prevails between supporters and detractors. They get it about right:

Stereotypes and simplifications are in rich supply. Many doctors think they are trying to curb a bunch of lentil-munching fanatics who ignore the dangers of something going suddenly, and badly, wrong in childbirth, when even a few minutes’ delay can be fatal. The home-birthers decry grasping, bossy doctors who turn a natural experience into a near-emergency needing medical intervention. Hospital births are more likely to end in Caesarean sections, and to involve episiotomies (cutting the perineum) and epidurals (which increase the odds that the labour will require forceps, which can tear the perineum).

The article points out that the research in the field is contested, and no one has proved definitively to disinterested observers which type of birth is better or safer. I’ve been at birthing classes where those who’ve had babies at home gushed about the experience. I also know someone who’s baby died when she delivered at home and the umbilical cord was wrapped around the baby’s neck. In the hospital I’ve seen medical errors and unpleasant experiences; but also stat C-sections after uterine rupture where the baby and mom turned out fine. Overall I think the debate between home birth and hospital birth advocates is productive as long as it doesn’t become too dogmatic. It’s made some OB/Gyn’s and hospitals more sensitive to the needs and preferences of birthing mothers, and some home birthers more open to the possibility that something could go wrong and the need to plan for that possibility. My own views on the matter are somewhere in the middle, tending toward the more traditional hospital-based approach, but with elements that de-medicalize the process and incorporate midwives and doulas. From what I’ve seen the major Boston teaching hospitals have embraced this approach to a fair degree.

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