Head of the UK’s Royal College of Midwives, Cathy Warwick, is calling for a “a seismic shift” in the way maternity care is provided. In a New Year’s message, she speaks out against a “concerted and calculated backlash” against midwives and home-births, describing the current state of affairs at “almost near breaking point.”

Home birth is a controversial topic, despite the fact that research shows that under the right circumstances, it’s a healthy option for some mothers.  “We want to  make sure that all women know,” said Warwick, “that the choice of a home birth is available to them. We feel that there is a concerted and calculated backlash by sectors of the establishment against home-birth and midwife-led care.”

The way maternity care is organized in the UK is different from what happens in America. For one thing there are lot more midwives delivering babies over there. For another there are more home-births. In America, only 1% of babies are born at home. In England the percentage of home births dropped from 2.9% in 2008 to 2.7% in 2009. Something Warwick calls “a real disappointment.” Wales, on the other hand, has a 4% home birth rate but only after the government made it a priority. In Scotland, 1.5% of women give birth at home. The lowest number is for Northern Ireland.

The obstacles to making home birth a more viable option are many; in her statement Warwick focuses on a number of big media stories in 2010 implying that home birth is less safe than hospital birth. The studies those articles were based on have been highly criticized as flawed in their methods. Nevertheless, the idea of normal, midwife-assisted births took a PR hit.

Speaking to the BBC on Wednesday, Warwick claimed certain researchers collaborated with the media to paint an unfair and alarming portrait of home birth safety. “We think people are comparing apples and pears,” she said, in reference to a tendency to generalize about the safety of various birth practices across different countries with vastly different populations and maternity services.

Warwick makes a good point in suggesting that pregnant women look not at vague, global numbers but “speak to midwives and ask them about evidence relating to their own circumstances, and be allowed to make an informed choice.”

A Department of Health spokesperson responded to Warwick’s statement thus: “We have made clear that women and their families should be given the information they need to make informed choices about their maternity care. The planned number of midwives in training in 2010/11 is 2,493 — a record level. We expect there will be a sustained increase in the number of new midwives available to the service over the next few years.”

America is behind other countries when it comes to midwifery care, but according to all the research I’ve ever seen, mothers and babies are best served when midwives and  doctors work together. Unfortunately the way maternity care debates are often framed, it’s either home birth or a highly “medicalized” hospital birth and the onus is on mom to pick the right side. But these are not good or even available choices for the majority of pregnant women. Most women would benefit from a third option that is too rarely presented in America: excellent midwifery care backed up by top obstetric technologies and doctors, if necessary. So in the spirit of New Year’s statements about birth, here’s mine: we need more birthing centers, more midwives, and more support for normal birth.

If you’re interested in the debate about birth safety, there’s quite a rager going on in the comments section of a recent post by my Babble.com colleague, Danielle; both legendary midwife Ina May Gaskin and renowned home birth-basher Dr. Amy have chimed in.

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