Dr. Whitney You, a maternal fetal medicine specialist, writing on the Huffington Post suggests: Maybe We Should Agree to Disagree: A Perspective on Homebirth.
It’s not that she thinks homebirth is safe; she doesn’t.
I am not in favor of home birth. I believe the safest place for a laboring woman is in a hospital or birthing center. Labor and the associated complications are not predictable. When potentially life-saving interventions are delayed because a woman is laboring outside a hospital setting, the consequences can be catastrophic…
She wonders whether agreeing to disagree on homebirth can be beneficial by maintaining the relationship between doctor and patient, thereby maintaining the potential that the doctors may influence the patient to make safer choices.
In an era where patients are seeking information beyond the advice of a medical provider and are vying for control of their medical care, medical professionals need to learn how to enter conversations where their recommendations may not be followed. Attempting to dissuade a convinced patient can be alienating, pushing the patient further away, and driving a chasm between the patient and provider ultimately benefiting no one. It is still the job of the medical community to offer information and voice a recommendation. Sometimes coming along side patients in shared decision-making, even when it goes against medical advice, may offer a chance for the best possible outcome.
But if we’ve learned anything from the vaccine debacle, it’s that agreeing to disagree is both ineffective and dangerous.
Why? Because homebirth, like anti-vaccine advocacy is not about science, it’s about an unmerited sense of maternal superiority.
Homebirth, like anti-vax advocacy, is about privilege. Nothing screams “privilege” louder than rejecting the hospital obstetric care that the majority of women around the world are literally dying to have. The “empowerment” of homebirth reinscribes the privilege of the Western, white, well off women who choose it in the most obvious possible way. The entire homebirth movement is premised on the privilege of having a fully equipped and staffed hospital nearby to rescue your baby when you’ve screwed up by choosing homebirth.
Homebirth, like anti-vax advocacy, is based on the delusion of women who believe they have “done their research” and pose as “educated” despite the fact that they are astoundingly ignorant on the subject of childbirth. Homebirth advocates are no more educated about childbirth than creationists are educated about evolution. Neither group has done research; they’ve simply read propaganda, and both groups need to be disabused of their delusions.
Homebirth advocates need to understand that they have been hoodwinked by an alternate world that bears no relationship to what science actually shows. Just about every premise of homebirth advocacy — that childbirth is inherently safe, that interventions are dangerous, that interventions interfere with breastfeeding and bonding, and that obstetric emergencies always allow for enough time to get to the hospital — are utter lies.
Obstetricians MUST explain to homebirth advocates that their fundamental assumptions are fabrication by the homebirth movement and that the only people who claim homebirth is safe are those who profit from it. I’ve corresponded with all too many women who have lost babies at homebirth, and if there is one common theme it is that these mothers never realized the massive gulf between what they were told and the actual scientific evidence. Obstetricians MUST explain what the scientific evidence really shows, and MUST encourage women to view homebirth advocacy with the same skepticism they would view any industry promoting its products.
Homebirth, like anti-vax advocacy, is a matter of life and death. Agreeing to disagree with homebirth advocates sends the WRONG message: that their claims have merit. Would we agree to disagree about carseats for infants? Would we agree to disagree about bicycle helmets for children? No, we wouldn’t because we recognize that children’s lives depend on parents understanding the deadly risks. The fact is that choosing homebirth is more deadly than forgoing a carseat, or letting children ride bicycles without helmets.
Finally, though every patient deserves to be treated with respect, every idea does NOT deserve to be treated with respect. Homebirth, like any other choice that places children at risk of death, is unworthy of respect. That’s why we must not agree to disagree on homebirth.
