Planned home births with a trained midwife are a safe,high-quality, cost-effective, emotionally-satisfying way to have babies
Women know that pregnancy is a natural event that should be celebrated, not a medical condition that has to be treated; and, despite major professional societies condemning the practice of home birth, over 38,000 American babies were born at home in 2017. This represents .99% of the 3.86 million total births according to the National Center for Health Statistics (NCHS). An average of 1% may not seem substantial but it’s an almost 80% increase from the .56% delivered at home in 2004.
Who gives birth at home?
According to a study published in the January 2014 issue of the Journal of Midwifery and Women’s Health, more women are choosing to have their babies at home than ever before based on data from almost 17,000 women that had planned home births. A landmark study published in the British Medical Journal (BMJ) studied over 5,400 low-risk pregnant women planning to birth at home in the United States and Canada, then analyzed and compared the results to the outcomes of over 3 million low-risk hospital births. The BMJ press release stated the following:
- 88% of the women birthed at home, with 12% transferring to hospital
- Planned home birth carried a rate of 1.7 infant deaths per 1,000 births, a rate “consistent with most North American studies of intended births out of hospital and low-risk hospital births”
- There were no maternal deaths
- Medical intervention rates of planned home births were dramatically lower than planned hospital births, including: episiotomy rate of 2.1% (33% in hospital), cesarean section rate of 3.7% (19% in hospital), forceps rate of 1% (2.2% in hospital), and induction rate of 9.6% (21% in hospital)
- Another study showed that home birth was associated with lower rates of infants needing admission to neonatal ICUs in addition to a lower rate of obstetrical interventions.
- 97% of over 500 participants who were randomly contacted to validate birth outcomes reported that they were extremely or very satisfied with the care they received
Who delivers babies at home?
The previously mentioned study from the Journal of Midwifery and Women’s Health stated that planned home births attended by a Certified Professional Midwife (CPM) result in low rates of interventions without an increase in adverse outcomes for mothers and babies. The authors of this study confirm the safety and overwhelmingly positive health benefits for low-risk mothers and babies who choose to birth at home with a CPM.
This study and others support what midwives have always said: planned home births with a trained midwife are a safe, high-quality, cost-effective, emotionally-satisfying way to have babies. Even the World Health Organization in 2016 said, “Midwifery is defined as ‘skilled, knowledgeable, and compassionate care for childbearing women, newborn infants, and families across the continuum from pre-pregnancy, pregnancy, birth, postpartum and the early weeks of life’. The evidence shows us that midwifery plays a ‘vital’ role, and when provided by educated, trained, regulated, licensed midwives, is associated with improved quality of care and rapid and sustained reductions in maternal and newborn mortality.”
Why deliver your baby at home?
According to the Centers for Disease Control and Prevention, home birthing in the U.S. is on the rise, despite only 35 of the 50 states actually licensing midwives. A Time magazine article in September of 2010 stated that women who choose to give birth at home are trying to “avoid what they deem over medicalized childbirth”. When considering that 32% of hospital births result in a c-section, and that studies have shown home births have far fewer medical interventions, it’s understandable that women are making the choice to give birth at home. Choosing to give birth at home with a midwife has many benefits that far outweigh the services provided at a hospital. For instance, a midwife will spend time with the expecting mother developing a relationship built on trust. This is proven by simple statistics: “the average prenatal visit to a midwife lasts 30-45 minutes (and longer if the woman is planning a home birth), compared to the 5-7 minutes obstetricians average with their patients.” A study published in the Journal of Midwifery and Women’s Health questioned 160 American women who had chosen homebirth. The women were mostly married (91%), white (87%) and college educated (62%). When asked “Why did you choose home birth?”, the majority of the women (38%) stated for safety or to avoid the unnecessary medical interventions common in hospital births. Some women (37%) had a previous negative hospital experience, and then some wanted more control over the birth process (35%) or preferred a comfortable, familiar environment (30%).
Finally, in 2019, USA Today published an article titled “Deadly deliveries: How hospitals are failing” in which they reviewed current statistics showing that the U.S. has the highest maternal death rate in hospital births among the world’s developed nations. The study showed that everywhere else the death rate has been stable or falling but, in the U.S., it’s been getting worse and the best estimates say that half of those deaths could be prevented.
Global Home Birth Stastics
In many countries home birth is as common as a hospital birth and, in some cases, hospital births are reserved solely for high-risk pregnancies or are the result of an unforeseen circumstance requiring a home to hospital transfer. In the Netherlands, CPMs are integrated into the medical system making home births easier and more common. An in-depth study in 2009 of the 529,688 women who gave birth in the Netherlands determined that 321,307 (60.7%) intended to give birth at home and 163,261 (30.8%) planned to give birth in a hospital. For the other 45,120 (8.5%) the intended birthplace was unknown. This study resulted in no significant differences between planned home and planned hospital birth when it came to infant death or admission to neonatal intensive care unit. The results were similar in a study published in the British Medical Journal in 2014 that determined there was no relation between the planned place of birth and the perinatal outcome. For first-time mothers absolute risks were lower in planned home births. Many have speculated that this could be due to the overall wellness lifestyle generally practiced by women who are making the choice to give birth at home rather than in a hospital setting.
Recent Challenges
Just as with osteopathy, acupuncture and chiropractic, any holistic profession that has become more mainstream in the past 100 years has found itself being challenged and under increased scrutiny, and sometimes the target of outright disdain. While still only about 1% of mothers choose to home birth (definitely not mainstream by any means), that number has doubled in the past 25 years and this has caused an increase in scrutiny – and disapproval. Recent articles are misrepresenting the statistics in order to make it appear that home births are more dangerous. It’s important to understand that these statistics are being distorted. For example, a paper published by Medscape in February of 2020, says that there is a 4 times greater risk of infant death among home births. They based this on the fact that studies have shown that 1 in every 1,000 infants born in the hospital have died and 4 in every 1,000 infants born at home have died. Yes, this is accurate, but this is egregiously flawed data as it was based on all infants born at home even unexpectedly, not just infants with planned home births. With the exception of the state of Oregon, states do not distinguish between planned home births and unplanned home births. Additionally, recent data confirms that of the 1.18% of births occurring outside of the hospital only 66% of those were planned home births.
In Summary
As women are becoming aware that there are more choices for how and where to deliver their babies, the decision to give birth at home will definitely become a more common one. Statistics are proving that home births are on the rise and your Family Wellness Chiropractor will always support a woman’s choice to deliver at home and be available to ensure those women are well informed.