Home-birth advocate dies in childbirth

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By Lisa Flam

With home births growing more popular in the U.S., the death of a home birth advocate who went into cardiac arrest during childbirth brings renewed attention to the debate over the safety of giving birth at home.

Caroline Lovell, who advocated for midwife funding and legal protection in Australia, died Jan. 24, a day after she was rushed to the hospital during labor, according to the Herald Sun newspaper. Lovell, 36, had planned a home birth and was believed to have been assisted by private midwives, the paper said.

Before she was taken to the hospital, Lovell held her newborn daughter, named Zahra, who survived. She has a 3-year-old sister named Lulu.

After nearly a century of declining popularity, the percentage of home births in the U.S. increased 29 percent from 2004 to 2009, though they still account for fewer than 1 percent of all births. Most women who give birth at home are assisted by midwives, not doctors.

Will this one, high-profile death dampen the enthusiasm for having a baby at home?

No, says Susan Moray, spokeswoman for Midwives Alliance of North America, which represents certified professional midwives who work outside of hospitals.

“For healthy, low-risk women, we believe birth is a normal process and the body is well designed to do it. Home-birth midwifery care has been proven to be a safe and nurturing alternative to physician-attended hospital births,” she said.

Moray, a midwife in Portland, Ore., notes that women do occasionally die in labor -- sometimes at home, sometimes in the hospital. And maternal deaths in the hospital rarely make international headlines. One tragedy won’t change attitudes toward home birth, she says.

“I don’t think one death is going to swing the pendulum” away from home-based labor and delivery, Moray said. “What’s swinging the pendulum to the 29 percent increase in home births is women talking about the satisfaction of their births and the good safety record.”

The American College of Obstetricians and Gynecologists, which has 55,000 members, said in a statement last year that hospitals and birthing centers are the safest place to have a baby.

“Although the absolute risk of planned home births is low, published medical evidence shows it does carry a two- to three-fold increase in the risk of newborn death compared with planned hospital births,” the college said.

Dr. Erin Tracy, head of the college’s Massachusetts section, said pregnant women are generally healthy and most will be fine, regardless of where they deliver. It’s the emergency cases -- when women need potentially life-saving surgery, blood products or medicine -- that make doctors worry about women delivering at home. The time is takes to get to a hospital often means the difference between life and death, she said.

“There are circumstances where medical intervention is necessary,” said Tracy, an obstetrician and gynecologist at Massachusetts General Hospital in Boston. “We can provide that intervention much more quickly in the hospital.”

Calling Lovell’s death a tragedy, she said any maternal death gets people talking and thinking about safety and risk.“There will be more dialogue about home deliveries in general,” she said. “It’s not adding to the literature and the studies. We know the potential risks of having a delivery outside of a hospital setting.

“People should decide what level of risk they’re willing to incur,” she said.

The college says women considering a home birth should work with a certified nurse midwife, certified midwife or doctor. Women should have a plan for a quick trip to a hospital in the event of an emergency.

The college says that 548 women died of pregnancy-related causes before, during or right after childbirth in 2007, the most recent year for which statistics are available. The number has been under 1,000 since 1960.

The top causes of pregnancy-related deaths in this country are uncontrolled bleeding, blood clots, high blood pressure, infection, stroke, amniotic fluid in the blood and heart disease, the college said.

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