Friday, July 17, 2009

Homebirth in the Hospital

I recently finished reading a new book called Homebirth in the Hospital (watch for my full review in the fall issue of CfM News). The book proposes an "integrative" model of childbirth--integrating natural childbirth with modern medicine. Interestingly, immediately after finishing the book I happened to come across the website of an OB practice in New York City called Village Obstetrics. With the tagline "minimally invasive obstetrics," this practice seems to be exactly the sort of integrative practice proposed by Stacey Marie Kerr in her book. I thought it was a neat coincidence. I was especially interested in the practice statistics on the Village OB site--they are excellent! (And it goes to show that when providers are proud of their stats, they have no trouble sharing them. It is a red flag if you ask a practitioner about their stats and they "aren't sure" or an unwilling to reveal them to you.) Without including scheduled cesareans (which appeared to be for legitimate reasons), they have a 6% cesarean rate (+ an additional 15% for various reasons)!

The Homebirth in the Hospital book doesn't address statistics specifically, but I assume physicians following that model would have similar, lower rates of interventions. (Do note that there are other things on the Village OB site, such as encouragement of continuous monitoring, that do not seem consistent with an integrative model.)

I finished the book (and the OB practice's site) feeling like a "homebirth" in a hospital is most definitely not for me (not really enough like homebirth at all!), but also feeling glad and optimistic that there are medical care providers out there who are seeking to practice in integrative ways that respect birth and women. I also am fully aware that the vast majority of American women give birth in hospitals and I think we desperately need other hospital-based healthy birth options to meet those women's needs!

I was also reminded of a section in the book Birthwork that addresses complementary care:

Parents who have quite comfortably given birth naturally and taken responsibility for their health are often perplexed by the zeal with which the medical model is upheld and promoted...Conversely, ardent natural birth activists can similarly perplex and infuriate those who have been grateful for necessary medical help their received when they gave birth in a hospital.

Like all great systems of belief, the revelations and tools of borth modern medical birth and natural birth are there to be embraced by those who choose to embrace them, and to be kindly offered to those who may benefit from them. We need to begin by negotiating the confusion that exists around the availability and right to medical help for a planned natural birth, and the availability and right to birth naturally within a medical setting. Rather than insisting on one right away, we need to appreciate that different systems of care can be complementary and helpful to one another. They can work together.
This section also reminded me of the recent study from the Netherlands about the safety of homebirth and how their maternity care system is is much more cooperative than we see here as it promotes access to midwifery as well as a good transportation and referral system (which necessitates working, egalitarian relationships between care providers).

CfM Blogger

1 comment:

Donna Ryan said...

I read the same book recently and even had the opportunity to meet Dr. Kerr at the Controversies in Childbirth Conference held in Ft. Worth in March 2009. I enjoyed hearing her speak and appreciate her message, but unfortunately, there are just not enough doctors out there who feel the same way or have had the same experiences with birth to cause them to view birth in the same light. Dr. Kerr is a family practice doctor, which, unfortunately, is becoming harder and harder to find who does OB. Her message at the Conference was geared towards family practice docs who are too scared to go into OB because of malpractice insurance rates. Who can blame them? We have created a mess!

I was intrigued by the name of the book, but ultimately, none of the births in the book really resembled birth at home. They all had intervention of some kind. I recently heard a doula comment that the first intervention takes place the minute you leave your house!