Monday, August 02, 2010

No, home births are *not* irresponsible

The other night I got an email from an online friend with a link to an article about a UK medical journal piece that has stated that pregnant women should perhaps not be allowed to opt for a home birth.  This opinion is based on a recent research meta-analysis published by the American Journal of Obstetrics and Gynecology that concluded that babies born at home might have higher death rates than those born in hospitals.  Basically, they (the UK journal) have decided that home birth is riskier than a hospital birth, and that women "do not have the right to put their baby at risk."

Many thoughts swirled through my head after reading that article.  For example, the many analyses of the AJOG study that suggest that it might be deeply flawed.  Or all the previous research that's found home birth to be just as safe as hospital birth (including, interestingly enough, many of the studies used in the AJOG meta-analysis).  And let's not even go down the slippery slope of the implications this type of statements holds, as it easily could be applied not just to a mother's decisions regarding childbirth but to every moment from conception all the way through infancy and childhood.  Are we going to start policing women for deciding to have a glass of wine during pregnancy or, say, doing something as high-risk as driving with their kid in the car?

Then there's this aspect of women not being "allowed" to decide.  This makes me angry on a few levels.  I immediately thought of our sky-high c-section rate, how clearly many, if not most, of those c-sections are unnecessary, and how c-sections are indeed riskier for both mother and baby than vaginal birth (especially so if the mother wants to go on to have more children in the future, in which case that previous c-section also increases the risk of all sorts of complications for each future pregnancy).

But I guess those are risks doctors are willing to take-- are willing to decide for us.  We moms, however, shouldn't have the "right" to make our own risk/benefit analysis and decide what we think might be better for us and our babies.

And that's the other thing that gets me-- behind every one of these articles about the "risk" and "danger" of home birth or of using midwives instead of OBs, lies the belief that those of us who choose this route are being careless and irresponsible.  That we aren't looking at the risks and have instead made our decisions based on our own selfish desires, on whim, rather than on evidence and what's best for our babies.

This assumption makes my blood boil.  It should go without saying how ridiculous it is, how erroneous.  The truth is most of us have spent hours pouring over websites and online studies, weighing very carefully the risks, and deciding, yes this is what's best for us -- "us" meaning both ourselves and our babies.  We look at the hospital model for birth, with the high rate of interventions (which you can in theory opt out of, but often not without a fight and labor is the one time you should not have to fight with anyone); the 30% chance (or higher, depending on the hospital) of ending up with a scar on your belly; the alarming increases in maternal mortality and morbidity in hospitals over the recent decades (which are quite likely linked to those higher interventions and c-section rates), and we say "No, thank you."  We realize there is some risk involved-- there always is, no matter how you give birth-- and we accept it, and we prepare as best we can to reduce that risk as much as possible.  We love our babies just as much as any other mother, we care about them and their well-being just as much, and we should be trusted to know how to make decisions that make the most sense for all of us.

There is one aspect in which the journal article gets it right-- that in high-risk, complicated pregnancies, it's best to give birth in a hospital.  Which is exactly what most midwives will tell you.  Part of a midwife's job is to help a woman determine whether or not she is a good candidate for home delivery, and if there are risk factors such a placenta previa, preeclampsia, or certain breech presentations, any decent midwife will urge that woman to give birth in a hospital.  One problem that can arise, however, is that of determining who should or should not be classified as "high risk."  As this post at Fertile Feminism points out, in the UK (not sure if US has this, either) there is no conclusive criteria for what it means for a pregnancy to be high risk.  Doctors get to decide what conditions or factors push a woman over into the high risk category-- these can be legitimate risk factors like the ones I mentioned above, or can be things like "advanced maternal age" (aka over 35) or just being overweight.  Until there are objective guidelines outlining what factors make a pregnancy high risk (and even with that in place) it should be up to the future parents and their medical provider (OB or midwife) to discuss the risks and benefits of different birth options, and up to the parents to make an informed decision about what they want to do.

Somehow our ability to assess risk has gotten completely skewed.  If a mother or baby dies after a home birth, you'll see headlines splashed all over declaring home birth unsafe and irresponsible (even if the death had nothing to do with the location or access to medical services).  If a mother or baby dies after a vaginal birth, the doctor gets sued for not "doing enough." If a mother or baby dies after a c-section... well, um, nothing.  No accountability, no wondering why, or what could have been done differently.  We blow certain risks out of proportion (home birth, vaginal birth, VBAC), while completely ignoring others (non-medically-necessary inductions or c-sections-- and yes, I have read doctors claim there are no risks to c-sections, even that they're safer than vaginal birth).

And that right there is the bottom line for me.  Let's talk openly about what are the pros and cons, the risks and benefits, but let's look at ALL the risks.  Let's not go on and on about how "dangerous" home births are while claiming that epidurals, inductions, and c-sections are "perfectly safe."  There are risks to consider no matter which way you go in the many decisions involved in childbirth (and child-rearing, for that matter) and women deserve to know about them all and make informed choices for ourselves.

PS- Here's a wonderful post on complications during home births, and how midwives deal with them.


  1. Jackie10:23 AM

    Well said! I knew I could rely on you to stand up for home births and midwives (including my sister in the UK) when I sent you the article. You really should consider getting into politics when the children are older.

  2. Anonymous10:37 AM

    I saw something on Discovery Health that covered women who were delivering unassisted, that is no midwife, no nurse, just husband and wife. Was this article referring to this "freebirthing" practice? It mentioned that it is perfectly legal in the US, but up for debate in Europe. The show seemed to mention home births as a perfectly acceptable alternative to hospital births.

  3. I think you would like this book I'm reading called "Bad Science". It talks all about how the media is really bad at reporting studies that are "cherry picked" to show one thing, how we are bad at understanding risks, etc.

  4. After watching a birth suddenly go horribly wrong in the last seconds of delivery for a friend, I have always been glad to have the hospital NICU staff ready and waiting in case my precious little ones needed them. They were there in seconds for my friends little one and saved her life.

    However, each mom should ABSOLUTELY have the right to control her birth and baby feeding options. No government should have the right to decide for you.

  5. Thank you for writing this. Thank you. Thank you. Thank you. As a very well-educated (both on paper & not) homebirthing mom, I've often said these same things. But thank you for wording it so well and arguing it so clearly. I'm sharing this one with many.

  6. There is one thing that seems to be left out here...

    If you have a home birth, at least in Canada, they are required by law to have the same exact equipment present as they do in hospital births...

    Hmmm. And so the difference is???

    What about all of the home births that are in the NL? Why not base the study there, they are the pioneers behind the midwife coming to North America.

    It seems to me, people are not being educated properly before writing or reading about these studies and processing an opinion off of on incomplete research...

    Having said all that, you should at least have the right to choose.

  7. P.S. Great report.. Hope you will at least get to make your own choices!

  8. It is heartbreaking how so many women begin their pregnancies believing that they need permission to give birth in the way, or in the place that suits them best. In the US it has been less than 100 years since physicians co-opted birth and drove midwives underground. We forget that childbirth has been the domain of women for the vast majority of our existence. Great synopsis of the risk-assessment women make when choosing safe, woman-centered birth at home.

  9. So glad I found your blog (through Sew Liberated!) and read this post.
    I just had a home birth in Alabama, where midwives are outlaws. Outlaws!

  10. Not sure about the "many, if not most, c-sections are not necessary". I was considered very low risk with my first pregnancy -- but without the c-section, I don't think we would both be alive right now. Women who are able to deliver vaginally, safely (even at home!) are quite lucky. But for me, c-sections are necessary and the most healthy choice for birth. I relate it to breastfeeding; although I've been able to breastfeed both of my sons (and for relativey long durations), I know that not everyone can. Yes, breast milk is best overall (just as a vaginal births are), yes, we need education and support and choice...but we must also be careful to remember that not every mother can breastfeed for medical reasons. I agree with you that a government should not restrict birth options, though.



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