Mama's Got a Plan:

Maternity Care, Health Insurance, and Reproductive Justice

Another media fail on “home birth safety”



The Washington Post receives an F for its particularly poor reporting on a new study by Janssen, et al., “Costs of Planned Home vs. Hospital Birth in British Columbia Attended by Registered Midwives and Physicians.” WaPo focused on an issue that was not the main subject of the study and, in addition, gave disproportionate weight to a known biased opinion.

  1. Safety, again. Even though Janssen cites four studies on the safety of home birth, WaPo chose to question safety in the title of its article. When we consider a medical system that has the only increasing maternal mortality rate in the developed world and an infant mortality rate that’s nothing to write home about, not to mention maternal morbidity, denial of maternal autonomy, and outright obstetric violence, it seems misplaced to focus – in the face of contrary evidence –  on safety issues in home birth.
  2. Whose controversy? “The practice is highly controversial in the United States,” writes the reporter. A more accurate characterization would be that the practice is highly controversial among some subset of doctors and medical interest groups. Other parts of the country find home birth to be perfectly normal and No Big Deal.
  3. Licensure. And yet, considerable column inches are given to Amos Grunebaum, MD, a frequent critic of home birth, who states that Janssen’s Canadian study cannot apply to the U.S. because, “In the United States, there is no blanket licensing system for midwives.” He is correct. The reason? Federalism. There’s no blanket licensing system for physicians or nurses either! Each state has its own licensing regime.
  4. Licensure again, and that darn border. It’s strange that Grunebaum should object based on licensure as a key difference between Canada and the U.S., because Janssen particularly addresses how the differences in care systems might play out in the U.S., based on figures from Washington State, where midwifery care and medical care are well integrated.
  5. More about that border. Our neighbors to the north have a national health system and the U.S. does not – and that’s why we can’t talk about cost, apparently. Except …  50% of U.S. births are funded by Medicaid, a government health care system.
  6. Licensure again, and on not helping. “Only 28 states legally authorize midwives to practice, but in other states, Grunebaum said, midwives can practice with a high school education.” This statement is incorrect on multiple counts:
  • Thirty states legally authorize non-nurse midwives to practice.
  • Guess who chiefly opposes licensure in the remaining 20 states? The American Congress of Obstetricians and Gynecologists (ACOG) and state medical societies. It would be more logical for them to support midwife licensure if they are concerned about credentials and training, which, in Mama’s opinion, are reasonable things to be concerned about.
  • Yes, all midwives have a high school education … plus midwifery training. Just like other professions that are not academic professions –  army medics and commercial pilots, to name two.
  • “I don’t even call them midwives,” [Grunebaum] said. “They are ‘so-called midwives.'” This remark enters the territory of Just Plain Rude. It’s not for a physician to decide who is a midwife and who is not.

WaPo’s coverage is disappointing. They are capable of better. See for example this much more balanced article from Medical Daily. Shape up, WaPo! Stick to the point, and find a less biased expert!

Dear Reader, after reading that stressful list of faults, you deserve a reward. Take a look at the beautiful mamas and babies at Black Women Do VBAC and share in their unmistakable joy.