Is home birth safe?
Yes.
The end.
Except, okay, it’s not the end, because every time an article about home birth runs on a parenting website, do you know what the comments say? They say things like, “Well, that’s nice for you, but I would never put my baby at risk just so I could have a special birth experience!”
And then my head explodes. Which is why I hardly read comments on those things any more. Too much mess to clean up.
So let’s talk about this for just a minute.
Is home birth safe? Or are women who choose to birth at home focusing only on their own “birth experience” at the expense of their baby’s health? Are mothers and babies less likely to survive a birth that takes place outside of a hospital?
A large body of literature indicates that giving birth at home is at least as safe as giving birth in a hospital.
A recent study conducted in Canada, for example, investigated the safety of home birth. [Read more about the study at Science & Sensibility, or in USA Today. Read the study in its entirety here.]
The study compared three groups of women: those who planned home births attended by midwives; those who planned hospital births attended by those same midwives; and those who planned hospital births attended by physicians. All of the women in all three groups qualified for planned home births. (That is, they were all healthy, carrying full-term babies, with no complications that would rule out home birth. This was true for the home birth group as well as both hospital birth groups.)
The women giving birth at home had the fewest obstetrical interventions, the lowest rate of maternal mortality (death), and the fewest adverse outcomes (problems such as severe tears, or postpartum hemorrhage). The home birth group also had the lowest rate of fetal mortality (stillbirth or infant death). Babies born at home were least likely to require resuscitation at birth, and least likely to aspirate meconium.
Women who gave birth attended by a midwife in a hospital had the next lowest rate of interventions, adverse outcomes, and maternal and fetal mortality.
The physician-attended hospital birth group had the most interventions, the greatest number of adverse outcomes for mothers and babies, and the highest rate of maternal and fetal mortality—though mortality rates for all groups were very low.
For healthy, low-risk women, home birth attended by a midwife is associated with less complication for mom and baby, and less risk of mom or baby dying. It sounds to me like home birth is safe.
Is home birth for everyone? Am I trying to suggest that everyone should give birth at home? Of course not. Every pregnant woman should be able to decide for herself where she is most comfortable giving birth.
Can every woman give birth at home? Again, no. Some health conditions and pregnancy complications can make home birth an inappropriate choice. (A qualified midwife can help a woman determine whether home birth is among her options.) And we’ve talked before about the fact that some women don’t have access to alternative birth arrangements, including home birth.
But for most women, midwife-attended home birth is a safe option.
There. That’s the end, really. (Well, the end of this blog post anyway.)
What do you think? Safe? Not safe? Do you have concerns about birth settings?
For more on birth and midwifery, check out my resources page.
{ 13 comments… read them below or add one }
Safe.
I think our culture equates control with safety, so a totally controlled, documented and timed experience strikes people as more safe. But the body isn’t terribly interested in our agenda.
Don’t we have an interesting culture?
I think you’re right about this. I think the value our cultural places on technology–and the idea that technology is synonymous with progress–feeds into this notion, too.
If you do your homework and are honest about your conditions it can be! I know many women who would be in some ways risking safety trying to homebirth. Many women are scared in to thinking their labor was or is a life and death situation which is the main issue here.
Heather had a great point, control does not equal safe and we are convinced it does. Maternal death among other things is increasing in light of all this “control”.
Anyone with a complication free pregnancy can homebirth. I did it as a first time mama with a “too small pelvis” and an almost 9lb baby. (birth video is on my blog)
Yes, I think doing your homework and looking honestly and critically at your situation are great suggestions for preparing for birth, regardless of location!
Certainly home birth is not for everyone, but most women are healthy and low-risk, and for them (er, us), research indicates it’s a safe option.
Safe in most cases and should be the norm.
Ah, what a different health care system that would be!
one thing they never mention is that the midwife is constantly monitoring the mother to ensure that a homebirth will be safe. There is no way a midwife would put a mother and baby in danger say if baby is breach or mom has ges diabetes complications, etc.
Having my own son born outside of a hospital (the midwife’s birth center, which I call the spa) I often wonder why people assume it’s safe to have a baby in a hospital, what with all the unneccesary c-sections? forceps? vaccums? the cutting of the vag!???
AND they never tell you about the side effects of Pitocin:
The following adverse reactions have been reported in the mother:
Anaphylactic reaction Premature ventricular contractions
Postpartum hemorrhage Pelvic hematoma
Cardiac arrhythmia Subarachnoid hemorrhage
Fatal afibrinogenemia Hypertensive episodes
Nausea Rupture of the uterus
Vomiting
Excessive dosage or hypersensitivity to the drug may result in uterine hypertonicity, spasm, tetanic contraction, or rupture of the uterus.
The possibility of increased blood loss and afibrinogenemia should be kept in mind when administering the drug.
Severe water intoxication with convulsions and coma has occurred, associated with a slow oxytocin infusion over a 24-hour period. Maternal death due to oxytocin-induced water intoxication has been reported.
The following adverse reactions have been reported in the fetus or neonate:
Due to induced uterine motility: Due to use of oxytocin in the mother:
Bradycardia Low Apgar scores at five minutes
Premature ventricular contractions and other arrhythmias Neonatal jaundice
Permanent CNS or brain damage Neonatal retinal hemorrhage
Fetal death
Neonatal seizures have been reported with the use of Pitocin.
go ahead and try to argue with the nurse you don’t want any while you are IN LABOR!
I think you’re right that many people just don’t understand what midwives are, or what they do, which is a big part of the confusion surrounding homebirth safety.
On the topic of interventions: most every intervention has pros and cons (or certain situations where the benefits outweigh the risks), but as you pointed out, labor is a difficult time to try to assess them for the first time–if that information is even available then. Of course we’re all glad to have tools like Pitocin at our disposal in those rare instances when they’re really necessary–I wouldn’t suggest that such interventions are never useful–but personally, in the absence of a clear indication that they were needed, I would prefer to avoid interventions and their accompanying risk.
While we’d all like to believe that every health care provider recommends only what’s in the laboring woman’s best interest (for instance, that no one would ever order Pitocin unless it was truly necessary), we know that sometimes other factors come into play. And we know that, even when health care providers want to offer what’s in women’s best interests, we don’t all agree on what that is, for a variety of reasons. That’s why I felt most comfortable researching birth locations, interventions, and so on ahead of time, when I was physically comfortable and had plenty of time to digest the information. And that’s what I like to encourage others to do, too, so they can be confident that they’re making the choices that are best for them, given their own individual circumstances. Having access to information–about the benefits AND risks of various choices–is always in our best interest. Thanks for the comment!
Maybe the question should be are hospitals safe?
That would be another useful question.
One reason I wish homebirth were more mainstream was because I think most women are hesitant to choose it the first time around. We have friends who just birthed who, early on in the pregnancy, decided on a local hospital. But when I talked to the woman at 9 months pregnant, her feelings had really changed. She had learned more, and felt less comfortable with her hospital. Closer to her birth, she realized that she felt differently about issues like health insurance, interventions, and homebirth than she imagined she would. But she also didn’t feel comfortable switching. Her birth experience unfortunately ended in a c-section. Who knows if it was medically necessary–but I do know she did not feel supported by her birth attendents, so I think she could have had a vastly different experience.
I think i felt comfortable with homebirth because I had actually attended one. I just wish that it weren’t such an out-there choice, because women with the first kids are reasonably reluctant to do something that seems risky or different–even if it isn’t.
I am so glad you posted this. I am getting ready for my next baby (by that I mean, I am getting ready to think about having another baby) and am weighing the pros and cons of hospital vs. homebirth.
Here is my question for you (and one my husband posed for me): are you referring to homebirths attended by a CNM? Or, is there a difference when it is not a CNM? Just curious.
Another thing, hospitals are often focused on intervention. That is what a hospital is for, you know? I have had both my babies in the hospital and have been fairly happy with the results. Still, I find myself wondering if I could skip the antiseptic smell and uncomfortable bed and have it in the safety and comfort of my own home. It would also be nice to not be woken up every few hours BY THE NURSES.
This study in particular involved Canadian Registered Midwives, who are direct-entry (ie, non-nurse) midwives. (Read here or here for more about Canadian registered midwives).
My own midwife is also a direct-entry midwife, a Certified Professional Midwife (CPM). Training for CPMs and CNMs varies, but both are qualified homebirth attendants. (I wrote more about types of midwives here.) There are other types of direct-entry midwives as well, and each state regulates who is (or isn’t) legally allowed to attend out-of-hospital births. Citizens for Midwifery keeps a state-by-state listing of the legal status of midwives. In my area, most homebirths are attended by CPMs rather than CNMs–and in fact, the American College of Nurse-Midwives says that 97% of CNMs attend births in hospitals, not in homes, so we’re probably pretty typical.
Births attended by CPMs in the U.S. have been shown to have outcomes at least as safe as births in hospitals, with fewer interventions and lower mortality rates, in line with the study discussed in this post.
I’ve also just posted a resources page with links to more information on birth and midwifery. (And feel free to ask me questions, here or via email!)