Midwifery on Trial on Today

September 14, 2009

Last week, the Today Show aired a segment initially titled “The Perils of Midwifery,” which despite the title was not about occupational hazards for midwives (ha), or even about midwifery in general, but about home birth specifically. Although it has since been recaptioned “The Perils of Home Birth” on the NBC website, the original titling as aired to many viewers can still be seen on various websites, including Hulu.

The piece itself tends to gloss over the variety of personal reasons women choose home birth, treating it as a simple lifestyle matter or consumer trend, with one interviewee quoting an unnamed doctor as saying that “home birth had become almost the equivalent of a spa treatment for women.” A montage of photos of celebrities who have had home birth is also provided. The story calls the tragedy experienced by the featured couple “the dark side of an increasingly popular trend.”

The 7-minute piece focuses around the story of a couple whose baby did not survive after what is reported as four days of laboring at home. The couple had CNM Cara Mulhahn as their midwife, who has gained recognition after being featured in the film The Business of Being Born. Mulhahn was profiled by Andrew Goldman (interviewed for the segment) for a recent New York Magazine piece. In that piece, she is framed as a risk-taker, with BOBB director Abby Epstein saying, “She’ll put herself on the line way more than most people, like taking on a birth that’s a little more high risk that most midwives wouldn’t take… She puts her ass on the line in a huge way every time she kind of steps out of bounds to help somebody. That’s just who she is.”

Given this assessment, it’s unfair to hold Mulhahn and her approach and outcomes up as representative of all home births and/or midwifery. Rather than providing women with information on the various types of midwives, their education and credentialing, or questions to ask to determine whether the woman and provider might be of different minds with regards to safety thresholds and approach, the piece simply includes a recommendation from Goldman to ask about malpractice insurance and back-up physicians. No representative of a professional midwifery organization or midwifery educational body was included in the segment, who might have addressed some of these concerns and factors.

The Today Show did feature an ACOG representative, who spoke about unpredictable emergencies and the organization’s position against home birth. The piece also cites unnamed doctors as claiming that it is “impossible” to compare home and hospital birth because of the higher risk cases hospitals tend to see, but this is simply not true. Although a randomized, controlled clinical trial will never be possible, there are good data, especially the recent British Columbia study (.pdf), that compare low risk, uncomplicated pregnancies among women choosing a hospital birth or a home birth. There are many areas in medicine where good data, although imperfect, can guide policy setting, and ACOG fails to appreciate that this is one such example.

Conveying this information, however, requires more detail and nuance than typically provided in a morning news show. As the ACNM concludes: “Women and health care professionals need to be making decisions that are informed by evidence-based medicine—not reactionary interventions and unbalanced investigative journalism. Women deserve better.”

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