In my paper High Risk, I reviewed all the literature that the Midwives Alliance of North America (MANA) claims forms the “best evidence” for the safety of home birth. I found that most of the studies were either not applicable to the United States, did not address issues of safety, or actually demonstrated the opposite of what MANA claimed. Read the whole paper (you can start here for the serialized blog version) for my detailed look at all those studies.
If MANA’s cherry-picked data paints a not-so-happy picture, wait until you check out what happens when you look outside of what MANA wants you to see. The literature on nonhospital birth in the United States is downright frightening. Despite what many midwives claim, these studies look at midwife-attended births, not accidental or unattended home births.
If you have had a nonhospital birth like I have, it is natural and normal to feel defensive about the safety of it. After all, to accept that you put your child at a substantial and unnecessary risk doesn’t feel good, even if you know that you made your decision out of love and a genuine desire to make a gentle, safe choice for yourself and your child. Sometimes knowing the truth hurts. I have accepted that my baby was one of the many lucky ones; I invite you to consider joining me in that realization.
If you are a midwife like I was, it is even more threatening to look at the data with a critical eye. You are probably used to relying on the midwifery industry to interpret everything for you; I know I was. We learned all the midwifery talking points and we sounded really smart. Intelligent parents would hang on our every word and decide to cast their lot with us, and this provided us with an ego boost. When the vast majority were incredibly satisfied with their birth experience, they sang our praises, and we ate it all up, humblebragging that, “You’re the one who did all the work,” while accepting the congratulations that they wouldn’t have done it if it weren’t for us. It would be totally counterproductive to our egos (and our finances!) to actually look at the evidence and realize that what we are doing is, shockingly enough, not really safe.
For those of you who are interested in finding out what the current science is on the relative safety of hospital versus nonhospital birth in the United States, here are some of the latest relevant studies:
Study shows significantly increased baby death after home births, especially for women of 41 weeks or longer and first-time moms: Early and total neonatal mortality in relation to birth setting in the United States, 2006-2009
Baby death significantly higher for those delivered at home or in a freestanding birthing center when compared to those delivered by midwives in the hospital: Term neonatal deaths resulting from home births: an increasing trend
In Oregon, baby death when using nonhospital midwives shown to be 6-8 times higher than hospital birth: Judith Rooks’ report to the Oregon State Legislature
Babies born at home had 16.9 times the odds of neonatal HIE (brain damage) compared to babies delivered in a hospital: Home Birth and Risk of Neonatal Hypoxic Ischemic Encephalopathy
Women who give birth at home have fewer interventions, but their babies have more complications: Selected perinatal outcomes associated with planned home births in the United States
Babies born at home at over ten times the risk of having no signs of life at five minutes of age; babies born at nonhospital birth centers at over 3.5 times the risk: Apgar score of 0 at 5 minutes and neonatal seizures or serious neurologic dysfunction in relation to birth setting