Yet another article popped up today on midwifery - one of several over the last months. This one is an opinion piece in the New York Times. In it, seven contributors weigh in on the safety of home birth versus hospital birth - four obstetricians (one of whom is the president of the American Congress of Obstetricians), a certified nurse midwife, a certified professional midwife (who is also the president of the Midwives Alliance of North America), and a home birth mother. Not surprisingly, opinions are pretty clearly demarcated along professional lines, with OBs arguing that home birth is too risky and midwives (and mother) arguing that home birth is a safe alternative to the hospital.
Despite the frustratingly biased title (jeez, NYT), the opinion piece, for the most part, lacks the nastiness and contempt that the home versus hospital debate so often stirs up. The most balanced opinions are offered by Aaron Caughey and Marinah Valenzuela Farrell. Both acknowledge that no matter the location, there is inherent risk around birth. Caughey, chair of the department of obstetrics and gynecology and the associate dean for Women’s Health Research and Policy at Oregon Health and Science University's School of Medicine, asks what risk is acceptable, and concludes that "as long as women are being properly educated about the risks and benefits of location and birth, hopefully they are able to make a decision that reflects their preferences." Farrell, a certified professional midwife and the president of the Midwives Alliance of North America, reminds us that hospitals carry risk too - a reality that anti-home-birthers often ignore. Several of the contributors articulated the need for better collaboration and care integration among different provider levels.
The NYT opinion piece follows a strongly pro-midwife article that appeared in late January in the Wall Street Journal. Using the Frontier Nursing Service, a noteworthy midwifery and nursing program started in Appalachia in 1923, as an example, the WSJ article nails it when it explains what makes the obstetric and midwifery models so different:
The great strength of American-style obstetrics is in reacting to catastrophe. But we're terrible at preventing catastrophes before they happen. While our traditional obstetric mode is reactive, the style of midwifery [...] is proactive. A low-tech, high-touch approach has been shown to effectively lower rates of C-sections and early births in several modern cases. Moreover, this personal, coaching approach is the most effective way to address chronic problems like obesity and diabetes.
Like just about everything else in our culture, our "standard response to health problems in the U.S. is more: more hospitals, more highly skilled surgeons, more access to the top technology. But we know for sure that at least some of the increasing danger of birth has been driven by the medicalization of the process."