We need to work to improve hospital-based maternity care. There are models in the US and around the world for good maternity care. Yes, there are hospitals that have <15% cesarean rates, high VBAC rates, offer breech and twin vaginal birth, and even hospitals offering water birth. There are doctors and hospital-based midwives who treat pregnant women with respect and offer informed consent.
We need to look at these models and expand them. This means building positive relationships with our local hospitals, no matter how much they make us want to pull our hair out. We need to encourage women to bring information about evidence-based models to their care providers. We need to encourage hospitals to employ midwives so that home birth is not the only option for midwifery care.
Why? Can’t everyone just have a home birth? Well, no, actually. Let’s set aside the issue of risk. Obviously, many women are not home birth candidates. There are women who have health issues and babies with health issues, as well as women who will develop complications during pregnancy. But I want to talk about the women who don’t feel safe at home. This is our reality. Even in countries with high home birth rates, and a midwifery model of care, some women choose to have their babies in the hospital.
It’s where they feel safe. Some women (and their partners) will always feel safest in the hospital. For some women, eliminating fear of childbirth means being in the hospital. We know that women usually can’t dilate or progress in labor unless they feel safe. Ina May’s “Sphincter Law” works both ways. While for many of us, we can’t open up in the hospital with strangers walking in and out and monitors buzzing, for other women, they cannot relax enough to birth at home. I’ve also worked with women who desperately wanted a homebirth, but their partners were not willing to explore the option.
If we want to truly improve outcomes and empower women, then I believe we need to work toward a maternity care system that allows collaborative care, focuses on evidence-based medicine, and encourages women and their families to make educated decisions and take responsibility for their health care decision.