I’ve been thinking today about the following statement contained in the AMA’s Resolution on Home Deliveries:
“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.”
Despite a large body of evidence attesting to the safety of home birth for low-risk women, the AMA continues to propagate lies about the danger of birth at home. Isn’t it amazing that the entire medical community will turn on a dime and stop supporting VBACs on the basis of one poorly designed study, yet turn a blind eye to the increasing number of studies supporting home birth as a safe option?
What is more, the illogic of the AMA amazes me. For a group of individuals who are supposed to be highly educated and skilled in critical thinking, they show a surprising lack of insight into their own argument that home birth is dangerous but delivery in an accredited freestanding birth center is safe!
As a midwife experienced in both home birth and birth center births, I can attest that this argument is absolutely ridiculous. During the time that I owned a birth center, I also maintained a home birth practice. Women could choose the birth location they were most comfortable with. A surprising number of women chose birth center birth because they dreamed of a home birth but felt “safer” in the birth center.
For some of my clients, I did feel the birth center was a safer location. I worked in an area where a number of my clients lived a long distance from the hospital–up to three hours away. If a woman did not have rapid access to a hospital, I would recommend the birth center because of its location only a block from the nearest hospital. Some women did not have a home setting they felt comfortable in–for example, a client who lived with her in-laws and wanted more privacy for birth. But in terms of safety, a birth center birth or a home birth with easy access to a hospital, are equivalent.
I had all of my emergency equipment and birthing supplies in portable bags which I used at either the birth center or at a home birth. I had the same trained support people helping at a birth, regardless of location. There simply is no difference in what happens in a birth center or a home birth. For any serious complication, both settings will require transfer to the hospital. There was nothing I could do for a woman in the birth center that I could not do for her in her own home.
The AMA demonstrates its own illogic by their assertion that birth in a freestanding accredited birth center is safer than a home birth. I would suspect that not one individual who drafted Resolution 205 has ever seen a birth center birth or a home birth. Once again, we have “experts” talking about things of which they have no firsthand knowledge.
Where is AMA’s evidence to the safety of institutionalized birth?
I suspect that in their minds, no evidence is needed, as they believe that hospital birth is the gold standard by which everything else should be measured. On the contrary, I believe that normal birth at home, allowed to occur without intervention, should be the standard by which we evaluate all our interventions to determine whether they are beneficial or not.
i couldn’t agree with you more. i also work at a birth center and have a home birth practice. in either setting we have no immediate access to surgery, the biggest risk of out of hospital birth! i don’t understand where that idea comes from that it is somehow inherently safer. is it because it’s a structure? a sort of institution in it! thanks for the post!
Could it be that homebirth can be unattended or attended? I think that it would be quite easy to sy that unattended homebirths would be less safe than attended homebirths, and if you lump them all together they would be less safe than birth center births (which are, defacto, attended). I’m just cheered that AMA acknowledges the merits of birth center births – it’s a start.