What Ricki Lake Doesn’t Tell You About Homebirth

Celebrity endorsements aside, giving birth at home is more dangerous and more likely to be attended by an untrained midwife

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Ricki Lake

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 Studies that claim to show that American home birth is safe are poorly done and compare home birth to out of date papers or high risk populations.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.

(MORE: American Women: Birthing Babies at Home)

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.

9 comments
koffeewitch
koffeewitch

The Netherlands have "the highest" rate of perinatal mortality in western Europe and the "highest" rate of home births?  That sounds just terrifying until you look and see that those "highest" figures are still extremely, extremely low.  "Dr."  Amy loves to play games with statistics because the safety of home birth infuriates her.  She must have a severe case of Hero Syndrome and I suspect it irks her women who choose midwifery as a profession tend to be much better at it than Harvard trained OB/GYNs.  Why would I say something like this?  Because every time I have given birth in a hospital they insisted upon lying outright about medical facts for their own convenience.  They insisted that it was better to give birth in lithotomy position (instead of up on all 4s) so they could assist me in getting the baby out and prevent me from tearing.  Any 3rd world village midwife can assist a woman squatting, on  all 4s, in water, whatever....but US doctors are incapable of this skill.  Doctors also seem unable to perform vaginal breech births, vaginal births of twins, VBACs and a host of other skills that midwives perform safely all the time.  I can't even remember finding an OB/GYN skilled in Leopold's maneuvers.  Why learn something safe and unobtrusive when you can use repeated ultrasounds, right?  Obviously, anyone has the right to disagree with me.  Your right to give birth in a hospital is not in jeopardy.  You can even get an elective c-section if you like.  Your choice in spite of the proven risks and dangers.  Just allow me to continue to choose the place and caretakers of my choice, as well.

akenheim
akenheim

Anyone who has studied statistics knows that looking at one year in one state is not a good sample.   Let's look at the study of 5500 women from the British Medical Journal that showed "Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States."   http://www.bmj.com/content/330/7505/1416

Chaya
Chaya

These opinions do not take into consideration the benefits of home birth (for one, that the home is the place the woman is least likely to catch an infection, given her immunity is highest against her most well-known environment, whereas the hospital is full of sick people and is not her most well-known environment). No matter what side you're on, question the stats - delve deep into the studies. Read the latest ACOG report against homebirth - read it fully, and see what the numbers are really saying. Then look into CPM's qualifications - they are trained as HOMEBIRTH midwives - they are not trained to work in hospitals. THEY ARE trained to know when a hospital is necessary. Homebirths are not able to be performed if a woman lives more than 20-30 minutes away from a hospital. HB midwives bring emergency equipment with them to each birth. It could be that the women who quality for a homebirth and later died simply did not tell the truth about their risk to the midwife. Question. All. Statistics. And then, most of all, ask 50 women about their hospital birth stories, and 50 women about their homebirth stories. That will really tell you how women feel, for the rest of their lives, about their births.

hadley.freesoul
hadley.freesoul

I was lucky to have a CNM, who had 10 years of experience in hospital births before she took the requirements to become a CNM. She was very thorough and took great care of me and my son, I only lived about 5 minutes from a hospital but luckily I didn't need one. She had the proper requirements that my state are finally stating is required for midwives here (I won't go into detail), and thanks to her (and my body) I had an amazing home birth that was in a birthing pool and I am so glad I did. Sadly it isn't for everyone, things can go wrong, but even if they don't, you have to seriously want this and trust your body. Any kind of doubt or anxiety can stop the birthing process or even put you and your child in danger. It would be so much better if hospitals AND midwives would work together here in the USA, it would be great if more and more hospitals would look into building birthing centers next to the hospital strictly or expectant mothers and midwives. Unfortunately hospitals and doctors are highly against midwifery and home births here in the USA and I don't think it will ever change.

TaraDukaczewicz
TaraDukaczewicz

Homebirth does sound so inviting.  It sounds warm and cozy and lovely.  This is what I thought when I considered a homebirth for my future pregnancies.  I am so relieved that my research showed me another side of homebirth, the loss and devastation that can come about when the worst happens.  I'm so happy I never entrusted any of my precious babies to the Russian roulette that is homebirth, and I thank Dr. Tuteur for that.  She takes a lot of criticism from the natural birth community, apparently she is not warm and cozy enough, but she speaks the truth in order to save mothers and babies.

Ediclyne
Ediclyne

I lost my son during a home birth just over a year ago. Even using a CNM and transporting rapidly to a hospital only 8 miles away could not prevent his death when my uterus ruptured. It's an uphill battle to convince women who hear nothing but glowing stories about home birth on the Internet and the demonization of OBs, hospitals and interventions, that home birth can be dangerous: perfect pregnancies can, so easily, end in catastrophe.

areawoman
areawoman

Thank you for this! So many people have no idea that there are two kinds of midwives in the US -- highly educated CNMs with masters degrees and CPMs who, until earlier this year, didn't even have to have a high school diploma. 

nami
nami

@Ediclyne How was it possible to have been prevented in the hospital, in your opinion?  Hospitals can save the mother due to hemorrhage, but they wouldn't be able to change the status of baby.