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Banning Home Births: The Next Wave of Reproductive Control?

Banning Home Births: The Next Wave of Reproductive Control?

There are a number of reasons that a pregnant person may choose to give birth with a midwife and at home rather than in a hospital or birth center. Some choose a home birth in order to remain more in control of the birth experience, believing that hospital births can be pushed too rapidly towards medical interventions like induction and c-sections. Others want to be able to feel more comfortable, conducting the entire labor in one convenient and familiar place, with the added benefit of moving straight to real life after the birth is complete. Even finances can play a role, as the average hospital birth grows more and more expensive even with insurance.

For many, an assisted home birth with a qualified midwife poses no more risk than a standard uncomplicated hospital labor and delivery. Yet there is a growing movement to regulate both midwives and home births, just like many other issues in reproductive health care, using the rationale that potential life always outranks the desires or beliefs of the person carrying that pregnancy, and that the pregnant person is not capable of making fully informed decisions about her own medical health.

That’s the situation in Arizona, where an “emergency” proposal is being introduced in the legislature to undo new advances when it comes to allowing assisted home births in the state. The bill, SB 1157, would forbid licensed midwives from taking on† medically complicated pregnancies, such as a breech, the birth of multiples or when a pregnant person is having a VBAC (vaginal birth after cesarean section).

Midwives, on the other hand, say that they have been trained for just such complicated deliveries, and that there is no reason to have a blanket ban on all of these scenarios, which should instead be taken up on a case by case basis with the decision made by the patient and her midwife. “Women and mothers are smart, informed and educated. We have a right to choose our patient care. We have a right to do our own research and make our own choices for our birth,” testified Tori Anderson, of the Right for Homebirth consumer group, in opposition to the bill.

Lawmakers proposing the ban disagree, and believe that the pregnant people in question either aren’t intelligent enough to weigh risks, or are selfish enough to put the health of their future child in jeopardy in order to stay out of a hospital. Sen. Kelli Ward (R-Lake Havasu City), the bill’s sponsor, says that it’s up to the legislature to care for the life of the fetus since the mother is obviously incapable. “I’m a pro-life legislator. I see the mom and the baby as two separate entities,” Ward said, according to the Arizona Republic. “I would love to preserve the choice of the mother for their home birth, but that child also needs to have a choice … the choice not to die.”

The idea that lawmakers, and not a patient, should be inserted into care decisions in order to represent what they see as the state’s interest in that fetal life is nothing new to Arizona, which also passed a bill saying that doctors could not be punished for withholding medical information from a pregnant person if the information may make her choose to terminate a pregnancy. In this case, however, legislators are once more making a case while manipulating facts.

Although medical best practices used to believe that once a person had a c-section, the risk of a future uterine rupture was too great to do anything but a second surgery for the next birth, opinions on that have changed. Risk of rupture now is placed at less than 1 percent ó yet many health practitioners still insist that a VBAC should only be attempted in a hospital where there is a team that can immediately provide care in the case of that 1 in 100 complication. For comparison’s sake, in-hospital births that end in emergency c-sections continue to rise, in some states to as much as one in three births.

If a pregnant person who had a c-section shouldn’t be allowed to give birth at home because she has a 1 in 100 chance of a rupture that would turn into a medical emergency, shouldn’t it logically follow that if 1 in 3 labors end in c-section all births should be required by law to be in a hospital?

Sen. Ward’s argument that the state must protect the baby from harm, in this case used against midwifery, is really in essence a declaration that pregnant people do not have the right to make a medical decision without approval of the legislature, who will weigh her opinions against their beliefs in what is the best action a “mother” should take at any given moment. From birth control to abortion to pregnancy and birth, from the moment of conception, the Arizona legislature now gets to judge and modify a pregnant person’s behavior.

All for the sake of the baby.

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Photo credit: Thinkstock

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278 comments

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10:06AM PST on Feb 25, 2014

A hospital is a far more dangerous environment bacteria etc to have a baby in.
Its an excuse to take away freedom.
"Life, Liberty and the pursuit of Happiness" is a well-known phrase in the United States

4:04AM PST on Feb 25, 2014

Unacceptable!!

6:34AM PST on Feb 24, 2014

(part 3, continued from below)

And this is in the south, in the northern parts the distances are even greater and many opt to travel well ahead of time to the city with the hospital in case the baby comes early. So it would probably be both cheaper and less stressful to have a skilled midwife nearby, even if medical backup wasn't available. Options in urban and rural areas are different. People should have the choice in what is best for their family, in their situation. Too narrow legislation is problematic cause there is no way for the legislators to be able to take all real life possibilities into consideration.

My cousin's wife was one of those VBAC whose scar ruptured when she tried having her second child naturally. They lived in Germany at that time, and the hospital staff encouraged her to have caesarian even though the risk of rupture was very low. She wanted to try natural (crazy Finn :) - among Finns caesareans are very rarely done if not medically necessary) but unfortunately her scar broke and she again had to have an emergency caesarian. Both children are healthy, and as there were complications before birth of the first they were already in hospital for the birth, as they were with the second. But it was their choice (in theory at least, pretty self evident choice, but then we don't have to pay huge fees to the hospitals either).
I think personally I would become claustrophobic if I weren't allowed to leave, even it would be the same as what I would choo

6:28AM PST on Feb 24, 2014

Maria A, excellent point!

"...after the Affordable Care Act, the medical system is going to be hugely overwhelmed with patients. Adding this ludicrous campaign against abortion and home births is going to make the situation so much worse."

Perhaps that is the real purpose of this bill. The republicans have proven that they will do ANYTHING to get what they want, no matter who's rights they trample on to get it.

6:27AM PST on Feb 24, 2014

(part 2, continued from below)

Personally I think birthing centres sounds good, a homey environment with skilled (and hopefully unhurried) staff and the possibility for c-section if things go wrong.

We had a really good one near where I grew up, that could serve the population on both national languages (in Finland we have two national languages, but only 5% speak Swedish, the majority speaks Finnish) and also drew rich Russians (although situated 300-400 km from the border), that was the reputation it had. But it got closed down by budget cuts (although it was cheaper per delivered baby than any other hospital in nearby areas), with the closest alternative being an hour away (two hours drive for those living on the far side of the area the hospital serviced) and lacking in Swedish speaking personnel. That's politics for you.

Choose between home birth or ambulance (or even your own car, as the ambulance may take an hour or more to get to you)? I think I'd prefer home birth before the stress of trying to get to a hospital where I'd have to communicate in my second language (I'm pretty good at it, but many in that area isn't, they might see it more as a third language after English) or be forced to endure misunderstandings due to lacking language skills (or maybe be lucky and have Swedish speaking personnel on duty).
And this is in the south, in the northern parts the distances are even greater and many opt to travel well ahead of time to the city with the hospital in

6:25AM PST on Feb 24, 2014

If legislators really wanted women to give birth in hospitals they would make it free and comfy. How will going to the hospital help the mother when she won't afford food for herself (when nursing) or her child(ren) afterwards due to a huge bill?
No, but free health care would be "socialism". Just like having the fire department come to your house in case of a fire. Should you have to pay a fire fee instead to avoid "socialism"? Should the fire brigade only come to your help if you have your fire insurance paid?


Midwives (with the right education) are specialized in the birthing process, unlike general practitioners or even OBGYNs that have to know everything else about a woman's reproductive organs so giving birth is just a small portion not necessarily prioritised (of course it depends on the doctor). If I were ever to give birth (hopefully not) I'd much prefer someone with 100+ births in their experience than a certified doctor that might know all about internal organs or brain injuries or even everything about ovaries but hasn't attended more than a handful births.

For those wanting home births it should be an options, although very few with any of the known conditions mentioned in the article would opt for home birth. But the body and the mind are connected, a woman about to give birth should be relaxed and comfortable, as this translates to the muscles, while stress or anticipating pain leads to the muscles tensing up and therefore a more difficult birth.

5:32AM PST on Feb 24, 2014

I'm just amazed so many women gave birth to these idiot Republicans.

6:55PM PST on Feb 23, 2014

Oops! I really am having a senior moment. When nasty Nurse Suzy and I met over my 3rd childbirth,I was at 1. She insisted I would NOT be having a baby in 1/2 an hour. But when they all-and I mean ALL got ready to leave for a coffee break ,I insisted someone check me one more time. "No,honey,you're just at 1." But I insisted and I was at 9 centimeters and then they got really busy and Suzy went were all good Suzies should go. And of course,I had a baby before midnight. Precipitous births.Luckily,even though my Doctor never made it to my 2nd or 3rd deliveries,he did tell me to ignore any and all advice given to me by experts at the hospital. He said follow your body,not the childbirth handbook for dummies.I called the hospital both times and each time they said,"come in when the contractions are 6-7 minutes apart." That would be never.I go from 20 to 3 to to 7 to 2 to "babies coming out now!"On the "up" side,the nicest nurse gave me terrific advice I could have used the first 2 times. She said just because the hospital stays have been reduced from 10 days to 10 hours,doesn't mean the new mother doesn't still belong in bed.She told me to go home and put on a nice nursing nighty and stay there.it would be a visual signal to the entire family that I still belong in bed with my baby.I had a 14 yr old and a 9 yr old and a mother in law visiting us and that's exactly what I did.

6:52PM PST on Feb 23, 2014

so wrong

5:55PM PST on Feb 23, 2014

Ridiculous!! So, would the pregnant mother be fined then if she ended up delivering before or on her way to the hospital?...
I was a birthing coach for one of my best friends 6 years ago when she wanted a natural water birth, but the twist for this particular commentary at least was that she planned her delivery to be at a hospital. It was her first pregnancy, and she called me with contractions in the middle of the night... she almost DID give birth at home in her own bathtub; then we thought maybe she wouldn't make it out of the back of my car; then there was a looooong moment on hands and knees on the sidewalk outside of the hospital. They barely were able to fill the birthing pool and get her into it before she started to push. A few minutes later... Clare was born!

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