“Babies deserve the best care they can get,” said Dr. Kristi Watterberg, neonatologist and lead author of the American Academy of Pediatrics (AAP) recent policy statement on home birth. “And we need to support women wherever they choose to give birth.”

Almost a year and a half ago, I shared the incredible story of getting to midwife my grand-baby Ariadne’s home birth. The most amazing aspect was the deepening of my bond with my daughter-in-law Sylvia Romm, and my son Iyah. Sylvia has a Master’s Degree in Public Health from Harvard, is a senior pediatrics resident at Harvard, and chose to have her daughter at home. This was a radical, yet carefully considered decision based on her interface with the medical community for prenatal care, and inaccurate test results that led her to question birthing in a conventional medical setting. While I made every effort not to influence her decision about birth place at all, she ultimately decided home was where she felt most confident for her birth.

In this interview Sylvia shares her decision to have a home birth with us, and we discuss the recent AAP policy statement. While some might accuse the AAP of being latecomers to the home birth conversation, and while there are limitations to their knowledge about the home birth model, this statement represents progress in the recognition of home birth as a viable, safe option, and is a potentially important step toward opening up more productive conversations between the conventional medical community and home birth practitioners and parents. This policy statement, in my opinion, acknowledges the safety of planned home births for low-risk moms. While the rates of home birth are still below 2%,  the 33% national average cesarean section rate and other escalating levels of hospital interventions are leading more women to consider this option.

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As you will read about in a forthcoming blog, 10 Steps to Maximize Home Birth Safety: Thoughts from a Midwife-MD,  the greatest risk associated with home birth, which is generally quite safe when mom is healthy and prepared, is a direct result of the illegality of midwifery in many states. This leads to variability in the quality of midwifery care, lack of access to, and lack of utilization of emergency medical care when home birth difficulties arise. Cooperative relationships between OBs, pediatricians, and home birth midwives can mitigate delayed transport or lack of appropriate use of medical care and enhance the safety of a potentially empowering, meaningful, and cost effective birth option for many women.

With much more to come on pregnancy, birth, and new mom care…

Please like this blog, share it with your friends and clients, and share  your wonderful questions and stories in the comments below.

Love,

AJR Sig

 

15 Comments

  1. Thank you Aviva for this post. I fully agree, and was very happy with both of my home births. I used an illegal midwife for my 2nd birth and feel that it’s wrong that she has to do her wonderful work in fear of prosecution by the law. Women most DEFINITELY should have the right to choose where and with whom to birth. And trained midwives are critical to this.

  2. Great post, and great news about the AAP’s slow turn-around. We are likely to benefit from the effects here in Canada too. I live in BC where home births are legal but still largely misunderstood, and I had both my boys at home (it had become legal shortly before I became pregnant the first time). My midwives were highly trained and competent and my first son and I did need a little oxygen and I needed a little extra oxytocin etc., but it was a great experience, especially the pre and post-natal care and having the choice to have no tests at all, no ultra-sounds – just everything on my own terms. For me, birthing my babies was the most empowering experience of my life.

  3. Thank you, Dr. Aviva! This post and the coming series is nothing short of providential for me. I have been praying and researching about midwifery and home birth for several weeks, searching for signs that it is the right choice for my next pregnancy (I have a tendency to anticipate the big decisions in my life rather far in advance). Partly because the hospital births of my two sons [particularly the Texas birth one year ago] were so discouraging and belittling; partly because we are preparing to transplant our family to Georgia; I want to be sure I have done everything possible to prepare for my next child even before my husband and I are ready to conceive. I’ve recently realized that part of being the best mom I can be for my children requires that I be much more pro-active and intelligent about our health-care. God has given me a healthy mind and an abundance of resources–so I intend to use them! I look forward to your blog series about choosing a midwife!

  4. I am from a traditional medical background and 6 months into pregnancy decided to get a midwife and have a home birth in rural Colorado (after a c-section 6 years earlier) for similar reasons of over medical testing issues and for my particular experience I wouldn’t do it any other way if I were to do it all over again! Just wish I would have had some more support from my doctor….he told me I was asking him to clean up a big mess if he were have to intervene! I totally respect and understand his perspective but I think for the right woman and the right setting it is soo much more healthy of an experience and it is a shame that there is not a bigger bridge between the two extremes of birthing! Thank you for your insight and for this video!

  5. Dear Aviva,

    Blessings to your beautiful little grand daughter .. blessings also to the so evident, beautiful bond you and your daughter-in-law share. Thanks for this interview and I am waiting to read the next part in this series!

  6. Great meeting your lovely daughter -in-law and precious grandchild.
    Just want to tell you also, that my daughter Anna is having her third child in October.
    Also,greetings to the family..
    I am so thankful for having my own home births. My first birth was in the hospital and ended in a c-section, the second was a natural birth in a clinic and the last 3 were born at home.. The home births were the best!
    Thank you for the path you are on. and the friendship we have shared.
    .

  7. Aviva, always a pleasure to hear you talk about anything. Thanks for this. FYI, here in California we practice legally as ‘Licensed Midwives’, and our regulatory agency is the Medical Board of California. The CPM (certified professional midwife) designation is not recognized as a stand-alone credential, even though most recently licensed midwives here graduate from a CPM program (only those approved by the medical board) and subsequently apply for a midwifery license after meeting several additional requirements.

  8. Hi,
    thank you for sharing this. Lovely to have more doctors having homebirths.
    I am also a doctor and had a homebirth during medschool and now in my final year government service while working in an obstetric ward. Interesting to hear colleagues opinions and I loved sharing my story with them afterwards. They would jooke about me going into labour during work and which dr would I like to deliver me! And I would just kind of grimace at the thought!! I loved my homebirths and am doing a presentation for the drs at work on hb. The big problem as you mention is the medical backup, here too – in South Africa,
    Thanks for your work,
    Love Gauri

  9. Aviva,

    just want to say that i am a deep admirer of all of your work… you are such a blessing to so many. this blog came to me at the very perfect time, as i am planning my next pregnancy and birth, and this was such a confirmation of the way i have been feeling. just wondering when the rest of the series will be coming, or did i miss it somehow?
    also, i would always “like” your blogs on facebook but do not have a facebook account, so please know that one person out there unaccounted for not olny “likes” your offerings but loves them.

    thanks so much!

  10. Thanks for posting this, Aviva! After my own grueling experience of overmedicalization during healthy pregnancies, I can fully relate to the sentiments of fellow moms who were robbed of their right to birth choice. I hope this information is found by many and is a great encouragement to them. Thanks for keeping it real (The goodbye kisses in the video were too darn sweet)!

  11. Hi Aviva

    It is a nice piece and I agree that home birth sounds ideal. I’d like to add something about c-section though. I know you very probably don’t mean that, but promoting home births vs. C-section rates (in a dichotomial way) sounds unfair to women, like me, who chose a hospital birth for various reasons despite knowing the caveats of the “normal” health care system – and ended up having an emergency c-section. It somehow makes it sound like we were entrapped in the system, and god knows that a unplanned c-section can be physically and emotionally traumatic for a mom, even if dearly necessary. So I guess my point is that not one solution is the best, and generalities hurt – the minority of women who really need a c-section is caught into the increasing stats of unnecessary ones – and are often looked down at by women who had a normal birth. I had to fight guilt and feeling worthless as I passed into review every detail of my pregnancy and labor that might have prevented it. Then I just look at the photo of my terribly bruised baby to remember it was necessary – but it is still an open wound for me and my hubby.

    • Hi Laetitia,
      Thank you for your candid note. And I agree — in fact, am working on a blog on birth shame. IT’s sad that the dichotomies are creating this for women. My goal as a midwife and also as an MD is to support women in birthing where they feel most comfortable and safe, and also to bring light to the fact that so many cesareans that are done ARE unnecessary and must be prevented for the safety and health of mom and baby. IT’s a fine line and I absolutely don’t want any moms to be blamed or feel blamed. I do hope you are able to find peace and healing in knowing that you did exactly what was right and best for you — and that as much as we torture ourselves with second guessing — there is no pure right or wrong answer. As mommas we just do what it takes to protect our kids and in any given moment, especially in those gray situations, it can be really hard to know what’s best. Again, wishing you peace and healing. Aviva

  12. Just a note of caution: I had my first baby in October of last year. I had a super healthy pregnancy, low risk, I eat paleo-ish, take high quality supplements and did yoga/pilates my entire pregnancy. I was originally going to birth at home, but I opted for a natural delivery at a hospital, with an OB who was on board and I connected with. My baby came early, on a Sunday at 36 weeks and 2 days. My water broke slowly about 3:15 am and I finally called the on-call doctor by about 4:00, I said I should be fine for awhile, right, no contractions yet. He said, no, come on in, you’re having the baby. I was not due for my Group B test until that Tuesday and because I was an “unknown” I had to be put on an IV antibiotic…I was bummed! I was only having mild contractions and was asked to consider taking a medication to get contractions going. I waited a couple of hours, ate a full meal my husband brought me from our local Mother’s Market. Then with a sudden urge to go to the bathroom, I went and it was a substantial amount of blood. FORTUNATELY the nurse walked in right as I went in the bathroom and as I was a “deer in headlights” she told me she had to come in the bathroom. “That’s too much blood, get in your bed,” is what she said as she called the “code.” Another FORTUNATELY, the hospital staffs a full-time labourist as the on-call doctor was tending to another delivery. He checked me, said we need to go to the OR, baby’s HR is really low. Within 10 minutes they had her out of me. I had a rare condition called Velamentous Cord Insertion, and my baby was born in a hypoxic state. She received two blood transfusions shortly after they pulled her out and as soon as I woke up from anesthesia, I saw my baby for a few minutes before the CHOC ambulance got there to taker her to another hospital. The NICU doc was telling me she may not make it. Heart drop. Another FORTUNATELY, CHOC utilizes a 72 hour cooling process that started in the ambulance. We got damn lucky. No seizures, no strokes and after 8 days, we got to take her home. My point is, if we had been ANYWHERE other than the hospital when this turned into a delivery, my baby would NOT be here. Again, I was barely having contractions when the blood loss occurred. I am a super granola mom, currently mitigating the world of to-vaccinate, or not-to-vaccinate and doing all things natural, but please consider these rare conditions. (the Velamentous Cord Insertion did not show up on any of the 4 ultrasounds I had). Lots of Love to all of you mommas and Aviva Romm for your work and research. XOXOX

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