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Are home births safe?

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My great, great grandmother Sarah Servatius died in childbirth in 1886, leaving six children and their father to fend for themselves.

Medicine has advanced dramatically since women regularly gave birth at home. According to the Centers for Disease Control, the mortality rate for babies has declined by 90 percent since 1900 and the maternal mortality rate by almost 99 percent. Now, some women are fighting to do it the way my grandmother did, even if it puts their baby at higher risk of death or injury during delivery.

Should we let them? Or should that be considered child abuse?

Enter "midwife" Amy Medwin. If a doctor's track record for the last few months was like Medwin's — the death of one baby and the injury of another — would you go to her for prenatal care, or to deliver your baby?

Supporters of Medwin, who now has three arrests for unauthorized practice of midwifery to her credit, apparently see the death of one baby and the injury of another under her care as an opportunity to promote the legalization of the prenatal and birth services Medwin provides to her patients. These people actually consider it an injustice that Medwin can't work legally as a midwife in this state. Last week, they signed petitions and marched in Raleigh, demanding that midwives like Medwin be licensed to deliver babies.

To legally practice as a midwife in North Carolina, you have to have a nursing degree, complete midwifery education, pass an exam and be supervised by a doctor. Medwin is a certified professional midwife (CPM). No college degree, nursing degree, or medical degree of any kind is required for that certification. North Carolina is one of 10 states that doesn't recognize Medwin's certification, so she was practicing illegally.

Since doctors rarely consent to supervise a home birth, where they will lack the equipment to save the baby's and mother's lives in an emergency, home birth is essentially illegal here unless you want to do it without assistance.

That has those who want to return to 1886 all worked up. They say it's their right to give birth at home if that's what they prefer. The problem is that there's a baby involved here, too. In North Carolina, you can face child abuse charges if you intentionally neglect to provide timely medical care for your child. Does giving birth at home with the help of a CPM who might not even have a college degree, much less a medical degree, fit that definition? Should it?

According to an American Journal of Obstetrics and Gynecology study of more than 500,000 births published this fall, planned home birth triples babies' mortality rate. The risk is still low, 0.2 compared to .09 of those born at the hospital. The main cause of death was breathing difficulties and failed attempts at resuscitation, two factors the study attributed to poor midwife training and lack of access to hospital equipment.

Previous studies that showed no increased risk to the baby were flawed, the study found, because when complications arise and a woman is rushed to the hospital, which happens about 40 percent of the time during home birth, the death or injury to the child is recorded as a hospital birth.

Is putting your child at that kind of risk child abuse? Should it be? Home birth advocates, who are some of the most militant people I've ever encountered, claim studies like this can't be trusted because they are engineered by doctors profiting off services that aren't really needed. They say women should give birth where they feel most comfortable, and that childbirth has only recently been done in hospitals.

You could, of course, say the same thing about appendectomies. Claudius Aymand performed the first successful appendectomy in 1736 on a bed without anesthesia, the way many appendectomies were done for the next 100 years.

Would you have an appendectomy on the kitchen table just because that's the way we used to do it? I doubt these women would either.

When a child's life is involved, it's not about what makes mom feel comfortable anymore. It's about the baby. That's why the state should leave the law just like it is — to protect babies from mothers who should know better. If Medwin wants to deliver babies, she should get a nursing degree.

For other takes on midwifery in North Carolina, check out:

Why is N.C. Afraid of midwives?

Sexism, xenophobia and midwifery in N.C.

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