Both my babies were born at home, as well as countless other children I know. I have friends that are midwives. I believe home births are a safe, natural choice for a typical pregnancy including good prenatal care. Even in atypical births, like both of mine (hemorrhage and congenital heart defect), midwives are superheroes.
Last week, I read about a new study claiming home births triple the rate of infant deaths due to lack of interventions. I didn’t want to write about it. Even though I am not a researcher or medical professional and the peer-reviewed study is to appear in the American Journal of Obstetrics & Gynecology, I thought the results were a scare tactic. The statistics just don’t match up with the experience of midwives, like Ina May Gaskin, and other studies. Apparently, the Canadian doctors agree with me and have called the study “political“.
Medscape explains the study’s findings:
Compared with planned hospital births, fewer maternal interventions were associated with planned home births, including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative delivery. Women who delivered at home had lower rates of lacerations, hemorrhage, and infections, and their offspring had lower rates of prematurity, low birth weight, and assisted newborn ventilation.
Perinatal mortality rates were similar for planned home and hospital births, but neonatal mortality rates were significantly higher with planned home births.
“Less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate,” the study authors write.
Even Medscape points out the limitations of the study as “self-selection of women for home birth, and insufficient data for some outcomes.” Researchers conducted a meta-analysis of English-language peer-reviewed publications from developed Western nations” to come up with results. There are so many flaws, that Canadians, whose research is included in the study, believe the results are politically motivated.
Dr. Joseph R. Wax, the study’s lead researcher, clearly states, “The American College of Obstetricians and Gynecologists does not support home birth, citing safety concerns and lack of rigorous scientific study.”
Given such a firm stance, could they really come up with any different results? The data and methods of the study are questionable. CBC News explains:
But Dr. Michael Klein, an emeritus professor of family practice and pediatrics at the University of British Columbia, said the U.S. conclusions are “crap” that don’t consider the facts.
“It’s a politically motivated study that was motivated by the American College of Obstetrics and Gynecology who is unalterably opposed to home birth, and they probably were quite happy to publish this article because it fits with their political position,” Klein said.
“The data and the methods taints the quality of the study,” Janssen said, noting the review includes studies where the qualifications of the caregiver were not known.
The qualifications of midwives varies greatly based on state requirements. From lay midwives to certified nurse midwives, seeking out a well-trained and experienced midwife is just as important as choosing a doctor. My experiences contradict those described in the study by parentdish:
The researchers of the study found that babies born at home are at higher risk of heart and breathing problems. They believe this is because they are not properly monitored for problems during labour…
Dr Joseph Wax, who lead the research at Maine Medical Center, in New Hampshire, US, said: ‘We don’t know exactly why this trend exists but there could be many causes such as a lack of equipment and expertise.
‘At home foetuses may not be adequately monitored for early signs of distress. In hospital they are constantly checked but at home the midwife is on her own doing everything.’
I strongly disagree with Dr. Wax’s statements. Midwives are not on their own. My midwives worked as a team (one for the baby, one for the mom), and they had an apprentice. They were supported by my family attending the birth, as well as my parallel care medical providers. Furthermore, my babies were constantly monitored during labor and after birth. Between every contraction, my midwives used a doppler to check my baby’s heartbeat. After my babies were born, they were thoroughly checked and given Apgar scores, just like if they were born in the hospital. When my son needed oxygen, he got it right away. When a pediatrician needed to be called, he was called.
It’s not just Canadians questioning the study’s results. Made for Mums reports:
Mary Newburn, head of research at the National Childbirth Trust, stated that it was an important study, but that it didn’t match NCT’s own findings and more research was needed. “NCT’s own detailed review of home birth concluded that, although the quality of comparative evidence on the safety of home birth is poor, there is no evidence that for women with a low risk of complications the likelihood of a baby dying is any higher if they plan for a home birth compared with planning for a hospital birth.”
Parents want a choice when it comes to birthing their children. Instead of scaring parents into hospital births, the American College of Obstetricians and Gynecologists would be better off recommending standards for midwifery training and certification, including funding. I doubt that would happen, but if the “problem” is lack of expertise and equipment, then midwives and parents should be supported to correct it. Home births in the western world are not going away.