Responding to the home birth debates

My latest column for RH Reality Check is up. With some serious hesitation I decided to respond to the conversation about the safety of home birth started by Michelle Goldberg recently at the Daily Beast. It’s been really challenging to see how polarized these conversations are, how vast the divide is between what feels like two camps: the home birthers (who are assumed to hate hospitals, obstetricians and people who use either) and the hospital birthers (who are assumed to hate midwives, home birth and people who use either). It feels like the potential for debate and rational dialogue is minimized because of this polarization. Maybe I shouldn’t be surprised by any of this. Anyway, my response is excerpted below.

A recent heated dialogue between journalists Michelle Goldberg and Jennifer Block about the safety of home birth has been the latest in a recent media flurry about the rise in home births reported by the CDC in January. A New York Times Magazine profile of Ina May Gaskin, arguably our nation’s most famous home birth midwife, was just one of the most mainstream of the recent articles, and seems to have stirred up much scrutiny of the practice.

I feel compelled to dip my toe into the conversation, if only to try and steer it in a different direction. The source of the back and forth between Goldberg and Block centers on this question: “Is home birth safe?” It’s not a new question; in fact it has been debated since the beginning of obstetrics and hospital birth at the turn of the 20th century.

Unfortunately, though, it’s exactly the wrong question to which to be devoting so much air time. A scant share of all women giving birth in the United States do so at home. Despite the reported 29 percent increase in home births nationally between 2004 and 2009, fewer than one percent of births happen out of hospital. While home birth gets much scrutiny, particularly when wealthy white women are seen as forging a new trend by choosing it, the place where the majority of women give birth in the United States — the hospital — goes largely un-scrutinized.

Hospital births do get a lot of attention in birth activist circles (where I spend significant time, as part of my work at Radical Doula). Midwives and doulas will quickly recite the problems with hospital birth, e.g., why high intervention rates (c-sections, inductions) are bad for mother and baby. But outside of that arena, where it’s arguably most needed, the conversation is stalled.

Here is the reason this matters: we are in the midst of a maternity care crisis. I’ve said it before, but I’ll say it again: our maternity care system is broken. Why? Because our maternal and fetal mortality rates are worse than 40 other countries worldwide, despite the fact that we spend more money than anyone else on maternity care. And where is  almost all that care being delivered? In hospitals.

Read the rest here.


What’s the connection between health care reform and midwifery care?

My first article is up at The American Prospect, about Certified Professional Midwives and health care reform. I talked to some amazing advocates in reporting for the piece, including Michelle Bartlett, an Idaho midwife who helped push through licensing legislation in her state.

Michelle Bartlett is not the typical Washington high-stakes health-care player. She’s probably not on the radar of anyone in Congress or the Obama administration. Bartlett is a midwife in Idaho, but in the last few years, she’s been trying her hand at lobbying. This came after a night spent in jail for using medication during a home birth she attended in 2000. Bartlett was the second midwife to be charged for this type of practice in Idaho, and thanks to her efforts, she will be the last in her state. “I’ve done a lot of hard things in my life, and giving birth was one of them,” Bartlett says. “But giving birth to a law was really hard.”

On April 1, Gov. C.L. “Butch” Otter of Idaho signed legislation allowing certified professional midwives (CPMs) like Bartlett to administer medication during births. Unlike certified nurse midwives who are able to practice in all 50 states and generally work in hospital settings alongside obstetricians, midwives like Bartlett are referred to as “direct entry” midwives, and practice exclusively outside of hospitals, mostly in homes or birth centers. These CPMs spend three to five years training and meet the standards for certification set by the North American Registry of Midwives.

State licensing fights may be the first step for these midwives, but it’s not their last. Now they’re turning their attention to the federal health-care reform debate, and a look at the maternity-related health-care costs quickly explains why. Childbirth is among the top five causes for hospitalization, and the No. 1 cause for women. According to Childbirth Connection, Cesarean section is the most common operating-room procedure, and in 2009 the C-section rate hit an all-time high according to the Centers for Disease Control and Prevention, at 31.8 percent of all births. These rates account, in part, for the increasing cost of maternity care in the U.S. Maternal and newborn charges totaled $86 billion in 2006, 45 percent of which was paid for by Medicaid. The federal government is already footing a huge portion of the U.S.’ maternity-care bill, and these midwives think they can help reduce costs significantly, and not just for low-income women.

Check out the rest of the article here.

If you want to join the advocacy efforts mentioned in the article, check out The Big Push for Midwives and The MAMA Campaign.

Livechat with me today about access to home birth at RH Reality Check


I’ll be doing a live chat with JayVon Muhammad, a Certified Professional Midwife, about access to home birth for low-income women at RH Reality Check today, Wednesday, at 12pm EST.

Information here.

Hope you can join!

Beautiful home birth video sells mattresses?

Via AFY_Mer at amplify, a beautiful video about a family’s home birth, complete with crowning shot. The catch? It’s a mattress commercial.

It’s a little hard to believe that home birth could be a selling point for mattresses, but who knows. I guess if I was going to give birth at home, in my bed, I would want a comfortable mattress. Either way I’m psyched to see this kind of imagery out there, and on the corporate dollar!

For those who don’t speak spanish, the tagline at the end reads: “Tu cama. El lugar mas importante del mundo.” which means “Your bed. The most important place in the world.”

Thanks to Kathy for the link

Help WNYC improve childbirth coverage

I got an email recently from a WNYC (NYC public radio) analyst about their new Public Insight Network. This seems like their attempt to really tap into citizen journalism and the expertise of the general public.

Housing. Transportation. Crime. Politics. The latest news from your borough – or your block. Whatever’s on your mind, WNYC needs your knowledge and experience to help our news programs stay connected to the issues that concern you. The Public Insight Network is a group of people from all walks of life who inform our news coverage.

You can help make our news coverage even stronger by joining WNYC’s Public Insight Network.

Or, you can share what you know about a subject we’re looking into:

  • Are you in favor of the plan to repeal the Rockefeller Drug Laws?
  • What special New York place would you landmark?
  • What’s driving the home birth movement in New York?
  • What’s news in your borough?
  • Are we a “nation of cowards” when it comes to talking about race?
  • What’s your personal connection to the Israeli/Palestinian conflict?

We promise that access to personal information shared with us will be restricted to a small group of journalists. The journalists may work for WNYC or for national programs like Marketplace and American RadioWorks. That means no spam, no marketing and no requests for donations as a result of signing up.

Here’s How It Works

As we look into various subjects, we will e-mail you and ask you to tell us about your experiences. If we’re looking into a medical issue, we’ll seek insight from doctors, nurses and patients who have direct experience with that issue. If we’re looking into education, we’ll talk to teachers and administrators as well as parents with school-age children. Your work, education and life experience, even your hobbies, give you knowledge and insight.

One of our Producers will pass on this knowledge to our reporters and editors. Network sources may reveal new angles on the stories we’re covering or may provide us with entirely new ideas. Reporters may follow up with you for quotes and comments for broadcast or online discussions.

As a Public Insight Network source, you can expect to receive an e-mail no more than once a month. If you don’t have knowledge about a particular topic, we’ll ask you to forward the message on to someone who does or simply delete it.

You can sign up here.

The Cost of Being Born at Home

Check out my latest article at RH Reality Check, The Cost of Being Born at Home:

Yesterday in New York City, Julie Finefrock appeared before the health fund subcommittee of the Service Employees International Union (SEIU) as part of her appeal of their denial of her homebirth coverage. Ms. Finefrock, who is six months pregnant, is married to an SEIU employee. Their insurance plan excludes homebirth coverage, despite New York State regulations that require that private insurance cover out-of-hospital birth with a licensed practitioner. Ms. Finefrock’s situation is just one example of a larger fight to increase access to homebirth nationally, and it’s a fight that has ramped up due to new media attention to the issue.

One mother laboring with her midwife on the roof of her Cobble Hill penthouse, gorgeous Manhattan skyline in the background. Another holding her newborn on her living room couch, exposed brick and high ceilings behind her. These are just two of the scenes from the November New York Times article and slideshow about the growing interest among New York City women in birthing at home. These images paint a very specific picture of homebirth–all the women were pictured in spacious, nicely decorated apartments and, with the exception of one African-American woman, all were white. Watch the popular Ricki Lake documentary The Business of Being Born, released last year, and you get a similar story: Lake and her interviewees were all financially well off and could afford to choose to birth at home. Neither the Times article nor Lake’s film touched on one thing that all these women seemed to have in common–money.

Read the rest here. Thanks to everyone who emailed me their thoughts and commentary. I really appreciate it!