My parents were born at home in 1921, as were most in their generation and by the 1940s, when I was born, 44% of births still took place outside of the hospital. But, by the time I was ready to have babies myself, things had changed dramatically and few births took place outside of the home: less than 1.00% in 1969.
This percentage stayed pretty much the same through the 1980s. In 1989, the CDC began to collect data about home birth specifically, and to differentiate it from other births outside of the hospital. The CDC data shows that homebirth declined from 0,67% in 1990 to 0.56% in 2004. But, in 2004 homebirths began to rise again and by 2009 were 0.72% of births.
While this increase in births at home from 2004 to 2009 is a 29% increase in percentage points, the rate of homebirth is the US still remains under 1%, as it has for the last 44 years. And, while the number of homebirths in 2009 is the highest level since the data first began to be collected in 1989, and was statistically significant in 31 states, it nevertheless represents a very small number of births: 29,650 in 2009.
THE HOMEBIRTH STATES
Montana has the highest percentage of homebirths: 2.55% in 2009. That’s 692 homebirths per year in Montana, which has a yearly birth rate of 12,594. 1.96% of births in Oregon (962) were homebirths and Vermont had 121 homebirths, 1.91% of all Vermont births. Five additional states (Idaho, Pennsylvania, Utah, Washington, and Wisconsin) had a percentage of home births of 1.50% or above (Figure 3).
In contrast, the percentage of homebirths was less than 0.50% for southeastern states from Texas to North Carolina, as well as for Connecticut, Delaware, the District of Columbia, Illinois, Massachusetts, Nebraska, New Jersey, Rhode Island, South Dakota, and West Virginia.
CRITICS OF HOMEBIRTH
Despite the increased popularity of homebirths and mothers’ preference for midwifery care—or perhaps because of it—the American College of Obstetricians and Gynecologists (ACOG) has increased its criticism of homebirth. While the ACOG Committee Opinion on Planned Homebirth gives lip service to informed choice, it warns that women who choose homebirth are endangering their child.
It is not surprising that ACOG, a trade organization representing direct competitors to midwives, should be critical of homebirths and of midwives. In 2010, they opposed the Midwifery Modernization Act after it passed the New York state legislature, despite its widespread support.
Midwives routinely have to claim their turf from doctors and sometimes even sue for restraint of trade. This happens often enough that the Academy of Certified Nurse Midwives (ACNM) has developed a resource packet on the subject for their members.
It is also not surprising that a recent study published in the American Journal of Obstetrics and Gynecology claims adverse effects from homebirth. The study flies in the face of existing scientific literature about homebirth safety and raises questions of conflict of interest.
THE SCIENTIFIC LITERATURE
One source that does not have a conflict of interest is the Cochrane Collaboration, internationally recognized as the highest standard in evidence-based healthcare reviews. When Cochrane compared the midwifery model of care to other models of maternity care, they concluded “that most women should be offered midwife-led continuity models of care…” Cochrane also says that there is no strong evidence to favor either planned homebirth or hospital birth.
Plenty of evidence does exist, however, to support the safety of planned home birth. In recent years, high-quality prospective controlled cohort studies and descriptive studies have established that planned home births achieve excellent perinatal outcomes.
Recent data from a large North American prospective study found that planned homebirth for low risk women was associated with lower rates of medical intervention but similar mortality to that of similar hospital births.
CURRENT STUDY CRITICIZED
In addition to the fact that the recent ACOG study is out of sync with other studies on the topic, it has also been criticized for its poor methodology. Midwife Wendy Gordon, critiques the study in a piece called, “Understanding Outliers in Home Birth Research.”
In a letter to members, the American College of Nurse Midwives calls the study flawed and questions both how it was conducted and its interpretations.
The sensational press over this recent, flawed study distracts from the bigger picture of our declining maternity care in the US. Both infant and maternal mortality are on the rise and medical interventions during childbirth are at an all time high. The situation is so bad that Amnesty International warned in 2009 that women in the USA “have a greater lifetime risk of dying of pregnancy-related complications than women in 49 other countries.”
According to the Centers for Disease and Prevention ( CDC ) US infant and maternal mortality failed to improve between 2000 to 2005. This plateau represents the first time since the 1950s that infant mortality has seen no improvement. The US spends more than any other country in the world on health care and yet is only 33rd in the world in infant mortality. A baby born in Cuba, Slovenia, the Czech Republic or South Korea has a greater chance of living for the first year than a baby born in the US. In fact, a baby born in Singapore has twice the survival rate of a US baby.
WOMEN PREFER MIDWIVES
Is it any wonder then, in the context of such poor maternal and newborn outcomes, that women who want to actively participate in their births prefer to be attended by midwives during birth and consider giving birth at home.
The families who choose homebirth are not reckless. They want their choice to be supported by scientific evidence and it is. The Midwives Alliance of North America (MANA) offers a comprehensive annotated guide to the literature on homebirth safety. And, here are a number of links to studies on homebirth safety that I’ve compiled.
What the studies show is that birth is safe in any setting.
Peggy O’Mara is the CEO of peggyomara.com. She was the editor and publisher of Mothering from1980 to 2011. The author of Having a Baby Naturally; Natural Family Living; The Way Back Home; and A Quiet Place, Peggy has conducted workshops at Omega Institute, Esalen, La Leche League, and Bioneers. She is the mother of four and grandmother of two.