With the recent Homebirth Summit that took place in Warrenton, VA October 20-22, our country has witnessed increased attention on the state and incidence of this birthing option in the United States. The Summit organizers have published the outcomes of the event, including Consensus Statements which can be viewed here. Additionally, you can read comments about the Summit from attendees on various blog sites like Rixa Freeze's Stand and Deliver, pediatrician Mark Sloan's blog site (part one and part two) and Childbirth Connection's Transforming Maternity Care blog site-written by former S&S editor, Amy Romano.

When flipping through the fall issue of the peer-reviewed journal Birth, I landed on the study,United States Home Births Increase 20 percent from 2004 to 2008 (MacDorman, Declerq and Mathews, 2011). This 20 percent increase isn't really surprising to me - there is so much momentum in the taking back childbirth renaissance. The opening paragraph of the article reminds us how much birth location has changed over the past ~ 100 years:

Major changes in United States childbearing patterns have occurred over the past century. At the beginning of the last century, almost all United States births took place outside a hospital, the vast majority at home. However, by 1940, only 44 percent of births occurred outside a hospital, and by 1969 this percentage had declined to about 1 percent, where it has remained relatively stable for several decades.

When looking at the Trends by State section of the article, I was interested to find the state in which I live, Montana, boasts the highest homebirth rate (2.18%). That's compared to the country's over-all current homebirth rate of 0.67% in 2008 (most recent data). While this trend feels significant (especially to homebirth advocates here in the Big Sky state) philosophical dichotomies still exist.

As a part of an email conversation I had with a friend the other day, I was yet again reminded of the age-old riff between hospital-based and home-based birth providers or, more accurately, the cracks birthing women fall into when attempting to traverse the chasm between these two models of care.

This friend of mine, a doula whose family recently relocated to a very small northeastern Montana town, is pregnant with her second child. Her first birth was successfully attended by a midwife at a birthing center in the town from which they recently moved. Desiring the same level of skilled, attentive, compassionate maternity care, my friend began her search for a midwife who would look after her throughout her current pregnancy, labor, delivery and postpartum care. And yet, due to their rather remote location, she found a lack of midwifery care in her exact locale. Hoping to piece together her prenatal care from readily available care providers (a local obstetrics clinic) and the philosophical maternity care she truly desires, she hoped to attend regular prenatal care appointments with an OB who was willing to co-supervise the pregnancy with a more distant midwife. We're talking true, interdisciplinary collaboration, here. However, when the OB clinic got wind of this plan, they flat-out refused to work in conjunction with a midwife, or to provide my friend with prenatal care if she chose to also work with a midwife. So, for now, my friend is tending to her own prenatal care, punctuated with telephone calls and intermittent visits with the midwife she has hired (who lives 270 miles away).

If this story is at all reflective of the state of maternity care collaboration in our country, then the multi-stakeholder conversations that took place at the Homebirth Summit are more important than ever.

What are your thoughts on the Homebirth Summit?

Posted by: Kimmelin Hull, PA, LCCE, FACCE

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