Experts Object to Homebirth Despite Recent Canadian Study

Although two new studies from Canada and the Netherlands found that home births were as safe as hospital births among low-risk women, Erin Tracy of Massachusetts General Hospital argues that the findings can't be extrapolated to the USA.

In Canada and the Netherlands, midwives who attend home births must have at least a bachelor's degree, which is not the case for all U.S. midwives, says Tracy, a spokeswoman for the American College of Obstetricians and Gynecologists, which opposes home births.

In the USA, certified nurse-midwives and certified midwives, both of whom are represented by the American College of Nurse-Midwives, will need master's degrees in midwifery to take the test for accreditation beginning in 2011. According to executive director Lorrie Kaplan, her college has accredited 11,500 certified nurse-midwives and certified midwives.

But a third group, certified professional midwives — who only attend home births — has no minimum formal education requirements.

According to the North American Registry of Midwives, which accredits certified professional midwives, they have varied educational backgrounds, ranging from self-study to college- and university-based midwifery programs. Certified professional midwives are allowed to practice in all but 10 states and the District of Columbia, according to the registry.

Source

Citing safety concerns, the American College of Obstetricians and Gynecologists (ACOG) has campaigned against home births, distributing bumper stickers that say "Home deliveries are for pizza."

And the American Medical Association's House of Delegates last year passed a resolution stating that "the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex."

Researchers in Canada and the Netherlands published two large studies concluding that among low-risk women, planned home births attended by qualified midwives appear to be as safe as hospital births. The new studies have fueled the debate but have not convinced ACOG.

For one, says Erin Tracy, ACOG's delegate to the AMA, the studies weren't large enough. Problems are infrequent in childbirth, no matter where it takes place, so only "really large numbers" could reveal whether the home truly is as safe as the hospital, says Tracy, an OB/GYN at Boston's Massachusetts General Hospital.

"The majority of patients ... might get away with it," she says, but low-risk pregnancies can become high-risk in minutes: A baby's shoulder might get stuck in the birth canal, or heavy bleeding could necessitate a blood transfusion for the mother.

Patricia Jannsen, the University of British Columbia researcher who is the lead author of the new Canadian study, notes that it included all 862 planned home births attended by midwives in her province from Jan. 1, 1998, through Dec. 31, 1999. Canada was the last developed country to regulate midwives, she says, and 1998 was the first year British Columbia women could opt for a home birth with a regulated midwife.

Source