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
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.
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.
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.
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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.
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:
- Natural childbirth I: is homebirth more dangerous than hospital birth?
- Natural childbirth IIa: is ultrasound necessary and effective during pregnancy?
- Natural childbirth IIb: ultrasound not as safe as commonly thought
- Natural childbirth III: why undisturbed birth?
- Natural childbirth IV: the hormones of birth
- Natural childbirth V: epidural side effects and risks
- Natural childbirth VI: Pitocin side effects and risks
- Natural childbirth VII: Cesarean risks and complications
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- Buckley, Sarah J. Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices. Celestial Arts, 2009. pp. 96 ↩
- Buckley, Sarah J. Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices. Celestial Arts, 2009. pp. 96 ↩
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.
Unplanned and unattended home births do not affect the results of the Cornell study, because that study broke home births into two categories: (1) midwife-attended and (2) not midwife attended (“other,” meaning anyone or no one could have been attending the birth).
As you might expect, midwife-attended home births were less likely to kill the baby than home births without a midwife: 13.2 deaths per 10,000 instead of 18.2/10,000.
But midwife attended HOSPITAL births were more than FOUR TIMES LESS LIKELY to kill the baby than midwife-attended home births:
http://www.ajog.org/article/S0002-9378%2813%2901155-1/fulltext
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/
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.
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.
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
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.
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.
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?!
You seem to be hung up on the “self-study” part of this link. In order to become certified, you still have to pass the NARM test. Self-study doesn’t preclude being able to practice as a direct-entry midwife. Someone practicing as a licensed midwife is that, licensed. It means that they have demonstrated that their “self-study” has prepared them to take and PASS the national exam that all direct-entry midwives must pass. Otherwise, you are talking about illegal practice, which is another topic altogether.
The NARM exam is a multiple choice test, 350 questions each with 4 possible answers. All it tests is whether you can memorize facts (actually know the answers) and/or logically deduce which of the four possible answers are probably wrong, so as to pick the correct one.
Personally I am not comfortable putting the life of my child in the hands of someone whose “expertise” consists of managing to pass a multiple-choice test and spending time at a few births.
I prefer someone who has years of education and years of clinical experience (e.g., a residency, in which OB-gyn residents typically assist at several thousand births).
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.
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.
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.
Home births are far safer.
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.
Rachel – I do not understand your comment about the research being old. In particular area of medicine, there is a lot of current and relevant research.
I found this on her site: http://rabn.org/wordpress/wp-content/uploads/2012/09/Home-Birth-Annotated-guide-to-the-literature-May-2011.pdf
Here is another link that looks at the research on home birth:
http://www.scienceandsensibility.org/?p=5628
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!!
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!
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.
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.
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.
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.
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?
Moms of mono-di twins (or higher-order multiples with monochorionicity) need to have ultrasounds every 2 weeks starting at 16 weeks to check for TTTS, so that if TTTS is detected laser surgery can be done immediately. Laser surgery is far more likely to save one or both babies than amniotic fluid reduction.
Moms of mono-di twins/multiples also need to deliver in the hospital, because there are some additional serious risks in childbirth that aren’t present in singleton or di-di pregnancies.
For instance, TAPS (similar to TTTS) can develop during labor and kill one or both babies before delivery unless it’s possible to do an immediate c-section. Also, because mono-di babies share a placenta, the risk of a placental abruption that could brain damage or kill the second twin is high: the placenta can start to detach (“abrupt”) during or just after delivery of the first baby, and if it abrupts while baby B is still in there, well… think of the placenta as an unborn baby’s scuba gear: they can’t live without oxygen any more than we can, and if the placenta abrupts while they are still inside, they will suffer oxygen deprivation. Just like with adults, 4 or more minutes without oxygen will generally cause irreversible brain damage.
I’m not at home or I would post links to studies on all of the above points, but you can easily find them on PubMed.
Chris,
the 2005 study seems to be deeply flawed, using old data as a control group
http://www.skepticalob.com/2012/06/homebirth-in-daily-beast.html
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.
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!
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.
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!
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! 🙂
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.