This article calls for a new way of looking at the home birth debate by challenging the underlying assumptions and beliefs that lead to the polarized discourse. The debate around home birth is about more than place of birth or perinatal mortality. It raises deeper and more complex issues that need to be explored. This article moves the debate about home birth from one about death to one about human nature, from one about statistics, to one about why the statistics will not end the debate. It explores less familiar discourses such as confirmation bias, group polarization, fear, risk, scientific paradigms, and power using insights from disciplines such as philosophy and psychology for guidance as to why “infinite love and enormous rejection” have come to fill the discourse about home birth. If we do not try and understand why the home birth debate is so polarized and develop new strategies to overcome the great divide, we will never make progress with important decisions as how home birth should safely be made available to women.

The global health community has implemented several initiatives over the past in the interest of accelerating country-by-country progress toward the Millennium Development Goal of improving maternal health. Skilled attendance at every birth has been recognized as an essential component of approaches for reducing maternal and perinatal morbidity and mortality.

Midwives have been acknowledged as a preferred cadre of skilled birth attendant. The International Confederation of Midwives (ICM) speaks for the global community of fully qualified (professional) midwives. The ICM document entitled Essential Competencies for Basic Midwifery Practice is a core policy statement that defines the domains and scope of practice for those individuals who meet the international definition of midwife. This article explores the meaning of competence and competency as core concepts for the midwifery profession. An understanding of the meaning of these terms can help midwives speaking individually at the clinical practice level and midwifery associations speaking at the policy level to articulate more clearly the distinction of fully qualified midwives within the skilled birth attendant and sexual and reproductive health workforce. Competence and competency are fundamental to the domains of midwifery education, legislation, and regulation, and to the deployment and retention of professional midwives.