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…
‘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.
It makes sense that this study does not have much validity if the only women who participated in the study were those who agreed to document their experiences based out of their own interest (self-selection bias) rather than a random sample that covered a diverse range of experiences. Without doubt, there are complications with some home births, just as there are complications in hospitals. Doesn’t mean that homebirths aren’t safe though.
i am no medical expert and ive read this entire article but aren’t you doing the same thing you are accusing the US doctors to be doing…you are using your own opinion to make a statement. sure, you may have had two fine births at home, and you may know 5 other women who had healthy home births, but what about the people these doctors interviewed? there are going to be complications either way but anyone with common sense would say it is SAFER to have a hospital birth. It may be safe to have a home birth but the way you are making it sound is as if it is just as safe to have a home birth as it would be in a hospital but that is just a silly thought because your home doesn’t have all the medical equipment and surgeons on hand to care for you or your baby if something were to happen that needed immediate attention. you are entitled to your opinions and i appreciate that you had a wonderful experience with home birth but don’t find one doctor who agrees with your thoughts…wait until more research comes about this..you shouldn’t let your emotions cloud your opinions because it just makes you seem…not stupid by any means but maybe uneducated in a sense
@annonymousstar: thanks for your comment and opinions. There are doctors that support home births, including the one quoted in the above post, as well as those that provide parallel care for families choosing home birth. Families that choose home births do see doctors too! Midwives have medical equipment, including oxygen. In fact, my midwife had to provide a small county hospital with the appropriate tubes for resuscitation when they did not have them. You also make assumptions, but I won’t call you uneducated.
Home births are not for at-risk births, which good prenatal care identifies, so the equipment you mention is not necessary. There is a risk involved with a birth at home or at the hospital, especially considering the access to such equipment often means it is overused. The high rate of Caesareans in this country (way above what WHO recommends) is just one example.
Unfortunetly not everyone that turns out to be ‘high-risk’ knows it before labor, even if they did have proper prenatal care. You take a huge risk choosing to deliver your baby in your home, where you are more than likely at least 5 minutes from a hospital. Irriversable brain damage starts to occur in as little as 4 minutes due to lack of oxygen.
There are so many choices for women who want a ‘natural’ birth, there are birthing centers attached to hospitals and etc, why would you take even the small chance that you are too far from the help you need in an emergency situation? No one forces medical care on you unless you are unconscious.
I hear so often women talk about how women having been giving birth for thousands of years and ‘babies know how to be born’…..well my comment back would be yes they have been doing it for thousands of years and until fairly recently women and infants died on quite a regular basis in childbirth. If I have cancer, or have a heart attack should I scoff at medical care because those are ‘natural’ things as well?
Unfortunately, the US has a very high rate of infant and maternal mortality.
http://mothering.com/peggyomara/midwifery/us-infant-and-maternal-mortality-a-national-disgrace
http://minnesota.publicradio.org/display/web/2010/07/23/midmorning1/
Actually you are wrong about not getting forced into medical treatment. There have been more than one instance where a woman wanting a VBAC showed up at the hospital with a crowning baby and was given a c-section without her consent. In fact I know one lady who was screaming I do not consent as they wheeled her to the OR. Many of these women made the choice to stay home as long as possible to avoid a c-section since the hospitals they were going to had VBAC bans. ( which is just another way of forcing a surgical birth on someone)
Also there is a huge issue with mothers getting TRUE informed consent about any of the medical procedures done to them in the hospitals. For example Cytotec ( Misoprostol) is used quite often now for induction in hospitals however there has been no scientific research done on this drug and its effects on mothers/babies to show it is safe for use. In fact there is an FDA warning that it should not be used as an induction method. There are documented cases of fatal uterine ruptures resulting in the death of mother and baby from the use of this drug and the label warns of the potential of birth defects in pregnant mothers. Do you honestly think that the doctors are telling their patients this before getting consent?
I have also had a homebirth loss and I am still an advocate for homebirth, still planned 2 more, and am planning another in the spring.
Ahhh!!!!! Hopefully, the power of internet activism will counteract this propoganda. I remember my daughter’s first midwife had done 1000 homebirths and had never lost a baby or a mother. I would like to find a Dr. with that kind of track record!!!!!!
Responsible birth is what we should be focusing on and when medical intervention becomes and option rather than a life-saving device, we are not being responsible! Those of us who know understand that medical intervention is a risk in itself!
I am a homebirthing mother as well and thank you for your research and work to bring the truth to your readers!
Granny Pants
This isn’t a new result. It’s actually been confirmed twice before, for example, here: http://www.sciencebasedmedicine.org/?p=2392.
In the US, there are very stringent requirements for a practicing MD. You can’t just hang up a shingle or take a few classes and claim to be an OB/GYN. But the same is not true for midwives. State licensing for midwives is less strict than state licensing for dietitians.
This sort of study is not a criticism of CNMs. It isn’t even a criticism of midwives in general, or of home birthing. It’s just a statistical analysis of outcomes.
It’s also worth noting that these results are US specific. In countries with more strict licensure of midwives, the statistics are very different. So I think that if the study ‘scares’ people into supporting higher standards for practicing midwives, that’s probably a good thing.
Amen
Actually J. Paul, this study was conducted via meta-analysis of other studies published and conducted in developed Western nations. It is not US specific, and the researchers did not conduct their own new study, but came up with new statistics. That is one reason why the results have been called into question, as there is inconsistency in the validity and reliability of the studies analyzed.
It’s really hard to take any commentary on a study seriously when their basic facts are flawed.
From the Parent Dish Quote:
“Dr Joseph Wax, who lead the research at Maine Medical Center, in New Hampshire, US,”
Maine Medical Center is in Maine, as the name implies. It’s been a state since the Missouri Compromise in the 1830s. it was never a part of New Hampshire. Someone needs to do a little more research before hitting their keys.
Good catch mainiac midwifery student!
Midwifery Today just published this great response to the study, including specifics about some of the studies used in this faulty meta-analysis.
http://www.midwiferytoday.com/articles/ajog_response.asp
Dear all,
without going into the political details and the biases behind the home birth issue, please answer to yourself the following question: Where would I rather birth “home vs. hospital” in the following scenarios: (1) fetal heart rate goes down to 50-60 beats/minute and does not recover (2) the placenta separates from the uterine wall and the fetal heart rate goes down and does not recover (3) the umbilical cord prolapses and the fetal heart rate stays down and does not recover (4) immediately after birth there is a maternal bleed of two or more liters of blood from a torn blood vessel or torn uterus. If you answered “i’d rather be at home” please reconsider. The occurrence of these events in healthy, normal pregnancies is not predictable more than 60% of the time yet, fortunately, catastrophic outcomes occur at a frequency of 1% or less. A study to demonstrate the safety of home births will require many thousands of patients and is not likely to be undertaken in the near future. Is the comfort of home for the parents worth taking this small risk? Neither hospital births nor home births have perfect outcomes. The solution is likely to be teaching formal Western medicine how to make the environment in the hospital as home-like as possible.
Jennifer, by “These results” I was referring to the papers cited in the link I posted. THOSE results are US specific.
I don’t, as a rule, trust meta-studies very much. But my point was that this meta-study confirms results that were previously found by much stronger studies. A tripling of risk is not an unexpected result, at least not in the US.
I live in Belgium, where home-birthing is quite rare. But our northern neighbours, the Dutch, have a very high home-birthing rate (about 30%, I think) and one of the lowest perinatal morbidity and mortality rates in the world! There, it is quite normal to be followed by a midwife (trained and qualified) or specialized GP during pregnancy, labour, delivery and the post-partum. No need to see an OB/GYN at all, they are reserved for sick (pregnant) women. There is a very strict list of indications which necessitate the intervention of an OB/GYN, or a hospital birth, so it’s really the midwifes decision whether you give birth at home or are sent to the hospital, at the beginning of labour, or later on (for example when fetal heart rate is too low, or when there is meconium in the water). Furthermore, it’s a very densely populated country, so you’re always near a hospital should you need one (and there are ‘birthing hotels’, for those who live in apartments with only stairs, or on an island, or some other hard to reach place). Studies there (sorry, don’t have any references on hand, I’ll try to get them posted later) show that home-birthing in this setting is just as safe for mother and child for a first birth, and safer for next births, than a hospital setting. They believe this may be because the home setting and familiar faces promote the secretion of the right hormones during labour, while a hospital setting and strange faces (no matter how homely and welcoming) trigger stress hormones, thus inhibiting the natural course of the labour and making more interventions, and all the complications linked to them, necessary. So, in the Netherlands (a very highly developed country, with top-notch health care), home-birthing is considered the safest option for a normal birth.
Safety (not comfort, or some new-agey notion of better bonding with the baby) was the reason I chose to give birth at home. If it where safer to give birth standing on my head, I would do it. I don’t know how well American midwifes are trained, and I can imagine being hours away from the nearest hospital is not how you want to give birth in a developed country, but I get the feeling that a lot of moms to be are choosing to give birth in a hospital, not for safety reason, but for reasons of fear (induced by a lot of OB/GYNs) or… a false sense of ”comfort” (think of all the unnecessary elective epidurals and C-sections).
I would plead for education and qualification of midwifes, and of future mums and their entourage. Until then I would recommend mums who want to give birth at home to find an OB/GYN who supports the idea and has experience, and can refer you to a very good midwife.
I am not in favor of home birth. It might work for some but not for all. I had a very pleasant pregnancy, no problems at all. Till the due date everything was fine. On due date I was not feeling any movements of my baby. When I called my doctor, he immediately told me to rush to hospital. Half an hour later my son was born through emergency c-section. He had very very low glucose level and was barely breathing. If we were just minutes late he would have given up. Fortunately he was saved as it was a big hospital with a NICU. He had to stay in NICU for a while and later on he was diagnosed with cerebral palsy as his brain was damaged (lack of oxygen in-utero).
If I had been planning on home birth my baby wouldn’t have made it in this world.
“I am not in favor of home birth. It might work for some but not for all.”
Hospital birth may work for some but definitely not for all.
Hospitals carry a risk of interventions that lead to a snowball effect of more interventions. The u.s. cesarean rate is something like 34%. In 1970 it was about 6.5%. There is a much higher rate of infections to new moms and babies in hospitals than born at home. There are other studies that find home births to be as safe as hospital births for normal pregnancies. I’m sorry for your complications in your pregnancy and your son’s disability. If you were having a planned home birth, and you did not feel your baby moving, you’d call your midwife and she’d tell you to go to the emergency room and meet you there. When a symptom of an abnormal pregnancy arises midwives are trained and experienced to be able to spot them and have you transfer to the hospital. It doesn’t sound as though your situation was any different having a planned hospital birth than it would have been had you been planning a home birth.
SS, I am sure any midwife would have sent you to the hospital as well even in a planned home birth situation.
Yes any midwife would have but the issue is would she be able to find the problem at the first place? My son’s heartbeat in utero was very stable and I am sure the midwife would have checked that and assured that everything is fine. To check the internal problem even after the good heartbeat it needed some fancy machines which homebirth/midwife setup don’t usually have.
It is common to not feel the baby move for 3-4 hours in a day during the last few days and thats what happened with me but my Dr was just cautious and wanted to check. For checking they had fancy machines and fortunately they were able to know that something is wrong inside which is not apparent from the outside. I am sure midwife would have been cautious too but after listening to heartbeat she would have sent me back with a chillpill to wait for labor to start.
May be in 98% of the cases everything is fine and you go on with your life with a healthy typical baby when you plan for a home birth but as I belong to the remaining 2% I don’t think it is safe.
you don’t have an MD, don’t say the research is unsound. just so you know, for an academic doctor to publish an article biased and tainted would mean for them to lose their academic career and reputation. This is a scientific article in a scientific journal. The process for review itself is so intense that if it was biased, it would be rejected before it even reached the journal editors. A medical panel reviewing this would consists of scientists and doctors. Also, if 10% of American women choose to birth at home, the OBs would jump for joy, there’s such a shortage of them, they deliver 15 babies a day (midwife – 15 really?!). Political article? I think not! if anything, they hope you give birth at home so they can sleep.
Secondly, I’m all for natural, but midwives can’t handle things when it really goes wrong. They don’t have surgical training and they don’t have extensive medical training. 2 yrs of whatever school is nothing compared to 15yrs of MD training to be an OB.
I am a firm supporter of NATURAL hospital birth. You have to fight for an OB who gives you respect or take the midwife to the hospital with you. BUT don’t go around telling women that hospital is unsafe. My friend had a healthy pregnancy, everything under midwife supervision, but when her baby was born, she had difficulty breathing and the midwives didn’t have the training or equipments to handle this child. She died.
How do you know if your midwife is qualified, you will never know. You can go on and on about how great they are, but lets face it, they did not make the cut to be doctors. They didn’t pass extensive board exams testing every aspect of their qualification, and they haven’t faced enough medical emergencies to see how bad things can become for a perfect labor and delivery and how fast that time frame can be.
Child birth is scary, make no mistake about it. Hospital births and C-sections were invented for a reason, because so many women use to die. Doctors push for C-sections at times because they would rather have you upset than grieving over a dead baby. They’ve seen it enough, and trust me, you never want to be next to a mother with a dead child.
I am wondering if the ones arguing so firmly for homebirth are the same women who believe that birth practice can actually make you a better mom. This whole competing mentality about how a kid is born is so stupid. Make sure the baby is safe! your preference doesn’t matter!
Thanks Loralee! you said exactly what I wanted to put across but got overwhelmed with my emotions. Just the thought of being at home delivering my son with a midwife shivers me to my core.
Loralee,
I hear you and I know your points are true and valid to you. I respect that. However there are many points to your well thought out post that are simply inaccurate. Starting with your commentary on research, it is important to not that there are many examples of junk science in every medical field. Cochrane Database offers a wonderful look into this. There you will see the highly regarded pieces of literature that have stood up to further review. You will also notice the withdrawal of certain studies, yes, the peer reviewed studies you speak of, which have been further scrutinized and have been found to be either biased, unfounded by fact, inconclusive, etc. They keep the rest and get rid of the junk. Looking back at peer reviewed studies of the past some can find comfort in the “safety” of regular routine x-rays in pregnant women, certain medications such as Thalidomide, and the “benefit” of continuous fetal monitoring in all pregnant women, etc. All of which we now know to be unsafe practices resulting in harm to mothers and babies. I’d also like to point out that my studies to be a midwife have taken many years of extensive training. I am well qualified yet I continue to learn to better serve my clients. During this process of training I have attended 9 years of hospital birth. Some of which have been lovely, but the majority of which resulting in unsafe and unfounded practices that the “patient” was blissfully unaware of. And sadly there have been a few births that resulted in assault, which I witnessed yet again 3 days ago. This breaks my heart and is frustrating beyond my ability to quietly cope sometimes. Many mothers would not have been the victim of an unnecessary surgery, their babies separated from them, medications pushed on them because their bodies were on a time clock, their patient rights stripped away/ignored/refused, etc. had they not put their faith in the system that is sold as the best and safest. To see a mother in the midst of the most poignant life defining moment she will ever experience (as designed by the release of incredible birthing hormones to cause her to fight madly for the protection of her newborn AKA- survival) be told that she is not strong enough, fast enough, quiet enough, she asks to many questions, etc is nothing short of cruel. And while I will agree with you on one thing… ” (re: midwives) they did not make the cut to be doctors. They didn’t pass extensive board exams testing every aspect of their qualification.” No, we, I, did not and will not “make the cut.” I am not a surgeon nor would I ever want to be. That is why I am a midwife. I have more training in normal birth then an obstetrician. OBs are trained very briefly in normal birth physiology. The majority of their training is spent on the pathology and complications of pregnancy, labor, and birth. This is why we need them. They know right well how to handle an emergency (though sadly many have lost the art of hands on techniques in place of technology and surgery) It is the 100% healthy normal “patient” that challenges them. And while you say that the OB’s would jump for joy if 10% of women would birth at home, their extensive lobbying says otherwise. Lastly I would happily put the skills of our local midwives who serve the Amish in their humble conditions, and our urban mothers as well in cases of normal, breech, twin, and VBAC delivery any day. Without a knife to “make the cut.”