How Safe is Homebirth?

How Safe is Homebirth?

How Safe is Homebirth?

Do Your Research — Know the Risks!

When the subject of birth crops up, inevitably so do the naysayers.  They suggest that homebirthers are uneducated and foolish, because surely if they had any idea what the risks are, they’d rush to register at the nearest hospital!    But is that so?

Actually, the opposite is true.  Most homebirthers birth at home because they know the risks — and have determined that, under ordinary circumstances, it’s safer to stay out of the hospital.

As much as we’ve been trained to feel like the hospital is safer because of all the interventions, the data suggest that, under normal circumstances, those interventions are as likely to cause problems as to address them.

What Does the Research Show about the Risks of Birth?

I can’t possibly get into all the research here — entire books have been written on the subject.  But just to give you a general idea of the actual facts available when you delve in, here are a couple of snippets from one of those books (A Good Birth, A Safe Birth).

 

How many mothers say, “my baby was in distress; if I’d been at home, he would have died?” who are unaware that the probability is high that if they’d been at home their babies wouldn’t have *been* in distress in the first place? (We can’t “what if” ourselves to death; we make the best decisions we know to do with the information available at the time, and when we know better, we do better. So my intent here is not to say that anyone “should have been at home,” but merely to point out that what the establishment has told you may not be the whole story.)

I accidentally cut off the very beginning of this first clip, obscuring the context.  This is a comparison study of mothers at the same (low) risk level in the same hospital — half of them in the regular labor & delivery area and half of them in the birthing center.

I know this particular study isn’t about home birthing, specifically, but it does still show us something useful.  The hospital’s traditional interventions were not improving outcomes.  In fact, the outcomes in the traditional hospital maternity wing were worse overall, and in most of the individual categories.  And these were all low-risk mothers, so we can’t blame it on the hospital’s having attracted higher-risk cases.

Although this particular study compared a birth center to a traditional hospital, and didn’t look at home births, there are other studies that did include homebirth.

It’s remarkable that even at high risk levels, out-of-hospital birth was stastistically safer.  (Although most mothers will choose to birth at the hospital if there are known significant risk factors.)

But My Baby Would Have Died If…

At this point in the conversation, mothers usually pop to say, “that’s all well and good for most mothers, but my baby would have died if not for the hospital interventions.”  It’s possible that’s the case.  But we can readily deduce from the numbers that it isn’t possible for this to be true in every case where a mother believes it’s true.  So what gives?

One possibility is simple exaggeration.  No doctor wants to tell you that he did an unnecessary surgery!    Perhaps a cesarean wasn’t really warranted — they’re still probably going to try to make you think it was necessary, because it might not go well for them if they admitted it wasn’t.  Or perhaps they did a cesarean “to be cautious,” but the situation wasn’t really that critical.

More likely, though, the largest contributor to the disconnect between anecdotes and hard data is the interventions themselves.  Out-of-hospital maternity care providers have long known about the “cascade of interventions.”  This refers to the phenomenon that one intervention tends to lead to another, which leads to another, and so on.  If the doctor unwittingly caused a problem with his interventions, he might legitimately believe he “saved the life” of the baby in question — even though the baby’s life wouldn’t have been in danger in the first place if it weren’t for his interventions.

We can’t live in the land of “what if’s,” and I’m not asking anyone to second-guess any past decisions.  We do the best we can with the information we have available at any given point in time.  But I do want to point out that we’re told to believe is not always the full story.  You can’t judge someone else’s birth decision based on your own personal experience.

(Speaking of “the full story,” if you look for studies involving home birth, pay attention to the inclusion criteria.  Some studies make home birthing look bad by including “home births” like crack babies born in back alleys.  That really isn’t a valid comparison to prepared mothers birthing at home with intention.)

Depression & Abuse

One of the most surprising things to me in the first study I showed you clips from was the fact that the hospital-birthed babies had higher rates of abuse after birth.  It seems that something about the hospital birthing process made mothers more prone to stress or depression, or…something.  This later study might have the answer: Pitocin® is linked to postpartum depression.

Now, that doesn’t mean that mothers can’t get postpartum depression without Pitocin, too.  But apparently — and not surprisingly — this interference with the natural hormonal patterns of a laboring mother increases the risk.  Yet another example of a largely routine intervention causing harm.

All of these statistics about the birth process and birth interventions are layered onto other, more fundamental concerns.  “The CDC estimates that 10% to 15% of patients acquire an infection in the hospital….Also, many microbes in health care settings are resistant to several drugs.”  That’s a direct quote from somewhere, but I’ve misplaced the citation.  The overall information checks out, though.  The CDC is currently placing their estimate at closer to 4%, from what I can see, but other experts say 5-15%1, and the idea of drug-resistant bacteria is not news to anyone.2  Going into birth, most mothers and babies are already healthy, so why would we want to take a 5%+ risk of acquiring a possibly deadly infection — when the data show that simply staying home is not unsafe?

A Note on Dates

I like A Good Birth, a Safe Birth becuase it makes information readily accessible by gathering relevant data all into one place.  The one down side is it’s getting dated at this point.  The physical process of birth hasn’t changed in the past twenty years, though, and routine interventions haven’t magically stopped leading to cascades, so I believe it’s still relevant.

Moreover, we’ve seen that newer studies help show the mechanisms for some of the earlier observations (as with the Pitocin study), and newer information similarly shows, at worst, no significant increased risk when birthing at home.345

Not Risk-Free

Don’t get me wrong; there is some risk.  Virtually nothing in life is completely risk-free.  And we want to employ common sense.  In most cases where a true need for intervention only a hospital can provide does arise, there’s the option of transporting.  (A lot of people act like, “once at home, always at home,” which isn’t realistic.)  But if you live 200 miles from anywhere, you might want to choose an option closer to a hospital.

Much of the research around homebirth also centers around the idea that a mother’s comfort level with her surroundings makes a physiological difference in the effectiveness of birth.  It logically follows, then, that if you’re uncomfortable at home, that might not be the best option.  There’s not just a single factor to consider.

But what I hope to have shown here is that homebirth is not inherently an unsafe, irresponsible choice.  It’s an option mothers confidently choose based on a body of empirical evidence.

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6245375/
  2. https://www.cdc.gov/hai/organisms/organisms.html
  3. https://www.ncbi.nlm.nih.gov/pubmed/29408739
  4. https://www.ncbi.nlm.nih.gov/pubmed/25204886
  5. https://www.ncbi.nlm.nih.gov/pubmed/29727829