When I gave birth to my first son in 2001, the labor pains were nothing compared with the trauma that we both experienced because of the hospital environment. The half-dozen yelling strangers, random people wandering in and out, the fluorescent lights, the 12 unnecessary blood draws from my healthy, full-term son’s heel: All of it left my husband, our newborn son, and me disoriented and upset. The two days in the hospital and the hospital-acquired infection I contracted interfered with my breast-feeding and made it hard for both my husband and me to bond with our firstborn.
The next year, in contrast, I chose to labor at home with a certified nurse midwife in attendance. My second son was full-term to the day, and his delivery was uncomplicated, not to mention fairly quiet. Were I less scientifically minded, I’d probably wonder whether those intensely (and unnecessarily) distressing earliest days with our firstborn caused my oldest son’s autism.
As a developmental biologist, though, I’m not given to such unscientific leaps or to detours away from evidence-based medicine. I know that the medical community is strongly biased against home birth. Many doctors, particularly OBs, think it is an unforgivably dangerous practice. Yet the data suggest that this mindset does not match the science—at least, when home birth is done a certain way. The variability of home birth practices in the United States means that the discussion requires more nuance. It’s not a matter of choice only between a dangerous but mother-oriented delivery at home with an untrained attendant or a safe but traumatic hospital delivery. At least, it shouldn’t be.
A CDC report indicates (PDF) that a growing but still tiny percentage of U.S. women are turning to home birth. The CDC identified a 29 percent increase in home-birth rates from 2004 to 2009 in the United States, a finding that angers people who view home birth as a child-endangering scourge. But recent large studies suggest that the experience and training of birth attendants and proximity of emergency intervention are more relevant to safety than birth location, while the birth environment is important to the level of stress the mother and infant experience.
A 2011 large U.K. study focused on birth location, monitoring outcomes of 64,000 low-risk births from 2008 to 2010. The researchers found that home births or births in a midwifery unit (the U.K. equivalent of a birthing center) were just as safe as a hospital delivery for women who’d already had a child, but not for women having their first birth. Further, births among first-time mothers were as safe in a midwifery unit as in an obstetric unit. Experienced midwifery care can, it seems, be comparable to hospital-based OB care for low-risk pregnancies and births.
In contrast, home-birth opponents like to cite an earlier 2010 analysis of 12 studies from six industrialized countries (developing nations have different, more fundamental issues). This analysis concluded that planned homebirths with healthy and low-risk mothers carried a 0.2 percent risk of newborn death versus a 0.09 percent risk for in-hospital births, a greater than two-fold increase. That increase sounds frightening and tragic, but the main factors associated with it were poor midwife training and a lack of access to hospital equipment.
“Poor training” takes me directly to the fact that home birth in the United States is, in practice, several different entities. The spectrum runs from women birthing unattended—which is both dangerous and counter to a long, multicultural tradition of woman-supported birth—to what I’d consider the gold standard: certified nurse midwife, backup from a hospital-affiliated OB, and a well-equipped hospital nearby. The 12-study analysis was not confined to that gold standard or to the newest practices. For example, one U.S. study that the authors included was “Outcomes of a rural Sonoma County homebirth practice: 1976-1982,” while the other U.S.-based study focused on the years 1989-1996. A Lancet editorial about the 12-study analysis noted, “In the USA … only a third of homebirths are accompanied by a certified midwife.” Achieving safer births overall in the United States clearly means having experienced, well-trained birth attendants, regardless of the setting.
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