It’s funny. I’ve recently been told—by more than one person—that Sara and I are “brave” for planning to deliver our baby at home. This from people who are educated, intelligent and have my respect. And yet, they couldn’t have picked a worse way to characterize the decision. What’s going on here?
Read on, and then you tell me: isn’t it actually more courageous for a low risk mother-to-be to voluntarily walk into a hospital to give birth?
First, let me point out that:
- “Home birth” means planned home birth. The process starts at home, but in those cases where a doctor’s intervention is warranted, the mother is taken to a nearby hospital.
- A planned home birth is attended by a qualified, certified midwife.
- In this article, I’m simply answering the question, “Isn’t home birth unsafe?” I won’t focus on “Why is home birth better?”
Q. Isn’t hospital birth safer?
A. No. If you’re a good candidate for home birth (and the majority of women are), then a planned, attended home birth is as safe, or safer, than a hospital birth.
Q. Come on, how can a hospital not be safer?
A. Surprisingly easily.
If you’re giving birth and you’re low-risk, then simply checking into a hospital greatly increases the likelihood of unnecessary interventions–pitocin drip, epidural, episiotomy, cesarean section, et al.–with no corresponding increase in safety for mother or baby.
I can also tell you this: my home is more sanitary (with respect to virulent infectious agents) than the cleanest hospital maternity ward .
Q. How do you know that home birth safe?
A. Evidence. Sara has searched through the medical literature, and every relevant study she has found has shown that home birth is as safe, or safer than, hospital birth. See references below.
The upshot of the research  is this:
Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.
Q. What if something goes wrong at home?
A. First of all, it’s worth noting that in the majority of cases, nothing goes wrong. Expecting that things will go wrong just isn’t rational. On the other hand, preparing for things that might go wrong, even if they’re unlikely, is wise.
Certified nurse midwives are trained, equipped and experienced at solving the most common (and remember, “common” is relative) problems. They’ll bring with them, into our home, oxygen, pitocin, resuscitation equipment, etc. Using instruments identical to those used in a hospital, they can stop hemorrhaging, perform an episiotomy, stitch tears, etc., as needed.
And, of course, a trained, experienced midwife will know if you need emergency intervention (e.g., cesarean), and in that case she will get you to the hospital and have the staff prepped and ready to receive you once you arrive.
Also, it’s important to note that you’re more likely to have one of these problems just by being in a hospital; birthing at home reduces the likelihood of many of them in the first place:
A study by Mehl compared a group of 1046 women giving birth at home with 1046 women having hospital births and found :
- 9 times as many episiotomies
- 15 times as many women receiving analgesia or anaesthesia
- 3 times as many caesareans
- 2 times as many forceps deliveries
- 3 times as many postpartum haemorhages
- 3.7 times as many babies requiring resuscitation
- newborn infection rates 3 times higher
- respiratory distress 17 times higher
- lower Apgar scores
- mortality figures were the same for both groups.
Q. But I heard a horror story about a home birth…
A. I’ve heard and read lots of scary anecdotes about both home birth and hospital birth. At the end of the day, my decision is driven by evidence, not anecdote.
Q. Midwives?? Aren’t obstetricians the experts at delivering babies?
A. In some deliveries, yes. Obstetricians are trained as surgeons, so that they can c-section a woman who needs drastic intervention. Consequently, that’s what they’re best at. But most women do not need a cesarean, and in that majority of cases, going to a surgeon may not (and often does not) provide the best outcome. (Part of a “good outcome” is avoiding a c-section unless it’s truly necessary. Some are necessary; most are not.)
Certified nurse midwives, on the other hand, are trained to handle healthy, normal births, including several types of non-drastic interventions. This is their expertise. They make sure that things are progressing properly, and know when to transfer you to the hospital if an obstetrician’s expertise is indicated.
Sidebar: “My c-section was necessary.”
Okay, yours may have been. But most c-sections that take place (yes, the majority of them) are necessitated by earlier “routine” interventions, which, in many cases, were not required in the first place. Henci Goer describes this “cascade effect” clearly :
Every intervention into the normal process [of labor] introduces risks as well as benefits…. When intervening becomes routine, meaning there is no reason for it, only risks remain. Moreover, because one intervention tends to lead to another, it produces a “cascade effect.”
So, for example, electronic fetal monitoring confines women to bed, which may slow labor. Doctors may then give oxytocin, which increases pain, causing women to want an epidural. The epidural may slow labor or cause abnormal heart rate patterns, ending the cascade in a cesarean section for poor progress or fetal distress.
The bottom line: many c-sections are made necessary by the routine protocols followed by hospital practitioners. 
Q. But I had my child in a hospital, and we’re both fine.
A. That’s great. Most hospital births go well, and are safe. (Hey, I was born in a hospital, and my mother says I’m perfect, so…)
Q. If home birth is so good, how come more women don’t choose it?
A. You can’t choose something if you don’t know it exists. Most of us in the U.S. (myself included) have been conditioned to go to a doctor when we get pregnant. I didn’t know the first thing about home birth until 12 weeks into our pregnancy; and even then, I thought it sounded crazy. That is, until I read the evidence about home births and hospital births, and their respective pros and cons, and realized that home birth was a wonderful option for us.
In the U.S. today, midwife-attended births are on the fringe. Not so in other developed countries. Holland is probably the best example of a country with a high rate of midwifery (and home births) and an excellent, low mortality rate (lower than the U.S. rate).
Q. Should every pregnant woman have a planned home birth?
A. No. Every woman should learn about the home birth option (and all other options), but home birth only makes sense for pregnancies which meet certain conditions, e.g., low risk, singleton (no twins), no breech.  [But see reader comment #3 for an alternate opinion.]
Q. I’ve read what you’ve written. But what if I still don’t want a home birth?
A. Okay. An informed decision–either way–is a decision well made.
In the end, it’s not the location of [a low-risk] birth that dictates how good the outcome will be; it’s who’s running the show. The people running the show in a hospital are well-intentioned, but much more likely to take unnecessary (and unpleasant) actions. Period.
-  Outcomes of planned home births with certified professional midwives: large prospective study in North America, British Medical Journal, 2005;330:1416 (18 June)
-  Cesarean Birth in a Culture of Fear, Mothering Magazine, Issue 144, September/October 2007
- Goer, H., The Thinking Woman’s Guide to a Better Birth, Perigree, 1999
-  Homebirth 101, ivillage.com
-  Collaborative survey of perinatal loss in planned and unplanned home births, BMJ 1996;313:1306-1309 (23 November)
-  Outcomes of 11,788 planned home births attended by certified nurse-midwives. A retrospective descriptive study., J Nurse Midwifery. 1995 Nov-Dec;40(6):483-92.
-  Young, G. and Hey, E., Choosing between home and hospital delivery, BMJ 2000;320:798 (18 March 2000)
-  Responses to Home births or hospital? It’s baby who knows best by Karen Robinson, The Sunday Times (UK), 29 August 1999.
-  Joint Interregional Conference on Appropriate Technology for Birth, World Health Organization, Regional Office for Europe, April 1995
-  Home Birth vs. Hospital Birth – Issues of Responsibility, March 2006
-  Hospital Birth and Risk of Infection, June 2006
-  Cesarean Fact Sheet, Childbirth.org
-  Normal Birth – What are the Chances?, Sally Tracy
-  Ina May’s Guide to Childbirth, Ina May Gaskin