Obstetric Lie #87- Home Birth Is Dangerous
This is a question that mothers, fathers, and critics ask frequently. There are a plethora of studies within the field of obstetrics, and contradictory information is rampant on almost medical study you can find. This post is an attempt to pull together a few well done studies concerning the safety of home birth verses hospital birth.
One of the best and most recent studies I could find was this one. You can read it in full here and I highly suggest that you do. The choice of where you birth is deeply important. There are risks and benefits to every choice, including some inherent risk in birthing no matter where you birth. Overwhelmingly this risk is higher for the baby than the mother. When we choose pregnancy we must accept some degree of risk.
What is most telling about this study though is the type of midwife that it is examining. The Certified Professional Midwife or CPM has been widely criticized, even among home birth advocates. ACOG (the American Congress of Obstetricians and Gynecologists) only endorses the use of CNMs or Certified Nurse Midwives. The difference between the two, in short, is the type of education they recieve.
CPMs in this study were certified through NARM or the North American Registry of Midwives. They do not necessarily have a bachelors degree nor are they registered nurses. They are not medical personnel per se. They do not have hospital rights in the United States. Their legality is questioned still in some states. CNMs however are medically trained, mostly practice within hospitals and are much more accepted among the medical world at large. They are nurses with an advanced training in midwifery.
It is also important to note that in the United States there is not often a good working relationship between CPMs and the medical model of care. They do not often have transfer doctors or MDs that they work with. They are not supported by the hospital system.
Why are these things important to note? Those within the medical industry grudgingly admit that some midwives (CNMs) who have more medical training are capable of attending births within the hospital setting. However the idea of a competent CPM is often found repulsive and is discouraged by ACOG. It has also been claimed by some that NARM refuses to share their actual data on the safety of home birth. This study proves otherwise.
But let's get to the data, the science, behind home birth safety in the United States.
To start, the sample size was decent, and this study compared home birth moms to similar hospital birthing mothers.
"We focused on the 5418 women who intended to deliver at home at the start of labour. Table 1 compares them with all women who gave birth to singleton, vertex babies of at least 37 weeks or more gestation in the United States in 2000 according to 13 personal and behavioural variables associated with perinatal risk."First, they found that intervention rates were quite different between the home birth and the hospital birthing groups.
"Individual rates of medical intervention for home births were consistently less than half those in hospital, whether compared with a relatively low risk group (singleton, vertex, 37 weeks or more gestation) that will have a small percentage of higher risk births or the general population having hospital births (table 3). Compared with the relatively low risk hospital group, intended home births were associated with lower rates of electronic fetal monitoring (9.6% versus 84.3%), episiotomy (2.1% versus 33.0%), caesarean section (3.7% versus 19.0%), and vacuum extraction (0.6% versus 5.5%). The caesarean rate for intended home births was 8.3% among primiparous women and 1.6% among multiparous women."They found that despite lower interventions, the home birth mortality rates were comparable to hospital birth rates.
"The intrapartum and neonatal mortality was 1.7 deaths per 1000 low risk intended home births after planned breeches and twins (not considered low risk) were excluded. The results for intrapartum and neonatal mortality are consistent with most North American studies of intended births out of hospital11-24 and low risk hospital births"
If you would like to see the table of mortality rates in hospitals, (it is a great resource) you can find it here.
This study also looked at client satisfaction with their midwife. They found that:
"Among the stratified, random 10% sample of women contacted directly by study staff to validate birth outcomes, no new transfers to hospital during or after the birth were reported and no new stillbirths or neonatal deaths were uncovered. Mothers' satisfaction with care was high for all 11 measures, with over 97% reporting that they were extremely or very satisfied. For a subsequent birth, 89.6% said they would choose the same midwife, 9.1% another certified professional midwife, and 1.7% another type of caregiver."
Some things to note about the strength of this study compared to others done are mentioned here.
"Our study has several strengths. Internationally it is one of the few, and the largest, prospective studies of home birth, allowing for relatively stable estimates of risk from intrapartum and neonatal mortality. We accurately identified births planned at home at the start of labour and included independent verification of birth outcomes for a sample of 534 planned home births. We obtained data from almost 400 midwives from across the continent."
The choice to birth at home is not a popular one despite some recent media attention to the contrary. Women overwhelmingly choose to birth in the hospital. The common criticisms of home birth, that only CNM's should be used and that the American CPM is badly trained and dangerous were not found in this study. In fact, their results were very similar to those of medically trained OBGYNs. The assertion that NARM does not disclose their statistics is also disproved in this study. One particularly telling thing is that these good results were present even in the United States where there is little cooperation between obstetrics and home birth midwifery care as compared to some other European countries where there is also stricter home birth midwifery requirements.
Wherever you choose to birth, it is imperative that you have studied your choice and that you are comfortable with it. Knowing your care provider, their skill level, their certifications, their experience, and their history of deaths, if any, is something that the woman entering motherhood should be far more interested in than the nursery theme.
If you are interested in more studies on this subject, there are many more. You can find them at the links below.
Birth safely and in peace and with full knowledge of what is safe and what is not. You have a responsibility to know what is true and what is false.
This is the response by Johnson and Davis to the critics of their home birth study, and is fascinating reading.