Each year in America, approximately 1% of the births occur inhome settings. In Illinois in 1992, 1,218 families filed birthcertificates that reflected a homebirth. Approximatelyone-third of the births occurred to Black families. Wisconsinhad 591 recorded homebirths for the same year of which 22 wereto Black families. 1 It is probable that many more Illinoishomebirths actually took place but weren't recorded due to adiscriminatory birth registration practice that places theresponsibility for registering midwife-attended homebirths onthe parents and requires a different mechanism than is used forany other occurring births.
One measure of the safety of birth place is infant mortality,specifically, neonatal deaths within the first 28 days.According to the Center for Disease Control, there were 19,098neonatal deaths for 1990 for babies born in a hospital. Forthose babies born at home, there were 260 newborn deaths.Infant mortality is figured as the number of deaths per 1,000live births. The death rate for babies born in the hospital was5.6 and for those born at home was 11.1, which would seem toindicate that a hospital is a better bet for a baby's survival.However, when the homebirth statistics are further broken downinto who attended the birth, the picture changes dramatically.Direct Entry Midwives had the best outcomes with a death rateof 1.9 compared to CNM-attended births (2.9) or physicians --D.O.'s (15.1) or M.D.'s (24.7).
History Until 1900, homebirth was the place of birth for mostevery American. In fact, over 90% of those alive on earth todaywere born at home! Hospital or institutional birth is arelatively new occurance which began to gain in popularityduring the 1920's due to physician promotion and the increaseduse of the automobile. As is the case today, it is a much moreeconomic use of a physician's time to attend patients in asingle place. There is also an economic incentive since aphysician can attend to more than one patient at a time in thehospital and other, less important helpers can attend to themore mundane tasks of birthing.
Part of this shift in birthplace must be attributed to thepropaganda denouncing midwives which took place during thissame time. With their economic and organized power, physiciangroups were able to legislatively increase hospital births byeliminating those who still attended homebirths -- byeliminating the midwife. From the 1930's through the 1960'sstate after state changed their laws to either restrict thepractice of midwifery or wipe out the legal practice entirely.Yet no valid study then or to date has proven planned homebirthto be less safe than hospital birth.
Studies
Many studies have been done in an attempt to prove thathospitals are the safest place to birth. Some of the earlierones included all births which took place out of the hospitalregardless of the gestational age or planned place of delivery.Those studies included miscarriages which took place at home aswell as precipitous births and births that were unattended. Tobe valid, a study must compare equals and change only one item.Lewis Mehl did this when he matched 2,092 women and comparedtheir birth outcomes. The result was that homebirth with atrained attendant was safer than a hospital birth.
What does "safer" mean?
Most families do not want to know the statistical odds ofhaving a good outcome, they want to know more concretelyexactly how a homebirth will be safer. Many studies addressthis by listing criteria and comparing the results.
Chart is one website http://www.midwives.net
As you can see from the chart, many complications seem to occurwith greater frequency in the hospital. Many women are told theywill need an episiotomy in order to prevent tears but the datafrom these births shows that this is not so since there were 9times as many tears in the hospital group! Fetal distress,often cited as the complication necessitating a cesareansection occurred 6 times more frequently in the hospital group.There were 4 times more newborn infections, 22 times moreforceps deliveries, 30 times more birth injuries and 3 timesmore cesarean sections in the hospital group.
EstimatingPreventable Childbirth Related Deaths
The following statistics, derived from data accumulated between1940 and 1980, are conservative estimates of lives lost due toour system of treating pregnancy as a medical event requiringmedical intervention and care. *about 1,000,000 babies died ator before birth that should have lived * about 1,600,000 babiesdied before their 1st Birthday who should have lived * at least1,500,000 children were left severely brain damaged by medicalprocedures * at least 45,000,000 children had minimal braindamage who would have been normal Today, it is estimated that50 newborns die unnecessarily each day whose deaths arepreventable if "the five standards for safe childbearing" wereemployed. This breaks down into a preventable baby death every29 minutes, every hour of the day, each day of the year. NAPSACwrites, "Since 1940 at least a million babies have died inAmerican hospitals who would have lived were it not for thedoctor dominated maternity system that dictates the Standardsfor American Childbirth."
Who should decide what is safer?
Childbirth is not a laboratory project that can be reproducedat will with the outcomes compared with each other. Nor isbirth a medical event, like planned surgery, that can be timed,controlled or forced to obtain the desired outcome. Each year,it seems, scientists discover some aspect of birth that hadbeen unknown or unverified. Also, it would seem that thetechnologies that are initially hailed as the "cure" for acertain problem are found to produce unacceptable side-effectsor increase risks for more serious complications. Birth alsohas a psychological component which can place some women atincredible risk in a hospital.
A recent article in a prestigious magazine looked at homebirthand asked the question, "Is it safe? Is it ethical?" Thephysician writers concluded that homebirth has a "definitesmall risk" and that "hospital births entail a wider range ofrisks". They also felt that since the actual risk factorsinherent in a home birth are very small, perhaps 1/1000, andthe consequences of the birth decision will be borneexclusively by the parents, physicians should support parentswho are willing to accept this risk so as to make theexperience as safe as possible. The Oxford Perinatal Projectalso came to this conclusion after an exhaustive look at everyscientifically valid study performed since the 1950'saddressing aspects of care of pregnant and birthing women andtheir babies. Since science cannot prove homebirth to be lesssafe than hospital birth, I believe that each family has theconstitutional right to choose where to give birth. I believethat until science can prove a detrimental effect on those whochoose to birth at home, medical personal should supportfamilies in their decision. The InterNational Association ofParents and Professionals for Safe Alternatives in Childbirth,NAPSAC, shares this view and asks, "Who is to decide what isthe optimal balance between medical and psychological risk? . .. It must be the parents.
"Sources:
1. Center for Disease Control, "Live births by placeof delivery and race of mother, 1992", section 1, Natality,page 246.
2. Center for Disease Control, "United States, BirthCohort of 1990", Table 43, pages 2 and 5.
3. Litoff, JudyBarrett, The American Midwife Debate, pages 1-10.
4. Mehl,Lewis, "Scientific research on childbirth alternatives and whatit tells us about hospital practice", NAPSAC, 21st CenturyObstetrics, 1978, vol. 1, pp/ 171-207.
5. Stewart, The FiveStandards for Safe Childbearing, pages 137-138.
6. Hoff andSchneiderman, "Having Babies at Home: Is It Safe? Is ItEthical?", Hastings Center Report, December 1985, pages 19-27.
7. Enkin, Keirse & Chalmers, A Guide to Effective Care inPregnancy and Childbirth, Oxford University Press, New York,1989.
NAPSAC is a non-profit and tax exempt organization that may bereached at Route 1, Box 646, Marble Hill, MO 63764, phone (314)238-2010.
Some may argue that statistics do not tell the entire story,and that is true, but it is the best scientific way to diminishthose who promote institutional birth as the only option foreveryone regardless of risk status.
About The Author: Yvonne Lapp Cryns is the owner of Midwives.net - http://www.midwives.net Yvonne is the co-founder ofNursing Programs Online at http://www.nursingprogramsonline.comand a contributor to The Compleat Mother Magazine athttp://www.compleatmother.com . Yvonne is also a law schoolgraduate, a registered nurse and a Certified ProfessionalMidwife
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