Shahar wasn't born in a hospital, but with a (fantastic!) midwife, in what is formally labelled as a "home birth". A big portion of the comments we got following the labor were of shock and surprise, often questioning whether we made a safe choice. Some people decisively said that having a home birth was a risky, not to say irresponsible, thing to do.
I spent a lot of time researching the subject, and figured I'll share some information, which might be of interest to some of you. I have a lot say about the subject, I hope this piece won't end up being way too long...
I'll start with a description of our personal birthing history.
Noga was born, 10 years ago, in a traditional hospital in Petah-Tiqwa, Israel. Back then, we weren't even aware of the option to give birth outside of a hospital. A few hours into labor, Anat chose to get an epidural shot, and the labor was long, difficult and traumatic. Eventually, Noga was pulled out using a combination of vacuum and forceps, on the verge of sending us to a C-Section.
2.5 years later, prior to Hadas' birth, Anat knew she wanted to insist on a natural birth, without an epidural. In an act we both fail to understand to this very day, we returned to the same hospital. Despite promises that they allow natural birth (notice, not encourage), the reality in the hospital labor room was very different. In theory, Anat was allowed to walk around the room and mitigate her pains with movement. But in practice, the crew wanted to constantly have a monitor attached to her. And while walking the monitor detaches, so, back to the position loved by physicians - lie on your back, without utilizing gravitation, with limited ability to move your pelvis as a way to cope with pain during contractions.
Only after a lot of insistence on our part, and standing up to a doctor that appeared to be shocked by an opinion coming from the other side of the birthing bed, Anat was allowed to give birth on her hands and knees (rather than on her back), a position suitable to her anatomy.
This second labor was a lot shorter (less than 2 hours), and a lot less painful, but the unnecessary medical intervention was so blatant that it was clear to us we'd explore other options the next time.
With Maayan, in Pittsburgh, PA, we turned to a great midwife center, in early stages of the pregnancy. The experience was so strikingly positive, that we couldn't believe it. It felt like 180 degrees from what we had previously encountered in hospital births.
Less than 3 months ago, we had a very similar positive experience, when giving birth to Shahar, in Israel, in Mindy Levy's Agoola birthing center.
To remove any doubt - there was nothing special about the hospital Noga and Hadas were born in. Stories shared by other women in a group meeting in the midwife center, described an almost identical attitude to birthing in US hospitals.
Simply put, in a hospital it felt like the crew wanted to manage the delivery, instructing the woman what to do. On the other hand, A trained midwife helps the woman to manage her own labor, and boy, what a difference that makes!
Now, if you had the patience to read until here, you're probably saying something like - "this is all very nice, but what about emergencies, when a medical intervention IS desperately needed?"
Ah, an excellent question, which I'll happily try to answer.
Let's first get some preliminaries out of the way:
- There should be a clear distinction between assisted home birth and unassisted home birth. Obviously, I'm praising the former.
- Midwives accept only women with low-risk pregnancy. Any birth of twins, breech (מצג עכוז) or the like would always start in a hospital.
- Midwifery is a well-defined profession, with extensive medical training. A trained midwife is capable of conducting many of the typical procedures upon emergency (such as resuscitation).
- A good midwife, at the first sign of complication during labor, will make the necessary decision to go with the birthing woman to the nearest hospital.
Now to your question. There is a solid body of academic research about the subject.
Almost none of the studies challenge the conclusion that home births are better for the mother's health.
And as for perinatal mortality and severe perinatal morbidity, the vast majority of studies conclude that assisted home birth is as safe as hospital birth.
Since you had to read a lot until here, you can choose to simply trust me.
Or if you, like me, are convinced only by seeing the data, read on below :-)
Cheers,
Giora
- Janssen et al., in a study from 2009 (http://www.cmaj.ca/cgi/rapidpdf/cmaj.081869v1, see also abstract) conclude that:
"Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician."
- de Jonge et al., in a Dutch cohort from 2009, spanning more than half a million women (http://novahomebirth.vamginc.com/safe/documents/DutchHomebirthStudy.pdf), conclude:
"This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well trained midwives and through a good transportation and referral system."
- A recent meta-analysis study by Wax et al. (http://download.journals.elsevierhealth.com/pdfs/journals/0002-9378/PIIS000293781000671X.pdf) claimed the opposite, and stirred a lot of buzz, including citation in regular papers (like Haaretz in Israel):
"Less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate".
However, upon closer examination, I was convinced that this study was severely flawed, for several reasons:
1. It didn't distinguish between assisted and unassisted home births, which is a crucial distinction. I read a comment by someone (though didn't see any data), that when applying that distinction, the above conclusion no longer holds.
2. It gave similar weights to studies with very small samples (few dozens of women), and to studies with very large samples (in the thousands and sometimes hundreds of thousands).
3. See an example response, explaining why the meta-analysis was flawed, pointing to some perplexing deficiencies. Well, not really perplexing - the issue of home birth is politically charged, and some would say that every study in the field is biased by the authors' opinion.
Note that, interestingly, even that study didn't question the fact that home birth was superior for the woman's health: "These women were less likely to experience lacerations, hemorrhage, and infections."
- A factor many people omit when considering risk, is the personal familiarity of the medical crew. A midwife typically conducts full prenatal care, and when labor arrives, she's intimately familiar with the birthing woman. This is with striking contrast to what happens in a hospital. Another related factor is the personal care during labor - a midwife is present during the whole labor, 1-on-1, which in most hospitals is certainly not the case.
Note that these factors aren't just for better atmosphere during labor; they dramatically increase the chances of identifying complications early on, and avoiding an emergency.
