Last week, the American Academy of Pediatrics released a new policy statement that, in part, called on members to “provide supportive, informed counsel to women considering home birth.”
That might not seem like a particularly bold position. But to Kristen Bernard, “it’s huge.” A midwife with River Valley Midwives, a home birth practice based in Northampton, she knows well the tension between home-based midwifery and the more mainstream practice of hospital-based births. But she also sees the effects of the increasing interest in home births. According to the Centers for Disease Control and Prevention, 0.73 percent of U.S. births in 2009 took place at home, a 29 percent increase from 2004. (Among white mothers, the increase was 36 percent.) In Massachusetts, the 2009 figure—0.43 percent—was below the national average, but still an increase from 2004. Bernard and her two partners attend 30 or 40 home births a year.
Home birthers, Bernard said, are “no longer the people who are outside the mainstream.” Many families, she said, opt for home births because it will cost them the same as a hospital birth but provide them with more personalized care.
The AAP, like the American College of Obstetricians and Gynecologists, maintains that “hospitals and birthing centers are the safest settings for birth.” But they note that women who do choose home births face “pervasive and systemic” obstacles—inconsistent regulations, a shortage of trained providers and a “lack of supporting systems”—that may contribute to the higher rate of neonatal deaths in home births reported in some studies. (Supporters of home births counter those studies with others that suggest the practice is as safe as hospital births.)
“Regardless of the circumstances of the birth, including location, every newborn infant deserves health care that adheres to AAP standards,” the policy states. Those standards include ensuring that healthcare providers have training in infant resuscitation, arranging in advance for the mom to be transferred to a hospital if necessary, and performing standard newborn screenings—all things, Bernard said, that she and her partners do. And, she added, they have good relationships with local hospitals and doctors, to ensure that mothers who end up in a hospital get the best care. “Our goal is not a home birth,” she said. “Our goal is a healthy mom and baby, and we’re really, really grateful that the hospitals are there.”