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??

Breastfeeding & Feminism: Day 1

I really need to take more notes at these things! So here are a few notes pulled out of my very scattered information overloaded brain:

- Eugene Declercq gave a great keynote on statistical trends in C-sections, VBAC, and other birth-related stuff. One of the most interesting sections was on homebirth. Still very tiny numbers, so hard to identify a definite overall upward trend, but it seems to be on the rise. He then broke the trends out by race, and that was fascinating: homebirth rates were the same or dropping for all races except for white women, who are clearly seeing an uptick. He reports that in the latest stats, 1% of all births to white women happened at home. That seemed high to me, but apparently that's what the statistics are telling us. I am not at all surprised, however, by the disparity.

- Bettina Lauf Forbes and Danielle Rigg of Best for Babes spoke about reframing breastfeeding, including how much they dislike the phrase "protect, promote, and support breastfeeding" - they want to replace it with "inspire, prepare, and empower moms". They really have a marketing mindset of helping introduce moms to breastfeeding via common consumer culture avenues like celebrity profiles, then help educate them on avoiding the "booby traps". As they pointed out, we have very high BF intention rates - we need to help moms achieve their personal goals!

- Keren Epstein-Gilboa, who came all the way from Canada, gave a really dynamic talk on breastfeeding and envy. She first had us imagine something that we really, really wanted - a job, a person, a house, whatever - and say how it made us felt. (Great!) Then we had to think about how we couldn't have it - and how that made us feel. (Well, pretty crappy.) Now how did we feel about that thing, and the person who had that thing instead of us? We often tell ourselves we didn't want it anyway, or that it really isn't that great, or we try to break it into parts. She used that introduction to discuss her research on the relationship of fathers to breastfeeding, and how different societies treat mothers and by extension how they treat breastfeeding, and also what it means for women who try to breastfeeding and aren't able to. I only wish she'd had more than 15 minutes!

That's all for now - I've got to start recharging my brain for tomorrow...

Link party!

First of all, Happy Olympics! I am so excited. I love the Olympics. My department had an Olympics party last night - come as your favorite athlete, sport, or country. We had everything from Brian Boitano to bobsledding to several people all in white ("Winter") and one Olympic torch. I was Sweden, which is a good Winter Olympics country to pick.

I've been trying to come up with some kind of play on words with the Olympics starting, Olympic rings, the rings are linked, links...I think I'm trying too hard. So let's just say that my Google Reader starred list is becoming too long to contemplate, and that it's time for a link party. I've been saving some of these up thinking "I'll write a post on this!" but the truth is, I might or might not eventually, and in the meantime why let the starred list get longer?

Academic review article on the risks of not breastfeeding for mothers and infants, and the role of obstetricians and hospitals in breastfeeding promotion. A very nice summary.

Via Empowering Birth blog, an informed consent roleplay. Has anyone ever used this with a class? It seems like a great idea to get people prepared to actually advocate for themselves - it's easy to talk about it beforehand, and harder to actually do in the moment.

And another link from Enjoy Birth about choosing hospitals wisely.

A dad talks about his thoughts on breastfeeding.

At Guerilla Mama Medicine, HUGELY important questions and thoughts about race and the natural childbirth movement.

An article from RH Reality Check about The Doula Project, which provides doulas for women who are having abortions and who are relinquishing their babies for adoption. I'm proud to say that I know one of the co-founders, Lauren Mitchell, who has an awesome quote in the piece: "You can't speak for your client, even if what's going on is the opposite of what she wanted - you're not in control of the room. But you are in control of what you are giving your client, and that is an informed ally and a deeply empathetic presence. When you're a doula you have to acknowledge how to be 'human' even when you want to be more than that. What keeps me going is the feedback from the clients that the space that I've created for them is unique and extremely important." If I end up back in NYC I would LOVE to volunteer with them!

From Birth Sense, thoughts about manual rotation of the fetal head. I have seen this happen once, and it was very effective - baby went from making very little progress with pushes, to crowning within minutes. But the midwife writing the article reminds us that it's also extremely important to move the mother!

I've also been enjoying Birth Sense's series, "Your Doctor or Midwife Still Does WHAT?" Here's a sample: #5, Cervical Exams. Reading expectant mothers' blogs I come across so many sighing with frustration that they're still not dilated at all, when is this baby going to come, etc. etc. Since there are very few actual medical reasons to do a cervical exam, it starts to seem like a highly effective method of psychological priming for induction.

Navelgazing Midwife did a great series of photo posts called "Teachable Moments" about placentas, vernix, trailing membranes, etc. Here's a great one on being born in the caul. I guess I should put in a disclaimer that these photos involve vaginas and birth fluids and stuff like that, although I have such a high tolerance at this point I have to remind myself that somebody else might need a warning.

That's all for now - off to watch me some Olympics!

Waterbirth with a doula, and race in the natural birth movement

Via Bellies and Babies:



I really liked hearing the doula in this video talk a little about the racial connotations that natural/unmedicated birth has in our country (I would venture to say class connotations are equally important). While several of the women shown giving birth in "The Business of Being Born" are women of color, in general the natural birth movement has been by and for white women.

I admit I am uncomfortable with the way this plays out in many situations. In AmeriCorps, my fellow doulas and myself were all young, white, native English speakers who had all grown up at least middle-class and attended college (and none of us had yet given birth ourselves). We were working with mostly low-income, Spanish-speaking Latina women. Do you need have the same background as a woman to be a good doula? Absolutely not, and we forged strong bonds with many of our clients. But the fact was that our AmeriCorps positions were not accessible many women from other backgrounds for a variety of reasons (the long hours and very low pay, a program that hired only college grads, and not a lot of resources for recruitment to ensure a diverse applicant pool).

In becoming an IBCLC, I will again be a white woman joining a mostly white profession...that aims to reach ALL women and help them to breastfeed. I would like to do some thinking in my doula and LC practice about how I can not only be more culturally competent myself (because it should never be the expectation that any individual is absolved from being able to work competently with the people they serve) but also take responsibility for the opportunities I've been given by encouraging more diversity in my professions. Our breastfeeding advocacy group is thinking about fundraising for a scholarship to help women from underrepresented groups access IBCLC training. I hope that will be a start.