It sounds great. Give birth at home, surrounded by only those you know and trust, and avoid unnecessary interventions in the birth process. If you’ve seen The Business of Being Born, talk show host Ricki Lake’s paean to home birth, you may be tempted. Now that Lake is issuing four follow-up educational DVDs called More Business of Being Born, complete with testimonials from Cindy Crawford, Alanis Morrisette and Gisele Bundchen and packaged with organic cotton “Born Free” onesies, it’s time to set the record straight and point out some important facts about home birth that Lake has left out, including the increased risk of neonatal death.
(MORE: The Myths of Natural Childbirth)
1. First, there are two different kinds of midwives in the United States. Home births are typically attended by certified professional midwives (CPMs), not by certified nurse midwives (CNMs) who are respected health care professionals. Home birth midwives are a second, less educated, less trained class of midwives. They are not eligible for licensure in the Netherlands, the U.K., Canada, Australia or any industrialized country because they don’t meet the basic requirements. Midwives in all other industrialized countries have university degrees and extensive in-hospital training. American home birth midwives have only a post high school certificate and no in-hospital training.
2. All the existing scientific studies, and state and national data, show that American planned home birth has triple the risk of neonatal death as hospital birth for comparable risk women. Studies that claim to show that American home birth is safe are poorly done and compare home birth to out of date papers or high risk populations. CDC statistics show planned home birth with a home birth midwife has a neonatal mortality rate of approximately 12/10,000. The rate for hospital birth of comparable risk women? Only 4/10,000. In 2009 in the state of Colorado, for example, licensed midwives provided care for 799 women. Nine babies died: that’s a home birth death rate nearly double that of the entire state, including high risk women. There were three intrapartum (during labor) deaths for an intrapartum death rate of 3.8/1000, ten times higher than the intrapartum death rate commonly experienced in hospitals.
3. Home birth advocates often point to the Netherlands to support the safety of home birth. A 2009 study published in the British Journal of Obstetrics and Gynaecology showed that home birth with a Dutch midwife has the same neonatal death rate as hospital birth with a Dutch midwife, but that’s not as reassuring as it sounds. A 2010 study in the British Medical Journal showed that any low risk birth with a Dutch midwife (home or hospital) has a higher death rate than high risk hospital birth with a Dutch obstetrician. Indeed, the Netherlands, the country with the highest home birth rate in the industrialized world has one of the highest perinatal mortality rates in Western Europe.
4. The Midwives Alliance of North America (MANA), the organization that represents home birth midwives, won’t release their own death rates. While collecting data on 23,000 midwife-attended, planned home births, MANA informed their members that the data would be used to prove the safety of American home birth. Once the data was analyzed, however they declined to release it. They have publicly offered the data to those who can prove they will use it for the “advancement of midwifery,” and sign an agreement promising not to release the death rates to the American public. This is a glaring red flag.
The absolute risk of death at home birth is still relatively low, so even when you learn the risks, you may still want to have a home birth. But don’t be fooled by a movie that leaves out the information that you need to make an informed decision.