Home Birth and Out-of-Hospital Birth: Is it Safe?

    How Safe is that Hospital Anyway?

    Information compiled by Jennifer L. Griebenow 4/97
     

    In the past, most Americans were born at home with lay midwives attending. The mortality rate for both mothers and babies was higher in 1900, at 700 maternal deaths per 100,000 births (Korte and Scaer 97), than it is now. Babies also died at a significantly higher rate at that time, which decreased to 28.9 births per thousand by 1960 (Korte and Scaer 98). Obstetricians tend to emphasize that many women used to die in childbirth, implying that we should be grateful for current obstetric practice. However, even in 1900, the percent of women who died giving birth was only 7/10ths of one percent! One has to wonder how this percentage compares with our countryís current cesarean section rate of 22%. Are the surgeries performed on these mothers actually saving them from imminent death? Maternal and infant mortality are lower now than they were 40 years ago. But the assumption that hospital birth is safer for mother and baby has never been supported (Jones 6). Prenatal care, better nutrition, antibiotics and blood transfusion have played more of a part in the relative safety of birth now.

    Sheila Kitzinger, British childbirth expert, states that planned home birth with an experienced lay midwife has a perinatal death rate of 3-4 babies per 1,000 births (51). Hospital births, by contrast, carry a perinatal mortality rate of 9-10/1,000. [Perinatal death rates include fetal deaths on and after 28 weeks gestation, whereas neonatal mortality rates only include deaths occurring in the first 28 days after birth (Jones 96,98)].

    Cesarean section and hospital birth is not doing for women and their newborns what doctors and hospitals claim it is! Ask for statistics and studies when your doctor claims hospital birth is safer than planned (not accidental, unattended) home birth. I would be interested to see them. If your doctor says, "Thatís common knowledge," you would be wise to seek another health care provider. I have only heard of one study done that claimed hospital birth was safer. It included deaths caused by unplanned, unattended births which occurred at home, and was backed by (guess who?) ACOG (The American College of Obstetricians & Gynecologists).

    Other studies:

    Carl Jones says, and I concur, "No one can tell a mother she is perfectly safe giving birth at home. Whether she is safer at home than in a hospital, however, is another question" (113). There is always going to be some risk when giving birth, as in all of life, and women should be carefully screened for any health problems that could be dangerous during labor and delivery. For certain women in rare instances, obstetric care is essential. However, for most women, better, healthier results are seen when mothers chose birth centers or home births. As far as the risk of home birth goes, Our Bodies, Ourselves states, "The times when hospital care unexpectedly becomes instantaneously necessary are rare" (341). In A Good Birth, A Safe Birth, Diana Korte and Roberta Scaer quote Tew, the research statistician, who says, "The danger of home as a place of birth does not lie in its threat to the healthy survival of mothers and babies, but in its threat to the healthy survival of obstetricians and obstetric practice" (50).

    Another factor that is important in making the choice about where to give birth may surprise you. It makes common sense, but has also been documented by several studies. Women who give birth in a hospital are much more likely to experience postpartum depression or even post traumatic stress disorder. Kitzinger states that the more interventions a woman experiences, the more likely she is to be depressed, with C-sections obviously carrying the greatest risk of depression (193). She quotes 5 or 6 studies documenting the effects of this "institutional violence."

    Aidan McFarlane, a British physician, notes that while 68% of hospital mothers experience postpartum depression , only 16% of home birth mothers do (Jones 24). On the Farm, a self-contained, alternative lifestyle community in Tennessee, the rate of postpartum depression was .03 percent (Korte and Scaer 183). Almost all mothers on the Farm had both a homebirth and a supportive, loving community of women to assist them postpartum. Depression, in itself, would be a major reason for mothers to consider giving birth in their own homes, if that is where they are most comfortable, especially if they had previously experienced postpartum depression and thus were at high risk for a repeat episode.

    Aspects of hospital birth that may strongly contribute to the incidence of postpartum depression in our country are the way the moment of birth is handled and the routine separation of baby and mother. In a study which appeared in the New England Journal of Medicine in 1972, Marshall Klaus, the "bonding" expert, found that holding the baby close released "dormant intelligences" in the mother and caused "precise shifts of brain functioning and permanent behavior changes" (Pearce 115). In other words, bonding is not just an emotional thing that only mothers think happens. It is a biochemical process that forever changes the mother, so that she knows more instinctively how to relate to her baby. In the hospital, baby cannot see mom with all the bright lights and is often inspected and observed for several hours before mother can hold it for any length of time. This is not to say love canít make up for this loss, but motherhood might come easier if we had those natural body changes to help us. Then babies are still routinely kept in the nursery, if not most of the time, at least part of the time. The routine separation of mom and infant makes baby frightened and mom depressed (Pearce 124). This may be why postpartum depression and difficult adjustments are so common in the US and rare elsewhere. Japan moved from midwifery to obstetrical handling of births approximately 25 years ago. When older Japanese recently asked Joseph Pearce why their mothers no longer "know what to do with their children," (129) one has to wonder how much the new hospital setting has to do with it.

    Most homebirth studies also show a significantly lower rate of C-section than hospitals have. Most stats I have seen show a rate between 1-5%, with the above quoted lower mortality rates as well. Cesarean sections themselves carry a far greater risk of additional illness or death than most people realize. I think because they have become so routine in our society, everyone feels "Itís no big deal." However, C-sections carry a 2 to 4 times greater risk of death than do vaginal deliveries (Boston Womenís Health Book Collective 341).

    Several studies on the risk of death from the surgery alone (i.e. factoring out the conditions the surgery was done for) have shown varying, yet consistently depressing, results. Errard and Gold found with eleven years of statistics that the risk of death from cesarean section was 26 times greater than from vaginal birth (Cohen and Estner 26). Cohen and Estner also cite a study done in Georgia showing a maternal death rate of 59.3 per 100,000 women who had cesarean section versus 9.7/100.000 for women who delivered vaginally (26). A California study showed a maternal death rate 2-3 times greater from C-section. Korte and Scaer state that obstetricians admit a maternal death rate four to six times higher with cesareans (162), and add that many believe the rate is higher, giving 1 in 1,000 as the true odds of death for a c-section mother (163). You should also be aware that death is not the only complication caused by cesareans; mothers commonly experience infection after a section. Infertility problems, organ damage, and paralysis from anesthesia complications are rare but possible risks. The pain at the incision site is no picnic either.

    Another thing to think about is how a surgery like this will affect you, your child, and your society in the long run. When mothers "fail" to give birth naturally in hospitals, as they so often do these days, their self image is harmed despite well meaning friends telling them it doesnít matter how baby came out. Especially if mothers are not certain their sections were absolutely necessary, there is often a hidden anger that canít be overtly expressed in our culture. Mothers may take this unacceptable anger out on the only people they can--their children. "In 1979, the government of California funded the first scientific study ever made of the root causes of crime and violence. Their first report three years later stated that the first and foremost cause of the epidemic increase of violence in America was the violence done to infants and mothers at birth" (Pearce 126). The "little things" really do matter, just as a small pebble thrown in a pond makes ripples that travel a long, long way.

    If you are a woman with no health problems or contraindications to safe labor and delivery, consider very carefully your place of birth. Your chance of having major surgery is one in four if you choose a hospital, regardless of your current health status. Those are very good odds. If you had the opportunity to buy a million dollar lottery ticket with odds that good, you would, wouldnít you? Donít assume that it wonít happen to you. Since the risks to you and your baby are lower at home, and your risks of having surgery are greater if you go to a hospital, please consider homebirth as an option.

    Wherever you decide to give birth is up to you; just remember that you can make the decisions that need to be made when you have true information. It is your body, your baby, your money, and your life on the line, not the doctorís or anyone elseís. You have the right to accurate information and the right to decide what is best for your baby. Donít let anyone tell you otherwise. Also, when you ask for information, beware of health care providers who say they judge each case individually, so they canít really give you their statistics. It probably means either they donít know or they donít want you to know. You will have to live with the consequences of decisions made during your labor, for better or worse. For more information or support, call me at 606/625-0185 or email me at griebenow@iclub.org

    The author disclaims any liability resulting from the use of this information, and strongly urges you to use your own mind.


    References

    1. Boston Womenís Health Book Collective. The New Our Bodies, Ourselves. New York: Simon and Schuster, 1984.
    2. Cohen, Nancy Wainer and Lois J. Estner. Silent Knife: Cesarean Prevention and Vaginal Birth After Cesarean. New York: Bergin and Garvey, 1983.
    3. Davis, Elizabeth. Heart and Hands: A Guide to Midwifery. 2nd edition. Berkeley: Celestial Arts, 1992.
    4. Jones, Carl. Alternative Birth. Los Angeles: Jeremy P. Tarcher, 1990.
    5. Kitzinger, Sheila. Home Birth. London: Dorling Kindersley, 1991.
    6. Korte, Diana and Roberta Scaer. A Good Birth, A Safe Birth. Boston: Harvard Common Press, 1992.
    7. Mitford, Jessica. The American Way of Birth. New York: Dutton, 1992.
    8. Pearce, Joseph Chilton. Evolutionís End: Claiming the Potential of Our Intelligence. San Francisco: Harper, 1992.
    9. New Our Bodies, Ourselves. New York: Simon and Schuster, 1984.
    10. Cohen, Nancy 

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