American College of Domiciliary Midwives

Member, Medical Board of California
Dr. Alan Shumacher, MD
Division of Neonatology
Children's Hospital
Dan Diego, CA

July 30th, 1993

RE: statement during the July.93 general meeting that "home birth is dangerous"

Dear Dr. Shumacher,

I want to thank you for being willing to serve the people of California in this important post. I suspect it is not an easy job -- your must be inundated with many different opinions about every minute detail of the Medical Board's work. I will try not to burden you unduly with mine.

However, I too have a request. In future public statements about the relative merits of homebirth, would you please consider the general unfairness of speaking anecdotally. You and I and every other person who regularly deals with the medical profession could make similarly derogatory statements about any facet of medical care -- medication errors, anesthetic accidents, mix-ups in blood transfusions, surgeries performed on the wrong patient and so forth. But these anecdotal characterization would not be synonymous with a fair or scientific examination of data.

In regard to homebirth babies you have encountered in your capacity as a neonatologist, you must acknowledge that the babies born at home during that same time period who were normal and needed no intensive care did not come to your attention nor did babies who would have been born prematurely if not for antepartum care received by their mothers from non-medical maternity caregivers. Such anecdotal commentary also ignores the benefit to mothers and babies initially seen for medical treatment because a non-medical caregiver either recognized the need when the parents did not or because she successfully prevailed upon the parents to seek care when they otherwise would not have done so.

The true question here is the ratio of babies born at home without 'incident' versus babies treated for a problem directly related to the choice to labor and/or birth at home. Since midwives file birth certificates, this information should be easily available from the California Bureau of Vital Statistics. Since 1988 birth certificate information has included the planned place of birth and an accounting of all complications of pregnancy, delivery and neonatal treatment. However, I must warn you from my own experience as midwife-of-record and from statistical data bank kept by the California Association of Midwives over the last ten years, that this ratio is very favorable to domiciliary care.

Statistically, every baby who suffered or appeared to suffer because of the choice of out-of-hospital birth is matched by one or more babies who suffered or appeared to have suffered as a result of hospital interventions. Please do not think that I mean that doctors are to blame for that situation -- many mothers require medical intervention because of dangerous life-styles or substance abuse; other mothers experience complications due to the use of anesthesia or labor stimulants which were medically indicated. It is just a statistical fact that the more medically-complicated the childbearing event becomes, the higher the likelihood of medical complications. In that regard, domiciliary statistics benefit both from the absence of medical ministrations and the presence of healthy mothers with normal pregnancies.

There are many fine studies available from jurisdictions where domiciliary midwifery is an integral part of the maternity care system. The W.H.O. Forum bulletin regularly reports on domiciliary care in other parts of the world and much of this statistical data is available on MedLine for those with computer/modem connections. I have enclosed a partial bibliography for your convenience.

However you personally feel about me, I want assure you that we share many of the same goals and no doubt a common interest in the health and practical well-being of mothers and babies. I love babies and I love my work, as I am sure you do also. We may have many different ideas about what that means and how to best bring about those goals, but I prayerfully request that you respect the long and honorable tradition of midwifery by becoming informed and by speaking about non-medical midwifery and home birth in a manner that reflects up-to-date information. And I assure you that I will speak about the honorable traditions of medical practice with the same respect and accurate information base.

faith Gibson, domiciliary midwife