Being Pregnant

Home Birth Up 29% Since 2004, Why Is That?

Posted by ceridwen on January 27th, 2012 at 11:20 am

86593808 8b82aebd5c z 1 300x247 Home Birth Up 29% Since 2004, Why Is That? According to the CDC, the number of home births in the US went up 29% between 2004 and 2009. The number is still low– it went form 0.56% of all births to 0.72 %, but that’s still almost 30,000 births.

“The increase has been driven by non-Hispanic white women,” said the author of the report Marian MacDorman. “For non-Hispanic white women, home births increased 36 %.”

Why is this happening?

“A lot of women really like the idea of home birth because they want a lower-intervention birth. A lot of women are worried about higher C-section rates and other types of intervention that happen once you go to the hospital,” MacDorman said.

Also of note: For white women, 1-90 births took place at home in 2009. Non-white women were much less likely to give birth at home. Women over 35, with low risk pregnancy and other children were also more likely to give birth at home. (This makes sense given that this population make the best candidates for out-of-hospital births.) There were some big regional differences. In 2009, only 0.2 % of births in D.C. and Louisiana took place at home but 2 % of births in Oregon and 2.6 % in Montana.

When I gave birth in 2004, I didn’t know home birth was a real option in NYC. By the time I was pregnant in 2007 with my second, it was starting to come up more and more. I had two friends who’d had their second babies at home. One woman was a novelist, the other an employment lawyer– both had read a ton before deciding to give birth at home. My decision to give it a shot was, in the final hour, based on research: I was a low risk, second pregnancy (after an uneventful first); I had an enormously experienced certified nurse midwife and live exactly one block from a major city hospital. But what got me to that decision was a comfort with the idea that came from knowing about it personally. Not just from a book or a movie.

My comfort came from my childhood (my mother gave birth to my younger siblings at home in the UK with a doctor and midwife present and it was considered a perfectly normal thing to do), and from my friends. Sitting down with these women I related to and trusted and hearing about how it all played out really helped me.

They were funny for one thing. They were funny about how painful it was and some of the logistics involved. They were also honest about their concerns– about birth at home and birth in general. And they took it all seriously. They talked me through the pros and cons, risks and benefits. They knew from their own experience that this is a decision no women should be “talked into.”

My birth at home was as magnificent as my first birth in the hospital. They were very different but equally profound. My home birth was fast and the recovery was shockingly easy. It was gruesomely painful and I howled to the moon, but that part only lasted 30-45 minutes. Most of the labor consisted of me reading a novel in bed while cold wind blew against the window and my older son played happily with his grandparents in the other room. I was never scared or overwhelmed. I just felt very focused on getting through each contraction. Being in the water was an incredible relief. And being able to snuggle up with my baby, husband and ecstatic three-year old afterward was so nice I’ll never forget it.

I’m definitely a part of this new CDC statistic– in 2004 I gave birth in a hospital, in 2007 I was at home; I’m a low-risk, non-Hispanic white women over 35…  So I wanted to share my story and my reasoning and my influences.

What’s made the biggest impact on your decision about where and with whom to give birth? Friends, media, research, books, your own mother, your previous experience with birth/hospitals/doctors?

I’m curious to know how our ideas about what is safe and what is normal are shaped.

 

 

photo: Chris&Jenny/Flickr

 Home Birth Up 29% Since 2004, Why Is That?

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4 Comments

Curiously, there’s one thing that the data brief didn’t mention at all: exactly how many of those babies died?

MacDorman and colleagues managed to analyze homebirths by race. They managed to analyze homebirth in each and every state. They managed to analyzed the risk profile of homebirths. But somehow they couldn’t manage to check the neonatal death rate for homebirth publicly available on the CDC Wonder website. They are curiously silent on the most important thing we need to know about homebirth: is it safe?

Had MacDorman et al. bothered to look, they would have seen that the most recent CDC data shows that homebirth with a non-nurse midwife has a neonatal mortality rate 7.7 times higher than comparable risk hospital birth!

While the authors were busily analyzing the state level data, they could have learned that in the state of Colorado, which has licensed homebirth midwives since 2006, the homebirth death rate has exceeded the death rate for the state as a whole (including premature babies and pregnancy complicati­ons) in every single year since and has risen in every single year since 2006, The death rates are so appalling that the homebirth midwives of Colorado refused to release the death rates for 2010. Or they could have learned that the state of Oregon has had at least 19 reported neonatal deaths in the past 10 years for a rate that is more than 4 times higher than the death rate for comparable risk hospital birth.

Every major news outlet has reported on this CDC data brief, and curiously, not one bothered to ask how many of the homebirth babies died.

Amy Tuteur, MD commented on Jan 27 12 at 3:36 pm

For newcomers to the home birth ‘debate,’ Amy Tuteur is famously and fiercely against home birth. She has devoted her life to her passionate belief that home birth is not safe and “natural birth” advocates are basically idiots. If you Google her you will see her incendiary posts and flame wars all over the place. You can read more about it in a Babble.com piece called, Birth Wars: (http://www.babble.com/pregnancy/giving-birth/winning-homebirth-debate/)

I recently saw an interesting article about home birth safety put out by the National Health Service in the UK, http://www.nhs.uk/news/2011/11November/Pages/hospital-births-home-births-compared.aspx.

ceridwen commented on Jan 27 12 at 4:37 pm

I happened to love giving birth at the hospital. I was in labor for 2 hours in a jacuzzi and pushed for 15 min on my hands and knees over a yoga ball … I did all natural, leave baby alone until we nurse bond etc and my doula was very helpful even though my obgyn caught my baby.

I was not happy about being forced to have an iv of a strong antibiotic because I tested pos for group b strep … Which apparently is present in just about everyone and goes and comes… And we had to stay for 48 hours … Which sucked since I gave birth at midnight. Do we were there so long an it was very uncomfortable to stay that long.

I totally see myself giving birth at home next time. Although I am grateful for how wonderful the nurses actually were even though the requirements about iv and me staying were annoying.

Hyman commented on Jan 30 12 at 4:37 pm

Thanks for the article link Ceridwen. It’s of particular interest to me as I’m 34 weeks and planning a home birth with an NHS midwife. I fit most of the ‘white, second child’ things but at 29 am younger than the age group the article talks about. My decision was made partly because the MLU (a mid-wife led unit without a consultant on board) my son was born at closed and the next closest is at least 35 minutes on a clear road and at least twice that at rush hour. My first labour was very quick so I had visions of giving birth in the car on the way. The car journey last time (albeit much shorter) was the most uncomfortable and restrictive part of my labour so I won’t miss that. First time around we lived in a lovely new-build flat but parking was impossible and it wasn’t exactly spacious whereas now our midwife can park outside our front door and I’m turning our dining/play room into the birthing room with yoga ball, futon etc – it’s next to the kitchen and bathroom but not as exposed to the rest of the world as our living room! I’m investigating birthing pools – didn’t have time to use one last time but spent a lot of time in the bath. There was a lot of negative press recently in the UK about homebirth for first time mothers but on further investigation the figures don’t affect low risk second time mothers (like me). I’m young, fit, healthy, have experienced labour already and have good support from my husband, mum and midwifery team. I’m doing it mostly for logistical reasons but if the MLU I used last time was still open maybe I’d think twice – the thing is that there, if I’d needed certain medical intervention e.g. C-sec /epidural I’d have had to be ambulanced across the city anyway.

Meg commented on Jan 31 12 at 7:24 am

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