Homebirth: As Safe As Birth Gets
Yvonne Lapp Cryns
Each year in America, approximately 1% of the births occur in
home settings. In Illinois in 1992, 1,218 families filed birth
certificates that reflected a homebirth. Approximately
one-third of the births occurred to Black families. Wisconsin
had 591 recorded homebirths for the same year of which 22 were
to Black families. 1 It is probable that many more Illinois
homebirths actually took place but weren't recorded due to a
discriminatory birth registration practice that places the
responsibility for registering midwife-attended homebirths on
the parents and requires a different mechanism than is used for
any other occurring births.
One measure of the safety of birth place is infant mortality,
specifically, neonatal deaths within the first 28 days.
According to the Center for Disease Control, there were 19,098
neonatal deaths for 1990 for babies born in a hospital. For
those babies born at home, there were 260 newborn deaths.
Infant mortality is figured as the number of deaths per 1,000
live births. The death rate for babies born in the hospital was
5.6 and for those born at home was 11.1, which would seem to
indicate that a hospital is a better bet for a baby's survival.
However, when the homebirth statistics are further broken down
into who attended the birth, the picture changes dramatically.
Direct Entry Midwives had the best outcomes with a death rate
of 1.9 compared to CNM-attended births (2.9) or physicians --
D.O.'s (15.1) or M.D.'s (24.7). 2
History Until 1900, homebirth was the place of birth for most
every American. In fact, over 90% of those alive on earth today
were born at home! Hospital or institutional birth is a
relatively new occurance which began to gain in popularity
during the 1920's due to physician promotion and the increased
use of the automobile. As is the case today, it is a much more
economic use of a physician's time to attend patients in a
single place. There is also an economic incentive since a
physician can attend to more than one patient at a time in the
hospital and other, less important helpers can attend to the
more mundane tasks of birthing.
Part of this shift in birthplace must be attributed to the
propaganda denouncing midwives which took place during this
same time. With their economic and organized power, physician
groups were able to legislatively increase hospital births by
eliminating those who still attended homebirths -- by
eliminating the midwife. From the 1930's through the 1960's
state after state changed their laws to either restrict the
practice of midwifery or wipe out the legal practice entirely.
Yet no valid study then or to date has proven planned homebirth
to be less safe than hospital birth.
Studies
Many studies have been done in an attempt to prove that
hospitals are the safest place to birth. Some of the earlier
ones included all births which took place out of the hospital
regardless of the gestational age or planned place of delivery.
Those studies included miscarriages which took place at home as
well as precipitous births and births that were unattended. To
be valid, a study must compare equals and change only one item.
Lewis Mehl did this when he matched 2,092 women and compared
their birth outcomes. The result was that homebirth with a
trained attendant was safer than a hospital birth.
What does "safer" mean?
Most families do not want to know the statistical odds of
having a good outcome, they want to know more concretely
exactly how a homebirth will be safer. Many studies address
this by listing criteria and comparing the results.
Chart is one website http://www.midwives.net
As you can see from the chart, many complications seem to occur
with greater frequency in the hospital. Many women are told they
will need an episiotomy in order to prevent tears but the data
from these births shows that this is not so since there were 9
times as many tears in the hospital group! Fetal distress,
often cited as the complication necessitating a cesarean
section occurred 6 times more frequently in the hospital group.
There were 4 times more newborn infections, 22 times more
forceps deliveries, 30 times more birth injuries and 3 times
more cesarean sections in the hospital group. Estimating
Preventable Childbirth Related Deaths
The following statistics, derived from data accumulated between
1940 and 1980, are conservative estimates of lives lost due to
our system of treating pregnancy as a medical event requiring
medical intervention and care. *about 1,000,000 babies died at
or before birth that should have lived * about 1,600,000 babies
died before their 1st Birthday who should have lived * at least
1,500,000 children were left severely brain damaged by medical
procedures * at least 45,000,000 children had minimal brain
damage who would have been normal Today, it is estimated that
50 newborns die unnecessarily each day whose deaths are
preventable if "the five standards for safe childbearing" were
employed. This breaks down into a preventable baby death every
29 minutes, every hour of the day, each day of the year. NAPSAC
writes, "Since 1940 at least a million babies have died in
American hospitals who would have lived were it not for the
doctor dominated maternity system that dictates the Standards
for American Childbirth."
Who should decide what is safer?
Childbirth is not a laboratory project that can be reproduced
at will with the outcomes compared with each other. Nor is
birth a medical event, like planned surgery, that can be timed,
controlled or forced to obtain the desired outcome. Each year,
it seems, scientists discover some aspect of birth that had
been unknown or unverified. Also, it would seem that the
technologies that are initially hailed as the "cure" for a
certain problem are found to produce unacceptable side-effects
or increase risks for more serious complications. Birth also
has a psychological component which can place some women at
incredible risk in a hospital.
A recent article in a prestigious magazine looked at homebirth
and asked the question, "Is it safe? Is it ethical?" The
physician writers concluded that homebirth has a "definite
small risk" and that "hospital births entail a wider range of
risks". They also felt that since the actual risk factors
inherent in a home birth are very small, perhaps 1/1000, and
the consequences of the birth decision will be borne
exclusively by the parents, physicians should support parents
who are willing to accept this risk so as to make the
experience as safe as possible. The Oxford Perinatal Project
also came to this conclusion after an exhaustive look at every
scientifically valid study performed since the 1950's
addressing aspects of care of pregnant and birthing women and
their babies. Since science cannot prove homebirth to be less
safe than hospital birth, I believe that each family has the
constitutional right to choose where to give birth. I believe
that until science can prove a detrimental effect on those who
choose to birth at home, medical personal should support
families in their decision. The InterNational Association of
Parents and Professionals for Safe Alternatives in Childbirth,
NAPSAC, shares this view and asks, "Who is to decide what is
the optimal balance between medical and psychological risk? . .
. It must be the parents."
Sources: 1. Center for Disease Control, "Live births by place
of delivery and race of mother, 1992", section 1, Natality,
page 246. 2. Center for Disease Control, "United States, Birth
Cohort of 1990", Table 43, pages 2 and 5. 3. Litoff, Judy
Barrett, The American Midwife Debate, pages 1-10. 4. Mehl,
Lewis, "Scientific research on childbirth alternatives and what
it tells us about hospital practice", NAPSAC, 21st Century
Obstetrics, 1978, vol. 1, pp/ 171-207. 5. Stewart, The Five
Standards for Safe Childbearing, pages 137-138. 6. Hoff and
Schneiderman, "Having Babies at Home: Is It Safe? Is It
Ethical?", Hastings Center Report, December 1985, pages 19-27.
7. Enkin, Keirse & Chalmers, A Guide to Effective Care in
Pregnancy and Childbirth, Oxford University Press, New York,
1989.
NAPSAC is a non-profit and tax exempt organization that may be
reached at Route 1, Box 646, Marble Hill, MO 63764, phone (314)
238-2010.
Some may argue that statistics do not tell the entire story,
and that is true, but it is the best scientific way to diminish
those who promote institutional birth as the only option for
everyone regardless of risk status.
About The Author: Yvonne Lapp Cryns is the owner of Midwives
.net - http://www.midwives.net
Yvonne is the co-founder of
Nursing Programs Online at http://www.nursingprogramsonline.com
and a contributor to The Compleat Mother Magazine at
http://www.compleatmother.com . Yvonne is also a law school
graduate, a registered nurse and a Certified Professional
Midwife.
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