And Speaking of Birth ...

The new South Dakota State Legislative session opened this week. I've been getting a lot more involved lately with a group of local families lobbying for legal recognition of Certified Professional Midwives. Currently, licensure is available only to Certified Nurse Midwives and the state actively prosecutes non-nurse midwives for practicing without a license.

Lobbyists from the state medical association and three regional hospital groups sent a letter to state legislators last week warning them against our efforts. Of course, the medical organizations told them homebirth isn't safe, basing their claims on the controversial "Wax Paper" published last summer. Using only 5% of their sample data, this strongly and repeatedly crticized meta-analysis of previous studies suggests that homebirth triples the risk of neonatal death (babies dying in the first 28 days of life). The study is so deeply flawed that fellow researchers have called for it to be retracted in both the British Medical Journal and the Lancet.

All of this hoopla brings me to a question I read recently. One I found startlingly, deceptively simple:

Why are US doctors so opposed to homebirth?

Doctors say it's for safety, as though they are saving women from themselves. Yet clearly the research demonstrates not only that homebirth with a Certified Professional Midwife is as safe as hospital birth for most women, but women and their midwives are quite capable of appropriately transferring care when the risk of homebirth outweighs its benefits.

Most homebirth activists will suggest it's really a money issue: Doctors don't want to give up the additional income they get for overmanaged hospital births. But I'm not so sure this is the case either. Homebirth represents less than 1% of all births in the US. Even if that number doubled overnight, that would be less than a 2% decrease in the average OB's caseload--and that 2% would be the moms who most want to avoid the monitors, medications, and surgical procedures that make childbirth most profitable.

So, if it's not about safety, and it's not about money, what is the real cause?

I've begun to wonder whether the real issue is that, despite the vast number of studies showing homebirth is just as safe as hospital birth for low-risk women (and the flaws of the few studies that found otherwise), most doctors have simply been trained to view pregnancy and birth as inherently a high-risk enterprise. No matter what evidence they may read in their journals, they just can't accept that natural, physiologically normal birth requires only rare interventions.

In other words, I think doctors may be having trouble accepting the fact that, most of the time, they are not needed.

What do you think?