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As a CNM with many years of experience in out-of-hospital birth and hospital birth, I have two comments:

1.  Women should have the opportunity to make informed choices in their birth site.

2.  In countries with well-documented safety in out-of-hospital births-- i.e. statistically decreased rates of cesarean section/less significant perineal trauma/ AND lower fetal morbidity and mortality-- there ARE strict guidelines for conditions that are NOT allowed to birth at home. Malpresentation (such as breech babies), previous uterine incision (such as women who have had cesarean sections), and multiple gestations (twins, etc) are birthed in hospital, no exceptions.  The use of these countries' statistics to argue for home birth for breech, TOL-AC, and multiples is very misleading.

Again, I support women in their choices 100%.  I sincerely hope that women ARE well-informed about risks and benefits of those choices.  Hospitals have an obligation to provide women with reasonable, compassionate, and EVIDENCE-BASED care--including normalized birth for trial of labor after cesarean, twins, and breech babies.

Thank you, 

Happy Barnes, CNM

posted 2 years, 10 months ago
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