Home birth on the rise in the U.S.

When I heard Eugene Declercq speak at the CIMS forum, I jotted down some notes on his data, but it was one of those "scribble it on the back of the conference program because you forgot to bring a notepad" situations, and he talked about so much interesting stuff I didn't have room or time to write it all down. One thing I was intrigued by was his statement that 1% of all births to white women are now happening at home. That seemed high to me, but he co-authored a new article out in the journal Birth, and it has that statistic plus a lot more info.

Some excerpts that were particularly interesting to me:

Large differences occurred in the percentage of home births by maternal race and ethnicity, and these differences widened over time... In 2008, 1.02 percent of births to non-Hispanic white women were home births, representing a 28 percent increase from 2004, when 0.80 percent of births to non-Hispanic white women were home births. In contrast, the percentage of home births declined slightly for non-Hispanic black women from 0.30 percent in 2004 to 0.28 percent in 2008. In 2008, the percentage of home births was 0.20 for Hispanic women and 0.38 for American Indian women, statistically unchanged from the 2004 figures. In 2008, the percentage of home births was 0.27 for Asian or Pacific Islander women, up from 0.24 percent in 2004. Approximately 94 percent of the increase in the overall percentage of home births from 2004 to 2008 was because of the increase for non-Hispanic white women. In 2008, 83 percent of home births were to non-Hispanic white women, compared with 54 percent of hospital births. [emphasis mine]

In 2008, Montana had the highest percentage of home births (2.18%), followed by Vermont (1.96%) and Oregon (1.91%). Three other states (Alaska, Pennsylvania, and Wisconsin) had a percentage of home births of 1.50 percent or above. An additional 10 states had 1.00 to 1.49 percent of home births. In contrast, 18 states had less than 0.50 percent of home births.

Interestingly, the recent increase in home births in the United States began before the release of a series of documentaries and newspaper articles about home birth... Such a development is not without precedent. In the United Kingdom, a government-endorsed movement called Changing Childbirth has been credited with leading to a growth in home births that has continued until the present. However, the home birth rate in the United Kingdom had already been increasing for five consecutive years before Changing Childbirth came into being... Women choosing home birth may be a harbinger, as much as a result, of increased activism related to childbirth...

These make me think about the highly culturally specific nature of the homebirth movement in the U.S. White women (in states with small minority populations) are accessing, promoting, and creating change around homebirth, and I would say I see a culture of normalcy arising around out-of-hospital birth in a certain segment of the population. (Overheard outside a prenatal yoga class: "Well, you don't have to pack a bag since you'll be staying at home, but what are YOU packing to bring to the birth center?") There is clearly a lot of privilege at work here...there are so very very few voices speaking to the non-educated-middle-class-white-woman demographic. I often think some of the Hispanic women I work with in CenteringPregnancy would be interested in having their babies in a setting other than the hospital - out-of-hospital birth with midwives being the standard in many countries they/their families come from - but there is simply no way for them to even know that homebirth is possible in the U.S., much less sort through the complicated process of finding and accessing it, insurance-wise. (And I can't pitch homebirth to them in my role, unfortunately!)

It comes back to my frustration that the people with privilege seek out the nurturing, mother-friendly, midwifery care; and the people who need that care the most, so frequently get a prenatal care through a health department or community health center, every visit with a different provider and then labor and delivery with another set of strangers, usually the general OB service at the hospital. I see basically zero outreach to low-income/minority communities from the birth community, and walking my delicate line between working in the system right now, I am guilty of that too. How do we fix this??

How much are spending cuts really cutting, and what would we lose?

Sociological Images has a nice breakdown of Republicans' proposed spending cuts. Check out the post for a full discussion, but here is a helpful graphic:



So, in cutting 4/10s of 1 percent from the budget, what do we lose? Proposed cuts of over $1 billion to community health centers and the National Institutes of Health, among others. Oh, and let's not forget cutting the entire Title X family planning program. And $758 million from WIC.

I am so sick of the hypocrisy. This money spent on health and prevention prevents us from needing to spend much bigger sums elsewhere in the budget. Slash it, and watch other expenses rise. Or refuse to pay those expenses either, and let a huge swath of America suffer. Just to score political points ("we're not funding that horrible Planned Parenthood anymore!") for what amounts to a miniscule amount of total expenditures and doing very little towards deficit reduction.

Doula memories

I've been puttering around today, catching up on some of the things I put off while getting ready for the exam. Some of my friends have been talking birth stories/birth plans lately and we talked a bit about wanting positive hospital birth stories since there are so many scary ones out there and yet there CAN be such lovely births at the hospital.

I started thinking about a birth I attended back when I was in AmeriCorps and went searching through my old birth stories (we wrote one up for each birth we attended, and when I left I kept a copy of all of mine and am SO glad I did - they are wonderful to look back through) to find what I wrote about it at the time. And I cannot for the life of me find it. I must have missed it when I was making my copies.

So, without that sheet of paper I can't remember all the information about the birth, like whether mom had an epidural or not, what # baby this was for her, even whether baby was a boy or girl! But I do remember that the family had a few older children, some of whom were present, and that they were very positive, friendly people - I really enjoyed being at the birth with them. There was a recently hired (but experienced) midwife at this hospital that I hadn't worked with before* and she was the midwife on all day as mom labored and I worked with her.

As the birth grew nearer, and mom was working hard and pushing, the midwife beckoned the dad over to where she was keeping an eye on the perineum. Baby began to crown and she said to dad, "Come here. Give me your hands." As the baby's head emerged, she laid his hands on the baby's head and guided him in catching his own baby - the first person ever to lay hands on his child. I watched his eyes widen, his face about to split apart with a smile as he did it. Together they handed baby to mom and she cuddled her new baby as they got baby cleaned off.

Afterwards, dad was just glowing, literally bouncing around the room, still unable to wipe that huge grin off his face. "Did you see that?" he kept asking everyone there. "Did you see what I did? That was amazing! It was AMAZING!"

It was even neater - to me - because these were not people who had sought out midwives to get greater control over the birth process. They were community health center patients who just needed quality affordable prenatal care, and ended up working with midwives because that's who did the births for the CHC at that hospital. And they were handed this really amazing gift of participating more fully in their child's birth.

Later the midwife told me that she had been watching me work with the mom all day, and had been going to offer ME the chance to help catch the baby, but could tell how excited the dad would be to do it. I was bowled over by that! I told her I was so glad she had the dad catch. I was just there for one day, but I hope that every year on this baby's birthday, that dad is still telling his child the story of how he helped catch him/her, and how proud he was to do it.

So that's your wonderful hospital birth story of the day, courtesy of my free association skills!

*Do any other doulas have the experience with new-to-the-system midwives that they're such a breath of fresh air? They haven't gotten trampled down by the system yet, they're not looking over their shoulders at the nurse who might "turn them in", they're just practicing how they want to practice. That's not to say that experienced midwives who know how to work the system aren't fabulous and valuable and just as subversive in their own ways - if not more - but being with a new midwife can be so...liberating.