Homebirth in the Hospital: Book Review

I just finished reading Homebirth in the Hospital: Integrating Natural Childbirth with Modern Medicine by Stacey Marie Kerr, a family practice physician. Kerr has an unusual background for a medical doctor; she lived for several years on The Farm, gave birth to her first baby in a birthing clinic and her second at home, and then entered medical school in her mid-30s. She strongly supports the midwifery model of care in a hospital setting. Her book explains more about her approach to birth, which she calls "integrative childbirth." She argues that by integrating the midwifery model of care with the best that modern medicine has to offer, a woman can have the "best of both worlds."

Dr. Kerr's book begins with a brief explanation of her childbirth philosophies. Next, chapter 2 explains what she means by "homebirth in the hospital." Written specifically for expectant parents, she outlines five essential elements for a successful integrative childbirth: choice, communication, continuity, confidence and trust, and control of protocols. Dr. Kerr supports natural childbirth and encourages women to birth at home or in birth centers if that is what they desire. However, she acknowledges that most women feel safer and more comfortable in a hospital setting and that the empowerment of a home birth can still be experienced in a hospital setting. She writes:

If we combine the two styles, basing our initial care plan on the midwifery model and using the medical technology only when necessary to save lives and to serve the needs of laboring women, we have a true integration: the best of both worlds.

The integrative childbirth model increases patient safety and decreases the physician's risk of liability be creating a strong focus on the individual and her family. Clear communication decreases the risk of litigation by improving patient satisfaction and involving patients in their own care. It is important to remember that technology should never replace experienced human attention during the birthing process.

When the midwifery model is applied, between eighty-five and ninety-five percent of healthy women will safely give birth without surgery or the use of instruments. Medical interventions come into play as part of sensible monitoring during pregnancy, labor, and delivery, but only if they're clearly necessary. In reality, intervention is often inappropriate and may actually be harmful when used purely for convenience or profit.

After these two introductory chapters, the bulk of the book contains fifteen different birth stories, including those of Kerr's two children. Each story is told through the words of the parents. Kerr also offers a brief introduction and commentary to each birth story. Some of these births were with Dr. Kerr, while others were with other integrative family physicians.

Kerr concludes with a chapter written specifically for physicians on how to practice integrative childbirth. This chapter largely repeats what was written in chapter 2. She stresses the same key elements--communication, continuity, confidence and trust, and control of protocols--from a health care provider's point of view. She reminds her physician readers that integrative childbirth is not only safer and more satisfying for the mother; it also can be more rewarding for the physician and, because of the enhanced communication and trust between physician and patient, leads to fewer malpractice suits.

I would recommend this book for pregnant women who are seeking mainstream medical care or who, due to certain circumstances, cannot choose an out-of-hospital birth. It explains how the judicious, rather than routine, use of medical technology is appropriate. For those women already immersed in natural childbirth/midwifery/home birth/unassisted ways of thinking, the book is less useful.

Now for some nit-picking: I do have issues with the phrase "homebirth in the hospital" and with the idea that a hospital birth with an integrative physician is "the best of both worlds." Kerr argues that the key elements of home birth are "satisfaction and empowerment." With that perspective, you can transpose the feeling of a home birth to any location. However, there are other elements of giving birth at home that cannot be transposed to an institutional setting. One could certainly argue that, however satisfying or empowering, a hospital birth can never be a home birth. Not to say that one is inherently superior--just that they are inherently different, and to respect that difference. Some of the best elements of a home birth cannot really exist in a hospital setting, and likewise some of the best parts of modern medicine--especially its strengths at responding to life-threatening emergencies--cannot exist at home. The idea that there is a "best of both worlds" implies that there is an ideal way to approach childbirth, rather than acknowledging that what is best for one woman might be terrible for another.

I also worry that women who read this book may become lulled into a false sense of security that they can "have it all" when, in fact, most physicians do not practice like Dr. Kerr. I know some fabulous family doctors who do, but they are usually rarities in their communities.

Despite these concerns, I am glad that Dr. Kerr has written Homebirth in the Hospital and hope that it will inspire more physicians to adopt integrative medicine. I also hope that it will spur women into thinking more critically and carefully about their maternity care choices.