[...] A great blog follow up to the article above: The Economist’s Refreshingly Even-Handed Take on the Home Birth Debate [...]

With home birth safety, the bottom line is that everyone is low risk – until they aren’t. A woman can have a completely healthy, low risk pregnancy and highly trained birth attendants, but she can still have a complication during labor that will hurt or even kill her baby unless a c-section is performed right away – sometimes there is no time to transfer to a hospital. Such complications are rare, but “rare” does not equal “impossible.” It can and does happen.

Now, does that risk mean I think home birth should be illegal? No. But I do think women should go into it fully understanding the risk of such complications. I really don’t understand why home birth advocates often try to argue that home birth is safer and ignore the possibility of things like cord prolapse or placental abruption.

My sister-in-law gave birth today at a hospital, although she had been considering a home birth. She had an easy and low-risk pregnancy (she’d tell you that herself!), but had major difficulty getting the little guy out. He was three weeks late, large, and she was in labor for 36 hours before he finally had to be hauled out with forceps. She had an epidural at about 22 hours in because she was exhausted, and had to have a blood infusion after he was born. The great thing, though, is that medical options were available to her, and that even if she’d had originally planned a home birth she could be moved easily to a hospital. Women all over the world die because they just don’t have the option of medical intervention. Long labors and blood loss kill many women.

I think what can be offputting in the home birth debate is the implication that medical staff are “the enemy”. Doctors and nurses have no interest in seeing babies and moms struggle with complications. EVERY childbirth professional would like to see every birth be simple and straightforward.

The oppositional posturing is not helpful. There is middle ground here- medically equipped birthing centers, midwives in hospitals, etc. Can’t we focus the childbirth community on working together to increase these options rather than tearing each other down?

From my observations working in a system where midwives are integrated into the mainstream system, have hospital admitting privileges, have good working relationships with the obstetric and hospital personnel and attend home births in addition to hospital births: the vast majority of transfers from home to hospital are for use of pain meds (moms change their minds for a variety of reasons about pain med use), after that comes the suspected complication (there might be something that needs closer monitoring, or the midwife desires an OB consult, the majority of these all turn out fine) . I’ve never been part of an emergency transfer but my discussions with the midwives I’ve worked with show that the only thing that really makes them nervous is hemorrhaging and those who are nervous usually just make sure they have extra injectibles on hand to manage excessive bleeding (pitocin is part of active management of third stage, some midwives sneak in a double dose, plus there are a couple other meds routinely carried for emergency situations). While there are rare and crazy complications that can come up out of the blue, midwives know which stuff needs surgery for and which stuff can be managed in alternative ways that surgeons wouldn’t use because, well, they’re surgeons. But, further and far more bluntly: babies die in hospital all the time, too. All the time! When a baby dies in home birth, the midwife is often made a pariah, but the corresponding OB doesn’t make the national news and hundreds of thousands of dollars and comment characters aren’t expended decrying how dangerous OBs are. And believe me, OBs are f@cking awesome! When the chips are down and you need surgery, you want a great OB doing what they do best. But good midwives are awesome, too.

It’s about choice. And in support of those choices, let’s stop arguing about which is better or safer, regardless of statistics. Let’s just work hard to make birth as safe as possible whereever it takes places, whomever attends the delivery.

When reading articles and studies about home birth in “the rich world”, it’s important to mention that midwifes in other countries (Europe and Canada) are highly educated, medically trained professionals. Their skill set and medical education is similar to the US Certified Nurse Midwife (CNM) which is a graduate level degree. If you give birth in a birth center, you are typically attended by a CNM. Most home birth midwifes in the US are Certified Professional Midwifes (CPM) which does not even require a high school diploma! So it’s dangerous to look at stats in other countries and apply them to the US because our home birth midwifes are not of the same caliber.

Babies and mothers die (or become brain damaged) at home births for reasons that would not have killed them in a hospital setting.