There's a battle brewing between physicians organizations and midwives who perform at-home births, and TV personality Ricki Lake has been dragged into the fray. She and filmmaker Abby Epstein came out with an interesting documentary in January called The Business of Being Born, which takes aim at doctors for treating every birth like a "potentially catastrophic medical emergency." The film included footage of Lake giving birth to her second son in the bathtub of her Manhattan apartment. Last weekend, the American Medical Association issued a resolution against home births at its delegates meeting and explicitly criticized Lake.
Making the case for home births, Lake and Epstein issued a joint response yesterday on the Huffington Post:
In fact, the largest and most rigorous study of home birth internationally to date found that among 5,000 healthy, "low-risk" women, babies were born just as safely at home under a midwife's care as in the hospital. And not only that, the study, like many before it, found that the women actually fared better at home, with far fewer interventions like labor induction, cesarean section, and episiotomy (taking scissors to the vagina, a practice that according to the research should be obsolete but is still performed on one-third of women who give birth vaginally).
The AMA was spurred into action by a recent statement from the American College of Obstetricians and Gynecologists that said that "the safest setting for labor, delivery, and the immediate post-partum period is in the hospital or a birthing center within the hospital complex." Clearly, physicians are worried about all those things that can go wrong unexpectedly, like the baby being in distress or the mom hemorrhaging after birth. But reproductive health blogger Amie Newman wonders what gives the AMA the right to legislate how a woman gives birth. And I'd like to know what role financial incentives play in all of this; some doctors' livelihood could depend on whether they maintain control of the childbirth process. Another resolution introduced at the AMA meeting concerned the regulation of nurse midwives who perform home births. The AMA—rightly, I believe—wants to standardize the practice of nurse midwifery and ban self-taught, nonformally trained "lay" midwives from delivering babies. The organization would like all midwives to go through the training and certification process defined by the American College of Nurse-Midwives and is planning to lobby states to adopt legislation to this effect.
This may be all very well and good, but nurse-midwives are a dying breed. Their malpractice insurance rates have skyrocketed in recent years, making it impossible for many to stay in business. States like New Mexico that have caps on damages insurance companies must pay when doctors are negligent don't have the same caps in place for nurse-midwives, so many have been forced to pay exorbitant premiums to get higher coverage than doctors. It seems to me that the AMA should put its muscle power behind lobbying for lower malpractice premiums for nurse-midwives—who, after all, handle the lowest-risk pregnancies—just as the association has stepped in to standardize the practice of nurse midwifery.
When I was pregnant with my third child eight years ago, I opted to go through labor without pain medication. Since my doctors weren't keen on natural childbirth, I consulted my friend Debby, who worked with a midwife practice as a birthing assistant. She taught me some breathing and relaxation techniques for those painful contractions, which, in addition to my super-quick labor, saved me from the epidural. Sad to say, the nurse-midwives Debby worked for are no longer in business. Their malpractice insurance rates simply rose too high for them to earn a decent wage.