Natural Birth KC

Homebirth is Safer than Hospital!

Statistics have demonstrated that, for the majority of women, home birth with the presence of a skilled attendant is a reasonable and safe option. "The American Public Health Association's policy statement on Reduction of Unnecessary Cesarean Births encourages the expanded use of midwives and out of hospital birth settings." Sakala, Carol. Citing the American Journal of Public Health 80, 225-2, 1990 in Midwifery Care and Out-of-Hospital Birth Settings: How Do They Reduce Unnecessary Cesarean Section Births? Social Science and Medicine 37, 10 (1993c) 1233-50 A Study of 3,257 out-of-hospital births attended by Arizona-licensed midwives from 1978 to 1985 showed a perinatal mortality rate of 2.2 per 1000 and a neonatal mortality rate of 1.1 per 1000. Sullivan, D. & Weitz, R., Labor Pains: Modern Midwives and home birth. New Haven, CT: Yale University Press, 1988, pp. 125-126

These rates are substantially below those for the U.S. as a whole, which had an infant mortality rate of 10.5 per 1000 in 1987. Another study compared 1046 planned home births attended by California midwives with a similar group of 1046 hospital births attended by physicians. The two groups were matched for mother's age, education, number of children, risk status, etc. There were no significant differences in perinatal mortality between the groups. But the midwives achieved lower rates of fetal distress, postpartum hemorrhage, birth injuries, and the need for infant resuscitation. While the hospital sample had 30 cases of birth injuries, including skull fractures, facial palsies, brachial nerve injuries and severe cephalhematomas, there were no such injuries at home. The home birth statistics included those couples who began labor at home, but ultimately needed to be transferred to the hospital.

Mehl, L., Ramiel, J.-R., et al., "Evaluation of outcomes of non-nurse midwives: Matched comparisons with physicians," Women and Health, 5:17-19, 1980
In the United Kingdom, the 1992 House of Commons Committee on Maternity Services stated in the Winterton Report that "this committee must draw the conclusion that the policy of encouraging all women to give birth in hospitals cannot be justified on the grounds of safety" and further in the report stated that "There is no convincing or compelling evidence that hospitals give a better guarantee of safety of the majority of mothers and babies. It is possible, but not proven, that the opposite might be true."

Midwifery care and out-of-hospital birth settings: how do they reduce unnecessary cesarean section births?

Sakala C.

Health Policy Institute, Boston University, MA 02215.

In studies using matched or adjusted cohorts, U.S. women beginning labor with midwives and/or in out-of-hospital settings have attained cesarean section rates that are considerably lower than similar women using prevailing forms of care--physicians in hospitals. This cesarean reduction involved no compromise in mortality and morbidity outcome measures. Moreover, groups of women at elevated risk for adverse perinatal outcomes have attained excellent outcomes and cesarean rates well below the general population rate with these care arrangements.

How do midwives and out-of-hospital birth settings so effectively help women to avoid unnecessary cesareans? This paper explores this question by presenting data from interviews with midwives who work in home settings. The midwives' understanding of and approaches to major medical indications for cesarean birth contrast strikingly with prevailing medical knowledge and practice. From the midwives' perspective, many women receive cesareans due to pseudo-problems, to problems that might easily be prevented, or to problems that might be addressed through less drastic measures.

Policy reports addressing the problem of unnecessary cesarean births in the U.S. have failed to highlight the substantial reduction in such births that may be expected to accompany greatly expanded use of midwives and out-of-hospital birth settings. The present study--together with cohort studies documenting such a reduction, studies showing other benefits of such forms of care, and the increasing reluctance of physicians to provide obstetrical services--suggests that childbearing families would realize many benefits from greatly expanded use of midwives and out-of-hospital birth settings.