Last week there was an article released online with a print version due in September of this year in the American Journal of Obstetrics and Gynecology on a new “study” or meta-analysis of the safety of homebirth by Joesph Wax M.D. The article I linked to is one written by the BBC as an analysis of the original. The meta-analysis concluded that – “Less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate.” Meaning that it was concluded that three times as many infants die in planned homebirth than in planned hospital birth. I have to immediately tell you that even with this statement (though I feel that some of the evidence is purposefully ignored and others flawed), I completely disagree at anyone drawing a conclusion from this “study” that homebirth is not a safe option for low risk pregnant women. The American College of Obstetrics and Gynecology has long opposed homebirth and has released statements concerning the topic. I’m not going to counter Dr. Wax’s “study” or the ACOG statement. That has already been done. See the recent post at Birth Activist. What I would like to offer you is a personal evaluation of the decision to have your baby at home.
My first child was born through cesarean surgery with no labor and no medical emergency. At the time, I didn’t know that suspicion of a large baby was not a reason for induction or cesarean according to ACOG guidelines. I consented to surgery for that reason with deep regret afterward as my baby and myself suffered side effects of surgical birth that could have been prevented. When I found myself pregnant again, I knew I wanted to avoid surgery. I had studied quite a bit about normal childbirth, attended two natural, hospital births as a labor support person (doula), was active in the community’s VBAC (vaginal birth after cesarean) support group, and I knew that I wanted to have a natural, vaginal birth with this baby barring any abnormal complications that would require medical intervention. This was the choice that made me feel safe. This was the choice that I felt would result, under my circumstances, in the safest outcome for me and my baby.
The problem was, VBAC was not supported by many hospitals and practitioners in the area I lived at the time, despite its proven safety. Because I knew I wanted a practitioner that would support drug-free, vaginal birth for me, I chose a midwife (certified professional midwife) who attended births at home. My midwife had experienced VBAC herself. She had received a college education in midwifery and nursing. She had apprenticed under an experienced homebirth midwife. She was trained in and comfortable with performing neonatal resuscitation, and my home was only about five minutes from the nearest hospital should the need arise. I was completely comfortable with my choice, and my experience did nothing but solidify that choice. The standard of care I received was better than that I had received from the obstetricians’ throughout my first birth. When hospital transfer was necessary during my birth because of some complications, it was handled calmly. I was never in danger, nor was my baby. I would not hesitate to make the same choice again.
The key to my firm belief in homebirth is the midwifery model of care. A well trained, educated midwife is so thorough in the care she/he provides, that most difficulties in pregnancy and birth are spotted before they become a medical emergency. Midwives such as Ina May Gaskin have been practicing for thirty or more years with excellent statistics on maternal/neonatal mortality and intervention. Even certain midwives of old in colonial England had excellent outcomes.
I am of the opinion, through the study that I have done personally and for my work, that homebirth is absolutely a safe option in many birthing situations when a low risk mother is seen by a fully trained birth attendant. What I mean by “fully trained” is that the attendant is not only familiar with neonatal resuscitation, but is capable of applying it properly in an emergency situation. The attendant is aware of the signs/causes of post-partum hemorrhage, and will deal with those cases effectively as they arise. The attendant is comfortable with their skills in assisting delivery or handling of complicated presentations and birth complications such as shoulder dystocia, prolapsed cord, and surprise breech. Also, the chosen attendant must be confident in their ability to detect pregnancy related problems and refer the mother to obstetric care when needed.
Recently, a friend of ours and his mother had a surgery in a hospital in our region, and both of them came away with a staph infection that required re-hospitalization and more surgery. This hospital just completed an ad campaign for their birthing facilities. Hospitals are not clean environments. Hospitals are for sick people, or those requiring treatment for ailments, and we can expect them to contain the germs and problems associated with that. This is not saying that hospitals can’t be suitable or clean enough places in which to birth our babies. We know that they are and can be. Our homes too are places, in many situations, that we are adapted to. Where healthy, normal life events play out. Why not have them as a place for healthy, normal birth?
In southeastern, Kentucky, we typically do not have access to homebirth attended by a trained, professional midwife. Fortunately, we do have a large midwifery presence in the area, and obstetricians who readily work with midwives in the hospital setting. I have to admit, that someday I would love to see a move toward bringing normal birth to the home for those mothers who are most comfortable in that setting. I would also love to see freestanding birth centers for those mothers who would like a little reassurance, but would like to avoid the hospital. I’d love to see hospitals and obstetricians actively working with midwives who deliver in the homes and birth centers to provide well-rounded and supported care to those mothers requiring special attention. It would be optimal for there to be that support so that all birth attendants are properly trained in areas that could create life threatening situations before offering their services to pregnant women. Why not? Other countries are doing it with awesome results.
In the meantime, read this post from Talk Birth, which explains in a wonderful way why it is important for women to have options in childbirth and to be the chooser of the type of care they prefer and receive. This post is in no way criticizing those who choose hospital birth. It is a matter of situation and your personal comfort level. It is the norm in our country with only 2% of women currently choosing homebirth. It is only a matter of options, knowing them, and making birth as safe and healthy for each individual mother and baby as it can be.