59 responses to “Homebirth vs Hospital: Statistics To Die For”

  1. womantowomancbe

    Thanks for posting this! I’ve been on that blog which shall remain nameless a few times (that is, a few different threads — it obviously was more than just a few posts), and have come to the same conclusions that you have — especially about how the “good doctor” slices and dices the numbers like she advocates for the slicing and dicing of women’s bellies for birth. Ah, statistics — you can make of them what you will! Thanks for running these numbers, because it is so important to see the truth behind the statistics.

    As far as your comment about the difference in death rates by maternal race — yes, it is awful! The “good doctor” basically implied on one of her threads that it must be genetic, because she noted that women of African heritage, regardless of the country in which they give birth, fare worse than women of other races. Shocked me to see her say that, because it sounds so racist when you put it that way! But this was her way of “blaming the victim,” of course, which is what she must do when she doesn’t like the stats. However, I’ve looked up stats/stories from the UK, and it was noted by the researchers that a large percentage of black women in the UK are recent immigrants, and are therefore more likely to be poor and not speak English, so are less likely to seek prenatal care, and are more likely to have health problems, which put them and their babies at higher risk of death.

    I asked her at one point why she focused so much on home birth if she was really wanting to reduce neonatal mortality, because only about 1% of all US births are planned home births. So, even if her grossly exaggerated numbers were correct, CPM-attended home birth would generate an excess of 360 deaths per year (out of 4 million live births). I asked her why she didn’t focus on trying to get all women married, since the neonatal mortality rate for unmarried women is approximately twice that of married women. She, of course, ignored that.

    You mentioned something about different types of midwives. Here in the US, each state has its own rules governing the state. Certified nurse-midwives are legal in all states, but the majority of them practice only in hospitals (some states have them so regulated that it is nearly impossible for them to do otherwise — they must have doctor back-up, for instance, and most docs won’t back them up if they attend home births). About half the states allow non-nurse midwives to attend home births, and most of these states have “certified professional midwives” as legal, although some of the states do not have specific legislation on them (they are neither legal nor illegal, but “alegal”). Non-nurse midwives are also called “direct-entry midwives” since they went into midwifery without first going into nursing. Since not all DEMs have received formal training and education in midwifery, the standard of care can be quite different from one midwife to the next. Some midwives can be certified but have chosen not to become certified, while others undoubtedly would not qualify, yet still attend births (there are “bad apples” in every profession). For the purposes of these statistics, I’d say that “other midwife” includes anyone who practices as a midwife (regardless of actual training), whereas “other” birth attendant would include family members, doulas, ambulance drivers, firemen — whoever happened to be on hand to catch the baby.

    And even tho’ this comment is already too long, I’ll throw this zinger in for fun — the “good doctor” posted a similar link to the state of Wisconsin’s linked birth-death certificates, and with much fanfare produced that “other midwives” had a much higher rate of infant death than did certified nurse-midwives. She said she removed the CNM-attended home births because it had a “much higher” death rate than CNM-attended hospital births. (She compared the two groups of midwives because she said that would get women of similar risk categories, which actually ignores the fact that since CPMs weren’t legal in Wisconsin at the time, they may very well have taken some high-risk clients they should not have.) However, the truth behind the statistics is that CNMs attended very few births (like 300 over the course of a year or perhaps several years — it’s been many months since I’ve looked at the stats, so I’m going on memory), and there was only 1 death which skews the results when extrapolating that to deaths per thousand; ALSO, that death was the result of a congenital anomaly, so the baby likely would have died regardless of birth-place. Also, of the “other midwife”-attended home births, 7 of the 17 deaths were due to congenital anomalies. It is important to note that most of the Amish (a religious group that wears plain clothing, refuse electricity and automobiles, etc., and tend to intermarry within their religion, which sets up for some interesting potential genetic problems) would have a CPM attend them, which accounts for the high percentage of lethal birth defects.

    Sorry this comment is so long, but I’m so glad you wrote this post!!

    Kathy

  2. Lisa Barrett

    Thanks Kathy for posting that fantastic comment. It just about qualifies as a post in it’s own right.

    You certainly clarified a few things and showed how complicated the Midwifery model is in the US.

    I did consider adding a facetious remark like ”Are neonatal deaths of women of African decent higher because they birth at home?”

    But I agree, the maternal race issue it’s not at all clear cut, there are a lot of interwoven variables at play there.

    So much energy goes into marginalizing homebirth under the pretence of reducing the tiny number of neonatal deaths. Yet if that energy was channelled into where the deaths were actually occurring it would save a lot more lives. Some people just like easy targets, which obviously rules out anything with a “race” angle.

    You see the same thing with the illegality of cannabis. The number of users is quite small but they are criminalised for the sake of their health. Yet tobacco is legally sold and kills a huge number of people each year. I suppose upsetting the tobacco companies and losing their tax dollars is simply unthinkable.

    There is a proverb (in the UK at least): Penny Wise – Pound Foolish.

  3. Kati

    Hello!
    Just curious – if only vaginal deliveries are included then how can be taken into account planned homebirths that end up in transfer and (maybe) in caesarean?

  4. Lisa Barrett

    Hi Kati,

    I was working on the principle that if a planned homebirth resulted in a transfer to hospital then the place of birth would no longer be “out of hospital” and would be incorporated into the hospital’s figures. Likewise, any planned hospital births that did not happen there, would not be included with their figures.

    I specifically removed the non-hospital caesareans as they seemed a peculiarity that few would advocate. As the “homebirth/out of hospital” figures are already low the dangerous practice of performing major surgery away from the hospital had the potential to unfairly impact their figures.

    There doesn’t seem to be any explicit way of identifying these “out of place” births, and even if there were it would be very contentious in agreeing who’d been responsible for client care. For example, in the case of a transfer to hospital, the hospital would immediately enforce their policies, but would try and shift the blame if the outcome was not good. Similarly if a planned hospital birth ended up badly at home or in the back of a taxi, I can’t imagine the hospital wanting it added to their figures.

    It’s a bit imperfect I know. No wonder statistics have such a bad rap.

  5. Susana

    Hi Lisa,

    So glad for your post. I read “HER” post and immediately began searching for clarifications so that I can have/write my own response.

    Even though I have birthed at home 5 times, 4 UC, I couldn’t help but be a bit startled by the statistics as she hyped them. Even so, the idea of all women being encouraged (even pressured) to undergo elective cesarean at 39 weeks was far more startling.

    I immediately googled studies and found that cesareans at 39 weeks may lead predispose baby to adult asthma, possibly autism and other brain damage, suicide, and cause maternal hemorrhage (sp?) and hysterectomy.

    As I read different studies I also found out that in Taiwan, ceasareans increased after the country instituted Universal Health Care and they now have the highest rate of c-sections.

    I think this will be the case in America if the Democratic candidate wins (since UHC is his platform), especially with the results of this new study being
    touted.

    And thanks for mentioning that part of the UC statistics are from those who have unwanted, unplanned pregnancies. They might even be from unplanned UC births, which are different from UCer’s who study and prepare.

    Susana

  6. Lisa Barrett

    Hi Susana,

    There isn’t really a lot of debate going on over there, everybody is just angry with one another. I think there’s more behind that crusade than there appears.

    The world export of the caesarian model is ironically like the export of McDonalds and the Western diet. Sure people have better nutrition but now they are suffering from obesity and chronic heart disease (amongst everything else). Still, the health industry can make even more money from treating those complains too.

    I am quite sure there is huge political pressure for many small countries to adopt our utopian health care model. Big business has to expand into new markets and our governments will help them. Can you imagine how much a modern hospital costs? They could spend it on water and sanitation but who’s going to make any money. Besides there are no recurring costs.

    I remember seeing a documentary a few years ago about how the British encouraged an African country to modernise it’s road network. They claimed the lack of infrastructure was preventing it from competing in world markets. So at enormous expense they built extensive 4 lane highways, service stations, even emergency telephones every few km. It would put much of Australia to shame! Eventually the money run out and the British left. Unfortunately, nobody is this African country had a car or could afford one. Even now the only thing that crosses those highways is tumble-weed and wilderbeast.

    I’m digressing off birth now, so I’d better not get started on IT in schools.

  7. Rachele Meredith

    Hey Lisa,

    Yes, I read her original post over there about this data as well as the recent one maligning your post. What a strange and bizarre woman and what an interesting fiddling of statistics on her part. I wonder why she is so intent on maligning homebirth? And so insistent that no one other than MDs can understand statistics? How insulting and rude. Luckily I do understand statistics and am capable of critically reading research and have not yet come across anything that convinces me that birthing in hospital with an MD in attendance makes birth safer for a healthy woman experiencing a normal pregnancy. These statistics do have limited use. We have limited information about the planned place of birth or birth attendant, neonatal death rates include babies with congenital issues who would have died regardless of place of birth, there is no way of differentiating transfers, etc. We can assume that an out of hospital birth with a midwife in attendance is a planned homebirth, but that is still an assumption. Some of the hospital births would include transfers from a planned homebirth. Some women who birthed outside the hospital may have had a high risk profile; we are not comparing matched risk groups. Anecdotally, the women I come across who choose to birth at home tend to be less inclined to have scans or terminate pregnancies due to a congenital anomaly; this would skew neonatal death rates. These statistics are interesting, but they do have limitations. I come from a family of doctors and must admit that, in my experience; doctors tend to put on an arrogant superior attitude whenever challenged, stating that they are the only ones who really understand the issue at hand at that everyone else is not properly qualified. I wonder if they teach that in Medical School?

  8. Lisa Barrett

    Hi Rachele,

    Thank you for your comment. I wholeheartedly agree with you. When I was writing the post I was thinking much the same thing.

    As I’ve previously said there’s something very suspicious about her motivations. Particularly concerning her frequent assaults on DEM. Nobody spends such an inordinate amount of time savagely maligning something without an axe to grind. If instead she put all that time into campaigning for better DEM training to allay her concerns then her intentions may prove credible.

  9. amanda

    I have been reading Homebirth Debate for quite some time, and I have seen Dr. Amy talk about ways to improve training for DEMs on many occasions. The issue seems to be that the DEM organizations do not want advanced medical training; their argument seems to be that they they do not want to be “medwives”. As a woman of childbearing age who did look into homebirth with a midwife while pregnant with my son I have to say that I do not understand that point of view. How could more training that enables more competent and capable handling of those rare, yet very real emergency situations be a bad thing? Why would anyone responsible for 2 lives willingly turn down additional training?

    What bothered me the most while reading some midwife blogs was the almost superstitious attitude toward training. The one that says “I am not going learn about how to handle it when things go wrong, because to do so would be inviting those things to happen.” The same attitude that causes people to not do the most basic checking to make sure things are still going okay, because of blind reliance on “intuition” to tell us if the mother or baby needs help. I have known people who needed help and intervention during birth, and they really had no idea.

    I suppose what I’m trying to say that is although Dr. Amy can sometimes phrase things in a way that hurts people’s feelings, I don’t see what she is doing as all bad. There are plenty of sites out there that will tell me that I don’t need a midwife at all…..that if anything happens to my baby it’s my fault because I didn’t trust birth enough and do what THEY told me to do. There has to be another side to the story and I’m glad she is presenting it. Personally, I don’t want to become complacent in regard to the health of mothers and babies. The discussion should remain open for the benefit of us all.

  10. Susana

    Hi Amanda,

    I appreciate the comment that you have left. It is much more in line with the term “debate.”

    You are correct that we don’t want to be complacent. It is good to study and learn the risks involved with our choices. But we must remember that there are risks in all of life. It is risky to allow my children in a vehicle, but I do it.

    Death happens in life. Sometimes we have to take chances to get the most out of life. We may work to minimize risk, but in birth there is risk whether at home or in the hospital.

    As for the new study that the “good” Dr. is touting, it MAY show that cesareans at 39 weeks bring about more live babies,(Dr’s have been mistaken in thier recommendations before) but for me the trade off of possibly prematurely ending my ability to bear children, dying, or having my child deliteriously affected for life is something I would rather avoid. I see hospital birth, and cesarean birth especially, as more dangerous since I am low-risk, and as long as I remain so.

    If me or my baby are at risk either way (hospital vs. home) I’ll take homebirth. There is so much more opportunity for family bonding at homebirth, and it facilitates less painful birthing and a more spiritual experience, therefore I view it as superior.

    Yes, I have birthed at home and in the hospital and I found homebirth to be more spiritual. I could pray and reach out to God in a way that I couldn’t do in the hospital with nurses standing around watching me, poking and prodding.

    Anyway, those are my thoughts. I wouldn’t feel comfortable sharing them on the Homebirth Bash blog, I mean the Homebirth Debate blog.

    I am not saying you have to agree or that you should feel the way I do. I just want the freedom to have my own opinion, and make my choices for my body, my baby, my family.

    I believe that if the menacing Dr. had her way homebirth would be illegal. That is her goal. 100% cesarean birth is what she is striving for and so I could never support her or her blog. I will never, ever believe that ceareans recommended for every woman, or hospital birth for every woman could every be right and true.

    Susana

  11. amanda

    Susana,

    Thank you for your kind response.

    I have to say, however that in the years I have spent reading Dr. Amy’s blog that she does NOT want to see homebirth made illegal. She has said several times that the choice of where to give birth is a woman’s choice to make. What she wants to do is challenge the information out there at says that “homebirth is as safe or safer than giving birth in a hospital”. She does so by using facts and figures.

    She says that the purpose of her blog is to make sure that every woman has information beyond “as safe or safer”. I have to say also, even as someone who loves the idea of giving birth at home, that the numbers do not seem to add up in favor of birth at home being “as safe or safer”.

    Don’t get me wrong, I think in most cases homebirth is relatively safe; certainly the good outcomes greatly outnumber the bad. What bothers me, though, is the demonization and attempts to silence anyone who wont fall in line with the party line of homebirth always being the safest thing to do. Kneelingwoman, a recently retired midwife http://closetotheroot.blogspot.com/ has written extensively about how the midwifery community has told her to “shut up” in so many words when she has broached discussions about birth safety. The same thing has happened to Navelgazing Midwife http://observantmidwife.blogspot.com/

    It is clear that there IS a discussion that needs to be had, and it worries me that some people don’t want that to happen. As an outside observer, it makes me wonder if the midwifery community is trying to hide something from birthing mothers to further their own goals.

  12. Rose

    Amanda, i find it fascinating that you think us midwives would conspire to hide something, for our own goals/agendas??!! i can guarantee you 110% that i do this not for myself or my family, but for the women and their families, because i KNOW what they can have and deserve to have, by birthing their babies at home.

    This job demands my time 24/7, 365 days of the year, and i have to put myself and my family on hold to be with women, when they need me, and i stay with them for as long as need, days if required, all for barely enough money to cover my costs…….

    Now lets compare the work Obstetricians do….. Inductions and elective caesareans to work in with their schedule (if the poor woman dares to say how ‘tired’ of being pregnant she is!), or em. caesareans at about 6-7pm each night, or how about the episiotomy rates, for failure to wait. Now how much do they get paid??? about 3x what we earn!!!

    What about the quality of care?? Each antenatal visit with my clients goes for 1-2hours, OBS 10-20minutes?? How about labour and birth care?? I am with my clients for as long as they need me (happy to sleep on the couch)days at a time. OBS get called in at fully dilated, and even still cant wait so do an episiotomy, so total of 1 hour?

    So Amanda i find it very offensive that you believe the midwifery community is trying to hide something!!!!!
    I KNOW the Obstetric community is hiding everything!!!!
    Why do Private Hospitals not have to submit their perinatal outcome statistics?? how much more evidence of ‘hiding’ do you want?
    We’re private practitioners, maybe we should stop submiting our statistics?????

  13. amanda

    Rose,

    You pretty much proved my point by responding to my polite attempt at discussion with a tirade.

    I’m not making this stuff up. I urge you to read through Navelgazing Midwife’s blog and Kneelingwoman’s blog. Two midwives with 60 years of experience between them, and they are the ones I got this information from. The midwifery community at large has attempted to silence 2 of its best and brightest for the unforgivable sin of pushing for better DEM training and licensing in the United States, which I brought up in response to Lisa Barrett’s comment about working to improve DEM training. I was pointing out that 2 of midwifery’s own have attempted to work toward that goal, and have been maligned by their own community for having done so.

    THAT is why I wonder if midwifery is hiding something. Why else would anyone want to silence 2 shining lights of their own industry? Kneelingwoman retired over it, for pete’s sake!

    I never suggested OB’s weren’t hiding anything, I didn’t even bring them up! Why did you? What does OBs hiding or not hiding things have to do with anything I said? It reminds me of when I babysit 2 little siblings. I ask one “Did you throw all that paper on the floor?”, to which he replies, “Sarah spilled her drink over there!”. He does this so he can divert my attention from the question I asked by telling me something that has nothing to do with what I wanted to know.

    1. Amee

      Amanda, you are so right on with both of your responses. I think people should be informative and as factual as possible – as well as expressive about their personal experiences – all while being open to healthy debate. It is obvious that Rose responded to you in a very defensive manner. I love how people of one side call out another for “bashing” and then go on a rant doing just exactly that. You can not even state something objective with out someone going on their “professional” tirate. These debates can be so one-sided/black and white, with a lot of “the pot calling the kettle black”. We should be informed in such a way to make our own person decisions that we are comfortable with. Then Rose went even further to say you called her a child, which you clearly did not. So silly. I, personally am for having a natural birth and think c-sections and inductions are way out of control, but I would not choose to have a home birth. My choice. I also think it is wonderful for those who decide to have home-births. But, I especially do not see why anyone thinks they need to go completely off bashing anything. Just be factual and passionately speak from the heart about what you are for and why. No need to make it a case that everything else sucks besides your view/and or profession.

  14. pinky

    Rose

    I am sorry you are offended. I sympathize. I have been offended regularly when patients think I am trying to hide something. When patients are thinking of sueing me and they have no case. It is upsetting when you spend all that time out of the goodness of your heart. I don’t think any of us do this for money. Most of the OB’s included. They could just do Gyn and make plenty of money. Most of them are getting out of obstetrics. INstead of looking at our differences, I think we need to look at what we agree on. We all want a healthy baby and Mother. Now, how to go about that is where we may differ. But if we work together our outcome will be better.

    I must admit. I love Doctor Amy. I just do. Cause she tells us things that are unpopular. And she will point you into the direction to read up on what she is talking about. I think that is a good thing. I have actually learned a lot more about stats from her. I did take stats in school. I wish I retained more of it.

  15. Rose

    Amanda, I don’t think you are making this stuff up at all, I talked about OBs hiding things, because i cannot understand why Dr Amy feels she has to have a spicific blog, bagging DEM midwives (i have commented on her blog about this), when she could be using her time better to help improve the outcomes to women, by doing something about the DEM training, not just bad-mouthing it and generalising all DEM, world wide. I am a DEM in Australia, and our training is 2 years longer than the nurse/midwife training, so i do not at all feel inadequate to attend HB’s. It was not my training that taught me the HB skills, but working in a supported environment, with HB mums, where i learnt these skills.
    Maybe a mentor relationship with a CNM/exp DEM could prove helpful??
    I have only had a quick look into Navalgazing midwife’s blog, but i will read more.
    I enjoy debate, but i DO NOT like personal attacks, like being called a child, that’s just plain rude!

    1. Amee

      Amanda, you are so right on with both of your responses. I think people should be informative and as factual as possible – as well as expressive about their personal experiences – all while being open to healthy debate. It is obvious that Rose responded to you in a very defensive manner. I love how people of one side call out another for “bashing” and then go on a rant doing just exactly that. You can not even state something objective with out someone going on their “professional” tirate. These debates can be so one-sided/black and white, with a lot of “the pot calling the kettle black”. We should be informed in such a way to make our own person decisions that we are comfortable with. Then Rose went even further to say you called her a child, which you clearly did not. So silly. I, personally am for having a natural birth and think c-sections and inductions are way out of control, but I would not choose to have a home birth. My choice. I also think it is wonderful for those who decide to have home-births. But, I especially do not see why anyone thinks they need to go completely off bashing anything. Just be factual and passionately speak from the heart about what you are for and why. No need to make it a case that everything else sucks besides your view/and or profession.

  16. Lisa Barrett

    Amanda, There is nothing wrong with debate, it it is healthy and we can all learn from each other. I have never seen any debate on Dr Amy’s blog and know that any comment is always met with personal abuse and attack. I am not a DEM but trained for 4 1/2 years back in 1988 in the UK to become a midwife. The shining lights of your crusade The kneeling midwife and the navelgazing midwife only became that when they started to disagree with their community. I have read both the blogs and they are interesting and thought provoking but really have nothing to do with the type of midwifery that happens in other countries of the world where a midwife is the primary point of contact for a healthy pregnant woman.

    There is no doubt that intervention creates risk. Obs and midwives alike all over the world agree with this. All it seems except Dr Amy. I am looking forward to her talking at a conference so we can record and take into consideration her research. When she has done some.

  17. Anonymous

    Lisa,
    I am curious about the statistics. Did vaginal births in the hospital include vaginal births to women with no prenatal care, hx of drug use, hx of a diagnosis that would catagorize her as high risk (i.e gestational diabetes, diabetes, gestational hypertension, chronic hypertension, PROM, etc.), women who demand induction of labor, women who demand epidural anesthesia? Many women with these issues deliver at or after 37 weeks, and carry only single or twin gestation, but I would not consider them "normal" births.

    I envy those of you who can participate in home births…how amazing that must be. But reality is that most women will deliver in a hospital, regardless of the reason why, and some of us have chosen to attend to those patients. I am offended that I would be portrayed as the bad-guy by many of these blogs, when they don't even know me. My practice is important to me, and I have spent the last 23 years taking care of those women who don't qualify or don't want a home birth. I try to go above and beyond to give my parents the birthing experience they want.

    I don't deny that there is abuse from the medical arena. Manipulation and coersion is all over the place. I am saddened by the lack of education among women when it comes to their body and the birthing process. I hate that women come in demanding C/S's, inductions, epidurals, etc. But..regardless…I am here to care for these patients with the same passion you care for your well educated, healthy, low-risk moms & babies.

    Please let your readers know that there are health care providers out there who have a passion for the work they do, and desire to support them in whatever birth choice they have made.

    Thanks…JLS

  18. Lisa Barrett

    Dear JLS, I wonder who it is doesn’t qualify for a homebirth or basic respect in their birth? The stats in Australia has just revealed that only 2.5% of c/s were elective and non medical, leaving 97.5% for other reasons, I have yet to see proof of women all demanding this type of care.

    Feel free give us all the facts, figures and evidence as you see them, so we can read it for ourselves. Everything that is said here is backed up.

    I care for women of all risk.

  19. Anonymous

    Lisa,
    Your comment “I wonder who it is doesn’t qualify for a homebirth or basic respect in their birth”…is, by your own stated RULES, rude and demeaning. I never said there was ANYONE who didn’t qualify for basic respect in their birth. Please don’t put words in my mouth. I believe you said you “do not believe EVERYONE should birth at home NO MATTER WHAT”…those are the women I am talking about. And again…some women don’t WANT to deliver at home. Who is to care for these women? Here, in Riverside CA, our midwives will not deliver anyone with fetal anomalies, severe IUGR, Insulin dependent Diabetes, Pregnancy Induced Hypertension, Lupus, certain Congenital Heart issues, Heroin abuse, Crystal Meth abuse, etc. at home. While you may feel comfortable managing these types of patients in a home birth…our midwives do not, and someone needs to be there to take care of these people. I should not be attacked for focusing my field of care on these patients.
    As for women who are coming in and demanding cesareans…this is real. In fact ACOG has released a formal opinion supporting “patient choice” C/S’s. Ann Fam Med. 2006 May; 4(3): 265–268, OB/GYN News, Sept 1, 2003 by Gwendolyn Hall, and CMAJ • March 2, 2004; 170 (5), all discuss this growing issue. It’s sad, we need to change this…but until then…someone needs to care for these women. Patients also come demanding induction of labor. We have had to limit our elective induction slots to 3 per day! And we don’t even want to do those! The NY Times published on this topic by LInda Villarosa on June 23rd 2002. She reports: A study last year by the National Institutes of Health found that the rate of labor induction more than doubled from 1990 to 1998, jumping to 19.4 percent of all births in 1998 from 9.5 percent of all births in 1990. ”In instances, we noted that more than 50 percent of inductions are elective,” said Dr. Jun Zhang of the National Institute of Child Health and Human Development in Bethesda, Md., who was the lead investigator on the study. This is what I see every day. Your readers can also read about this issue at http://www.aafp.org/afp/981115ap/vincent.html The CDC here in the us also reports the growing number of epidurals in their 2003 stats @ http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_02.pdf
    BUT…my whole reason for writing was not to throw numbers around, it was to ask for some respect for the work I do…just as I respect the work you do. There aren’t any STUDIES on that…sorry. JLS

  20. Lisa Barrett

    Dear JLS, I was certainly not rude or demeaning in any way. Plus I have no idea who you are and you very clearly know all about me as I have been very open about it here.

    In instances over 50% of inductions were elective. This means nothing.
    “If you want me as your ob why don’t you get induced as I’m on holiday next week” is an elective induction. The jump in inductions hasn’t really affected outcomes for mother and baby except to increase the c/s rate x3. In South Australia as I have said 62% of first time mothers who opted for an induction had a section.
    I have no respect for practitioners who blame women for the poor maternity care provided. I myself would opt for an epidural if stuck in one room with no escape no food and water and nothing to do but listen to constant stream of negative.unnecessary and often untrue statements of progress and expectation
    I have the greatest respect for very few wonderful Ob that support women’s choice and provide fantastic and live saving help when it is required, leaving well alone and to the women and normal birth specialists on every other occasion.

    You cannot remand respect, it is earned.

  21. Anonymous

    Lisa,
    I’m not sure what else you need to know about me in order for you to offer your respect. I already shared with you that I have spent the last 23 years of my career working in a hospital invironment caring for women who did not want a home birth, or who are high-risk. I already shared with you that I am acutely aware of and disagree with the coersion and manipulation I see in the perinatal arena. I already shared with you that I respect the work you and others like you do. I already shared with you that all I ask is for you to let your readers know…that there are people in the hospital invironment who are passionate about the birthing process, about caring for them, and caring for their babies… should that be where they deliver, no matter the circumstances.
    I will assume your statement “I have the greatest respect for very few wonderful Ob that support women’s choice and provide fantastic and live saving help when it is required, leaving well alone and to the women and normal birth specialists on every other occasion.” refers to myself and all the others out there who have commited, with passion, to take care of the thousands that have and will deliver in the hospital invironment! Thanks. JLS

  22. Anonymous

    I am a homebirth mama. After a kidnapping, rape and torture 10 years ago, I felt that I was reliving all that, being forced to undergo exams and tests in the hospital. I was chastised for not getting prenatal care — when my insurance co could not find a dr with an appointment for four months. CNM’s that I worked with while a little better, still maintained the medical model. One that included suggestions for epidural to “support me ” during labor since I was likely to “freak out”.

    When we got the midwives it was like coming home. They also were understanding of my native american heritage and birth ritual.

    I used a CPM/LM here in CA – that means they have had book training and hands on exams as well as an internship. Just like any other healthcare professional, it is the responsibility of the customer in US healthcare to look into the credentials and such of the caregiver.

    My son was almost 9 pounds born in water at home – in about 4 hours. In the hospital, we would have had to fight a c-section since they arbitrarily determined that I was too small to have an 8 pound baby. (fat chance – my mom was tiny -under 90 pounds and had a 10 pound breech before she had me) No drama.

    My second will be born at home with the same midwives in late summer. I get a lot of negative feedback, and I just don’t listen. One woman who had an elective section, I just told, you know what? you dont’ want me to comment on your choices. You are not welcome to comment on mine.

    Cheers all, and happy homebirthing!

  23. Anonymous

    Hi Lisa,

    Thanks for your statistical analysis. I agree with almost all of the assumtions you made, and it was very informative.

    As an aside, it seems that you are against immunisation. Correct me if I’m wrong, but is this because you are going along with the anti immunisation hype, similar to anti-home birthers? Maybe you could apply your same rational processes to immunisation risks to separate the hype.

    To semi-quote you, there is an uproar whenever immunisations have a negative effect, but you never hear about the multitude of deaths/incapacitations of the unimmunised by these diseases.

    Thanks again for your work.

  24. Lisa Barrett

    Dear Anonymous,

    I have never been one to go along with any hype, I have not mentioned immunisations on this blog as my personal view on this although backed up by research isn’t really related to birth.
    I wonder why you mention it?
    Thanks for reading.

  25. Anonymous

    “You retain control and are not obliged or encouraged to comply with hospital policy such as immunisation/injections that may have health implications further down the track.”

    You used it as a pro-homebirth benefit.

    I honestly don’t intend to offend, and only brought it up because it is an important issue that is touted as dangerous by the ignorant, exactly the same as homebirth is.

    Lyle

  26. Anonymous

    Lisa,

    Couldn’t help but notice that, regrdless of practitioner, the maternal mortality was higher in the homebirths group than hospital group. (Eg CNM Homebirth 0.7%vs CNM hospital 0.49%).

    This is even taking into account you’re excluding complications during homebirth that resulted in transfer to hospital. (Thus possibly increasing the mortality stats for hospital?)

    Please explain how you can summarise from this that homebirths are just as safe as hospital births? I would say that they show you are better off having a midwife at hospital than at home! (From a life and death point of view that is!)

    RC

  27. Anonymous

    I would also like an answer to the question Anonymous wrote on March 6.

    Your data is flawed because we don’t know the deaths in hospital were in fact transers from a homebirth that had gone wrong causing the death of a baby.

    Those results should not have been put in with the hospital results and should have been included in another table.

  28. lucy-in-the-sky

    JLS:
    if you don't want to be doing elective inductions, indeed limiting to 3 per day, and that you say the ob's generally don't want to do it- then WHY? why are ob's, the learned experts, bowing to the demands of women, knowing that what they are asking for is wrong, dangerous and irresponsible?

    this is NOT caring for women's choice. but providing a service to ill-informed women for money. Would it not be best practice to educate women on the birth process and empower them to be happy for their body to dictate the babies birth date. Inductions are convenient for doctors too.
    This is just an indication of the McSociety we, the informed, must suffer.

  29. choice

    I’m quite offended by the heading that infers that those who deliver in hospital ‘can’t be bothered’. Isn’t this about increasing choice rather than insulting those who CHOOSE to give birth in a hospital.
    Shouldn’t we be working towards uniting women not dividing.
    I’m also curious as to the comment “You retain control and are not obliged or encouraged to comply with hospital policy such as immunisation/injections that may have health implications further down the track.”

  30. Larzi

    I worked in the media for a few years…
    basically if we wanted to make people think something was wrong/an epidemic/ make them think 1 way…we would get a famous medical doctor to say “this is an epidemic”…and most of the public would believe it.
    What is interesting is that a truly educated opinion (from both sides of the story) was not a popular one with in the media, because it caused people to have varying points of view and this did not ‘sell’ the issue or idea we were trying to sell.
    Why am I saying this….

    1. We should be careful of how issues like homebirth and immunisations and even things like swine flu and other diseases are represented in the media. Often both sides will not be publicized because it doesn’t create the desired point of view media-makers need to ‘sell’ the idea. Even breaking news is highly edited and not actually real.
    2. its often those ‘on the ground’ who actually experience the issues we are talking about that can give us the greatest perspective. Those often making the policies are not necessarily experiencing it for themselves.

    Incidentally….
    I had to interview some vaccine manufacturers as part of a story, several years ago. Much of what they said- including things I’m not allowed to publicise- ie about how dangerous the vaccines actually are, were edited out back in the news room. It didn’t fit with the agenda of the tv station to broadcast such controversial comments. Even though, I am pretty good at looking at both sides of the story, after talking to those guys and seeing stuff the general public often doesn’t I am completely convinced that most vaccines are very dangerous.

    I was born at home back in the 70s long before much of the research about home birth was put forward. My 2 sisters were also born at home in the 1980s. Interestingly, when I had to do a story on something similar- births in hospitals- most good, research based and educated ideas about homebirths were edited out (those that made them look like airy-fairy hippies were kept in), and those opinions that supported birth in the hospital were kept in the story. Tell me who’s side of the story they were promoting?

    I bring all this up because in my experience there is a lot more to some of these issues that we see broadcast or even publicised.
    It pays to do your own research, and talk to the folks who have experiences these things, for a greater understanding of the risks involved. If someone is only one-sided- ie homebirth is great, there are no risks’ or ‘hospital births are completely safe’ chances are they haven’t been fully informed themselves or have some kind of agenda.

    1. kate Johnson

      Thankyou! Thankyou! Thankyou! More people need to understand the point you have just made. The media can say whatever the hell they like and I have been trying to tell people this for years. Anyone who believes that vaccinations are ‘safe’ has been brainwashed. simple as that.
      And Lisa, i love your blog so much, thank you so much for everything you do. It is my dream to be a homebirth midwife in South Australia and i hope one day to be with women in their own homes as they bring their children into this world.

  31. Anita Roell

    I have been researching risks on Home-births because my daughter is having her second child at home. My own children were born in the hospital during the mid-nineties. As a health care professional, I had/have confidence in the doctors who attended me. So, I am not at all comfortable with her choice. I am quite sure that all will go well. I know stats don’t always tell the complete story. I was present during her first daughters birth, and she did have some problems. And, yes, there are lots of things one can say as to why. Abigail simply got stuck. Only with my daughters strong determination, and the Dr. giving her 15 more minutes did she avoid a C-section. My concerns are that even if the chance is less than 1% that a serious problem could arise…. ( sudden hemorrhaging does happen ) why in the world would would you risk your life… AND, who, may I ask, will be the other child’s MOTHER?

  32. Dan Barrett

    Hello Lisa, I found your posting very informative and certainly the statistics support your points to some degree. The concern I have is that the figures themselves are skewed beyond the filters you have applied.

    Other health issues exist which can put the mother and/or the baby at higher risk… and therefore some mothers are in hospital for those reasons, rather than being part of “a herd”. Such risks not considered in those stats (or the filters) are placenta previa, abruptio placentae, and preeclampsia. As with any health issue, when more risk factors exist, the more likely that the mother will opt to be in a hospital setting rather than at home.

    I am not saying that our culture has not fostered the need for medical intervention surrounding labor and delivery. This is entirely true, regardless of risk factors. However, I live in Canada which provides a public health care system… no “McHospitals” with a profit-focused business plan… and yet I know that the facts and stats you have provided are exactly the same for any hospital within our health system. This is not due to marketing strategies or even cultural herding, but rather a simple understanding that only the healthiest of mothers with no forseeable complications are the ones who choose to deliver at home. Everyone other mother is therefore at their local hospital.

    For this reason, when you try to compare these two data sets, especially with only limited filters, it is extremely difficult, if not impossible, to gain an accurate and fair comparison.

  33. Jair

    So I have a question for you. I will admit that I kind of skimmed through your article, so maybe you covered this, but just looking at death rates doesn’t seem to tell much of the story. It seems it would be common knowledge that not all women are candidates to go to a midwife. In fact, a good midwife (and any that I have ever hear of or seen) do a pre-screening to make sure you are being safe to come to a midwife. In that simple practice, they are already saying, “Hey, a midwife is not for everyone. We cant handle all cases and if you have a concern or something that would possibly cause complications, you need to go to a doctor.”

    Now, that depends on the midwife and whether she is practicing at a home using a medical facility, where a doctor would still be available.

    What I am getting at, is that naturally, midwives will almost always have the best of the best when it comes to patients. Not to mention that a large basis of their customers come from people that are generally more healthy. Their clients would include more healthy consceince people. where doctors at a hospital dont always get to choose their clients. They get whoever. They also get the emergencies, which would include women they have never even consulted or seen before delivery. If you took only the doctors who practice no hospital service and pick all their clients strictly and do not take people that are at risk, then you would have a comparable situations, but thats not how most doctors do things.

    Doctors will always have a higher death rate, because they are dealing with the most extreme cases at times, and midwives do not experience this as much, and if they find a serious problem, they turn them over to the doctor during pregnancy.

  34. Katelyn

    Out of 7 homebirths of women I know, 2 babies died, 2 babies ended up in the emergency room and 3 were healthy births. So 4 out of seven ended badly. The reason I’m writing is that I find it hard to believe that I’m watching the anomoly. These women were healthy. And yet their babies died or had to spend their first days in an NICU. Listen, I’m pretty crunchy. I’m into yoga, meditation, I eat practically no processed foods. And I’m watching these women and their babies suffer and yet I keep hearing how safe home births are. So I want answers that don’t include “This is not a typical outcome.” Even if you say it – you’d better say it a little more creatively because quite frankly, I’m very upset.

  35. Dominick

    Don’t Midwives specialize in low risk pregnancies? If so, is it not expected that their results be better? Hospitals cannot turn away their patients because they have a high risk pregnancy. So could their numbers be affected by an abnormally large pool of high risk patients? I mean, I am sure you would turn around and easily shoot off a blog post about obesity, diabetes, drug use, drinking while pregnant, – in society, and all the other failures of mankind. Oh we’re all so fat, Oh we’re all stupid. Then turn around and say why aren’t Hospitals able to not kill babies of all you healthy smart people? So does it not stand to reason that Midwives are benfitting from cherry picking?

    Just being fair – because your article kinda makes it sound as if using a midwife is inherently safer. This implication would be a disservice to women.

    Maybe what you should say is “If you are an intelligent, healthy pregnant mom, followed healthy guidlines while you were pregnant, and a doctor has told you that your birth is low risk, then sure, consider a Midwife. And I’d have to agree.

    Oh, and of the things to add to your “Many things were once culturally normal” – Midwife.

    Ciao

  36. Cara

    What an interesting debate!
    i have a perspective on this that in a way may represent some of the “middle ground” that gets left out of most of these conversations.
    I am 41, and pregnant after doing one round of IVF. Choosing this route was an interesting process for me as I have always been very healthy and well, didn’t really believe that this type of option was really safe or healthy. It certainly is not an ideal manner. However, after trying to get pregnant for 3 years, seeing a decline at checkups in my follicle count and ovary size during this time period, some issues with male factor as well, and after meditation, chinese herbs and acupuncture,etc and a lot of personal reading on fertility to educate myself, i decided that this was something to try within an age / time period. i was very surprised to find that the self-administered injections were not difficult and that the medications were very easy for my body to handle, in fact I felt pretty great physically and had none of the symptoms I had heard and worried about. The egg retrieval procedure itself I found very difficult because I am very wary of hospitals and well, never go! I am lucky that my life and health has allowed me the opportunity to avoid most illnesses and other than regular check ups and preventative care and occaisonal stitches have not needed the healthcare system excessively. But I did it, and feel very lucky to be pregnant after one go. I found the endocrinologist who worked with me to be extremely intelligent, educated, respectful, and a great doctor all around. I feel lucky to have access to this type of medical care and person.
    i became pregnant with fraternal twins initially, and lost one which had stopped developing at 6.5 weeks. It was reabsorbed into my body, and the other is doing very well at this time. I did not feel many of the symptoms I was told or read to expect with pregnancy, only a little bit of tiredness otherwise felt (and still feel) hungry and sexy and super!
    I am looking at how and where to give birth, and which caregiver to rely on.
    I live in a very busy urban area. The issues surrounding ‘natural” birth and “hospital” birth are very prominent here, and there is a great deal of politics that have altered the situation of choice here exceedingly, and have caused people to take sides on this natural birth / assisted birth debate and there is a loss of middle ground which really hurts women who have to choose from two extremes which may not be ideal for a variety of reasons ranging from philosophical to medical.
    Speaking with other women in my age group, there is a huge (and i will stress huge) group of women who are insistent on hospital, epidural, and to my shock, have spoken with a number of women who inabashedly told me that they are insistant with their doctor to have a schedule C section. Reasons vary. To blame this solely on the medical industry is in my opinion, a mistake. I also know many women who have had or desire to have a home birth. I have attended both a hospital birth and a homebirth, and this experience has me decidedly leaning towards a home birth for my own reasons.
    However, it is not that easy.
    After speaking to a number of birthing centers and private midwives, I found that not one would take on a home birth with a twin pregnancy, first pregnancy, and over age 40 pregnancy.
    After the “vanishing” twin stopped developing at about 8 weeks, i approached this topic again with phone calls and consultations. It was explained to me for a variety of reasons that I would be considered too high risk for a home birth, primarily for my age and first time birth. Although it is not likely, an IVF pregnancy could possibly include additional risks (such as IUGR) however up until now (4 months) everything looks just fine, and my health seems to be extremely great (luckily, but I take care) and doctors always seem surprised by my good numbers which amuses me. But back to the midwife choice – to qualify for a home birth I have to be considered extremely low risk. Also, there is a huge political impact here because midwives are required to be associated with a hospital / doctor and these by and large mostly do not support the home birth. So I was opted out of a home birth, unless I choose to go with a midwife who will practice “outside the law” basically, and the problem here is that should anything go wrong at all I will have to go to the Emergency Room. I would rather choose to give birth in a hospital and know who my doctor team is and which hospital and have a chance to go there first and get my bearings and know their policies anyday rather than go through the ER which is a nightmare system.
    Ok, that brings me to the option of a CN midwife who can deliver in a hospital or an OB doctor in the hospital. Because I am over 40 and first time birth (and even though I am now a singelton birth) I am disqualified from using the “birthing centers” as a “high risk” patient. So no water birth for me, it means hospital proper, and understanding and working around the hospital procedural policies such as required IV or heplock, required fetal monitoring, and limited “guests” such as my family or friends, and required by law eye drops and vitamin K shot etc.
    So in consultations with both midwives and OB doctors, i have come across something interesting, which is that I seem to fall spiritually and technically into some kind of middle ground on the process. The OB feels that I am trying to push her to guarentee me a ‘birthing center” type of birth experience, as I am trying to limit hospital procedure as much as possible, want a doula (which the hospital is trying to ban due to conflicts between doctors and patients and doulas on interventions – basically no professional wants to be second called on decisions at what they feel is a crucial moment) and the Midwife feels that I am too scientific and have too many medical related questions, and also does not really want a doula as she put it – only if I need that much “hand holding”, she also does not want another opinion on the floor.
    Another issue is that very few hospitals here (only four or five) allow a midwife to practice – and I don’t like the choice of hospitals I have with the midwife. Also, with the midwife, if anything does go wrong as they say, or if I do need end up needing any type of intervention (which hopefully I will not) I will not have met the doctor or know who will be assisting me at that point. At a hospital at which I am not really that happy with as a choice. On the other hand, with the midwife, I feel I am more likely to be able to progress without intervention should I have a slower labor, and perhaps get more personal assistance trying more “natural” methods to move me through the birth process such as positioning, breathing, maybe be allowed to eat even :) if I want to, although the hospital does not allow.
    With the doctor choice, she has been very insistant that if I do not want an epidural, they will not give it to me, and that I can birth in any postition I want as my body “knows what to do” however they will intervene if they determine there is any fetal distress. I will know the doctor team, and know who will be in charge at all times of medical decisions that concern me.
    So really, my choices each have some pros, some cons. The doctor has been very instructional on technical points such as what type of interventions, when they might be considered, what the stats are for my age, she seems pretty confident that I can have the “natural” birth I want although they will intervene should they deem it necessary (we are still working on what exactly neccessary is) and doc is not happy with my questions about who will be guiding me through labor methods that are breathing and positioning, use of massage or other non- medicated pain relief – basically for a hospital birth here you are supposed to study these things on your own time and have your partner help you (although it will be my husband’s first birth so not sure how that will go!). With the midwife she was very helpful to talk about natural methods of pain relief, diet recommendations, herbal remedies, but I feel she is very resistant to medical questions about interventional procedures (even though her hospital has just as high a c section rate even though they did not come from her) she tends to gloss them over.
    I really wish I could have a nice simple home birth – and have it go perfectly!
    If I can’t have that I wish I could merge the midwife and hosptial practice somehow. Ideally – it would be great to be able to give birth in a hospital where I have the security of knowing who my surgeon would be in case of an emergency. I would have even more security knowing that my doctor / midwife will be able to prevent most of these emergency situations from ever arising. I would know I am steps away from emergency treatment should any mishap or unforeseen element arise that would require it, such as excessive bleeding or baby not breathing or anything. I could relax knowing I am in good hands to help me though the process and to help me to avoid those problems to the best of my midwife/doctors ability, yet know that in the last ditch effort, in a true emergency I would also be in good hands. I would be able to have personalized care in a professional setting. This would be ideal! All this politicking is separating the midwife and medschool type doctor even more than idealogical belief systems. I think a lot of women agree with me – at least from asking so many different types of women their opinions.
    Sorry so long a paragraph.

  37. Katie

    You cited the 129 vs. 6,067 figure as working in favor of home births, but you failed to mention that there are far and away more hospital births. If you go by percentages instead of numbers, which are a better indicator of safety (figures which are included in the tables you provide), then the death rate for home births is more than twice that of hospital births. You also failed to mention that even when someone carries to term and has a vaginal delivery, it’s still more likely that people with known issues with their pregnancies–gestational diabetes or other congenital defects that don’t always or often result in pre-term labor or require C-section–will deliver in a hospital. So even as far as you’ve filtered down, that doesn’t mean that the pregnancies are always “normal.”

    I was honestly quite impressed with this article until you got to the “We scare because we care” and “McHospital” sections. I agree with you 100% that home births, especially when attended by a certified midwife, are almost always safe. However, that does not make them as safe as a hospital birth, and to misrepresent the statistics–presenting raw numbers as opposed to percentages, knowing that there are millions more hospital births every year than home births–really damages the credibility of this article.

    I agree that everyone should base their birthing choice on facts. This article, however, distorts them.

  38. Julia

    “You cited the 129 vs. 6,067 figure as working in favor of home births, but you failed to mention that there are far and away more hospital births. If you go by percentages instead of numbers, which are a better indicator of safety (figures which are included in the tables you provide), then the death rate for home births is more than twice that of hospital births.”-Katie

    “By your thinking there could never be anything written on homebirth unless there were the same amount of births at home as at the hospital. That is nonsense.”- Lisa B

    No, Lisa, she is not saying that there could never be anything written on homebirth. She merely said that using percentages is a more accurate representation than absolute numbers when the total number of events on the categories you are commenting on is vastly different. I thought her comment was very objective and accurate.

    You might not be looking for approval but you’re a provider of a valuable service which places you at a privilege position of having your clients’ trust which creates a power differential. As such, you owe it your clients to present facts as accurately as you can without resorting to cheap tricks in fear mongering.

  39. Racheal

    Kati – she’s right. We transferred at crowning with my HBAC (seriously, the only “progress” that happened at the hospital & not at home was a vaccum assist just to get him crowned & out). Officially (for statistical purposes) he is considered to have been born ‘in hospital’. So even though in a hospital I probably would have ended up with a cascade of interventions (again) & ultimately probably deemed ‘incapable’ (again) & ended up in 2nd c/s (which we all know has a higher risk associated… therefore more likely we wouldn’t have been ok) & the only reason my labor & birth went as smoothly & beautifully & safely as it did was because we were at home…. the hospital still gets the credit. *sigh*

  40. Tracy Cassels

    Love it! I did a post myself about how the numbers got skewed in the most recent North American study by Wax and colleagues. It’s so sad that people used faulty data (because that’s the way you can use statistics to show what you like) to make a point that if otherwise examined would suggest the opposite of what they are trying to claim. Homebirth is safe for normal deliveries. And even in higher risk deliveries, it’s not the death trap opponents like to make it out to be, especially seeing as they fail to consider the dangers associated with bringing a newborn with an absent immune system into a place that is filled with disease!

    Anyway, thank you again for this – just a wonderful analysis of the data. Something every study should have :)

  41. Tracy Cassels

    Katie – there is data out of Canada that looked at normal, planned homebirths versus hospital births (meaning that even if a homebirth had to transfer, they remained in the homebirth category). The results of the two large-scale studies on this (and one in the Netherlands) show that homebirth is *as safe or safer* than hospital birth in all categories (except one weird one about jaudice but it seemed to be due to the fact that it was a admittance criteria and babies born in the hospital simply stayed longer instead of needing to be admitted in the first place). Now, I can’t speak to the data for Australia, but if it’s in line with these other places, than homebirth is probably as safe as delivering in a hospital, especially with a trained individual (and note that in Canada, in terms of professionals, only certified midwives can do home deliveries so we didn’t have doctors increasing the rates as it seems was the case with this particular data).

  42. Cait Walker

    Hi my name is Cait and currently a senior at Belmont University. My senior project is a twenty page research project over midwifery/natural childbirth. I came upon your site in my research and wondered if you had any resources you could give me. Finding a hospitals policy regarding natural birth and statistics seem to all favor hospital birth. Any chance you have any good recommendations for me? Thanks so much!

    Cait

  43. marja cartright

    As I grew up in a Northern European country, I am familiar with the idea of midwives delivering babies. However, unlike the American medical system, midwives practice in harmony with the obstetricians, providing a safe environment for moms and babies. Here in America we have an adversarial atmosphere that endangers the health and safety of mothers and babies. A 2011 article in the American Journal of Obstetrics and Gynecology reported that “babies born at home were far more likely to die from heart and breathing problems, which could be because they are not properly monitored for signs of distress or treated in time in an emergency.” The research covered 549,607 births in North America, Australia and Europe, and also found that “the average mortality rate of babies born in hospital was around 0.3 per 1,000 births, but this rose to 1 per 1,000 births for those born at home.” http://www.dailymail.co.uk/health/article-1291085/Home-birth-trebles-risk-babys-death.html.
    Although my last baby was born in 1983 in Seattle, WA, the debate over which is safer, gentler, better for the patients, and so on, continues nearly identical to what it was 30 years ago. Home births, clinic births, and any births outside the hospital by midwives remain just as dangerous as they were then.

    In my time the clinic where I was to give birth was headed by an obstetrician, who had diagnosed a narrow spot in my birth canal. As he had warned me, it was impossible for me deliver the baby without being transferred to the hospital, an ensuing epidural, episiotomy, and the dreaded forceps! Yet, I was able to leave the hospital the next day, tired and sore, with my little baby. Her head healed and my soreness was gone fairly quickly. Sadly, I felt like a failure for not being able to deliver my daughter “naturally,” as though I was not strong enough to be considered a real mother because I had to go to the “dark side” of the hospital. Today I know it was the right decision.

    Lucky Me!

    Recently, I attended my grandson’s birth. My daughter, whose birth I described above, was determined to give birth at the “Birthouse” with a certified midwife in attendance. She ended up in the very same situation as I did 30 years earlier. Except the midwife did NOT diagnose the narrow section of her birth canal. My daughter pushed and pushed, with no result. She kept pushing very hard until she shot the baby out like a cannon ball. The whole baby all at once!
    The joy of birth quickly turned into a nightmare as the baby turned blue and stopped breathing within 2 minutes of birth. The midwife was very skillful in resuscitating the newborn and was able to revive the baby in 5 minutes, so he was breathing when the Emergency Medical Team arrived. After 5 days of observation in the hospital, a visit to the emergency room a week later, followed by several visits to the pediatrician, he is now a thriving little 3 month old.
    And the mother? Her female organs were ripped to pieces! She suffered a 3-4 degree tear, involving the outer and inner parts of her perineum as well as her rectum. The surgeon at the hospital could not tell us how many stitches she put in, but said she put in 3 rows. Imagine 3 rows of stitches as a result of childbirth! Within hours of birth she fainted and had to go through a blood transfusion – 2 units of blood – to replace most of what she lost during birthing. She also stayed in the hospital for nearly a week, most of the time separated from her baby in the NICU. Later, an unbearably painful hematoma made her bedridden for a week or more.
    She was later diagnosed with post-partum depression – this cannot be a surprise to anyone — and is now receiving medicine and counseling. Through all of this she is breastfeeding her son, but has to supplement with formula because her battered body is unable to nourish a baby while trying to heal itself. A few days after she was discharged, she too had to visit the Obstetrics ER.

    I spent 3 months with this new little family helping to take care of mom, dad, and the newborn baby. Although the physical strain on all of them was horrific, overcoming the fear of losing their precious baby boy is taking the most time, and the parents are now receiving counseling for anxiety. If I was not able to stay, they would have had to hire someone for at least 3 weeks while the new mom was unable to walk or carry the infant.
    Financially, this family is also suffering. Not only are they paying full fees for the “Birthouse” midwifery services, but are also facing huge hospital and emergency room bills.

    As I said, lucky me!
    I had a miserable unhappy birthing experience, but recovered relatively quickly.
    But my daughter watched her newborn son dying in front of her, and her own life was endangered.
    No new mother should go through all this!!!

    I take all the “horrors” of the hospital births (the uppity Obstetricians irritated at having to fix the Midwifes mess, know-it-all OB nurses giving conflicting advice, rotating hospital Pediatricians, helpful sweet NICU nurses, germs, noises, “un-necessary” checks of temperature and blood pressure, etc.) before I will recommend a home birth, or even a “Birthouse” birth.
    As long as midwives do not have the adequate education to handle the dangers of childbirths, and the mainstream medical community treats them with disrespect and contempt, birthing anywhere but in the hospital is an unnecessary risk.

  44. Kaitlyn

    Hello,
    I am currently a senior in High School. I want to become a Midwife, and so i am writing a research paper about home v. hospital birth. Lisa, would you be able to tell me where you got your information from? Could you, along with everybody else on this cite, help lead me to other information that could help me out?
    Thanks!
    -Kaitlyn

  45. Aroura

    Lisa,
    As has already been pointed out, but needs pointing out again as you failed to understand it, your statistics actually show that home birthing has more than twice the deaths as those in a hospital.
    Do you see that total in your column, deaths per 1k? That is the percentage (2 deaths per 1k would be 0.2%), and that is the number that counts. 2 deaths per 1k (for home birth) is HIGHER than 0.87 deaths (for hospitals) per 1k. I know maths are hard, but this is very straightforward. @ is a larger number than 0.87. A baby is more than twice as likely to die at a home birth, using your very own statistics. The In hospital: 6,067. Out of hospital: 129 figures are completely irrelevant due huge difference in number of total home births to number of total hospital births. You must use percentages in cases such as these to arrive at correct figures, and your figures DO include percentages, you just chose to ignore them! You are the one skewing figures, and badly.

    You also provide very little in the way of actual statistics (and even trying to filter them to favor home birth, they still show against), and most of your post is just an insulting rant.

    I had a midwife at my child’s birth in a hospital, and I am SO glad I had the option of both at the same time. The midwife was indispensable, and a wonderful woman who was a very positive person. You clearly are not! You are caustic, negative, and divisive in your post and in your responses (to those who don’t agree with you 100%, anyway).

    Women need our medical professionals to work together to make births the safest AND the most satisfactory to all that they can be. You are part of the problem with your bitter, negative, fact twisting rant. Try being more honest and kind and work with OB’s to be more flexible and understanding, and then you will part of the solution.

    I suspect you won’t publish this comment, as it points at factual inaccuracies in your interpretations of the data, but I thought that you should at least be aware of those inaccuracies.

  46. Danielle

    I found this article very refreshing after only hear of mortalities occuring at home births and never hearing of any hospital neglegence. I also find it interesting how very black and white these two worlds seem to be. My family is very hosptial, doctor, and intervention minded. My sister is a NICU nurse who only sees worse case scenarios and have 4 other siblings in the medical profession. On my husband’s side, he is one of 12 children and 9 of them were delivered at home overseen by a mid-wife. His mother now assists her mid-wife with her births. With both of us coming from these two extremely different backgrounds, when I was pregnant with my first child this proved to be a very difficult and volitile subject for my husband and myself. We decided on a hospital birth and that we would do it naturally. We attended the birth classes and felt very prepared and that we had a plan we were going to stick to. It didn’t take very long for that plan to change after the OB broke my water when I was only 4cm. This led to extreme labor pains, which led to an epidural, which made my contractions stop, which led to pitocin and 22 hours later I finally gave birth to my daughter vaginally. I am now 34 weeks pregnant with my second, and when we found out I knew i had a difficult decision to make all over again. I finally came to the conclusion that I can’t fear what one side of the family or the other thinks of my decision and I can’t base that decision based on only the facts and opinions that they give me. I needed to do my own reading, my own research and make my own decision. The only thing I knew is that I DID NOT want a repeat of my first birth. After doing my own thinking, I realized that child birth is a natural process and not a disease that needs to be treated by medicine or doctors. Doctors are there to treat illnesses. And in high risk pregnancies I absolutely think you should seek the medical care you need. Midwives are here to assist and coach the rest of us and know the limitations of their abilities to care for babies or mothers that need more medicinal attention. I also found that you need to do your research on the caregiver you are seeing, not just overall world wide or nation wide statistics. It’s my job as a responsible woman and mother to know who I am seeing and to know what their rates and track records are. They are the person I am choosing to see, not anyone else in the country, so I don’t care about everybody else’s statistics. So if you have to see an OB or give birth in a hospital, it’s your job to find one that will work with you and your plan to have the baby. If you want extra coaching and support, then you need to find someone that will work with that demand. If you don’t want interventions, then you need to find an OB that will work with you on that. They are out there, you just have to do your research and find them. I’ve decided to have a home birth with this baby attended by a D.E.M/C.P.M. I know her and trust her and know her track record. If there’s a complication she isn’t to proud to send me to the hospital. She knows her limits. Ultimately there is an extreme to both sides of the spectrum. It’s your job to find the middle ground and do what’s best for you and your baby.

  47. Larzi

    When my mum was planning my birth (it was a home birth) in the 70s she was told “if the baby dies at home it’ll be your fault.” So she asked them “And who’s fault is it if the baby dies in hospital?” They replied- “Oh it’s nobody’s fault when that happens…”
    It hasn’t changed in over 30 years. Personally, I’d rather wear that responsibility myself. If i made the baby, I’ll be responsible for it until it makes it’s own choices.

    P.S. Growing up in the shadow of the death of a sibling, and seeing how victimised my parents were because of my brothers death (he was almost 7yrs old) and how the hospital wouldn’t accept my parent’s claim of the cause of his death- despite overwhelming evidence, simply because in their opinion nobody could possibly die from THAT (he died from the dioxins contained in herbicide spray that is used to kill the weeds on roadsides) despite the autopsy being inconclusive, so they put down cause of death as Pneumonia (he had NONE of symptoms!! and he died within 24hrs of exposure to the chemicals).

    Too often information is vetted to a degree that we are forced to just accept because of lack of knowledge and other facts. Hippocrates himself said “They are, indeed, two things, knowledge and opinion, of which the one makes its possessor really to know, the other to be ignorant.” Today, it seems most knowledge is based on opinion.
    Let’s get ALL knowledge out there…not just some, not biased bits of knowledge, not socially-acceptable knowledge. ALL knowledge. That may be revolutionary for those who think medicine is only contained to those with degrees.
    We should be making informed and educated choices based on a whole wealth of knowledge. not just on the opinions and objects of a few.
    Just Sayin’. :)

  48. Comadrona

    I though you might be amused by this little nugget I found while reading journal articles for a research proposal…I posted this on my Facebook page so my midwife mates could have a little chuckle.

    Quote of the day from an article I’m reading in the American Obstetrics and Gynecology Journal: “Archie Cochrane (architect of the Cochrane review) contributed to this growth (of evidence from RCTs) by emphasizing careful evaluation of healthcare interventions.. (He) famously accord(ed) the Wooden Spoon Award to Obstetrics as the specialty that least used evidence from randomized controlled trials to inform practice” ——Got it in one, Archie!

    The sad thing is, though, that lack of respect for evidence (such as VBAC safety, leaving cord intact at birth) etc. is still being blatantly ignored by hospitals.

  49. Elisa

    For the folks doing the math of the total numbers and the percentages:
    Yes, she did use percentages and not just the raw numbers.
    The percentages comparing births attended at home by a CNM vs all hospital births comes out better for the home birth than the hospital birth.
    And it certainly seems to me to be quite fair to filter out home births attended by “unknown” where the baby was suffocated or drowned afterwards. (see the cause of death stats)
    Reading the entire article rather than just skimming the numbers in the boxes, gives a better idea of the bigger picture.

    Of course, the large scale studies, comparing like to like, result in the more reliable statistics, and everything I have seen shows home birth with a CNW or CPW being the safest choice for low risk women.