Is Home birth with a Midwife Safe?

The Texas Department of Health's own statistics show that midwives in Texas have a lower infant mortality rate than physicians.

(Texas Lay midwifery Program, Six Year Report, 1983- 1989, Berstein & Bryant, Appendix Vlllf, Texas Department of Health, I 100 West 49th St., Austin, TX 78756-3199.) 

"In The five European countries with the lowest infant mortality rates, midwives preside at more than 70 percent of all births. More than half of all Dutch babies are born at home with midwives in attendance, and Holland's maternal and infant mortality rates are far lower than in the United States..."

In the Western European countries that have lower infant and maternal mortality, lower cesarean birth rates and lower health care costs than the U.S., midwives are the primary care providers for over 70% of births; about 5% of US babies are delivered by midwives. For years the World Health Organization has recommended that most births should occur outside the hospital, attended by midwives, without routine technological interventions. In the US, only about 1% of births take place outside the hospital.

". . . why, in the interest of improving care, so many hospital maternity services have uncritically introduced interventions that have been shown, in well-designed studies, to be useless, inappropriate, excessively costly, and frequently dangerous for mothers and babies. . ."

by David Stewart, PhD:

...Every study published shows midwives to be safer than doctors. Every study. No exceptions. If your physician disagrees with this, challenge him or her to produce the data that supports otherwise. They won't be able to do it. Such data does not and never did exist. In a nutshell, that is the strength of the case for midwifery. It is unanimous.
. . . over and over again, throughout history, the data shows that when doctors displace midwives, outcomes get worse.

BMJ No 7068 Volume 313 General Practice Paper Saturday 23 November 1996
"Home versus hospital deliveries: follow up study of matched pairs for procedures and outcome"

Conclusion - Healthy low risk women who wish to deliver at home have no increased risk either to themselves or to their babies.

Why Homebirth is Safer, an excerpt from the book, A Woman in Residence, by Dr. Michelle Harrison, M.D. (who is a family practitioner and did residency work in OB/GYN) will make us all do some reflective thinking.

"Imagine dancers on a stage. Once, doing a pirouette, a woman sustained a cervical fracture as a result of a fall; she is now paralyzed. We try to make the stage safer, to have the dancers better prepared. But can a dancer wear a collar around her neck, just in case she falls? The presence of the collar will inhibit her free motion. We cannot say to her, 'This will be entirely natural except for the brace on your neck, just in case.' It cannot be "as if" it is not there, because we know that creative movement and creative expression cannot exist with those constraints. The dancer cannot dance with the brace on. In the same way, the birthing woman cannot "dance" with a brace on. The straps around her abdomen, the wires coming from her vagina, change her birth."

In response to: "Is homebirth safe?"

Rather a large number of studies have been done on this. To date, the studies show, without exception, a lower rate of mortality and morbidity for mothers and infants in all risk categories with home birth.

How can home birth be safer than hospital birth? Most "problems" in hospital births come about due to "failure to progress". This leads to interventions, and interventions have consequences and side effects. In the hospital, this often leads to more interventions, etc. Why failure to progress? Imagine for a moment that your cat is about to have kittens. It will seek a warm comfortable place, where if feels safe. Imagine you bring it out into a strange, brightly lit area full of strangers, who poke it and examine it. Do you think it will give birth? Or will this profound and difficult process be interrupted while it takes in its new surroundings?

"Home Birth can be safer. Unnecessary medical interventions, which can lead to complications, are avoided (restrictive, continuous, electronic fetal heart monitoring, routine I.V.'s, drugs, etc.). There's no handling of the infant by numerous hospital personnel. Exposure to hospital bacteria and viruses is avoided."

...After studying homebirth in depth, the British government concluded:

[We] must draw the conclusion that the policy of encouraging all women to give birth in hospitals cannot be justified on grounds of safety...[It] is no longer acceptable that the pattern of maternity care provision should be driven by presumptions about the applicability of a medical model of care based upon unproven assertions...Hospitals are not the appropriate place to care for healthy women...We recommend that the Department of Health vigorously pursue the establishment of best practice models of team midwifery care...

Dr. Lewis Mehl did a study comparing home and hospital birth with mothers from California and Wisconsin with matched populations of 2,092 mothers for each group. Midwives and family doctors attended the homebirths; OBGYNs and family doctors attended hospital births. Within the hospital group, the fetal distress rate was 6 times higher. Maternal hemorrhage was 3 times higher. Limp, unresponsive newborns arrived 3 times more often. Neonatal infections were 4 times as common. There were 30 permanent birth injuries caused by doctors (Jones 99).

Robert C. Goodlin reported in the Lancet on 1,000 births, half occurring in a hospital, half in a birth center. There were no IVs, monitors or anesthesia used in the birth center, but the babies were born in better condition. Besides that, three times as many cesareans were performed in the hospital (Korte and Scaer 37-38).

A British research statistician, Marjorie Tew, did long term studies of the safety of birth in various settings during the 1980s. She found that among a sample of 16,200 births, the perinatal mortality rate was lower for out-of-hospital births, even for very high risk mothers! At a relatively high risk level, perinatal mortality was three times higher in hospital (Korte and Scaer 49). Tew then expanded her research by using information from the Netherlands, a nation where both obstetricians and midwives practice. The perinatal mortality rate was ten times higher in the hospital births there, even though the risk status of the mothers at the time of delivery was not much higher than that of mothers who chose midwives(Korte and Scaer 50).

Carl Jones says, and I concur, "No one can tell a mother she is perfectly safe giving birth at home. Whether she is safer at home than in a hospital, however, is another question"

Aidan McFarlane, a British physician, notes that while 68% of hospital mothers experience postpartum depression , only 16% of home birth mothers do.