I could list several recent large prospective studies (this one out of Canada, this one out of the Netherlands, and this one out of the United Kingdom) all comparing where and with whom healthy women gave birth, which found similar rates of baby loss—around 2 per 1,000—no matter the place or attendant. We could pick through those studies’ respective strengths and weaknesses, talk about why we'll never have a “gold-standard” randomized controlled trial (because women will never participate in a study that makes birth choices for them), and I could quote a real epidemiologist on why determining the precise risk of home birth in the United States is nearly impossible. Actually, I will: “It's all but impossible, certainly in the United States,” says Eugene Declercq, an epidemiologist and professor of public health at Boston University, and coauthor of the CDC study that found the number of U.S. home births has risen slightly, to still less than 1 percent of all births. One of the challenges is that “the outcomes tend to be pretty good,” Declercq says. “So when Tuteur says no study anywhere has found this, it's a crock. There are studies that have found good results.” But to really nail it down here in the U.S., he says, we'd need to study tens of thousands of home births, "to be able to find a difference in those rare outcomes.” With a mere 30,000 planned home births happening each year nationwide, “We don't have enough cases.”
Declercq's statement makes Goldberg's only other source on safety also questionable. Martha Reilly, M.D., of Eugene, Ore., tells her that every OB at her hospital, McKenzie-Willamette Medical Center, has seen a baby dead or injured by a home birth: “The death rate we're looking at ... it's outrageous.” But how can this be? The Department of Health reports 102 planned home births in Lane County in 2010. Reilly's claim is improbable given that the odds are in the per-thousand range, though it's perhaps indicative of how polarized some providers are on this issue. A few years ago Melissa Cheyney, anthropologist at Oregon State, investigated a physician's claims that several babies had died in home births, but she could find none.* “What we found is that the animosity is so high between midwives and obstetricians that all kinds of rumors spread that are unsubstantiated,” she told me. UPDATE, July 6, 2012: This piece should have mentioned that, in addition to being an anthropologist, Melissa Cheyney is also a certified midwife and is chair of the research division of the Midwives Alliance of North America, though she did not have this Alliance role at the time of the Oregon investigation mentioned in the piece.
Deep into her piece, Goldberg repeats the Tuteur talking point that some midwives—nurse midwives—are fine and safe because they “have the same sort of training as midwives in countries like the Netherlands,” but not “the other kind,” i.e., the certified professional midwives, who attend home births in the United States but are not nurse practitioners. Actually, midwives in the Netherlands and other countries are not nurses. They don't go to nursing school, and they don't practice under the supervision of physicians like nurse-midwives do here. They're independent, autonomous pregnancy and childbirth-care providers who set their own standards just like any other profession. What's relevant is that, unlike the non-nurse midwives in the United States, European and Canadian midwives have hospital privileges and are integrated into the system, which everyone agrees is the safer protocol. But in the United States, medical groups oppose legislative efforts to license CPMs.
Like Tuteur’s new site, Goldberg builds her piece around two horrific home birth tragedies. Any reader would, and should, be moved by them. By these women's accounts, their midwives made terrible decisions and, worst of all, didn't get informed consent from their patients, which is central to midwives' practice standards. But is it responsible journalism to construct a story around the rare outcome? And is it logical for us, as readers, to take away from the anecdotes that home birth is dangerous?
“What we're talking about is felt risk rather than actual risk,” explains Barbara Katz-Rothman, professor of sociology at the City University of New York and author of much scholarship on birth, motherhood, and risk. Take our fear of flying. “Most people understand intellectually that on your standard vacation trip or business trip, the ride to and from the airport is more likely to result in your injury or death than the plane ride itself, but you never see anybody applaud when they reach the airport safely in the car.” The flight feels more risky. Similarly, we can look at data showing our risk of infection skyrockets the second we step in a hospital, “but there's something about the sight of all those gloves and masks that makes you feel safe.”
I'll venture that the reason most women don't choose home birth is because it doesn't feel safe, and that trumps data any day. What's unfortunate is that if we could get past the professional turf wars and the mommy shaming, women might have a clearer path to making informed decisions that both are safe and feel safe. It would almost be like having it all.
Correction, July 5, 2012: This article originally misspelled Melissa Cheyney's last name. (Return to the corrected sentence)