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I am a Labor and Delivery nurse with 20 years experience and a Mama who had 2 home births.  I must point out how fortunate we are to have articulate, thoughtful, and compassionate OB/GYNs like Karen Adams in our midst who support home birth for true low risk, term candidates.  Likewise, Holly Sholles strongly represents her community of DEMs, being a well spoken passionate and intelligent provider.  In Oregon, we have the components to lead the country in the creation of a strong, safe home birth culture with seamless and safe transport to hospital care when merited.

Here is the obstacle to this perfect comprehensive birth culture from my perspective.  Currently, licensed DEMs are able within their written scope of practice to deliver breech, twins, and VBAC at home.  There are no clear guidelines for them to establish fetal well being (how often they must listen to babe's heart beat), limit length of time for safe second stage (time spent pushing), length of time for bag of waters to be ruptured.  In the hospital, I have personally witnessed sad and devastating outcomes transferred in from attempted home birth related to these vague and wide open Standards of Practice.   Sadly, despite years of controversy, the DEM community has not established MANDATORY data collection to support their claims that high risk practice within home birth is safe. What we know is that there have been term losses of infants due to these practices documented in the complaints to their State Board of Licensure.

The latest research strongly establishing safety of home birth comes from the Netherlands.  Almost one third of Dutch women deliver at home.  It must be noted, though, that the Dutch midwives function with strict and clearly spelled out Standards of Practice prohibiting breech, twin, and VBAC delivery at home. 

I have met many competent, compassionate, skilled DEMs in our state.  Sadly, relations between hospital and home birth culture will continue to be fractured as long as we are on the receiving end of bad outcomes related to these high risk practices attempted at home.

posted 4 years ago
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