08/01/2007 02:18 pm ET | Updated Nov 17, 2011

Homebirth is Safe, But Should be Assisted

A recent Washington Post article describes a movement toward "freebirth," or unassisted home birth. It says, "Some experts worry that vulnerable or gullible women will be misled into thinking that giving birth alone at home is a viable, even reasonable, alternative. These mothers, they maintain, may not understand that calling 911 -- which many homebirthers cite as their emergency backup -- is a poor contingency plan when every second counts."

What really alarms people about "freebirth," or unassisted home birth? Is it the fact that women are shunning the hospital birth experience and choosing to give birth at home, or is it the fact that it is unassisted?

Obstetricians and the American College of Obstetricians and Gynecologists (ACOG) are against any home birth, claiming that it is unsafe. As the article states, "The college 'strongly opposes' all home births on safety grounds." But what is the evidence? In fact, the scientifically-sound evidence all suggests that homebirth, when assisted by a qualified midwife, is safe. In fact, the scientific evidence shows that homebirths assisted by midwives are safer than hospital births attended by obstetricians, and countries where more women give birth at home with midwives have lower maternal and infant mortality rates than the United States. What ACOG doesn't want the American public to know is that maternal and infant mortality rates in the U.S. are actually going up -- largely because obstetricians engage in interventions that are not evidence-based and haven't been approved by the FDA or the scientific community. (For example, the use of Cytotec against label to induce labor is common, in spite of explicit warnings against ever giving it to a pregnant woman. There is no evidence that the drug is safe for labor induction, and yet many doctors use it anyway, often without informing women of what they are doing.) Marsden Wagner, a MD and perinatal specialist has written a brilliant expose of the obstetric community that discusses these issues, and the scientific evidence, in Born in the USA: How a Broken Maternity System Must be Fixed to Put Women First. I'm surprised that the obstetric community doesn't have a price on his head.

That women are choosing to give birth unassisted suggests that many women know that something is amiss with the maternity care system. They want childbirth to be an experience that honors their personhood and doesn't turn them into patients when they are not sick. They don't want their birth experience to be dictated by surgical specialists who are not even in the hospital when they are in labor. But the scientific evidence suggests that it is births assisted by midwives, whether they occur at home or in independent birth centers, that are the safest alternatives to hospital birth -- not "freebirths." I had both of my sons in a birth center, attended by wonderful midwives who knew what to do when complications arose, and I felt honored and empowered by the experience. Women have always needed the support of other women in childbirth and the anthropological record shows this. As a culture, we need to affirm that fact, as well as women's needs to control birth rather than having it controlled by doctors, by educating the public about midwifery and making midwifery services a more integral part of the maternity care system.