Are Home Births Dangerous?
AMA Says Women Should Use a Hospital -- Some Doctors Disagree
By AINA HUNTER
July 11, 2008—
The American Medical Association has agreed to support proposed legislation that, some physicians say, could make make having a planned birth in one's home difficult, to virtually impossible.
As of now, no actual legislation has been drawn up, but the AMA has agreed to back a measure called "Resolution 205," a request to support the American College of Obstetricians and Gynecologists' (ACOG) position that home births are not safe.
"We are against home births, period," said Gregory Phillips, an ACOG spokesman.
Women who give birth outside of a clinical setting risk putting themselves and their newborns at risk, Phillips told ABCNEWS.com.
In an e-mail to ABCNEWS.com, AMA board member Steven Stack, MD, wrote that the AMA "stresses that the safest setting for delivering a baby is in the hospital or a birthing center within a hospital complex."
The influential medical groups -- AMA and ACOG -- now find themselves at odds with those who say women should have the choice to give birth at home or in a hospital.
The American College of Nurse-Midwives has issued an unequivocal statement in support of planned home births, citing a study in the British Medical Journal that showed home births to be no riskier than hospital births.
Although only about 1 percent of babies born in the United States are born outside of a hospital, the debate has been framed in some circles as a battle between our country's troubled medical system and mothers-to-be who want to break free of it.
ACOG's call for support came after the release of "The Business of Being Born," a recent documentary by former talk-show host Ricki Lake, in which she depicted the final stage of her pregnancy, up to the point of giving birth.
Lake chose to have her second child at her home in New York's West Village with the assistance of a certified nurse midwife. She explored, on film, the thought process behind her decision.
But it may have been the documentary's criticism of the medical establishment, both explicit and implied, that rubbed ACOG the wrong way.
Phillips said ACOG's decision to ask the AMA to support legislation to curtail home birthing -- as well as the prospects for what he (and many other physicians) consider under-qualified "lay-midwives" -- had "nothing to do with Ricki Lake."
Yet, in the ACOG proposal to the AMA's annual June conference, Lake was called out by name.
Abby Epstein, the film's director, told ABCNEWS.com that the point of the documentary was not to vilify OB/GYNs. She said that Lake's first birth was "fantastic" and was performed at a hospital birthing center. And, as the documentary explained, she added that she, herself, had complications that made it necessary to perform a c-section in a hospital.
But that does not mean that the tone of the documentary was uncritical of typical hospital-birth protocol.
"What the film has done is to cause a lot of women to choose midwives over OBs -- especially younger women who've never heard of midwives," said Epstein. "We've received calls from midwives saying that their practices have doubled since our film was released. There's a lot of ego in this -- that one would want to choose a midwife over an MD. It's really a turf war going back 100 years between the medical establishment and midwives."
Phillips said ACOG's goal is not to criminalize home birthing. Still, the group's moves may leave key questions unanswered: If the medical group wishes to let the public know how it feels about home births, why not simply issue a public service announcement? Why the call for "legislation?"
The relevant section of Resolution 205, which received the AMA stamp of approval, suggests "that our American Medical Association support the recent American College of Obstetricians and Gynecologists statement 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, that meets standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, the Joint Commission, or the American Association of Birth Centers.'"
One of ACOG's dissenting members, Dr. Stuart Fischbein of California, told ABCNEWS.com he has no doubt ACOG wants to ban home births. Even if officials never pass legislation, the effect of their statement -- now approved by the AMA -- will have a chilling effect on the practice, he said.
"This will trickle down to the insurance carriers. If the AMA says home births are dangerous, fear of litigation will cause insurance carriers to refuse to support doctors who oversee midwives," said Fischbein, who oversees four midwives in addition to his regular practice.
The effect, Fischbein added, would be that he and other doctors would be forced to drop midwives who perform home births.
ACOG has also received letters from other physicians, including Dr. Lauren Plante, an associate professor of obstetrics and gynecology at Thomas Jefferson University in Philadelphia.
Plante wrote that she was "dismayed to read the ACOG statement opposing home birth, and specifically disallowing any support for individuals that advocate home birth."
Plante added that "home birth remains a viable option in several developed nations where birth outcomes are excellent. I personally know several ACOG members who, themselves, have chosen to deliver at home."
In a letter to the ACOG board, Canadian ACOG member Dr. Andrew Kotaska wrote, "If ACOG and the AMA are passive-aggressively trying to coerce women into having hospital births by trying to legally prevent the option of home birth, then their actions are a frontal assault on women's autonomy."
Yet, there are at least as many doctors who stand on the other side of the fence, who believe that, until more studies are done in the United States, ACOG and the AMA are on the right track.
Dr. Erin Tracy, a delegate to last month's AMA convention and an OB/GYN who works out of Massachusetts General Hospital in Boston, told ABCNEWS.com that even in healthy women, potentially fatal complications can arise that can only be successfully resolved in a hospital setting.
"I worry about the small percentage of women who have unpredictable complications," she said. "The studies are conflicting. My fear with home deliveries is that, even in the best, most capable hands, a home doesn't have the equipment needed to save a life in an extreme circumstance."
Tracy emphasized that, although the AMA's resolution calls for legislation, at no time in the conference was there any talk of criminalizing women who have home births.
Nevertheless, that's what it looks like to home birth advocates like Debbie Young, president of DONA International, an organization of doulas.
Doulas are assistants who give emotional support and look after the physical comfort of the delivering mother. They generally work in hospitals and birthing centers alongside doctors and midwives.
Young said her 5,500 members wouldn't be professionally affected if legislation was passed, but they are "all about patient choice. We want women to be able to choose for themselves."