I feel the need to clarify that I did not include certified midwives in my letter below because they are not yet authorized to practice in Virginia, which is where my pediatrician is located, and I want to avoid any unnecessary confusion over midwifery credentials. Please also consider that this letter arose out of my very personal health care and birth decisions as well as what I think our pediatrician most needs to hear. My opinions are forever evolving, and I respect the validity and fervor of opinions and decisions that differ from my own.
Dear Dr. Wayne Eriksson,
My son has been coming to your practice for 1 year, and I have thoroughly enjoyed and benefited from our experience. I’ve found your advice in particular to be practical and effective. When I called to arrange care for my second son, due at the end of November, I was quite disappointed to hear that you will not provide him with the pediatric care he needs due to my choice of planned home birth.
I chose home birth with a certified nurse-midwife because of Virginia’s limited availability of freestanding birth centers staffed by certified nurse-midwives with pre-existing facility arrangements for emergency care. Instead I chose BirthCare and Women’s Health based in Alexandria, VA, which offers the option of birth center or home birth with pre-arranged emergency care and consultation built into their practice system. Given that my first labor and birth happened so quickly and given that the birth center is nearly 40 miles from my home, I believe the safest route is for the midwives to come to me at my home on the big day.
I am aware that the American Academy of Pediatrics recommends that birth take place in a hospital or birth center. However, their latest Policy Statement on Planned Home Birth also states that pediatricians should respect the right of women to make a medically informed decision about delivery and that:
- “Regardless of the circumstances of his or her birth, including location, every newborn infant deserves health care that adheres to the standards highlighted in this statement.” (Of particular note, the statement says that newborns should be evaluated by a health care professional who is knowledgeable and experienced in pediatrics within 24 to 48 hours of birth.)
- The goal of providing high-quality care to all newborn infants can best be achieved through continuing efforts by all participating providers and institutions to develop and sustain communication and understanding on the basis of professional interaction and mutual respect throughout the health care system.”
Less than 1% of women in the United States choose planned home birth. However, the rate of home birth has increased by 41% from 2004 to 2010, especially among white, non-Hispanic women. In the coming years, your practice is likely to encounter more mothers seeking pediatric care following a planned home birth. By denying care to their infants, an opportunity is being missed to provide patient education and to advocate for the safety of the baby.
I am aware of recent studies that found an increased risk of neonatal mortality, low Apgar scores, and seizures among infants born at home in the United States as well as the support and criticism these studies have attracted. I am also aware that choosing a certified nurse-midwife as your care provider at a home birth appears to mitigate these alleged risks. My midwives, collaborating OBGYN, medical assistant, and I have taken great care to ensure a safe environment for my baby and me, including GBS screening, availability of IV antibiotics and oxygen if needed, standard maternal and newborn screening procedures, emergency transfer arrangements, and ready pediatric consultation.
I am disappointed that our pediatric consultation will not come from Union Mill Pediatrics, but I hope that my letter may have a positive impact on your practice and your future patients. Thank you for your care and advice over the past year, and thank you for considering my concerns.