Is home pregnancy / midwifery safer than going to a doctor?

Factual Questions
1

I can’t search the archives, so although I’m sure this topic has been brought up before, I can’t find it. I want to know what the current facts / studies / consensus (if any) are on home pregnancy.

My sister-in-law is a very new-agey kind of person, and pretty much every other thing she believes in or talks about smacks of pseudo-scientific bullcrap to me. So I take just about everything she says with a grain of salt. She has had two children so far at a “holistic birthing center” that was run by a couple of nurses and a bunch of midwives. When I asked her what a birthing center was, it was described to me as “a hospital without doctors and harmful technology.” They did ultrasound testing and checkups and so on, but did not offer epidurals or any of the other stuff that I’m familiar with as far as pregnancy goes. The reason she chose this place instead of a hospital is because, according to her, infant mortality rates are higher at hospitals than they are with home pregnancies or midwives.

My wife and I already agree that when (if?) she’s ready to be pregnant, we want lots of doctors and a hospital because we’re both very skeptical of this claim. But I’m curious, and since I’m certainly not an expert, I’d like to learn more.

I’ve tried doing some brief web-surfing on the issue, but the only sites I seem to find are published by midwifery.com or gentlebirths.org or whatever. Of course, they argue that doctors are more harmful to babies than midwives, but somehow, I don’t trust that as an unbiased source.

Anybody have any information from straight-forward statistics or medical journals or anything? Is natural birth (by “natural birth,” I mean, non-hospital, non-doctor birth) the safest choice for delivering a baby? Are doctors killing babies with their evil Science Machines?

2

I’m not a physician or a midwife, and my experience with childbirth is long in the past, but our physician was perfectly agreeable to overseeing the birth with as little intervention as we wanted consistant with the health of the mother and baby. The main difference is that if at the last minute a C-section was required the facilities to do so were available.

Midwife assisted births can be and are as safe as hospital births in some large percent of the time. When they are not as safe you don’t have a backup plan. If you have to transport a woman exhausted by 48 hours of labor to a hospital and perform an emergency C-section you may not get the best outcome.

Of course, if the mother or baby dies in this kind of a situation, it gets listed in the statistics as a hospital death.

3

I have no idea whether it is factually correct that infant mortality rates are higher at hospitals than at birthing centers, but I can think of a couple reason why that might be the case. As mentioned, if the mother and child are in extremis they’re going to be rushed to the hospital, where the death would be listed as a hospital death. Also, birthing centers and midwives get to choose their clients – hospitals don’t. If the pre-natal evaluation shows that a particular pregnancy/delivery would be complicated or dangerous, the center or midwife can simply decline to take the mother as a client. Simply for liability purposes, I would assume that most of these centers select only the safest pregnancies.

4

Two anecdotal stories – both reasons I adamantly oppose not using a hospital.

1 – a friend’s wife was having trouble with her home birth, and had to be rushed to the hospital. In Los Angeles. During rush hour. Heavy traffic being the understatement here. They couldn’t find the baby’s heartbeat on the trip over and told her the baby was dead. At the hospital, they had no choice but to go through the delivery anyway and it turned out that the baby was fine. Happy ending, but could have easily been disastrous. And would have been much safer had the emergency trip been moving from one hospital room to another instead of having to deal with the freeway system.

2 – My sister gave birth to her first two kids at home. Our father, a physician, finally convinced her to stop doing that and go to a hospital for her third child’s birth. That birth ended up happening unbelievably quickly… labor lasted under 1 hour! All was fine, until two hours after the birth… at which point my sister hemorrhaged and started losing blood at an alarming rate. Guess what? She was at a hospital and the emergency was dealt with immediately and she was fine. Had she needed to be transported who knows what would have happened.

Hospitals aren’t perfect. There are certainly risks associated with them, and preventable infection rates are completely unacceptable as far as I’m concerned. And home births are just fine… as long as nothing goes wrong. But in case of an emergency, give me a hospital any day.

5

What were they using to try and find the baby’s heartbeat? I picture this going down in the family minivan.

6

It was in an ambulance. Apparently the heartbeat dropped drastically and was so low they couldn’t find it on the trip over. I don’t have details as to what happened in the hospital, just that the parents were convinced for nearly an hour that they were going to give birth to a stillborn baby, and it wasn’t until the baby was born that they knew otherwise.

7

Personally I’d like to know what this “harmful technology” is. It sounds like complete BS to me. If you go to a hospital, I’m sure they will respect your wishes with regards to your desires on whether or not you want an epidural or drugs or whatever. But if something goes wrong, then they will do whatever they need to do to save both mother and baby’s lives.

How about you ask Steve Jobs how is “holistic” approach to cancer went? He was VERY lucky. When it was discovered the doctor broke down in tears about how lucky he was to have the treatable kind. What did that asshole do? He spend several months trying some holistic BS because he didn’t want surgery. In the end he got it and was cured.

If this holistic garbage were actually provably better, then it would be a part of modern medicine. Modern medicine has no bias towards one solution or the other. It’s just biased towards objective, provable, and repeatable remedies.

It’s not like all maternity wards are cold sterile rooms filled with stainless steel. I’m sure there is a lot of variety actually. Risking her life and her baby’s life over some stupid non-science bullshit just angers me. I hope your wife doesn’t do the same.

8

As flurb mentioned, any statistics are going to be skewed by the fact that all high-risk pregnancies are going to be handled by a hospital. Birthing centers are generally safe for low risk pregnancies, but those one in a million problems are going to result in a trip to the hospital, and you’ll be worse off for it.

If you want reduced intervention, you can get it at a hospital. You need to choose your doctor carefully, so he/she understands what level of care you want. No hospital will give you an epidural if you don’t want one, though they will subject you to the horror of asking you if you want one. They may require things like electronic fetal monitoring (ultrasound pads to monitor baby’s heartbeat and contractions) which may be of limited benefit, but isn’t exactly the devil’s work.

Personally, I get kind of angry about the holistic “natural” childbirth concept. Labor is something that is very difficult, and can be very dangerous to mother and child. The natural birth movement places the burden on the mom to deliver in a single manner, vaginally with no pain relievers. Any deviation from this, regardless of how necessary it is to protect both mom and baby (or even to just prevent hours and hours of agony) is perceived as a failure. I read a story in a “get ready for your labor” book (the Mrs. is due in about 3 weeks) where the parents were sitting in the hospital room with their healthy newborn son, and were SAD because the birth didn’t go according to plan.

9

I had Ivygirl delivered by a midwife at a hospital.

In SC at the time, if you were healthy and not in a high-risk category, you had the option of having a midwife. The doctors were always there as back up, and when I thought I was going into early labor (I wasn’t) I was told that because I wasn’t close to my due date, the doctor would have to take over.

Don’t think of midwives as some medieval hag who sticks a piece of wood between the mother’s teeth to bite down on. They are trained medical professionals, and in most normal, low risk pregnancies, can handle everything.

I found the midwife more personable and the treatment was more personal.

10

It sort of depends on what you mean by “safer” but for low-risk women it appears to be equally safe.

Low-risk women having home births attended by a Certified Professional Midwife have a lower rate of medical interventions as compared to equally low-risk women birthing in a hospital.

It looks like about 14% of the women who planned a home birth were transferred to a hospital, most (12% out of 14%) were transferred before giving birth with “exhaustion,” “Pain relief” and “failure to progress” being the reason in just over 50% of the transfers.

The baby died in 2 per 1,000 births, consistent with babies born in a hospital to women of equally low risk. No mothers died.

11

I’m surprised nobody has mentioned hospital borne infections. Does anyone know how often they affect birth?

12

(OB-GYN Nurse here)

Birthing Centers can be a nice alternative for delivery for a low risk pregnancy. For example, you SIL in law has already had two (I suppose) uncomplicated, term deliveries, so if she has no risk factors and the baby is growing well and is positioned well this time around, she would be a good candidate for such a center. All these factors can be evaluated by the Doctor or midwives as the pregnancy progresses and the final decision made at the time draws near.

My field is high risk pregnancy (11 years, 16 years in OB-GYN, total) and I have had two children myself. Certainly my professional and personal experiences color my opinion, and here it is: There is no way I would ever deliver out of a hospital setting.

I have seen far too many pregnancies “go south” in every kind of way and have had one normal, happy delivery and one disastrous everything-that-could-possibly-go-wrong delivery myself.

I often feel some women place far too much emphasis on “The Delivery”. Delivering a baby is only one very small part of parenting.

13

There are plenty of non-kooky reasons to be in favour of midwife-lead care rather than doctor-lead care. Most women who give birth do not need a doctor - it’s a good idea to have access to a doctor somewhere nearby, but that’s not the same as having the doctor be in charge of the process from the beginning.

The trouble with doctor-lead care is that the sorts of medical interventions that doctors do (eg inductions, caesarians, epidurals) can lead to poorer outcomes for the mother and/or baby if they are done when they are not actually necessary.

Cite on induction:

“Odds ratios for epidural anesthesia, cesarean delivery and diagnoses of nonreassuring fetal heart rate patterns were independently increased following elective induction” - that is, it makes you more likely to need an epidural or a caesarian, and your baby is likely to be more stressed during the birth

Cite on cesareans:

“Infants delivered by elective cesarean delivery had a higher risk for respiratory morbidity vs infants delivered vaginally or by emergency cesarean delivery”

And another cite

"The team studied more than 5.7 million live births and nearly 12,000 infant deaths in the United States from 1998 to 2001.

They counted neonatal deaths among babies (occurring within 28 days of birth) and found that the neonatal death rate for Caesarean birth among low-risk women was 1.77 deaths per 1,000 live births while the rate among vaginal births was 0.62.

The rates of Caesarean operations have been increasing rapidly in the U.S., where they now account for 29 per cent of births.

Experts suggest that the natural vaginal birth process as well as squeezing fluid out of the lungs, releases hormones that promote healthy lung function.

The authors hope the results will promote greater discussion within the obstetrical community about the pros and cons of offering Caesarean sections for convenience.

A French study has co-incidentally suggested that Caesarean delivery more than triples a woman’s risk of dying in childbirth compared with a vaginal birth."

Cite on epidurals

“Serious problems:
These are rare.
The epidural catheter can be put in the wrong place. About 5% of the time it goes into a blood vessel in the back, and has to be pulled back or reinserted. Very rarely a dose of local anesthetic is injected into the blood vessel and the patient notices a metallic taste in her mouth, becomes dizzy, and may go on to have a convulsion or even a heart attack. With prompt treatment, complete recovery from this complication is possible.
About 1-2% of epidurals enter the fluid which surrounds the spinal cord. This frequently causes a severe headache, which may need further treatment. Very rarely a large dose of local anesthetic is injected, causing serious complications.
Other complications include the introduction of infection into the area around the spinal cord.
Exceedingly rarely, epidural analgesia can cause death or permanent paralysis.”
Note that I’m NOT saying that medical interventions should never be done - that would be ridiculous. It’s obvious that, eg Cesareans have saved countless lives when performed when they are necessary. The point about midwife-lead care is that the philosophy is to make sure that these interventions are necessary before calling in the doctors, whereas having a doctor involved from the start increases the chance that interventions will be done “just in case” as if there is no risk at all involved, when clearly there is some.

I suspect that in your sister-in-law’s birth centre there actually are doctors involved - either on-hand out of sight somewhere in the centre or by some sort of arrangement with a local hospital - just not in the faces of the actual women giving birth. I really doubt if any reputable institution would fail to make some sort of plans for in case things went wrong. But the main focus will not be on what to do if things go wrong - it will be on how to make it go right.

Also (finally!) this is all pretty marginal - the vast vast majority of women give birth to a healthy baby and end up healthy themselves, no matter what type of birth they have had.

14

Well, just ancedotally, I never understood why you have a delivery room pediatrician until he was recussicating my youngest and then restarting her heart. Of course, that was a high risk delivery (twins). Certainly for “high risk” it would be prudent to have as many bases covered as possible.

15

(Shrug) Holland has a very high percentage of home births, and the best mother/child mortality rates (meaning fewest die. That sounds ambiguous) in the developed world.

I had a midwife because if possible I didn’t want everything to go medical- there is a distinct snowball effect with inverventions. I’m not a kooky credulous new-agey type. Midwives tend to offer everything as a choice. Most doctors don’t. Midwives spend more time with you, and around here they’re all RNs and also make house calls.

In the end, everything did go wrong and I had a c-section, but I was really really happy to have an advocate who would explain everything, ask me if I wanted it, and provide all kinds of support.

16

Something to remember that is cast aside all too often. Before all our technology was brought to bear, moms died alot more often. Getting so focused on baby often ignores what is best for mom as well.

17

I know that in a lot of places you can go to a hippy dippy birthing center… that’s attached to a hospital. Across the street, or through a breezeway or something. So you can labor with your midwife and your doula and have the dolphins brought in and all, and then it something goes wrong you’re across the street in seconds and on the operating table. Sounds like the best of both worlds to me.

18

My wife is going to give birth at the end of the year and we’ve been bombarded by my cousin’s wife with all the hippy-dippy BS about why hospitals are evil (which is ironic, considering that she and/or her baby probably would have died if she didn’t give birth in a hospital).

As someone who studies health care for a living, I am well aware that modern health care isn’t completely safe and that often people get unnecessary care. There are risks that people take when they go into a hospital. A certain percentage of care actually hurts, not helps, people. However, the home birth and midwife movement is filled with cranks, IMHO. I’ve seen and read a bunch of their stuff. Their main point seems to be that giving birth should be some sort of beautiful, natural experience that is essential to being a woman. Well, as they say in Knocked Up, “if you want an experience go to a Jimmy Buffet concert.” My wife and I want the kid out of her womb and healthy and my wife alive. If having that birth in a hospital will ensure this will happen, then we are no worse off because my wife didn’t give birth the way that women in pre-modern times did.

In the end, in a lot of cases home birth is just fine. But the movement promoting it is doing so as an ideology, not based on science as far as I can tell. They are the same folks who believe (without any facts to back them up ) that organic food is better for you, that aspartame causes cancer, and a bunch of other anti-science concepts. It’s a nutty crowd, so keep that in mind when you evaluate their claims.

19

Important reminder, midwives and birthing centres exclude women they feel are going to be high risk. Therefore they don’t deliver obese women, women with diabetes or other serious medical conditions, multiple pregnancies, premature deliveries, breech babies, women with poor obstetric hisotries, women with previous sections… anything which makes you less than ideal, that is automatically high risk and therefore an exclusion criteria. If you just deal with normal, you may be out of practice and inexperienced with dealing with the abnormal. If something does go pear-shaped a midwife who works in a birthing centre might not be as helpful to you as a midwife who has spent the last 10 years working in the high-risk maternity ward of a hospital.

If you are low risk, and definitely don’t want an epidural or an on-site operating theatre, blood bank and paediatrician- and are willing to accept that this might be a potentially risky choice, well and good. Go into it aware that the choices you have made may have adverse consequences as well as benefits.

Advocates of birthing centres and natural birthing don’t scare me as much as the crazy people who advocate “freebirthing”. I read an article in a women’s magazine about some woman who was advocating freebirthing- i.e. you deliver your own baby, alone, at home. No midwife, no partner for assistance. She seemed to think that if she started haemorrhaging she would be able to call her partner, who could staunch the bleeding with some towels while they waited for an ambulance.

That woman was living in a fantasy. Obstetric haemorrhage can be torrential, and you can bleed to death from it in under 3 minutes. Even delivering at home with a midwife you’ll have access to drugs to make the womb contract and reduce the bleeding, which could be life-saving.

Natural childbirth is a wonderful, miraclulous thing which kills millions of women and babies worldwide every year. In the developed world you might be lucky enough to have a choice how, when, where and by whom your baby is delivered. You need to weigh up the risks and benefis of those choices and make a decision that is right for you, based on your unique circumstances…and as long as that choice isn’t delivering by yourself in your bathroom while your husband sits outside the door with a few towels and a telephone, I’ll support you.

As long as you have a healthy mother and baby at the end of the delivery, whether the baby was delivered vaginally, abdominally or by teleportation, and whether mum was using hypnosis, nitrous oxide, essential oils or narcotics to cope is fairly irrelevant.

20

Yeah, a friend of mine just gave birth, (30 HOURS OF LABOR! :eek: ) then hemorrhaged a couple of hours later and lost 1/3 of her blood before they got it stopped. No way in HELL would I give birth outside an environment where immediate medical help was available.