I’m married to an engineer. We have discussed the way data collected during traffic studies can be legitimately arranged to show that a traffic signal is needed and that it is not beneficial. It is not surprising that individuals, including scientists and engineers, find it possible to interpret data to reflect their opinion (or the desired outcome of their financial sponsor). I’m not so naive that I discount the data entirely, nor do I embrace with enthusiasm everything I read.
And women who are considering homebirth should know that there are very few studies that can compare “apples to apples” for hospital and home birth settings. There are, in my opinion, so many variables that make a true comparison extremely difficult. For example, in the US care providers generally practice within a hospital setting or provide care at home, but not both. This means the type of care received prenatally (medical or physiologic models) may vary, before the birth setting becomes a factor. Licensing criteria for midwives may differ by state; the experience of individual practitioners may vary regardless of birth setting (including experience of nursing staff who provide most direct care during labor in hospitals); protocols differ from one hospital to another, from one state to another (homebirth); and perhaps an often overlooked factor- women and the support they receive before, during and after pregnancy and birth differ.
This means also that their perspective on their care may differ from another woman who received identical care.
I don’t believe homebirth is right for everyone. I don’t think it’s a decision to make lightly. There are risks to being away from the technological advances that are absolutely responsible for saving lives, and there are benefits to avoiding the technology as well. Women don’t escape risk by choosing to birth in a hospital. They are exposed to different risks.
Because some women will choose to birth at home- either to avoid the risks of a hospital setting, to ensure autonomy, or because they simply feel it is the best choice for them, the obvious question is: How do we reduce the risks that exist for homebirth, and try to add the benefits of homebirth to the hospital setting?
While I draft my thoughts, please comment. This will be part of the conversation when I interview midwife & author Amy Romano on Feb 8th 2010.
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