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Column: Home births, midwives, hospitals and the battle over being born

A study released in December highlighting the risk associated with home births has reignited a polarizing debate among obstetricians, midwives and opinionated mothers everywhere.

For an example of the debate, consider this New York Times column from last spring, in which two New York obstetricians referred to home births as “junk science.” The column set off a heated debate with one commenter comparing home births to blood letting and another disputing the claim, calling hospitals “wasteful and full of unnecessary procedures.”

The latest study, published in the New England Journal of Medicine and based on data from two years’ worth of Oregon births, revealed that planned out-of-hospital births are associated with a small but statistically significant increase in fatalities (both mother and baby). Planned hospital births resulted in 1.8 deaths per 1,000 deliveries, while planned out-of-hospital births resulted in 3.9 deaths per 1,000 deliveries — a two-fold jump.

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The safety of out-of-home births, whether at a birthing center or at home, is the crux of the debate.

On the one hand, hospitals offer all sorts of interventions available to save lives if something goes wrong during labor and delivery. If a baby is in distress, doctors and nurses can get that baby out in minutes. They’ve got drugs and scalpels and incubators and breathing treatments — and let’s not forget the “machine that goes ping.” Modern medicine really has come a long way.


Monty Python’s 1983 comedy film “The Meaning of Life” includes this parody of modern birth.

On the other hand, many moms find those hospitals to be cold and the professionals to be overbearing. They lament protocols that put convenience over patient satisfaction, and point out that they sometimes feel pressured to use all those drugs and breathing treatments and pinging machines — even when such interventions are not medically necessary. (In the Oregon study, 25 percent of the planned hospital births ended in Cesarean sections, while only 5 percent of the planned out-of-hospital births required C-sections. Nationwide, the rate of C-sections recorded by hospitals is a whopping 32 percent.)

Moms who have delivered both in a hospital and out of a hospital consistently report feeling more in control of their bodies and far less stressed with midwives by their sides.

How and where and whether someone has a baby is, by and large, every bit as personal as the business that led to conception in the first place.

Melissa Geoffrion, an Arizona account executive, had her first two children in a hospital. Her first was delivered via C-section — and, because of that, her doctor advised her to deliver her second the same way. But she was determined to deliver naturally, with no interventions.

“They kept offering surgery or pain medication and forcing me to sit or lay in the hospital bed, instead of truly supporting the natural birth process,” Geoffrion said. “I was in labor for over 40 hours and even injured my back somehow, which left me unable to walk properly for two months after my son was born.”

When she got pregnant a third time, she found an experienced midwife and delivered at home.

“The home birth experience was amazing and wonderful, and left me feeling empowered and confident in my body,” she said. “I … really wish all three of my children had been born at home.”

Personally, I’m a big fan of hospitals. As some of you may recall, my own life was saved in a hospital.) And when it was time to choose a place to deliver my own daughter 10 years ago, I never once considered a home birth. Why? Because pain, that’s why. Shortly after arriving at the hospital, my nurse asked me what pain level, 1 to 10, I was willing to endure. My answer: “One or two.” She laughed and called for the epidural. When my contractions were at their strongest, I was reading People magazine. My birth plan involved all the drugs.

Shortly after arriving at the hospital, my nurse asked me what pain level, 1 to 10, I was willing to endure. “One or two,” I answered. When my contractions were at their strongest, I was reading People magazine. So, yeah, my birth plan involved all the drugs.

Was mine an ideal birth experience? That depends who you ask. But, in my mind, at least, it went really, really well. And I’m convinced that it went “really, really well” for the same reason that Geoffrion loved her third delivery. Because I got to call the shots; I got to make my own plan, including my own back-up plan. Nothing happened to me that I didn’t want to happen.

I think we, as a society, have this rather perverse tendency to shame women’s choices when it comes to pregnancy and childbirth. The entire subject is rife with extremism and saturated in judgment. It starts with the abortion debate and trickles down from there: hospital versus home, doctors versus midwives, drugs versus natural, vaginal versus cesarean, breastfeeding versus formula, the list goes on and on.

And why?

I mean, most rational people understand that what goes on in people’s bathrooms and bedrooms is none of our business, right? So why don’t we extend that privacy privilege to birthing rooms? How and where and whether someone has a baby — unless it involves breaking a law of some sort — is, by and large, every bit as personal as the business that led to conception in the first place.

This is not to suggest that all parental decisions should be above reproach. Some decisions — refusing to vaccinate kids, for example — deserve to be criticized. Because we’re not just dealing with junk science bordering on superstition; we’re dealing with individual decisions that have an effect on the health of us all.

But childbirth is different. What a woman is willing to put her own body through in order to have a happy, positive birth experience is personal. Is there room for these statistics in decision-making? Yes! There must be. But there must also be room for other considerations. Is the mom healthy? Is her pregnancy low-risk? Is her midwife licensed, experienced and reliable? Is her home close to a hospital should something go wrong? What is her pain tolerance? Is this her first pregnancy? What are her options? I don’t mention these questions because they’re our business — they’re not — but to offer examples of the questions parents must grapple with for themselves.

Scientific studies don’t exist so we can use them to prop up our soap boxes, or justify our moral outrage, or shame women who are doing the best they can. They exist so we can all, each of us, make informed decisions about how to best move forward in life — and so hospitals, doctors and midwives can improve safety conditions for all expectant moms. It should be said that some doctors and midwives enjoy excellent communication, cooperation and trust. But not all of them do — and the oppositional posturing between these two groups of professionals in the media only makes matters worse.

Will some women make mistakes? Yes. And no one will suffer more than they if that happens. But let us remember that no birth is without risk. Life is risk. And to say something is “less safe” is not the same as saying it is “unsafe.” As long as expectant mothers have their babies’ health in mind (and you’d be hard-pressed to find an expectant mother who doesn’t!), childbirth is a personal matter and should be treated that way.

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