At-home births carry safety concerns

April 29, 2011

We read with concern the April 19 Metro article " Midwife charged in Va. in death

of baby after difficult delivery, " which presented the story of an unlicensed

lay midwife who delivered a 43-year-old woman of her first baby, which was in

the vaginal breech position. The midwife has been charged with child abuse,

neglect and acting without a license.

While it is controversial whether Caesarean delivery is protective for a breech

at term, it is commonly accepted that any attempt at vaginal breech delivery

should occur with well-selected patients in hospitals, attended by practitioners

experienced in the manipulations necessary to accomplish a successful delivery

without head entrapment, with immediate access to Caesarean delivery and

neonatal resuscitation facilities.

Even in the best of circumstances, a recent review of 12 studies of more than

500,000 deliveries showed that for in-home births to low-risk mothers the risk

for neonatal mortality tripled when compared with a similar group of women

delivering in hospitals.

Women are drawn to home births because of concerns that a hospital delivery will

result in a less natural and more " medicalized " experience. But it is important

to recall that all that is natural, including intrapartum fetal death, is not

necessarily desirable. We find it ironic that the organization raising money for

the defendant is named " In Service to Women. " Who is in service to their babies?

H. Poggi, Chevy Chase

Alessandro Ghidini, Washington

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