Homebirth Safety

 

“Birth is as Safe as Life Gets”

First: Below my comments are links to web-based information and research on homebirth safety.  Find books on birth options, including evidence and critique on medical protocols for birth, on the Books/Media page. 

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Many families exploring birth options wonder–is homebirth as safe as birth in the hospital?  There is no quick answer to this question, because there are many things to consider–including your personal definition of safety and what makes you feel safest, even if not proven safest.  As a wise woman once said: “even placebos work a great deal of the time”–now proven beyond a doubt.  In deciding if homebirth is ‘safe enough’, you can explore the things that apply to you: your state of health, your willingness to make sensible choices, the availability of homebirth care, your preferences and your beliefs. 

I believe that “birth is as safe as life gets”, and this means first, that pregnancy and birth are life-events: normal processes of our physical lives.  Whether you believe in a Creator’s intelligent design or in evolution, it is clear that our bodies work well for birthing, growing, and healing.  Before obstetrics emerged only 100 years ago, our population was already growing steadily for millennia.  Humans could not be so numerous today, without all the people already alive in the era before we created modern obstetrics; natural law governing population growth shows this.  Because human birth works as well as the rest of life, those people were born safely—not saved from birth by medical intervention.

Being “as safe as life gets” also means that birth is just as safe–and no safer–than life.  Birth is most often safe, yet isn’t safe every time.  Like life, birth carries the primary possibility of life and joy–and includes possible sorrows.  Some women enter pregnancy with health issues that may make birth less safe.  ‘Misfires of the plan’ can occur even in a healthy mother, so a baby cannot live through birth.  Life includes storms, epidemics, mistakes and tragedies, and so does birth: not often–but upon occasions that we can’t always prevent.

The good news is, birth, like life, can be safe and joyful; the marvelous design of birth works well, most often, for reasonably healthy women and babies.  It’s an integrated process of our physical lives, working under natural laws, so we can serve birth with the same simple daily actions that serve anyone’s health.  We can’t control birth; we can understand it enough to help ourselves in many ways and create births as safe as the rest of our lives.  We can make ourselves as safe as possible, through daily self-care and otherwise preparing for birth’s possibilities—partly by making considered choices about pregnancy and birth care.

For normally healthy women, humans can’t improve upon birth’s natural design.  Moving normal birth from home to hospital has reduced some natural risks, while bringing many newly human-engineered risks to babies and mothers.  Some may appreciate pain medication, for instance, but it increases risk because those chemicals carry side-effects and can even be lethal.  The epidural not only has ‘chemical risks’ for mothers and babies, but risks connected to paralyzing a laboring woman—because normal birth is an activity.  Women make themselves and babies as safe as possible through their physical participation with birth, by moving and shifting as needed for them to accomplish normal birth.   The point is that no medical applications truly improve the safety of normal birth for humans— they may reduce certain naturally-occurring risks and some unpleasant parts of birth, but only by introducing human-created risks to mother/baby. 

The hospital environment itself, introduces risks not found at home.  Especially worrisome are the dangerous hospital-bred germs, or ‘human error’–sometimes-grievous accidental malpractice that so rarely happens at home, simply because the most dangerous medical tools are so rarely found there.  But other more indirect risks are posed ‘by the way’ of subjecting women to harsh lighting, excess noise and interruptions, and routinely restrictive,  invasive care.  ‘Nurse-technicians’ deliver this care, overseeing groups of several laboring mothers, and ‘monitoring’ mother/babies mostly from the nurse’s station.  Just by hindering women’s movement, rest, eating and drinking, medical routines hinder birth itself; just disrupting bonding and breastfeeding poses real risks to families emotionally and physically.   

 We can alter the face of birth. We can even improve birth outcomes for many women and babies at unusual risk.  But so far, we have not improved on normal birth through human meddling, and normally-healthy mothers are still safest at home.  There are risks posed at home or any other place of birth, yes—because “birth is as safe as life gets, and no safer”—still, homebirth poses the lowest degree of risk to mothers and babies, in the greatest number of ways.  At home, women are freer to birth instinctively, in keeping with their own and baby’s needs each moment.  At home, birthing women choose the company of loved ones and assistants who give personal attention to comfort and safety for one unique mother/baby pair.  These are the very things that best help safe birth to happen so often–they are in harmony with birth’s natural design and necessities.   

Is homebirth safer than hospital birth?  That is a question to answer in light of your own situation and general health, your priorities and beliefs.  Many authors have addressed this in research studies and commentaries that explore it in-depth and stand as my citations for this essay (below).  You can look at the information, weigh the benefits and risks of your options, and choose care that seems safest for you.  I believe homebirth is the safest and most rewarding choice for many—to me, it’s the natural ‘default choice’ for healthy women—yet I know that medical care truly keeps some families safer. I know too, that women often birth safest wherever they feel safest for any reason.  No one else knows what is best for you and your family; you must create your own ‘face of birth’, to serve safety and all the important elements of this transformative experience we call birth.

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 Great Links: Below are links to information on the safety of homebirth.  Much of it compares home and hospital birth; I have included links to information that analyzes and critiques standard medical maternity care.  Please use the comment box to share your good links for this page.

Note on some words: ‘perinatal’—around the birth time: soon before, during, or soon after birth.  ‘Intrapartum’ means ‘during birth’.  ‘Neonatal’ means newly born babies. ‘Lower intervention-rates’ (compared to hospital) means ‘lower risk of harm’; women and babies were less-often given chemical or manual/mechanical treatments that elevate mother/ baby risk.  ‘Mortality’ means death; ‘morbidity’ means illness or damage. 

http://gentlebirth.org/ronnie/homebirthBenefits.html  and  http://gentlebirth.org/ronnie/hospitalDangers.html   These 2 articles are essentially companions.  Ronnie Falcao’s whole site,   http://gentlebirth.org/ contains a wealth of information about homebirth, birth safety and natural health.

http://www.wombecology.com/index.html    This website focuses on the life period with the highest adaptability and vulnerability to environmental factors – the period inside the womb.

http://www.nashvillemidwife.com/safety.html

This links to a page containing links to many studies about homebirth safety going back about 30 years.

http://rixarixa.blogspot.com/2009/04/dutch-home-birth-study.html

This is a link to a great blog.  The page linked discusses a recent and very large study from the Netherlands, comparing hospital birth to planned, attended homebirth; the page also has links to other articles of interest on homebirth safety. 

http://www.cmaj.ca/cgi/content/full/cmaj;181/6-7/377

Their Conclusion: that planned, attended home birth was associated with very low and comparable rates of perinatal death, and lower intervention-rates compared with planned hospital birth.

http://www.bmj.com/content/330/7505/1416.full?ehom

Their conclusion: Planned home birth for low risk women showed lower rates of medical intervention but similar intrapartum and neonatal mortality as low risk hospital births.

http://www.childbirthconnection.org/article.asp?ClickedLink=194&ck=10218&area=2  This goes to the book Guide to Effective Care in Pregnancy and Childbirth, “an overview of results of the best available research about effects of specific maternity practices. The full text of the current edition (Oxford University Press, 2000) is available on this website courtesy of the authors: Murray Enkin, Marc J.N.C. Keirse,” et alThe authors examine medical maternity practices to determine which are likely to be safe, useless, or unsafe for mothers and babies.  The main website is full of great information and links  http://www.childbirthconnection.org/

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