I am disappointed that Dana Stevens, Slate's movie critic, apparently cherry picks her scientific studies.

In the last 10 years, there have been 6 major, peer-reviewed scientific journal articles in Birth and the BMJ on homebirth safety. All, including the Australian study she apparently is citing for her "statistic" stating that homebirth has double the infant mortality rate as hospital birth, actually fall in line with this statement:

Homebirth, under the care of a licensed midwife, is at least as safe as hospital birth as measured by infant mortality, as hospital vaginal birth (and safer than c/sec), under the following conditions: The birth is not preterm (less than 37 weeks), post-date (more than 42 weeks), breech or multiple.

The australian study she cites is the only one that gives a higher infant mortality rate, and it is only when the above conditions (preterm, etc.) apply. I think just about anyone would intuitively realize that homebirth is probably not optimal under these circumstances, though apparently in Australia at the time they did not.

I can cite each of the 6 studies, but in the interests of space condensation I will only cite the most recent:

BMJ 2005 Jun 18:330(7505):1416.

Outcomes of planned homebirths with certified professional midwives: large prospective study in North America

Authors reviewed all home births involving certified professional midwives across the United States and Canada in the year 2000 (5418 women).

Conclusions: homebirths resulted in lower lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.

If Dana was aware enough of the literature to cite one part of the Australian study, why didn't she give a more balanced overall picture?

If anyone is interested I can cite the other 5 studies (including the australian one) so that people can look them up for themselves on Pubmed and make their own decision.

I am a scientist myself and I researched homebirth thoroughly before attempting it. I am not "crunchy." I wanted the birthing option that would result in the least unnecessary medical intervention while not sacrificing safety for myself or my baby. If my research had brought up only "homebirth twice the infant mortality as hospital birth" I would NEVER have chosen it. I think Ms. Stevens should either print a retraction or give a more balanced overview of the scientific literature on homebirth. I would be happy to give her a list of studies if she wants more information. Or just go to Pubmed and type in "home birth safety." Look especially for studies in Birth and the British Medical Journal, big behemoth peer-reviewed journals.

Everyone's births are special. Everyone should be able to get the birth they want, safely, whether it is planned c/sec or homebirth. Twisting the scientific literature is not helpful to anyone trying to make an informed choice.

Okay that could have been more clear:

Homebirth, under the care of a licensed midwife, is at least as safe (as measured by infant mortality) as hospital vaginal birth (and safer than c/sec), under the following conditions: The homebirth is not preterm (less than 37 wk), postdate (more than 42 wk), breech or multiple (twin).

Sorry I was so indignant I did not proofread!

"Homebirth, under the care of a licensed midwife, is at least as safe (as measured by infant mortality) as hospital vaginal birth (and safer than c/sec), under the following conditions: The homebirth is not preterm (less than 37 wk), postdate (more than 42 wk), breech or multiple (twin)."

So homebirths are at least as safe when there are no complications...well duh. That's kind of not the point though.

"So homebirths are at least as safe when there are no complications...well duh. That's kind of not the point though."

Thank you for bringing up this point. I'm sorry I didn't make it more clear above.

"No complications" is not the same as "low risk." In this case, a low risk birth would be defined as between 37 and 42 weeks, head down, single baby birth. I'm sure we can all come up with horror stories about complications that can occur even given these starting-out stats. What the studies are showing, is that a midwife in a homebirth situation is apparently as adept at handling these complications, as a doctor in a hospital, since in both cases you have the same infant mortality. I am going to post my own homebirth story to give examples of how my midwife dealt with several complications, just as skilfully but with far less slicing and dicing than an OB/GYN probably would have.

I hope this clarifies for you. If not, please let me know.

Conclusions: homebirths resulted in lower lower rates of medical intervention....

That's kind of like saying that the Sahara has lower rates of rain. Homebirths are attended by midwives, and midwives aren't trained to provide medical intervention. That's kind of the crux of the issue. Sometimes, you need medical intervention. Sometimes, you need it quickly. And I hate to be trite, but labor hurts. It hurts a whole f*king lot, for hours and hours and hours! Relaxation isn't effective. Hee-hee Lamaze breathing isn't effective. I didn't try it, but I kinda doubt sitting in a bathtub or rolling around on a beach ball is effective, either, that's why they don't advocate those methods of pain control for knee surgery. You might want your attendants to be qualified to hook up an epidural or nearby to perform a leisurely c-section, as opposed to one 10 minutes after you careen into the ER in an ambulance, soaking wet, smelling like patchouli bath oil and suffering from a dislocated hip-joint from four hours in the Leaping Frog position.

"What the studies are showing, is that a midwife in a homebirth situation is apparently as adept at handling these complications, as a doctor in a hospital, since in both cases you have the same infant mortality."

But how often were these complications "handled" by rushing to the nearest hospital in a panic?

"That's kind of like saying that the Sahara has lower rates of rain. Homebirths are attended by midwives, and midwives aren't trained to provide medical intervention. That's kind of the crux of the issue."

It depends on the kind of medical intervention you mean. My midwife came prepared for all kinds of complications. She brought 7 bags to my first birth, and none of them (to my knowledge) contained patchouli bath oil. She is a registered nurse practitioner as well as a certified nurse midwife, and is able to perform minor surgical procedures (ie., give me an episiotomy if necessary, give me lidocain and stitch me back up afterwards), she brought oxygen to the birth in case the baby had trouble breathing, she had pitocin in case of hemhorrage (sp?), I can't even list all the stuff she had. No, she could not provide an epidural or a c/sec. Funny how homebirthers in general seem to need c/sec only about 5% of the time while in the hospital the rate is more like 35%. If you want a c/sec or an epidural, the hospital is the place for you. That's fine. If you don't, then you really need to educate yourself on your options or the chances are you will end up with one anyway.

"Sometimes, you need medical intervention. Sometimes, you need it quickly."

Amen! Thank God there we have the facilities for all sorts of emergency procedures should birth go wrong. An experienced mw will tell you that when birth does go wrong, there is usually a lot of signs well in advance (depressed baby heart rate, unusually slow contractions) that she can read and get you to the hospital on time. Usually. If "usually" and the stats are not enough for you, then maybe homebirth is not for you. That's fine. It's not for everybody.

" And I hate to be trite, but labor hurts. It hurts a whole f*king lot, for hours and hours and hours! Relaxation isn't effective. Hee-hee Lamaze breathing isn't effective. I didn't try it, but I kinda doubt sitting in a bathtub or rolling around on a beach ball is effective, either, "

If you didn't try it, how do you know it doesn't work? I totally agree about Lamaze. What a waste of classes. What really helped me was being able to walk around during contractions. One reason I knew I couldn't give birth without meds in the hospital was b/c they expected you to labor lying down! Talk about torture! The birthing tub actually really, really helped too, but that's another post.

"that's why they don't advocate those methods of pain control for knee surgery."

Knee surgery without meds - what's the point of that? I don't even get my teeth filled without painkillers. In my case, it was important to me to be able to breastfeed (not an issue with some people) and I knew that I would have a better chance of succeeding at bf if I could give birth without medications. That was enough for me. Everybody has their own cost/benefit analysis.

"But how often were these complications "handled" by rushing to the nearest hospital in a panic?"

This is a legitimate question and you better believe it's one I asked my midwife when I interviewed her. At the time, she had ten years homebirthing and over 1000 babies under her belt so she had stats she could give me. For her, 5% of her clients' births resulted in hospital transfer. The vast majority were for maternal exhaustion (the mother said "I'm tired of this cr*p. Get me to the hospital.) About half of her hospital transfers (for whatever reason) ended up in c/sec. Each mw will have different stats and that's something you will want to know. Good question!

Hi Krulic,

Ok, a nurse practitioner has quite a higher degree of knowledge and education than a midwife, as far as I understood. She's just short of a doctor, and midwifery is her specialty, right? If you'd have said you labored at home with a nurse practitioner, I would have better understood what you meant. You pretty much hired a doctor to make a house call. Touche- I wish I'd have thought of that.

I had to be induced, placenta had disintegrated, so birthing at home wasn't an option, and neither were a whole slew of interventions. It did feel like a racket, as one led to another, each going ca-ching as it added to our bill.

Ok, you know how good studies are randomized? It cuts down on skewing of the results due to a certain type of person choosing to participate? Perhaps homebirth tends to attract a person with a high degree of motivation, who is in turn more likely to endure what would encourage someone else to take the epidural or c-section. Your story about the given reason for most of your doc's hospital transfers supports my theory. Even the toughest people have limits, huh? Ninteen hours of baby trying to come out face-first was enough for me. Perhaps a midwife could have handled that complication, I don't know. All I wanted was a c-section. I didn't try the birthing ball or the water tub, but I did show up with my little stupid relaxation tape from hypnobirthing, along with some of what were in hindsight, ridiculous expectations, and I wanted not only my money back, but to beat the crap out of that little tree-hugging hippie girl who taught that class I threw $350 at.

Hey, look, I'm a tough chick. I've got a black belt in martial arts- for the test, I had to fight the whole class five at a time. When it was over, I had a black eye and a broken rib, which didn't bother me. I'm not a wimp. But an epidural to me is a good reason to go to the hospital. Episiotomies, in all my research, for whatever that's worth, seem to cause 3rd degree tears, and trust me sister, I'd rather have the c-section. If your delivery is uncomplicated, the hospital will often let you walk, sit in a tub, roll on that birthing ball, whatever. You can even bring your midwife to advocate against any nonsense you don't feel up to fighting about.

Sorry if I sounded snarky, I wasn't aiming for that, really. It seems like birthing has become a huge racket with doctors and hospitals and practioners of all kinds of alterna-quackery making money off us at every turn, while everyone out there with an opinon on the matter seems to regard it as a competition to prove who is toughest, most informed or most conscientious or just plain most martyred. That's not you, you seem pretty reasonable, it's just a pet peeve of mine. Glad it worked out for you by the way. C-section recovery was a real piece of hell.

Ok, a nurse practitioner has quite a higher degree of knowledge and education than a midwife, as far as I understood

See Certified Nurse Midwife.

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"She is a registered nurse practitioner as well as a certified nurse midwife, and is able to perform minor surgical procedures (ie., give me an episiotomy if necessary, give me lidocain and stitch me back up afterwards)"

Out of curiosity, isn't there an increased chance of infection when even "minor" surgeries are conducted in the home?

since few pts use home birth, the low compliction rate will rise as its use increases. its not just the gestational age and number of gestational sacs and position that determine risk. there are a number of medical conditions that arise and some aren't even apparent till labor. Also the abruptions, the previas, meconium aspiration by the fetusare not something youwant to deal with outside a medical facility (L&D).

as happens every day, you don't even need to be a mid-wife to catch babies. you can be a fireman, a policeman, or even a cabby---to catch the uneventful progressing labor. but don't expect me or my colleagues to perform magic when you come in emergently.

Thanks alldenwall. That's fine. I didn't mind the tone, honestly. Birth can be a real b*tch. I asked a lot of questions too, when I was looking into birthing options, and I don't know that I was always polite either. I'm just trying to send it down the line by answering questions now, myself. A round-about thank-you to the people who patiently answered my questions. I'm sorry your experience with ncb was negative, but happy that you got the birth you wanted with the c/sec. Enjoy your baby!

"since few pts use home birth, the low compliction rate will rise as its use increases."

That's an interesting position to take. I haven't ever seen that particular take on statistics backed up by any studies. If you have a big enough sample size to be significant, then adding to the sample size will not change the outcome. If it did, what in the world would be the point of statistics?

"its not just the gestational age and number of gestational sacs and position that determine risk. there are a number of medical conditions that arise and some aren't even apparent till labor. Also the abruptions, the previas, meconium aspiration by the fetusare not something youwant to deal with outside a medical facility (L&D)."

Since when is placenta previa not apparent till labor? That's what ultrasounds are for. Meconium aspiration is very dangerous, I agree. It also is most likely after 42 wks of labor, which is why the caveat about 37-42 wks only for homebirth. Abruption is obviously dangerous. Any stats for me on exactly how common it is? For instance, is it more likely that I'll have placental abruption, or that I'll get in a car accident on the way to the hospital? I truly don't know. I'd actually like to see some stats on that.

"as happens every day, you don't even need to be a mid-wife to catch babies. you can be a fireman, a policeman, or even a cabby---to catch the uneventful progressing labor. but don't expect me or my colleagues to perform magic when you come in emergently."

Yes, anyone can catch a baby. But unassisted child birth has (if memory serves me) ten times the infant mortality rate as assisted (by mw or dr) childbirth.

Calm down, doc. Homebirth will always be a choice taken by less than 1% of birthing women. Nobody is taking away your patients.

Out of curiosity, isn't there an increased chance of infection when even "minor" surgeries are conducted in the home?

I don't actually know the stats on this question (believe it or not!) but I can tell you what the mw told me. At home, you are "used" to the germs that are present. They are "your" germs. Chances are that when the baby was conceived, you weren't using sterile technique, but you managed not to get sick.

Hospitals, OTOH, are very dirty places. Very sick people come there to be healed, and there can be "superbugs" that are resistant to antibiotics. That's why the entire room needs to be sterilized (in as far as practicable) in a hospital whereas, at home, not so much.

I don't know if this makes any sense to you or not. All I can give is the anecdotal story that, in my first birth when my mw had to stitch up my tear, she did use sterile instruments and alcohol, etc., and I didn't have any problems. But that's just me. I would like to see a study on this topic. I don't know if there have been any.

Thanks for the good question!