To the editor:

In Errol R. Norwitz's review1 of my book, Pushed, he writes that my solution to the problem of overmedicalization of childbirth is “not...a system in which care is provided by certified nurse midwives...Instead, she is proposing the use of community-based lay-midwives, whose only 'training' consists of an unofficial apprenticeship of variable length.” Norwitz calls this solution “alarmingly simplistic,” and I would agree—directing all women to give birth at home with unrecognized midwives is not a solution at all, and it is certainly not one that I propose in Pushed.

As I am a journalist, it is my job to illuminate what I see as a major public health and women's rights issue: women are being physically restricted during labor, subjected to interventions that are not evidence based (such as continuous electronic fetal monitoring), denied vaginal birth after cesarean and vaginal breech or twin deliveries, and prevented from choosing how, where and with whom they give birth.

One could fairly criticize the book for not proposing adequate solutions, but I'm not a policy-maker. Instead, I set out to tell what I felt was an important story and to document it as thoroughly as possible. Part of that story is that out-of-hospital births and the midwives who attend them have been pushed underground, in spite of several large studies showing that such births are safe2,3,4,5. Norwitz does not address the research on out-of-hospital births (which is cited in the book) and argues that I make “selective use of case histories.”

But the safety of home and out-of-hospital births that are attended by trained midwives for low-risk women is not something that I show with anecdotes; it is something that epidemiologists have shown in peer-reviewed research involving large study cohorts2,3. Norwitz mentions “extensive scientific evidence to the contrary.” But the fact is that there is no strong research evidence that home births, for low-risk women, pose any danger to either mother or baby6. There is one study7 that is sometimes held up as showing that home birth leads to more infant deaths. But this study stands alone, away from the bulk of the research, and has been widely criticized for lumping together unplanned, unassisted home births with planned, midwife-attended home birth.

Though I don't profess to have a simple remedy, I would agree with Norwitz that we shouldn't “throw the baby out with the bathwater.” Women must have access to emergency obstetric care, and women must also have support for physiological births.