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I'm so glad that you are talking about this as well!  I agree with our first commenter that birth outside of a hospita,l and birth in general, is not nearly as dangerous as people imagine.  That said ALL of the good-quality studies on the risks/benefits of out of hospital birth include only women experiencing low risk pregnancies- excluding breech presentation, twins, and VBAC.  I am totally in support of a woman being able to make her own decisions about where and how to birth, but I am only in support of this if the woman has received evidence-based and thoughtful counseling about the risks and benfits of all her options.  Certain homebirth and birth center practices in Portland cite the research on homebirth's safety on their websites and trumpet these studies to support their practices but fail to clarify to the women they care for that these studies only include low risk pregnancies.  It would be far more honest to share with women that we have little good data regarding the risks and benefits of birthing out of hospital with breech, twins, or VBAC.   The American College of Nurse Midwives has a statement on homebirth that I agree with: http://www.midwife.org/siteFiles/position/homeBirth.pdf

I think the key to this discussion lies in the question regarding what the line is between low risk and high risk pregnancies and labors.  Midwives around the world agree that twins, breech, and VBAC present higher risk situations.  I am very concerned that some midwives in our community seem to be pushing to minimize these risks.  And in the controversy over this subject, this lawsuit as an example, we all fail to move toward the Scandinavian model: the 90% of healthy low risk women birthing out of hospital and the 10% of ill or higher risk women birthing in hospital.  Portland can achieve this model but only if we can all move beyond the current argument.

posted 2 years, 10 months ago
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The majority of low-risk women (by this I mean essentially healthy women, carrying one baby, without pregnancy complications) who are cared for by experienced and well-trained midwives are likely to have safe and positive births at home or in birth centers.  There are several well conducted studies to support the safety of homebirth under these conditions.   Problems emerge, however, with those few out of hospital midwives or "cowboy midwives" who agree to care for women with higher risk pregnancies or do not transport to the hospital in a timely manner when complications arise during birth, resulting in higher morbidity and mortality.  The evidence to support homebirth as safe has only been established with low risk women. 

I disagree with xelakann's statement regarding the delay in receiving emergecy care in the hospital.  The only time that response to an obstetric emergency would be delayed 30 minutes would be if you are receiving care in a rural hospital or one in which essential emergency staff (anesthesiologists, physicians) are not at the hospital at all times but take call from home.  Large hospitals, like many in the Portland area, are set up to be able to respond very rapidly to an emergency.  For the rare birth that results in a true, unforseeable emergency, large urban hospitals are exquisitely well prepared and are exactly where that laboring woman should be.  The problem with in-hospital birth is not the rare emergency but involves the majority of normal laboring women who are birthing in an environment that can interfere with their normal process.

There is no escaping risk when pregnant or birthing or in being alive, for that matter. Birth is as safe as life gets.  The question each pregnant woman must ask herself is if she feels more comfortable taking on the higher risk of cesarean section by birthing in a hospital or if she prefers taking on the higher risk of not having emergency care if needed at home.  A woman can minimize her risk of unneccessary cesarean section by receiving care from a nurse-midwife in the hospital, and a woman can minimize her risk of poor care at a homebirth by verifying that her homebirth providers are well-trained and won't delay transporting to the hospital if there are problems in labor.

posted 4 years ago
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