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Are home births safe?

September 10, 2009

The safety of home births is a contentious issue. Colleges of obstetricians and gynecologists in Australia, New Zealand and the United States oppose home births, while the Royal College of Obstetricians and Gynaecologists in the United Kingdom supports a woman’s choice to give birth at home in uncomplicated pregnancies.

According to the American College of Obstetricians and Gynecologists (ACOG):

Unless a woman is in a hospital, an accredited freestanding birthing center, or a birthing center within a hospital complex, with physicians ready to intervene quickly if necessary, she puts herself and her baby’s health and life at unnecessary risk.

However, a new study published in the Canadian Medical Association Journal says giving birth at home with a registered midwife is as safe as delivering in a hospital. The study compared 2,889 planned home births attended by midwives to 10,083 hospital births attended by either midwives or doctors. All the women involved were equally low-risk.

The study found the risk of infant death was low in all three groups: 0.35 per 1,000 among the planned home births, 0.57 among the hospital births attended by midwives, and 0.64 among the physician-attended hospital births. Women who planned a home birth were significantly less likely to use drugs to stimulate or speed labor, narcotics for pain, electronic fetal monitoring and forceps deliveries. They were also less likely to experience a postpartum hemorrhage, and their babies were less likely to suffer a birth trauma, require resuscitation at birth or oxygen therapy.

In many cultures, births have traditionally been attended by women trained as midwives. Midwives assisted women during labor and delivery; often they continued to help the mother and her family after the baby was born. The way of birth began to change during the late nineteenth century, as competition between midwives and physicians increased. Physicians quickly won out, thanks in part to propaganda against midwives and the alluring promise of sterile, painless childbirth. Ami McKay’s beautifully written novel, The Birth House, is an excellent fictionalized account of the struggle between traditional midwifery and medicine’s approach to childbirth in Scots Bay, Nova Scotia in 1918.

During the 1960s and 1970s, the Women’s Movement sparked renewed interest in home births. Many women sought an alternative to the medical model of childbirth and were drawn to the principles of midwifery, including: informed choice, continuity of care, choice of birth place, non-authoritarian relationship between woman and caregiver, and appropriate intervention.

In a statement reiterating its long-standing opposition to home births, the ACOG said:

Childbirth decisions should not be dictated or influenced by what’s fashionable, trendy, or the latest cause célèbre.

The ACOG’s dismissal of women’s desire for personal care and natural childbirth as nothing more than frivolous trend-seeking isn’t surprising given the historic treatment of women by the medical profession, but it’s worth noting that more than 31 percent of all deliveries in the United States are by cesarean – an all-time high (and given the number of celebrities having highly-publicized, elective cesarean sections, this seems a far more likely candidate for what’s “fashionable”).

Meanwhile, the Society of Obstetricians and Gynaecologists of Canada (SOGC) has been warning of looming shortages in obstetrical care for several years: nearly one in three obstetricians is expected to retire over the next five years and 36 percent of family physicians don’t provide any maternity or newborn care. Midwives – whose numbers are growing – are one way to fill the gap.

The new study doesn’t win the debate over the safety of home births, but hopefully it scores some points for midwifery and leads to more, larger studies of home birth. After two hospital births attended by physicians, my own mother chose to give birth to my younger brother at home. She maintains that it was her best birth experience: she was in her own bed, in her own clothes and she didn’t feel any pressure to use drugs or medications. All women should be able to choose the birth options that best meet their needs – and the needs of their baby – without the implication that home births are chosen carelessly.

As Andre Lalonde, executive vice-president of the SOGC points out:

We definitely understand that it’s a woman’s decision to choose where she wants to give birth, in a hospital or a home.

Based in Halifax, Nova Scotia, Amelia DeMarco works as a research and policy analyst and holds a Masters degree in Public Administration. You can contact her at amelia.demarco@gmail.com.

4 Comments
  1. Miriam permalink
    September 13, 2009 7:52 pm

    From what I’ve seen most women come to homebirth from one of two places: 1 their first birth in the hospital was a horrific experience or 2 their first birth in the hospital was “OK” but they felt it was missing something. I know lots of women who have had second and third children at home, but few who had their first child at home.
    I am a member of the first group. My first pregnancy was totally normal and totally low-risk. Yet when I arrived at the hospital already in labor, they immediately started with lots of interventions that compounded on each other. Finally it was deemed that I needed a c-section because of “failure to progress” the classic bullshit reason for a c-section. In reality, they had no idea how far I had progressed because something like 8 different people checked my dilation and each had a different number.
    I was extremely traumatized by my experience. Even though my son and I were “OK” I had complications from the surgery and had almost immediate feelings of rage and violation.
    Four years later, after much education and seeking I came to homebirth as my only safe option for giving birth again. I would have had to fight tooth and nail to even be “allowed” to attempt a VBAC in a hospital, and I fundamentally DID NOT FEEL SAFE in the hospital environment anymore when it came to birth.
    My daughter was born is past spring in my home and it was a wonderful, loving experience. I felt safe and secure to move around, eat and drink as I needed and to do what my body needed to give birth. While the labor was painful, it wasn’t anything I couldn’t handle and in the end it was far less painful then the medicated labor and c-section I had in the hospital. The recovery was a walk in the park in comparison as well. We had no problems with breastfeeding. (I was successful with breastfeeding my son, but it was a difficult struggle to get over all the problems we had at the start, thanks to many issues from the c-section!)
    In the end, I feel that women should be free to make the choice themselevs about where to give birth, and that choice needs to be respected.

    • ameliadm permalink
      September 14, 2009 2:59 pm

      Thanks so much for sharing your experience – I believe my mother was part of the second group. It was very important to her to give birth naturally (without medication) and during her first two experiences giving birth in a hospital, she felt a lot of pressure to do just the opposite. I know giving birth to my brother at home was much more comfortable for her, in large part because she was finally able to have the natural birth experience she wanted, without having to fight tooth and nail for it.

  2. September 14, 2009 5:35 pm

    If and when my husband and I decide to have a second child ours will be an attempted home birth, if a midwife will let me. My story is very nearly the same as Miriam’s, down to the feelings of anger and violation from being in the hospital. I don’t think midwives in my town do VBAC at home, unfortunately.

    • Miriam permalink
      September 14, 2009 9:25 pm

      all the homebirth midwives in CT will do a VBAC, they don’t consider it a high risk factor. but I’m sure this varies from place to place. my midwife was fine with a VBAC, but she told me that she wouldn’t be comfortable doing twins. (not as a VBAC, just any kind of twin birth situation) but she said she knew midwives in Mass who would do twins at home.

      I would strongely encourge you to spend the time seeking out a midwife who will openly and honestly talk to you about your options. I know LOTS of women who have had VBACs at home and every single one of them said it was totally worth it. I know two people who had VBACs at the hospital, but they had to fight for it, also in both cases, they had older OBGYNs who knew that VBACs were just fine as long as you don’t medicate the labor. (medicating the labor with Pitocen is what makes a VBAC more high risk for rupture, so like duh, don’t medicate the labor and you are fine!)

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