You are at a legislative season Cracker Barrel meeting and have stated to your legislator your request for access to a home birth midwife. You identified the ways in which licensing and regulation of midwives would benefit you and the community. You then neatly avoided the "selfish mother" trap by answering the question of why you would choose home birth with reasons that center on safety and the well-being of baby. But then your legislator waves a handful of papers he says are printed out e-mails from the many reputable physicians in his district that are after him to defeat any bill involving home birth and midwifery because it is so dangerous. The physicians’ e-mails cite worrying statistics. NOW WHAT?

Step One
Remain calm.
Expect this kind of opposition. The American Medical Association has pledged to strongly oppose home birth and midwifery and has created the Scope of Practice Partnership (SOPP) to oppose all expansion of practice by non-physicians. On the surface AMA members will claim it is because of concerns for safety, but this year the Supreme Court in Missouri listened to their arguments and told them safety and protection of patients was not their motive, rather it was economics. Protection of their "turf" under the ruse of representing the health and safety of the patients earned them "Lack of Standing" in their case opposing CPM practice. The case was dismissed and CPMs in Missouri are legal to practice.

Step Two
Remain confident.
By their own admission in their own documents to their own members, the American College of Obstetrics and Gynecology "does not defeat this issue on the merits of the debate." They have no solid research with which to defend their position so they instead will grab whatever information looks like it might favor them and try to lead the less-critical thinkers into believing their position is evidenced-based. They describe their own efforts as "deft political maneuvering and hardball tactics." Licensing and regulating home birth practice using the CPM credential is based on evidence. The position of truth will eventually see justice. In the meantime be aware of the hardballs about to fly.

Step Three
Be prepared.
Last year the South Dakota State Medical Association mobilized its members around this series of statistics:
• Approximately 20% of the women intending on home births were transferred either prior to or after delivery to a hospital due to complications or the need for additional care.

• While a mother is in labor, the intrapartum death rate among normally formed home-born infants weighing >1000g (2.2pounds) is three times higher than the national average.

• Over half of all in-home delivery deaths are associated with asphyxia (lack of oxygen) during labor, despite knowledge of an increased risk of intrapartum asphyxia before the onset of labor.

• There is excess mortality with breech, twin, and post-term births conducted in-home.

These statistics were alarming to the physicians who read them. They were alarming to the legislators who received them in e-mails from concerned physicians. We all should be worried about these statistics. They are real observations from home births in Australia and were published over ten years ago with the intention of demonstrating that the risks of home birth are predictable and that with adequate regulation and practice standards there does not need to be excess loss of life associated with home birth. The authors observed that the pattern of excess deaths was associated with unregulated practitioners working in countries which lack consistent practice standards.

According to the authors, where practitioners are regulated and standards are well-known, home birth represents an acceptably safe option. The authors of this study were not trying to discredit the practice of home birth. Their research was to bring recognition to the essential role of regulation in home birth safety. The SDSMA forgot to mention the point of the study to the physician members; the members in turn were unable to pass on to their legislators the essential message of that research as it applies to South Dakota. The message to South Dakota is "regulate the practitioners of home birth, hold them and the families who choose home birth accountable to evidence-based practice standards." If the physicians had actually read the study, they would have been urging their legislators to pass the CPM licensing bill and hold the midwives openly accountable for evidence-based safe practice standards.

It remains to be seen what scary statistics will be used to generate hysteria this coming year. Be prepared to hear just about anything, but realize that whatever statistics are offered to discredit home birth, they will be numbers taken out of context. SDSCO will be on the lookout for abuse of "research" and provide the background needed to correctly interpret the hype, and hopefully provide some means of bridging understanding.

Statistics posted above come from the articles:
Perinatal death associated with planned home birth in Australia: population based study
Hilda Bastian, consumer advocate, a Marc J N C Keirse, professor, b Paul A L Lancaster, associate professor.
British Medical Journal 1998;317:384-388 ( 8 August )

Physician- and midwife-attended home births. Effects of breech, twin, and post-dates outcome data on mortality rates.
Mehl-Madrona L, Madrona MM. Journal of Nurse-Midwifery Volume 42, Issue 2, March-April 1997, Pages 91-98