Natural childbirth I: is home birth more dangerous than hospital birth?

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In this series we’re going to explore natural childbirth (home birth) as an alternative to industrialized childbirth. Industrialized childbirth could also be called “disturbed birth”, which Australian family physician Sarah J. Buckley, MD defines as follows:

Anything that disturbs a laboring woman’s sense of safety and privacy will disrupt the birth process. This definition covers most of modern obstetrics, which has created an entire industry around the observation and monitoring of pregnant and birthing women. Some of the techniques used are painful or uncomfortable, most involve some some transgression of bodily or social boundaries, and almost all techniques are performed by people who are essentially strangers to the woman herself. All of these factors are as disruptive to pregnant and birthing women as they would be to any other laboring mammal – with whom we share the majority of our hormonal orchestration in labor and birth.1

Buckley embraces an evolutionary perspective on pregnancy and childbirth. Such a perspective affirms the natural process of gestation and birth and recognizes a woman’s genetically inherited capacity to give birth without medical intervention.

In the same way that we evolved to eat a species-appropriate diet (i.e. paleo), we evolved to give birth in an undisturbed environment.

This innate system of birth has been refined over 100,000 generations. It involves a complex, finely tuned orchestration of hormones that prepare both the mother and baby for a successful birth and catalyze profound neurological changes that promote the bond between a mother and her new baby.

And just as we experience health problems when we stray from the evolutionary dietary template, women are more likely to experience complications and difficulty in labor when they stray from the evolutionary template of “undisturbed birth”.

Natural childbirth is in our genes

Throughout the vast majority of human history, women have always given birth in a familiar place, with family members or other trusted companions.

Even now, babies are still born at home in most places around the world. And although the move from birth at home to the hospital began in the 18th century, home birth was the norm even in westernized countries until the 1950s.

Think of it this way: humans have been giving birth at home for 999,998 generations, and it’s only in the last 2 generations that hospital birth has become common.

This means that women have given birth at home for 99.998% of human history.

Yet in the U.S. today, fewer than 1 percent of births happen in the home. This abrupt and almost complete transition from natural childbirth toward industrialized childbirth has had profound repercussions on mothers, babies and the culture at large.

My wife Elanne and I have chosen to have a home birth with our first child (who is, as of this writing, due in about 2 weeks!) It has been fascinating to watch people’s reactions – outside of our close friends, who have almost all had home births – when we tell them this.

Some come right out and say “that’s brave!” Others are more suspect, using words like “interesting” or maybe even wondering out loud if it wouldn’t be a better idea to use a hospital midwife. Still others are more direct in their opposition to our choice.

This is evidence that the medical establishment has done a fantastic job convincing people that hospital birth is “normal”, in spite of the fact that home birth has been the default choice for 99.998% of human history.

Doctors and the medial have also managed to convince most people that hospital birth is safer than home birth. But is that really true?

Another myth bites the dust: hospital birth is not safer than home birth

In the Netherlands, where 1/3 of babies born at home under care of midwife, outcomes for first babies are equivalent to those of babies born to low-risk women in the hospital, and outcomes of second or subsequent babies are even better.

A UK analysis found that birth at home or in small family practice units is safer than birth in an obstetric hospital for mothers and babies in all categories of risk.

Other studies have shown that modern obstetric interventions have made birth more dangerous, not safer.

In fact, in terms of outcomes for mothers & babies, studies show that planned home birth has perinatal mortality levels (the numbers of babies dying around the time of birth) at least as good as – and often better than – hospital figures, with lower rates of complications and interventions.

A landmark study by Johnson and Daviss in 2005 examined over 5,000 U.S. and Canadian women intending to deliver at home under midwife. They found equivalent perinatal mortality to hospital birth, but with rates of intervention that were up to ten times lower, compared with low-risk women birthing in a hospital. The rates of induction, IV drip, episiotomy, and forceps were each less than 10% at home, and only 3.7% of women required a cesarean (c-section).

Other studies have shown that women who plan home birth have around a 70-80% chance of giving birth without intervention. And because of low use of drugs, home-born babies are more alert and in better condition than those born in the hospital.

Contrast this with the 2002 and 2006 Listening to Mothers surveys which examined 3,000 births in conventional settings. They found “virtually no natural childbirth” in either survey.

In the 2006 survey, around 50% of women were artificially induced; almost 75% had an epidural; and 33% gave birth by c-section.

Finally, in a review of the safety of home birth by the esteemed Cochrane collaboration, the study author states:

There is no strong evidence to favour either home or hospital birth for selected low-risk pregnant women. In countries where it is possible to establish a home birth service backed up by a modern hospital system, all low-risk women should be offered the possibility of considering a planned home birth…

I agree with the author’s conclusion that hospital birth is no safer than home birth. But if you consider the statistics above which suggest that having a natural, undisturbed birth in a hospital setting is exceedingly difficult, I would argue that there is strong evidence to favor a home birth.

Birth complications are more likely to occur in a hospital environment

A common defense of hospital birth by medical professionals and laypeople is the assertion that it’s necessary to be in a hospital during birth in case something goes wrong.

While it is certainly true that complications may arise during labor that require medical intervention, what is often ignored by proponents of hospital birth is the fact that such complications are more likely to occur in the hospital environment.

In other words, the distortion of the process of birth – what Buckley calls “disturbed birth” – has come to be what women expect when they have a baby and in a way has become a self-fulfilling prophecy.

As Buckley states:

Under this model women are almost certain to need the interventions that the medical model provides, and to come away grateful to be saved no matter how difficult or traumatic their experience.2

TV shows almost always depict birth as some kind of medical emergency, with the woman being rushed down the hallway on a gurney or connected to machines and wires in the delivery room surrounded by medical personnel. Since most people have never witnessed a home birth (or any other birth) before giving having a child themselves, their impression of what labor is like comes almost entirely from television.

It’s easy, then, to understand why people are afraid of birth and feel the need to be in a hospital setting in case something goes wrong. But that doesn’t mean giving birth in a hospital is safer. The studies I’ve presented in this article demonstrate that it’s not.

I want to be clear: no matter where birth takes place, complications may arise that require medical intervention and I am 100% in support of it in these cases.

When the mother or baby’s life is at risk, we are fortunate to have access to surgical techniques that can save lives or prevent serious complications.

The point I am making in this article, and will make in more detail in the articles to follow, is that the scale of medical intervention in birth today is not only far beyond what is necessary, but is contributing to the very of the problems it attempts to solve.

If you’re interested in learning more about natural childbirth, I highly recommend Buckley’s book Gentle Birth, Gentle Mothering. I’d also suggest checking out her free eBook called Ecstatic Birth and her eBook/audio package Giving Birth At Home.

Note: this series will very likely be interrupted by the home birth of my own child. Elanne is due on the 17th of July, so the baby could be coming anytime. When that happens, I’ll be taking some time off to spend time with my new family. I’ll pick this up again when I return from paternity leave.

Articles in this series:

  1. Buckley, Sarah J. Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices. Celestial Arts, 2009. pp. 96
  2. Buckley, Sarah J. Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices. Celestial Arts, 2009. pp. 96

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Comments Join the Conversation

    • Zac says

      What happens when the baby has meconium aspiration and the midwife is unable to suction his lungs out? I’ll tell you. 20 minute ride to hospital with barely alive baby. 17 day stay in NICU because of HIE. And then Cerebral palsy. For life. That’s what we’re going through. Fuck home birth.

      • Aundrea says

        Zac, home birth has things present to take care of these types of things. A GOOD midwife can control those situations. You can’t blame home birth. It’s not home birth, it’s the doctor you choose.

        Terrible things are just as likely to happen at home than a hospital.

  1. Noon says

    I’m keeep 90% paleo and do believe in the basic philosophy behind it but this is just ridiculous. Most people in the world have natural birth most people in the world, in 3 world countries do not have access to hospitals. Are you seriously trying to say that they do it by choice??? what kind of dumb thing to say is that??

    “I want to be clear: no matter where birth takes place, complications may arise that require medical intervention and I am 100% in support of it in these cases.”

    DUH!!!!!!!!!!!!!!!!!!!!!! well wouldn’t it be nice to do it in a hospital where you do have access…JEEZ…no wonder paleo has a tough time catching on, because of dumb things like this!!

    You can argue that you shouldn’t use drugs but what is the advantage of not being in a hospital? there is always a risk…when my baby was born his umbilical cord was wrapped around his throat thank god we had a doctor…

    • Chris Kresser says

      I guess you didn’t read the article. I listed several advantages of not being in a hospital, including fewer complications, lower rates of induction, lower rates of forceps use and c-section. In the articles to follow, I’ll be explaining several other advantages in great detail. You are clearly misinformed, and haven’t provided any evidence to support your objections. You’re just spouting off conventional wisdom, with nothing to back it up.

      • Chris Kresser says

        And, in the Netherlands, where people do have access to modern medical care, 33% still choose home birth and perinatal mortality rates there are as low or lower than low-risk births in hospitals.

        • Christy says

          I worked in high-risk delivery/NICU in a Canadian hospital for 7 years.
          Get a mid-wife. Get a doula. Stay at home.
          Midwives are VERY well educated and will take excellent care of you. If you don’t like the risk of being too far away from a hospital, take your ‘birth team’ with you.
          They will at least give you a fighting chance from all of the standard hospital interventions that lead to C-sections.
          Don’t be fool and blindly trust the hospital system. Read. Read a lot! Then decide what you think is best for YOU.

          • Elaine says

            In Canada (and in Europe/Netherlands/UK), midwives are educated nurse-midwives. Not so in the majority of states in the US.

            Recent data (2012 and 2014 CDC data) shows that, in the USA, 2x to 4x more babies die per 1000 births at home than in the hospital–when delivered by midwives.

            According to the Midwive Associaton/MANA’s own data, over 22% of first time moms had to be transferred to the hospital, and 3 out of 1000 infants died–much higher than the rate in the hospital (with higher risk pregnant women).

            • says

              Elaine, your information is inaccurate.

              In Canada, Registered Midwives (R.M.) are NOT nurses.

              One can be a nurse, but the 4 year university Midwifery Education Programme is required for practice. An RN is definitely not required for midwifery practice.

              Most homebirth transfers are for long labours (usually the baby is persistent posterior “aka back labour” – an occurrence that is about 30% of births). A homebirth transfer is not, in and of itself, a problem and most transfers are medically boring.

              The model of care chosen in Ontario specifically identified the need for midwives to be competent in both home and hospital settings. In fact in Ontario, Registered Midwives are required, by law, to meet minimum numbers for homebirth deliveries.

              While the models throughout the US vary, there is ample research other than what you are citing to show the safety of planned homebirth.

              For more information, check the AOM website at: http://www.ontariomidwives.ca/care/birth/home

      • Serinitee says

        Hello. Thank you for providing this article. I’m currently doing research about the safety of home birth vs. hospital birth in the United States. I noticed that the studies you provided were located in Britain and Denmark where the birth culture is considerably more positive towards midwives and natural birth. Also, only the study from Denmark had a date on it that was satisfactory for my needs. Do you think that you could provide me with some recent statistics in the United States, where in many states, practicing midwifery still isn’t even legal? I haven’t been able to find any that haven’t had strong indication of biases after further investigation. My thanks if you can assist me.

        • Elaine says

          It’s legal to practice midwifery — in some states, it’s illegal to NOT be a trained medical professional and practice midwifery (nurse midwife).

          In Europe, all midwives are highly trained, there is universal prenatal care, AND all high-risk mothers are mandatory opt-outs of home births. This is not the case here, to the detriment of the babies who die because of the lax policies.

          (He didn’t include US studies, because they show the opposite conclusion of safety than do those from developed countries with universal care and high midwifery standards).

          • anahi Rodriguez Peria says

            I want to know what happens when there is a problem, undetected before birth, with the baby or the mother. What the doctor or the nurse or dula do, if the baby need resuscitation? what if they need oxygen? how the do resolve the emergency?
            how do you know, even if the baby would die anyway, if it was possible to do something else to save his life?

            • Shawn Gallagher (@ChildbirthJoy) says

              Ahani – you are asking very good questions.

              First – a doula does not provide any medical care and would not be involved in any newborn resuscitation or providing care in any emergency .

              Anyone who attends birth (i.e. doctors, nurses and midwives) are required to be trained in newborn resuscitation and have the appropriate equipment on hand.

              Also, they have the exact same questions you do and all their training and care provided is to ensure the best outcome possible. Just know, however, that medicine is not an exact science and, for the most part, there are typically many correct solutions for any given problem.

              The short answer is that the majority (over 90%) of babies are born healthy and breathing. Apart from the fact that giving oxygen to a newborn can cause damage, it is vital that a baby is breathing within the first minute of birth. Drugs such as narcotics (demerol, morphine) that can be used in labour act as respiratory depressants and can chemically prevent a baby from breathing. The safest birth is one that is without medications to start labour, move labour along or provide pain relief because all medications affect the baby.

              There are many types of emergencies, that while rare, require immediate attention and health care providers receive training for this. For example, midwives in Ontario re-certify on a regular basis in Emergency Obstetric Skills.

              Nobody ever knows for sure how a birth will unfold, which is why a practitioner with appropriate skills and training is a good thing. It is the responsibility of the parents-to-be to become informed in pregnancy by asking specific questions of the health care provider.

    • Chris Kresser says

      A nuchal cord (the umbilical cord wrapped around the baby’s neck) doesn’t necessitate medical intervention, except in extreme cases. A nuchal cord occurs in 20 to 30 percent of births, and is usually easily loosened, or the baby can be “somersaulted” through, as described by Mercer et al.. Cutting a nuchal cord removes the baby’s blood and oxygen supply, which can have devastating effects (such as cerebral palsy) if the baby’s first breath is delayed by shoulder dystocia or other birth difficulties.

      • says

        Chris, I’m going to stand in defense of this woman because I too am really grateful that when we needed an OB there was one. I lost 4 pregnancies before having my son and lost 1 following him. You can say all day long that the natural way is the best way on whatever topic it applies but there is always an exception. You can’t tell a woman who’s baby was at risk that her’s shouldn’t have been intervened. My son was frank breech, two common problems with frank breech first babies are the cervix closing down on the neck and hip dysplasia. You would probably say, I shouldn’t have gotten a c-section because this is only a problem with X percentage of frank breech births. I would disagree that for me, if I can avoid that risk by having a c-section, its a no brainer. Especially after 4 miscarriages. Some of us are quite grateful that someone intervened and made sure that our baby was born safely.
        I think what a lot of people forget about our homebirth only past is that a LOT of women died before their time due to childbirth. It was the most common cause of death historically for women. I wish I could remember where I read it but there is a blog regarding a 3rd world county with limited hospital access and the women there with the use of lay midwives will sometimes labor for days at home because the hospitals are so far and hard to access. They often lose their first babies and develop bladder and rectal incontinence. They leak waste all over their legs and become outcasts of their society. OBVIOUSLY, this is not happening in the US…..thank goodness, we’ve come further than that in our society. This is though what can happen when things are left to nature.

        So please don’t patronize her by giving her a statistic. She had good reason for her response, maybe she didn’t go about it the best. Ok. I’m done.

        • says

          FWIW, I really feel that if I had attempted a homebirth I would have risked my life. I have a clotting condition related to pregnancy (antiphospholipid antibody syndrome), which is why I lost so many babies in my past. I also had an abnormal septate uterus which required surgery to correct and likely had a part in my son’s breech position.

          I have friends who are fans of homebirths and have had very successful ones, I think thats great. I wanted one too once upon a time. Then I had all this trouble. I would offer a friendly reminder to the ones who are big homebirth fans to not be insensitive to the ones who cannot. If I were a woman of the 1800s, I would be a barren woman. Possibly considered a witch because of all my losses.

          • Liz Downunder says

            I don’t imagine anyone would question your decision not to homebirth!! You are exactly the type of woman that the hospital system is there to serve.

          • Sherri Holley CPM says

            The one thing that everyone keeps talking about is the women of 1800 and earlier. Most people think that just because Doctors were slowly beginning to be in the childbearing realm, is that these doctors saved the women and babies. Not so, you can easily read the history and see that once women started going into “laying in hospitals” for the births or Doctors came to your home. The women died by the 1000′s very easily under the physican’s care.
            Why were things so bad then…. the germ theory just started to be thought of, many physicans did not wash their hands or aprons from patient to patient. They in fact were killing these mom’s and babies and it was easy for these infections to go from woman, to woman and affected the baby’s. As the advent of science came about to test for certain diseases and conditions, the”odds” at coming through birth alive got better.
            The true fact that has been shown in thousands of studies is: home births are as safe if not safer than a hospital for a woman who is lower risk. Hosptials are there for a reason, and can often save the lives of women and babies who would not have made it through their process a hundred or more years ago. To the woman who had the clotting problem, this would have been found in normal bloodwork and then followed up to see the extent of the clotting problem, so you would not have been acceptable for a home birth anyway. I too have a clotting problem but I went on to have my children at home with no problem because it was dealt with. I have deal with other women with these problems also. I’m glad women who want to have their babies in the hospital can, and those of us want a out of hospital birth center or a home birth can also have that option. I am a Midwife of 32 yrs and have attended several thousands of babies. never lost a mother or baby to date. I do not attend births in the hospital because I do not choose to do so. By the way I lost 10 babies because of my clotting problem that was not picked up by the doctors. Once I found out because a Midwife ordered the right testing, I was treated.

          • virginia says

            melody d. i also have antiphospholipid antibody syndrome. the apparent risks are miscarriage, intrauterine growth restriction and preeclampsia, none of which affected me! the medical protocol is to take blood thinners and be induced at 38 weeks. instead i undertook preconception care and took herbs to counteract it and suffered no ill effects, then went on to have 2 homebirths with healthy babies weighing 3.95kg and 4.49kgs. its a shame you trusted the medical model instead of looking into natural therapies for treatment!

        • says

          “You can’t tell a woman who’s baby was at risk that her’s shouldn’t have been intervened.”

          That’s the thing, he didn’t say that. Not once in the article did Chris say that people shouldn’t use hospitals.

          If you’re at risk, go to a hospital. If you have a low-risk pregnancy, be mindful that the hospital might not make your delivery any safer or easier.

          Either way, the fact remains, that you are free to use a hospital. However, the AMA is increasingly aggressive about limiting access for midwives, and lobbying to make home births illegal.

        • cheryl coburn says

          In response to above where women become outcasts, it wasnt due to childbirth that these women leak waste its because they have been brutally raped and their bodies dont function properly because of the rape not from childbirth, women are meant to give birth its a natural process if everytime a women birthed our bowels and bladder stuffed no one would be having babies, rape however especially brutally like these women endure from soldiers etc does damage lots of it

          • Beth says

            It’s more complicated than that. Birth does actually cause “Obstetric fistula”. But it’s usually a result of malnutrition during the mother’s development. Conditions such as rickets, during childhood, can cause deformations in the hips that allow the baby to become stuck in the birth canal for long enough to cause tissue death.
            I myself had 2 homebirths, am an aspiring midwife, and barring a real problem would encourage my daughters to birth at home.

            • says

              Obstetric fistula can happen to anyone. Even a healthy woman in an industrialized country. If you search, you will find groups of these women everywhere suffering from one the most horrific complication for a woman postpartum.

        • Comadrona says

          Melody, as a midwife I would never argue about your right to have a C/S in hospital if that is your choice. The problem is that women’s choices are being killed off by downright lies and misinformation about homebirth and breech vaginal birth, for that matter. The Term Breech Trial, which is the reason most breeches are now born by C/S, has been shown to be suspect and unethical, and there are many vested interests who would like to shut down homebirth altogether – not because it is not safe, but because it takes control and income out of medical hands. I have a few medico friends who have admitted to me that they like C/S because they get more money for doing less, it is quicker and they don’t have to hang about for hours waiting on Nature to take its course. This is NOT evidence -based practice! This is criminal and wrong-headed and women are being scared into unnecessary surgery which can impact badly on them and their children for the rest of their lives. The main cause of death in developing countries, by the way, is not obstructed labour but anaemia followed by post-partum haemorrhage. Women need perinatal care (so that problems can be picked and dealt with before they become life-threatening) and they need proper food – with both these things, the incidence of maternal and infant mortality would plummet. Obstructed labour does happen, but one of the main reasons is totally preventable – FGM. If there were enough well-resourced and trained midwives in every country, with nearby hospitals for extra help if needed, 3rd world countries would be much better off. The other problem is that people think that S**t doesn’t happen in hospitals – Oh Yes it does! Mistakes get made, infections get acquired, babies and mothers die – sometimes it can’t be helped and sometimes it is iatrogenic. Every women is entitled to make an uncoerced informed choice about how, where and with whom she will birth – and that includes out-of-hospital birth!

          • Erin says

            I completely agree. As a military member, I’m being told that I need to give birth in a hospital “for my own protection.” I’m angry, and I’m trying to find a way around it. I do not believe it is a valid stance, especially one not based on research favoring hospital births over planned home births (key word being “planned”).

            It’s horrible not having choices.

            • Sherry says

              Erin, I am a military wife and I had three babies at home. Talk to the pediatrician instead of the obstetrician. I have found the peds doctors to be supportive. :)

              • Erin says

                Sherry,

                I’m not a military wife – I am a military member. Tricare specifically refuses to cover anything “in home.” I can’t even go to a hospital off base. It’s one of those things I wish they would make VERY CLEAR to enlisted female members upon joining. Had I known this a few months ago before I got pregnant, things would be very different right now. As in I honestly wouldn’t be pregnant. It, excuse my language, is quite the crock of sh*t.

                • Comadrona says

                  Erin, maybe you should just quietly labour at home as long as possible and go to hospital at the last moment. Can you hire a private midwife to keep an eye on you? Anyhow, what are they going to do if you give birth at home? They surely can’t fine you or sack you? If your insurance doesn’t cover it (just like here in Australia for the most part) can you just pay for a midwife out of your own pocket?

        • anahi Rodriguez Peria says

          Melody,
          I really agree with you 100% a friend of mine, just have suffer the death of her baby because it was not time to do anything at home. This terrible thing that happen to my friend, didn’t happen in USA, but anyway all over the world people is doing this, and can be pretty dangerous. I don’t think we are the same people we were 200 years ago, and our bodies even less , if we have babies at home we should try to be prepare for everything and anything!

      • Sherri Holley CPM says

        Midwives know how to take care of a nuchal cord ( cord around the neck), such as described by MERCER et al. Nuchal cord is quite common and rarely does it need to be cut prematurely.

    • Jill says

      I think you can voice your opinion without being so rude. It’s a sign of maturity to show respect for the author of this post – whether you agree or not.

    • Sheva says

      Having the cord wrapped around the neck is a very common thing (approximately 1/3 of babies are born this way). It is almost never a danger to the baby. I caught one baby unexpectedly in a very non-traditional setting (very fast labor and second stage) in the caul with the cord wrapped and a hand presenting with the head. In a hospital this scenario would have been considered an emergency. Yes, we were lucky. But this scenario is just a variation of normal birth, not an anomaly, and doctors are just too narrow minded to see it that way.
      Great article, can’t wait to see the rest! And best of luck on your child’s birth!

    • phoenix says

      My first baby was born at home, with his cord around his neck. My midwife moved it. My second baby was born at home and I suffered a hemorrhage afterwards due to retained placenta. My midwife fixed that too. I am utterly convinced that I would have been worse off in a hospital, both times, due to the prevalence of unnecessary interventions as well as the lack of control of the atmosphere in which to give birth.

      • Jo says

        Yup, mine came out with cord wrapped twice around the neck. I caught him myself in the water and just intuitively unwrapped him before bringing him up.
        I hemorrhaged with my first in the hospital and with the second baby, at home, I was afraid it might happen again. So much so that I subconsciously refused to push out the placenta for several hours. When I did finally do it, I placed a small cut out piece of the placenta inside my cheek. I didn’t bleed much.

        I cannot imagine ever giving birth in a hospital again. The homebirth was just as painful as the hospital one, but because I was left in peace, I was able to handle it quite well. Bi labored completely alone for four hours, no disturbance–luxury.
        Pushing was done on *my* terms and lasted 15 min compared to 2 hours with the first hospital birth, where I was forced to be in a reclining position, as well as instructed to restrain from the urge to push for 3 hours before eventually starting the second phase. It was a busy night in the hospital and my midwife probably didn’t mean to keep me hanging for that long. Industrialized birth, for sure.

    • says

      My second daughter was born unassisted (accidentally… it was REALLY fast) at home with a nuchal cord and I had to somersault her through. I didn’t even have to think about it. My husband was just standing there in complete shock :)

      • Natalie says

        Great work, Mama! If this ever happened to me I would hope my “instincts” would kick in, too! (and I would assume my husband would faint).

      • Megan says

        I’m so glad you shared this. When people think of Midwives for some reason they are under the impression they have no formal education. That is absolutely not the case. Any licensed Midwife has formal education (Certified Nurse Midwives are Registered Nurses first and foremost) and is trained to deal with the “emergencies” that may come about during labor and delivery. Thank you for sharing your experiences of homebirth with complications and highlighting that a Midwife is trained and prepared to handle such complications!

    • Christena says

      A midwife can unwrap a cord too. And the midwife is there throughout labor, not just for the last few minutes like the doctor, and will know early on if something is not going well. They are so much more in tune with the mother and baby. The stress of being in a hospital (read about the hormonal response of any animal in labor when a stranger approaches…how many times does that happen in the hospital? Try every couple of minutes), the body position during labor (in a bed, mobility limited by monitors, so labor slows, the pelvis can’t fully open, etc.) contribute to all the complications that the hospital then needs to fix. Take away the hospital, and you take away a lot of the complications of labor and birth.

    • Tabitha says

      About 1/4 of all babies are born with their cords around their necks, but as long as the cord is not clamped they are fine. My second homebirthed child had a cord around her neck, and the midwives unwrapped her. No emergency, just action. There are many advantages to being at home. The germs in one’s home are one’s own, meaning a laboring mother already has immunities and antibodies to the germs/bacteria in her space. In the hospital setting there are many contagious bacteria that the mother is not immune to, increasing her and the babies chances of Post Partum infection. The chances for episiotomy or cesarean section in the hospital are far greater than at home, in most studies homebirth transfer patients had a 5-10% csection rate vs a33% and up rate for moms choosing to deliver in the hospital setting. Up to 30% of women recieve genital cutting, i.e. episiotomy in the hospital, with individual doctors rates going as high as 100%. There is no medical reason to do this. Tears heal better, but evidence based care is not generally practiced in American obstetrics. Women who feel safer at home should deliver at home. Those who want the hospiatl can have it.

    • swinthe says

      you don’t need a doctor to unwrap the umbilical cord. That’s a thing that happens all the time and I saw many midwifes unwrapping it and everything was fine! (by the way I’m a midwife student working in a hospital and I’ve seen MANY things I wish I had never seen. It makes me ANGRY what doctors do with laboring women in hospitals…and the women are just thankful and don’t realise how DIFFERENT it could be!

      It’s ur own choice, but after what I saw the hospital is the last place I want to give birth to my child (it’s just good for emergencies)!

      • Julia says

        Thats the thing- homebirth sounds a lot better but emergencies are just that- emergencies! they aren’t planned and when it comes down to the possibility of the mother or child dying or having lifelong complications because they don’t have quick access to a surgical team or blood transfusion whatever, I think it is irresponsible to think the answer lies in avoiding the safest place and not in changing the methods/processes/attitudes that are so common and negative in the vast majority of hospital births. My guess is that as homebirths increase sadly so will homebirth tragedies and the medical community will have to start getting the message. It is just unfortunate that people stand on one side of the fence or the other not realizing you could just walk the rail and enjoy the view. There are complications that arise unforeseen which a midwife does not have the tools or training to handle and the attitude on this board is one of “a midwife can handle anything just as well as a doctor” which simply isn’t true. However I completely agree that doctors and nurses in hospitals typically make the birthing process extremely uncomfortable and basically force “treatments” on the vast majority of women who would probably be blown away by the high of the experience if they were encouraged and properly supported to handle it naturally as is the norm in home births

        • Sheva says

          Like what? You say there are complications that midwives don’t have the tools or training to handle. Can you give a few examples?

          • LB says

            How about a spontaneous pneumothorax (collapsed lung) with meconium aspiration into the chest cavity. My pregnancy was completely low risk, yet my perfectly healthy boy would be dead if it weren’t for the presence of a NICU team. And this isnt even that rare, 1 in 100 babies. It’s absolutely mind numbing to me that anyone would take a risk like this. For what? Candles and soft music in your living room? Grow up.

            • says

              LB – I am so sorry that this happened in your birth. It must have been very frightening for you.

              There are standard protocols of care for meconium regardless of who the primary careprovider is (MD or Midwife). The College of Midwives of Ontario, for example, require all midwives (by law) to follow specific standards for meconium. Particulate meconium is a Category 2 automatic consult with a physician. In the event of a planned homebirth, the midwifery team would transfer from home to hospital so that respiratory therapists are available if needed. See Mandatory Discussion, Consultation and Transfer under Standards at http://www.cmo.on.ca/policies.php

              There are experts who would even argue that with undisturbed birth (far more likely with a home setting), the rate of meconium is dramatically reduced because the mother`s autonomic nervous system is calm and capable of calming the baby`s bowels. Drs. Michel Odent and Sarah Buckley are well-known leaders in the obstetric community in this regard for anyone who is interested in learning more. The presence of medicine does not automatically mean the elimination of risk; medicine actually adds to risk in ways that we are just beginning to understand. For example, as a wonder drug, antibiotics are revolutionary. But Chris would one of many who explain more eloquently than me the damage they do the gut and more.

              It is not my intent to change anybody`s mind, especially those who are inherently frightened by birth. Fear always trumps logic and reason.

              The reason for my reply is your “grow up “` comment.

              You do not get to make medical decisions for me. I am an intelligent woman who has thoroughly reviewed the research and I am fully capable of deciding for me and my family.

              By all means, make comments (especially if you can resist doing do in a shaming way). However, please refrain from dictating what the rest of us can and cannot do – it is NOT your decision to make.

              • LB says

                Apologies for sounding so condescending, but having “been there” it’s hard for me to understand how people wouldn’t give their baby the best opportunity for survival. So you are saying that at the time meconium is found in broken water, that means an automatic transfer to the hospital in the case of home birth? I find that hard to believe but perhaps.

                My point is, in this debate the rare “what ifs” are often cast aside as something that will not happen to you. Well, it happened to me, and a hospital transfer once a midwife had discovered the pneumothorax would have been too late. My baby quite literally would have suffocated on his own feces. And this is not rare. REAL serious consideration of the risks need to be involved. My personal advice? Find a midwife practice that operates in a hospital setting. Do it for your baby, and relinquish the utopian notion that your birth won’t be the rarity.

                • says

                  LB – those of use who have planned homebirths have done so because the review of the science has convinced us that this this the safest approach for our babies. I realize that this may sound incredibly foreign to you, but when you really look at the research and you really know how many problems are actually caused by the hospital system, this starts to make sense.

                  For example, I was at a hospital birth about two years ago where the women declined Pitocin after the birth (she has some rare biochemical pathways that do not process meds appropriately) and because the MD had never delivered a placenta without this particular pharmaceutical, he totally messed up the process…long story short, she ended up with a serious postpartum hemorrhage about a day later….and a nightmare in terms of recovery after.

                  Hospitals are known for iatrogenic infection and many Americans and Canadians die every year just because they picked up a hospital induced infection (if you look at the actual figures, it is really quite alarming). We know that some obstetric drugs have actively killed healthy women (i.e. Cytotec)…so please, do not assume that “hospital” equals “safe.” All settings have risk…no setting is risk free. Parents need to review the research and decide for themselves what risks are acceptable.

                  Yes, absolutely, in our system in Ontario, meconium is a homebirth transfer. All Ontario midwives are required to have hospital privileges and homebirth transports are handled professionally as a result.

                  The reason that Ontario midwifery requires, by law, competence in both the home and hospital settings, is that Ontarians saw a fractured midwifery model in the US that resulted in homebirth midwives in one corner of the “boxing” ring and hospital birth midwives in the other. We decided that the best midwives work in both settings. I agree with you that your midwife should also have hospital privileges.

                  Again, I am so sorry that you experienced this very, very difficult situation for your baby. I am so glad that your baby is doing well. And while you perceive that your experience is a 100% incidence (because it happened to you), heavy meconium that causes severe respiratory distress is actually not common. In the old days, the MD would physically prevent the newborn’s first breath by pressing all of his/her weight on the chest. Today, this would be barbaric and is no longer done. The old protocols of suctioning and intubating regardless of the type of meconium have been updated based on research and are no longer considered standard practice. In fact, most newborns can handle light meconium in the lungs without distress. These babies have their sterile feces in the lungs and it is ok. Heavy meconium is usually problematic, of course and best dealt with in a setting that has intubation capability.

                  It is like saying that “all fever is dangerous.” But a fever of 38 degrees Celsius is different than one of 41 degrees. Also, the other signs are relevant (age of the person with the fever, other illnesses, etc). And most fevers are actually beneficial because the body uses the heat to “burn off” the pathogens. Today, more health care providers advise against using over-the-counter anti-febrile chemicals to reduce a fever that is under a certain level – the fever is a good thing.

                  I drive on highways that have rare chances of catastrophe. And I have my children with me in the car. Thee are lots of decisions that we, as parents, need to make that weigh to decisions of risk. Again, as much as we like to believe that a particular choice “guarantees” protection, place of birth (home or hospital) is never a guarantee.

                  For all the trauma that I’ve seen and all that I know about serious obstetric consequences that are possible, if I were to have another baby, I would definitely choose homebirth again. And this is my choice.

                  It is not my decision to decide for another. Nor is it your decision to decide for others.

                  You may not understand it, but intelligent, well-educated and well-informed parents are deciding what is best for themselves and child and it is not our place to tell them what they can and cannot do.

                • Jo says

                  You may need to relinquish your naive notion that no one dies in a hospital… People die in hospitals, including new mothers and newborns. People are injured and harmed in hospitals, including new mothers and babies. That’s just reality. Humans are not immortal.

                  I choose to home birth partly because I knew it would be safer. Some women may feel completely at home in a clinical setting with strangers poking and prodding her with regular intervals while birthing her baby, but many find it difficult. Humans are not unlike other animals in that they intuitively seek out solitude during labor. Michel Odent, and I see he’s been mentioned before in this discussion, has written extensively about how labor complications often arise from having this need unmet. Ina May Gaskin also likes to refer what she calls the sphincter reflex. Imagine taking a crap in front of strangers, or anyone really. It’s just not as efficient. Lack of efficiency has its consequences. Physiologically, that baby is meant to come out rather quickly. Hospital births aren’t known for being quick, though certainly many are. For me, hospital birth was 27 hours, home birth 4. And sure it was my second child, but my kids are 6 years apart. The first time, my midwife was so busy with other moms that she left me alone for 3 hours with instructions not to push because there was a lip. After I struggled with fighting off the urge for who knows how long, my labor stalled. That I hemorrhaged quite badly after the birth may have something to do with that. I was completely exhausted. My son had jaundice.

                  Fast forward six years. I labored for 4 hour. When I felt the urge to push, I pushed. And I did so without reclining in a bed. For the first time I felt what pushing is supposed to feel like and I’m certain that me being able to act out my animal instincts (I won’t go into details here, but suffice to say, whatever I did then I would not have had the decency to do with strangers around me). That lasted 10 minutes. My baby was healthy, no jaundice, no complications.

                  My hospital experience was much more unsafe than my home birth experience. At home, I was able to labor completely undisturbed for the whole duration of first stage (save for a couple of short intrusions from hubby) and it made a huge difference. While the pain was extreme, due to some back labor, I was able to manage it as long as no one was around. Whenever my husband appeared, the pain would become intolerable and I would panic. It felt like at the hospital, only there, the panic lasted for at least 20 hours compared to a few seconds at home!

                  According Odent, it’s this that easily can lead to complications because of the increase in stress hormones. And yes, the presence of meconium is one.
                  I’d much rather not have complications than expose myself to an environment that is known to increase the risk. The vast majority of women are obviously unaware of this, but something tells me most of them would still choose the hospital. Because it’s likely not so much about what is truly the safest option, but that we follow the norm. Well, the norm can be heavily influenced by misinformation.

            • Robert says

              Our first son was the product of a completely uneventful full-term gestation. He was OP as we began delivery, so three hours of positional pushing ensued, followed by the discovery that the cord was wrapped. He was 8 lbs. 8 oz. and suffered a spontaneous pheumothorax unrelated to mecomium aspiration. It was immediated diagnosed in the NICU, and he was intubated, and mecahnical ventilation through his chest wall not only saved his life, but within 24 hours he was out of the box and feeding, with his very relieved mother. Had we not been in a hospital setting, his exposure to delayed diagnosis, delayed treatment, and potentially catastrophic infection and anoxic brain injury would have increased exponentially. He’s a perfectly healthy happy four year old today. Two takeaways, no-one and nothing, not your midwife or your ob/gynor all the books you want to read, can prepare you for all the unforseen possibilities of childbirth. Put yourself in the best position to avoid catastrophic injury by going to the hospital. Yes people die in hospitals all the time – becuase they have conditions that put them there in the first place. Yes people get infections in hospitals, but attributing the general rate of infection in hositals to the labor and delivery suites is just clever marketing by midwifes. The second takeaway – confirm that your midwife has a lot of professional negligence insurance. The lifetime cost of a newborn with anoxic brain injury is about $13 million, conservatively.

        • Jo says

          It is *not* irresponsible to avoid hospitals when giving births, on the contrary. Many life threatening things happen *because* a woman was in the hospital in the first place. It’s called unnecessary medical interventions that end up where it shouldn’t have ended up. Most true birth related emergencies don’t require attention within seconds or minutes, thus a home birthing woman usually has time for a transfer.
          You admit yourself that hospital staff force treatments on women–do you understand what consequences this may have? It’s *not* merely a question of having a ‘high experience’ or not. It’s a question of safety. And this is one major reason I decided to birth at home. Read the article to find out why this is so. I would recommend to anyone objecting to the title to first read the article before commenting.

          • says

            Jo – your births are an important teaching about the understanding that both Ina May Gaskin and Dr. Michel Odent provide – birthing women need to feel safe and protected.

            I am so sorry to hear about your difficult birth. It must have felt wonderful to know that your body is capable of birthing naturally. :)

            • Jo says

              Thank you Shawn! Yes, it was probably the most amazing experience of my life. In a very non-hippie, non-touchy-feely, non-utopian kind of way;).

              If it wasn’t clear, my response above was directed to LB. It looked like it was to you Shawn, maybe. I forgot to mention her by name.

          • Elaine says

            No one during my (complicated) hospital birth “forced” anything on me. I was unmedicated, and coached in laboring how I pleased.

            Your experience was a bad one; just as many home birth experiences go badly–in my state, the latest numbers show 4-5x the rates of death in home births than in hospital births. That is the bottom line for me. Many women choose “unnecessary” interventions, such as pain medication, because it’s there choice. I chose not to, but don’t begrudge women who do.

          • Daleth says

            Where did you get the idea that, as you say, “Most true birth related emergencies don’t require attention within seconds or minutes, thus a home birthing woman usually has time for a transfer”?

            Here are just a few of the most common birth-related emergencies that require attention within seconds or minutes:
            - Shoulder dystocia
            - Cord compression
            - Placental abruption
            - Post-partum hemorrhage

            Also, when was the last time you tried to get a woman in active labor from her laboring room (or pool) into a vehicle? Any thoughts on how many minutes that might add to the hospital transfer process? And how much time do you think it adds to the process to get her from the front door of the hospital to an emergency room with emergency obstetricians, and to get the doctors to understand what’s wrong with her (if she’d been laboring in the hospital they would already have blood pressure, fetal monitoring, etc. info and would know what was wrong as soon as the problem arose)? And how long would it take to (if needed) get an anesthesiologist over to ready her for an emergency c-section?

        • britney says

          Seriously? O.o Midwife’s can help you just as much as a doctor if not more. The doctor is only in the room for the birth the whole time it is a nurse. And there are also alternatives like home birthing centers which give you the advantages of home birth with a midwife, but there is still a doctor on hand, one day when I have kids I think that is option I will choose.

          • Daleth says

            Midwives can certainly help *with a normal birth* as much as a doctor if not more.

            But if anything goes seriously wrong? That’s what the doctors are for. And BTW birthing centers generally do not have doctors present, at least not in the US.

            There are plenty of hospitals where you can get all your prenatal care from midwives and deliver with midwives, so if your birth goes fine you have the midwife experience you wanted… but if something does go wrong there are doctors right there to save your baby’s (or possibly your own) life.

    • Elainie says

      My 4th child had her cord around her neck 3 times- it was even something I knew would happen at the birth in early pregnancy and I told my midwife that. I had her at home without any complications, we just flipped the cord over and then the rest of her body was born safely.

    • Celeste says

      Cords wrapped around the neck are no emergency. They are long enough to not choke and a midwife in a home can just as easily unwrap the chord as a doctor can. The author just wants to dispute any misconceptions about their belief in westerb medicine all together. It’s just that unnecessary interventions of all kinds, especially in birth, have been proven to be dangerous, and it tends to be overused in hospitals everywhere. There is a ton of research to back all of this up. I think you misunderstand the whole article. Re read it and check the resources cited.

      • Jo says

        The mother can easily unwrap the cord as well, which is what I did. I caught my own baby and upon feeling the cord I unwrapped it. I don’t really remember it because it was an act of complete intuition. My husband is the one who remembers those details.

    • Sherry says

      One thing I learned from having two babies in the hospital with two different doctors is that doctors do not know much about childbirth. If you expect a surgeon to deliver your baby, you should expect to be cut. I was cut with both doctors. With my four other babies, including a set of identical twins, I used midwives, had normal physiological births, and there was no cutting involved, no stress at all, and so much less pain! I would never tell someone I love to birth in a hospital. As far as I am conserrned, hospital birth is not a viable option.

      • Daleth says

        Those two doctors and that hospital don’t represent all doctors or all hospitals. I’m delivering at a major teaching hospital and their episiotomy rate is like 4%, so 96% of mothers there do not get cut. To quote the doctors I’ve been seeing there, they “NEVER” do episiotomies unless it’s the only thing left, short of a c-section, that can get the baby out.

    • Aundrea says

      My birth story:
      My son was compelatly healthy, perfect pregnancy, everything. I went to my MIDWIFE and told her I was uncomfortable at 38 weeks pregnant. She offered to induce me. Being a first time mom I didn’t know anything about my options, what things did, nothing. So I assumed, like any new mom, pitocine was just as good as natural labor.
      I was wrong…. So wrong

      I went in at 6am on a Sunday, started the pitocine. My sons heart starting dropping at a fast fast rate. So fast he almost didn’t make it, the first time….
      They took me off the pitocine and started it again at 7am. Things where better then, but monitored close. I was on the monitor for the heart and contractions, on an iv of pitocine and on an iv for fluids so the pitocine would not dehidrate me. The contractions where bad, worse then anything I have ever felt. I sat at 3cm for 24 hours. 24 hours went by and still strong contractions and no change. What was happening is my body was being forced to go into labor and it didn’t want to. So I was suffocating my son with these contractions that where doing nothing for me. SO they where trying to push C secion I mean PUSH C section because the strain on my body was nearly killing my son. The doctors said either do a C section or get an epedural to relax my body. They said kept saying when I would be second guessing that it was “the best” for your baby. Like they where using my baby as a tool to get what they wanted. They where at this time sassy with me, cranky, tired didn’t want to even come help me. My midwife refused to give me a C secion so I got a epidural. The epidural relaxed my body enough to start dialating me. I finally got to a 10 after 6 more hours of labor. I didn’t however feel a thing. I started pushing at 11pm and had my son at 1:09 am on 1-11-11. I opened my eyes after the last push and seen blood all over my midwifes face, all over my spouse, my sister my whole family! The umbilical cord ripped in half when he was coming out because someone tried forcing it off of his neck the wrong way. He was not breathing…. not breathing at all… after 7 minutes of not breathing they finally resuscitated him and I was not allowed to see him for 8 hours. My son is alive… but I don’t no who to thank… I guess I can just say my son was strong on his own because I was to dumb to do any research.

      All of this happend from being induced and not given the proper knowledge and understanding of what pitocine does. Pitocine pushes your body into over drive to deliver your baby as fast as possible. Your body is being forced to go into labor, which puts lots of strain on your baby every contraction you have. Your babys heart goes higher and higher with each contraction. That was killing him. After 24 hours of that he was nearly dead because of the medical intervention. I couldn’t get up, was not offered the tub, was not offered anything but a C section. Thats all they offered, not anything natural to relax me to get me to dilate. I feel like I should have been told, I should have been notified what that stuff can do to you. I should have never done it and being hooked up to the machines and not able to walk around made it worse. Everything in this article was right.

      I can say from EXPERIENCE that doctors and intervention and that hospital almost killed my son and I wish I would have known better.

      I am due in less then 5 days from now with my second. I am doing a hospital birth, but I will have a sign on my door that says absolutely no intervention unless asked for BY ME, I will have a tub and I will be LEFT alone.

      Do your research before you have children. I can honestly say having children is more then just feeding and bathing. It starts before they’re even born, it starts with the parents and there knowledge. Taking care of a baby starts way before there even thought of.

      I can proudly say I nursed for a whole year even though doctors told me not to, that it was making my son fat. I didn’t listen. My son is now 2 years old and probably smarter then a 5th grader these days ;) Thank you for this article. Made me feel better about my natural decisions.

    • Steven Doletzky says

      Our new little boy is now almost 24 hours old and our 7 year old rock solid specimen of a human being is also injection, chemical and immunization free!! These lucky boys have a Mom who realized that nature and She have this figured out. Midwives know so much more about child birth than profit driven institutions.

      Fear in birth is certainly understandable but like all things it only blocks our natural strengths.

      • Daleth says

        Oh, your midwives didn’t charge you any money? That’s funny, most midwives charge $4000-$6000 to do a birth. Which, coincidentally, is also about what my local hospital charges.

    • Celeste says

      Yeah, I’m going to let an ignorant comedian decide for me what’s the best and least dangerous way to birth my child instead of doing my own research and using that smart brain of mine.

  2. says

    It’s also telling that OB/GYN insurance is the most expensive to obtain and maintain, due to the high legal risks. This will undoubtedly affect practice style. When your goal is to produce an alive baby, the mother’s wishes and opinions can suddenly seem beside the point.

    I feel very fortunate to have a hospital locally that encourages natural birth, provides access to water births, provides doulas free of charge, but also has the ability to perform interventions when needed.

    I encourage all potential mothers to do their homework, and your primer here, Chris, seems like a good complement. And to contrast the popular imagery of childbirth, as you mentioned, I highly suggest reading examples of mothers giving birth in natural ways and settings. Ina May Gaskin’s books, while a bit giggle-inducing due to the hippie language, are also full of birth stories that gave me confidence I could have an undisturbed birth. And I did.

    Thank you for contributing to the wealth of information out there about birthing without interventions.

    • Qu says

      “I feel very fortunate to have a hospital locally that encourages natural birth, provides access to water births, provides doulas free of charge, but also has the ability to perform interventions when needed.”

      I wish more hospitals would be like this: combining the natural with the medical (when it is needed).

  3. Elanne Kresser says

    Dear noon,

    I’m a glad that you have a healthy child and were satisfied with your hospital birth. Your reason for thanking God that you were in the hospital though, the cord around the neck, is one of the biggest birth myths out there. Babies are born with cords around their necks often. Midwives are just as skilled, perhaps more skilled, at dealing with this as doctors. Often the cord around the neck is not a danger at all as the oxygen supply is still coming to the baby through the cord and baby does not yet need to breathe through the nose, trachea etc. My niece was born at home with only my brother and her two grandmothers in attendance. The cord was wrapped around her neck and it was very simple to unwrap it and watch that little one begin to breath easily on her own. No problem.

    Women are told in the hospital that the reason their baby is having troubles is that the cord was wrapped around the neck. This is just not seen in home births. Babies in hospitals have troubles breathing because they are doped up on the epidural drugs and pitocin.

    As for women in many countries around the world not having home birth by choice, this is true. Sadly and to their detriment much of the rest of the world is eager to follow in our “advanced” footsteps. And it is also true that in many non-industrialized countries perinatal mortality rates are much higher. This is likely due to malnutrition and poor health. We know that how a woman is nourished through her pregnancy has a great effect on how she will give birth, her own health and the health of her baby. Weston A Price and others who studied traditional peoples eating their traditional diets noted how easily mothers give birth, often simply wandering off by themselves and returning hours later with a healthy baby. For much of the non-western world people are no longer able to eat their traditional diets and are in very poor health.

    There is a lovely African saying, ““The goat has no midwife but delivers with ease, the sheep has no midwife yet brings forth a live offspring, and you, little mother, will give birth to your baby.” To me this indicates a true understanding of how birth can be.

    • Terri says

      “Often the cord around the neck is not a danger at all as the oxygen supply is still coming to the baby through the cord and baby does not yet need to breathe through the nose, trachea etc.”

      If anyone has ever studied the unadultered birth process, they’d know that babies get their oxyegn from the umbilical cord until from 10-30 minutes or so after birth, when the cord starts pulsing, and the baby learns to breathe on it’s own. Cutting the cord in a nuchal cord birth, would actually deprive the baby, still half way in the mothers womb, of the oxygen. Usually the cord is cut with only thehead out, and the baby;s chest is still inside the mother – leaving no room for the chest to expand for breathing. This, in turn, causes the baby to have oxygen deprivation, which the doctors then blame on the nuchal cord, when in fact, the doctor’s themselves caused the oxygen deprivation. The cord was still supplying the baby’s needs.
      Now, that being said, it’s not a good idea to leave the cord wrapped around the neck of the baby and continute pushing! Doing so would leave the mother at risk of the placenta being ripped from the womb, rather than detaching naturally.
      Expertise – I’ve birthed 3 babies in a hospital setting with the cascade of interventions, 1 peaceful birth in a hospital setting where we refused to allow un-necessary interventions, and my husband and I are currently preparing for an unassisted homebirth of our 5th child, to be attended by our doula. Not being able to afford insurance can change your mind about what is acceptable and what is not. :)

  4. says

    I had all my kids naturally and 2 of them at home. I’m having my fourth in December, as a child I presenced many births at home and helped once or twice. I had the chance to go to Holland where almost 80 % of birth are at home. Women need a private, quiet setting, with minimum interruptions. Congratulations! your wife will do wonderful! great article!

  5. says

    I had a homebirth 3 years ago, and it was the best choice I ever made. I have a huge fear of hospitals and allopathic doctors, so I would surely have had a stalled labor, just because of fight or flight hormones pouring out of me in such a frightening setting. But I also had a 63 hour labor, with my water breaking 2 days before delivery. No U.S. hospital would tolerate laboring for more than 4-6 hours, especially after the water breaking (despite the fact that it is natural for women to labor longer, especially on a first birth), and I would have surely been induced and very possibly c-sectioned unnecessarily, at grave risk and cost to me and my family.

    At home, on the other hand, I was allowed to labor in the peace and comfort of my home, bathe, walk, and eat as I pleased, and finally give birth to a beautiful baby girl that really needed NO medical intervention to come into the world happy and healthy. In fact, my husband and I labored alone for all but the last few hours of it, truly owning what should be a transformative, if not spiritual, process for families. I was also able to rest and breastfeed in my own bed, within just a few minutes of delivery, while the cord was still attached and giving up its last pulses of blood and oxygen to my child. There is no way to describe this experience, it still makes me cry in joy to think about it.

    I cannot say enough good things about home birth for low-risk women.

  6. Rikke says

    Hi Elanne and Chris!

    Congratulations with the soon delivery; I was born at home myself (20 years ago), and thought for many years that it was the normal procedure. My friends were always stunned when I told them I was born in my parents’ bedroom.
    Birth was quick and completely free on complications. There was a midwife present (oh, and the rest of my family; my siblings at age 4, 6 and 8 years – they thought it was VERY exciting).
    I believe it’s much easier for the woman to relax in familiar surroundings; not that I really know, but it would seem natural to me.

    I believe you’ve made a wonderful choice, and I hope the birth of your son/daughter will be (relatively) smooth.

  7. Ink says

    Hi Chris, great article.
    I too had my first baby at home with an incredibly experienced midwife. the birth was smooth and amazing, if not also really painful :) Its so interesting to see the venom spewed at people that are proponents of natural birth or choosing to homebirth, as exhibited by Noon. She attacks your personal opinion on this subject and then holds you accountable for her observation about how popular the Paleo diet. It is sad to say that this behavior is very common. The fear that people now associate with birth, and seeing it as a medical condition instead of a natural part of life, goes to show how well the medical community has been able to manipulate people around this subject. In a situation like this one where “noon” felt it was appropriate to insult you directly and call you and your decision stupid, it is clear that no amount of information can educate a person on this topic. In my case some of my family members were so opposed to homebirth that we outright lied to them and told them our baby was born in a hospital. It is then ironic to me that all of my births have been fast and problem free while ALL of my relatives who have birthed in the hospital have ended up with major intervention, complications from the interventions, and about 50 percent of them have had c-sections (because the doctor felt that 12 hours was too long to birth.)
    I applaud and support your decision to birth at home, I wish that more of the west would engage in real conversation and thought that might help us return to a place where our children enter this life in a gentle, natural way. The subtle processes of human birth have been evolving for 100s of 1000s of years. The hospital births I have attended appear to me like the medical staff is constantly picking at a scab and then getting mad when it wont heal.
    Blessing on the birth of your child!

  8. Justin Ross says

    Yes, we’ve been giving birth “naturally” for millenia. Infant mortality rates were also stupidly high for most of that time. This is often cited as one of the main reasons that paleolithic life expectancy is so low, even when humans making it past adolescence had a pretty decent chance of living into old age.

    Here’s the thing with home birth: Even *if* there are more complications at a hospital, they’re better-equipped to deal with the unknowns that can arise.

    Eliminating “distractions”, “disturbances” and “interruptions” isn’t as important as giving your child every possible chance to make it past their first 48 hours. Whether the experience is “peaceful” or “traumatic” or somewhere in-between doesn’t matter. What matters is that you leave the hospital with a healthy baby. That’s all.

    —————————————-
    “There is no strong evidence to favour either home or hospital birth for selected low-risk pregnant women…”
    —————————————-

    Home birth is perfectly-safe… if you’re low-risk for things they can easily deal with in a hospital. The problem is, most people don’t know whether they’re low-risk or not.

    While I don’t trust the medical industry (and it IS an industry) to prevent sickness/maintain health, they have the tools and knowledge to deal with emergencies as they arise. The odds are, you’ll never need those tools/experience. If you did, though, could you really say you wouldn’t rather have them and not need them than need them and not have them?

    Related post:
    http://blog.dreamhost.com/2011/03/09/wren-jones/

    • Chris Kresser says

      Here’s the thing with home birth: Even *if* there are more complications at a hospital, they’re better-equipped to deal with the unknowns that can arise.

      So what? If there is a serious complication, you transfer to the hospital. Problem solved. That’s not a reason to invite more complications by giving birth in a hospital environment to begin with.

      Eliminating “distractions”, “disturbances” and “interruptions” isn’t as important as giving your child every possible chance to make it past their first 48 hours.

      We’re not talking about touchy-feely “distractions” or “disturbances”. We’re talking about real consequences – some of which I already pointed out in this article, and others which I’ll be covering in detail in the articles to follow. They include: interfering with the delicate hormonal interplay between mother and baby (which has real and measurable long-term effects), increased risk of maternal death (even among healthy mothers) and a traumatic birth experience.

      I agree completely that it’s most important to give a child every possible chance to make it past their first 48 hours. I linked to several large studies demonstrating that perinatal mortality rates are equal for home and hospital births for first births, and actually lower for home births for the second and subsequent children. So I’m not sure what your point is here. Having a hospital birth does not increase the chances that your baby will survive the first 48 hours.

      • Justin Ross says

        Since I don’t have time to read through all of the articles posted (and several are subscription-only, so I could just see abstracts), I’ll just ask:

        The studies you refer to that show hospital births to have higher PNMR’s… How do they count situations where (for example), a home birth is planned, but the child/mother end up going to the hospital? That is, if there’s an issue with a home birth, I would imagine most of the time, the child would get taken to the hospital before it dies, in an attempt to save it. Is that being counted toward the hospital’s PNMR, or the home birth?

        When you say “distraction”, I don’t know what way it could be defined other than the “touchy-feely” sense. Is it a medical term I don’t know about?

        As for transferring to a hospital, sometimes you don’t know there’s a complication until it’s too late (like in the link I posted originally). What, then? Fault of an unskilled midwife?

        • Chris Kresser says

          It varies from study to study. The situation you refer to is called a transfer and it is often taken into account. But keep in mind with a home birth rate of 1% in the US, transfers as an overall percentage of hospital births are extremely low. Most of the studies on home birth in the developed world have taken place in the UK and the Netherlands, where home birth rates are much higher (>30% in the Netherlands).

          I explained the negative consequences of home births (above and beyond “distraction”) in my previous reply to you.

          Yes, babies do die in childbirth. If you think that doesn’t happen in the hospital you’re kidding yourself. As I’ve pointed out repeatedly, the PNMRs are the same in hospital and home births.

          • Margy says

            So I’ll jump in with a little perspective. I am a licensed homebirth midwife. I have personally had three home births. I have worked in the hospital as an employee and attended about 40 births as a labor doula. Home birth midwives monitor mother’s vitals and baby’s heartrate, amongst many other responsibilities. We protect the laboring mother’s space and bodily integrity so she can labor without disturbance and develop effective coping techniques. We are trained in resuscitation and management of hemorrhage. We can accomplish a transport to hospital, in most cases, in less time than a community hospital can call in an OB, CRNA, and Ped for a c-section for an on-site labor. (Please realize that almost no community hospital has the on-site staff for continuous on-site surgical staff for cesarean surgery. Does this mean these hospitals are unsafe for laboring women?) If my client lives farther from the hospital than 20 minutes, we discuss conservative decisions. When I have to transport, I always call ahead and give the hospital staff as much notice and information as possible.

            The biggest issue with the hostile atmosphere that divides home and hospital birth is the fact that hostile receptions lead to delayed transports and worse outcomes. Homebirths, even unattended births, will continue no matter the vitriol of critics. Many, many of us believe that we can have the best of safety and normal, undisturbed birth with midwives as primary care providers. I participate in the US’ largest homebirth prospective (as opposed to retrospective) research study, conducted by the Midwives Alliance of North America, which does account for every client that begins care with a midwife and tracks her story… healthy home birth, transfer to an OB for prenatal complications, or labor/ postpartum transport for medical care.

            About “distractions” and “touchy feely”: It takes a lot of effort for a laboring mother to maintain effective coping when hospital procedures mandate frequent EFM fiddling because “it just isn’t picking up well when you are in that position”. I have had many clients who were also veterinarians… and commented that no mammal would be able to give birth without surgery in the conditions of a hospital LDR room. The hormones just don’t work.

            And finally, a loop of cord around baby’s neck is extremely common! It’s one of the safest places for the cord to be… it is protected and MUCH less likely to be compressed in the course of labor and can be easily unwound after the birth.

      • Qu says

        Do you think that hospitals should allow natural births AT the hospital (making it as comfortable to the mother as possible) and that doctors should only intervene when serious complications occur? Transferring to a hospital might take far too long and be hazardous to the mother and child.

    • Barbara says

      The related post tells a tragic story that doesn’t support the argument against home birth because that mother should have been informed of the risks, and advised to deliver in hospital. Being positive for strep B makes you high risk. If the obs/gyn had forgotten to order antibiotics before or during the labor as he or she forgot to inform the parents of the significance of the positive strep B result, the outcome would have been the same. Babies die in hospital the same way from the same thing when staff miss the dx. There’s no time for an emergency because no one knows anything is wrong until it’s too late.
      In hospital, healthy, low risk women are routinely induced. Under the influence of the drugs used for induction of labor, there is no time for the mother’s levels of endorphins to rise to the occasion. Labor is more painful, and epidurals are usual. Labor can stall after an epidural, and intervention becomes necessary. Intervention HAS resulted in injury to and deaths of too many babies.
      Unfortunately, hospital isn’t a place where a woman is permitted to deliver in peace and safety with the security of professional health care just outside the door in case she needs it. In hospital, delivery is often pathologized and the medicos can take over, just because they can.
      For low risk women and their babies, the risks of unnecessary intervention in hospital are real.
      The negative effects of trauma from a bad birth are real, too. What you dismiss as touchy feely disturbance can contribute to post-partum depression. As post-patum depression is rife, and suicide seems to be the greatest cause of perinatal maternal mortality, you’d think more attention would be paid to whether the mother’s experience was peaceful or traumatic.

    • Elanne Kresser says

      Ricki Lake the maker of the film The Business of Being Born lays out very clearly why undisturbed birth is important for the health and future health of of our children and our relationships with them. http://www.huffingtonpost.com/ricki-lake/mothers-deserve-options_b_884900.html

      I want a home birth because I want a healthy child. One who didn’t receive drugs during birth and one who’s hormonal and neurological template are set and attuned to mine because our communication during the birth process was allowed unimpeded. A very complex cocktail of hormones are released during birth that help the birth process along. Disturbances, as any person who has worked with animals will tell you, interrupt the proper release of those hormones and the proper functioning of neurological processes. Animals interrupted in birth will halt the birth process or have difficult births. Many times they won’t bond well with their offspring after this happens.

      Those hormones that get released in undisturbed birth are there to facilitate not only the birth but the process of bonding and breastfeeding after the birth, both crucial to the physical and emotional health of a child and a mother.

      Proponents of industrialized birth are often thinking of health in extremely limited terms. As is true of industrialized medicine as a whole.

      • lori says

        hurtbyhomebirth.com there is two sides to every story… I believe in a persons choice to home birth just know things can happen in any situation…

    • Terri says

      “Whether the experience is “peaceful” or “traumatic” or somewhere in-between doesn’t matter. What matters is that you leave the hospital with a healthy baby. That’s all. ”

      Very well spoken by a MAN who has never birthed a baby. A traumatic birth affects mother AND baby in ways that sometimes don’t show up until weks after birth. With each of my “intervened” births, I had severe depression. With my 4th, I had a natural delivery, refusing doctor’s help, because it wasn’t needed (in the hospital), and I had not one bit of the “baby blues” – AND – my other children weren’t affected by it, and neither was my husband. The birth was a joy and a blessing. Our next will, Lord willing, be born at home, in December.

      • Qu says

        There is no need to bring up gender/sex when trying to prove your argument. You certainly can’t do the same thing when talking to a woman who has given birth, too. Some women have had good experiences with hospital births, so keep that in mind.

    • Cristina says

      I know it is several years after this comment, but I HAVE to respond because it completely rubbed me the wrong way. I must say, as a WOMAN, it is a very “man like” thing to say, “Whether the experience is “peaceful” or “traumatic” or somewhere in-between doesn’t matter. What matters is that you leave the hospital with a healthy baby. That’s all.” You know what? YES, IT DOES MATTER. A lot, for different reasons. We as women are not just “incubators”, we are still people who have needs and we all deserve to have the BEST and most comfortable, peaceful birthing experience we can. We bring life into this world and more people, men especially, should realize how big of a deal that is and have more respect for women and what they go through even though it is a natural process. I am Cherokee and my people have so much respect for women because they bring life into the world. So however we choose to birth to make ourselves more comfortable and at peace is how we do it and we are commended by the educated for our decision to do so. It IS about having a peaceful, wonderful birthing experience for the mother because that experience equals the baby being brought into the world in a peaceful, non-traumatic way as well, and it gives them the best start in this world. My great grandmothers had many children at home with a midwife only. One had 11, the other had 9. No complications and they were out working the fields the next day. Guess what? No children died and both great grandmothers lived to be over 100 years old. Both of my grandmothers had natural births but they felt pressured to be in a hospital, but there were no complications and all survived. Then you look at my mother for example. I am her only child. She decided to go to a hospital because of being told statements like yours that “all that matters is that you have a healthy baby and it doesn’t matter what happens to you in the process.” She had no respect for her own self, took the ill informed advice of others against her own wishes, and in the process lost confidence in her ability to birth. She went to the hospital and was lied to that she was not “progressing” and that I was supposedly in distress and also that she supposedly had a pelvic deformity where I couldn’t fit and she was also given the false excuse of my cord being wrapped around my neck being an emergency when all of us (besides Noon obviously) know that isn’t an emergency. My mother has wide set hips, has had no pelvic injuries and never had rickets or any health issues at all. Her pelvis is perfectly fine. But guess what? She ended up having a very traumatic C-section where she felt every bit of it because of false interventions and the medication not working. So that being said, you are saying that a woman is of no worth basically and it only matters that the baby is healthy because it doesn’t matter if the birth is peaceful or traumatic? WRONG!!! It does matter. Out of respect for my mother and all women who have had painful, unnecessary hospital interventions, it matters. So I am choosing to birth my first baby in February like my ancestors did, and my great grandmothers did. They have given me faith in my body that I was made to do this and everything is fine. I have a midwife and see her twice a month and couldn’t be happier. So please, think before you speak and realize, YES, it matters.

      • Cristina says

        My comment was in response to JUSTIN ROSS by the way. That part of my message was cut off for some reason but I wanted to clarify.

  9. Jesse says

    In general I have no argument, though I did think it was somewhat misleading of you to quote the Cochrane review the way you did. You implied that the review was saying that, despite a body of evidence that is large enough to draw conclusions from, the evidence does not lean strongly either way. What it was actually saying was that the authors did not find enough solid evidence (they included only a single study of 11 subjects) to make any conclusion. Big difference.

    On the other hand, what do you think of this recent meta-analysis that found that, while perinatal mortality is comparable in either situation, neonatal mortality seemed to be three times higher? http://www.ncbi.nlm.nih.gov/pubmed/20598284
    It is a meta-analysis, but it seems worth considering.

  10. says

    I totally agree that having a baby in a comfortable/safe/home environment is best – I’m also glad that we have a hospital 3 minutes away in case something happens. My 1st son was born in a hospital and with pneumothorax in both his lungs. Without medical intervention he would have died.

    Still, we didn’t know he was sick until 6 minutes after he was born. I had a horrible experience with my doctor and nurses. Nobody said “good job” “keep going” “you’re doing great” … My doctor told me to shut up! And I wasn’t even screaming. My husband never got to cut the cord and my dr never held up my baby for me to see. I understand soon after they discovered he was sick and I COULDN’T see him. But before those 6 minutes? Why? I was pushing out my son and was reminding the dr between pushes, “make sure Mike cuts the cord.” …. nobody listened to me. I really felt like a nobody.

    I felt like I was a slab of meat on a convener belt. There were no personal connections, no calmness…it was very sterile. I hated giving birth in the hospital. It took me over 5 months to recover from the episiotomy.

    If I wasn’t so afraid about what may happen with my next child, I would consider giving birth at home. I’m about 50/50 at this point. I can tell you my insurance would not cover anything that may happen to my child if it were born at home. That’s another consideration – the “system” basically forces you to the hospital because god-forbid something happens. who has $100,000 cash to pay for medical expenses in case the newborn needs medical care? Our bills for our 1st were around $80,000 – glad our insurance payed for it all …. just because we were in the hospital to begin with.

    It’s all about the money now…and not about the woman or her comfort or her baby. So disappointing. Interestingly, about 80% of my friends had c-sections… why? I think they are so quick to do those. And that’s a whole other post…lol.

    • Sheva says

      I’m so sorry you went through all that! Try hiring a doula to advocate for you and be your support – and go with a midwive’s practice, if you can. And interview them thoroughly – some of them are ‘med’wives and aren’t all that great.
      Best of luck!!

      • Natalie says

        Great advice! I had a doula and a midwife from a supportive practice and I had an amazing hospital birth….but only because I knew what to expect from medical protocol and didn’t let it interfere with my positive thinking. I also used relaxation techniques learned through Hypnobabies…which allowed me to drown out the unwanted distractions.
        I hope you’ll consider looking into hiring a doula…and I hope you have nurse-midwives in your area! They usually practice under a physician so insurance isn’t an issue…

  11. Mary says

    Thanks for your article. I just want to point out that “people” don’t give birth, women do. Women do not need any more blame or shame thrown at them for decisions involving child birth but I do appreciate how you laid out the options of home birth and hospital birth. Spreading knowledge and information is the foundation for empowerment. It is an extremely personal decision to have a child and a decision made considering numerous contextual factors. For example, having a midwife can often be a privilege for those in a stable financial position. The topics of pregnancy and childbirth need to be discussed with compassion and understanding, perhaps even gratitude.

  12. says

    Two months ago, I gave birth to our seventh child in the grass beside the highway under cover of darkness. This wasn’t Plan A, of course, but it was my favorite birth by far. I don’t know if any studies have been done on outdoor birthing, but I recommend it. :-)

    This was our first non-hospital birth. It’s given us confidence so that maybe next time we’ll try it at home. Maybe in the back yard.

  13. says

    Chris,

    A premature Congrats and Best wishes for a healthy and happy birth. Eagerly looking forward to an upcoming post where you put the smack down on the barbarous process of injecting science fiction like ingredients into newborn humans, soon after they leave the safety of the mothers womb. (I am of course referring to vaccinations)

    Best

  14. says

    Congratulations on your up coming delivery!

    My daughter’s dad was adamant that we have our baby in a hospital. I had a terrible feeling that everything would go wrong if we did. I totally hate hospitals and doctors (no offence, of course, you are an unusually awesome doctor). Within the first 5 minutes of entering the doors (maybe 3 minutes) nurses told me they were going to cut the baby out. It was so weird. It was exactly, well actually quite a bit worse, than I had imagined.

    I will definitely have my next baby in my home where I am comfortable, with a midwife who cares about me and isn’t off-call when the baby is born.

    • says

      My first birth was horrible in the hospital. My second two were at home and so lovely. I hope your next birth is wonderful.

  15. Rachel says

    Hello,

    I am a huge fan. I ordered The Healthy Baby Code and love it and was hoping that you would be discussing this matter in that material as well. I think even more importantly then where you have the baby, is the support you receive while preparing and during the actual birthing. Obviously, at home you have more control over who is there and what they are doing (or not doing). If you plan to futher this topic in future posts, I think covering doulas (I like to think of them as birthing angels) could be helpful to those who, for whatever reason, choose to birth in hospitals. The most important thing I did to prepare for my natural childbirth (that took place in the hospital, no intervention or any kind just raw, beautiful birthing) was surround myself with a community of women who had done the same. For whatever reason, people like to tell pregnant women all the birthing horror stories they know. I found my oasis at Blooma, a wonderful prenatal yoga studio in Minnesota. Every week I would go and the teacher/owner, who was also a doula, would tell us about all the amazings births she had been to since the last class. Then she would teach us how to move through yoga big bellies and all, with lots of tips about what movements she had found helpful at recent births. I always left there feeling very powerful and knowledgable about my body. The birth of my son was one long, intense yoga practice where the ending was the most amazing shavasana with my new freshly born baby lying skin-to-skin with me. On that note, please also cover the importance of skin-to-skin contact with the baby.

    Birthing Blessings to you, your wife and your baby!

    • Chris Kresser says

      Hi Rachel,

      The last article in the series will cover “third-stage labor” and the importance of skin-to-skin contact after birth.

  16. Joan says

    I had all 3 of my kids at home. I had to laugh when people called me brave because to me the hospital would have been so much more frightening. With my first I had to push for 4 1/2 hours…no way I’d have gotten away with that in a hospital. I’d have been cut one way or the other for sure. That was 23 years ago, my youngest is 14 now. Probably hospitals are even worse nowadays. I think you have the right idea. Go for it. Best wishes to you…

  17. Jenni says

    This is a great article, and obviously there are many people who are stuck in believing what the hospitals and OB’s want them to. OB’s are surgeons who are very minimally trained in natural vaginal birth, they would much rather be in and out in 20 minutes vs. waiting and responding to the natural birth process. I love it when people say ‘Im glad we were at the hospital’ when most times the problem arose because of medical interventions which were uneccesary. sad. i had my son at the birth center and my midwife has everything she needs in case of emergency, and takes NO risks. ya, the cord was around his neck, normal really considering how the baby moves through the birth canal. He was born at 42 weeks, with lots of meconium in the amnio fluid. he had no problems, was breathing very strong at birth, and was not ‘too big’ to fit through me. Most people think you have some witch doctor chanting over you as you birth, when actually you have the most qualified in natural childbirth person there making sure everything turns out wonderfully. Midwifes are very relaxed, childbirth is an everyday occurence and really no big deal to them! My midwife never lost a mom or baby(who would have lived) in over 4,000 births. bet there arent any OB’s out there with those kind of numbers!
    Baby coming anytime huh?! that’s what I thought! then i found out it’s very normal for 1st babies to go to or past 42 weeks! it’s a guess date, not an actual due date. really are we telling these babies when they are ready???? as we soon find out, everything is on their schedule! best wishes to your family, I’m sure your child birth will be everything you expect it to be and more!

  18. Jenni says

    And I think people who birth in the hospital are the ‘brave’ ones! keep me the heck outta there, I hate those places! talk about being uncomfortable and feeling uneasy! whew

  19. says

    I hate to play devil’s advocate here, but it seems to me that people choosing home births are more likely to have an interest in health – so it’s no surprise that their births/babies are healthier.

    Of course, this doesn’t mean that there’s any benefit to industrial birth, just something to think about.

    • says

      You are right Kit. As a traditional midwife the families who call me are very health conscious and very connected to their bodies. They eat well, exercise, do yoga, meditate and usually have done lots of research on their own. They are very self-directed in their own well being.

  20. Michelle says

    Thank you for posting this. I gave birth for the first time last year. I was determined to have an unmedicated and low intervention birth and spent my pregnancy preparing for that. I chose to give birth in a hospital under midwife care. Never again! I am not sure Whether I would choose a home birth or some kind of birthing center. But I will definitely not do it in a hospital a second time. Even under midwives the monitoring, the bright lights, the shift change right before I started pushing, the monitoring of the baby after birth, being separated from my child for routine procedures like weighing and measuring, I could go on! And then they forced us to stay despite us both being perfectly healthy for 36 hours because of a policy! I was so upset and longed to be in my own bed at home. I am convinced my labor (8 hours start to finish) would have been faster and easier on me had I not gone in to the hospital. I did have a drug free birth – didn’t even have an IV even though the nurses insisted on it because the nurse placed the cath in my hand and completely misses my vein! I was howling in pain not from my labor but from them trying to run saline into my flesh! But i also think it’s important for a woman to birth wherever she feels safe and comfortable even if that is the hospital. Anyway congrats on your upcoming birth!

    • Natalie says

      I also had a hospital birth with a nurse-midwife, however my experience was a positive one. I am not saying you shouldn’t look into home birth, as I am, but you may be able to find a better midwife and hospital. I went to a practice where the midwife attended the whole birth (not just labor) and there were only 2 so I knew one or the other would be there the whole time. Shift-change did not happen. Also, we had low-lights, a tub and I kneeled with a birthing bar while pushing. I spent as little time as possible in the hospital before and after due to the support of a doula.
      If possible, look into your options, especially a doula, and learn how to make a hospital or home birth what you want it to be.

  21. says

    I had my youngest two children at home with a midwife and it was an amazing experience both times. I can’t imagine ever choosing to give birth in the hospital again, unless of course there were complications.

    And by the way my daughter had the cord wrapped around her neck. It was no big deal- the midwife just unwrapped it.

  22. Joann says

    If you are the mother of a child that died during a home birth you have a totally different opinion. Your child died and society views you as the evil mother who killed her child. It destroys all your family relationships, sometimes it ends in divorce. Family members point fingers and whisper. If you are the “ONE” that this happens to, you have a whole different opinion of the dreaded “hospital”. Statistic speech, only works when it’s not you.

    Mothers like me who have lost the child, we don’t usually speak, because we are so consumed with guilt and grief. Ask a mother that’s lost her child what she would do and then act on that.

    • Chris Kresser says

      Joann: I’m so sorry that happened. I can’t imagine anything more difficult to go through.

      Unfortunately, babies can and do die in the hospital, so the same rationale could be used to avoid hospital births. The idea that you are 100% protected from bad things happening when having a baby in the hospital is exactly the myth I am debunking in this article.

      • Qu says

        Joann, I’m sorry for what you went through.

        Chris Kresser, I don’t think that any rational person would argue that hospital births are 100% safe. However, the advantage of hospitals is that they can intervene when things go wrong. I wish that more hospitals would allow natural births in their hospitals, only intervening when things go wrong.

        • Natalie says

          however, when a baby is lost in a hospital it is seen as a medical complication and the blame is placed on the doctor who is then protected by the medical community and insurance…when it happens at home, the mother is vilified and, as Joann has experienced, carries the guilt for the rest of her life. I think the point is, society views home birth as irresponsible and dangerous, while the hospital is “safe” and there is so much less guilt when things go wrong!

          Joann, I hope you are able to share your experience with other moms….what you said certainly made me think about it from a different perspective!

      • student midwife says

        I have studied natural birthing among rural midwives in the third world. I am now studying nursing in the first world. I had one baby via unnecessary c-section in a hospital and was unable to walk for an entire year afterward. I had my second child at home. I had a very experienced midwife who knew how to handle the frightening amount of blood I lost after my second child. I had an OB who rejected the mere thought of experiencing labor pains with the birth of her own children (she is a wonderful person, but believes in medicine more than the human body’s ability to birth.)

        I am the very first person in my ancestral history, which I believe goes back bazillions of years, to have been born in a hospital. Somehow, every one of my ancestors managed to survive.

        I know 4 women who have lost their newborns to hospital acquired infections. I have witnessed a great many home births and I personally know of not one woman who has lost a child in a home birth. I myself had an atrocious experience because of a botched, unnecessary C-section (doc had appointments to keep, my time ran out). I have witnessed women in the developing world give birth under terrible conditions with surprisingly wonderful statistical outcomes. I cannot abide by people saying that hospitals are safer because they can treat things that go wrong. In a low-risk pregnancy, hospitals are dangerous places for newborns and laboring mothers. There are bacteria that grow in hospitals that mothers are not immune to and antibiotics cannot treat in a newborn. A dear friend lost her baby to multiple organ failure weeks after the hospital birth of her child because of a MRSA infection she acquired shortly after delivery. For those of you who ask how the home birth mother feels when her baby dies, how do you think that mother felt when her baby died? See, it’s not a valid argument because the statistics don’t show that home birth is less safe. On the contrary.

        My OB encouraged me to birth at home. He told me that a VBAC birth at home was statistically safer than a repeat major abdominal surgery in the hospital and that his insurance company no longer allowed VBACs to be performed, despite the statistical body of evidence that showed their safety. He said that if anything goes to court, docs are protected by enumerating the interventions they performed, even if the interventions are the cause of death. He said interventions make it look like they tried harder, and docs will intervene even when they know it is dangerous to do so, because it covers their butts.

    • Christina says

      Joann,
      I am so sorry to hear about your loss. I am also a mother who lost a child during a homebirth. Unless you’ve been through it, you just can’t understand it. In my case, none of my family or friends supported my choice to have a homebirth. They all warned of the horrible things that could happen and told me how foolish it was to choose to birth at home. I spouted the statistics and reassured them that everything would be fine.
      Family came to the funeral, and offered their concolences, but I knew what they were all thinking. I made the decision. I killed my son. Not one person ever said to me “it could have happened even in the hosipital.” My baby was gone. I was dead inside, overwhelmed with guilt and depression, and had no one to turn to for help because I knew what they all thought.
      We also had the awful experience of dealing with the hospital staff when we transported. I was treated horribly. The doctor pulled my placenta out while I was screaming at him to stop, the nurse catheterized me when I told her I didn’t want to. I was in such a state of emotional shock that I didn’t have the willpower to argue. When my husband took a stand for me and tried to make them stop, the doctor called security and threatened to have him thrown out.
      At the OB’s insistance, the medical examiner held our son’s body, so they could decide if they had any legal premise to file a wrongful death suit against me. They didn’t, and no legal action was taken against me, but he almost missed his funeral. My midwife had legal action taken against her, even though she had not violated the law in any way.

      Imagine the recourse from our family when we became pregnant with our second, and again chose to have a homebirth. If it hadn’t been obvious before, it was now very clear who they all thought held responsible for our first son’s death.

      At first, I didn’t want to consider a home birth again. But the more I did consider it and re-researched it, the more I knew that I couldn’t give birth at a hospital. We were the one in a million. Yes, it had gone horribly wrong: our son was lost. But there was no gurantee that he would have been saved at a hospital. Giving birth at home gave us the best chance of having a healthy baby, and that was the only thing that mattered.

      Our second son was born healthy and happy at home. So was our daughter. And if we have more children, they will be born at home aswell.

      The decision to birth at home isn’t for everyone. It’s immensly important that the woman is comfortable wherever she chooses to birth. If she isn’t comfortable at home, things will not go well there, and the same is true at the hospital.

      Joann, you are 100% right about mothers of lost homebirth babies not speaking up. We broke the societal “norm” and ended up losing the thing that is most precious to any mother. But you did not kill your child and anyone who blames you is simply ignorant. Would they still blame you if it had happened in a hospital? Of course not. You made the choice that you felt was best for you and your child. No one should ever blame you for making an informed decision, about your or your child’s healthcare.

      • Natalie says

        Joann and Christina–
        I know you have only shared a snapshot of what you have experienced, but I was so moved! If I was an agent, I would make sure your stories were published to help open the eyes of others! I know what I’m saying sounds cheesy, but you have been through the worst-case scenarios of childbirth and had to depend largely on yourself to recover. You’re right, in a hospital, the finger-pointing and guilt would be so different. I want to thank you for helping me think of childbirth from a rarely-heard perspective. Christina and Joann, I hope you’ll reply with some insight for mothers who are thinking about homebirth and may have been swayed by your stories…that includes me!

      • Stacy says

        Thank you so much for sharing your story, despite how difficult it must be. My deepest condolences for your loss, and bravo for having the courage to move on in such a healthy manner, rather than caving under a system who has wronged you. You considered your options again, and made the best choice for yourself.

        I had a conversation with someone once about how I can’t think of another facet of our life that is so deeply imbued with fault and blame when something goes wrong as it is with birthing. No one blames a parent whose child died in a car crash that only had a 3 star rating of killing their child because they didn’t get the 4 star. No one tells individuals to only eat peanuts and shellfish for the first time in a hospital because allergic reactions occur.

        We cannot play God. There are risk factors associated with birth. It’s an egregious offense that because complications can arise, and there are times for medical intervention, that such a large number of women should submit to laying down, being pumped full of drugs and cut open.

    • Comadrona says

      Joan, what a terrible tragedy – I too lost my little girl (stillborn) but just after I had transferred to hospital and everyone blamed it on the fact that I had planned a homebirth and laboured at home. So I know how it feels to be cast as the devil, and my marriage did not last in the long run, either. As a result, my next child was brutally born by elective C/S and had respiratory distress and was kept from me for many hours while they made sure he wouldn’t die (so much for hospital safety). My last child was born at home after I realised that I (and only I) had to decide what was best for me and my child, and not expect anyone to make decisions for me. That birth went a long way to healing our family and was the catalyst for me becoming a midwife myself. NO MOTHER puts her wish for a great birth ahead of her baby’s wellbeing. Most of us would rather cut off our right arm. If we make the choice to birth at home, it is usually after much research and consideration and we are usually very motivated to be healthy. Unfortunately babies die – our sick society does not get that death is part of life – and sometimes the reason is preventable and/or predictable, in which case you make best use of the resources at hand to deal with it. But at least 50% of the time a perinatal death is out of the blue and the place of birth would have nothing to do with it. I hope things get better for you as time goes by, Joan.

  23. cary nosler says

    We were fortunate to have a wonderful home birth room experience at a local hospital. I would like to think that it may be the best of both worlds for those who choose to be closer to medical help if needed. I was also wondering if people who want home births might be better informed and practicing positive lifestyle habits that would influence having fewer complications.

  24. says

    I had 3 homebirths and 3 hospital births. It was the intervention in the first that drove me to have the next 3 at home. I hated being invisible; they only wanted to look at the monitor, not take care of me. The third at home came quickly and was unattended by the midwife, though she was there to take care of my massive hemmorhage, and she did an amazing job. My last 2 births in hospital stalled both times because of the constant interruptions and my fear of hospitals. They both involved pitocin, but the first midwife watched me and saw how little it took to do the job. With the next, they paid absolutely no attention to me and just kept turning up the dosage every 15 minutes until I put a stop to it!

    I know bad things can happen, and we were within 10 minutes of a hospital in case of emergency, but I would never say everyone should birth at home or vice versa. Every mother should give birth where she feels safe and comfortable. Unfortunately, that’s too often a hospital with an astronomical c-section rate!

    I wish there were more birthing centers where you could have all the comforts of home and the skills of a well-trained midwife, but emergency equipment seconds away.

    I wish you luck in your birth, Chris and Elanne. I hope it will be beautiful!

  25. Melissa says

    What about birthing centers? I guess I wish I could have backup access to medical intervention AND am environment supportive of natural methods.

  26. Julie says

    Thanks for the post. I agree that the most important outcome of birth is to have a healthy mother and healthy baby. Both of my births were at home and afterward I felt strong and empowered. I feel that the mental/emotional aspect of a woman’s birth experience is so important. Have you come across research comparing the rates of postpartum depression in women after homebirth vs. hospital or c-section? I personally know of many women whose traumatic hospital experiences seem to have contributed to postpartum depression. Best wishes!

    ps- sleep will soon be your weakest link!

  27. BK says

    I have had all three of my babies naturally (no inductions/drugs/forceps/etc). The first was born in an ambulance (on the way to the hospital -long story) while the second two were born in a hospital. I had a doula with all three and I was fortunate to be able to labor and birth exactly how I wanted with minimal monitoring/intervention. I was mobile right up until delivering and was able to deliver in the position of my choosing as well. Perhaps this isn’t the case with some hospitals, but I felt wonderful about all my deliveries and did not feel they were “disturbed”. I think with a good doula and a good birth plan – it is possible to have a great “natural” child birth in a hospital.

  28. Liz Downunder says

    All the best for a wonderful peaceful birth, Elanne and Chris. As someone who fell victim to ‘the system’ with my first child, then had a wonderful VBAC at home 3 years later, attended by wise women who understood and trusted birth, I totally support anyone’s choice to home-birth. One thing my husband noted was the amount of medical equipment the midwives brought with them (none of which needed to be used) – they are very astute at observing, and dealing with, complications, rather than creating them by interfering with the process. Unfortunately, changes to the maternal healthcare model here in Australia mean that it will soon be against the law to birth at home with an independent midwife.

    The ‘Paleo’ diet gets a lot of press, but pregnancy, birth and childrearing is a whole other part of the picture – something which the likes of Sarah Buckley, Michel Odent etc have shared so much on. Carrying the baby, co-sleeping, baby-led and gentle introduction to (REAL!) food, full-term breastfeeding etc. Babies have not evolved beyond needing these crucial elements, and neither have we, no matter how clever we think we are in our priveledged Western society. Looking forward to more posts in this series, Chris.

    Happy birthing and baby rearing – a wonderful journey awaits.

    PS being at an ‘alternative’ school we are surrounded by home-birthing families and only one transferred to have the baby in hospital.

  29. Sara says

    This is a response to distractions being touchy feely:
    A woman giving birth is very vulnerable, and often the positions she wants to be in or is forced to be in, anyone would find vulnerable. Strangers coming and going in your space, uncomfortable temperatures and clothes, all the loud noises in a hospital; these things all make it hard to relax, which is exactly what you need to do during birth. The vagina is a sphincter, would you find it easy to use the bathroom laying flat on your back with your feet in the air, people coming in and out, bright lights in your face and cold air blowing on your nether regions? I have known people that couldn’t pee if someone might hear them.
    “Distractions” can slow the pace of labor, then the interventions start, such as pitocin, and more risk is introduced.

    • Chris Kresser says

      For the record, I don’t view distractions as being touchy feely. I was responding to an earlier comment. As you point out, distractions can lead to medical intervention, such as induction, epidurals and c-sections, which have real, measurable and lasting physiological and psychological consequences.

  30. Long Term LC Dieter says

    I went in having read the pros and cons. I didn’t want pain medication, went to Lamaz classes. I read 13 books about pregnancy and labor (my OB/GYN said, “it’s not a test” when he walked in and saw me highlighting the book).

    At the time, I was fully aware that 25% of births resulted in c-sections, so I refused the epidural. I was really sorry I did, because when I needed it the anesthesiologist was not available. I thought I was going to die of pain. No one talks about this, and no one even in the family would let me talk about it. It was unbearable, and after it was over, my mother told me she thought she was going to die in childbirth too.

    I would much rather have had a c-section than go through that bloody, horrible, hell. I was angry that my mother didn’t warn me about how bad it was going to be.

    So, I had natural childbirth. What are the consequences of this? Think about this. It’s called incontinence. No one talks about this either. Now in my 40′s, I’ve had surgery to “correct” this, which helped only a little for two years, and now it is almost as bad as it was.

    If I could do it over, I would ask for a c-section. Seriously.

    • Margy says

      I am so sorry that you feel so obviously traumatized by your experience. I never advocate suffering, only coping with effective support from loving people. Labor is incredibly hard work, and can be intensely painful. Anyway, I wanted you to know that incontinence is common even with women who have cesarean births and also women who have never born children at all. I hope you find both physical and emotional healing.

    • says

      Apparently your Lamaze classes were not very good! I teach natural childbirth classes and we discuss everything you mentioned in great detail!

    • Sheva says

      Natural childbirth does not only mean un-medicated. It means natural in every way – the support, the treatment, the respect, and the trained care. It doesn’t sound like you had that.
      Incontinence is not an effect of vaginal birth. It also afflicts nulliparous women. In women who have given birth, it is usually because of being coached to push in an unnatural and prolonged way. I don’t have the names of the studies, but I was just reading an obstetrics textbook on the subject. And surgery to correct it, according to this book, is unsuccessful at least 25% of the time.
      I wish you the best of luck in finding a good doctor who can successfully help you.

    • Qu says

      I’m sorry for what you went through, but I can’t comprehend why you’d be surprised that giving birth can be extremely painful and can cause incontinence, especially after reading so much about pregnancy. I know this and I won’t be having children. It is bad that no one really talks about the disadvantages of pregnancy. I don’t know why. Also, a C-section might have been worse because it’s a lot more risky than vaginal birth. It all sucks basically. LOL.

    • Natalie says

      Incontinence most likely occurs because of stress on the pelvic wall during pregnancy, not just during childbirth.

    • Tabitha says

      Because all women are different, it stands to reason that all labors are experienced differently. I have given birth 5 times, all at home. First baby, Twin A, terrifying, painful , intense, overwhelming. A half an hour later, baby B second twin, absolutely NO PAIN. It was peaceful, relaxed, almost pleasurable. Third baby 3 years later, labor and delivery very hard. 5 years later, 4th baby, wonderful labor, hard pushing because of shoulder dystocia. 5th baby, hard labor wonderful pushing. So one woman, 5 different experiences. Women can’t “warn” you of the pain, because they may be doing you a great disservice, it may not hurt you. There is no way to know, until you do it.

      • Comadrona says

        I loved reading this comment…it is a good reminder, especially to us midwives, that women are so individual and so are their labours. Although a woman may experience what seems like a lot of pain, many times afterwards they will tell you how they’d like to do it all over again. When I’m educating women I tell them that pain is usual, but that for most of the labour it will be totally bearable with breaks in between, plus she has her own body’s helpers, to “work with it” (rather than “relieve it”). To my mind women’s experience of pain is bound up in their expectations, FEAR, and their trust/or lack thereof in their body’s ability. In most homebirths I’ve been at, the women are definitely feeling pain, but they are not suffering (the mental and emotional response to pain). Add in the encouragement and support of loved ones and midwife, plus our obvious confidence in her ability, and very few women need to transfer for pain relief.

  31. J says

    Having a home birth will be a fantastic experience for most who opt for it. However for the few who have a medical emergency good outcomes are measured in minutes and even seconds. That shouldn’t stop people from making the choice to home birth but it should be taken very seriously and planned for as well as possible.

  32. J says

    Long term LC dieter,

    I have had 5 children. 2 unmedicated deliveries, 2 epidurals, and one unmedicated emergency c section.

    The pain of labor is more intense than the average c section [mine excepted obviously] but the recovery from a c section is just dreadfull. I’d take a vag delivery any day. However I’d take it with an epidural if I had my ‘druthers.

  33. J says

    PS during my 2 unmedicated L and Ds I would have gladly received an epi when those contractions got “for reals”. There comes a point where pain is so intense and unrelenting for such a long time that all philosophies fly right out the window leaving me to admit fully and unblushingly that I would not care one whit if they had to stick that needle in my eyeball as long as there were sufficient drugs on the other end of it.

    It’s a bit of a western notion that drugs are to be avoided, tribal people certainly make good use of them and have for a very long time. YMMV

  34. says

    congratulations on your upcoming birth! I’ve had 3 hospital births, but wish they could have been home births. My most recent birth (feb) was a gorgeous experience, until the Dr decided for no reason at allt hat ten minutes was long enough to push and pulled my baby. The pain was excruciating. The damage was horrible, and preventable. Recover was long. This was my best hospital experience yet.

    A CNM is the way we’d go if we had a chance, but it is important a person does their research prior to choosing a homebirth. Knowing what could possibly go wrong, and what they want done. For us there is very little that could go wrong at home that couldn’t be resolved at home as well – in the small chance that a hospital was needed, we’d transfer. We also know that in the majority of cases there are indications prior to delivery that something is amiss.

    In the case of GBS it is easily treatable, it is highly unfortunate that a family did not receive proper care, but IMO that is an omission of that individual care provider and not an over all picture of home birth. Of course, here, only CNM are allowed to practice and standard protocol is that all women are screened (and if mom isn’t screen, then baby is deemed positive), if mom is negative, then no worries, if mom is positive, then she is treated, if she is not treated IN LABOUR, then baby is deemed positive and treated – or if parents refuse initial treatment, then baby is monitored closely, with antibiotics standing by. In other words, as long as the midwife follows protocol, then GBS is no more of an issue than in the hospital.

  35. Evan says

    My random thoughts

    In preparing for the birth of our first of two my wife and I really enjoyed reading Ina May’s Guide to Childbirth. Birth in Four Cultures by Bridgette Jordan is also very interesting.

    The most alarming thing to me related to this whole topic is the growing rate of c-sections. At our local hospital it’s nearly 50%!

    Despite our prejudice towed natural childbirth, we know plenty of mothers who had perfectly acceptable birthing experiences at hospitals.

    Bear in mind that in industrialized countries the average age of first-time mothers is increasing which means those moderate to high risk pools are growing too.

    One thing we really liked about the birthing center we used is that we didn’t have to clean up after the birth!

  36. Miranda says

    @ LC dieter – sorry to hear about your experience. I had a vaginal birth and have no incontinence issues whatsoever. I even had a 2nd degree episiotomy but was downhill skiing 3 weeks later. Everyone is different, but most vaginal birth recoveries are much less heinous than a c-section recovery. Then again, some people recover from c-sections quickly too. You can never know which you’ll be. I guess I’d just rather go through that pain again than have my abdomen sliced open and baby ripped out of me, but that’s just me.

    That’s the thing about childbirth. No matter how much you prepare for and educate yourself, it is so totally unpredictable. I knew from the beginning of my pregnancy that I really wanted a natural, unmedicated childbirth. I checked out every book from the library on the subject, spent countless hours researching online, practiced the Bradly method exercises, kept working out and eating healthy while being mocked for not just indulging in cravings because I was ‘going to get fat anyway’, etc. . Well…I won’t go into the full story, but I did end up getting medical interventions, and the moment of her birth was more of a drugged up fog with a room full of NICU staff and others than the moment of love I had really dreamt of. I don’t know how it would’ve gone had I tried a home birth or birth center, if it would’ve been alright and the hospital staff were just making it more dire, or if I would’ve been one of the emergency hospital transfers. In the end, I guess I don’t believe it’s fair to say any one birth choice is ultimately ‘safer’ or ‘better’. Whether you’re the type to schedule your c-section in advance to work for your life, or have a homebirth with a doula + midwife attending, the safest birth is the one where mom and baby both end up healthy. You just have to decide what is right for you, but also be open to the possibility you may get a wild card.

    To Elanne and Kris – I think your choice is an awesome one and I can’t wait to read your birth story. Hopefully you will post about it. =) It is really such a beautiful experience.

  37. Long Term LC Dieter says

    The way incontinence statistics are presented varies. There is a lower rate of incontinence with c-section. You might find that the way you feel about it depends on your problem and how it progresses as you get older.

    Women are expected to bear the pain and be silent about it.

    • Tabitha says

      Fecal incontinance is higher with csections. Some urinary incontinence is due to genetics, and if you were told to push for an extended period of time, or you aren’t a walker or don’t spend time squatting, you could end up incontinent anyway. A csection is by no means a fool proof way to avoid that.

  38. Matt says

    My second daughter was just born at home last weekend, and subsequently rushed to the community hospital, and then airlifted to another hospital (where she is now), because of a variety of lung-related issues (number one: not breathing on her own). Definitely not the original plan!

    Was it scary? Yes… incredibly. Would we do homebirth again? Yes… not because we’re crazy and “committed to the cause” but because we’ve gone over and over everything during those long hours watching our child fight determinedly as we stood helpless, or driving back and forth to the hospital that’s an hour away…

    We believe that we did the best we could have for our child – that she wouldn’t have received better care anywhere else. We are grateful for the midwife who helped provide the best birth environment and immediate care possible, as well as all the skilled doctors and nurses who provided the best emergency and intensive care possible.

    I wasn’t worried about the “what-if” before this birth – I knew that there was a 99.5% chance we’d have a safe homebirth and stay at home. Well, we hit the 0.5% – but it was still not only “OK” but as good as it possibly could have been.

    I pray that your experience is what we wanted for ours… and for what it is worth, though it is hard to think of now, the 4-hour labor (yes… just 4 hours) that my wife had went EXACTLY as she wanted, and it was truly an awesome (in the full sense of the word) experience rather than an awful experience.

  39. Emily Deans MD says

    I had two hospital births – I am obviously very comfortable in hospitals having spent many years in them. Decent hospitals nowadays really focus on you having your choices, I was asked about a detailed birth plan prior to the deliveries, skin to skin contact right at birth and immediate nursing were highly encouraged. I spent quite a lot of labor unmonitored, the rooms included a birthing tub if you wanted to go that route. My only issue was a pushy nurse after the delivery of my first who kept critiquing the breastfeeding. After my second the nurses pretty much left me alone, which was fine by me – I was out of the hospital kid in hand about 36 hours after each one. We were strongly encouraged to room in with the baby also. Neither child had complications (knock on wood) – mostly I was glad that after a hospital birth I wouldn’t be the one doing the laundry ;-) (I’m hopeful laundry is arranged for a home birth – I’m sure it is, oddly enough that is what I think about though!) In medical
    school I participated in the delivery of many babies so was very familiar with the hospital process. Having also seen many complications (I worked in an inner city southern hospital where many of the mothers were ill or had no prenatal care at all when they showed up in labor) – that it obviously a skewed sample but that sort of training does bias doctors against home births. It is not a fair sampling or a cochrane review by any means. Even in that hospital there was a midwife ward and a doctor ward – there are over 15,000 babies a year born there so everyone is exceedingly experienced and of
    course there would be complications with so many… but when I had a child I was glad to be minutes from a NICU though more glad it was never needed. However, hospital germs were a concern of mine as well!

    • Liz Downunder says

      I fully support hospital birth if that is where the birthing woman feels safest, assuming she understands her options and has made an informed choice. Just wanted to say, though, that here in Australia, trainee midwives complete their course having never even witnessed a natural birth (unless they are one of the few who train with an independent midwife). So what are they learning exactly??? How to interfere and then how to mitigate inevitable complications (usually more interference). They do not learn what a natural, unhurried, unintervened birth (and labouring woman) looks like. They do not learn to sit back and observe, they do not learn about the hormones etc. Their training is medical in nature, which, as we know, ignores the very nature of birth.

    • Rachel says

      I can fully understand your comfort with hospitals. It’s a good thing you’re comfortable there :) But as a doula witnessing births and hearing lots and lots of birth stories from other women, I know that OBs may be comfortable with hospitals but not many of them are comfortable (or familiar) with natural childbirth where interventions aren’t used unless necessary. And by interventions I mean all of it, heplocks, gowns, birthing on the bed, routine vaginal checks, intermittent monitoring (10-20 min of each hour) vs. doppler monitoring for a few minutes, limitations on eating and/or drinking, etc. A friend just recently had her fifth baby, unmedicated, and her midwife decided not to break her water this time. She just sat back as mom had her baby (born in the caul). Nurses kept coming in and looking at her because it was so unusual. Afterwards her midwife said something to the effect of, “It’s really good sometimes to just sit back and watch what a woman’s body can do if we don’t interfere.” Amazing to hear and yet a little scary that that sentiment comes from a midwife, implying the truth that we too often meddle (and I know she does, I’ve attended births with her) instead of patiently waiting and watching. Another friend gave birth without medication and her nurse, who was pregnant, said, “You know, I think I could do that.” We don’t see enough normal to know what normal really is.

    • Tabitha says

      I never saw a soiled twoel, sheet, nightgown etc. My midwife whisked them all away before I was ever aware of their existance

  40. Oregano says

    Chris, I really love your research usually, but it seems to me you dropped the ball on this one. You sound as if you have swallowed the homebirth propaganda without your usual skepticism. You say if there’s a problem, “just transfer to the hospital” – it is really not that simple! If you are with a laboring woman with a catastrophic problem (for example, placental abruption) you have to get her into the car, drive to the hospital, get checked in at the hospital with paperwork, be examined by an OB and nurses there, and finally transferred for a c-section. Even if you live 5 minutes from the hospital, transport can be a very time consuming process and unfortunately can end with tragic consequences.

    I highly recommend you check out the blog “The Skeptical OB” – the web site is http://skepticalob.blogspot.com/ – her tone is unpleasant but the information there is invaluable. She addresses so many of the exact homebirth lines you throw out in this article, and backs them up with studies too, for example, the claim the Netherlands statistics show it’s safer to homebirth.
    No, the Netherlands has, and has had for some years, the HIGHEST perinatal mortality rate in Western Europe. It also has a high and rising rate of maternal mortality. The Dutch government is deeply concerned about these high mortality rates and a variety of studies are underway to investigate.

    The most recent study published in the BMJ is early November 2010 revealed and astounding finding. The perinatal mortality rate for low risk women cared for by midwives is higher than the perinatal mortality rate for high risk women care for by obstetricians!

    Her “10 things” article rebuts many of your claims point-by-point:
    http://skepticalob.blogspot.com/2010/11/ten-things-you-shouldnt-say-to-dr-amy.html
    But there is a lot more to read than just that snarky summary. Please get past her tone, because the information is important, and I think you are doing women a disservice by downplaying the risks of complications, and the ease of solving problems during homebirth.

    • Chris Kresser says

      I started to write a point-by-point rebuttal to Dr. Amy’s ridiculously biased and myopic post, but after scanning the comments found that someone (Ellie) had already done that. So I’ll reproduce it for you here:

      1 – Perinatal mortality is lower still in western Europe where obstetric care is a last resort and midwifery is the default method of care.

      Central America is behind all of Europe and South America.

      Ref: http://whqlibdoc.who.int/publications/2007/9789241596145_eng.pdf

      2 – The Netherlands are in Northern Europe and experience lower rates of perinatal mortality, neonatal mortality and stillbirth than Central America. The fact that the Netherlands are experiencing increasing issues with maternal and infant deaths coincides with the very recent rapid decline of home births (from two thirds in 1965 to less than a quarter today). The rise in maternal death is still less than half that in Central America.

      Ref: http://whqlibdoc.who.int/publications/2007/9789241596145_eng.pdf
      Ref: http://www.guardian.co.uk/lifeandstyle/2011/apr/16/home-birth-trial-or-rewarding

      3 – I happen to agree, there are many obstetricians who are actively in favour of normal birth with surgery being an absolute last resort. They aren’t all, however. I’m not sure what the history behind point three is, but it’s very heavily loaded with contempt. Calm down!

      4 – This is little more than statistical manipulation. Looking at the data, in the neonatal period, 9 babies died. 3 died from congenital abnormalities and 2 (possibly 3) died from SIDS – which has nothing to do with where a baby is birthed as far as current medical evidence is concerned. The case of vasa previa was handled as quickly as any hospital could have done. You cannot, realistically, know whether or not this or the remaining deaths would have happened in a hospital. Furthermore, non of this considers the possibility of death via unnecessary interventions.

      5 – There is no conclusive evidence stating that it is any riskier to transfer from home to hospital, should a complication arise. All available statistics suggest that, actually, trained and qualified midwives are indeed very capable. And again, calm down.

      6 – Obstetrics has, undeniably, contributed greatly to lower mortality rates. However, that doesn’t necessarily mean that it is correct in all areas. Midwife led care, when practiced properly, is demonstrably safer than obstetrician led care.

      Ref: http://whqlibdoc.who.int/publications/2007/9789241596145_eng.pdf

      7 – Quite right. Obstetrics certainly has its place. Sanitation and Hygiene, however, have played an undeniably important role.

      8 – Essentially, you’re just speculating here. Since the evidence you’re looking for isn’t solidly available.

      9 – As with the above point and point 4, there’s an awful lot of being selective with available statistics taking place here. Looking at unnecessary induction, while the risk of neonatal death may be no different (and that’s important from all angles) the impact of birth upon childrearing is not to be underestimated.

      10 – Indeed. Modern Obstetrics certainly contributes to the lower levels of infant and maternal death. 7% and 1% are, however, somewhat lower than one would consider to be “inherently dangerous”. Hence, even 50 years ago the population of this planet was greater than could comfortably be sustained via natural resources.

      11 – So, it’s not rising – it’s just higher than had previously been known? Right.

      12 – Again, quite right. Evolution isn’t perfection, sometimes obstetric intervention is very much needed. Over time, however, as a result of these important interventions, women with this issue will become steadily more common so it is important that this is known in advance and measured. After all, I think we can all agree than elective C-Sections are safer, calmer and can emulate a natural birth in many respects in order to achieve the optimum birthing conditions for the baby.

      In all, I found this to be somewhat bizarre… “Natural childbirth advocates make up their “facts” as they go along. They don’t read the scientific literature. They don’t interact with science professionals. Indeed, professional natural childbirth advocates take special care to never appear in any venue whether they might be questioned by doctors or scientists.” – It reads very much like a paranoid conspiracy. As though it is impossible to be a natural childbirth and scientifically minded.

      As somebody who studied astrophysics at degree level, amongst other things, I am hugely interested in the scientific evidence available but, I am also painfully aware that, often, science doesn’t have all of the answers. It also cannot always be used to prove what we logically know to be true. Theoretical physics is responsible for a great deal of describing our casual observations of the universe, and yet it remains largely theoretical, interspersed with empirical data.

      Biology, and more importantly the science of child birth, is no different. I take issue with statistical manipulation of the few pieces of evidence based research that we do have.

      On top of that, I will be explaining several other ways that “industrialized birth” can negatively impact not only birth itself, but the baby’s health during infancy and for the rest of his/her life. As an example, we are now beginning to understand that early changes in the gut flora of an infant can predispose him/her to lifelong health problems like obesity, diabetes, asthma and allergies. These changes are far more likely to occur in a hospital environment. The comparison of hospital vs. home birth goes far beyond perinatal mortality rates, as I will demonstrate in future articles.

    • Comadrona says

      To use your example of a dire emergency, placental abruption is rare and can happen before labour even gets going, whether or not you are booked into hospital. But some placental separation can easily be picked up long before harm is done and midwives are trained to look for signs. Also, smoking and drug taking are risk factors and I personally would not attend a woman at home who did either of those things. Homebirth planning takes into account how far away the nearest hospital is and the midiwfe builds trust with the parents so that if she says “We need to go” they go. Birth in itself is actually a fairly low-risk activity – 7 billion people on the earth and most of them are born out of hospital to mothers who typically have a lot of kids (because they have no control over their reproductive rights) and have not necessarily had the best nutrition and perinatal care. We Westerners are so wrong-headed about it all – giving birth is what women are designed to do and, in an otherwise healthy woman, what gets in the way is fear and interference for the most part. BTW if you look closely at the Dutch demographic, their immigrant population (who have the most babies) are also the least well-off, young mothers or grand multiparas and are often poorly educated and not well-nourished. These women are often the ones who are having (unplanned) out-of-hospital births with poor outcomes – a very different propostion to a planned homebirth with a midwife.

  41. Nora says

    I had one child in the netherlands, and one in the US. The baby in the Netherlands was a planned home birth with a totally excellent midwife. I pushed for half an hour on a birthing stool before the midwife called a halt and proceeded to drive me to the hospital for a vacuum extraction (baby was 9lb 9 oz and I could not push it ’round the corner’). She stayed with me the whole time, and was the one who visited the next 10 days (Dutch perinatal care is very good). I was grateful for the hospital, but I would have opted for a home birth again with the second, as I thought my midwife was brilliant.

    However, with the second one we were in the US. I had to fight very hard not to get a preemptive IV, the nurse told me to push in the wrong direction, (resulting in a bruised sacral nerve which took 12 months to heal – the midwife in NL had indicated in which direction to push by touching me in the correct place), the doctor was at lunch when it came time to deliver so there was panic in the room when push came to shove (heh), it was not a great experience. (I also don’t get the insistence on rough cotton open-backed, short-sleeved hospital gowns designed to freeze many parts of the body here, what is that all about?)

    Overall though I agree that people have to go where they are comfortable and feel safe, but then they have to be prepared for the environment they choose.

    BTW the perinatal mortality in NL could be higher due to a different policy on the very very early preemies. There is not an automatic “keep it alive at all costs” policy. The parents are told the risks of serious disabilities of various kinds with these barely viable infants, and I believe that many parents choose to let the child go. I’d have to look up the reference on that, heard it during a lecture on preemies and developmental disabilities.

  42. Barbara says

    Kris, I enjoy your podcast and posts very much and am learning so much. This one really resonated with me as I was going to have a home birth 28 years ago after participating in both of my sisters home births with their children. I didn’t have to be convinced, I just instinctively felt that it was the right thing to do for mother and baby. But dangerously high blood pressure and no progress in dilation forced us to the hospital for an emergency C-section. I was glad my midwife had insisted on a doctor back-up but at that time not even my husband could go into surgery with me. Except for a very compassionate nurse who missed her son’s little league game to stay with me through the whole ordeal, I felt so completely alone. I had to fight for the doctor to let me stay awake to greet my new son and was heartbroken to not be able to hold him for almost 4 hours! After they brought him into my room, I had to fight to keep him with me and let him nurse as he pleased. Yes, I was glad we were both alive but the psychological damage was long lasting and took me by surprise. It took a bit of therapy and 5 years to have the courage to try again. Longer story than we have room for here, but my second and third were also C-sections but planned so the experience was a bit better. Still, I couldn’t wait to get home and have my babies to myself despite the pain and long recoveries. Your last comment about the infant’s gut flora hit me like a ton of bricks since my first son born so traumatically has been a type 1 diabetic since he was 5 with absolutely no family history and a fairly good diet with what I knew at the time. I will look forward to reading your future articles as you go into more depth. Sincere best wishes for you and your wife to have the home birth experience you all deserve. I still believe it is the best way to welcome your most precious gift.

  43. Kari W says

    Chris -
    Another GREAT post!
    I’ve taken your Healthy Baby Code course (AMAZING!) and wanted to see if you have a good book recommendation for pregnancy. Preferably something more in tune with your philosophies than I’d find on a mainstream “best sellers” list….
    thx! Kari

  44. Adria says

    Congratulations on your upcoming joyous event!

    I just wanted to say that the natural birth of my son was the most beautiful, serene event of my life. I experienced no pain at all–just a sense of pressure. In fact, it took me a couple of hours to even realize I was in labor. Once we got to the birthing center, while I was walking around and around outside the building, I entered a trance-like mental state. My son was born after about 10 hours of labor, where I spent much of the time in a big, comfy tub and my husband, my sister, and my mom in the room with me. My doula was wonderful and made me feel completely safe. I knew that she knew what she was doing, so I could just relax. I did end up with an episiotomy and a third-degree tear, but I didn’t feel a thing and that healed right up after a couple of weeks, so it was no big deal.

    I ascribe my glorious experience to big hips, excellent health, fantastic care, a reassuring location (birthing center right across the driveway from the hospital ER), and positive expectations: All of my life my mother told me that my (natural) birth in a hospital was like a religious awakening for her, so I was predisposed to think positively of childbirth.

    My experience makes me wonder if the fear of childbirth causes pain, but the rational side of me points out that fear is more likely driven by the pain. I just got lucky. So on the one hand, I am reluctant to tell other women about how easy and painless my birth was, because I don’t want to sound like I’m judging or bragging or telling them they “did it wrong.” On the other hand, I want other women to know that childbirth isn’t always a painful event to be endured, and I hope that openness to the possibility might allow them to experience something beautiful.

  45. Jesse Timm says

    Great post Chris. I have recently discovered your blog and love the topics and insight that you provide for your readers. My wife and I are also planning a homebirth, which should be happening literally any day, and are very excited about the opportunity to start our family and welcome our baby in that setting. One of the most influential pieces of literature, not the whole book but some very well presented theories, I have come across is Dr. Grantly Dick-Read’s book “Childbirth Without Fear.” This book was published in 1949. Specifically the presentation of the Fear-Tension-Pain cycle that speaks to the “distractions” and “disturbances”. From a perspective of an expectant father I am amazed at the capability of the human body and more importantly the brilliance of a pregnant woman’s body. Pregnancy is unknown territory for most people, even if you have had previous babies, and the current medical system capitalizes on that unknown and, unfortunately, justifies many of the procedures based on the risk, real or perceived. Keep up the great work and I look forward to seeing the rest of this blog series. The world needs more people like you supporting the natural biological process of childbirth.

  46. Jackie says

    Please, please remember that not everyone lives in California or other metropolitan or forward thinking areas. Can a home birth be safe? Yes. Can a hospital birth be beautiful, serene and natural? Yes. I have had 2 births in the hospital, one with no interventions one with pitocin and epidural (labor had to be induced because water broke and did not start after 2 days). I noticed no difference in either child at birth, both calm and alert both nursed immediately and are very healthy and intelligent. Bonding was actually easier with the one born with epidural because I was not hindered by the pain of labor and tearing. I know the medical system in my area having worked in it for 13 years and if anything had happened (living 30 minutes from a hospital) I know that our paramedics rarely encounter a newborn in need of advanced resuscitation or airway management. I also know that the midwives who will assist with home births in my area have little to no medical background and minimal education. How is the lay person to know this? It can be safe to deliver at home but take advantage of the good the medical community has to offer. A skilled and talented practioner will facilitate the kind of delivery you want (or think you do – hey things change in the heat of the moment) but they also know every possible scenario and are prepared to deal with it.

  47. Angela P says

    I am pregnant and I am also a federal government employee. We are getting ready to move back to Colorado, where my husband and I are from, and because my HMO here does not cover that area I get to switch insurance policies (yay!). There are many different options and I was just wondering if anyone had a home birth that was covered by your insurance. If so, I would love to hear the details (insurance provider, whether they covered the hospital transfer if there were problems with the delivery, mom, or baby, etc.).

    Thanks!

  48. Jack Kronk says

    Chris,

    You say 100,000 generations, but then you count up to almost 1 million in your mathematical example. Simple error, but I think you meant to put 99,998.

    -JK

  49. Debbie says

    Hmm, when my son was born 32 years ago *no one* was talking about home births! I was born in a hospital in the 50s, my parents were both born in hospitals in the 20s. Home birth seemed so 19th century to me at the time, LOL. But I guess I was pretty lucky as hospital births go. I only had a 5-hour labor from start to finish. No IVs, no drugs, no episiotomy. My son just popped out and the doctor caught him despite his being nearly 9 pounds! After a quick once-over by the medical staff he was laid on my stomach, still bloody from delivery, and the entire medical staff left the room and left me alone with him for some 60-90 minutes to give us “bonding” time. I did have a 4-day hospital stay (standard at the time) but I enjoyed it. I loved being waited on and having meals brought to me, LOL. Since I was breast-feeding I was allowed to have my son with me as much as I wanted. The nurses were all great at giving me, a first-time mother, tips on care and feeding and diapering, etc. :-)

    My son was also born almost 3 weeks after his supposed “due date”, but my obstetrician merely said, “You don’t think their’s anything magical about that due date, do you?”

    Things do seem very different today though. When my grandson was born 2 years ago my DiL was induced because she had gone 10 days past her due date and the doctors refused to allow her to go longer than that. She did deliver vaginally at any rate – and she is a tiny woman and my grandson was nearly 9 pounds at birth, so who knows what size he would have been if he had come at his appointed time. But he was one of about 20 babies born in the hospital that day, and was the **only** one not born via C-section, and that only because my son and DiL fought against it – as her 18-hour labor exceeded the hospital’s standards.

    My sister delivered her first vaginally and her second via emergency C-section, and to this day says if she’d know the difference she would have demanded a C-section for the first too! Said it was far less painful, far easier, and her recovery was so much easier and so much faster. She says a C-section made all the difference in the world to her with how easy and painless it made the experience. So funny how we all differ. :-)

  50. M says

    Hi Chris
    If a baby has to have antibiotics after birth, would you recommend using a probiotic designed for babies, or is it better for mum to use them and pass it on in the breast milk ? (we planned a natural homebirth, but my partner got an infection after her waters broke and needed a c-section as our baby girl was in distress) . It is a bit dissapointing to not do the natural home thing but we are glad for the hospital in an emergency situation. The difficult thing is once you are in hospital there are so many interventions they want to do and it is hard to work out which ones are absolutely necessary. For instance, our girl had an increased respiration rate which was getting worse which could be a natural process but also could be from infection so she was put on antibiotics. She is doing great now, but I am a bit concerned the antibiotics could lead to problems with allergies and autoimmunity if we dont address it. All the best, its an amazing feeling to be a dad even though everything we didnt want to happen with the birth process did

    • Chris Kresser says

      I would do both. Ther-biotic Infant is the brand I use here – not sure if it’s available in NZ, but you can check the strains it has in it and try to find something similar. For mom, a good multi-species probiotic like Ther-biotic Complete plus a prebiotic like Biotagen would be good.

      Sorry to hear about your difficulties with the birth. The reality is we don’t always have full control over our circumstances, and sometimes things don’t turn out as we would have wished. In that situation we do the best we can with what we’ve got – which is exactly what you’re doing. The good news is that human beings are remarkably resilient, and I’m sure with good nutrition and a healthy environment your girl will live a long, happy life.

      • M says

        Hi. Thanks for the kind words. Mum and baby are home now and doing great, so good to get away from the hospital although everyone was amazing there. Overall, it was still an amazing experience and has changed my perception about medical care- they do a good job at risk management in emergency situations.
        I will see if I can get those supplements shipped over, I found a probiotic with similar strains but it also contained rice maltodextrin,silica and short-chain oligosacchrides which I am not too sure about.
        thanks again for all your help.
        PS: on the day she was born it was 6foot and offshore here which must be a good omen : )

  51. Becca says

    I’m proud of your decision to birth this way! The truth is, most “birth emergencies” are completely fictional, created by hospital personnel (and I’m an experienced medical professional working in a hospital environment). Very rarely is there a true emergency. Women are created to birth and every aspect of birth serves a purpose. As a woman who has given birth 3 times in a hospital and 1 time at home (the last), I cannot overstate how much easier the unmedicated home birth that was allowed to proceed at its own speed went compared to the hospital births.

    All of my hospital births were induced, 18+ hours of horrible discomfort, people constantly poking you or sticking their fingers somewhere, a Dr announcing to me how I should be birthing and telling me to stop making noise, after birth being woken up every hour for something, being told what i can and can’t do with my baby. Recovery of weeks before feeling like human again.

    My home birth…my body and baby went into labor on their own, very mild labor from 3 am to 8 am, a little tougher from 8-9 and some harder labor from 9-10:20. Baby was born then, in the water, midwives cleaned up while I crawled into bed. Midwives were gone a few hours later and despite thinking I should rest, I couldn’t stay in bed, I was up and doing things, nearly no recovery time at all because my body was allowed to adjust at the speed it needed to.

    We were designed to do this without interference and although I once would have gasped at the thought of home birth, and I once would have felt the same way as many of the others do, that it would be a “stupid” thing to do; once I educated myself, I saw the light. Having birthed at home, i would NEVER EVER EVER go to a hospital to birth. Not unless there was a true, forseeable emergency that required it, and being overdue is not an emergency.

    Which brings me to my last point. I’m sure you know this already Chris, but not every baby comes before 42 weeks, so if yours doesn’t, don’t let them push you into going to a hospital. Babies come when they are ready, not by a calendar.

    Congrats on the new addition, I can’t wait to read your posts after baby is born!

  52. sarena says

    My daughter (who lives overseas) had her first child 3 years ago as a homebirth in my bed! There was a midwife present and a student midwife too! It was a beautiful experience for all. My granddaughter and I have a special relationship.

    My daughter then had her 2nd child in her home in Israel as a homebirth with an obsetrician who only does homebirths now. I was at her house about a 1/2 hr after my grandson was born and stayed to help them out for a week or so.

    My daughter and son in law fully embrace homebirth and the natural quality and ability to bond with each other and the new baby (and the older toddler too)!

    I only wish I knew about these options when I was having my own children.

  53. Christena says

    My daughter was born at home 6 years ago. I loved it. It was an amazing, intimate experience between me, my daughter, her father, and our midwife, and I would do it again in a heartbeat. The one and only time labor became unbearable was when I decided to lay down for a few minutes, which incidentally is the position you are in while laboring in the hospital. I get the same reaction as you when I tell people she was born at home. Outside of a few who “get it” mostly I get the “wow, you were brave! I would never…” (when I suspect what they really mean is “wow, you were careless!”). But there are so many reasons to birth at home, I can’t even begin to list them all. Another good read is Ina May’s Guide to Childbirth. Best wishes to you and your wife Chris. It’ll be the coolest experience of your life. I almost wish I could do it again :D

  54. linda says

    I had an extremely easy labour with my first child and no complications. When i became preganant with my son there were no problems throughout my pregnancy, however during labour things went downhill quite quickly, and to put it bluntly, if we had not been in hospital we both would have died. So whilst the idea of a homebirth appealed to me, I was more than happy that I had decided to use my local hospital.

    • Chris Kresser says

      Linda: nowhere in the article do I suggest that we shouldn’t make use of the hospital when necessary. In fact, I highlighted the following sentence in bold text in the article:

      I want to be clear: no matter where birth takes place, complications may arise that require medical intervention and I am 100% in support of it in these cases.

      The issue is not whether to use medical intervention at all, but when medical intervention should be used. Right now, it begins the moment a laboring woman steps foot in the hospital. I’m simply arguing that “undisturbed birth” should be the starting place, and medical intervention should only be employed when necessary.

  55. Elisabeth says

    There are so many types of breech births, a few can be dealt with even at home, but many do require a hospital. The author does not think that if you are high risk you should have a home birth. He does not even say if you are low risk you should. He is saying that if you are low risk you ought to know what the benefits and risks are for each kind of birth and make an informed decision.
    A midwife will refer a mother to the hospital if they have a frank breech. It is part of their training. On the other hand, my friend had a c-section for a posterior baby. Maybe she would have needed the c-section anyway, but the docs didn’t even bother to see what position he was in at any point during her pregnancy and labor. In her second pregnancy, she had a hospital midwife who informed her before she was even due that she needed to turn the baby to prevent a posterior birth. They were sucessful, and my friend went on to have an unmedicated vaginal birth after c-section. Midwives have a ton to offer, whether at home or at the hospital, and know things OB’s do not! OB’s in general ought to be available for surgery, but unless they have training beyond what is required to become an OB, have no idea what to do for a natural normal birth.

  56. says

    I’ve given birth three times at a hospital in Finland. I would call the births undisturbed and natural, no drugs. It’s quite a normal Finnish hospital. It has several big rooms where the mother-to-be and father can stay together, and are interrupted almost only when needed. In each room, there’s a rocking chair and other furniture that help you select the position you want. There’s a private shower in each room, too. There’s a radio, magazines, etc, and the walls are painted in happy colors. And there are bath tubs outside the room, if one’s available you can have that too. I’ve used it all three times.

    If you seem to have very many hours left, you will be guided into another kind of room before the birth room, as there’s a limited number of these. This first room has a double bed, TV, etc. Like a hotel room.

    When you arrive at the hospital, you are asked what kind of birth you want, do you want an epidural, how do you want to deliver (on chair, lying down, on all four, etc.) and if you have special wishes.

    I had three wonderful births, they’re the coolest things I’ve ever experienced. Even though they were hospital births.

    I have no idea what U.S. birth hospitals look like, but if they looked like mine did there would probably be a lot less need for the home births, which I don’t object to either. Home births are very rare in Finland.

    • jenni peterson says

      well Finland has their sh*t together! It seems women and birth are respected there, in the US women are just sexual figures and most OBs want to control birth. its easier and more profitable to do interventions and cesareans, than it is to respect a woman and her child’s birth, and let things happen and support them.

    • Jo says

      I was watching a show in Sweden about severe tearing becoming more commonplace, and they made frequent references to why we should adopt the Finnish model of obstetric care where natural birthing methods have not been embraced as much. So, I’m not sure that for a woman in Finland wanting a completely natural birth would be able to have that in a hospital.

      And coming from a highly socialized country, spending tax money on hospital birth doesn’t seem right when the majority of women can safely birth at home.

    • Aundrea says

      Birth in the US is anything but luxurious.. if I had that kind of experience at a hospital like what you had heck yeah I would LOVE the hospital.. but I have given birth in the USA at home and in a hospital… I had complications at the hospital, non at home. I choose home. I’ve never felt so safe in my life.

  57. Shelly says

    I gave birth to four of our seven children at home. They weighed between 10.5 lbs to 11.5 lbs, the cord was around my son’s neck (no problem for my midwife), and having experienced both options, I DEFINITELY choose home birth over hospital birth. I didn’t have to listen to the doctor talking to his assistants about his last golf game – I was surrounded by family and friends and it was a positive atmosphere in which to bring new life forth.

  58. rachel says

    My sister almost lost her life giving birth at a hospital. It was an unforseen problem after a normal, low-risk birth. Home birth sounds nice sometimes, but in her situation, minutes counted, and she would be dead if she had not been in a place where doctors could help her immediately. I am thankful for hospitals and doctors, even though they drive me nuts. I think if all the effort people put into publicizing how wonderful home birth is toward making changes in hospital culture and having better hospital births, we would really all be better off. I am not against home births per-se, just happy to have my sister alive.

  59. says

    Thanks for this article, things are a little different in Nz we all tend to have are own independent midwife with many choosing preivate obstetricians (not great for increased intervention) so having baby in hospital dosn;t tend to mean intervention.

    With my 2nd I was only in the birthing room for 50 minutes.

    What I prefare with a hospital birth is that there is someone there to check on my baby in the 1st 24 hours of their life and I get to spend 3 complete rest days in a nice private room focusing on my new born and not running around chasing a toddler.

    Women do need to rest to recover from pregnancy, labour and birth and a private room at a hospital or private birth care unit can provide that.

    I too follow paleo and completley believe women can and should give birth naturelly and interventions should happen in cases of emergencies only

  60. Zaggs says

    “This innate system of birth has been refined over 100,000 generations”
    “Think of it this way: humans have been giving birth at home for 999,998 generations, and it’s only in the last 2 generations that hospital birth has become common.
    This means that women have given birth at home for 99.998% of human history.”

    No, no, no, no. Any “doctor” that has to resort to lies like these really does not need to be giving anyone advice on anything. Yes, lies. These numbers are far too out of bounds of actual history to be a mistake. Modern humans have only been on the planet for like 250,000 years. So maybe a quarter of a million years and not even close to a million generations or 100,000 generations. Or if you’d like modern humans have existed for 12,500 generations.

    • Chris Kresser says

      Homo Erectus evolved 1.8 Ma, or roughly 90,000 generations ago. Do you think H. Erectus gave birth to offspring in a fundamentally different way to modern humans? For that matter, does birth in mammals in general differ in a fundamental way?

      I’m not a doctor, nor have I ever claimed to be.

      • Zaggs says

        “Humans” are Homo Sapien Sapiens. We show up only about 200,000 years ago. If you’re going to go that way why not use Homo Habilis at 2.3 million years ago? Or Homo Ergaster at 1.9 million years ago?
        Your whole pitch is predicated in what had been done for 99% of the time. We don’t even really have recorded history for 98% of our existence. The how mammals give birth does not differ, but again thats not what you are talking about is it? You’re talking about an accepted practice somehow being perverted. Well one can argue that for 98% of human existence people didn’t use hospitals at all. So by your theory they shouldn’t use them now. For 99.5% of time human didn’t leave the area they were born in, so I guess we should stop traveling to other countries.

        • Chris Kresser says

          If you have actually read the rest of the article and the series, it’s disingenuous of you to suggest that my “entire argument” rests on the evolutionary history of birth. I could remove that entire section and the modern research alone would support the argument I’m making in the article, which is that home birth is no more dangerous than hospital birth for low-risk pregnancies.

  61. Britte says

    I am a CNM (Certified Nurse Midwife), which means I was first a RN, then obtained my Master’s Degree and took a formal examination to become certified as a midwife. I happen to work in a hospital, offering the most natural births I can possibly offer in that setting, and also in a licensed, free standing birthing center. That is one option that I haven’t seen discussed here (although I didn’t read all of the responses). For many women who desire to avoid the unnecessary hospital interventions, but do not have access to a licensed midwife for a home birth (due to the unfortunate condition of state laws on this issue, that make it impossible for most certified midwives to perform home births), a free standing birth center can be a wonderful option. Birth centers are typically very home-like environments with no continuous fetal monitors, and none of the “typical” hospital interventions are done there. Such as inductions, forceps, vacuum extractors, etc. However, medications and equipment are available in the event of an emergency, and protocols are in place for rapid hospital transfers for situations that need a hospital. Birth centers are very safe alternatives to home or hospital birth, not to mention much more affordable. More information can be found at American Association of Birthing Centers website.

    BTW, I completely agree with this article and applaud you for writing it! I hope your home birth was very blessed!

  62. Janice says

    If we do our research and really think, it’s obviously safer to give birth at home. Anyone who thinks differently has not:
    a) read the relevant research
    b) attended both home and hospital births
    c) given birth
    and/or d) seriously thought about it.

    Hospital births are like hospital conceptions. Sketchy at best and definately NOT a good time. (Unless, of course, that’s your thing! And even if it is, you’re still better off having the birth at home!)

  63. Rachel says

    Put me down as another one who has seen countless Moms give birth in the hospital (as an RN) and chose to have all five of her babies outside the hospital (4 at home) (I also only had one sonogram for one baby).

    No one is suggesting that women don’t get medical care. We’re just suggesting you might get better medical care at home. I can absolutely attest to that.

    You’d be surprised how many “complications” were created by the Dr at the Hospital but then they made you believe that you were lucky to be in the hospital so they could “fix” the problem.

    BTW, I had my first two babies at home with a Dr. (Well, he missed the second one by about 5 min, but the nurse was there.) (Homefirst in Chicago.) They were excellent but I’d still rather have a baby with a midwife.

  64. says

    Chris, you may have answered this in one of the 142 previous comments but I only read the article and the first 10 (got overwhelmed with the negative peeps) .what are your thoughts on vaginal birth after an abdominal myomectomy. Everything i have read (mainstream medical stuff and many midwife sites) say that if the cut is high (where mine was) that VB should not be attempted. Something about that stinks of people not wanting to take a a potential liability (the risk is somewhere around 10% I think – but who knows what it could be now because they have frightened women into having C-sections). I have no desire to be cut open again and subjected to pain meds while I am trying to breast feed and care for a newborn. Everything I have read suggests that the risks of rupture are EQUAL during the entire pregnancy as they are during the birthing process. In other words, if it was that dangerous, I should not be getting pregnant in the first place . . . It makes NO SENSE to me at all. . .
    Thanks for writing this very thorough article allowing us to make the choice for OURSELVES.

  65. Lina says

    I wish I would have given birth at home. I was induced and the whole experience was rushed, impersonal and downright horrible.

  66. ac says

    for a skeptical view of home births, i really think the informed opinion of an OB would be the best place to go. Chris, please do take a look at this blog- there’s a lot of food for thought here, and i do think its worth revisiting the idea of home births being safer than hospital births. http://skepticalob.blogspot.com/

    • Chris Kresser says

      Not at all. I’ve already seen her site, and she left some comments here which I disputed. I’ve researched this thoroughly and I know where I stand.

    • swinthe says

      She doesn’t “proof” that giving birth in hospital is more save! She just talks about deaths during/after Homebirth…

      If u would SEE the births in hospital that I have seen you would think different!

      By some of the stuff I had to watch I thought this is physical abuse!
      And those comments: “The mothers who want homebirths are careless and selfish” -> no they just don’t want to get stuffed with medicin and fear! That’s what hospitals do – they make pregnancy to a DESEASE doctors have to supervise!
      There are MORE complications in hospitals – more interferences!

      Midwife student from Germany

  67. Emily says

    I haven’t read through all of the comments, so forgive any repetition. I started my pregnancy in British Columbia, where home birth is covered by the national health plan for precisely the reason the author states–that for healthy women with low-risk pregnancies, home birth is as safe if not safer than hospital births. I had my choice of many well educated midwives who had hospital privileges should a transfer be necessary. This is not a few hippies advocating for home birth–this is an entire nation (and not the only one) looking at very clear scientific evidence and actually paying for women to birth at home.

    Mid-pregnancy, I moved back to the US, where the thinking about natural health and natural birth are so polarized that you see debates like this one, where people are often incapable of even listening to each other. One camp says home birth is almost criminal, that you are risking your child’s life. The other camp says the same for hospital births. It is all such nonsense. In the States, I managed to find amazing midwives to work with, but it wasn’t easy since home birth is almost like and underground subculture (comparatively speaking). I also had to shell out between $4,000 and $5,000 even though I have medical insurance. In addition, I had to set up a separate relationship with medical doctors should I need to birth in a hospital. (Interestingly, the Kaiser doctors and nurses I dealt with were familiar with the home birth safety rates and had no problem with serving as “back up”. It was mostly uninformed lay people who gave me flack for my decision.)

    Birth is always potentially dangerous, and any midwife worth her weight will acknowledge this. In order for home birth to be a safe and healthy option you must be low risk and you must be comfortable with the idea of being outside a medical setting, as fear and stress can inhibit labor and cause complications. Most midwives will screen you carefully to make sure that you meet these criteria. Midwives are also well equipped to deal with most birth emergencies, such as hemorrhage, and will be quick to transfer you to a hospital should they even so much as suspect a dangerous complication. Very well trained and experienced midwives can handle breach births and other complications.

    I would encourage all pregnant women to seek the care of a midwife, whether they plan to birth at home or not. Midwives provide prenatal care that is FAR above and beyond what you get with allopathic medicine. You will be seen every month in the beginning, then every week. You will be given intensive nutritional and lifestyle guidance and will be tested for common complications, like blood sugar problems, far more often. Problems are noticed very early, when they can be reversed with lifestyle changes or natural interventions like homeopathy. The mind-body connection, so important for healthy birth, is also given far more attention. This preventative approach is so incredibly valuable.
    The same goes for post-natal care.

    • Comadrona says

      Emily, birth may be potentially dangerous but, as 7 billion people on the planet can attest, it is usually quite safe and successful. A midwife worth her weight will, of course, screen women and look for problems but these days we are seeing more and more women who want a home birth who are “refugees” from a poor hospital experience, who might have had an unnecessary C/S, or who simply don’t accept that hospital is any place for their child to be born. We are now being told (in Australia) that we are not to attend VBACs at home…what should we do? There are women are badly hurt, and frightened of having a similar experience again, but it is their (human) right to have good birth care wherever they choose. As it happens, I have no problem with attending a VBAC at home because the risk is very little more than for a primip, but my professional organisation and the insurance companies say no. We midwives are being hunted down and penalised, and women are going it alone – which can and has led to tragedies.

  68. Louise Ferreira says

    None of the studies cited in your blog supports your subsequent conclusion that “complications are more likely to occur in the hospital environment”. I question the impartiality of your blog, on the basis that you fail to state the underlying difficulty with the studies cited in your blog, viz.: once cannot compare mortality rates for “hospital births” to those of “home births. The “Hospital group” contains women of all risk levels, with all possible pregnancy complications, and all pre-existing medical conditions, whereas the women who are generally allowed to have home births in the USA and Europe are low risk, falling in the top 5% of birthing mothers when it comes to age, weight, fitness levels and history of complications. It is simply misleading to compare apples with pears in order to support your conclusion that “natural” births are safer, and therefore, preferable, to hospital births. Your conclusion s simply not supported by the evidence…

    • swinthe says

      That’s ’cause just few to no people question WHY some of the c-sections happen…
      In general all the mothers think (or made to believe) it was necessary and it saved their and their babys live.
      Sometime c-secions happen ’cause the doctor interfered and made a mistake or the doctor just want to get home (belive me I SAW something like that happen!!)…but it always ends up that they say: Thank God you were in a hospital and the c-secion saved you..
      What about those examples? They are NOT included in whatever studies there are…no doctor would admit they made a mistake or they are just lasy…

      I don’t say anything against c-secions IF they are necessary, but I’ve seen situations in hospital that just make me cry inside!
      The whole life is filled with “danger”…runover by a car, fall down the stairs,…but you wouldn’t stay home your whole life and don’t go outside…there are risks with everything, but if you have a good and caring Midwife she KNOWS what is ok or if it is saver for you to be in hospital ’cause there are some difficulties in your pregnancy!

      Midwife student from Germany

    • Kim says

      Louise, in the studies, they actually do compared apples to apples – low-risk pregnancies in both hospitals and home births. So, the “Hospital Birth” group only contained women who fit the same criteria as those in the “Home Birth” group.

  69. Samantha says

    I found this article to be misleading. I had a still born at 40 weeks. i was considered low risk, and shit happens no matter where you plan to give birth. I was the doctors office the day before, and they were going over my options. I was in labor for a few hours before i went to the hospital. Preparing to give birth they hooked me up to the machines, and couldn’t find the heart beat. My cervix was not cooperating, and my choices were to have c-section or remain in labor for another day while they gave me some stuff, and maybe if the stuff worked to give birth to a baby I knew would never cry. I didn’t have it in me to go through that, and i opted for a c-section.

    Unfortunately, I am not considered low risk anymore, and I would do anything to give birth naturally, but since the hospital had a mess-up with the paperwork and did not perform an autopsy I will never know what happened to my baby girl. I had a hard time reading your article. She was my first pregnancy, and I had every intention of having a natural childbirth at the hospital. I took birth classes and had a doula. The hospital I was going to give birth at, had private rooms with tubs in them for water births, and those yoga ball things. There was the birth room and the after birth room. They kept me well informed through out all my pregnancy, and even with all the complications they constantly gave me choices for my options. I had the choice to try to have a vaginal birth, but I chose to have a c-section.

    I was very well informed, and I would hope anyone having a baby would do lots of research to what their options are. I was skeptical of having a childbirth at home because of the “what-if” situations. I have many friends who have had many successful at home births and I am not against it, just not for me anymore. I know I am an exception, and this article is for low risk pregnancies, but I was a low risk pregnancy before.

  70. Sloane says

    Chris — Thanks for the info! I’m curious of what you and your wife’s home birth experience was like and what you think about it after having gone through it, pain level (if she did it without pain meds), etc. You may not want to share about it since it’s about your personal experience, but I thought I’d at least ask. I am not pregnant currently, but whenever I do become pregnant I definitely want to do a home birth but am nervous about the pain aspect without any medication. I know that our bodies were made to bear children naturally without any medication but, as you know, this has become more abnormal than normal in today’s world and people keep telling me horror stories and are generally shocked any time I mention I’d like to go the natural route. If you could provide your opinion (or any readers!) I’d really appreciate it! Thanks so much!

    • Kim says

      Sloane, your best option for a successful birth without using pain medications, is to use a Doula. A Doula is a professional labour support provider, and will help you and your partner (or other support person) in managing the discomfort of labour. Women who use a Doula have a lower need for pain medications, tend to have faster, easier births, and report a better, more satisfying experience. Of course, having a midwife helps, too, and many midwives will help you the best that they can, but they are the medical caretakers, and may have to focus on other things when all you want is a double hip squeeze! :)

  71. says

    Chris, Thank you for providing information and a forum for people interested in having the healthiest and most satifying pregnancy and birth experience. I am a Licensed Midwife who has attended women primarily in the home environment for 37 years. I have also practiced in Birth Centers and have functioned as a Doula in the hospital. I had 3 children myself, all in hospital before the advent of routine, IVs, epidurals and a 36% national Cesarean rate. My first two births were easy, about 8 hours from start to finish. My first baby was born an hour after arriving at the hospital, my second baby was born 2 hours after arriving at the hospital. I wanted to have my 3rd at home, but was unable to find a midwife. Instead, I was induced by my doctor for convenience, with what I believe was an overdose of Pitocin. My son was a high need baby who was eventually diagnosed with Dyslexia and learning disabilities. My birth experiences helped me make the decision to become a midwife. In 37 years, I have never lost a mother or a baby. I have seen complications occur at home, but always with good outcome, because the complication was handled safely at home or we tranferred to hospital for medical intervention. The key to safe home birth is 1)Have a healthy mom who trusts in birth. 2)Have a well trained, experienced attendant who puts safety first. 3)Have an “Emergency Care Plan”. (A back-up obstetrician and pediatrician and identified hospital.) I don’t understand how anyone can defend hospital birth as safer than home birth when Maternal and Infant Mortality are rising due to the rates of Cesarean, Pitocin and Technological Childbirth in the United States today. The US is now rated 42nd in Maternal Mortality and 34th in Infant Mortality. I believe the overuse of surgical childbirth and technology is dangerous,as it contributes to the mortality and morbidity of mothers and babies (besides costing unnecessary billions). Natural Childbirth is the safest. Remember there are no drugs known safe in pregnancy. High risk mothers should deliver in the hospital setting and healthy moms should be given a choice as to where and with whom they deliver. Woman, believe in nature, believe in your body. We have been doing this naturally for thousands of year.

  72. mamie says

    Let me tell you all the biggest danger of HOSPITALS: impatient doctors that are eager (and push very hard) for you to take drugs, allowed them to perform a not necessary C-section and etc!

    Doctors don’t want what’s best for you or your baby but they have brainwashed you into believing that.

    A woman in my family had a baby recently and the doctors would not allow her to breastfeed her child as they put it on her and tried to take it away for the night, she was so angry and upset she decided to go home and then, it seemed like they didn’t want to allow her to do so! Hospitals are filled with crazy, incompetent, unsympathetic people!

    But, of course, many women want the baby without the pain, then they load them onto nannies and done with them! Like they say: cannot make an omelet without braking eggs!

  73. Amy says

    Hello, I am wondering if you could include an aritcle on circumcision as part of your baby series. It is essential that parents are equipped with full information on this topic, and not only the new heavily publicized statement by the AAP that the benefits might outweigh the risks. The practice is discouraged in much of the world, and all health authorities have access to the same research. It is traditionally a Muslim and Jewish practice, but still many Jewish mothers I know have opted out for their sons. The AAP position reflects poor ethics and poor medicine. Your stance on natural birth seems incomplete without addressing the topic.

  74. Michael Ray Overby says

    I wanted to get your opinion on Monochorionic Multiples, the Vast Majority of which are Identical Twins, As you should be well aware, these pregnancies carry an order of magnitiude higher risk than Singletons for issues such as Twin Twin Transfusion Syndrome TTTS, & Cord Entanglement for the much rarer Monoamniotic contingent. Somewhere over 14%, one in 7, Monochorionic Diamniotic pregnancies will develop TTTS, which has a Very High mortality rate. What should pregnant women do to protect themselves from these Threats endemic to Monochrionic Multiple pregnancy?

  75. Marianne says

    Keep in mind the obviously obvious: Home births have a high success rate now because, if there are complications beyond the body’s (or midwife’s) capabilities, then the home birth plan goes out the window and to the hospital she goes! Naturally there are more high-risk births in a hospital; that’s where they tend to end up (if they’re lucky). Thanks to hospitals (industrialized as they may be), the mortality rate of women in childbirth is considerably lower now; dying in childbirth used to be a more common reality for women. Not so much in the modern world! ObGyns are a lot more plentiful than talented midwives and birthing acupuncturists in the US, unfortunately, and not a ton of women are informed of, or interested in, a drug-free home birth.

    I agree that the US gets a bit crazy and lazy with the C-sections (it’s a bit more sane up in Canada; only a bit, mind you). If that’s not something that interests you, let them know what you want (ie. have it printed on paper ahead of time and discuss it with them ahead of time), otherwise they’ll never know you wanted no drugs and a doggy bag for your placenta. They usually do their best to accomodate. (Of course, if that’s not the vibe you’re getting, by all means find someone/someplace else!)

    Many women have a revived interest in more natural birthing now; I may do the same in a few months -I’m certainly open to it (it will most likely be in a hospital; our home’s too cramped, plus we live up 27 flights of stairs). But if your birth plan doesn’t work out the way you dreamed it to be, please don’t beat yourself up over it. When you are healthy and your baby is healthy, all that stuff won’t matter.

  76. Marianne says

    P.S. If it cheers you up any, think of the last time you had dental work done and asked the dentist for no novacaine whatsoever, and insisted the drill be replaced by a hammer and chisel, since you wanted your tooth drilling experience to be as nature intended.

  77. Jules says

    Hi. I just read some of the articles and Im with you!
    I had my baby 9 months ago. I had a beautiful waterbirth at my house with wonderful, loving, caring midwives! I felt in control of my body and my labor process. My body did what it had to do and i just went with my instint! I didnt have anybody telling me what to do, giving me meds and what not… I was at home, my hubby… Playing music for me while i did my thing… We danced, i took showers, walk around my house… It was a beautiful experience!
    I NEVER went to a OBGYN! I went to a midwives clinic and the 9 months were just incredible. The attention, the care, how the midwife gets to know u is incredible, to the point that they become family and u feel so good theyre there for u. I live in canada and everything is cover by our health system. So i only paid for the rental birthing pool. In all i can say ill do it again and again!
    In regards of any risk or complications… In order for u to deliver a home u have to had a healthy low risk pregnancy… Of course anything can happend but if u are healthy and confident on yourself! Then why not go for it! Us women are strong! More than we think we are. And let me tell you… Natural homebirths are faster! I started slow contractions at 9pm then really bad contraction at 3am and by 730am i had my first born! I recommend The bussiness of being born. I watches this way before i got pregnant and i learned sooo much… It got me curious and i did my research and at the end chose to go with midwives instead of doctors.

    Thank you so much for the articles.

  78. says

    Midwifery in Ontario, Canada has been regulated since 1994. The provincial government covers the costs of midwifery care (as well as Family Practice and OB) and midwives are well-paid with benefits.

    In order to maintain competency, midwives are required by law to attend home and hospital births. If birth centres are available, they can attend in this setting (these are just starting to be set up). Midwives are primary care practitioners with hospital privileges, can order ultrasound and lab work and can write a for a small number of pharmaceuticals.

    Parents choose place of birth and if a planned homebirth needs to move into the hospital, the appropriate care (OB or Peds, etc) is accessed. The most common reason for transfer to hospital is long labour for first time mothers – a 1991 published journal showed a transfer rate of 32%. http://www.researchgate.net/publication/227799969_Outcomes_of_1001_MidwifeAttended_Home_Births_in_Toronto_19831988

    A more recent study showed similar results – just under 30% transfer of care for nulliparas (never birthed) and approx the same rate of epidural use for planned homebirth. Scroll to bottom for Ontario Homebirth Study: http://familymidwiferycare.ca/birth-place/homebirth

    The site for the Association of Ontario Midwives has more information at: http://www.ontariomidwives.ca

    Birth has been in the hospital setting for less than 100 years and was seen as mark of wealth. In fact, my husband was born at home in Ontario before health care was covered by the government – it was cheaper for his mother to do this. When we had our first in 1990, we paid out of pocket for a midwife attended homebirth!

    My sympathies to to all those who have posted here who have suffered trauma in pregnancy, birth and postpartum. I applaud Chris and his thorough approach to this conversation and I encourage everyone to consider what the science has to say and make informed decisions.

  79. Kristal says

    Thanks for writing this article. I’ve been trying to find unbiased info on homebirths and haven’t come up with much. In addition, I have a major lack of support from my family and friends because I said decided on a home birth. I’ve also been under a lot of criticism because I decided to go with a midwife and not an OB. I feel a lot more confident in my decision!

  80. London says

    Thank you so much for writing this!! I have been looking everywhere to find research on a natural birth vs a medicated birth. When you really stop to think about it, a natural birth is the LOGICAL choice! We’ve been doing it since the beginning of time! Yes, at times we need medical intervention and thank heavens for it, but most women (including myself, with my first child) use a hospital because it’s the “normal” thing to do. We don’t even hear about the option, the benefits and all the good that can come from a natural child birth. I want to give birth to the rest of my children naturally and have been dying to find more research on the subject. My biggest concern is the Safety of my baby! It’s funny that during pregnancy women can’t so much as take medicine that can be bought without a prescription but all of the sudden it’s fine to be induced, have an epidural, etc etc. That doesn’t make any logical sense. There hasn’t been much research done and it bugs me that people think that it’s “wrong” or “dangerous” to give birth anywhere but a hospital and without pain relief/medication. If/when you find more research please continue to post it, I would greatly appreciate it!!!! Thank you!!

  81. rachel says

    The author uses medical reports and statistics from the 1980′s or later, I hardly think that is relevant at all in 2014 medicine. If the argument can’t be supported by relevant statistics, clearly there is no argument to be made.

  82. Kennedy says

    Out of my acquaintences 9 homebirths, 2 babies died. 1 ended up with Cerebral Palsy from a traumatic birth. 1 would have died if the baby hadn’t been delivered at the hospital. 1 ended up at the hospital with oxygen deprivation and 3 were born without complications. 1 out of the successful births was from a mother who was 18 years old. The other 2 the mother was a nurse practioner herself. I hate homebirths. I’ve seen it destroy lives. I am fundamentally a left wing cruncher but I can’t believe my community’s experience is an anomaly.

    • says

      Kennedy – I am sorry to hear about the experiences of the people you know. These are painful stories to hear. And stories are important, but they do not tell the whole picture.

      I can match all of your stories (and more) with detailed reports of trauma created by the medical system within a hospital birth unit…babies who died as a result of medication errors and inappropriate medical care…women who were seriously harmed physically (not to mention emotionally).

      As a result of these experiences (that I personally witnessed), I could easily say “I hate hospital births,” but I don’t.

      What we both hate is the pain and suffering that can accompany birth. It is not fair. It should not be happening in our enlightened era. But it does.

      And anyone who looks to modern-day medicine as a way to ensure that poor outcomes will never occur has a serious misunderstanding both of the nature of birth and the limits of western medicine (i.e. pharmacology and surgery). Neither of us know the details of the births you mention (most cerebral palsy injuries occur in pregnancy, not at the birth) so we are not in a position to pass judgement.

      This is why I am a strong supporter of Chris’s work because every day more evidence emerges that not only do healthy mothers create healthy pregnancies and births, they also pass on this health to their grandchildren and subsequent generations.

    • Daleth says

      Here is another home birth tragedy, resulting in a healthy 36-year-old mother dying:

      http://www.theage.com.au/victoria/homebirth-mother-told-midwives-she-was-dying-court-hears-20140610-39vba.html

      This is especially horrifying:
      “Just over an hour after Zahra was born in a birth pool, Ms Bourne said Ms Lovell was light-headed and hyperventilating, telling her midwives she was dying and needed to go to hospital.

      “Gaye then questioned Caroline as to what she was feeling, in this conversation Caroline did not identify any physical symptoms,” Ms Bourne said. “Gaye and I also made efforts to calm and reassure Caroline.”

      …as opposed to IMMEDIATELY CALLING AN AMBULANCE?!?!?!?! And apparently they didn’t even examine her or take her blood pressure–which would have told them she was in serious trouble.

  83. Daleth says

    Why are you using tiny studies (5000 women) and studies from other countries, when we have big studies in the US here that show that midwife-assisted home birth in this country is more than four times more likely to result in a dead baby than midwife-assisted hospital birth? For instance, the Cornell study, which looked at over TEN MILLION births (*every* full-term singleton weighing over 2500g/5.5lbs born in the US from 2007-09):

    http://www.ajog.org/article/S0002-9378%2813%2901155-1/fulltext

    Neonatal mortality rates for these babies when born at home with a midwife: 13.2/10,000

    Neonatal mortality rates for these babies when born in a hospital with a midwife: 3.1/10,000

    And isn’t it a little bit dishonest to use Dutch or other European statistics to evaluate the safety of home birth in America? We are the only developed country that lets people with minimal to no medical training be licensed and practice as “midwives” (they’re called “direct entry midwives,” “certified professional midwifes,” etc., as opposed to “NURSE-midwives”). All they have in Holland or other first-world countries is the equivalent of Certified Nurse Midwives–in other words, real midwives with actual medical training, liability insurance (i.e. an incentive to ensure that high-risk women do not deliver at home), and working relationships with OBs and hospitals.

    • says

      I post Canadian, Dutch and European studies because I am Canadian and our system is similar to the European system.

      You have a valid point that Americans should look to American studies – the neonatal AND the maternal mortality rates are shockingly high, especially because of the amount of money that is funneled into your health care system. Developing countries have much better rates with far fewer dollars. And, given that midwives in your country deliver so few of the babies, these scandalous stats are squarely laid at the foot of the inequitable system in the US.

      Please do not equate nursing with a higher level of care. Midwives in Ontario spend 4 full years at the University level to receive their designation. As I have posted on this thread, it is the highest standard on the planet. And nursing is not a requirement to be a midwife. It is like requiring your auto mechanic to also know carpentry. Midwifery is not nursing.

      And Canadians specifically chose this model for midwifery care because we looked to our southern neighbours and were appalled at what we found. Direct entry midwives not allowed any access to hospitals; nurse-midwives with zero knowledge of out-of-hospital birth because they are forbidden due to insurance restrictions.

      And Dutch midwives are not nurses. They are midwives.

      More and more, women are voting with their feet. If you have seen even 1% of the inhumane medical treatment that I have witness, you would, too.

      This is a link that explains relative risk – and if you follow Chris Kresser, you should have an understanding of this concept:

      http://www.scienceandsensibility.org/?tag=ajog

      • Daleth says

        My point about midwifery in the US is that about half of US states let people become licensed as practicing midwives without any medical training (unless a weekend CPR class counts as medical training), without any university education, without any education in medicine–without necessarily even having a high school diploma, much less training in anatomy, obstetrical care, etc.

        I’m not saying Dutch (or Canadian) midwives are nurses, I’m saying that in terms of education they are equivalent to what we call Certified Nurse Midwives (CNM’s) in the US–in other words they’re drastically better qualified than the other quote-unquote “midwives” in the US, who are called different things in different states, but often Certified Professional Midwives (CPM) or Licensed Direct-Entry Midwives (LDM).

        Dutch and Canadian midwives, like British midwives and licensed midwives in every other developed country, have years of university-level education in medicine (anatomy, physiology, etc.) and obstetrical care, including at least a year of clinical experience in a hospital or birth center. The same is true of CNM’s in the US.

        But NONE of that is required of any other type of so-called “licensed midwife” in the US. Generally speaking all that CPM’s or LDM’s are required to do to get their license is pass a written exam, assist another CPM/LDM at a very small number of births (in Oregon for instance it’s just 25), take a CPR class, and act as the responsible midwife at another very small number of births (again, 25 in Oregon). There is NO educational requirement at all.

        So I really think it’s important, given that you have readers in the US, to clarify that what you say about home birth safety applies to countries like Canada, Holland, the UK etc., where the people who attend home births are PROPERLY TRAINED midwives. The statistics for home birth in the US are far worse than yours, for various reasons, but no doubt including the fact that most home births are attended by CPM’s/LDM’s and NOT by CNM’s–in other words not by properly trained midwives.

        • Celeste says

          You are obviously making assumptions about direct entry and CPMs and their education. If you actually looked at a midwife’s training and requirements, it is comparable to medical school (not nursing). Just bc time isn’t wasted at a university taking expensive and irrelevant classes doesn’t mean the entire education process isn’t adequate.

          Btw- looking at studies in other countries is beneficial in being able to rule out bias. When others get the same results, you know it’s good science. But, if in fact different results are found, someone (or everyone) got something wrong and further research is needed. You also have to consider the fact that infant mortality is about the same among most developed AND developing nations. Countries who have most home births as well as those with mostly hospital births. The US has the highest maternal mortality rate and we have mostly hospital births. Consider these facts all together and you can clearly see there’s something concerning going on with our healthcare system. I don’t see how one could know these facts (they’re out there for anyone willing to find them) and still deny that there’s a problem.

          • Daleth says

            Gosh, no, I’m not making assumptions–I looked up the actual legal requirements for becoming a licensed midwife in a few states and was appalled. For instance, here are the requirements in Oregon:

            http://www.oregon.gov/OHLA/DEM/pages/midwifery_how_to_get_licensed.aspx

            There is a big difference between a 2 to 4-year university degree in midwifery and “self-study,” which is all that’s required to be a licensed midwife in Oregon.

            How on earth could you say that some undefined length and quality of “self-study,” plus assisting at 25 births, attending at 25 births, and doing 100 prenatal visits is even remotely comparable to medical school?!

  84. says

    I think you are tussling with the wrong girl here.

    I am not the best person to engage in this discussion, but as you have thrown down the gauntlet, I will respond just this once.

    I did my direct entry training in the US prior to the legislation of midwifery in Ontario. I am one of the truly horrible people you decry.

    In fact, I delivered babies in Ontario prior to legislation when it was, for all intents and purposes, not legal. I never had a bad outcome. Many of my clients are my friends today as their children are off to post-secondary education.

    So, I am doing my best to not take this as a personal attack.

    I chose to have a midwife deliver my first (when midwifery had an uncertain legal status) and as a junior practitioner, my midwife actually had less experience than me at the time.

    But I trusted her way more than any medical stranger who I would have encountered if I had chosen to birth in the hospital L&D unit.

    I have been at births with obstetricians, nurses, and yes, midwives, who, while highly qualified, actually put the lives of mother and baby at risk. Unlike the US, in Canada our system does not encourage litigation, so these tragic outcomes have not been made known to the general public.

    Are you a birth attendant?

    Do you have ANY idea of the assembly-line approach that happens in the medical system when it comes to birth?

    Do you have any scholarship in the histories of medicine, midwifery and birth?

    Do you have any clue about the biochemical processes that are required to birth successfully? (Hint: it involves feeling safe, not being interfered with, quiet and dark environments. None of which are offered in a standard hospital L&D room. Heck, even race horses get better treatment – humans realized that if they hovered while the horse is in labour, problems result. But when you have a valuable race horse you make sure that she births successfully. With human females, interference, strangers walking in and out, needles, being monitored (watched), being restrained to the bed, continual ultrasound on her belly for fetal monitoring, no fluids or food, etc, etc is somehow considered reasonable and then we wonder why medicine had to swoop in and save the day.)

    The American system is broken. Watch The Business of Being Born. Even a cursory study of the history of birth will provide insight into the tragic division of hospital midwives and non-hospital midwives in your country. The politics in this goes very deep because all along, it is more about controlling women and their choices than it ever was about saving babies… because if it was about saving babies and their mothers, very different policies would be in place in today.

    You can be punitive and judgemental and (in my mind) thereby adding to the problem, or you can become informed and open yourself to the actual dialogue that is happening among midwives and expecting parents.

    Demanding more legislation is not the answer. Demanding more drugs, more surgery, more tests are not the answer.

    Telling women what choices they can and cannot make is unacceptable i this day and age. I chose a direct entry midwife for my first; I had a university trained midwife for my second. Both homebirths were lovely, easy and natural and I would not trade them for the world. The care was the same for both. The only difference was I did not have to pay out of pocket for the second as the government health care system covered all costs.

    There is a long, long history of the persecution of midwives that is still happening today – even in developed countries! This is outrageous.

    Birth is a natural process and to say that that only specialists in pharmacology and surgery should attend birth because they are some type of gold standard is demeaning to women. Specialists in surgery who attend birth, surprise, surprise, are a significant reason for the increase in caesarean (Brasil, China and Iran are at 50% – countries that mimic the US in their medical aspirations) that only leads to higher maternal mortality and morbidity….and…wait for it… WITHOUT a corresponding decrease in neonatal mortality.

    If you want to make a difference, lend a hand to the CPMs and LDMs so that they are supported in receiving the integration into the current system. A dismissive approach, especially from someone who (I can only assume), is not knowledgeable about the system, adds nothing to the discussion.

    In fact, the majority of the babies in the world are delivered by Traditional Birth Attendants in absolutely appalling conditions. War, unclean water, walking miles in labour to the nearest hospital, no basic medical supplies are routine for most women giving birth on our planet today. If you are not willing to help out in your own country, perhaps you can donate in some small way to reduce maternal and newborn mortality in developing countries. They can certainly use any help that those of us who live in a Western country (and are therefore privileged) can spare.

    While you are at it, take a look at the International Confederation of Midwives happening in Prague right now. http://www.midwives2014.org/

    • Daleth says

      Perhaps I wasn’t clear, but I’m not seeing where in my post it said that only specialists in pharmacology or surgery should attend births? I did say CNM or equivalent midwives are absolutely properly trained to attend births, and of course they’re not surgeons at all nor are they specialists in pharmacology.

      And I’m sure there are some good midwives who lack the CNM or equivalent credential, but the problem with CPM/LDM licensure is that you can’t tell which people have proper training and which don’t, because the states that recognize those “credentials” have such minimal training requirements (for instance in Oregon you can become an LDM with NO educational qualification other than “self-study”). So with the exception of those CPMs or LDMs who actually do have significant medical training and experience, I can’t in good conscience support integrating CPMs or LDMs into the medical system in any capacity other than, for instance, as doulas.

  85. says

    Studies published in the United State re: Home Birth often use Birth Certificate statistics including unplanned and unattended home births. They are not tracking births attended by licensed/educated professionals. There is no matched risk comparison. The “studies” are inadequate and inappropriate. I have been licensed in Florida as a midwife since 1986. When I first started filing Birth Certificates, there was no category for planned home birth attended by a Licensed Midwife. That changed in 2004 when the categories of Licensed Midwife and planned or unplanned home birth were added to the Birth Certificate. In Florida we have a required 3 year educational program based on World Health Organization standards. Our educational curriculum is outlined in statute and rule as are practice guidelines requiring a risk screening allowing for delivery out-of-hospital of only low risk women. Daleth, if you would like to review the law that regulates midwifery in Florida, which I think is an excellent standard, I encourage you to research F. S. 467 and associated Administrative Rule Chap. 64B24. Every state in the U.S. has different laws that regulate Midwifery. Out-of-hospital birth should be a CHOICE available to all healthy pregnant women. The American Medical Association has done its best to eliminate the practice of midwifery beginning in the 1920′s. It is only due to the needs of women and a few brave souls who were willing to battle the money and power of the AMA that Midwifery is beginning to make a come back. Midwifery is the world wide standard of care for women. The United States has dismal statistics when it comes to Maternal and Infant Mortality. The standard in the U.S. is hospital delivery and we spend more money on Obstetrical Care than any other nation in the world. The average cost of delivery in the U.S. today is $30,000. We are ranked 45th in Maternal Mortality and 50th in Infant Mortality. This is a public health problem that could be easily remedied by Midwifery care being encouraged, supported and the standard for low risk pregnant women and families.

  86. Daleth says

    Sharon,

    Thanks for the info on Florida law. I will look into it.

    Based on what you said about inadequate studies, it sounds like you may not have seen the Cornell home birth study, which did exactly what you say a study would need to do in order to be valid. That is, it compared *midwife-attended* home births to midwife-attended hospital births. (It also compared those types of birth to home births attended by non-midwives–in other words it clearly broke out births by not only their setting, but the qualifications of the person attending.)

    This was perhaps the largest study of its kind, since it looked at over 10 million births–namely, every recorded birth in the US for three consecutive years (2007-09) that fit the study’s “low-risk baby” criteria (singleton, full term, at least 2500g/5.5lbs, no congenital abnormalities). Here is a link:
    http://www.ajog.org/article/S0002-9378%2813%2901155-1/fulltext

    And here is what it found, in order of the death rates for babies:

    Neonatal death rate for hospital midwife births: 3.1/10,000

    Neonatal death rate for birthing-center midwife births: 6.3/10,000

    Neonatal death rate for home midwife births: 13.2/10,000

    Neonatal death rate for home births attended by non-midwives: 18.2/10,000

    Long story short, babies born at home with a midwife were just over 4.25 times more likely to die than babies with the same risk profile who were born at a hospital with a midwife. They were also a hair more than twice as likely to die as babies born at a birthing center with a midwife.

    I don’t know what the figures are for Florida–I’m guessing they’re better, if the requirements for licensure are as solid as you say (I haven’t had time to look at the FL laws yet). But at the nationwide level, the results are clear.

    Oh, also–”infant mortality” is not the correct measure of how safe childbirth is in any given country, because it includes all deaths of all children under 1 year old. In other words it includes car accidents, childhood illnesses, SIDS, etc. etc. etc. If you want to look at how safe childbirth is for babies, the correct measure is neonatal mortality (deaths from age 0 days to age 28 days).

    On neonatal mortality, with countries ranked #1 being the best, the United States ranks high–tied with Canada and a few other countries at #4: http://apps.who.int/gho/data/node.main.ChildMort-2?lang=en

  87. Sharon says

    I am saddened at the loss of the life of any mother or infant and wish that all such loss could be prevented. Mothers and infants may die no matter the birth site or the practitioner. Unfortunately, midwives and home births seem to be targeted rather than doctors and hospitals. Mothers and babies die or are damaged daily in hospitals. Unfortunately, it does not get the press coverage that bad outcomes at home get. Safety must always be paramount. Education, standards, licensing, competence, risk screening, medical history, are all important. Making home birth or the practice of midwifery illegal is not the answer. Proper education, training, regulation, standards are essential to safe delivery no matter the site.

    • Daleth says

      Babies die far LESS often in hospitals than they do at home births, at least in the US. You can see that in the Cornell study, which looked at over TEN MILLION births (*every* full-term singleton weighing over 2500g/5.5lbs born in the US from 2007-09):
      http://www.ajog.org/article/S0002-9378%2813%2901155-1/fulltext

      Neonatal mortality rates for these babies when born at home with a midwife: 13.2/10,000

      Neonatal mortality rates for these babies when born in a hospital with a midwife: 3.1/10,000

      Even for babies born with an OB-gyn in a hospital, the death rate was still only 5.4/10,000, far lower than low-risk home births with midwives. And that’s a very eye-opening number, since the babies born with a hospital OB-gyn include **all the high-risk pregnancies,** for two reasons: (1) hospital midwives and competent home-birth midwives “risk out” high-risk women (i.e. send them to hospital OB-gyns for birth), and (2) many women who start labor with a midwife at home but have complications, and all women who start with a hospital midwife but have complications, end up delivering with hospital OB-gyns.

      5.4/10k vs. 13.2/10k! So even hospital OB-gyns delivering babies at high risk have less than half the death rate of home-birth midwives delivering babies at low risk.

  88. helen says

    I had 6 children. My 5th born would likely have died if I had had a midwife at home during his delivery. he was born “flat” and suddenly the team of professionals attending the birth had to scramble . THE COMPLICATION WAS AN EXTREME EMERGENCY AND CAME WITHOUT WARNING. Since the usual solutions to this complication were not successful , it took a full team to deal with it, to both attend to the baby and fetch needed equipment. I will never forget the team’s scramble and seeing some of their eyes riveted to the clock. It seemed so long, it was obviously critical. I won’t forget turning away from my beautiful baby so that I would not fall in love with him.
    ( Don’t judge me on this, of course I already was. The fear was excruciating) If I had been with a single midwife by the time she had tried various standard methods and without others to scramble and fetch the final solution to get him kick started severe brain damage would likely have occurred. I’m sorry but my sons life could have been very tragic if one person had had to deal with this at home. It is selfish in my opinion to put the mothers desire for a peaceful , emotionally fulfilling , home environment, that met her romanticized imaginings of the perfect, painless (ya, right) birth. Prepare for the worst possibilities which could better be dealt with by a team. If it might come up its stupid to take the chance of losing your baby. Another friend of my hemorrhaged and flat lines on the gurney when giving birth. Fortunately she was resuscitated. Why take the chance??????!!!!!!

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