What if your baby dies?

Boy, doctors sure love to scare women who dare to question their judgment.

Via Susie Bright, here's an issue close to my heart. My first son was born in a hospital with a obstetrician and a nurse-midwife. They induced labor for what I found out later was a weak reason, he was born prematurely with hyaline membrane disease and he almost died.

I told my husband: "If I have to go back in the hospital, I'm not having another one." Fortunately, we located a supportive doctor and some good lay midwives, and my second child was born uneventfully in our bedroom. (On a bean bag chair.)

"What if something went wrong?" well-meaning people kept asking. "Being in the hospital saved your first kid's life." I tried to explain to them he would have been born full-term if I'd been at home, and no life-saving would have been necessary, but there's no talking to people about this. They're just too well indoctrinated with fear tactics.

Most complications of labor are identified with good pre-natal care. Obviously, if you have high blood pressure, an infection or similar factors, you should be in the hospital. There are very few conditions that are the proverbial "bolt from the blue" - and there are enough things that go wrong in hospitals.

What I avoided: An unnecessary episiotomy, low blood sugar (because I could eat in labor), hospital-bred bacterial infections, a higher risk of C-section (often brought on by staying in bed so the ultrasound monitor would work, causing compression on the umbilical cord -- or by an impatient doctor with a tee time, or by Pitocin-induced contractions) and being separated from my other kid. I felt so good after delivery, I got up and made breakfast for seven people.

Women should have real choices in childbirth. (In European countries, home delivery is no big deal.) But labor and delivery is the biggest cash cow American hospitals have, OB-GYNs are often reluctant to share power with their patients, and medical consumers have been trained to follow a doctor's authority without question:

The collapse of New York's legal home birth midwifery services has come as a result of the closure two weeks ago of one of the most progressive hospitals in the city, St Vincent's in Manhattan. When the bankrupt hospital shut its doors on 30 April the midwives suddenly found themselves without any backing or support.

There are 13 midwives who practise home births in New York, and under a system introduced in 1992 they are all obliged under state law to be approved by a hospital or obstetrician, on top of their professional training.

St Vincent's was prepared to underwrite their services, but most other doctors and institutions are not, and they now find themselves without the paperwork they need to work lawfully.

Miriam Schwarzschild, one of the 13, is now in the invidious position of either abandoning her clients or operating illegally. "Apparently by taking a woman's blood pressure I am committing an illegal act," she said. She has no doubts about what she will do: she will stand by the six to eight women she helps in labour every month, law be damned. She said she intends to "fly under the radar", but is anxious about what would happen should she be reported to the state authorities. "At any time a nurse or doctor could report me, and once that happens they could go after my licence and shut me down."

Jitters are spreading among the tiny community of home birth midwives. The rumour has circulated that one of them has already been shopped to the authorities by an obstetrician at a hospital where she transferred one of her clients in need of medical attention.

The crisis of home birth in New York city is an extreme example of a pattern found across America. Fewer than 1% of babies are born at home in the US, and in New York that figure is as low as 0.48% — about 600 babies every year out of 125,000. That compares with a rate of about 30% in the Netherlands.

he crisis of home birth in New York city is an extreme example of a pattern found across America. Fewer than 1% of babies are born at home in the US, and in New York that figure is as low as 0.48% — about 600 babies every year out of 125,000. That compares with a rate of about 30% in the Netherlands.

In much of Europe, midwives play the lead role in assisting most low-risk and healthy women to give birth, handing over to a specialist doctor or surgeon only when conditions demand. In the US, that relationship is reversed.

Obstetricians, who are trained to focus on interventionist methods and often have never even witnessed a natural birth, are in charge of about 92% of all cases. As a body, they are fiercely resistant both to midwives – who under the private medical system in America are their competitors – and to women choosing to remain at home.

In 2008 the American Congress of Obstetricians and Gynaecologists put out a statement effectively instructing its members to have nothing to do with the "trendy" fashion towards home births. Yet despite Acog's stance, and despite the fact that the US spends more money on pregnancy and childbirth-related hospital costs than any other type of hospital care ($86bn a year), the country has the unfortunate distinction of having one of the highest rates of maternal mortality in the industrialised world. Its rate stands at 16.7 maternal deaths per 100,000 live births, compared with 7.6% in the Netherlands and 3.9% in Italy. Britain's rate is 8.2%.

On top of that, about one in three pregnancies in the US end in a caesarean section — a product, critics say, of the highly interventionist approach that includes frequent induced labours and epidurals. Amnesty International recently dubbed the US record on childbirth as a whole a "human rights crisis".

Knowledge of these statistics, and of what is now happening to New York midwives, makes Julie Jacobowitz-Kelly see red. She is one of Schwarzschild's clients and is preparing to give birth to her first child, a boy she and her partner have already named Benjamin, whose due date fell today.

She said the current illegal status of the home birth midwives was "a travesty, it's absolutely ridiculous. It angers me that experienced midwives like Miriam are in jeopardy."

That is a view shared by some senior New York politicians, including Scott Stringer, Manhattan borough president. "There are 600 women who are going to give birth in the next year who want midwives with them at home, and to take away their rights and choices is so backwards it's embarrassing," he said.

Midwifery organisations are scrambling to persuade other hospitals to take over St Vincent's role by signing the so-called "written practice agreements" the midwives need to be legal. So far 75 hospitals have been approached; not one has replied.

Meanwhile, a bill is sitting before the New York state assembly that would scrap the system of practice agreements and allow the midwives to offer their services free of the control of obstetricians. But the bill may not be put to a vote at all this year.

"At the end of the day, hospitals are for sick people, and I'm not sick," said Jacobowitz-Kelly. "I'm going through one of the most natural processes women can go through, so why do it anywhere other than the most natural setting — my home."