When Do Home Births Go Too Far?

And should anyone be held accountable when things go terribly wrong?

With dismay and profound sadness, I read the Washington Post’s recent story about the death of a baby delivered by Karen Carr, a Baltimore-based midwife, in an Alexandria home birth last September. I know I wasn’t alone in these feelings. But frankly, I also felt rage. Rage at Carr and with the parents who had access to hospitals that come staffed with doctors and nurses and everything else you could possibly need during a high-risk delivery. These parents still chose to deliver at home. They eventually called an ambulance, but it was too late.

To be clear, today’s piece isn’t an attack on people who choose to deliver at home, though I have yet to understand this choice. I don’t understand it because even when all the signs of a normal delivery are there, anything can happen, and I can’t get my head around opting out of delivering in a hospital in the event something goes wrong. Call me risk-averse, if you want. I’m open to hearing the rationale behind taking this risk, and I’m even willing to suspend judgment to hear it because I know people deliver children safely at home all the time.

My problem is with people who choose to deliver babies at home when they go into the delivery knowing that they’re a high risk. In this case, the baby was in the breech position. The Post’s piece noted that other midwives had passed on the chance to deliver in this instance because of the baby’s position. The article also noted that babies in the breech position are typically born via C-section.

Again, here’s where I go back to the parents, not necessarily just the midwife. What kind of parents listen to the advice of doctors and then just decide this advice doesn’t apply to them? I also wonder why parents think that their needs—such as delivering in the comfort of their own home or having the right lighting and music during labor—are more important than the needs of a newborn baby, one whom the pregnant woman has nurtured for the preceding nine months. These mothers likely haven’t been smoking, drinking alcohol, or perhaps even eating sushi or unpasteurized cheese. So how does taking fastidious steps for months preceding the big day align with choosing a risky option over a more conservative one when it’s time for delivery?

I’m honestly asking: Does this mindset stem from a fear of epidurals or emergency C-sections? A loss of control because of an opinionated doctor? Or just the plain old unexpected? Except, isn’t that the whole reason we laugh out loud when someone has a “birth plan”? What the heck is a birth plan? Everything I’ve learned about parenthood, starting with labor, is that you really don’t control much of anything, and the unexpected happens precisely when you don’t want it to.

I was also startled to learn that not all midwives are required to complete the same education and training and that licensing standards vary widely across the states. I can’t help but wonder if federal-government regulation is needed. Considering that obstetrics is a path that many promising young doctors don’t choose because the insurance is so high and the lawsuit threat so great, how can we allow midwives to deliver babies at home if they haven’t met consistent education, training, and certification standards? I applaud the Alexandria prosecutor for starting a critical dialogue by pursuing this case. Someone needed to be an advocate for that baby.

As I mulled over this story for several days, I consistently kept going back to the parents and their role in this tragedy. Why aren’t they being held accountable by the courts? Obviously, no judge or jury could sentence them to a punishment worse than what they’re now facing every day. We don’t even want to think about such a loss. But in this particular instance, we should think about it and talk about it.

As parents, we have to live with “what ifs” all the time when we make decisions on behalf of our kids. So when we’re making one of the first big decisions for them—where and how they enter this world—why would we knowingly open the door to risk?

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