Wednesday, August 19, 2009

The Truth--and Myths--About Home Births

When I told my women friends that my older son's first baby--and my first grandchild--would be born at home, most of them looked shocked. They immediately voiced fears, saying that they thought it was much safer to have the baby in a hospital because things can go wrong, and in that case, an operating room would be immediately accessible.

It didn't change their minds when I told them that this was a low-risk pregnancy, that my son's girlfriend had been healthy throughout, and that everything showed that the baby--a boy--was doing well. Nor were their minds changed when I said she would have a birth assistant (a certified doula) to help her through the labor, and then a highly experienced midwife to deliver him.

Well, he was born a week ago today, and came into the world with eyes open wide, pink and healthy and calm.

I know exactly how he looked because I saw him within moments of his birth. All four of his grandparents, his uncle and aunt, were there at home waiting. We suffered along with Nicole as we listened to her cry and yell during the last throes of childbirth. But once we heard his cry, we ran upstairs, applauded, cried, hugged and poured champagne. I'll never forget that morning.

Baby Henry began nursing like a champ immediately, and has been calm and content ever since. When he wakes up to nurse, his eyelids flutter and he frowns as if all that light is still a shock to him.

And then I remember the hospital nurseries with fluorescent lights glaring, 24 hours a day. No wonder the nurseries are usually ringing with the howls of the newborns!

So the outcome for my grandson was perfect. The midwives--a second one came at the end to help--called it a beautiful birth. They should know. For one of them it was the 251st. birth she had attended.

The birth assistant, by the way, was with Nicole throughout her labor, coaching her on changing positions, massaging her, using aroma therapy, accupressure, a birth chair, etc. to help her.

But what of my friends' fears? Justified or not?


Here's the evidence, culled from the best and most recent study of home births. It comes from a study of 7,600 births in the U.S. and Canada, published in the British Medical Journal in 2005, that were planned to occur at home with certified midwives attending. All of the births studied were low-risk, meaning that the mothers were healthy, with no chronic health problems, and that all pre-birth exams showed the babies in good health as well. The outcomes of the home births were compared to low-risk births that occurred in hospitals.

  • Infant mortality was 1.7 per 1,000 births, a rate as low as occurs in hospitals with low-risk births.
  • Medical interventions occurred at less than half the rate as in hospitals. For example, only 2.1% of the women at home suffered an episiotomy, compared to 33%--yes, one in three--in the hospital. Only 3.7% of the women at home ended up delivering by caesarean section, compared to 19% in the hospital.
  • None of the mothers died. Some of the women--12%--were transferred to a hospital when problems developed. If a woman is within 20 minutes of a hospital, she is likely to be under care in an operating room as quickly as a woman who labors in the hospital. That's because it takes some time to mobilize the equipment and staff needed, and that mobilization can get started just as quickly with a phone call from home.
The study concluded: "Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar (infant)...mortality to that of low risk hospital births in the United States."

The bonus, of course, in this era of soaring health costs, is that a home birth is far less expensive than one that takes place in a hospital.

Meanwhile, the American College of Obstetricians and Gynecologists continues to oppose home births while infant and maternal mortality rates for the U.S. continue to be far worse than those in other western countries where medical interventions, like cesaereans, occur far less often.

Which leads me to believe that opposition to home births is rooted in the desire of the medical establishment to protect their income stream, and not out of concern about the safety of women and babies.

Yet, American women are so frightened of childbirth at home that less than 1% choose to stay out of the hospital. A pity. For them, their families and babies.##


nicole mills said...

Thanks Frances, as little Henry's mom I can attest that though grueling, giving birth in our familiar environment, surrounded by people we love, and without the added stress that at any minute the hospital might intervene and start some procedure on us, started off our new relationship in the most comforting way possible. Henry is a calm, trusting and happy baby, and I have to believe it is in large part due to the fact that his entry into the world was so unmarred by all those stressors associated with hospital births.

Ms Sparrow said...

I would be interested to know the difference in costs between home delivery and the hospital. Were those figures included by your source?

Frances Cerra Whittelsey said...

Ms. Sparrow's question is one I also wonder about, but didn't have time to answer before doing this post. I'm going to check it out and will blog on it soon. I'm also curious about whether insurance companies cover the costs of home births.