Re “Miles for Midwives 5k to raise awareness for childbirth options” (News article, Oct. 3):

I read with interest Megan Brightwell’s story in The Anniston Star. I agree with her that Alabama’s mothers and babies deserve more from our health-care system. We disagree considerably, however, on how that can be accomplished.

Comparing Caesarean rates for Alabama to the rest of the world is not apples-to-apples. High rates of hypertension, obesity, diabetes and tobacco use in our state are what increase the likelihood of complications that in turn drive up C-section rates. Further, if a doctor believes a C-section is warranted, he or she is basing that decision on the wellbeing of the mother and child in accordance with the prevailing standard of care. Medicine has standards for a reason — practicing contrary to them is a disservice and danger to patients.

Despite claims by proponents otherwise, home birth is inherently more dangerous than hospital birth. Earlier this year, the Society for Maternal-Fetal Medicine — one of the foremost authorities on childbirth issues — released a study finding babies delivered at home by midwives had a four times higher risk of neonatal death than babies delivered in a hospital by nurse midwives. Importantly, the study found increased neonatal mortality risk associated with the location of a planned birth. Even an OBGYN would be at a disadvantage in a home-birth setting as compared to a hospital setting with modern medical equipment and trained staff. Lay or non-nurse midwives, sometimes called CPMs (certified professional midwives), are at a much greater disadvantage since they lack any formal recognized nursing or medical education.

Researchers at New York-Presbyterian/Weill Cornell Medical Center found the risk of neonatal death was 3.2 per 10,000 in midwife hospital births and 12.6 per 10,000 in midwife home births. For first-time mothers choosing to birth at home with a midwife, neonatal death rates increased to 21.9 per 10,000. These are startling figures that underscore how the location of childbirth plays a significant role in determining survival.

While there will probably always be babies born in elevators and taxi cabs without the slightest complication, I cannot imagine the grief those 12 mothers will experience who choose to birth at home with a midwife and lose their newborns. In a hospital setting, these lives may have been saved. The question is not “who can deliver a baby when everything goes right?” Rather, the question is, “who can deliver a baby when something goes wrong?”

Alabama’s mothers and babies do deserve better. They deserve better information on healthy eating and lifestyle habits and about the dangers of tobacco use during pregnancy. But they also deserve to know the dangers to their babies and themselves associated with home birth, even if they choose, as some certainly will, to do it anyway.

Ronald Franks, M.D., is president of the Medical Association of the State of Alabama.