Ask Dr. Amy

Dear Dr. Amy -

I'm writing you here because I'm pretty sure you wouldn't publish anything that I write on your blog, since it seems that you pretty ruthlessly censor opinions that don't fall in line with your own. I suppose maybe somewhere in your blog lie the answers to some of my questions but to be very honest, I have no desire to go read your blog, so I'll just ask here. I have to wonder - why you are so vehemently anti-homebirth? Some people think you are an ACOG plant, stirring up the internet so that when women search "homebirth" they'll find your "information" before they find something more balanced. I think that's probably pretty unlikely. Since you don't actually practice medicine (and since it appears you aren't even licensed) I know it isn't because of things you see in practice (did you even ever practice anything related to maternity care?). Did you or someone you care about have a bad experience with a planned homebirth? Are you conflicted about the choices you've made in childbirth? A lot of women are, you know. Usually the sort of rabidly biased information that you present about homebirth comes from an emotional base(or a financial one, like ACOG's but I don't think you are losing money when women plan homebirths), not an intellectual one . I have to assume that there's some irrational basis to your hatred of homebirth for you to so willingly ignore the body of research about homebirth, for you to depend on intellectually feeble arguments against the safety of homebirth, because I'd like to assume that you are, in fact, a reasonably intelligent person. Do you really believe research done in Europe isn't legitimate? Of course a lot of the research on homebirth has been done outside of the U.S., with such a low homebirth rate here, its very difficult to do studies on it in the U.S. (not to mention pretty much impossible to get a study on homebirth published in one of the obstetrical journals!) I'd guess the Dutch and other European countries would be saddened to hear that their research and medical care is so substandard (I suppose the editors of The Lancet and the British Journal of Medicine would also be surprised to learn that their selection process for papers is so flawed), since we can't really admit their homebirth studies into the discussion. I wonder how you'd respond to the argument that midwives aren't capable of knowing pathology when they see it because they aren't trained in how to treat pathology if the argument was turned against physicians -- its irresponsible to see a Family Practitioner, rather than a Cardiologist because we all know that Family Practitioners don't have the training to treat something like heart disease. Of course, that's ridiculous -- Family Practitioners specialize in basic medical care -- well-care visits and minor illnesses and injuries and they know very well when to refer to a specialist (at least that's my experience with them, and I have always used a Family Practitioner as my primary care-giver). If you can think about it logically, it actually makes a lot of sense that a trained midwife (if a midwife is CPM qualified, she is very well trained, maybe you might want to go look and see what's involved with NARM credentialing) would be very good at seeing when a pregnancy or birth is deviating from normal -- and she would have no real incentive to ignore that. I've never quite understood the argument against homebirth based on "what we see when they transfer from home" because I'd expect the transfers to not be normal births anymore...if they weren't complicated, then they'd never be seen at the hospital in the first place! I have to assume that you've never actually met a midwife or a woman who's chosen homebirth because you seem to have a very odd notion of what we are like. I'm certainly not hippy and I'm definitely well-educated (I'm also a doctor, though a Doctor of Veterinary Medicine, with a Master's of Science as well. I am currently licensed to practice and actually do practice in Emergency Medicine/Critical Care) . I'm not a religious fanatic, nor am I likely to follow some trendy craze blindly and most people I know plan hospital births. I could care less what some celebrity is doing, and rarely know what they *are* doing. Heck, I thought homebirth was something crazy women did until I started meeting real women who planned them. Turned out they weren't anything like I assumed. I wouldn't have had that much dreaded primary cesarean if I hadn't been persuaded that it was the safest choice to make for my babies because all of my planning for my births was based on the safest choice for myself, my baby and my family. I definitely didn't plan homebirths for some nebulous selfish experience. I haven't yet met a midwife who is desperate for more clients, so I know there isn't some grand push to "steal" patients from the OBs. The midwives I know would love to have a truly collaborative relationship with an OB, because it would allow them to provide even better care for their clients. I know I'd be furious if someone told me my professional standards of practice were going to be determined by some group other than my profession, and I'm going to assume that you'd feel the same way, if you were practicing. Why in the world then would it make any sense at all to not expect midwives to determine their standards of practice? AFtger all, no one knows better what a midwife is and isn't capable of than a midwife. Sure, there are fringe fanatics in the "homebirth" world...just like there are obstetricians who think a 50+% cesarean rate is ideal. I'd consider them to be pretty fringe fanatic too. But most people understand that a fanatic is just that -- and certainly doesn't accurately represent the group. Same can be said about "bad" midwives -- sure, they exist. So do "bad" obstetricians. Doesn't mean the whole group is incompetent or negligent. Maybe you are right and the maternal mortality rate in the U.S. isn't really going up, the increase really is just a product of better reporting. The problem is, even if you're right, it doesn't explain why our maternal mortality rate is so much higher than other developed countries (and a number of developing countries). That can't really be explained by a change in reporting, since its been a consistent finding for decades. Maybe it doesn't have much to do with the fact that the countries with the lowest rates of maternal mortality use a lot more midwives and have a lot more planned homebirths, but you've got to admit, it sure looks like there's a correlation there. No one has come up with a different explanation. I've yet to hear a homebirther say that planning a homebirth should be mandatory for all women, or even for all low-risk women. We all know that homebirth isn't going to be for every woman or even a significant number of them. Honestly, the vast majority of women I know who plan homebirths just want the choice to be one that is accepted and understood, and to not find themselves faced with increasingly onerous obstacles to something that really isn't anyone's business but theirs. So I don't know, Dr. Amy, you just don't make much sense to me. Which leads me to believe that perhaps, you just don't have much sense, not when it comes to birth choices. And that's a sad thing.