birth “safety” (& two homebirth articles)

[originally published at my old blog on 1 September 2008]

Madeline Holler’s personalessay “My Illegal Homebirth“┬áis interesting and funny and demystifies home birth a bit, though of course her experience isn’t representative (and took place in a state where attending a home birth was┬áillegal); check it out.

Michelle Gienow’s Baltimore CityPaper article “Home Made: Inside Baltimore’s Home Birth Underground” focuses primarily on unassisted childbirth, though it also hits on midwife-attended home birth and on physician- and midwife-attended hospital births. It’s pretty balanced and worth reading.

I find it amusing, though, that what I see as the biggest endorsement of out-of-hospital birth in the article comes from the mouth of a physician whose intention is to support hospital birth and depict home birth as unacceptably dangerous. Victor Khouzami “oversees Maryland’s most prolific labor and delivery hospital ward [where] physicians and staff delivered nearly 5,000 babies in 2007. Almost half–42 percent–of those babies arrived via surgery.” And he says: “If you are here long enough, we are going to do something to you. It’s a matter of time. I will be the first one to admit that. [...] The trade-off is that I am going to make sure that nothing happens to you or to the baby. [...] So which risk do you want? You can’t have it both ways.

*blood boiling; head exploding*

Why not?

Why can’t I give birth with someone who watches protectively over the physical well-being of my fetus/baby and me, without being subjected to interventions based on arbitrary time tables and a desire to mold my labor into a textbook labor? Nothing about providing safe, evidence-based care requires (or even allows) forcing women to have unnecessary interventions in our labors, pushing our labors to conform to the convenience of the facility or caregiver, etc., etc. His assertions–”we are going to do something to you”; “I am going to make sure that nothing happens to you”–simply do not make sense together.

Part of the issue is, of course, the wonkiness of our healthcare system, including the immense pressure of possible litigation on physicians and the screwiness of our legal system and everything that’s so very wrong wrong with our insurance system.

But a lot of it is what we mean by “safe,” and what we mean by ‘something happening to you.’ We all agree that “safe” first requires a live mother and a live baby; absolutely. But what people prefer to ignore is that no one, in no facility, can possibly guarantee that outcome for every family. Women and babies die wherever births happen. People die wherever people live. Dr. Khouzami cannot really “make sure that nothing happens to you or to the baby.” So we’re really talking about ways to decrease infant and maternal mortality and morbidity rates, and people disagree in good faith about how to accomplish that goal.

However, here approaches diverge radically, and communication seems to break down. Is “alive” all we mean by “safe”? Is death the only bad thing that can “happen” to someone?

I don’t think so. In my daily life, when I think “safe,” I mean (in part) ‘not being sliced open’ (in my abdomen, in my perineum … pretty much anywhere, you know?). I mean ‘not being bullied or scolded.’ I mean ‘not having tubes or needles stuck into my body.’ I mean ‘being able to move freely.’ I certainly mean ‘not having someone put fingers in my vagina without my permission.’ For me, “safe” encompasses not only still alive but also uninjured, as well as a larger sense of emotional and spiritual security. Home birth and freestanding birth center advocates are often talking about these sorts of safety in addition to infant and maternal survival, while I get the sense that many (though certainly not all) hospital-based obstetricians’ definition of safety begins and ends with survival. Perhaps this definitional difference helps explain miscommunications amongst people who take radically different approaches to birth but genuinely want to help and/or protect mothers and new babies?

One last suggestion: Don’t bother reading the comments after either article, particularly Gienow’s. They’re just people yelling at each other without a whole lot of interest in evidence or etiquette.

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  1. Omi
    Posted 6 February 2011 at 3:15 AM | Permalink

    hi molly. i wrote you a comment on your last post. i am a south-african born now living in jerusalem birth activist and adjunct university lecturer (in women’s rights and health), with all the attached stress as you know:) i am about to begin some research on unassisted birth, which is beginning to pick up here. i am particularly interested in how other countries have managed the legal problem of registering the babies so born. this is becoming a more real problem in light of the global trade in babies and surrogates. anyway, i would really appreciate it if you have some leads for me. thx. and i’m loving your blog. omi. p.s. i also have a blog but i write in hebrew mainly.

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