In part one, I talked about my first daughter’s birth and shared how, although good for a hospital birth, it could have been better at home. In part two, I explained the increased likelihood of medical interventions in the hospital setting and many of the dangers caused by them. Today, I’m delving into the reality of birthing safely at home.
Most doctors and nurses will tell you that it is very dangerous to give birth outside of a hospital. Our doctors happen to be supportive, but they are the exception, not the rule. It is almost uncontradicted in our country that a woman must have her baby in a hospital with an obstetrician and several nurses on hand… just in case. They say it is a FACT that having a baby anywhere other than at the hospital is dangerous and foolish. Where is the proof? Considering the 40-week model of pregnancy being so far off and the stubborn way that they (most medical professionals) adhere to it anyway, I wanted to find out where their “facts” were coming from. Granted, we occasionally hear a horror story about some baby dying due to lack of medical care in a homebirth, but it is such a rare thing to hear about. Babies tragically die due to unnecessary medical interventions in hospitals across the country EVERY DAY, but the news people don’t find that interesting enough to report on it. By the way, mothers die in hospitals, too. It is often from a ruptured uterus caused by the drugs used to induce labor for a “late” baby. Very sad. (I do want to interject, that I have friends that are in the medical profession whom I love dearly, and I know that they have only the best interest of the patient in mind. I am very thankful for people like them when a true emergency arises that requires their training and knowledge. My concerns, as I’ve mentioned before, are about the unnecessary interventions in a healthy pregnancy that cause injury to the mom or baby.)
So, it is taught to obstetricians-to-be that, statistically, homebirth is very dangerous. Where does that statistic come from? The American College of Obstetricians and Gynecologists released a report in 1978 (yep, they are still being taught from a report that old!) stating that, “Out-of-hospital births pose a two to five times greater risk to a baby’s life than hospital birth.” Sounds pretty serious… until you learn what they included in the “out-of-hospital” birth numbers. They counted planned, mid-wife attended births. Good. Then they added unattended births. (Okay, in my opinion, usually not a good idea, but some women do opt for that.) Then they included unplanned births. That would be the “oops, we’re on a flight/in the middle of nowhere/lost in Kansas and couldn’t get to the hospital” births. Those people were not intending to have their babies out-of-hospital. That would include all of the high-risk mothers who needed to be in a hospital and had every intention of being there. THEN, to make the numbers say what they wanted them to say, they added… miscarriage! ALL MISCARRIAGES! As if the outcome would have been different in the hospital! So, in the situations that are NOT planned and attended homebirths, yeah, there could be problems.
We’re told we need to be in a hospital “in case something happens” so that the doctors can perform an emergency c-section. That is the safest thing for our babies, right? Let’s look at some REAL statistics about those c-sections. (Again, there are cases when c-sections are necessary and life-saving. Usually, they aren’t.) I haven’t been able to find one chart that compares c-section rates with infant mortality (baby death) rates, so I used two sources. For the most recent infant mortality rates, see https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html and for a page with some statistics on C-section rates, read http://www.nytimes.com/2010/03/24/health/24birth.html
|Country||C-section rate||Infant Mortality per 1,000|
|The Netherlands||Less than 15%||4.59|
|United States||Over 30%||6.06|
The Netherlands also do not use obstetricians, except in high-risk pregnancies. Women receive care from midwives and deliver in their home, a birthing center, or a hospital. For a low-risk woman to get a doctor’s care, she must pay out-of-pocket. Here in the States, it’s the other way around.
Now, I’m not saying that all countries with low c-section rates have fewer babies die. There are many countries where babies die from lack of sanitation or from malnutrition before they were born. But, in countries where medical care is available, if needed, babies die more from unnecessary drugs and c-sections than from being born out-of-hospital. So, those “just in case” c-sections are not “saving” babies. Often, they do just the opposite. If you want to give your obstetrician a good reality check, point out the CIA statistics to him. There are 42 other countries that have LOWER infant mortality rates than the United States! All of their “life-saving” interventions are clearly not doing what they are intended to do.
What if we made a comparison between moms with low-risk pregnancies birthing at the hospital versus moms with low-risk pregnancies birthing at home with a trained midwife? Well, they did that in 2000. Over 5,000 midwife-attended homebirths were compared with 5,000 comparable hospital births. About 12% of the homebirth women changed their minds or had a situation requiring a doctor’s care and were transferred to a hospital during labor. What was the outcome? No mothers died. The c-section rate was only 3.7%. The infant mortality rate (excluding congenital abnormalities that could not have been prevented, even if they had been born in the hospital) was a very low 1.7 per 1,000. Compare that 1.7 to the chart above. Here is the official conclusion:
“Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.” http://www.bmj.com/content/330/7505/1416.full
So, if you’re low-risk, the only thing you have to lose by having an attended homebirth is unnecessary interventions!
Some of you are probably like I was… “Yeah, but what if…?” Am I right? 🙂 There you are, in labor at home, and SUDDENLY something goes horribly wrong. Well, that’s television. Yes, on EXTREMELY rare occasions there are times when the doctor “needs to get the baby out NOW”, but that is almost always from the damage they cause with inductions and/or epidurals. If you don’t start down that slippery slope, real emergencies are few and far between in a low-risk pregnancy. Still, how would a midwife handle them?
Ideally, you will have a supportive back-up doctor. Your midwife should be able to call the doctor any time, day or night, with questions, concerns, or to say, “Hey, she needs your medical expertise and we’ll meet you at the hospital in ten minutes!”
Let’s say you have a prolapsed cord (the umbilical cord comes out first and is compressed when you have contractions. That means baby isn’t getting the oxygen he needs during contractions). The midwife will have you get on your elbows and knees, and while you are en route to the hospital, the doctor will be prepping for a true emergency c-section. Same as if you were at the hospital. No biggie. This could also apply if the first thing out is an arm.
What about “failure to progress”? MOST of the time, there is nothing wrong with the mom, it’s just an impatient doctor who doesn’t want to wait for the baby to come naturally. However, there are rare occasions when the baby just won’t come, such as being very tangled up in the cord or an unusually short cord. This is not a sudden emergency and a trained midwife will say, “This baby should have come by now. Let’s give the doc a call and we’ll go see him, if we need to.” Easy.
I often hear concern about the cord being wrapped around the neck. I think this is another television-created emergency. As my midwife said, you just slip it off and finish having the baby. If it’s extremely tight around the neck, she supports the head and helps the rest of the baby’s body to “summersault” out, then she unwraps the cord.
How about the baby not breathing? If you leave the cord alone, rather than clamping and cutting it right away like most doctors, the baby doesn’t actually NEED to breathe for several minutes. He is still getting the oxygen he needs from the blood pulsing through the cord, just like before birth. The midwife can rub the baby’s chest to stimulate breathing, and she should have oxygen on hand “just in case”. She will do exactly what a doctor would do, and if the baby’s breathing doesn’t even out she will get him to the hospital. A baby that hasn’t been drugged by epidurals will seldom have difficulty breathing, though. My midwife also mentioned that she almost never has to “suction” a baby whose mother drinks raw milk, but often has to suction the “phlegmy” baby of a mom who drinks pasteurized milk. Interesting, huh?
The last major emergency that I have seen frequently mentioned is the mother hemorrhaging. Again, this happens MUCH less often outside of a hospital than in it, because it is usually caused by drug inductions. Most midwives will have either herbs that have strong anti-hemorrhaging properties, and/or they will have the same drugs a doctor would use to stop bleeding. If she can’t slow it down enough, that’s what 911 is for. It is very unlikely for things to get that far, though, in a natural birth.
This is not an exhaustive list of possible emergencies, but these are the most common concerns I’ve heard from women. With a well-trained midwife, and a low-risk mama, all of these things can be handled just fine. The midwife needs to be humble enough to be willing to get you to the hospital, if needed, and competent enough to know when you need to be there. Choose wisely, and a homebirth is statistically safer than a hospital one!