The Facts About Home Birth

The following is my letter to the editor of Wise Traditions (which is the quarterly publication of the Weston A. Price Foundation).  This letter was published in the Summer 2011 edition of Wise Traditions.

In 1940, 44 percent of all births in the United States occurred at home. Since 1969, about 99 percent of all births in the United States have occurred in hospitals, according to an article in National Vital Statistics Reports titled, “Trends and Characteristics of Home and Other Out-of-Hospital Births in the United States, 1990-2006.” This means that the last few generations of women in the United States have had very little exposure to home birth, either in firsthand experience, word of mouth, or the media. The predominant feelings about birth in our culture are negative, and women have generally bought into the idea that labor and delivery are medical occurrences that need a doctor’s attendance.

In planning to have a home birth for each of my children, the response I typically encountered from others was something along the lines of “what if something goes wrong?” or “you are really brave!” These responses underscore the fact that most people in our society have no idea that home birth is a safe option, and they certainly don’t think labor is something women are designed to handle naturally, without interventions or drugs. In fact, home birth is as safe (if not safer) than hospital birth for low-risk women. The Canadian Medical Association Journal article, “Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician,” details birth trends for nearly 13,000 births.

There were three groups of women in this study: those planning home births with a registered midwife, those planning hospital births with a registered midwife, and those planning hospital births with a physician. The first two groups were attended by the same group of midwives; additionally, all of these women met the eligibility requirements for home birth, which means that women in both of these groups did not have any preexisting disease, significant complications of pregnancy (such as hypertension and gestational diabetes), or multiple fetuses, among other criterion. The study showed that rates of perinatal death (that is, death during the last weeks of pregnancy and up to four weeks following birth) were slightly lower in the planned home birth group (0.35 deaths per one thousand births) than in both of the groups of women planning to give birth in the hospital (0.57 deaths per one thousand births in a hospital attended by a midwife and 0.64 deaths per one thousand births in a hospital attended by a physician). This means that there were fewer deaths of mothers and babies in the planned home birth group than in both of the hospital birth groups.

All obstetrical interventions, such as episiotomy, electronic fetal monitoring and assisted vaginal delivery, pose some risk to the mother and baby. The same study showed that “women who planned a home birth were significantly less likely to experience any of the obstetric interventions [that were] assessed, including electronic fetal monitoring, augmentation of labour, assisted vaginal delivery, cesarean delivery and episiotomy.” For instance, 3 percent of mothers in the planned home birth group received an episiotomy, while the women who planned hospital births with midwives and doctors had episiotomy rates of 7 percent and 17 percent respectively. Twenty-four percent of women who planned homebirths had some augmentation of labor (such as rupture of membranes or oxytocin), while the women who planned hospital births with midwives and doctors had labor augmentation rates of 40 percent and 50 percent respectively. Additionally, women who planned to give birth at home were also much less likely to have adverse maternal outcomes, such as third- or fourth–degree peritoneal tears or postpartum hemorrhage. Furthermore, newborns in the home birth group were less likely to have birth trauma, require resuscitation at birth, or have meconium aspiration. All of these trends make it clear that mothers and babies in the home birth group were safer and healthier than those that planned births in a hospital.

Birthing at home allows the mother to be in control of her birth experience. It allows the mother to give birth as directed by her body’s intuition, not as directed by protocols and rules. It is a safe and healthy choice for mother and baby. It facilitates bonding, breastfeeding, and family closeness. It allows women to experience the true joy of labor and birth. A mother giving birth at home can listen to music, dim the lights, soak in her own bathtub, or even go for a walk and revel in the nature around her home. She also maintains control over important decisions, such as whether or not her child gets vaccinated, which germs the baby is exposed to, and what kind of food and drink she consumes. I am hopeful that someday our society will awaken to the truth about labor and birth, and will let go of the idea that the only place to give birth is in a hospital.