Tuesday, June 21, 2011

Open forum for the Home Birth Summit

Several blog readers expressed concerns or comments about the upcoming Home Birth Consensus Summit, to be held this fall. This post is an open forum for your comments/concerns/questions. I will make sure your input reaches Geradine Simkins.

If you were able to attend the summit, what would you say? What are the biggest obstacles you have experienced to home birth in general? In your own community? What would make it safer, more accessible, etc?

Speak up!


  1. Great idea, Rixa!

    What would I say:
    1. some women are choosing homebirth because they're afraid to go to the hospital. not optimal.
    2. some women are choosing homebirth because viable CPs in obstetrics do not exist. they either pressure women towards unnecessary interventions or refuse their requests w/o discussion.
    3. some women have "shadow care" with an OB because they're afraid they'll be treated poorly and receive sub-standard care if they need to transfer from home.
    4. women want and expect options these days.
    5. women with multiples and breeches are at high risk of being cut open. women with multiples and breeches are usually risked out of homebirth care even when it's what they believe is best for their families. this is wrong.
    6. women who desire to VBAC at home or a birth center should be able to and shouldn't be treated as exploding uteri waiting to happen.
    7. we need to take back vaginal breech birth. vaginal breechers will self select and are likely the best candidates for this version of normal birth.
    8. OBs, CNMs, and DEMs (CPM or not) must work together for the best outcomes.

    Well, that's what I've got off the top of my head.

  2. I like the list that labortrials made! I would also add that when we talk about homebirth we have to talk about hospital birth. Hospital birth is the norm in this country so a homebirth is a conscious choice NOT to hospital birth. What is happening or not happening at the hospital that drives homebirth choices? What is the treatment or lack of treatment that is being witnessed by patients, families, doulas, and other birth professionals in the hospital that leads women away from choosing hospital care for their births?

    I personally believe an awareness of high c-section rates is driving more and more women away from the hospital. They simply do not have faith that they will be allowed to labor and birth vaginally and the statistics seem to be on their side.

  3. Along with agreeing with a lot of what labortrials said, espeically with respect to improving hospital care. As someone who has looked into becoming a midwife someday, here are some things I see:

    1. We need a widely-avilable option for direct-entry midwife training that provides the same type of experience as those in many other developed countries--one that includes an academic curriculum and hands-on experience in both hospital and out-of-hospital birth. And it would be wonderful if direct entry midwives with hospital training were able to apply for hospital privileges, which would increase continuity of care for women who risk out of homebirth or transfer during labor.

    2. CNMs, both in hospital and out of hospital, need more freedom to practice without OBs breathing down their necks.

  4. I am in Georgia, USA. I had a homebirth this past April and it was wonderful - can't imagine having a baby any other way.

    I would like the direct entry midwife to be able to order blood tests.

  5. Just one quick thought:

    Often, I see articles posted online about the latest study about how homebirth is just as safe as or safer than hospital birth - but it's (of course) a study that's not from the US. Immediately, flocks of US Americans show up to say, "That's all well and good for them, but it's just not applicable to America for reasons X, Y, and Z."

    I know that you yourself are not US American, but my impression is that this is a US-centric conference and so that kind of attitude will pop up.

    I think it is a debate-silencing tactic. It just doesn't make any sense that home birth with a trained attendant would be safe in every country except for the US! I wish that instead of trying to find reasons why home birth in the US can't possibly be safe, they/we could try to find ways to make home birth as safe as possible. It's not an insurmountable task. The "it can never be safe her opposition" is often straight-up racism (e.g. "we have so many immigrants and that's different) or straight-up American exceptionalism (as if America is so radically different from other countries that we could not possibly make use of the solutions they've found).

  6. There needs to be a seamless way to execute an emergency newborn transfer. I would prefer to talk about my experience via email over public forums, but there were serious issues with execution that put my baby at risk, not the least of which was the midwife assistant (a CPM) arguing with paramedics on the scene, delaying transport.

  7. Linda Bennett7/23/11, 11:21 AM

    Dear Rixa, I am very pleased you will be going to this "Summit". It appears that my concerns have been dismissed by your statement in your blog:"some have already dismissed the summit as inherently flawed" I have not dismissed this "Summit". I think it is critically important that the forces opposed to mothers' choice of Home Birth are exposed for what they are. I prefer "Truth". This is not the time for a group agreement if the group includes forces opposing midwifery and home birth.

    I believe the weighting of the "Summit" is what stimulated concern. I prefer open communication and more of it, not less.

    These are my concerns as I wrote in my letter (slightly abbreviated here)about the "Summit":
    Subject: Home Birth Summit:
    Are you invited? Who is going?

    I have concerns about this "Summit." I want to encourage communication with invited participants the same way I have encouraged communication with our elected representatives. These participants have been appointed to represent the interests of mothers, families, and, coordinated by a midwifery group, I also assume the interests of midwives. I have every hope this will be the case. My long experience with some of the groups that have been invited raises some doubt.

    The "Home Birth Summit", scheduled for some time and some place in the Fall of 2011, is being coordinated by the organization called "Future Search". The ACNM originated and identified a need to hold this "Summit".

    The American College of Midwives has many CNM members who actively support families and mothers who want a low-tech physiologic labor and birth in the hospital, in birthing centers and at home. CNMs have demonstrated over and over the value of personalized physiologic management that dramatically reduces unnecessary major surgery while improving outcomes. Their work continues to be overlooked, ignored and impeded by Obstetric professionals in overt and subtle ways. If this summit was only held with these particular participants I would have little concern for the outcome.

    Unfortunately the ACNM also has very vocal and politically active members who oppose home birth and/or non-nurse midwifery on local and national levels. Here in Oregon we have the "Home Birth Safety" committee organized by L&D nurses and CNMs in Portland at OHSU for instance. Nothing they have done has improved home birth safety in Oregon, rather their actions have polarized the birthing community and has caused even more mothers to consider unassisted home birth for their VBAC attempts after multiple cesareans.

    It should not surprise the ACNM and Future Search organizers that home birth families, midwives with home birth practices, and long-standing Birth Activist groups and individuals feel uncertainty about the outcome of a "Summit" top-heavy with groups who have a history of opposition to maternal choice as well as to the independent practice of midwifery.

    We have a vested interest in this "Summit" as its pronouncements will be used against maternal choice at every possible opportunity. Statements made in any documents released as a result of this "Summit" will be entered into testimony for or against legislation affecting mothers, families, home birth and midwives across the USA.

    Is Lynn Paltrow invited? Her work with NAPW has been as one of the most effective advocates for mothers in the USA in the tradition of Doris Haire.

    The reality is that home birth exists in the form it is currently functioning in the USA because of what it offers mothers and families AND because of what hospital-based ACOG-controlled maternity care does not.
    Please communicate to individuals carefully selected for participation in this "Home Birth Summit". They have been selected to represent you.

    Linda Bennett
    retired Home Birth Midwife
    Home Birthing Mother
    Birth Activist

  8. Aside from what has already been mentioned: Birth needs to be covered by ALL levels of insurance (medicaid on up) no matter WHERE it takes place.

    Low income mothers should not be put at more risk simply because they can not afford the cash out of pocket expenses for a midwife. Especially since many of these mothers automatically qualify for medicaid.

    I would point out that the NHS is calling for MORE homebirths, because they are safer, and cheaper, for your average low-risk mother.

  9. I see a lot of comments about women choosing home birth because they are backed into a corner, and that makes me sad. MANY women choose home birth, because they, well, choose it. Many women choose to birth at home because they don't feel that birth is an illness that needs medical attention in the hospital. Many women birth without any formal attendant at all, because they trust their bodies to do just what they are designed for. Many women birth at home because they know that with our current ranking in infant mortality here in the U.S., their babies are safer if born at home. Do some women birth at home because they don't have better options? Of course. That's the very reason for my first home birth, and the very reason I became a Midwife. But after that? I birth at home because I know it's where I want my babies to be born. *Most* of my clients birth at home because it's what they WANT - not because they don't have better choices.

    I would really love to see some of the stigma taken away:

    1) Only super-crunchy women birth at home.

    2) Only women backed into a corner birth at home.

    3) Only women who do not have a better choice birth at home.

    4) Educated women will only choose Midwives with credentials, and ignore the Midwives who are traditionally trained and forgo credentials in order to serve more.

  10. Hi Rixa, I read with great pleasure that you will be a part of this event. I sent you a personal e-mail discussing some of my thoughts. Above all, if the conclusions of this panel are to be widely accepted, then secrecy has no place in any of the processes. Not in selection of attendees, motives, agenda, sponsorship or basis for conclusions. All of which will have a lasting effect on birthing options for decades to come. I have read Geraldine Simkin's letter of explanation about the process and am somewhat reassured. The biggest concern for many of us is skepticism when it comes to organizations like ACNM and ACOG which have been openly hostile to home birth saying this summit is about making it safer. Safety is always the alibi of tyrants and often a code word for controls and restrictions. That is their history. The best thing they can do for credibility is put stakeholders on the panel who are trusted and respected by those in the home birth world, like you!

  11. I would like to leave a longer comment at a later time; for now I am wondering how those of us who are interested can find out who else was invited and what stakeholder they are representing? What stakeholder group are you representing?

    Rachael McGraw CPM (currently inactive)

  12. One major thing that comes to my mind is the discussion about routes of entry for homebirth midwives, quality of education, and credentialing. If we want homebirth to be safe and accessible to larger numbers of women, we need more trained attendants. This is very clear.

    Training to be a CNM can cost $100K or more for a three-year program, and some of the CPM programs at MEAC-accredited schools are equally pricey. Homebirth midwives don't make money like doctors do, and being saddled with that much debt is a heavy price for the midwife to pay if she's moving to a rural community where she might only clear $40-50K/year and have a family to raise.

    If we can reduce the cost of training the attendants and get more trained attendants out there, it would make homebirth safer. One of my suggestions, if any of the Summit attendees is coming from an educational institution or an organization with a large endowment, is to consider how to make training more affordable and accessible.

  13. Ingrid Andersson7/25/11, 4:03 PM

    Thank you for this opportunity, Rixa. As you know, our planet is steadily warming: 2010 was the warmest year on record, and we've seen associated chaos across the earth. As you also know, federal and state governments are embroiled in unprecedented economic crises with no end in sight.

    I hope someone at the meeting can read the writing on the wall and pursue a proactive consensus around homebirth with the above in mind. Homebirth with a skilled midwife is a time-proven, sustainable model of maternity care and the rational response to energy and healthcare resource predictions.

    The real questions: how can we assure access to effective prenatal/birth/postpartum/newborn care for EVERY woman in a reality of unstable resources and mounting uncertainties?; what would/should a fully integrated homebirth system look like in America, as compared to the UK for example?; what would/should fully integrated midwifery education and practice look like?; do the new ICM core competencies apply?
    Ingrid Andersson, CNM

  14. Linda--I've been corresponding with others via email and so was not necessarily referring to your comment.

    Anon--feel free to email me about your transfer experience.

  15. Rachael, I'm actually not sure which stakeholder group I was selected to represent. I hear that the summit is getting a website ready with all names of applicants, a method for the public to give input and feedback, etc. I'll post about it once it's up and running.


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