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Globe Editorial

Increase in home births shows need for new rules on midwives

July 27, 2011

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FEW EVENTS in family life are as powerful and memorable as the birth of a child. So it’s little surprise that people have strong feelings about whether it should take place in a hospital or a home. Ultimately, a birth plan is the parents’ choice, so long as they understand the risks involved. But a bill to create new oversight for Massachusetts midwives who perform home births could make the home-birth option even safer. It deserves the Legislature’s support.

Home deliveries make up only a tiny portion - less than 1 percent - of births in Massachusetts every year. But the numbers are growing, led by women who wish to avoid what they see as overly intrusive or restrictive hospital practices, such as the constant monitoring of fetal heart rates, or the restrictions on vaginal births for women who have previously had caesarean sections. Safety statistics are hard to analyze, since it’s impossible to conduct a randomized trial. But in many other industrialized countries, home births are a far more popular and tested choice. Home-birth midwives support the Massachusetts bill, which they believe would draw more people to their services. (The bill would not mandate insurance coverage for home births.)

The American College of Obstetrics and Gynecology opposes the bill, saying a registration process would be cumbersome and costly. The home-birth midwives covered by the bill are accredited by a national agency that requires hands-on training and written exams. But the obstetricians’ group notes that they lack the type of medical training that doctors and hospital nurse-midwives receive.

In the rare event of an obstetrical emergency - one, for instance, that requires emergency surgery - a swift transfer to a hospital is crucial. Anecdotal evidence suggests that transition doesn’t always happen smoothly now - partly because of a lack of trust between home-birth midwives and doctors, and partly because of hospitals’ concerns about being held liable for the consequences of midwives’ mistakes. Obstetricians point out that a hospital would never turn away a patient. But in the event of an emergency, even a heated conversation in a hallway could waste crucial time.

The bill before the Legislature could establish a healthier relationship. The new state board, housed under the Board of Registration of Medicine, would require home-birth midwives to be licensed, and would establish standards of training and testing. It would require explicit emergency transfer plans, and would relieve doctors and hospitals of liability for cases they take on in emergency situations.

There are certain to be startup costs and growing pains, as formal communication lines are established. But in the end, the bill would likely create a smoother working relationship between hospitals and home-birth midwives - something that would benefit both parents and their babies.