Is Homebirth Safe?

Another great article I've received through Google Alerts.

Is Homebirth Safe?
by Lauri Smit

Many people ask if homebirth is safe. Our society views labor and birth as pathological, an illness that needs to be fixed or cured. Since the beginning of time, humans have given birth without medical help or intervention.

Is the Hospital Really the Safest Place to Deliver?

The National Perinatal Epidemiology Unit concluded in Where To Be Born in 1994 that "no evidence exists to support the claim that a hospital is the safest place for women to have normal births." The World HealthOrganization (WHO) reports that "it has never been scientifically proven that the hospital is a safer place than home for a woman who has had an uncomplicated pregnancy to have her baby. Studies of planned home births in developed countries with women who have had uncomplicated pregnancies have shown sickness and death rates for mother and baby equal to or better than hospital birth statistics for women with uncomplicated pregnancies."

David Stewart states that "since the founding of NAPSAC in 1975, we have searched for the data, if it exists, that supports 100% hospitalization for birth. We have not found it. We have formally requested all of the major medical associations (ACOG, AMA, AAP, AAFP) and any other professional organization who supports 100% hospitalization to share their data. To date, they have not. We have asked them to write chapters for the NAPSAC books. We have offered to publish their documentation. We have given them the opportunities to speak before large audiences at NAPSAC conferences in order that their valid statistics, if they have any, can be made known. To date, they have failed to produce even one study in support of their contention." If your doctor tells you that home birth isn't safe and you should birth in the hospital, ask for his/her statistics. Chances are, s/he doesn't have any.

Unnecessary Medical Interventions

The research shows that lower intervention rates are achieved at home, making for a more natural, gentle birth experience for mother and baby. Overuse of interventions in low-risk deliveries have iatrogenic results, meaning the intervention caused more problems than it was supposed to remedy. A.M. Duran stated in The Farm Study, published in the American Journal of Public Health in March 1992, that "home births attended by lay midwives can be accomplished as safely as, and with less intervention than, physician-attended hospital deliveries." Dr. Lewis Mehl compared matched populations of 2,092 home births and 2,092 hospital births. Midwives and family doctors attended the home births, while OB/GYNs and family doctors attended the hospital births. Within the hospital group, the fetal distress rate was 6 times higher, maternal hemorrhage was 3 times higher, limp unresponsive newborns arrived 3 times more often and there were 30 permanent birth injuries caused by doctors. In another study, Dr. Mehl compared matched groups of 1,046 home births with 1,046 hospital births. There was no difference in infant mortality. In the hospital births, there was greater incidence of fetal distress, lacerations to the mother, neonatal infections, forceps delivery, cesarean section, and nine times as many episiotomies.

Perinatal/Infant Mortality

The United States is in 22nd place among developed nations of the world. David Stewart reported in the NAPSAC News that the national infant mortality rate in 1991 was 8.9 deaths per 1000 live births. Washington D.C. had the highest mortality 21 deaths per 1000 births. The state with the lowest death rate was Vermont, with only 5.8. "Vermont also has one of the highest rates of home birth in the country as well as a larger portion of midwife-attended births than most states." Stewart adds that "the international standing of the U.S. did not really begin to fall until the mid-1950s. This correlates perfectly with the founding of the American College of Obstetricians and Gynecologists (ACOG) in 1951."

British childbirth expert Sheila Kitzinger states that planned homebirth with an experienced lay midwife has a perinatal mortality rate of 3-4 neonatal deaths per 1000 births, as opposed to 9-10 deaths per 1000 births in the hospital. In a study of births in the Netherlands in 1986, 41,861 women having their first babies in the hospital had a perinatal mortality rate of 20.2. 15,031 having their first at home with a trained midwife had a perinatal mortality rate of 1.5.

Marsden Wagner states that the countries with the lowest perinatal mortality rates in the world have cesarean section rates below 10%. The United States' cesarean rate is 25%. Obviously medical interventions, including cesarean section, are not doing for women what doctors claim.

What About "Emergencies"?

Birth isn't without risk. There is a slight risk that a major catastrophe could happen which could possibly be better handled in the hospital, such as umbilical cord prolapse, uterine rupture, abrupted placenta, postpartum hemorrhage. Birth is generally a slow process and there is usually ample time to transport even in the case of a true emergency. A skilled midwife provides one-on-one care and monitors the laboring woman carefully for potential problems.

Shoulder dystocia is handled better at home because of the freedom of birthing positions. If there are signs of trouble, a midwife can easily and quickly help the birthing woman get onto her hands and knees (the Gaskin maneuver, named for Farm midwife Ina Mae Gaskin). In the hospital, the beds aren't as adequate for allowing this type of position change.

The baby's oxygen supply is preserved at home by delaying umbilical cord cutting. In the hospital, the cord is cut immediately, increasing the need for resuscitation efforts.

Postpartum hemorrhage can be remedied at home by putting the baby to the breast immediately to stimulate oxytocin production and uterine contractions. Compression of the uterus can also be done at home. Some midwives carry IVs or an injection of Pitocin for these circumstances.

For true emergencies that require transport to the hospital, women laboring at home 20 minutes from the hospital have the same access to emergency surgery as women laboring at that same hospital. Many hospitals cannot prepare for an emergency surgical delivery in less than 20 minutes. The ACOG standard is currently "30 minutes decision to incision" for all non-scheduled cesarean sections.

Postpartum Depression

Women who give birth in the hospital are much more likely to experience postpartum depression or even post-traumatic stress disorder. Sheila Kitzinger states that the more interventions a woman experiences, the more likely she is to be depressed, with cesarean sections carrying the greatest risk. British physician Aiden McFarlane notes that while 68% of mothers that delivered in the hospital experience postpartum depression, only 16% of mothers that delivered at home do. This could be because of how birth is handled in the hospitals in this country, including numbing medications and routine separation of mother and baby.

Hospital Risks and Errors

There is a chance that your doctor won't be there for your birth and you may end up with an inexperienced student or someone you don't like. At home, your midwife remains with you throughout labor and delivery.

There is a chance that your or your baby could contract a disease or illness (hospitals are for sick people). Your own germs are in your own home.

Your baby could be switched with another baby or snatched by a stranger. In 1983, 101 newborns were stolen from healthcare facilities; 94 of those were recovered, seven are still missing. No fear of this at home.

You have a one in four chance of having a cesarean section in the hospital, compared to 1-5% at home. Cesarean section carries a greater risk of death than do vaginal deliveries. A study in Georgia, cited by Nancy Wainer Cohen and Lois J. Estner, showed a maternal death rate of 59.3 per 100,000 women who had a cesarean section compared to 9.7 per 100,000 for women who delivered vaginally. Other complications of cesarean include infection, infertility problems, organ damage, postpartum depression, pain, and paralysis from anesthesia.

Conclusion

So are you perfectly safe delivering at home? Carl Jones states, "There is always going to be some risk when giving birth, as in all of life, and women should be carefully screened for any health problems that could be dangerous during labor and delivery. For certain women in rare circumstances, obstetric care is essential. However, for most women, better, healthier results are seen when mothers choose to birth at home." If you are a woman with no health problems or contraindications to safe labor and delivery, consider birthing at home. The risks to you and your baby are lower at home.

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References

Bloyd-Peshkin, Sharon, "Midwifery: Off to a Good Start," Vegetarian Times, December 1992, p. 69.

Duran, A.M. "The Safety of Home Birth," American Journal of Public Health. 82(3):450-3, March 1992

Goer, Henci. Obstetric Myths vs. Research Realities, Bergin and Garvey, January 1995.

Institute of Medicine. Research Issues in the Assessment of Birth Settings, National Academy Press, Washington, 1982, p. 175.

Jones, Carl. Alternative Birth, Los Angeles: Dorling Kindersley, 1991.

Kitzinger, Sheila. Home Birth, London: Dorling Kindersley, 1991.

Stewart, David, PhD., "Five Standards for Safe Childbearing."

Stewart, David, PhD. "International Infant Mortality Rates--U.S. in 22nd Place," NAPSAC News, Fall-Winter 1993, p. 36-38.

"Where to Be Born", National Perinatal Epidemiology Unit, 1994.