This blog has been welling up for a while, but the last phone call I got from a midwife about a failed home delivery — I knew it was time to write it.
First off — home deliveries. Oh my goodness, do I love them! There are AMAZING stories about how your instincts kick in and what a loving thing it can be for your whole family. I have a labor and delivery nurse friend who did a home delivery and her story totally gives me chills. I realize how many times the hospital stops all that. It’s horrible. Home deliveries are wonderful. Especially the stories of a home delivery, where I already know the ending (hopefully that ending is cuddling with their mom at the time).
Hospital deliveries. They’re sterile, not at home, they’re in odd positions and you do it often with strangers. We make you do weird things, you wonder if the blood pressure cuff will actually dwell inside your arm soon. We’re always coming in, and typing. There’s 9 million questions, antibiotics, pitocin, you feel like you’re out of control of the whole thing. Your doctor doesn’t seem to give you many choices. They’re just not the sweet loving moment you would hope for.
And then I read this study. I am well versed in how studies can be skewed and how it can certainly be read many ways. I’ve actually read worse studies, this one seems fairly even handed — especially for women who have had multiple children. But, there is a part I need you to hear if you’re considering a home birth:
“… researchers at New York-Presbyterian/Weill Cornell Medical Center found the absolute risk of neonatal mortality was 3.2/10,000 births in midwife hospital births, and 12.6/10,000 births in midwife home births, and it further increased in first-time mothers to 21.9/10,000 births in midwife home deliveries. Neonatal mortality was defined as neonatal deaths up to 28 days after delivery.”
That is a 4 times greater risk in general population, and a SEVEN TIMES greater risk in women having their first baby.
Wow. I seriously had NO idea. The thing is, I’ve seen babies who would have died. So often the baby is doing amazing right through delivery and then comes out and is dead. Dead. Not breathing, heart barely going, and without all the equipment we have — it would most certainly have died. And while on many births we have a decent idea of how the baby is doing prior to delivery, sometime we don’t. Which means your midwife wouldn’t have a clue either.
However, the reality is that 21 out of 10k really isn’t a big number. It’s 2 tenths of a percent (compared to hospital births being 3 hundreds of a percent). It’s a VERY small number, but it IS there. Keeping in mind these deliveries were all done by a midwife, either in the hospital or at home.
I also saw the official page of ACOG comparing planned home deliveries (which should not be confused with women who receive no prenatal care and just explode out a baby at home). It shows an almost 3 times great chance of death in nonanomalous (physical limitations not compatible with life) delieveries. I will also say there is a much larger chance of infection with a hospital delivery, cesarean sections and 3-4 degree lacerations. So, there are certainly risks associated with both of them.
After that little review of literature, here are my thoughts on home deliveries vs hospital deliveries:
1. If you REALLY want a home birth that doesn’t involve an IV or monitoring or people coming in and out of your room. Deliver at home. I can’t be dragged into your fantasy. I’ll be dragged into the courthouse next. We have policies that we HAVE to follow. We leave ourselves open to limitless litigation if we don’t follow them. I WANT you to be happy and have a wonderful delivery, but there are rules I HAVE to follow. Of course, if things are going naturally and the baby looks good there are ways I can accommodate you, but you can not plan on that.
2. Choose your practitioner. This goes for both ends. If you are having a home birth you need an experienced midwife who is certified and can tell you specific things she does to keep you safe. If you have chosen a hospital delivery you need a practitioner who will avoid the things you don’t want, unless it’s unsafe. Ask to see their statistics. I promise they have them, and I promise that they will try to skew them for you just like any good practitioner. Ask around, if you know any labor nurses ask them. Tell them what you want. They can help you. I 100% promise that good bedside manners do not equate with a good physician, so if you can — ask someone who has an opinion of their actual skills as an OB.
3. Have you considered a midwife? I have delivered with midwives in the hospital. They are smart, they will be with you but also keep you so safe. Because they are with you much of the time, they are able to limit some of our policies in some regards, or at least answer all your questions more adequately. Still, find one you trust. Just like any other practitioner, there is a wide variance in their ability to practice well.
4. Consider your history. As noted above, first time moms have more to think about for a home birth. You just don’t have a tested pelvis, or any other information to go off of. Subsequent deliveries ARE safer in home. Also, what other risk factors do you have? Someone came to my VBAC post suggesting that TOLAC’s should consider a home birth. I can’t more strongly disagree with this statement, as does ACOG.
5. Consider the outcome. Having a home delivery, to me, is like taking your baby, putting them in the car without buckling them and driving off. Almost ALL of the time, that is totally fine. Happy outcome and you get to your destination – it’s just the times it doesn’t. The outcome I wanted was an amazing family with a healthy mom and baby. I didn’t particularly care how we got to that end. I empathize people who really want that amazing delivery. It just wasn’t my concern.
If you’re planning a hospital delivery – don’t miss my beginning online prenatal class:
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Hilary is a labor and delivery nurse who sometime writes about pregnancy and health. Please don't consider anything written here as advice that you should take over your doctor's recommendations. Talk to your doctor, you're paying him/her. Make them work for it!