Natural Childbirth I: Home Birth vs Hospital Birth | Chris Kresser

Natural Childbirth I: Is Home Birth More Dangerous Than Hospital Birth?

by Chris Kresser

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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 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

275 Comments

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  1. These posts are truly disappointing. While less interventions may be preferable, home birth as it stands in the United States, with lay midwives attending the majority, who have spotty training outside of medicine, who exist on the fringes of medical care, without standards of practice or a foot in evidence based medicine, is just not a safe practice and cannot and should not be endorsed. I am a proponent of safe home birth, with highly trained, masters prepared, nurse midwives, who are state licensed, who are integrated into the medical community, who have relationships with physicians and hospitals and are able to and comfortable enough to transfer care to a maternity ward when they see fit. This is the case in Canada, where midwives transfer approximately 25% of their low risk home birth mothers and continue to care for them in hospital. The transition is smooth. Not so in the US, where the transfer rate is around 10%, is usually through an emergency room and care is handed off to an unknown provider and potentially not an obstetrician. This is reckless and causes delays in treatment that may be lifesaving. Homebirth in the US is like the Wild West, with mothers prioritizing a need for a particular birth experience and perception of care over the well being of a helpless infant and potentially their own well being. It is a completely reckless decision.

  2. Good lord. In many countries a ” natural” child birth isn’t a choice. Its the only way. They don’t have access to the scientifically proven methods and life saving resources we have. Methods and resources that have greatly improved the survival rate of both mother and child. I find the “natural” birth movement insulting to every woman who lived before medically assisted births and to ever woman lives now suffering without it. Shame on you

    • Actually shame on you. I’ve had two of my children at home. My first was born in a hospital and it was a miserable experience. Doctors are outdated in their methods and the use of invention based on fear is inescapable. Home birth is the way to go.

    • Yes, I feel sad for so many women who are afraid of birth, birth is so easy. I didn’t think it was easy the first time I gave birth in a hospital, on my back with lots of drugs, that birth hurt like hell. But with my last birth, I was terrified of having to go to the hospital, I prayed and finally decided to educate myself about birth and have my baby at home without a midwife, it was the BEST decision I’ve ever made. It showed me how natural and painless childbirth is. I would do it 50 times in a row. It is a remarkable difference. My body literally did all the work, I stood up and didn’t even have to push, my body pushed her out on its own. My baby was also born without my water breaking until she came out, which i think also helped. Hospitals always break waters which puts the baby at risk. No thanks. I was up doing laundry and cleaning my house within the hour after having her. It was beautiful and so free. Birth is natural like menstruation, but i guess some folks rather stay scared, thank God we have choices!

      • The problem now a days is that young women no longer have an example, the do not watch their mothers (our aunts) give birth in de normal and natural way. De media and medical world is scaring them, so they go into laber with fear.
        I’ve had three kids the “normal” way, no problems, and yes it may hurt a bit, but that is over and forgotten the moment you hold you baby in your arms. I took my shower aftherwards, cooked a meal and went shopping the next without any problems. The key is to be relaxed, your body kbows exactly what to do, we’ve been dooing it for millions of years and if it was that terrible or dangereus I think the human race would have long been extinct. Childbirth is normal and not an illness, let nature do what see does best, procreate.

    • LOL what a joke. The medical industry is where the corruption really lies: Big Pharma and Rockefeller “modern western” medicine.

    • You are so right. And the biggest study yet, the recent Cornell study, looked at EVERY low-risk baby born in the US from 2007-09, so almost 10.5 MILLION births, and broke the data down by where they were born (home, birthing center or hospital) and who attended the birth (doctor, midwife or other). They defined low-risk baby objectively: singleton, vertex, full-term babies weighing at least 2500g (5.51 pounds).

      Home births attended by midwives were more than 4 times more likely to result in a dead baby than hospital births attended by midwives! The chart showing the results is at the bottom on this page:
      http://www.ajog.org/article/S0002-9378%2813%2901155-1/fulltext

      And here’s the Skeptical OB’s take on it:
      http://www.skepticalob.com/2014/02/new-cornell-study-shows-homebirth-has-4x-higher-death-rate-than-comparable-risk-hospital-birth.html

      • I just read the ‘study’ referenced comparing neonatal death rates between OBGYNs, home birth midwives, etc. I found this so called study to be the same as every other ‘investigation’ done by the medical community concerning midwifery and home birth…ie: extremely biased in the way it was set up from the beginning! They make no differentiation between lay midwives, who may be well intentioned but very under trained and under equipped, and fully equipped, fully trained, licensed midwives who have as much (and in many cases more) training in neonatal emergencies as almost any OBGYN! In November of 2014 I was a participant in the home birth of my granddaughter, which was attended by a fully licensed, trained and equipped midwife and her assistant. Because of placental detachment during delivery, something just as likely to have happened in the hospital, Lilly was born gray, limp,with no heart beat and not breathing and the cord was completely limp with no blood flow. The midwives had all of the equipment needed for neonatal resuscitation, and Lilly took her first breath 3 1/2 minutes after her birth. She is now a perfectly healthy baby with no evidence of neurological or developmental damage from her traumatic birth. And yes, her Mom says she will still have the next baby at home. BTW, this was the first time in 30 years as a midwife that ‘B’ has ever had to resuscitate a newborn! Also, this was the seventh home birth in my family in two generations, starting with me, and the first time there was an emergency of any kind.

        • Midwives do not, and cannot, have (as you put it) “as much (and in many cases more) training in neonatal emergencies as almost any OBGYN.” I think the only way you could believe that is if you don’t actually know what training is involved in becoming an OB-gyn.

      • Our baby was terminally injured, and by a young, exceptionally poorly-trained ER doctor. This doctor never should have been anywhere near us, but was placed in an unfortunate situation because of the poorly-managed medical system in which she worked.

        One thing I noticed in the months I spent in hospital with my daughter was, as everyone knows, that hospitals are far more concerned with quantity of lives, rather than quality of life.

        Most hospital workers were eager to perform any painful, traumatizing act, even if it might damage in the long run, as long as it kept our baby alive during their shift.

        Because our baby lived for most of a year, her birth is statistically counted as a “success” by the medical industry, even though her death was caused by the outcome of injuries created by the hands of her doctor.

        I can believe that newborns are less likely to die in a hospital. I also believe babies and their parents are more likely to be injured and traumatized. As terrible as it was to lose our daughter’s to Death, we mourn far more all the pain that was inflicted at the hospital–the 500+ needle pricks, the round-the-clock bright lights, the alarms, the mean words of some workers….

        At last we were released to home hospice, where our daughter finally slept, in the quiet of our home, and finally smiled, and seemed finally to improve, but instead died. Perhaps she would have “lived” a bit longer in the hospital, but she never would have known any beauty in Life.

        A few years later I gave birth alone with just my husband and son and a friend in the house. A doctor who supports homebirth was in the neighborhood, available for an on-call homevisit if I got scared, which I didn’t. I was aware of the risks of homebirth, and the benefits. What a marvelous, healing birth it was, almost perfect enough to erase all the trauma of the hospital fiasco.

        I hope every mother will have the knowledge and right to chose between these options.

        Until our culture learn to face Death honestly, we won’t be able to embrace Life.

  3. I’m currently 34 weeks pregnant with my first child and planning for an out of hospital birth with a very good midwife. I’m not birthing in my home, but rather in a dedicated birth house that is more like an unlicensed birth center. My husband and I took a great deal of time in deciding who would deliver our baby, and are very happy with our choice. There is no way to provide a true apples to apples comparison and each mother needs to look at her own options.

    My midwife’s statistics are far better than those of any doctor I know in my area. The intervention (practically 100%) and cesarean rates (over 40%) in my local hospitals are extremely high. My midwife carries emergency medicine (not just herbs!) such as pitocin, oxygen, etc. and transfers early instead of later. She has over 30 years of experience. I also have been seeing a backup Obstetrician that I can call in the case of an emergency, along with taking exceptional care of my body throughout pregnancy. All midwives are not equal, and each practice is so different than the next. We live in an area where natural hospital birth is practically unheard of and there are no birth centers or hospital midwives within a 2 hour drive from us.

    Know your practitioner’s statistics and speak openly about your options. That’s the only way to make the best decision for your own family!

    • I was about to wish you good luck when I realized from the date on your post that you must have already given birth. How did it go?

  4. 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??????!!!!!!

    • This was preventable. Not blaming mothers. We’ve had ancient wisdom strippedout of us.

      • What utter nonsense. You do know childbirth used to be the number one killer of young healthy women, correct? Even with all that ancient wisdom, abruption, dystocia, hemorrhage, eclampsia (gosh how did the wisdom correct that? Did the wisdom come with magnesium?) were all deadly circumstances a woman could face. 🙄

  5. 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.

    • 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.

      • Juste a question, have you ever looked at the qualiti of live some of those babies have and which births they call succesfull?
        Start learning how data is manipulated for de benefit of the medical world!

  6. 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