Planned Homebirth: What is that “something that can go wrong”?
The majority of women who deliver in hospital in Israel think that hospital is the safest place in Israel for all women to give birth. Hospital is the safest place for high risk pregnancies and for sick women to give birth. In the hospital, birth is managed using obstetrical management which involves intervening in the birth process for the convenience of the hospital and the workers. At home, women receive one-on-one woman-centered midwifery management which means allowing the woman to birth using interventions only if problems develop. Low risk women in Israel usually choose hospital saying that they want to be in hospital incase “something goes wrong.” When asked “What is that something?” they admit that they do not know. What is the something that can go wrong?
In which birth setting is a bad outcome most likely for a low risk pregnancy?
Low risk pregnancy = Delivering between 37 – 42 weeks, one fetus, head-down, with no serious diseases like high blood pressure or childhood diabetes:
Outcomes of Low Risk Pregnancy in Israel 2000-2008:
Hospital Attended Homebirth Planned Unattended
Perinatal Mortality 0.6/1000 0.6/1000 10/1000
Perinatal Morbidity low low sl. higher
Maternal Mortality 1/100,000 transferred* 1/1000
Undisturbed birth 0 % 90% 100%
Hemorrhage 4% 2% 2%
Uterine Infection 4% <1% <1%
Baby Breathing Problems 5% 1% 1%
Cesarean Surgery 12% 3% 0
Vacuum Extraction 10% <1% 0
Epidural 50% <1% 0
Pitocin Induction 25% 0 0
Pitocin Augmentation 15% <1% 0
Episiotomy 30% 0 0
Artificial Rupture of Membranes 50% 5% 0
Strapped to a Monitor 100% Transfers 0
Baby taken away for >5 minutes 100% 0% 0
COST: Hospital- you get paid. Planned Homebirth 2000- 5000 shekels
*women that run into trouble are transferred and unlikely to die at home.
The best birth outcomes are known to happen when there is one-on-one care by an attendant trained in midwifery management who is constantly present, and medical backup available who recognize the ability of both women and midwifery management. Please ask your doctor or midwife what they are referring to specifically when they say that “homebirth is dangerous because something can go wrong.” Show him or her the chart and ask, “Isn’t it true that you are talking about unaccompanied, unplanned homebirth? In fact statistically, planned, accompanied homebirth has better outcomes than hospital birth.
If they say that infant morbidity (disease/ brain damage) is higher at home- then ask them for a planned homebirth reference showing this. There is none.
Hospital Birth for low risk women USA
MacDorman MF, Declercq E, Menacker F, Malloy MH. Infant and neonatal mortality for primary cesarean and vaginal births to women with “no indicated risk,” United States, 1998-2001 birth cohorts. Birth. 2006 Sep; 33(3):175-82. Rate for vaginal delivery is 0.62 deaths per 1,000.
Hospital Birth for low risk women Israel:
Slome J. Cesareans and Low Risk Women in Israel. The Practicing Midwife. 2004.7:7:28-31.
Planned Homebirth Outcomes in Israel:
Shemesh I. My Midwifery Practice in Israel. Midwifery Today.2007. 81:48-51. and unpublished statistics.
Unplanned Unattended Homebirth: largely unresearched
McKenna P, Matthews T. Safety of home delivery compared with hospital delivery in the Eastern Region Health Authority in Ireland in the years 1999-2002. IrMedJ 2003; 96(7)198-200.
Sheiner E, Shoham-Vardi I, Hadar A, Hershkovitz R, Sheiner EK, Mazor M. Accidental out-of-hospital delivery as an independent risk factor for perinatal mortality. J Reprod Med. 2002 Aug; 47(8):625-30.
www.mana.org : Midwives’ Alliance of North America
www.homebirth.org.uk : home birth reference site
www.sheilakitzinger.com : thoughts on home birth from a well-respected natural birth advocate.
www.changesurfer.com/Hlth/homebirth.html : review of literature on homebirth by J Hughes.
www.birthbalance.com : a resource dedicated to Integrating Balance and Birth
www.acnm.org/siteFiles/position/homeBirth.pdf : a position statement from the American college of nurse-midwifes
http://parenting.ivillage.com/pregnancy/plabor/0,,6rl1,00.html: information compiled by Henci Goer on homebirth safety