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

Having a midwife-attended birth isn’t quite as, um, rustic as some of yall are making it out to be. My two children were delivered by midwives - the first in a hospital and the second in a stand alone birthing center.

A couple of things: midwives do often deliver high-risk pregnancy babies, but it’s just usually done at a hospital in consultation with a specialist OB. This means that midwives do have experience with high-risk situations. Midwifery certification (at least in Maryland) requires several years of experience as a hospital-based OB nurse (in addition to a master’s degree). Also, birthing centers do have plenty of high-tech medical stuff. Midwives and their supporting staff are prepared to deal with hemmorhage, to suction an infant in case of meconium aspiration, etc.

Nothing in life is risk free, of course, but it’s not like hospital births are inherently un-risky. I, for one, preferred the risks associated with a birthing center to the risks associated with hospital birth. (And I’m not an especially “hippy-dippy” sort of person.) I can certainly understand why other people would make different choices, but this isn’t really off the deep end crazy.

I haven’t actually had my baby yet (due in about 9 weeks), so I’m not qualified by actual experience, but I agree based on what I’ve learned so far. The birthing center in which we plan to have our baby is actually on a floor of the hospital. I am not very “hippy dippy” either, but what I love about the midwife philosophy is that they are able to provide a WAY more pleasant experience (I don’t mean aromatherapy, either) without compromising health of the mother or baby, in the following ways: you can move around freely, walk around, get in the shower, labor in a tub (at our birth center you can’t birth the baby in the tub, but you can labor in it), eat or drink, use birth balls, or hang out on the big, regular queen size bed, and generally do the things that keep labor happening and ease your pain naturally. The reason you can do this in the birth center is that they do not do continuous electronic fetal monitoring* unless you are high risk (they do intermittent monitoring – auscultation – instead), require you to have an IV, unless there’s some real need for it (antibiotics for strep B, for instance) or require you to keep a blood pressure monitor on. They do intermittent blood pressure checks – more work for them, but makes life better for the patient.

In hospitals, most of the time you have the aforementioned trappings, which keep you close to or on the bed, so you can’t do the water/moving around/birth ball/trying all kinds of different positions stuff that eases pain and keeps labor going. Also, the midwives I’m with have about a 1% episiotomy rate. They do perineal massage/hot cloths/oil – which is a lot more work for them, again – but keeps you from tearing or needing to be cut.

I have nothing against hospitals, doctors, and drugs personally (heck, I love drugs. But I would like to avoid giving them to my baby if possible). And who likes pain? That’s why I want to labor in a tub…apparently the warmth, water, and feeling of weightlessness really helps. Also, one medical intervention can tend to lead to another, so if your labor isn’t progressing, they induce you…which usually leads to stronger, more intense contractions…which often leads to increased need for epidural…which can slow down labor and also make it harder for you to push because you can’t feel anything…and can lower the baby’s heartrate and hinder respiration…et cetera. (I’m not saying that any of those things are the end of the world. I’d just like to avoid them if possible.) All the while you’re prisoner to the bed because of the monitoring. So…THAT’S why I’m using a birth center with midwives. Not because doctors are evil and not because I am against pharmaceuticals or hospitals. But because I see this as the best of both worlds, I am low-risk, and I think that my birth experience will be so much better this way. And I’m not talking about having “an Experience.” I’m talking about it sucking less. :slight_smile:

*apparently outcomes in low-risk pregnancies are not statistically any better with continuous electronic fetal monitoring. The following is from a journal published by the American College of Obstetrics and Gynecology: I didn’t link to it because it’s either on a paid site or you’d have to scroll too much on the unpaid site where I found it…there are several other journal articles saying the same thing, though.

Sandmire, H. F. 1990. “Whither electronic fetal monitoring?” Obst Gyn 76:1130-4.
Largely based on promising animal studies, continuous electronic fetal monitoring (EFM) was introduced into clinical practice in the early 1970s. After almost 20 years of experience, it is now apparent hat the anticipated benefits of this technology have not materialized. Undesirable side effects of EFM include inappropriate operative intervention for some patients and increased liability for physicians and hospitals, resulting in an increase in the costs of obstetric services. After reviewing several research studies, The American College of Obstetricians and Gynecologists concluded that EFM and intermittent auscultation are equivalent methods for intrapartum assessment. We have developed a protocol for the performance of intermittent auscultation, including indicated responses to different levels of bradycardia. This protocol has allowed us to substitute auscultation for EFM in a high percentage of patients using existing nursing personnel. Laboring patients should, at a minimum, receive information on both intermittent auscultation and EFM to enable them to make an informed choice of method for intrapartum fetal assessment. Author-abstract. 30 Refs.

This was my experiance as well. With my first I had a regular doctor who was very hands off and was not available when I gave birth to my son. I was young and really did not know a lot and I wish I had had a better doctor at the time. I had a long labor but a normal child birth other than he was six weeks early.

With my daughter I had a midwife who was wonderful. She was always available and I never felt uncomfortable or rushed with her. As it got near the end it looked more and more like I might need a c-section so we also consulted the doctor in her office. He just happened to be the same doctor that delivered my son.

I did end up having a c-section but she was there the entire time with me. She did not leave just because she could not do the delivery and visited me more times afterwards then the doctor did.

If I had decided to have a third I would have went to her again in a heartbeat.

While it is true that low-risk pregnant women in the Netherlands are traditionally encouraged by doctors to give birth at home with a midwife present, and while the Dutch perinatal mortality rate certainly isn’t bad, the Dutch perinatal mortality rate does not deserve their glowing reputation anymore.

In fact, more and more Dutch women feel that homebirthing needlessly deprives them of pain-relieving options. A Dutch midwife isn’t medically allowed to give anything stronger then an aspirin and a backrub for labor pain. That isn’t much ! More and more Dutch women are comparing the Dutch lack of pain relief with the situation abroad where epidurals are offered almost routinely,and opt for a hospital birth instead of a home birth.
That trend also shows in the number of Dutch women who start labor at home, but still end up in hospital. Currently almost half of the women first delivering at home can’t stand the pain and give up, half way through labor, and are taken to a hospital to get an epidural after all. Like said upthread, that give a lot of stress to everyone involved.

Oddly enough when this was first up my wife and I were having our second child, which a midwife. Here in Maryland the midwives need to be certified as been stated. The ones we went through do on average one or two deliveries a day, while that doesn’t sound like much there are only three of them. They will accept at least some high risk women, and do a few VBACs a week.

My wife started going to her OBGYN and switched about halfway through the pregnancy. While I liked the doctors just fine they were way too quick to advise things like, lets schedule a C-section now, months in advance, told us the baby was huge based on an early reading when she wasn’t. The doctors all seemed to just do everything by the odds, which is fine, but when we know when the baby was conceived and they are telling us something different you have to roll your eyes.

Here in Montgomery county when you first go to the hospital they start asking you when you want to start your drugs, hook you up to an IV, and hospital policy is to have 100% fetal monitoring. This means you’re basically bed bound even though it has been shown that moving around can make delivery easier.

I don’t have the stats with me, but I know my wife looking into having a midwife for months. She agonized over having a midwife for months, mostly because she heard some of the crazy stories people hear about them. In the end my wife is very glad she went with the midwives.

I’ve known several women who had home births with midwives attending (and one home birth on the stairs trying to get to the hospital with her mother attending, but that wasn’t planned). The only bad case was a woman who gave birth in front of her two sons to a dead baby boy. The police were called and started talking about how the woman gave birth in “squalor” with “no medical attention” and that she would probably be prosecuted for murder. Right in front of her sons after the poor mother has given birth to a dead baby.

It turned out the baby’s heart was malformed and the best doctor in the best hospital in the world couldn’t have saved him. But it was very crass on the part of the police to treat her like that.

I’m actually planning a homebirth for my first child. While I don’t think it’s necessarily safer than going to a doctor, for a low-risk pregnancy it’s as safe as a hospital birth, with many fewer restrictions. For example, my OB/GYN (I am currently receiving tandem care, but will switch to just the midwives after my 20w ultrasound), who works with midwives who do most of their low-risk hospital births, still requires an IV, no food or drink during labor, and continuous fetal monitoring. So basically you’re stuck in a hospital bed with limited movement and limited ability to change positions for comfort, and no ability to replenish lost strength (important for me, since I feel like crap with low blood sugar). And this is one of the best OB/GYNs in my city! There’s no birthing center anywhere near here (I think the closest is in Dayton, an hour’s drive away), so home was my only other option. I live two minutes away from one great hospital and 7-8 minutes away from a great teaching hospital, so I don’t feel like I’m at any more risk at home than I would be at a birthing center.

And I must say, I love my midwives. On average, they spend 1-2 hours talking with me per appointment. My OB/GYN spends about 10 minutes, tops. The senior midwife on my team has been delivering babies since 1977. I was born in 1978. None of the OB/GYNs in the entire practice I go to have been doctors for that long.

Other people have mentioned the whole cascade of interventions and rising c-section rates, so I won’t go into those too much. If you’re interested in reading why the American maternity system is as screwed up as it is, check out Pushed by Jennifer Block–it’s an excellent book.

When my wife went into labor with our first kid (low risk also) she started throwing up with every contraction. It turns out that’s how she handles pain, and every muscle contracted together. She started at home - going into the lobby with a barf basin gets you fast service - but it was quite a mess by the end. Hope you have someone to clean up after you.

Plus, it turned out that our daughter had a heart issue, which happily went away without any intervention. Once they noticed this, it was very impressive how fast they moved. Forceps delivery, and I had to watch through the window. I suspect everything would have been fine without an intervention, but I’m happy we didn’t take chances.

Being a techie, I’m more comfortable in a room with monitors and flashing lights and duckies than in one with just duckies.

Although safety is an important concern of childbirth, it isn’t the only thing to consider. Both of my kids were delivered at home by a fantastic midwife. My wife and I did lots of research on the statistics back then (18 years ago for the first one) and found that for her very low risk circumstances and our favorable location in a well-served metropolitan area, home births were as safe as hospital stays.

But after the first one, even with her very long labor, we had a hard time imagining ever going through the kind of experience some of our friends had had in hospitals, and even birthing centers. Being at home was such a tremendous benefit. We made the bed with fresh linens, then put a fitted plastic sheet over it all and made the bed again. After the baby (et al) had arrived and been dealt with, we just pulled up the plastic sheet and tossed it all, crawled into our own bed with our new baby, got a kiss goodby from the midwife and were done.

Mitigating risk can become an obsession, especially for parents. But there are other factors to consider both in birthing and raising children.