Tuesday, January 17, 2012

Home birth "as safe as" hospital birth?

An older article from the USA Today reporting on a major medical study in Canada has been making the rounds on Facebook. The title sounds like it proves the point home birth supporters have been trying to make for years: Home birth with midwife as safe as hospital birth

But - this article irks me. Because the title is NOT accurate. Home birth, according to the study it quotes, is NOT as safe as hospital birth. In fact, the numbers given in the article show home birth to be ALMOST TWICE AS SAFE as hospital birth:
The mortality rate per 1,000 births was 0.35 in the home birth group, 0.57 in hospital births attended by midwives, and 0.64 among those attended by physicians, according to the study.

Of course, mortality rates are just one factor. Other factors are morbidity rate, and rate of interventions. Both of those latter two are much, much lower with home birth. No pitocin inductions, rupture of membranes, epidurals, and the like mean fewer occurrences of meconium aspiration, need for resuscitation, trouble breathing, botched epidurals, babies with poor response due to being drugged, etc. Rates of episiotomies, vacuum/forcepts deliveries, Cesareans etc. are non-existent, while producing better outcomes. 

People often say they are too scared to have a baby at home.  I am the biggest worry-wart when it comes to our children's safety, which is precisely why I choose home birth. While birth will always be dangerous, it is the safer option. 

Edited to add: This study compared similar low-risk births at home vs. hospital. High-risk deliveries were not included. 


  1. Sometimes these reports make me feel bad about the births of my children. I had both by c-section and I worry I did not do right by my babies (or by myself) Maybe I didn't assert myself enough? Did I allow myself to be bullied or simply go with the norm? (I do not think you posted this to make others feel bad; it just brings back memories of my own experiences and how I've dealt with them)

    Eighteen and twenty years ago, the options were not quite as clear cut; however, I know I could have educated myself more. Today I would look into more "unconventional" options like homebirth or a birthing center with midwives.

    I do, however, try to focus on the fact that my children were born safe and healthy and I recovered from each delivery very well but there is a sense of failure that I didn't do it the "right" way. I'm glad that more women are looking into options that are best for them and their babies.

  2. I don't think you can conclude that they are twice as safe due to mortality rates. You have to take into consideration that hospital births attended by a doctor will naturally have higher mortality rates because higher risks deliveries, i.e. where the infant is already in trouble, will always be handled by a physician.

  3. I used to believe that people were crazy having their babies at home. I've completely changed my mind now because of what I've read in various places. If a woman feels she can give birth at home, it should be her right.

    I'm past having my babies so it's hard to say whether I would give birth at home now that I've changed my mind. I'm not sure I could trust myself in dealing with the pain without an epidural. It would take a lot to convince my husband that we could do it. He'd be terrified about me expressing pain.

    It must be so wonderful to be in your own bed with your brand new baby right after birth. I love that idea. I hated being in the hospital after the births. I was ready to leave an hour later and had to stay 48 hours.

  4. I'm not married and don't have children yet, but I like the idea of a home birth. My sister-in-law delivered at home last year, it all went so fast that my niece was born before the midwife even made it there. It was all very relaxed, she recovered very quickly, it was a wonderful experience.

    Still, I'm not sure you're coming to the right conclusions when you say they're twice as safe as hospital births. If there are complications with a home birth, the midwife calls an ambulance and the mother is taken to the hospital. Naturally, births attended by physicians will have a higher mortality rate because they're called in when there are problems.

    However, I do hope that when my time to have children comes, I'll be able to have home births.

  5. Just to clarify: This study compared similar low-risk births at home vs. hospital. High-risk deliveries were not included.

  6. Great post Zsuzsa! I would LOVE to home birth, if God blesses us with more children.

    All our other children have been born at hospital...my last experience there was not pleasant.

    My husband is very unsure about homebirthing, and often suggests (when I bring it up) that I can stay home labouring...and he'll head to the hospital himself! Ha! Perhaps I'll show him these figures! :)

  7. To the poster who feels guilty - please don't. You gave birth to healthy children and they were not ruined by being born in a hospital via c-section. I find that especially us women second guess ourselves so much and it can be detrimental. Instead, leave the past in the past and look forward. Learn from what has happened but don't dwell on it.

    All of my children have been born in a hospital. Honestly, I COULD have tried to deliver at home but it would have ended with the same ending - a c-section. True CPD (my pelvis is fused from an old riding accident and the baby was moving UP during contractions when I was fully dilated) was the reason for me. My doctor was great, tried everything we could in positioning to get baby down but it wasn't happening. You could see the imprint of my pelvic bones on her head when she was born. :(

    But my kids are here and healthy. The way they were born will not affect their eternity. For that I am grateful.

    I do think that generally, women who decide to give birth at home tend to have a healthier lifestyle and I think that can contribute to less issues at birth. Additionally, if a woman tried to give birth at home and experienced complications then went to the hospital, that would now be termed a hospital birth and would be a strike against the hospital in statistics should that child die. Honestly, I do think we'd have to see the case by case and see if being born in a hospital and having hospital intervention - or being born at home without hospital intervention - is the cause of the statistic that it goes towards. We just can't judge by straight numbers IMO. :)

  8. HW,

    I wanted to respond sooner, but it's been a crazy morning.

    Like anon above said, I could not agree more that there is absolutely no reason at all for you to second-guess your births. Whether or not they could have turned out differently is not the question. Fact is, both your children are healthy, happy, loved, and adore you in return. As moms, we cannot ask for more than that.

    My reason for posting on subjects such as this is NEVER to make anyone feel bad about their current or past decisions. It is simply to put the information out there, to make it available to those looking for alternatives. In your case, while home birth was around two decades ago, it was unheard of because we had no internet, no social networking, no blogs. In order for you to learn about it, you would have had to run into some pretty "crunchy", often weird people that were probably not in your normal "crowd". Until my second pregnancy, I had never even heard of anyone still voluntarily having a home birth in the 21st century.

    Most mothers will remember each of her birth stories in great detail until her death. That is another reason to make it as joyful as possible of an occasion. Conventional medicine is trying hard to make a secret out of the fact that birth is normal, and an everyday function of our bodies. It is almost impossible to assert yourself in a hospital situation while in labor. I strongly encourage any moms delivering at a hospital to hire a doula. Going to the hospital without a doula is like going to court without a lawyer.


    48 hours? Wow, those were the days! :) Now, they kick you out after 48 if you've had a Cesarean.

    And yes, there is nothing sweeter than cuddling in your own bed with your new baby, surrounded by the whole family.


    before our first home birth, my husband was EXTREMELY skeptical. In fact, he was almost completely against it. Once he saw the difference first-hand, he has been the biggest home birth proponent. It is understandable that husbands have these apprehensions. Have you seen "The Business of Being Born"? If not, let me know and I will send you a link to view it online.

  9. HW please don't feel bad. One of the negatives of the natural birth movement, and I was just discussing this with some ladies this morning, is that it can make a mother feel like a failure if things didn't go 'just right'. My baby was induced prematurely, which began the cascade of interventions. I managed with just gas, but I couldn't move around like I wanted because no one helped me and the contractions went practically from period cramps to near transition strength when my water broke. Part of me felt like a failure afterwards, because I didn't have a natural, free moving, 'perfect' birth.

    But you know what, I had a healthy baby. And apart from some major tearing I was healthy too. And ultimately, does it matter if we had a birthing ball or the doctor used forceps if the baby is healthy? Sure we have preferences and things we think should happen, but sometimes they don't, and yet God blessed us with a healthy bubbly baby anyway.

    As for this report, oh I wish I could homebirth. I do agree it's far safer with less intervention. Unfortunately after what happened with my first, I am at risk of the same happening again. If it dosen't I'll be fine, and I hope to birth at the birth center as we had initially planned last time, which is almost as good as a homebirth to me. But if it happens again, I become high risk and start to prepare for another slightly premmie baby. And you know what, I'm ok with it this time. I wont feel like a failure, and I will prepare even more. Look on the bright side, as least the condition allows for an induced birth, instread of emergency ceserian. As hard and potentially dangerous as an induced birth is, since I don't have a previous ceserian scar it's still safer than gaining one. (as I understand it, induction after ceserian is a bad idea because you're far more likely to tear the old scar with the drug induced, harsher contractions.)

    Maybe one day. If I don't develop the condition again int he next couple of pregnancies, I can probably consider it again. Hopefully by then we will get a local HB midwife that isn't insane, and maybe it'll even be covered by medicare at that point! (I know you don't agree with public healthcare, but when it is how people are used to dealing with medical expenses, and the ecconomy is structured around not having to pay medical expenses often, people have no reason to save for medical expenses, it suddenly becomes very hard to find and give $6,000 for a homebirth)

  10. I don't disagree with the article, but then I don't have a concrete opinion since I've not had children (hopefully I can append YET to that.lol)

    Question is for you Z...what happens when your child is breach or you have some complication? Are you going to be willing to go to the hospital? I'm not knocking you for having your kids at home and if you love it, I love it for you (truly!) But I am honestly interested, if you and your husband intend to have as many as God sees fit then at some point you may (and I know, I know....we can what if to death right?) some serious complications. There are plenty of women who are healthy as can be and don't find out until either late pregnancy or during childbirth that there's some kind of emergency. I know you're kind of anti-doctor/hospital and I'm really interested to know how you would handle that in that circumstance.

  11. Wow. Thank you for all your kind words, ladies.

    I don't know that I feel "guilty" so much as I feel like I missed out on a true birth experience, or rather the birth experience I'd hoped for. But that feeling also has faded over the years as I enjoy my children. I certainly haven't held on to the "if only..." attitude for 20 years. (only about two years after each baby...lol)

    There are some, in my opinion, who promote natural childbirth to the point of making those who could/would not go that route feel like a failure as a woman. Motherhood is difficult enough without getting into that.

    My first delivery was "failure to progress" due to probable CPD. The decision was made 24 hours after my membranes ruptured with about 22.5 hours of active labor. My second baby, as much as I wanted to have a VBAC, came via c-secion after I had stroke-like symptoms and my doctor decided that the labor process, especially pushing, would be more risky to my health than a c-section would be to the baby's health.

    As with all things concerning motherhood, this topic is an emotional one. I just don't want it to become contentious; but I'm sure you will moderate it well, Zsuzsanna.

    Thanks again for the encouragement. Great discussion - can't wait to read more.

  12. What about the attempted homebirths that that lead to complications that end up with a hospital transfer? Do these numbers take those situations into consideration as well?

    Most of the time when life-threatening complications occur the mother is transferred to the hospital and because of delayed medical care this may increase the likelihood of death for baby and/or mother. Are those deaths included under the hospital mortality rate or homebirth?

    Please correct me if I'm wrong but I would think that *most& of the time when something goes wrong the midwife would recommend a transfer skewing the data quite a bit.

  13. Two small points of note:

    In Canada, midwifery is legislated differently than in many states. Anyone who calls themselves a midwife *must* have a four year midwifery degree (normally in addition to a previous bachelor's health degree) and be licensed similar to a medical doctor.

    Also, I agree that the rates of 'safe births' at home are higher than those in a hospital, but the data is a skewed by the fact that (at least in Canada), any pregnancy considered high risk, likely to have any complications, or any mother who has had previous high risk births, is automatically required to give birth in a hospital. So in a way, the home births are "cherry picked" for the most likely simple and safe ones.

    Just my two cents worth.

  14. I apologize for being off topic I was just hoping you would actually just do a blog on this instead of posting this. I find this so disturbing and wrong and disgusting on so many levels.

  15. I gave birth to my daughter in a hospital with NO medical interventions. Yet when she was born, she had aspirated on meconium and was in bad shape. I had been considering a home birth, but because of this experience I was glad that she had been born in a hospital, because they were able to give her the appropriate care immediately. Had she been born at home, and there was just the midwife, would she have been able to appropriately take care of my daughter? What if there had been a medical issue with both of us? If there is only one midwife, how does that work? I am genuinely curious about your thoughts.

  16. Zsuzsanna ~ No, I haven't yet seen "The Business of Being Born". I would be very grateful if you could email me the link, or let me know if I can get it via YouTube, to save you the trouble. Thank you so much! :)

  17. "Just to clarify: This study compared similar low-risk births at home vs. hospital. High-risk deliveries were not included."

    Where does the article say that? I couldn't find anything about all the pregnancies being low-risk. I did find that the authors admitted that their study could be biased since women who are less healthy tend to give birth at hospitals, so if relatively unhealthy women were included in the study, it only makes sense that there would be high-risk pregnancies.

  18. Jenna- that is true, but a lot of midwives work kind of "under the radar"- my sister works in this manner. She has no degree, but has been attending births for almost 30 years. It's a big risk for her personally if something goes wrong, but she does have a lot of experience akin to midwives back in the day, and her births pretty much always have good outcomes. She is also supportive of transferring to a hospital if necessary of course.

    I can never have a home birth due to a heart condition- and would have died had I not been born in hospital with constant monitoring- so I am naturally skeptical of home birthing, but in the end it comes down to freedom of choice. IF your pregnancy is healthy and you have some backup plan, then go for it! But don't ever shame those who have hospital births- they are just looking out for their children's safety, same as any mother would, and in many cases they have good reason to be there. Home is great, but thank goodness hospitals are there for those who need them.

  19. I was not surprised to see meconium aspiration listed as a reason for mortality in the hospital. We almost lost our daughter (firstborn) for that very reason. She was in the nursery when a nurse saw that she was turning blue. She had to be resusitated and then was whisked to the NICU without me even being notified! I was furious, but thought the doctors knew what they were doing and that I should trust them. It only fueled my growing distrust of "doctors" over the years. They kept her in there for 3 DAYS! I couldn't hold her, they wouldn't swaddle her, and she was given an IV "just in case". All these precautionary measures to cover their liability and all she really needed was her mother. There were so many adverse effects from that experience that I won't even bother to list them all. Needless to say, I will NEVER let that happen again...

    Anyway, I am in agreement with you that home births are safer than hospitals for normal deliveries.

  20. Obviously, high-risk pregnancies are best cared for at a hospital. If complications arise during birth, a hospital transfer may be necessary in order to ensure the safety of mother and/or baby. You should go wherever is the safest option.

    Many complications that arise at the hospital were caused by their interventions to begin with, while home birth midwives instead focus on preventing many such complications.

  21. Just to let some people know, 'lay midwives" or non-nurse midwives do have training. Most of them are Certified Professional Midwives. There are schools for training non nurse midwives and they go through many years of learning, training, and apprenticeship, Zsuzsanna does not use untrained hacks.

  22. Well if my newborn ever turns blue from meconium aspiration, which is certainly not something that only occurs in hospitals, the last place I want to be is in my living room or bedroom miles away from an oxygen source or resuscitative equipment.

    Zsuzsanna, what is your point in posting this article? After all, you are hardly a "low-risk" pregnancy or birth at this point so you wouldn't be included in any of those numbers. You're a grand multip with a history of a possible complete placental abruption. For you to continue to birth at home is terrifying and I am praying for you and your baby. May God forbid you find yourself with a birth story fit for the Hurt by Homebirth blog.

  23. People just show their ignorance. Midwifes DO HAVE oxygen with them and lots of other stuff like that. They have stuff with them to stop excessive bleeding as well.They know just what to do. They are very well trained and have much lower mortality rates!

  24. To Amanda-if your little girl had been born at home, would you have known what to do when she turned blue? Do you have the equipment to suction out meconium? The immediate actions of the nurse saved your daughter's life! In a life threatening situation like that, the staff does not have time to walk down to your room, explain the situation, get you to sign the consent forms, walk back to the nursery, and begin life saving procedures.

  25. Midwives do have the equipment to suction babies. Most of them are iv certified and carry the equipment to start iv's and administer iv medications if necessary. As stated above, Certified professional midwives are not untrained hacks just because they did not go to nursing school. Do some research and educate yourselves about non-nurse midwives.

  26. I know this post is older and I'm not sure if people are still reading it, but I wanted to respond to some of those who said this study was skewed because (a) high risk births happen in hospitals, which would naturally skew the mortality rate up, and (b) home births that experience complications transfer to hospitals, again, skewing the mortality rate. If you read the article, you would see that both of these points are incorrect. The original study is here:


    The study was commissioned by the BC Ministry of Health after they decided to fund midwifery care under public health care. To ensure that midwifery care was safe, they tracked EVERY SINGLE MIDWIFE-ATTENDED BIRTH that occured over the course of a few years, whether those births occured at home or hospital. Then, they carefully matched those births to LOW-RISK hospital births where the mother had chosen to deliver in-hospital with a physician- however, to be included in the study, every birth included had to meet the criteria for home birth regardless of where the birth occurred. Then, because there were way way more low-risk hospital births than home births, they randomly selected from the low-risk hospital birth pool a group of births to compare to. Basically, the only variable was where the woman chose to give birth and with whom. It is also important to note that births were classified into either homebirth or hospital birth by where the woman intended to birth at the onset of labour, meaning that homebirths requiring hospital transfer due to emergency stayed in the homebirth group (you can see this is true as otherwise the c-section rate would be zero for the homebirth group, as no c-sections would be occuring at home). This was actually a very thorough study, and it did find that the outcomes were better for women who birthed at home compared to low-risk women who chose to deliver in hospital.

    However, as someone above said, midwives in BC are required to have a degree in midwifery, so there are no "lay midwives" with possibly little training.


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