Grand Forks doctor weighs in on home vs. hospital births

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Dr. Michael Brown, of Grand Forks, an obstetrician-gynecologist with Altru Health System who has more than 30 years’ experience, is a proponent of midwifery — with some caveats.

“Midwives provide a wonderful service in the appropriate environment,” he said.

But he does not recommend home births attended by midwives because “3 percent of the time, things can go terribly wrong, and you want to be prepared for emergencies, you want that team standing by” that can help if problems arise.

“If it happens to you, it’s 100 percent of the time.”

Years ago, as a resident in UND’s obstetric-gynecology residency program, Brown trained alongside midwives, he said. “When I was in the Air Force, we were fortunate to have midwives as physician-extenders.”

People have a right to choose their health care services, he said.

“Health care is a matter of choice, and we hope to educate people to make the safest choice,” he said.

“Obstetricians feel strongly that care is given in the appropriate setting with appropriate medical back-up and staff. Labor and delivery is a very critical time in the mother’s and baby’s life. Things can go wrong and go wrong very quickly.”

At Altru, no midwives are credentialed to deliver babies in the hospital, he said, because the need for these services is being met by obstetricians on staff.

“A lot of people want to receive care at home,” he said. “We’re happy to give care. We visit with them and, often, they get comfortable with us and decide to give birth in the hospital.”

He estimates only three of his patients have delivered their babies at home in the past 15 years, he said.

‘Less intervention’

The field of obstetrics may be starting to address the concerns that prompt some families to seek care from midwives.

“There’s a movement toward more monitoring and less intervention,” he said. “We’re finding, more and more, that the less intervention, the better.

“Nature has this (process) figured out pretty well. For example, we don’t suction the baby’s mouth right away, while the umbilical cord is attached, to allow for bonding with the mother.”

Also, doctors are doing far fewer episiotomies, an incision meant to ease a vaginal birth, he said. “It used to be that almost everyone had one.”

Nationally, about 20 percent of babies are born by Cesarean-section, or C-section, to save the life of the baby and mother, he said. “You need to have someone immediately available to provide that critical care,” if needed.

“It used to be ‘once a C-section, always a C-section,’” he said, “Now, if a proper incision was made, mothers can give birth vaginally even after (having) two babies delivered by C-section.”

But in 1 percent of cases, the scar from a previous incision separates during a natural birth, posing serious danger to mother and baby, he said.

He supports licensure for those who practice midwifery, he said.

“It’s important to have standardized training and credentialing of health professionals. It validates that we are giving good care.”

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