It doesn’t matter how many insults are thrown at those who choose and support homebirth; research study after research study continues to show that this is a safe and reasonable option. This week, the Journal of Midwifery and Women’s Health published two papers – which they have kindly made freely available (links below) – that report on key outcomes of 16,924 planned home births in the first data set (2004-2009) of the MANAStats data registry. Although this was a descriptive study which did not compare the outcomes of the planned home births directly with another group of women, the authors compared the outcomes of the women with national statistics and the results speak for themselves…
- A 5.2% caesarean section rate for women who planned home birth compared to a national average of 31% for term infants.
- A 1.2% instrumental delivery rate (forceps or vacuum extraction) for women who planned home birth compared to a national average of 3.5%.
- Only 4.5% of women were perceived to need oxytocin to augment or speed up their labour (the national average is 40%, though this includes induction as well as augmentation).
- Only 1.4% of women who planned a home birth were given an episiotomy compared with about 25% nationally).
- Women were far less likely to need epidural analgesia (4% for women planning home birth versus a national average of 67%).
According to the authors, “while neonatal mortality rates are similar to population based observational cohort studies with reliable inclusion criteria, and slightly better than the overall national statistics for term births, the intrapartum rate is slightly higher. We hypothesized that this may be due to the fact that there are some higher-risk pregnancies and births in this sample … that are not included in the other studies to which we are comparing.”
As a home birth midwife, I have seen the profile of home birthing families change over the last two decades. These days, those of us who support home birth see an increasing number of women whose pregnancies are not straightforward. Some of these women have problems or risk factors which mean that – if we look purely at the statistics that describe safety – they might be better off giving birth in hospital, and yet the women themselves are concerned that they will not be safe within the system.
‘Safety’ is a complex and multifaceted concept. It is not just about physicality and mortality rates; it is also related to how a person or place makes us feel. (Nadine Edwards wrote a fab book on this.) Women want care which is individualised and based on evidence, but are instead quoted policies and pathways. Women want to know that their caregivers understand their concerns, but often feel that they are dismissed or accused of ‘caring more about themselves than their babies’. This is untrue and unfair, particularly in the light of the potentially damaging consequences of obstetric intervention on babies. Women who I have cared for have often been told that it is the hospital’s way or the highway and it is then not surprising that some of them come to see home birth as the only way in which they can retain any control over their decision-making and the integrity of their and their baby’s body. Generally, these women make the decision that is right for them and their baby in full awareness of the risks and benefits that characterise each option.
It is, then, both ironic and unfortunate that some people will view the publication of this research as another opportunity to continue to attempt to undermine womens’ right to decide where to birth their baby. This kind of animosity is one of the very things that undermines some womens’ faith in mainstream medicine and pushes more and more women into realising that it might be safer for them to stay out of the institution or even the system.
Cheyney M, Bovbjerg M, Everson C, Gordon W, Hannibal D, & Vedam S. Outcomes of care for 16,984 planned home births in the United States: The Midwives Alliance of North America Statistics Project, 2004-2009. doi:10.1111/jmwh.12172
Cheyney M, Bovbjerg M, Everson C, Gordon W, Hannibal D, & Vedam S. Development and validation of a national data registry for midwife-led births: The Midwives Alliance of North America Statistics Project 2.0 dataset. doi:10.1111/jmwh.12165