The morning news had a segment on the latest home birth study. Unlike most studies that I have read about home birth having very similar risks levels to hospital births and improved outcomes for mothers, this study states that being at home puts your baby at much higher risk of low apgar scores and neonatal seizures or serious neurologic dysfunction. Their medical health expert, Dr. Shapiro, synopsized the findings, stating very clearly that she felt the study had accounted for other factors and that it was clearly the location of the birth that elevated the risk levels. It all sounded very official.
As someone who has had a successful home birth and is a proponent for more women returning to the home to have their babies, these findings concerned me greatly. Being a non-medical professional, I read a few more reviews of the study before taking a look at the original document. I thought that those with medical knowledge would have a more critical eye regarding these new findings. But it was just the usual hospital birth supporters who are all too willing to demonize home birth. The study was, to them, clearly without flaw and being at home is akin to dooming your baby to neurological impairment or even death.
I cannot say de facto that the study is wrong or absolutely flawed. Perhaps there is some truth to the findings; however, I do have one serious issue with their data and I think it deserves attention or clarification before we all swallow the conclusions wholeheartedly.
My issue with this study is that its entire sample, though large, are all from the U.S. You might be wondering what is wrong with an all American population being studied. At first glance this may seem to be quite appropriate as it provides consistency across the study; however, in my opinion it actually does the opposite. American healthcare both inside and outside of the hospital setting is very erratic. Even state to state there are broad differences in care.
Here are the categories of care this study included: hospital physician, hospital midwife, freestanding birth center midwife and home midwife. Other than the hospital physician, there is no stated standard for what they consider to be a midwife and yet many types of midwives practice in the US.
I am going to assume that a hospital or freestanding birth center would expect the midwives allowed to practice there to be certified by the American College of Nurse Midwives (so a CNM or a CM.) Though I have no proof to back up that assumption as I do not know exactly how these institutions work in the States, but let us move forward as it’s the home births that they are saying are so risky.
The study lists a “home midwife” as the attendant at these “dangerous” home births; however, there is no description of what that actually means. It is really only saying that it is not an unattended birth. That “someone” who calls themselves a midwife was present. In the case of a Lay Midwife this can be someone who’s read a bunch of books at home and has decided they can help a woman give birth. In my opinion this is virtually an unattended birth and, yes, I do think this is a more risky situation. You cannot compare a hospital physician with a person who has “read some books” and claim that these are equals. This makes the “home” setting just a backdrop for the ensuing disaster, and not the reason for the poor outcome.
This study does not adequately state what credentials they are comparing in order that the focus can be solely on the environment. Where you give birth may be a factor due to a lack of hi-tech medical equipment for necessary intervention; however, unless you have the same human standard of care it is impossible to say that the location truly plays such a large factor. In many cases a properly trained midwife (in a country that has a national standard of education) can identify potential issues and a need for transfer of care early on, either in pregnancy or labour.
Basically, I just don’t buy what this study is selling. I think what would bolster these findings is a study of the different medical professionals attending home births and what their outcomes were. If all had the same rates of low apgar and other issues, then it would be clear that the attendant wasn’t a factor in changing the outcomes. But then that would be asking the OBs to leave their secure little hospitals and actually attend a whole birth rather than pawning it off to the nurses or families to manage the majority of labour. They couldn’t race to slice a woman open and “deliver her” of her offspring. I digress.
So if you’re thinking of a home birth and this study has scared you off a bit, I hope this argument has helped you reconsider these findings and given you new hope and the courage to try birthing at home. It is an amazing experience- when you have the right, well-educated, care 🙂
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