There’s a paradox at the heart of homebirth advocacy. It depends entirely on the deeply held belief that no matter how poor the prenatal care, how stupid and incompetent the midwife, and how dangerous the unanticipated complication, the obstetricians at the local hospital will be able to save the baby’s life and the mother’s life.
There is probably no group of individuals in the world who has greater faith in obstetricians than homebirth advocates.
How do I know that? I learned long ago that watching what people do is far more revealing than listening to what they say. Sure homebirth advocates have lots of nasty things to say about obstetricians — they don’t follow scientific evidence, they just want to cut you, and horror of horrors, they think your baby’s life is more important than your birth plan — but in the end, what they do indicates that like they believe obstetricians have far more knowledge, skill and powers than even we think we have.
Every homebirth advocate and every homebirth midwife implicitly and explicitly assumes that in the event of disaster, they will simply transfer to the hospital (“It’s only 10 minutes away!”), where the obstetricians will do whatever it is they do to save the baby’s brain function and life.
But unlike the 99% of women bright enough to realize that obstetricians have the best chance to prevent injury, preserve brain function, and save lives of both mother and baby when you come to them BEFORE a disaster happens, homebirth advocates and homebirth midwives think so highly of obstetricians that they trust them to prevent injury, preserve brain function, and save lives of both mother and baby them AFTER the disaster has occurred at home.
Most people recognize the value of preventive medicine. It is much easier to prevent medical complications than to treat them. Obstetrics is preventive medicine writ large. Nearly every test and procedure in obstetrics is designed to predict complications by recognizing risk factors and by monitoring so that the complications can be detected in their earliest stages when they are easiest to treat.
But homebirth advocates and homebirth midwives often reject preventive medicine. They often refuse the routine tests of obstetrics designed to identify risk factors because they don’t want to know about the actual risks an individual patient faces. They often refuse the routine preventive care measures like antibiotics to prevent group B strep infection and vitamin K to prevent hemorrhagic disease of the newborn. It apparently makes perfect sense to them to wait until the disaster occurs before they seek treatment.
The types of complications most likely to prove deadly to babies share common characteristics. They typically result in oxygen deprivation to a baby and require either an emergency C-section or an expert neonatal resuscitation with intubation. They are situations which require operating rooms, anesthesiologists, neonatalogists and specialized equipment, none of which can be found at home or carried by a homebirth midwife. They are situations in which literally seconds matter, yet homebirth advocates are typically 30-45 minutes away from help of any kind. Despite all that homebirth advocates and homebirth midwives believe that obstetricians can save the day.
Simply put, homebirth advocates can promote the absolute nonsense that they so adore ONLY because they expect obstetricians to rescue them from their own folly. The dirty little secret of homebirth is that advocates and midwives don’t trust birth, they trust obstetricians.
