As a woman and mother-to-be, I am an avid proponent of natural childbirth at home. This morning, while browsing for the most recent news about pregnancy, I came across an article entitled “Right of Home Birth versus Right to Put Baby at Risk” on Medical News Today. The article responds to an editorial published in The Lancet earlier this month that argues that a mother has the right to choose when and how to give birth but not the right to put her baby at risk. As this article correctly points out, women with low risk pregnancies (which, according to my careful research, accounts for approximately 90% of all pregnancies) who attempt natural childbirth at home instead of giving birth at a hospital in general experience faster recovery times, fewer lacerations, fewer postpartum hemorrhages, fewer infections, and a lower risk of placenta retention. However, I must question some of the statistics about the outcomes for newborns born via natural childbirth at home quoted in this article.
According to this article, the risk of neonatal death for natural childbirth at home is 0.2% as compared to a rate of 0.09% for giving birth in a hospital. For comparison sake, those percentages translate to 2 infant deaths per 1,000 home births versus 0.9 infant deaths per 1,000 hospital births. I question this finding for a number of reasons. First, other studies on the safety of natural childbirth at home have found conflicting results. For example, in a study published as “Outcomes of Planned Home Birth with Registered Midwife versus Planned Hospital Birth with Midwife of Physician” by Patricia A. Janssen PhD, Lee Saxell MA, Lesley A. Page PhD, Michael C. Klein MD, Robert M. Liston MD, and Shoo K. Lee MBBS PhD in the Canadian Medical Association Journal, the researchers found a perinatal death rate of 0.35 deaths per 1,000 births for planned home births attended by midwives, 0.57 per 1,000 for planned hospital births attended by midwives, and 0.64 per 1,000 for planned hospital births attended by physicians. These results, although similar, conclude to better safety for natural childbirth at home compared to giving birth at a hospital.
My second problem with these statistics is that the variables of the study are not disclosed. Although this article states that the increased neonatal mortality associated with natural childbirth at home is most likely the result of poor midwife training and a lack of access to hospital equipment, the statistics take into account all home births instead of separating home births attended by trained and accredited midwives versus under supervised home births. As a study published as “Outcomes of Planned Home Births with Certified Professional Midwives: Large Prospective Study in North America” by Kenneth C. Johnson and Betty-Anne Daviss in BMJ: British Medical Journal concludes, favorable outcomes of home births are contingent upon the attendance of a certified professional midwife at the labor and birth. By not factoring who attended the birth into the equation, the above percentages of neonatal mortality rates are misleading at best.
So, do articles that question the safety of giving birth at home versus giving birth at a hospital make me question my desire to attempt natural childbirth at home myself? The short answer is no. The long answer, which is still ultimately no, requires some explanation. First, although not inherently dangerous, birth, like all of life, does come with risks. Sometimes mothers and babies do die. More importantly, the outcome of birth should not focus solely on the baby. Research clearly indicates that mothers who succeed in natural childbirth at home have lower maternal mortality rates than mothers giving birth at a hospital. Fewer babies but more mothers dying is not better. Furthermore, although I would not want to be the additional 0.11%, the difference between 0.2% and 0.09% is negligible. So, as long as I can find a well-trained and qualified midwife to attend my birth and as long as my pregnancy is low risk, my desire to attempt a natural childbirth at home has not been deterred.
Update: I gave birth to my daughter at home with a homebirth midwife and my family in attendance.
Originally written on August 18, 2010
Right of Home Birth versus Right to Put Baby at Risk: http://www.medicalnewstoday.com/articles/196576.php
Ranch Style House in California: http://commons.wikimedia.org/wiki/File:Ranch_style_home_in_Salinas,_California.JPG