Thursday, September 22, 2011

The Truth about Homebirth

I have recently discovered an outspoken group of people who are strongly opposed to homebirth, natural birth and other choices that women in the natural childbirth community make. Their argument is that homebirth is "dangerous" and therefore, if you choose it you are a selfish mother and you don't care about your baby's life.  They also believe that CPMs ( Certified Professional Midwives) are so incompetent and uneducated, that the entire profession should be abolished.
It's quite obvious that they are biased and their extreme views on these matters make them all the more unbelievable. The generalization that all CPMs are one way is another example of their rigidity in thinking. What I take offense with, is that there is simply not enough true scientific evidence in our country to make either of these claims about homebirth safety or homebirth midwifery care.

Let me explain...
Here, in the United States, only a few studies have been done on the safety of homebirth. Unfortunately, the two most well known studies, the Johnson and Davis and the Wax study, are controversial, for they both have been criticized for being flawed. I think it would be fair to say that neither of these studies should be used to prove the dangers or safety of homebirth.
The Wax Study, for instance, concluded that the neonatal death rate is 3x higher for homebirth babies. The neonatal death rate is the numbers of babies who die between day 7 and 28. However, the perinatal death rate, which includes stillbirths and babies up until seven days old and is considered the best measure of obstetric care, was equal for both home and hospital in this study. Another significant point, is that the perinatal death rate in the Wax Study was based on close to 500 babies, whereas the neonatal death rate was only based on 37 babies. Clearly, the perinatal numbers are more robust and therefore should be more significant. This is just one example of the study's flaws, for a deeper understanding of why it has been criticized you can look here:

The one thing I do think should be more closely examined, is the fact that all the studies done on homebirth, in this country and others, shows many, many benefits to baby and mom. Benefits such as a significantly lowered chance of interventions and c-sections as well as a lowered chance of tearing, laceration, PPH and infection. There is less birth injury in the babies and less need for oxygen within 24 hours after birth. Those findings alone should make people stop saying that homebirth is only about the mother's experience. The experience is often very good but that doesn't mean it's the only reason mothers choose homebirth.

So, you may ask- if this is our only source of data about homebirth, how is it possible that people can claim it is dangerous as if they know it as a fact? Well, there are two other points people make about homebirth to "prove" it is dangerous. One thing that is often brought up, is the CDC dataset. The CDC numbers are based on raw data and have not been peer reviewed. A dataset that has not been peer reviewed is not scientific evidence, I think we can all agree on that. The numbers are also based on only a few years and they lump all non-nurse midwives into the same category. Meaning, the most inexperienced, lay midwife is put in the same category as licensed CPMs. Even women who aren't midwives can be put into this category, such as a doula, friend or childbirth educator. There is also no sure way to exclude all the high risk women who gave birth at home because birth certificates give us only minimal information. Obviously, it is more dangerous for someone to give birth to a footling breech with a doula posing as a midwife,  over a low risk woman with a licensed CPM.
Even Amy Tuteur has claimed that birth certificates are inaccurate when it comes to the mother's pregnancy complications and risk factors.

Nevertheless, opponents of homebirth still like to use this data, because it shows that the homebirth neonatal death rates are higher at home than at the hospital. When they analyzed it, they found that the neonatal deathrate for homebirth babies is 1.15/1000 and .61/1000 for hospital babies.
Now, please take into consideration what was posted above. The homebirth neonatal death rates include low risk women and high risk women, women attended by licensed midwives, lay midwives, inexperienced midwives, and people who are not even considered midwives. The homebirth numbers also include highly religious people who will refuse transfer to a hospital, no matter how dire the situation and the Amish, who live in rural areas and have many children, becoming more high risk after having the fifth child.
It's clear to me, that if the CDC data proves anything, it proves that homebirth is actually quite safe!

The bottom line is that those who harshly judge women who choose homebirth in our country need to realize that they don't have sufficient evidence to do so. They also don't have sufficient evidence to claim that all American homebirth midwives are dangerous, greedy or unnecessarily killing babies. Until the day comes where we have a well done, unflawed American study, I really don't think anyone has the right to be pointing fingers at homebirth mothers or midwives.

Now, the second point opponents of homebirth like to make, is that emergencies happen and the best place to be is the hospital if those emergencies happen. Yes, that is true but ultimately, we can't look at specific cases to prove anything is dangerous. Someone's personal story is nothing but an anecdote. Saying, "If I hadn't been in the hospital, my baby would have died", does not prove homebirth is dangerous nor does finding homebirth loss stories on the internet. No, you have to look at the whole picture and the only way to do that is with peer reviewed studies done here, in this country.
Using anecdotes to make a point, proves nothing. But I will delve further into that on the next post......


  1. Great post! Many people also don't know that many emergencies in a hospital are caused by non-evidence-based interventions that would not happen at home. Or that the real "emergency" was that your doctor didn't want to miss dinner or wanted to go home.

    Yes, there are some conditions where the hospital is the safest place (and a competent midwife would never take these clients on anyway), but for some of us, home is the safest place.

  2. Yes Erin! I find it interesting that the VBAC numbers are higher in the hospital then having a homebirth because as we all know, women do attempt VBACs at home quite often. This can either mean two things, 1. The hospital is responsible for causing problems for VBAC mothers with the interventions they use, or 2. the numbers are so low for the low risk mothers doing homebirth that when combined with the high risk women, they are still lower than VBACs done in the hospital. Either way, the CDC numbers are most certainly NOT an indictment on homebirth safety at all.