The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Homebirth Safety - What Really Keeps the Baby Safe?

It's a relaxed birthing woman who really keeps the baby safe, not the machines.

Birth is generally a slow process; there is usually ample time to transport even in case of true emergency.

In terms of birthing emergencies that really happen suddenly, normal homebirth is inherently safer than hospital birth:

With shoulder dystocia, homebirth offers much better positioning options, since a woman is usually giving birth on or near a bed that she can get on/off and roll over on. The hospital bed is woefully inadequate for supporting position changes, and the hospital's trump card, cesarean, is of course useless with a shoulder dystocia.

With babies that are slow to start, homebirth typically preserves the baby's oxygen supply through the umbilical cord, even while beginning resuscitative efforts. Hospital protocol typically dictates cutting the cord as soon as possible so the baby can be moved to the radiant warmer. I'm told this also facilitates a clearer liability distinction between the OB and the neonatal resuscitation team.

Regarding postpartum bleeding, a homebirth is more likely to facilitate prompt breastfeeding and/or upright positions for delivering the placenta, both of which will reduce the incidence of postpartum bleeding. If there's a troublesome amount of bleeding, you have all the same remedies available as in the hospital, except for hysterectomy and transfusion, which are generally considered treatments of last resort. Compression of the uterus and IV administration can control bleeding and shock during transport to the hospital for medical care if needed.

Those are the "biggies" that I hear about when people worry about "an emergency" at a homebirth.

Also, I think people imagine that emergency procedures are always available at the hospital. Most people don't understand the reality that their doctor will not always be at the hospital once they've checked in; in some cases, there may be no doctor in the house or only a resident; it often takes as long to set up for an "emergency cesarean" as it does to transport a woman from her home to the hospital.

And, of course, it's very difficult to comprehend that hospital policies and procedures, as well as the anxiety of simply being in the hospital, may cause problems rather than solve them.

I guess it all boils down to the question of whether you think giving birth is really a normal physiological process or a medical emergency. I'm reminded of the great spoof about "home conception" and its many inherent dangers.

There are some really big issues about taking personal responsibility for your choices. If something goes wrong at a hospital birth, nobody goes "Tsk, tsk, if you hadn't followed your fool notions about wanting to have a nice, hospital birth, everything would have been fine". Unfortunately, one does hear of stupid things that are said to homebirth parents who have had a less-than-ideal outcome, even when it's obvious that the location had nothing to do with it, e.g. chromosomal oddities. Birthing is such a vulnerable time for many families, and it's hard to expose yourself to yet another vulnerability if you don't have good family and community support.