A reader commenting on a home birthing thread on Andrew Sullivan’s the Dish sums up how medical regulations can fail better than I’ve heard before:

The tragedy to me in this whole story is that once again a medical debate is being left to the extremes. Screams of “death panels!” drowned out any fair discussion of end-of-life care and the wholesale suffering that has been inflicted on the dying and the old in the name of modern medicine’s “advances.” As an advocate of home birth, bolstered by the fact that 30% of Dutch babies enter the world at home, the development of home birth in America as it stands now is disheartening.

The obstetric medical establishment is in need of some serious questions about overuse of medical intervention and gadgets, which culminates in an extremely high C-section rate. For one, I think women should get better information about the numerous side effects of epidurals. But any discussion of including home birth as an legitimate option has been met with disdain, and licensed medical professionals are often legally barred from attending home birth.

The result is that lay midwives have taken up the slack. Probably many of them are smart, cautious and aware of the risks and have done a great job for women in labor and their babies. I personally know many women who birthed at home successfully and happily. But the swift growth of a home birth culture that is openly hostile to modern medicine and all its benefits is only going to lead to tragedy.

On the website you linked to, Hurt by Homebirth, it’s hard to read most of the stories. They are terrible, sickening tragedies that could have been averted if the practitioners had an inkling of what was going on, or if they weren’t actually practicing an extreme ideology more than practicing midwifery. The malpractice in these cases is absolutely appalling. But is it home birth, or the fact that lay midwifery has grown with little direct supervision from the medical industry that prefers to demonize it rather than supervise it?

In the Netherlands, home birth is something that must be approved by a doctor, and the midwife that is attending the delivery is part of, not an alternative to, the medical system. When I gave birth in 2007 and 2009 at a birth center in Cambridge MA, a doctor had to sign off before I was allowed to deliver there, and there were very clear rules about when a midwife should transfer me across the street, something that made me much surer about the safety of my babies (and me). There was an awareness that birth is a risky business, and that merely wishing for a “natural” “beautiful” birth was not a guarantee – and that the hospital across the street was there for a good reason.