Wait, so the argument here against home birth is that one time you witnessed a baby needing resuscitation? Not a very convincing argument at all!

Dr.Gottesfeld, I'm glad you chose this subject for a blog entry and your argument is well-reasoned. Simply stating "Homebirth midwives are exceptionally well skilled and educated women who are also trained to resuscitate newborns" doesn't necessarily make it so. It fails to recognize that board-certified obstetricians and certified nurse midwives are even more exceptionally well-skilled and educated professionals who generally perform more deliveries in their training and lifetime practice and have more experience and skills in managing obstetric emergencies than lay midwives, who make up the majority of midwives who take on the risk of home births. That statement also doesn't take into consideration that the neonatal nurses, certified registered nurse anesthetists/anesthesiologists, respiratory therapists and pediatricians/neonatologists who are members of the IMMEDIATELY AVAILABLE neonatal resuscitation team are far more skilled and EXPERIENCED than the homebirth attendant. As anyone who has been in attendance in the kind of resuscitation you describe knows, it takes a TEAM of experienced health care professionals to perform a complicated emergency resuscitation. As an obstetrician, I am ACLS (advanced cardiac life support) and NRP (neonatal resuscitation program) certified and you do not want me performing a resuscitation as I don't do them often enough to maintain skills, nor do I have the necessary experience for good clinical judgment. Oh, and incidentally, even working with high-risk populations, my primary (first-time) cesarean delivery rate among patients whose labor I manage (I also back midwives who do their own vaginal deliveries but turn patients over to me for cesarean delivery) is about 12%. And I rarely (less than 1% of the time) cut episiotomies. Ultimately, it boils down to this: If a woman chooses to create a life and bring it into the world, she has the responsibility to protect that life, starting from conception, which means good prenatal care and diet, refraining from practices which could harm the fetus, and having as safe a birth as possible. Yes, most babies deliver themselves, quite honestly, but one never knows until it's all over how it's going to turn out. Hospital births do not necessarily equate with cesarean section and it is more important to pick a clinician who shares and respects your philosophy. Home birth is an esthetic; do you really want to run the risk of losing a child or having a neurologically impaired child over an esthetic? A similar analogy is that the vast majority of car rides do not end with a motor vehicle accident, and some babies and children hate their car seat. Yet any sensible and responsible person would put their child in a safe car seat just in case the unthinkable happened. Why would you not do the same for delivery of that child? Dr. Gottesfeld and I trained around the same time in the same institution and we were blessed to have certified nurse midwives among our training faculty from whom we learned a great deal about labor management and birth attendance. We also saw first-hand the result of the lack of training, fund of knowledge and experience of some local lay midwives who didn't know the first thing about what to do with preterm premature rupture of membranes and other complications and subsequently put mothers and fetuses at grave risk over things that a third year medical student would know how to manage. Lay midwives are technicians, not professionals. Their training is severely limited. One may want to think of it as an art, and one could make the comparison that one can be a greater artist without a college education or formal training than someone who majors in art in college. But no one dies from lack of art training. Why do you think obstetricians choose to deliver at hospitals and birthing centers? It isn't the money: from what I have gathered, lay midwives are paid more in cash directly from patients than we are paid by insurance. We do it because, stereotypes aside, we care deeply about our patients, both the ones who walk into our offices and the ones who are yet to be born. The greater cost of a hospital birth is the cost of having all those resources available. Yet Medicaid and TriCare (military dependant coverage) won't pay for a home birth and I don't think most private insurance will either. It would be cheaper for them, but they would open themselves to huge liability. Speaking of which, lay midwives aren't required to carry medical liability insurance and most, if not all of them, don't. I'm not sure there are any carriers who would cover them. Wishful thinking isn't fact. The study that Dr. Gottesfeld quotes compared planned home births, which by definition are supposed to be low risk with ALL hospital births, not just the low risk ones. The rate of prematurity was greater in the hospital-delivered population, so it was actually an unfair comparison, biased AGAINST the hospital-delivered experience. And yet 2-3 times as many babies died in the exclusively "low risk" population. Those are terrifying statistics. And statistics aren't personal experience: Can you imagine how devastated the parents of the babies who died after home birth must be, and how they must wish they could turn back the clock and deliver in a setting where team resuscitation is immediately available? I imagine those same mothers would give anything to have had a cesarean section if it would have saved their baby. Delivery in a hospital setting is not a guarantee, either. Note that babies did die in that group, too, but the numbers are clear. Home birth in and of itself raises the risk of neonatal loss. That's a risk that is unacceptable to me, to all obstetricians, and should be to everyone. It's interesting that this discussion coincides with the growing movement for elective cesarean delivery. The argument in favor of that movement is potentially less incontinence or prolapse (collapse) of pelvic organs, or the ability of THE MOTHER, not the physician, to deliver at her convenience. I find both of these movements selfish, putting the mothers' DESIRES ahead of the babies' NEEDS. As one of the wisest obstetricians (who was, at the time she said it, the mother of young children) once said to a laboring mom who was stressing over how bright the lights would be at delivery, "When that child is 15 and sassing you in the mall, you're not going to remember how bright the lights were." The miracle and gift of a healthy child should be the greatest goal for all of us.

From a mom of two "hospital" births, who has not given a second thought to this setting in any way, shape or form! I am thankful to have been in an environtment with caring physicians and nurses who focused on my needs with medication (due to back labor) and my babies needs, incase of an emergent situation, which would otherwise not occur at home. I did NOT want to take the chance during delivery of even being minutes away from emergent care. It was also important to receive coordinated care handled by the hospital deliverying physician, who ultimately triggered my post-partum care. As a non-clinician, my hospital birth provided peace of mind with anesthesiologists, NICU if needed, and an OBGyn physician who happened to be a Kaiser Permanente physician both times!! With regard to the arguement of a baby being resuscitated, the one question I would have for any home birth mom- what if this was your baby receiving the resusitation? Would YOU be able to live with your choice if your newborns outcome was anything but good and you had control over the environment of the birth?