A study published March 24, 2014 in the American Journal of Obstetrics and Gynecology and featured today in the New York Times, reports significantly more neonatal mortality in out of hospital births than in hospital births. For the study, the researchers looked at the birth and death data from the CDC between 2006 and 2009. They compared neonatal mortality for singleton babies “delivered by midwives and physicians in hospital and midwives and “others” out of hospital.”
This study links raw CDC birth and death data. It does not differentiate between high-risk and low-risk women or between planned and unplanned homebirths. Midwives in the study have the same neonatal mortality rate as taxi cab drivers. More rigorous studies have shown that birth is safe in any setting.
A meta-analysis of six controlled observational studies of low-risk women showed no significant difference in perinatal mortality between planned homebirth and planned hospital birth.
A November 2013 Cochrane Summary from the well respected Cochrane Collaboration, stated, “Increasingly better observational studies suggest that planned hospital birth is not any safer than planned home birth assisted by an experienced midwife with collaborative medical back up, but may lead to more interventions and more complications.”
And, finally, a January 2014 study in The Journal of Midwifery and Women’s Health of 16,924 women who planned homebirths with midwives shows low Apgar scores in just 1.5% of the births and early neonatal mortality of 0.41 per 1000.
In this 2014 study, the Cesarean rate among the women who planned a home birth was 5.2%. The Cesarean rate in US hospitals is 32.8%. No wonder women are choosing home births at a growing rate.
For more on recent anti-homebirth studies that lump planned and unplanned home births together, see Homebirth: Safe and Sane. Here are links to Homebirth Safety Studies over the years. And, finally, a list of 15 questions to ask your midwife if you’re considering a home birth.
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Peggy O’Mara is the editor and publisher of peggyomara.com. She founded Mothering.com in 1995 and was its editor-in chief until 2012. She was the editor and publisher of Mothering Magazine from 1980 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.
Thanks for your succint educated response Peggy. Since the institutionalisation of women and medical dominance the argument of birth@home has persistently been promoted as unsafe. The cynical and real crux of the issue is the almighty dollar. Healthy, strong women capable of birthing their babies are now big business. Human mammals no longer know how to deal with this unshakeable control of their bodies and minds unless they decide to birth@home when appropriate. By appropriate I refer to responsible decision making about the best possible outcome for mother and baby. Added to the promotion of fear is the blame game attracting the legal phenomena now associated with birth@home, while the legal repurcussions of insititutional birth gone wrong remains feircly protected behind closed doors.
Thanks for your succinct educated response Peggy. Since the institutionalisation of women and medical dominance the argument of birth@home has persistently been promoted as unsafe. The cynical and real crux of the issue is the almighty dollar. Healthy, strong women capable of birthing their babies are now big business. Human mammals no longer know how to deal with this unshakeable control of their bodies and minds unless they decide to birth@home when appropriate. By appropriate I refer to responsible decision making about the best possible outcome for mother and baby. Added to the promotion of fear is the blame game attracting the legal phenomena now associated with birth@home, while the legal repercussions of institutional birth gone wrong remains fiercely protected behind closed doors.
This finding harks back to the ignorance of the Maternity Services Committee of the 1970s in New Zealand when out-of-hospital birth was lumped in with planned home births. I went back into official documents in my doctoral research and found the poor outcomes were very rapid, unattended and often very preterm labours, women who had no antenatal care or even women who did not know they were pregnant. None of the poor outcomes were from planned home births! And as far as the “midwives and “others” out of hospital” goes – it is a shame that so much funding is wasted on researchers who have yet to see that a 2 year old child, a plumber, the postman and the many variations of “others” are just a tad different from “midwives”. Perhaps they should ask home birth women what the difference is …
Maggie, soooooooo good to hear from you! You are an icon of midwifery care. What bothers me about this study is that none of us would be having homebirths if the death rate of babies was 4 times that of babies in hospitals. The homebirthers are a small group of people who mainly learn about homebirth through word of mouth. Plus the states in the US that certify midwives would not do so.
Peggy,
You are wrong on several points. That study did loook only at planned homebirths, those done by midwives. It also looked at lower risk women by excluding those with risks. The increased unnecessary neonatal deaths rates in homebirths relates directly to where the baby is born.
Why are we continuing to debate and often argue? Research evidence or not, women as they have done for centuries will decide to labour and birth at home. There are some women who believe home is the best place for them. Isn’t it better for researchers and professionals the guardians of women and birth, reconsider how they can willing provide responsible services in communities and where possible have hospital back-up facilities available (without criticism), for easy welcoming transfer and wherever possible, ensure that every woman is attended by an experienced midwife or experienced health worker? While professionals prefer not to listen to women some neonatal deaths, in and out of hospitals, will continue. The human species like any other mammal species cannot expect a 100% guarantee that all babies will survive regardless of place of birth. I have confidence that if we come to our senses that women and professionals will work together and listen. I say this with confidence based on 25 years of birthing@home with women where there was one death in-utero and in this instance the male of the house decided not to call me for the labour. Rally together and include the women.