DR. GEORGE WOOTAN is an upstate New York doctor who specializes in delivering babies at home. He landed on the front page of the New York Times this week because the state health commissioner suspended his license for 60 days on the grounds that "deficiencies" in his medical methods are an imminent threat to the health of the people of New York.
Dr. Wootan contends that the real issues in his case have much more to do with the health of the medical industry than the people of New York, and that hospitals and obstetricians have a lot of money at stake if more and more parents decide to give birth at home.
Dr. Wootan faces 11 charges, all of which were reviewed by a professional conduct committee that recommended his suspension, according to Linda Milstrey, a spokeswoman for the state health commissioner. The charges include failing to provide proper coverage for home births when he is unavailable, failing to properly diagnose and treat a case of prolonged unproductive labor which subsequently contributed to the death of a newborn child, failing to properly diagnose and treat a situation that resulted in a stillborn birth, and failing to administer silver nitrate in the eyes of newborns. Milstrey would not disclose what or who initiated the charges against Dr. Wootan, but she said the suspension is not an action the state health commissioner would have taken "just to prevent someone from doing home deliveries if they were doing them properly. He has to be able to show there is enough evidence to constitute imminent danger."
Dr. Wootan's tribulations are the latest in an ongoing controversy over "home-birthing" that has pitted parents, midwives and a few doctors against the medical establishment. To hear one side tell it, the well-being of mothers and babies are at stake. To hear the other side, the well-being of doctors and hospitals are at stake.
The medical establishment has long opposed home births as risky. "To have your baby at home is anybody's right, but in my opinion it's stupid," says Dr. William H. Cooper, clinical professor of obstetrics and gynecology for George Washington University and president of the medical staff at Sibley Memorial Hospital. "Eight percent of deliveries are complicated and complications cannot be handled at home."
So, in the interests of "safety," the medical establishment in Washington has gone to extraordinary lengths. Last October, for example, the obstetricians at the Washington Hospital Center, the only facility in the city where nurse-midwives were allowed to deliver, voted to end that privilege. The doctors told the midwives that the vote was a reflection of their opposition to home deliveries. But, in effect, says nurse-midwife Barbara Vaughey, the doctors' actions encouraged home births. "If, indeed, they were trying to prevent home births, they would allow nurse-midwives to have hospital privileges in D.C. so patients who want midwives could have the option of coming into the hospital. Now their only option is for home birth."
Wootan and Vaughey both stress that women with potential problem births are screened out and referred to hospitals. "Home births have proven over and over again to be safe alternatives among healthy women with safe pregnancies," says Vaughey. Maternity Center in Bethesda, which she and two other nurse-midwives own, delivers an average of 25 babies a month at home and has had no infant or maternal fatalities in its five-year existence. The crux of the issue, she contends, is economic. Obstetricians can make more money practicing in hospitals.
"It's very expensive to deliver someone at home. It's very time-consuming. You can only do one person at a time. You can't send a woman in labor to the hospital and have the resident check her," Vaughey said.
The American way of birth has been revolutionized in the past 15 years. Fathers are out of the waiting rooms and into the delivery rooms; mothers are awake and home within days or even hours of birth. With the reduction in maternal and infant mortality, American parents are now more than ever able to enjoy the miracle of childbirth. But crucial to this has been the assertion of their rights to make choices about how they want their babies born. Home birth has emerged as an alternative to hospitals and nurse-midwives have emerged as alternatives to obstetricians. Sooner or later, the quest for more humane childbirth -- and the declining birth rate -- was bound to have economic repercussions on the medical profession, which has a long history of being able to protect itself against economic repercussions.
Many, probably most, parents will continue to opt for hospital births. But that should not prevent others from choosing safe alternatives. Should the medical establishment succeed in stifling the home birth movement, it will not be a victory for public health but a triumph of self-interest. The hospitals and obstetricians will be the winners. The losers will be American parents who will be deprived without good cause of the right to choose how and where their children will be born.