Safety of Homebirth
Myth: Up until the early 1900’s, many women and babies died in childbirth. Then doctors took over maternity
care from ill-trained and ignorant midwives, and childbirth moved into the hospital. As a result, maternal and infant death
rates plummeted, and today almost everybody lives healthily and happily ever after thanks to the skills of obstetricians and the superior
resources available in hospitals.
Truth: In the 1920s in the United States, middle-class women began having babies in hospitals
with physician attendants, partly on grounds of safety, but history seems to indicate it may have been a culture shift in the status-symbol
of hospital birth. By the mid-1920’s half of urban births took place there, and by 1939, seventy-five percent of all urban women
gave birth in hospitals. Despite this shift, maternal mortality did not drop below the 1915 levels of 63 maternal deaths per
10,000 births (74 deaths per 10,000 births in city hospitals) and infant mortality rates increased 40 to 50 percent. Then in
the late 1930’s, when sulfa drugs and antibiotics to treat infection were introduced and more stringent controls were placed on obstetric
practices, maternal deaths decreased due to better living conditions and the development of antibiotics and blood transfusions. Another increase in safer childbirth practices began toward the end of the 19th century, when Ignacz Semmelweiss told the doctors
to wash their hands after performing an autopsy, commonly done by the same doctor who would tend to a laboring woman.
Myth: The United States ranks among the best obstetrics systems in the world.
Truth: The United States currently ranks 42nd ininfant mortality in the world (down from 26th in 1998, when the cesarean rate was 23%) with a 2005 cesarean rate of 30.2%. Seventy
percent of births in the Netherlands (ranked 26th in infant mortality with a cesarean rate of 11.7%) are with midwives and 1 in 3
births takes place at home. Dutch midwives have a 19% lower rate of infant deaths and a 33% lower rate of neonatal mortality
(infant death in the first month) than doctors attending comparable births. In New Zealand (36th in infant mortality), 80% of
all births, both home and hospital, are attended by midwives. Click here to see how each state in the U.S. stacks up in infant
mortality rates of midwife-attended births.
Myth: Hospital birth is safer than homebirth.
Truth: There have been dozens
of studies done over the last 30 years evaluating the safety of homebirth. No study has ever proven that hospital birth is safer,
and in some cases found that for normal, healthy women carrying a healthy baby, home birth was found to be safer than the hospital,
even when controlled for risk factors.
Myth: Obstetricians are better qualified to attend natural childbirth.
Truth: A study published in the British Medical Journal in 2005 studied over 5400 women planning a homebirth with a Certified Professional
Midwife (CPM). The overall transfer rate was 12.1%, roughly 3 out of every 25 planned homebirths. Of these, 83.4% were
non-emergency transfers for prolonged labor, exhaustion, or pain relief. The cesarean rate still remained remarkably low at
3.7% (versus the U.S. cesarean rate of 30.2%), with comparable infant mortality, no maternal deaths, and dramatically lower rates
of medical intervention, even when hospital transfer occurred. The researchers concluded, “Planned home birth for low risk women
in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum
and neonatal mortality to that of low risk hospital births in the United States.”
In 1998, the Centers for Disease Control in
Atlanta published the outcomes of a study of every singleton vaginal birth in the United States in 1991. Excluding high-risk births,
and comparing similar obstetrical cases, it was found that babies' chances of dying in their first few days [after birth] were 23%
higher if they were attended by doctors rather than midwives in their births, and were 50% more likely to die in their first months
[after birth] if they were attended by doctors. Research in Washington state found that births attended by physicians had a higher
risk of low birthweight, a common risk factor for neonatal death.
Myth: If there is an emergency, I will get a cesarean faster
in the hospital.
Truth: Most emergency cesareans take 30 minutes from “decision to incision”, even in the hospital. There is no difference in maternal or baby outcome for decision to delivery interval between 16 and 75 minutes.
Myth: Babies
born in the hospital are healthier.
Truth: A recent study of homebirthed babies concluded that infants born in the hospital
were more likely to be colonized with unhealthy gut flora in the months after birth. The number and type of gut bacteria have
been shown to influence immune system development, risk of allergies and asthma, and metabolic functions such as the production of
vitamin K. Those born at home and breastfed had the most beneficial gut flora. While it could not be proven, this may
translate into homebirthed babies having a healthier immune system, less risk of allergies & asthma, and better metabolism of
vitamin K.
References:
http://www.bmj.com/cgi/content/abstract/330/7505/1416
Hismidwives email, Debby S., 03/22/06
Studygroup email,
Lauren S., 08/31/06
Private email, Kirsten M., 10/04/06
Studygroup email, Susanne M., 03/28/07
http://www.changesurfer.com/Hlth/homebirth.html
http://ican-online.org/resources/statistics4.php
http://ican-online.org/resources/statistics.php
GoerTWG,
p202-203
https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html (infant mortality world rank)
http://www.gentlebirth.org/archives/advocacy.html#Statistics
BMJ. Published
online March 15, 2004, received via KCICAN list, Eva G., 5/10/07