Lately, I’m having this conversation over and over:
ACQUAINTANCE: When’s your baby due?
ME: End of August.
THEM: That’s coming up! Where are you having the birth?
ME: At home.
THEM: Oh! Wow! Hey, did you hear about that study…
Let me just say right now: Yes. Yes, I have heard about that study. Whatever study it is, if you’ve heard about it, if it’s been in the news, I’ve heard about it too. Unless it’s brand-new, I’ve probably read it already. And I’m happy to talk about it!
I’m not interested in telling anyone else where or how to give birth; that’s a decision every pregnant woman ought to make for herself. But I do think we all should have access to accurate information when we’re considering our options.
So. Given that the biggest, best-designed, most comprehensive studies available all conclude that home birth is at least as safe as hospital birth for healthy, low-risk mothers and babies, how do studies in the news come up with “evidence” that suggests otherwise?
Often, like this: They compare normal, low-risk hospital births to something other than normal, low-risk home births.
- Some studies have compared planned hospital births to unplanned home births.
Why does this matter? For two reasons.
First: a planned home birth is attended, almost always, by a certified midwife. Midwives carry equipment and medications to address emergency situations, and midwives have training and experience to help them identify those uncommon situations where a mother requires medical assistance. Research shows that out-of-hospital births attended by midwives have excellent outcomes. Unplanned out-of-hospital births don’t have access to those same benefits.
Second: while some unplanned out-of-hospital births involve healthy, full-term mothers whose labors simply progressed too quickly to get to a hospital, research tells us that many unplanned out-of-hospital births involve women whose pregnancies are at higher risk. Women who have unplanned out-of-hospital births are more likely to smoke, less likely to have had prenatal care, and their births are more likely to be preterm, all of which means they’re more likely to experience complications and poorer outcomes.
Unplanned out-of-hospital births, then, aren’t the same as planned home births, and studies comparing planned hospital births to unplanned out-of-hospital births don’t give us any information about the relative safety of planned home births with a qualified attendant. (This, by the way, is where the most recent AJOG headlines went wrong; their widely-reported-on study relied on data that has repeatedly been criticized for, among other problems, including unplanned out-of-hospital births.)
- There are other studies comparing hospital births to planned home births that took place decades ago.
Why does this matter? Today’s certified midwives have access to education and training that wasn’t as available years ago, and carry emergency equipment and medications that midwives didn’t have access to decades ago.
Planned home births that took place in decades past weren’t necessarily similar to home births today, so older studies of home birth may not offer us accurate information about the safety of home birth today.
- Some studies have compared hospital births to home births that took place without medical backup.
Why does this matter? Because no one is suggesting that home birth is always safe, in every circumstance; only that, for healthy mothers carrying healthy babies, laboring and birthing at home is a safe option.
But when a mother or baby ceases to be healthy—or when a labor moves beyond the range of what’s normal—medical care can be helpful or even necessary. Planning a home birth, then, typically includes having the ability to transfer care to a medical facility if needed.
Remote areas don’t always have nearby hospitals. Studying out-of-hospital births taking place in such areas—out-of-hospital births with, essentially, no medical backup available—will not provide useful information about the safety of planned home birth with medical backup available. And most planned home births have some sort of medical backup available.
So yes, I’ve heard about that study. I hope you get a chance to hear about this one and this one and this one, too. Because we all want to know—deserve to know!—which options are safe. And the best-designed studies show that planned home birth is at least as safe as hospital birth.
Thanks for asking, always. Have any other questions I can help with?
For more information on birth, midwifery, and safety, check out the birth resources page.
