Many people ask if homebirth is safe. Our society views labor and birth as pathological, an illness that needs to be fixed or cured. Since the beginning of time, humans have given birth without medical help or intervention.
For healthy women at low risk for complications who choose skilled and experienced caregivers and have a good system in place for transfer to a hospital when necessary, most studies show that giving birth at home is just as safe as giving birth in a hospital. They also show that moms who planned to give birth at home (regardless of where they ended up having their babies) ended up with fewer interventions, such as episiotomies and c-sections, compared with a group of equally low-risk women who had planned hospital deliveries.Is the Hospital Really the Safest Place to Deliver?
The National Perinatal Epidemiology Unit concluded in Where To Be Born in 1994 that "no evidence exists to support the claim that a hospital is the safest place for women to have normal births." The World HealthOrganization (WHO) reports that "it has never been scientifically proven that the hospital is a safer place than home for a woman who has had an uncomplicated pregnancy to have her baby. Studies of planned home births in developed countries with women who have had uncomplicated pregnancies have shown sickness and death rates for mother and baby equal to or better than hospital birth statistics for women with uncomplicated pregnancies."
David Stewart states that "since the founding of NAPSAC in 1975, we have searched for the data, if it exists, that supports 100% hospitalization for birth. We have not found it. We have formally requested all of the major medical associations (ACOG, AMA, AAP, AAFP) and any other professional organization who supports 100% hospitalization to share their data. To date, they have not. We have asked them to write chapters for the NAPSAC books. We have offered to publish their documentation. We have given them the opportunities to speak before large audiences at NAPSAC conferences in order that their valid statistics, if they have any, can be made known. To date, they have failed to produce even one study in support of their contention." If your doctor tells you that home birth isn't safe and you should birth in the hospital, ask for his/her statistics. Chances are, s/he doesn't have any.
For a normal, low risk mother and baby homebirth is as safe, if not safer than hospital birth.
Safety has been held up as the reason why all women should give birth in the hospital. This is despite the fact that no data support the contention that homebirth holds any excess risk provided:
- the mother is low risk
- the homebirth is planned
- she has a trained, experienced birth attendant
- there is a modern hospital within a reasonable distance
- In the hospital, 3.7 times as many babies required resuscitation.
- Infection rates of newborns were 4 times higher in the hospital.
- There was 2.5 times as many cases of meconium aspiration pneumonia in the hospital group.
- There were 6 cases of neonatal lungwater syndrome in the hospital and none at home.
- There were 30 birth injuries (mostly due to forceps) in the hospital group, and none at home.
- The incidence of respiratory distress among newborns was 17 times greater in the hospital than in the home.
- While neonatal and perinatal death rates were statistically the same for both groups, Apgar scores (a measure of physical well being of the newborn) were significantly worse in the hospital.
Summary of Results of Matched Population Study Comparing Hospital Birth with Home Birth
Summary of epidemiologically controlled comparison of home and hospital birth. Original study, by Mehl LE et al. Outcomes of elective home births: a series of 1.146 cases. J Reprod Med 1977;19(5):281-90.[web page lost to web entropy - please e-mail me if you come across this page anywhere on the web. Thanks.]
Mehl, L., Peterson, G., Shaw, N.S., Creavy, D. (1978) "Outcomes of 1146 elective home births: a series of 1146 cases." J Repro Med.19:281-90What are the benefits of homebirth?
- You are much less likely to be subjected to potentially problematic procedures, drugs and restrictions. Every obstetric intervention carries risk as well as benefit. When interventions are used with women who don't need them, on a routine or "just in case" basis, or on women whose problem could be resolved by waiting or by simple, risk free measures such as: walking, change of position, talking over worries, or a warm bath, than those women are exposed to the risks without any chance of benefit. The end result is that some women and babies will develop complications, minor or major, that never would have occurred had they not been subjected to the intervention. This truth is why numerous studies examining individual procedures, drugs and restrictions have consistently concluded that outcomes are equally good and often better with restricted use of the intervention
- You will have greatly increased attention, care, observation, and monitoring by a trained person or persons. Doctors don't come into the hospital until close to the birth, and they may never have met the woman before, or know her only through a few brief office visits. Some hospital based midwives may labor sit with their clients, but not all do. Even before the money crunch forced cutbacks in staff, few nurses spent extended time with laboring women.This system of providing care has important disadvantages: It flies in the face of a large body of research that says women have fewer problems and complications and feel better about themselves and their babies when accompanied throughout labor by a caring, experienced woman. A woman's physical and psychological status has profound consequences for her ability to meet the challenges of adjusting to parenthood.
- The best judgments will be made by caregivers who are familiar with the woman and whose presence on the scene enables them to pick up subtleties that would be missed by someone who doesn't know her and pops in now and then. Small problems can be addressed before they become big ones, and overreaction can be avoided because the caregiver has context and perspective.
- You have a greatly decreased chance of infection. This is for two reasons: Hospitals are reservoirs for microbes the likes of which are never found in homes, including and especially antibiotic resistant ones . Women are far less likely to have procedures that increase the risk of infection, such as cesarean section, internal monitoring and rupture of membranes and subsequent vaginal exams.
- You will be in a familiar, supportive, relaxed environment. It's a classic tale: The woman has been experiencing strong, regular contractions at home, but they disappear when she gets to the hospital and do not resume until she settles into her new environment. It may take hours before the contractions return to the same intensity. Few stop to think of the reason why, namely that stress and anxiety inhibit labor. Any veterinarian will tell you that laboring animals require a quiet, dimly lit, familiar environment with no strangers and nothing to alarm or disturb them. Humans need the same, and hospitals are generally none of the above.
- Your family is in charge and you are the center of undivided attention. At a homebirth, all others, including the midwife, are invited guests. This makes for a very different social dynamic than in even the best-intentioned hospital. Moreover, with few exceptions, hospital policies are not intended to meet the needs of the individual woman. Maternity care policies are designed to process as many women and babies as efficiently, cost-effectively, and conveniently for staff as possible.