The New Jersey Black Women’s Physician Association (NJBWPA) is writing this letter in response to Insider NJ’s coverage of Assemblywoman Timberlake’s bill requiring coverage of home birth services in the state of NJ.

We acknowledge the vulnerabilities of expectant minority women during Covid-19 including economic and psychosocial stressors, the strain of the pandemic on the healthcare system, and systemic racism and health inequities faced by minorities. We are supportive of continued conversations to address access to care for pregnant women during this crisis.  However, mandating coverage for home births is not optimal for solving the problems that women of color face during the perinatal period.

NJBWPA supports women’s options for natural births, which can occur in a hospital setting. Natural birth does not equal home birth. The American College of Obstetrics and Gynecology (ACOG) Committee Opinion 697 “Planned Home Births” states that  home births are associated with less intervention but have more than a two-fold increase of perinatal death and a three-fold increase of neonatal seizures or serious neurologic dysfunction.^[1] Research shows that the American healthcare system is unable to support and coordinate care for women planning a home birth safely. The addition of home births as a covered option of care may impact already strained health services in an emergent situation.

Approximately, 0.9 percent of all births are planned home births.^[2] This option has largely been available to wealthy white women who can afford these services.  Home birth clients have access to a supportive care team that includes a certified midwife, doula, obstetrician, pediatrician, and an emergency medical system.  Families make an informed decision about home birthing, understanding the risks associated with this option and a plan to address any emergencies that may arise. Moderate and low-income women may face barriers to implementing this type of comprehensive plan. However, legislating this at this time without a comprehensive and collaborative review could be more harmful in regards to black maternal and infant morbidity and mortality than previously observed. As a result strides we are attempting to make in New Jersey may be further challenged.

In summary:

• The infrastructure to support safe home births across diverse populations does not exist today.
• Addressing Black maternal and infant morbidity and mortality requires comprehensive, multi-factored solutions.
• Establishing alternative options and choice of care is better positioned in a collaborative environment that is inclusive of all stakeholders.

Sincerely,

The Executive Board of Directors of NJBWPA

Dr. Terry Johnson, President

Dr. Pamela Brug, Vice President

Dr. Damali Campbell-Oparaji, Secretary

Dr. Juana Hutchinson-Colas, Treasurer

^[1] Collaborative survey of perinatal loss in planned and unplanned home births. Northern Region Perinatal Mortality Survey Coordinating Group. BMJ 1996;313:1306–9. [PubMed] [Full Text]

^[2] MacDorman MF, Matthews TJ, Declercq E. Trends in out-of-hospital births in the United States, 1990-2012. NCHS Data Brief 2014;144:1–8. [PubMed] [Full Text]