The Safety of Home Births

by David Crank

From Volume 2 Issue 2 of Unless the Lord ... Magazine


Why don't more people have home births? Most have been led to believe that a home birth is not safe. They falsely associate home births with high infant and maternal mortality. Even a little research is sufficient to show that this is untrue! There are more problems with totally unplanned, unprepared and unattended home births than with hospital births. But when you are talking about planned home births with a midwife in attendance, many studies indicate that the home birth is safer than a hospital birth.

“Studies of ... home births have shown them to be as safe or safer than hospital births (Hazel 1975; Mehl 1977; Dwitt 1977; Tew 1978)” (Romalis, 27)

You ask, how could this be? What could be safer than a hospital staffed with doctors and well trained nurses and surrounded by all the best equipment? Well, if you were going to the hospital for surgery, then all these things would be of benefit. But birth is not surgery, nor is it a serious illness.

The problems with most hospitals are: 1) the interventionist philosophy of doctors, nurses and hospital policies; 2) the concentration of disease germs that the mother and baby have not previously been exposed to; and 3) the absence of quality labor coaching throughout labor (such as is provided by midwives).

“While Sweden, Finland and the Netherlands compete for the honor of having the lowest incidence of infant deaths ..., the United States continues to find itself outranked by fourteen other developed countries. “(Haire, 1)
"Norway, Denmark, Holland, and Sweden all rely on midwives to conduct normal labors, and these countries have the lowest perinatal mortality rates in the world."(Inch, xiv-xv)

Interventionist Philosophy. The truth is that God designed the normal woman's body to handle labor and delivery quite well. When the woman is encouraged to work with her body and not against it, complications are rare and medical procedures are very rarely needed. In a hospital, the incidence of complications and problems multiply tremendously. 
When the woman should be walking, standing, squatting, or kneeling during labor, she is often being confined to a bed on her back with an electronic fetal monitor strapped to her belly, tending to make the labor longer and considerably more uncomfortable. Drugs are usually offered and encouraged to lessen discomfort and pain. But the drugs also inhibit the mother’s ability to push her baby out and pose an increased danger to the infant. Whereas the U.S. has a high incidence of infant brain damage, a country such as Holland, where more than half of all mothers deliver at home with a midwife, rarely has newborns with Apgar scores lower than 9 (Haire, 11-12).

"All regional anesthesias …tend … to inhibit the mother's ability to push her baby down the birth canal, which in turn, tends to increase the need for fundal pressure, uterine stimulants and forceps extraction - conditions which should be avoided if possible in the best interests of the child." (Haire, 6)

One intervention tends to lead to another. Drugs may slow the progress of labor, so the labor may be induced or sped up with another drug (usually pitocin). This may create further problems, making labor more difficult and encouraging the doctor to bring a quick resolution with a cesarean section. 

There is also a high incidence of cesarean section in hospitals related to fetal (infant) distress. Some of this is due to false alarms from the fetal monitors or overreaction to minor indicators. In other cases, the previous interventions (especially drugs used) have contributed to distress by affecting the infant’s heart rate and oxygenation level of his blood. 
This isn't all that the mother is typically (not always!) subjected to in the hospital. Nourishment is often refused, just in case surgery becomes necessary. With a long labor this is almost a self-fulfilling prophecy. Without nourishment to maintain strength through a longer labor, surgery may become required! Sometimes the hospital's solution is intravenous nourishment. This again helps solve one problem while creating another. Being hooked up to an IV tends to further limit the mother's walking, squatting, getting in the shower, etc. to help both her tolerance of the labor and its successful progression.

Lack of Patience. One of the biggest factors in poor infant mortality rates in U.S. hospitals is a lack of patience and trust in the birth process. Whenever a labor goes beyond the averages and statistical norms, there is concern and impatience to quickly bring it to a close. In reality, there are huge variances between the lengths of normal successful labors. This is borne out by research and by just talking to different women about their labors.

Many doctors worry that something just might be wrong and know how quick parents are these days to sue for malpractice. They worry that the mother may be too exhausted to deliver (a small but increasing risk when they deny nourishment, prevent laboring in differing positions, fail to allow the natural rest periods that the mother's body takes when labor is slowed, etc.). Often the mother and father also become worried and impatient - certainly the mother would be glad to have this done and over with! And usually there is no one there urging patience, trusting the way God designed the woman's body and the birth process. 

“ Dutch obstetricians point out that when the labor of a normal woman is unhurried and allowed to progress normally unexpected emergencies rarely occur.” (Haire, 11)

Impatience results in many unnecessary cesareans, artificial stimulations of labor with drugs (may exhaust the mother and also increase risk of uterine rupture), and unnecessary birth complications. Many women are a lot slower in delivering babies than doctors would like. Midwifes, from having observed large numbers of labors from start to finish and having a minimal intervention philosophy, tend to be much more patient, advising the parents also to wait patiently unless there are true signs of problems.

a typical home birth

Throughout the pregnancy the mother meets with a midwife rather than a doctor for prenatal care. The midwife checks fetal heart tones, checks the baby's position and size, checks the mother's blood pressure and weight, and advises the mother concerning good nutrition and in preparation for labor and delivery. Many midwives will send the mother for a blood test to screen for possible problems and provide urine tests to screen for blood sugar problems. The midwife takes her time with each mother and is often more responsive to the client's wishes than many doctors. An ultrasound may also be recommended at some point, but optional. 

Most serious birth complications can be detected prior to the time of birth and a determination made of whether a doctor or surgery may be needed. As the due date approaches the midwife can assure that the baby is head down, and if not, provide instructions to the mother on how to encourage the baby to turn. 

When the mother goes into labor, the midwife, and/or her associate /assistant, will come to the mother's home to monitor, advise and assist. If needed, she may stay there for 24 hours or longer. If delivery is not near and the mother is handling the labor well, she may leave for a time and then return a bit later or when called. 

During the labor the midwife will regularly check the baby's heart rate, carefully watching for any signs of distress or complications (but without strapping on a fetal monitor). She will periodically check the mother’s blood pressure or check dilation progress (but not excessively and in accordance with the parent's wishes). She will offer advice (not commands) to the mother and father for how to make the labor easier and progress more effectively. If there are any warning signs, she will provide counsel and assist. Many midwives bring a few "tools" with them for quick response to problems (such as a canister of oxygen).

Most midwives have a lot of faith in how God designed the woman's body and the process of labor. An experienced midwife has witnessed a very large number of labors from start to finish (something few OB/GYNs have done). They have learned how to best help the laboring mother and how to be patient in waiting for labor to progress. They have seen how labor sometimes slows and almost stops for good purpose. 

During the final pushing, the midwife may repeatedly check the baby's heart rate to ensure there are no problems. When it comes time to deliver, the midwife is prepared to help the baby gently emerge in a manner to prevent or minimize any tearing (episiotomies are wholly unnecessary with a good birth position and proper management). When the head emerges, a quick check is made for a chord around the neck, which can usually be easily removed before the baby is pushed the rest of the way out. 

After the birth the midwife will assist or advise with cutting the umbilical chord and will check the baby over for any problems and ensure all is well with the mother. She will stay to observe the birth of the placenta to ensure the entire placenta is expelled and that the uterus clamps down well, minimizing bleeding. If there is any bleeding problem, she will massage the uterus and /or take other action to rectify the problem. In the rare instances that these efforts do not fairly quickly succeed, she will probably recommend transport to a hospital where further treatments are possible.

Throughout the process, most midwifes take a very non-interventionist approach. They carefully monitor for problems but without hindering the woman's laboring success. The midwife offers encouragement as well as advice and expertise.

A home and midwife assisted birth is not ideal for every woman or even every pregnancy. There are some health conditions of the mother that would be better managed in a hospital. There are also some health conditions of the baby or special birth problems that cannot easily be dealt with by a midwife in a home setting. 

But for the vast majority of births for most women, the home birth offers a safe alternative and one that promises a very good birth experience with a minimum of unnecessary intervention. As added dividends, as much of the family as desired can be present (at least nearby) and mother and baby can immediately rest in the comfort of their own home and bed.

When the unexpected happens and the help of a doctor and hospital are needed, the midwife recommends transport and does what she can in the meantime to assist. Unless the hospital is more than 30 minutes away, rarely will the transport time have an impact on the outcome.

Hospitals can’t handle every problem. Infant and even maternal deaths occasionally occur even with the best hospital care.

"It is misleading to suggest that a death that occurred at home could necessarily have been prevented if the birth had taken place in a hospital. A study of 5,000 home births in Holland showed that, of the few deaths that occurred, not one could have been prevented by hospitalization …Holland, which still has the highest home confinement rate in the developed world, also has one of the lowest perinatal mortality rates." (Inch, 4)

Quoted Sources

Haire,Doris. The Cultural Warping of Childbirth, 1972;
 Inch, Sally. Birthrights: What Every Parent Should Know About Childbirth in Hospitals , 1984;
Romalis, Shelly, ed. Childbirth: Alternatives to Medical Control, 1981.
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