When I tell people that I birthed my son in a free standing birth center with a midwife attending, and that we will be birthing our second child at home with the same midwives, one of the first questions out of people’s mouths is “What if something happens?”.
As I mentioned in Part 1 of this series on demystifying midwife-supported natural childbirth, safety is one of the most common misconceptions about midwife-supported childbirth, especially for out-of-hospitals births (like mine was). I know it’s the question I get asked the most often.
Since there is so much information about risks with hospital births, safety of midwives, and ways midwives promote safe childbirth I am dividing this information up into two articles.
- This article will focus on a higher-level discussion of the safety of midwife-attended births while also highlighting the risks with hospital births, which many people may not be aware of.
- The second article will follow in a few days and will describe in more detail the specific ways midwives promote safer childbirth.
Before we discuss the safety of midwife-supported natural childbirth, especially in out-of-hospitals births, let’s take a look at what most people in America consider the safest place and the safest way to give birth: in hospitals with surgeons.
Current State of Childbirth in America
There are four million births in the United States each year, with 99% of births occurring in hospitals and over 90% attended by surgeons. Maternity care affects large numbers of women. It is also big business, totaling $20 billion a year.
- The United States has the highest per capita spending on health care in the world.
- Care for mothers and newborns combined is the fourth largest category of hospital expenses.
- Childbirth is the most common reason for the hospitalization of women in the United States.
Common hospital practice is to speed up and control the birthing process, therefore nearly all women giving birth in hospitals are subjected to some level of technological or medical intervention, even though medical evidence shows that the routine use of unnecessary interventions put mothers and babies at risk.
Citizens for Midwifery list the most common interventions:
- Over 31% Cesarean Surgeries – Has risen over 50% since 1996 (highest ever)
- Vaginal Birth after Cesarean (VBAC) rate has fallen over 50% since 1996 (access is disappearing)
- 34% of Labors Medically Induced
- 41% Need Vaginal Stitching (episiotomy, tears, vacuum extraction, forceps)
- 47% of Labors Artificially Stimulated
- 60% of Women Denied Fluids
- 76% of Women Restrained In Bed
- 85% of Women Denied Food
- 86% Given Drugs For Pain Relief
- Over 90% of Women Attached To Electronic Fetal Monitors
I was surprised to find out C-sections maxed out at 4 p.m. and 10 p.m. (doctors want to go home or not have to stay through the night waiting for a baby to be born).
If we had better outcomes to show for it, perhaps this would be more acceptable. Unfortunately, our outcomes are not nearly as good as those of developed countries that rely more heavily on midwifery care. The United States has:
- A high infant mortality rate compared to other developed countries (29th in the world).
- A maternal mortality rate that has not improved in 20 years (25th in the world, one of the highest in the developed world).
Risks With Hospital Births
Despite 75 years of routine hospitalization for birth there are still no reputable studies or scientific evidence showing that hospitals are the safest option. In fact, there are numerous reputable studies showing the various risks and hazards of hospital birth.
Since most women choose to birth in a hospital setting due to its presumed safer environment, many might be unaware that there are risks associated with many hospital birth practices. One study compared an equally matched number of midwife-attended home births to hospital births.
The study found that women birthing in hospitals were:
- five times more likely to have high blood pressure during labor
- nine times more likely to tear
- three times more likely to hemorrhage
- and three times more likely to undergo cesarean sections
Hospital-born babies were:
- six times more likely to suffer fetal distress before birth
- four times more likely to need assistance to start breathing
- four times more likely to develop infections
Does that information surprise you? I shared the information with you to open your eyes to the current birthing situation in the United States so that perhaps you will be more open to hearing about a perfectly safe and valid way to have babies: with the care of a midwife.
Is Midwife-Attended Birth Safe? Yes!
Regarding home birth, the best research continues to show that home birth for women with low-risk healthy pregnancies, attended by a qualified birth attendant, is no more risky than birth in the hospital.
“Every study that has compared midwives and obstetricians has found better outcomes for midwives for same-risk patients. In some studies, midwives actually served higher risk populations than the physicians and still obtained lower mortalities and morbidities. The superiority and safety of midwifery for most women no longer needs to be proven. It has been well established.” (Madrona, Lewis & Morgaine, The Future of Midwifery in the United States, NAPSAC News, Fall-Winter, 1993, p.30)
There are many aspects to consider when talking about safety in childbirth.
Type of Safety: Perinatal Mortality
From Citizens for Midwifery: Perinatal mortality (fetal death after 20 weeks of gestation plus infant death up to 28 days of age) is more relevant to the discussion of home birth safety than infant mortality, since the quality of prenatal care and effectiveness or harm of birth practices can contribute to this outcome.
Home and hospital have similar perinatal mortality rates for populations of mothers who are “low risk”. So by that standard, planned home births and hospital births are equally safe for babies of healthy mothers.
Type of Safety: Maternal Mortality
Despite the highest per capita spending on health care in the world, the United States has a maternal mortality rate that has not improved in 20 years (25th in the world, one of the highest in the developed world).
There is good evidence that overall cesarean rates should be about 15%. Cesareans are major abdominal surgeries that carry an array of health risks and consequences. Recent studies have found that though overall rates are low, maternal death occurs 2 to 4 times more frequently with cesarean section than with vaginal birth.
- The average rate of cesarean for all hospital births is now over 30%.
- As of 2000, the average rate of cesarean was around 20% for women who were “low risk” when they entered the hospital.
- Fewer than 5% of planned, midwife-attended home births end in cesarean.
For a healthy mother, her chances of avoiding a cesarean (and having a better outcome) are increased by choosing care with a midwife.
Type of Safety: Maternal and Infant Morbidity
Injury or illness associated with the birth for mother and baby (morbidity) is another important component of safety. A recent study indicated that over 40% of women birthing in a hospital experience some level of morbidity related to childbirth.
Morbidity for the baby can include:
- bruising or lacerations from operative deliveries (cesarean section, forceps or vacuum extraction)
- breathing difficulties due to drugs or pulmonary immaturity
- infection from exposure to hospital germs
- complications related to late preterm birth from elective inductions and cesareans
Morbidity for the mother can include:
- drug reactions
- surgical incisions from cesarean section
- lacerations of the perineum (from tearing or episiotomy a surgical cut to the perineum)
- drugs used in labor (to induce and/or speed up labor, and for pain) can cause a range of complications for both mother and baby
The problems listed above occur because of the medical interventions used in a hospital setting. By birthing at home with a midwife, the chances for these common birth injuries can be reduced.
Better Outcomes With Midwives
Midwifery clients experience lower rates of:
- induced labor
- electronic fetal monitoring
- epidural analgesia
- assisted vaginal delivery (forceps and vacuum extractions)
- Cesarean sections
- babies born requiring resuscitation
Because women choosing home birth with a midwife have far fewer interventions during their labor, birth and immediate postpartum period, they also have easier healing, breastfeeding, and bonding with their new babies.
What If Something Happens?
This question alone shows how most people view birth and laboring women: like a ticking time bomb, just waiting for something bad to happen, almost like it’s guaranteed. Let me remind you again that birth is a normal physiological process. As women, our bodies know how to birth babies.
Midwives recognize that birth is a normal, healthy process. Midwives focus more on women and babies as individuals and less on technology.
While I can’t go over every potential birth complication and the ways a midwife would handle them, I can share the following general information:
- Most of the complications seen in hospital births are actually caused by all the interventions used. With midwife-attended births, most complications are avoided because of the method that they deliver babies – naturally.
- Midwives are well-trained to recognize signs of complications developing and are able to handle most of them. (Not every problem requires a trip to the hospital; sometimes, just a change in the mother’s position or re-hydration solves the problem.)
- If there are developing complications, midwives also assess the need to transport for medical care well in advance, in the rare cases where it is needed. Serious complications almost never occur without some preceding signs that there is a problem.
- Midwives are trained in emergency procedures and have necessary medical equipment at hand in case something serious happens. They carry IVs, oxygen, tubes to help breathing, pitocin for hemorrhaging, suturing supplies, and are fully trained in resuscitation.
In the European countries with the lowest infant mortality rates, more than 70% of all births are attended by midwives. More than 50% of all babies born in the Netherlands are born at home with midwives in attendance, and the Dutch infant death rate is much lower than in the United States.
Most Common Reasons for Hospital Transfer
According to one study, 12.1% of women transferred to the hospital during their planned home births. Only 3.4% of those were considered an emergency by the midwives. Most of the hospital transfers were during labor and due to:
- maternal exhaustion
- request for pain relief
- failure to progress
- other non-emergency situations
What About Those Medical Interventions?
With the mention of “fewer medical interventions” with midwife-supported natural childbirth, I bet some of you are confused. After all, aren’t all those interventions used in a hospital good? Aren’t they justified to protect the babies, even if they are hard on the moms? Hospitals wouldn’t use them unless they were necessary and safe, right?
Even though medical interventions are well-meaning, their risks and complications are often ignored. Each intervention carries significant risk of harm to the natural process and to the mother and/or baby. In addition, the use of any intervention tends to lead to other interventions, in a cascading effect.
A thorough knowledge of birth allows midwives to minimize the use of technology and medical interventions.
Medical interventions are costly, largely unnecessary, and frequently harmful. Here is a table that provides an easy way to compare labor and birth data between the World Health Organization’s (WHO) recommendations, planned homebirth, and hospital birth.
|WHO Recommendations1||Planned Homebirth2||Hospital3|
|Electronic Fetal Monitoring||Not Routine||9.6%||90%|
|Pain Relief Drugs in Labor||Not routine||NA||86%|
|Induction of Labor||10% or less||2.1%||34%|
|Stimulation of Labor||NA||2.7%||47%|
|Episiotomies||Systemic use not justified||2.1%||23.7%*|
1 World Health Organization Recommendations, Ideals vs. Reality in U.S. Births on Citizens for Midwifery
2 2005: “Outcomes of planned home births with certified professional midwives: large prospective study in North America.” Kenneth C Johnson and Betty-Anne Daviss. BMJ 2005;330:1416 (18 June)
3 2005: State of American Childbirth on Citizens for Midwifery
I hope I’ve shed some light on the facts that show how safe birth with a midwife is. I believe that having all the information is important for an expectant mom so that she can make an informed choice for herself and her birth.
Don’t forget to watch for the following article on the ways midwives promote safe childbirth.
- The Thinking Woman’s Guide to a Better Birth by Henci Goer
- The Business of Being Born movie
- 10 Homebirth Facts No One’s Telling You on Blinded By The Light
- Why Homebirths Are Worth Considering by Melissa Cheyney on the Huffington Post
- Birth By the Numbers on OrgasmicBirth.com (great video)
- Birth Misconceptions: Myth and Fact on Birthingthefuture.org
- Ideals vs. Reality in U.S. Births by Citizens for Midwifery
- Cesarean section rates by state on The Unnecesarean
- Overview of Maternity Care in the US on Citizens for Midwifery
- Safety in Childbirth on Citizens for Midwifery
- State of American Childbirth on Citizens for Midwifery
- Overused Interventions
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Wendy – ParentingTips365.com
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