When obstetric emergencies do arise in the home setting, necessitating emergent transfer, it is critical that the transfer be managed in a way that ensures the best outcome.
One disturbing article describes both “disarticulations” that occur “when there is no correspondence of information or action between the midwife and the hospital staff” and “fractured articulations” that arise from “partial and incomplete correspondence.”42 A number of midwives were interviewed who no longer feel comfortable bringing patients to certain hospitals because of the negative response they received from health-care providers, sometimes to the detriment of the patient.
Can we improve the situation?
First, we need to choose our words carefully when we counsel women about labor and delivery, in recognition of the buzzwords used by advocates of home birth (“empowerment,” “choice”) and the sense of failure and distress some women feel when they eventually require heightened medical intervention.
Perhaps we should dispense with the term “failure,” as in failure to progress, failure to dilate, and so on, to avoid implying that this “failure” is the woman’s fault. And instead of saying that a patient’s pelvis is “adequate,” implying that another woman’s pelvis isn’t, we could use a term that sounds less judgmental.
We can also make the hospital environment more nurturing and supportive of women’s choices for labor, as long as safety isn’t compromised. And when we receive a transfer of a patient whose home delivery has gone awry, we should openly, efficiently, and professionally communicate with the home-delivery provider to best benefit the patient, regardless of our feelings on the subject.
Home birth isn’t going away
That’s my take on the literature. There are certainly data supporting the safety of home birth for the vast majority of women who choose it, but there is also a significant number of women who will experience unpredictable events that could be fatal if blood products or surgery isn’t rapidly available. For that reason, and in light of the very high stakes involved, I wonder: Why take that chance?