Friday, March 15, 2013

Thoughts on Home Birth

Some people, unbelievably, still seem to think that homeschoolers are either like the "quiverful" Duggars or hippies living off the grid and eating/wearing organic whenever possible. We're religious, but my girls go to public school part-time and wear pants most of the time. We try to eat and live healthily, but I vaccinate my children, give birth in the hospital, and buy whatever produce I can afford without worrying about whether it's organic.

When I embarked on the adventure of childbearing back in 2004, my husband and I took a Bradley childbirth class in the Philippines. We read books by Dr. Sears and Ina May Gaskin. We determined to do everything possible to avoid a C-section, partly because of what we were learning and partly because of the fact that I had decided to opt out of returning to the USA to give birth and didn't want to undergo major surgery in the Philippines (among other concerns, my blood is Rh-negative, which is uncommon in Asia). Since I have low blood pressure and pass out easily from needles (good-bye, epidural, not going to mess with you...), information on giving birth without pain medication was quite welcome. 

However, despite having a sister and good friends who homebirth, I have never felt like that was a good choice for me personally. I know of too many things (like eclampsia, postpartum hemorrhage, shoulder dystocia, cord prolapse, placental abruption, cord wrapping issues, maternal heart attack, fourth-degree tears, obstructed labor, uterine rupture, life-threatening but previously unknown physical abnormalities in the infant that require life support measures followed by surgery as soon as possible--this happened to my nephew--and infant respiratory issues--meconium aspiration contributed to the death of an infant cousin of mine--just to name a few) that can unexpectedly go wrong and need the prompt medical attention available in hospitals.

A year ago, I found out that an acquaintance of mine, who had been due to deliver her baby a month before mine, lost the baby after a home birth attempt. There is no doubt that this was a previously healthy baby who died as a result of birth complications that could not have been dealt with outside a hospital. The experienced midwife had reason to think that the baby was in an oblique breech position but decided to go ahead with the home birth; she even brought student midwives so they could see the birth. After an excruciating labor that went on too long and during which their midwife discouraged them from going to the hospital, my friend and her husband finally went to a hospital where their baby, who was most likely the victim of a cord prolapse, was born by C-section. However, because he had been deprived of oxygen for an hour during labor, he suffered extensive brain damage and passed away after being taken off life-sustaining machines. The heartbreak that she and her family did and do suffer is immense. The midwife, who I assume was also greatly saddened by the baby's death, had an official complaint lodged against her and no longer practices midwifery here in Colorado.

While I once praised home birth, I now hold a negative opinion about both the practice of home birth and the legislative choice of many states to permit minimally-qualified (i.e., neither nurses nor doctors) midwives to attend out-of-hospital births. Even experienced, highly-knowledgeable midwives sometimes face unanticipated situations that require immediate remedies which they cannot provide, and those who practice a healing art outside hospitals should attain a high level of education and supervised training, such as occurs in nursing and medical schools. As I've been following this issue for the past year, I've learned that Colorado has a high (compared to hospitals) death rate for home birth attempts with non-CNM midwives. Today I found out that out-of-hospital birth attempts in Oregon result in a 6-8-fold increase in the rate of intrapartum and neonatal demise of full-term babies. Here is part of the testimony about this, the entirety of which is online at

Oregon now has the most complete, accurate data of any US state on outcomes of births planned to occur in the mother’s home or an out of-hospital birth center.
On the 1st row, you can see that nine babies died during or soon after labor in homes or birth centers.
The total mortality rate for planned out of hospital births was 4.5 per thousand, as seen in the last column of that row.
I have included the number of neonatal deaths both with and without the death of one baby who died of congenital abnormalities. That death cannot be attributed to the care given by the DEM attendant.
The 2nd row shows data on deaths associated with planned OOH births with direct-entry midwives as the planned birth attendants.
The total mortality rate associated with those births – excluding the one involving congenital abnormalities – is 4.8 per 1000.
For comparison, data on births planned to occur in hospitals is provided in the bottom row of the table. [The 2012 mortality rate in Oregon for term births planned to be in the hospital is 0.6/1000.]
Note that the total mortality rate for births planned to be attended by direct-entry midwives is 6-8 times higher than the rate for births planned to be attended in hospitals. The data for hospitals does not exclude deaths caused by congenital abnormalities.
Many women have been told that OOH births are as safe or safer than births in hospitals. This is true in some places, including British Columbia.
But out-of-hospital births are not as safe as births in hospitals in Oregon, where many of them are attended by birth attendants who have not completed an educational curriculum designed to provide all the knowledge, skills and judgment needed by midwives who practice in any setting.

I'm not an OB/GYN, nor do I work for one. Sure, my dad was a family doctor who delivered some babies in his day, but there are no surgeons in my immediate family. To make four TMI stories short, I have experienced four non-medicated births in hospitals in three different countries. I am a natural childbirth success story. (I'm not sure I can really take credit for that, for I come from "childbearing stock"; my mom had ten children vaginally--the first one was breech--and all six of my sisters have had multiple children with nary a section required.) I'm all for supporting women who want to move while giving birth, eschew epidurals, engage in natural methods of relaxation during labor, breastfeed, room-in, etc. I have no financial motive to make midwifery look bad. The mortality statistics sadly speak for themselves. Midwife-attended home birth, at least as practiced currently in my state and Oregon, unnecessarily and significantly increases the risk of a helpless baby dying. To me, the life of a precious child weighs far more heavily in the balance than the short-term comforts of giving birth in one's own home.

Do I persuade or do I offend in writing this post? And if the latter, what has happened to the natural childbirth culture if someone expressing concern about practices that contribute to avoidable infant loss is considered offensive?

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