Recently there have been a bunch of good essays (links below) discussing how the birth location, and type of attendant, affect outcomes. These pieces all take the time for some non-propaganda, nuanced thought and reflection about what would improve things for a diverse American population of mothers. It’s a welcome change from some of the less rigorous thought we often see on this topic. Instead of having a pitched battle about whether ALL HOMEBIRTH IS VERY DANGEROUS AND IRRESPONSIBLE AND RISKY! and whether ALL HOSPITAL BIRTH IS TOTALLY OVERMEDICALIZED AND DANGEROUS AND HATEFUL AND NOT EVIDENCE BASED, these essays look at the improvements we need, overall, to our maternity care system.

Here’s a brief summary (but honestly, these are issues that aren’t well suited to brief summary):

we need a standardized care practice for doctors, nurses, and midwives who attend hospital births. The practice should minimize separation of mother and baby after birth to true medical need, appropriately support normal infant feeding, prioritize comfort, dignity and infection-avoiding after-care for mother and baby, eliminate practices associated with post-partum depression and PTSD, and train all hospital personnel in all of these areas. And this should be available to all women in every hospital across the land.

Is that really too much to ask for in 2012 in the United States of America?

we need a nationally standardized training practice for midwifery that encompasses homebirth and hospital care, so that “midwife” means one thing, everywhere. Without that, it is impossible to accurately say how “midwifery” care compares to OB care, or how home-birth compares to hospital birth.

These changes would create a more functional system in which each woman could get care appropriate to her particular needs, not the needs of women in general. This is called reproductive choice, and it should be available to everyone, not just educated, white-glove-insured people in major cities.

A functional system would also get us away from the kind of strident hysteria that too often accompanies discussion about birth, which, when you care about these issues, become truly a pain in the ass to read. (don’t get me wrong — emotional discussion of one’s birth when you’ve just had a baby is totally appropriate. Ideally, though, that personal topic is handled separately from a policy discussion of how care can be improved for everyone.)

Here’s what you can do, meanwhile:

If you’re pregnant and planning a hospital birth: take the time to talk to your care provider about her training and experience, including her experience of this hospital’s post-natal care, which she may or may not be familiar with. If you’re in New York state, you can look up your hospital’s stats including breastfeeding rates. Take a childbirth class that covers infant care and breastfeeding. In my childbirth classes, we do role-playing to help students get comfortable with how to talk to personnel in the hospital in a way that gets the information they need and reduce unnecessary stuff happening.

During and after your birth, remember that you are the customer. If you’re not getting good customer service, ask for better. If that doesn’t happen, write a letter to your care provider’s office and/or the hospital, later, and let them know you weren’t happy. Policies change when people do this.

If you’re pregnant and planning a home birth: take the time to talk to your care provider about her training and experience in, and out of hospital, and learn about the laws relating to midwifery in your state.

Write to your legislators and propose standardized care practices for hospital births and midwifery training. Send a copy of the letter to all your facebook friends and ask them to do it, too.

Here are the links to the essays: The original piece in Slate by Emily Willingham, an article about it on Babble by Ceridwen Morris, Emily Willingham’s blog followup, and a Comment by Midwife Amy Romano.

This stuff matters.

How did it go for you? If you gave birth in the hospital, how did you feel about the post-natal policies and the care you received? If you gave birth at home, were you in a state where you had access to a CNM? And what was her home-birth training? You can email me comments or use the Disqus feature below.