“Tradition means giving votes to the most obscure of all classes, our ancestors. It is the democracy of the dead. Tradition refuses to submit to the small and arrogant oligarchy of those who merely happen to be walking about.” ― G.K. Chesterton, Orthodoxy
Considering that for the 10,000 years humans have been reproducing, at least 98.5% of births were conducted in a non-hospital environment, I feel that a better question than “Why a Home Birth?” should be “Why Not a Home Birth?”
All of the best reasons for having a hospital birth boil down to the principle that there is less risk of mortal complications for both mother and infant when conducted in a medical facility with trained medical professionals. Right?
Because, I mean, when you think about it objectively – no one LIKES hospitals. I have yet to find anyone who goes and hangs out in the emergency room because of the comfortable chairs or intelligent conversations; no one dines at a hospital cafeteria because they offer gourmet food and a soothing ambiance. No. We go to hospitals because something is wrong that we can’t fix ourselves. It’s a last resort for people who are sick, injured or dying. It’s a house of aberrations.
So the question becomes: Is giving birth natural or unnatural? A sickness or celebration?
“But…” you say, “just because it’s natural, doesn’t mean it’s not dangerous! Women and babies die all the time when giving birth at home.”
You’re absolutely right. And women and babies die in hospitals as well.
You know me –I love research. Unfortunately, my research was kind of thwarted, because I discovered that this issue is really difficult to study and compare scientifically for several reasons.
1. In general, because of regulations, planned home-births tend to start with a lower-risk pool of candidates. In the state of California, for instance, midwives are not allowed to serve women who:
- are over 45
- will be having multiples (twins, etc)
- have a baby in a “breach” position at term
- have “pre-existing” (but heretofore un-identified) medical conditions
- are under 37 weeks or over 42 weeks
…because these all qualify as “high-risk” pregnancies.
2. Not all midwife care is created equal. Each state has its own regulations and there are different levels of medical training – licensed midwife (LM), certified professional midwife (CPM), and certified nurse midwife (CNM).
3. Not all homebirths are planned, and not all planned homebirths end at home.
4. There is a smaller number of homebirths to study than hospital birth data.
All that said, the least biased scientific journals I could find gave some version of the following results:
“Perinatal mortality was not significantly different in the two groups (OR = 0.87, 95% CI 0.54–1.41). The principal difference in the outcome was a lower frequency of low Apgar scores (OR = 0.55; 0.41–0.74) and severe lacerations (OR = 0.61; 0.54–0.83) in the home birth group. Fewer medical interventions occurred in the home birth group: induction (statistically significant ORs in the range 0.06–0.39), augmentation (0.26–0.69), episiotomy (0.02–0.39), operative vaginal birth (0.03–0.42), and cesarean section (0.05–0.31). No maternal deaths occurred in the studies. Some differences may be partly due to bias. The findings regarding morbidity are supported by randomized clinical trials of elements of birth care relevant for home birth, however, and the finding relating to mortality is supported by large register studies comparing hospital settings of different levels of care.
Conclusion: Home birth is an acceptable alternative to hospital confinement for selected pregnant women, and leads to reduced medical interventions.”
For fun, let’s compare our hospital-preferred system to another developed country which highly advocates midwife maternal and natal care.
In the United States, where midwifery was effectively banned near the turn of the 20th century, we still have a very low percentage of midwife-assisted births (7.6%) and only 0.72% conducted at home (as of 2009).
United States Infant Mortality Rate: 5.90 per 1000 births (.59%)
United States Maternal Mortality Rate: 21 per 100,000 births (.021%)
Compare that to the Netherlands, which has the highest rate of home births (29%), plus 13.4% more hospital births also attended by midwives.
Netherlands Infant Mortality Rate: 3.69 per 1000 births (.37%)
Netherlands Maternal Mortality Rate: 6 per 100,000 births (.006%)
Now some people want to quibble with these statistics by pointing to the fact that in the Netherlands, midwifes are fully integrated into the health system, but that instead of invalidating the power of the data, it seems instead to pose a very strong argument for integrating midwives more effectively into the United States health care system, doncha think?
So, given that the risks of death for mother and infant (given normal, low-risk pregnancies) seems to be comparable between obstetrician observed hospital births, and planned home births overseen by trained midwives — plus there are significantly fewer medical interventions — my question, again, is:
Why Not Have a Home Birth?