There’s No Place Like Home: Why Having a Home Birth is a Good Option

We embrace change in our medical practice, just as long as nothing is altered or different
I have to admit my biases. Like every other person on the planet I have many. Here are some of mine:

1) I think having a baby is an amazing miraculous wonderful feat that the female human body has evolved to be able to perform.

2) I believe that every woman should birth where she feels most comfortable.

3) I know that birth can be exciting, empowering, fun, and even — sometimes — funny.

4) I know that things don’t always go the way we want them to.

5) I feel grateful that we have the option of modern medicine when we need to use it.

6) I know many women have strong feelings of disappointment around the way their baby was born. Those women often want to blame someone for what went wrong.

I know this because I am one of those women.

I still feel upset about the way my first child came into the world.

The obstetrician who told me I was “being selfish” and “making people wait” because I wanted a natural childbirth and did not want Pitocin does not remember me.

I am one of hundreds, maybe thousands, of women who he has berated and shamed during childbirth.

But I will never forget him. I will never forget how he ignored me when I told him I was ready to push, failed to come into the room as my baby was being born, rushed in angrily and pushed the nurse aside, told her she was “making [him] look bad.” How the labor and delivery nurse scoffed at me while I was in pain, told me I wasn’t dilated at all “not even a dimple!” after more than 15 hours of hard labor with contractions coming every two minutes apart, and forbade food even though I was shaky with low blood sugar and pleaded with her for something to eat. I will never forget that the hospital “lost” the placenta even after we told them repeatedly, orally and in writing, that we wanted to bring it home to bury in our garden. How the nurses refused to shut off the epidural medicine although I begged them to do so. How I my leg was numb for weeks after my daughter’s birth. How I was slapped with a hospital bill that was the equivalent of more than half a year of my graduate stipend that had an additional charge for each intervention that I had not wanted. How my healthy perfect baby who needed nothing but her mother was taken out of my arms by nurses who insisted she go to the nursery when all I wanted to do was hold and cuddle and love her. How my insurance company denied the claim because my pregnancy was a “pre-existing condition” even though I had proof of being insured by them for over four years.

Obstetrics is the least evidence-based care

I no longer blame the people at Crawford Long Hospital in Atlanta, Georgia who treated me with so little respect and so little kindness at one of the most vulnerable moments of my life. I feel sorry for them. I feel sorry that they are living their lives with so little kindness, hurting so many women, and perpetuating so much badness in the world. And I blame the American hospital system and our medical professionals in general who believe that bullying, lying, and berating women, which they do, every day, every hour, is somehow acceptable.

I didn’t always feel this way. For months after my baby was born I was relieved we had had her in the hospital.

I would have died, I told myself, or she would have died, if we had not had a hospital birth.

Those doctors saved my life.

The problem had not been with them. It had been with me. Of course. My body was broken. It — I — couldn’t have a baby without their help. Without their Pitocin. Without their fetal monitors and medical supplies.

It wasn’t until months after my baby was born that I realized the hospital had not saved me but had hindered me. It wasn’t until months after my baby was born that I realized I had no one to blame for myself. I had not educated myself to have an empowered, gentle, fun childbirth. I had read the mainstream books and watched the mainstream TV shows. I had believed that birth was dangerous, that women were weak, that my life was at stake if I didn’t follow our culture’s rules and have my baby in the hospital. Instead of seeking out experienced moms who had positive, exciting, gentle births, I had allowed myself to be duped by health care practitioners and our culture’s fallacies.

profit based care

I made that mistake once.

But I never made it again.

We have four healthy, smart, energetic, exasperating children. We had our firstborn in the hospital. We had our next three in our home.

If you follow the endless internet debates about home birth you probably read some of the news stories that said that having a home birth is like driving in a car without a seatbelt. The pundits spreading those myths have their own biases. I find it ironic that mainstream medical professionals would spend so much time critiquing and vilifying home birth when the VAST MAJORITY OF BIRTHS IN AMERICA HAPPEN IN AMERICAN HOSPITALS and when AMERICA HAS AMONG THE HIGHEST MATERNAL MORTALITY RATES OF ANY COUNTRY IN THE INDUSTRIALIZED WORLD. Every pundit, every doctor, every researcher should be desperately trying to change that — to find out why our hospital system is so dangerous, why our outcomes are so poor, and how to improve them. Something else to consider: much of what you read about home birth on the internet is simply untrue or irrationally exaggerated or so skewed as to lose much of its truth. I am a very skilled grant writer. I successfully raised 9 million dollars for one major research university to fund underrepresented minorities to study graduate level science. I have also raised thousands of dollars for a non-profit non-government organization to fund a child survival campaign, provide warm clothing for women participating in an off-season garden project, and build a handicapped artisan workshop in Niger, West Africa. It’s very easy to massage the numbers — for or against what you believe to be true. That is why you should not take my word, or anyone else’s, for anything. You should read the studies yourself, even if you’re not a scientist. Analyze them thoughtfully, look at the way the experiments were implemented, pay attention to the numbers, the inevitable confirmation biases, the design flaws … and then draw your own conclusions.

What will you uncover when you start doing research on childbirth best practices (which is something I’ve been investigating and writing about for over ten years)?

That midwife-assisted birth leads to many fewer complications and is often, if not always, safer than doctor-assisted birth.

That, as Alice Dreger, a professor of clinical medical humanities and bioethics at Northwestern University’s Feinberg School of Medicine, puts it, the most scientific birth is the least technological.

That continuous electronic fetal monitoring during labor is not beneficial for fetal outcomes but has been shown to lead to unnecessary C-sections.

That women do better with continuous labor support. (News flash ladies: that doctor you’ve spent at least six months developing a relationship with has no intention of being with you during your labor. She will come in when the birth is imminent. The rest of the time you will be on your own with labor nurses checking on you periodically. You might end up with angels. Or you might end up with angry overworked overtired labor nurses like the one I had. I still remember her name. Ebony. She never bothered to learn mine.)

Evidence based birth

We also know from over half a dozen studies of home birth in other countries that home birth is a safe option for most moms and their babies. And now we have a large longitudinal study, released this morning, that shows that home birth is also a safe option for American women.

Since I suggested you do your own reading, I am including the entire press release about the study, published in Journal of Midwifery & Women’s Health, here:

Press release: Largest Ever U.S. Study On Planned Home Birth Finds Low Rate of Interventions, No Increased Risk for Mother and Baby

In the largest ever examination of planned home births in the United States, a study released today found that, among low-risk women, planned home births result in low rates of birth interventions without an increase in adverse outcomes for mothers and newborns.

The study – which looked at nearly 17,000 women and their newborns – found that for planned home births with a midwife in attendance:

  • The rate of normal physiologic birth was over 93%
  • The cesarean rate was 5.2%
  • The rate of vacuum- or forceps-assisted vaginal birth was 1.2% and less than 5% of mothers required oxytocin augmentation or epidural analgesia
  • Only 1.5% of newborns had a low Apgar score (a measure of newborn health in the first five minutes following birth)
  • 2.5% of newborns were admitted to the intensive care unit (NICU) at some point during the first six weeks following birth
  • 87% of women with a previous cesarean (VBAC) delivered their newborns vaginally
  • Of the 10.9% of women who transferred from home to hospital during labor, the majority changed locations for non-emergent reasons, such as a slow, non-progressing labor, or maternal exhaustion
  • At six weeks postpartum, more than 97% of newborns were at least partially breastfed and 86% were exclusively breastfed

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“These rates of intervention are significantly lower than those seen in U.S. hospitals, without a simultaneous increase in adverse outcomes,” said Dr. Melissa Cheyney, PhD, CPM, LDM, Associate Professor of Medical Anthropology at Oregon State University, and lead author on the study. “Direct comparisons cannot be made between home and hospital birth samples because of differences in risk level, but nonetheless these data are compelling. It should be possible to achieve lower c-section rates in this country.”

The study was released today in the Journal of Midwifery & Women’s Health (JMWH) and was conducted by researchers at Oregon State University, Bastyr University, the University of California-Davis, and the University of British Columbia.

“This research tells us that, for low-risk women, a planned home birth with a midwife in the U.S. can be a safe option,” said Cheyney. “Data from other countries have shown that planned home birth with a skilled midwife is safe for low-risk women. But there are enough differences between the U.S. and other high-resource nations that this question needed to be re-examined with a U.S. sample. Findings from our study, including low rates of interventions and low rates of death or injury, are comparable to findings reported in other large observational home birth studies from Europe and Canada.”

The risk of death to the baby during labor, in the first week of life, or the first 28 days of life, was very low in this study. However, this risk was even lower when women with certain health issues or who were carrying babies that are considered to be in higher-risk categories were excluded from the analysis; for low-risk mothers, the risk of death to the baby was about 1.6 per thousand.

“When parents are making a decision with their providers about place of birth, it is critical that they have access to the best possible evidence,” said Cheyney. “Home birth may not be the best choice for every pregnant woman, and risk factors must be weighed. However, our study suggests that for a healthy woman with a single, head- down, full-term baby, planned home birth with a midwife can be a safe option.”

This study is based on a voluntary dataset collected by the Midwives Alliance of North America. A separate article, also released in the JMWH today, provides evidence of data validity. The MANAstats registry contains high-quality data that uses the gold standard—the medical record—instead of birth certificate data, which research shows is unreliable for studying intended place of birth and newborn outcomes.

“Our goal was to design a dataset that could help to reliably inform health care providers, policy makers, and families about the outcomes of midwifery care in all birth settings, and the characteristics of normal physiologic birth,” said Geradine Simkins, CNM, MSN, Executive Director, Midwives Alliance of North America. “Planned home births are only a small percentage of all births in the U.S., but the numbers are growing each year. Given these data, we hope providers in all settings can learn from what’s working well at planned home births.”

Both articles will be available for free online for all of 2014. Go to www.jmwh.org, Find Articles, and then click on Early View. The articles will be live sometime today – watch mana.org for updates.

Copyright issues forbid me from publishing the entire study itself. But here’s a screen shot of the first page:

Breaking news: the largest study of home birth in the United States to date, of nearly 17,000 low-risk women, finds that home birth is a safer option than hospital birth. Women had much lower rates of C-sections and much higher rates of successful breastfeeding

There will be backlash. From birth haters. From women haters. From people — both women and men (but, sadly, mostly women) — who do not want you to have the right to choose where you have your baby, who gnash their teeth at every positive piece of evidence that reinforces the idea that birth is a natural, beautiful, wondrous process.

Read what they have to say too. Some of their arguments may be valid. Bringing another human being into the world is not without risks. There are incompetent or inexperienced practitioners in the midwifery community and the home birth community, just like there are incompetent and inexperienced doctors in the hospitals. Sometimes these practitioners’ faulty judgment puts women at unnecessary risk. The fact that home birth midwifery is illegal in some states and that American doctors often antagonize and feel competitive with midwives makes birth less safe for everyone. But notice how the birth haters launch ad hominem attacks and try to discredit researchers, organizations, journalists, and birth supporters by dismissing them as biased, calling them names, and ignoring previous research. The personal attacks and rude language are childish and unfortunate but one part of their premise is right. Those who advocate for a better safer birth environment for all women in America are biased. We are biased in favor of mothers and babies. We are biased in favor of healthy birth. We are biased in favor of happy moms.

Read everything you can.

Talk to everyone you can.

And then decide for yourself.

Jennifer Margulis author photoJennifer Margulis, Ph.D., is a senior fellow at the Schuster Institute for Investigative Journalism at Brandeis University and author of The Business of Baby: What Doctors Don’t Tell You, What Corporations Try to Sell You, and How to Put Your Pregnancy, Childbirth, and Baby BEFORE Their Bottom Line. She has worked on a child survival campaign in West Africa; taught postcolonial literature in inner city Atlanta; and appeared live on prime-time TV in France. Jennifer was the recipient of a Fulbright Award in 2006-2007  and her writing has won several awards. The Business of Baby is a finalist for a BOOKS FOR A BETTER LIFE AWARD, along with Temple Grandin’s The Autistic Brain, Anne Lamott’s Stitches, and Katy Butler’s Knocking On Heaven’s Door.

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Categories: pregnancy and childbirth.

Comments

  1. Jennifer, thank you so much for sharing your thoughts and your story, and for taking the time to review and highlight the recent research on planned home birth. We agree–the outcomes of this study are pretty impressive. And we look forward to more research studies using the MANA Stats Registry–about many aspects of planned home birth–from outcomes, to cost savings for insurers, to women’s own experiences of childbirth.

  2. I love this: ” Those who advocate for a better safer birth environment for all women in America are biased. We are biased in favor of mothers and babies. We are biased in favor of healthy birth. We are biased in favor of happy moms.” Your article is thoughtful and I appreciated both the information you provide, and the encouragement for mothers to do their own research. The Midwives Alliance Division of Research continues to work hard to demonstrate the safety of home birth and the realities of evidence based care. Thank you for highlighting and sharing such important findings today.

  3. My daughter is 30… when I was pregnant, I read several hundred books on pregnancy, childbirth and childraising – cause I’m that kind of person and there was no internet back then. I burnt up my library’s interlibrary loan budget in 9 months! So… I have no references, but I CLEARLY remember this was known to be true even back then, though we didn’t have US-centric data.

    I remember because I was upset cause my insurance wouldn’t cover a midwife, not even at her own center, let alone a home birth – they would only pay at a hospital, and I had LEARNED that wasn’t the best. 🙁 The hospital was ALSO a lot more expensive, but the insurance didn’t want to hear about something so wildly “alternative” as a midwife trained and certified by the state.

    We’ve had these insane statistics since back then – particularly the ridiculous c-section rate, but also the higher mortality rates. I remember thinking it’d likely be healthier to be in a third world country and squat in a field…

    And yeah, at my hospital, they did an episiotimy even though I’d clearly stated, in writing and verbally, that I did not want one unless my life or the life of the baby were in danger. And told me to stop yelling cause I was scaring other mothers and a whole lot of little things like that that added up to a whole bunch of unkindness. Idjits.

    You DO have to think things through logically with ALL these studies. Even this one – sure there’s better outcomes, for LOTS of reasons besides the obvious ones. The women who choose home birth are educated, informed and motivated – therefore likely doing more things that are healthier overall. And the women who are high-risk are much less likely to choose home birth in the first place.

    But it seems to me that the biggest problem with hospitals is that regardless of the instructions you give or your consent, you are at high risk of unnecessary procedures that in themselves increase risk. And even if you escape that risk, you are definitely at high risk of being treated unkindly.
    Jackie Patti recently posted…real food for busy womenMy Profile

  4. Thanx for posting more about your own birth story with your 1st daughter. Have to say that I always wanted to learn more about this and beyond. Now, just wish that others would see what we see with this and beyond. In which I have really nothing of my own to add to this because I have yet to go through this myself. Hopefully in the near the future. At the same time will be sharing this including my reply to you.

  5. A little bit of bait and switch in the article. The objective set forth at the outset of the article was to examine “outcomes from planned home births” yet the conclusion regarding neonatal mortality clearly states it is only counting “low-risk women in this cohort.”

    This is an important, and regularly glossed over, detail.

    The conclusion that “low-risk women” do not experience increased complications or adverse outcomes does not actually address the objective of the study which was to examine “outcomes of planned home births.”

    Not all “planned home births” in this data set were “low-risk.”

    I wholeheartedly agree with the sentiment: READ EVERYTHING YOU CAN.

    Let’s start with the abstract of this article.
    Liz recently posted…There’s No Place Like Home: Why Having a Home Birth is a Good OptionMy Profile

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