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Homebirth as the standard of care.

One of the most exciting aspects of the First International Conference on Homebirth held in London in 1987 was Janet Balaskas' formulation that birth at home is the standard of care by which all birth should be measured. Balaskas' radical formulation demands that we consider the unphysiological and sometimes inhumane birth practices of industrialized nations in the 20th century against the vast backdrop of women birthing through all time on this planet. Seen in the continuum of human history, modern obstetrics is only the briefest and most recent aberration from the global traditions that have led up to it.

But what about all the babies and mothers who used to die--and still do at alarming rates in countries with inadequate health services? The medical establishment would have us believe that the change from home to hospital is the reason for improved outcomes, but British statistician Margery Tew has shown that moving birth to the hospital is not the cause of the improvement. In her book Safer Childbirth? (New York: Chapman and Hall, 1990) she demonstrates that the years with the greatest shift to hospital birth did not show the greatest improvement. Rather, improved outcome is a result of improved hygiene, economic status, nutrition and access to prenatal care.

If birth at home were inherently more dangerous, how could the Frontier Nursing Service in Kentucky and the Chicago Maternity Center have had better statistics than the hospitals of their time? How could Holland have such exemplary statistics with 1/3-2/3 of all births occurring at home with midwives? How could The Farm in Tennessee have had 2000 births with statistics superior to those of current hospitals?

At this point the statistics are in (see studies cited on the next several pages). It is not the place of birth, but the health and preparation of the mother and the skill of the attendant which have the greatest impact on homebirth statistics. And it is precisely the training and philosophy of the attendant which have a negative effect on outcome: Tew showed that obstetricians had more problems with similar populations than did general practitioners or midwives (see Table I). The same was true in the Netherlands (see Table II).

Not only is birth at home not statistically more risky, but so many of the standard practices of hospital deliveries--IV's, stirrups, episiotomies, constant electronic fetal monitoring actually create problems (called iatrogenic conditions) which then require further interventions to try to correct. The fact that the cesarean rate is between 25-30% while the United States still ranks lowest of all industrial nations is a sign that our health care system is definitely not working.

Why is homebirth the "standard of care?" Because it shows us, without sacrificing safety, how birth can and should be physiologically, emotionally and psychologically for the birthing woman, the baby and her family. What can we learn from homebirth? We can learn the obvious things: that mothers and babies should not be separated after birth; that a woman does best when she is able to move about, to work with gravity, to eat and drink to maintain her strength, to feel comfortable in her surroundings.

Birth at home has been the transition thread between technocratic birth in which women were completely knocked out (pieces of meat from which obstericians delivered the baby) and birth which is more "family centered" in "home-like environments" called birthing centers. How far we have come from recognizing that birth at home is the standard of care was again evidenced by a newspaper article about the new ldrp rooms at a Detroit hospital. The director said the idea for allowing labor, delivery, recovery and postpartum to occur in the same room came from high risk women, who couldn't be moved about all the time.

When I had my first child at home nearly twenty years ago, it was almost impossible to find information on birth at home--Spiritual Midwifery and Special Delivery hadn't been written yet! And finding an attendant was no easy task. We asked ourselves if we were taking greater risks, and if it was even possible to deliver a baby without a shave and an enema!

Things have come a long way, baby. The American College of Nurse Midwives has started to include a training module on birth at home, and direct-entry midwives are more skilled and easier to find. Books, support groups and people who have given birth at home are easier to find. ICEA has issued position papers supporting both homebirth and midwifery. Articles in popular women's magazines mention birth at home as an option for some women.

If you are contemplating a birth at home in the '90s, we hope that this issue of the newsletter and the other services of Informed Homebirth will make your task easier, and we hope that your birth will be the best possible for you, your baby and your entire family. [TABULAR DATA OMITTED]
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Author:Baldwin, Rahima
Publication:Special Delivery
Date:Mar 22, 1992
Previous Article:Homebirth: The Essential Guide to Giving Birth Outside of the Hospital.
Next Article:Homebirth/midwifery safety studies.

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