When sitting down to write a blog on the safety of homebirth, my first go-to was Google, of course, to find the statistics. I came across a great article from the Midwives Alliance North America on the safety of home birth. MANA cites a landmark study publish by The Journal of Midwifery & Women's health which confirms that among low-risk women, planned home births result in low rates of interventions without an increase in adverse outcomes for mothers and babies.
The MANA statistic dataset looked at the outcomes of nearly 17,000 reported planned homebirths between the years of 200-2009. Within this reporting, 89.1% of the women successfully had a home birth. There was an 87% success rate of those having a vaginal birth after a cesarean section (VBAC). There was a low rate of intrapartum and neonatal death rate of 2.06 per 1,000. APGAR scores were consistently higher and there was a 97.7% rate of successful breastfeeding at 6 weeks. Transfers for 'failure to progress' and 'fetal distress' were rare. The c-section rate was at 5.2% compared to the national average of 32%. Less than 5% used Pitocin or epidural anesthesia. All of these statistics are positive and point to wonderful outcomes of low-risk mothers choosing an at-home birth.
A commenter on the article was upset at the fact that midwives 'cherry pick' their patients and that it was this that skewed the results of the study. I actually think this is something that should be pointed out. Yes, midwives do carefully select the women that they agree to assist in home and birth center births. This careful selection is in place to give babies and their mothers the best outcome possible. Not every birth is suited for a home birth; just as not every birth is suited for a hospital birth. Each birth, baby and mother are unique. There is no 'right' blanket answer for every expectant mom.
Cristen Pascucci published an article entitled Home Birth vs. Hospital Birth: YOU'RE MISSING THE POINT, PEOPLE. I LOVED this article. It brings to light the real issue that should be discussed and that is what options do mothers really face. What decisions are they allowed to make? Pascucci shares several real stories of birth that highlight this. One is of a woman in New York that had her baby at a local hospital:
"(She had an), unmedicated (birth) and with no need for intervention. However, she has to fight every step of the way to avoid risky interventions and must compromise on some things in order to get others. Hospital protocol includes a number of non-evidence-based practices, including routine admission strip, continuous electronic fetal monitoring, restriction to bed on the back, prohibition of anything by mouth except ice chips, and a 12-hour time limit to give birth. Staff is irritated that she has a doula, and upset with her for declining routine procedures. They insist on keeping her healthy baby “in observation” for four hours after he is born despite an Apgar score of 9 and no medical indication. When she begs to meet her new baby, she is told that observation is mandatory. Her husband then attempts to advocate for her and is told CPS could be called if he continues to try to see their baby. Later, the family meets with a lawyer and is told that there is nothing that can be done legally either about the attempt to force certain interventions or to withhold the baby. Both parents realize that entering a hospital again means they have no meaningful right to say “no” to anything."
Regardless of the outcome of a healthy birth, women that go through these types of situations, come away with fear. Many times, PTSD. There are also wonderful stories of hospital births. Both my daughters had wonderful hospital births with their children and I have attended many others that had the same experience.
I believe home birth is a beautiful option for women. It is only in the US that this is so highly debated. In many other countries it is very common place. No one should control a women's choice of birth place or the methods in which she decides to deliver. When it comes to the question of safety, I believe that the safest place to have a baby is where you and your caregivers have decided it to be after looking at mother and baby's health. As I said before, there is no single answer that covers every birth. Every birth is different as every mom and baby are different. Whether home, hospital or birth center, I encourage every mother to speak open and honestly with their caregivers about their wishes and the risks of each environment.
I ask that we, women especially, take a moment to look at what the issue really is. It is about choices and making those choices have the safest outcomes possible. Pascucci sums it up perfectly by stating:
"For real people making real choices, let’s open up the discussion with compassion instead of trying to choke it to death. Transparency and collaboration can make birth safer in all of these settings, but it can’t happen in a hostile environment. If we can let go of our own biases of where women “should” give birth, maybe we can start making birth safer in all of those locations."