If you are a low risk woman and you choose to give birth at home, your baby has more than a 1/1000 chance of dying. You are sending them to school where they have 1/1000 chance of not coming home that day.
Let's compare those to the hospital rates of neonatal death. If you look at the recently published study by Weill Cornell Medical Center, their numbers show that the neonatal mortality rate for low risk women who give birth in a hospital is 0.31/1000. Your baby has a 1/3226 chance of dying.
Cornell found that the neonatal mortality rate for low risk white women who give birth at home is 1.32/1000. Your baby has a 1/756 chance of dying at home. That risk of death is more than four times higher than at the hospital.
If you had to send your daughter to school, would you send her to the school where her chance of dying was 1/3000, or 1/700?
And if you sent her to the school where her chance of dying was 1/700, and she came home alive, was it because the school was equally as safe as the other? No. It's because you were lucky.
Homebirth is not, and can never be, as safe as birth in a hospital. There isn't nearly the same equipment and there aren't the same teams of highly educated, highly trained, highly experienced people watching over you. You get very basic equipment and one (possibly two) undereducated, under experienced midwives who are "experts in normal birth" (a.k.a., they cannot properly deal with emergencies and may not even recognize that there is one.) When you choose homebirth, you are taking the chance that an unpredictable, unavoidable emergency will happen to you or your baby (prolapsed cord, placental abruption, shoulder dystocia, amniotic fluid embolism, severe post partum hemorrhage) - and you will not be in the place where there is the equipment and people who could save your lives.
How long can you hold your breath? Because living "five minutes away from the hospital" means that if you have a placental abruption during labor, your baby will be holding their breath as long as it takes to recognize that it's happened, call an ambulance, wait for the ambulance to arrive, load up into the ambulance, drive to the hospital, get to the OR, get anestethized, and for the doctor to cut your baby out. Could you hold your breath through all that? Your baby won't be getting oxygen for that entire period. And if they don't die (which they almost certainly will), they will suffer serious brain damage.
And now that I brought it up, let's do talk about brain function. Babies' brain function is preserved in labor if they get enough oxygen during labor and delivery. One of the best ways of detecting if a baby is getting enough oxygen is electronic fetal monitoring. It shows a constant tracing of their heart rate and can detect things such as decreased variability (a sign of oxygen deprivation) and subtle late decelerations (a sign of oxygen deprivation). By just listening to the heart rate with a doppler (what a midwife will use at a homebirth), you cannot detect these things. So a baby can have a heart rate in the normal range the entire period of labor, and still drop mostly dead (and almost certainly brain damaged) into the midwife's hands. That wouldn't happen in a hospital, because their distress would have been picked up on the monitors and interventions would have been performed to save them. Home birth advocates often complain about interventions in the hospital, seemingly without realizinog that these same interventions save lives and brain function. When you decrease interventions, you increase brain damage. When you decrease interventions, you increase deaths.
This study showed that home birth increased the risk of a 5 minute Apgar score of 0 by nearly 1000%. (Yes, a thousand percent.) An Apgar score of 0 means that there are no signs of life - the baby is completely blue or gray, has no pulse, is not breathing, is not moving, and does not respond to stimulation. If you deliver with an OB in a hospital, the chance of an Apgar score of 0 at five minutes only 1/6250. If you deliver with a midwife (CNMs included) at home, the chance is 1/613. Ten times higher. Tell me, do you want there to be a 1/600 chance that your child will be grey, not breathing, and not moving five whole minutes after they were born? Well, if you choose a homebirth, that's the number you're choosing.
For the babies who are able to be revived at this point (and it's not many), what do you think their brain function is? After not having had oxygen for at least five minutes OUT of the womb, and certainly for a much longer period before being delivered? They are, almost without question, going to have serious brain damage.
And those are just the babies who almost certainly have serious brain damage - what about all the others with mild or moderate brain damage from undetected oxygen deprivation at homebirth?
Why would you choose your care provider from a group of women who believe that shoving garlic in your vagina can cure GBS? Or that putting a hat on a newborn can cause maternal postpartum hemorrhage? Or that eating stevia (yes, stevia, the sugar substitute) can increase amniotic fluid? Or that if something goes wrong and the baby dies, and the mother questions the midwife's actions, it is always, always, always the mother's fault?
It makes sense to me that homebirth advocates blame the mother when a baby dies. If they blame the mother, if they say she did something wrong, then they are assuring themselves that the same thing will not happen to them. Because they will not make the same mistake that she did. But that is a lie. The only "mistake" most of these women make is trusting that their midwife is actually the competent care provider that she says she is, and not just some birth junkie who knows so little that she doesn't realize how much she doesn't know.
Almost all lay midwifes (and tons of doulas) seem to suffer from Dunning-Krueger effect - "the inability of the unskilled to recognize their ineptitude." They've read 15 or 20 books on birth, done months of research on google (months, people, months!), and been present at 100 births, and they think they know as much as an OB who went through at least 8 years of medical school and has presided over many hundreds, if not thousands of births. In 2012, MANA "strengthened" the requirement for the CPM credential to require a high school diploma. Strengthened. Boy, doesn't that give you confidence in your care provider? That idiot in your history class who BARELY passed high school might have more education than the person you've entrusted your baby's life to.
Just one problem with non-nurse midwives' education is that training in an apprenticeship under another CPM is where they get a great deal of their "knowledge" in how to deliver babies. So if the trainer midwife has a gap in her knowledge, she passes that on to her student. Barb from Navelgazing Midwife (who, as the name says, used to be a midwife herself), explained it like this:
So your midwife may not have ever had basic biology, anatomy, or physiology, but don't worry, she'll be culturally sensitive!"Each non-CNM midwife has what I call “black holes” in their education and skills training. When they teach, they also teach the black hole… or rather, they leave out the knowledge of the black hole, thereby passing on the black hole from generation to generation of apprentices/midwives. Unless a student/apprentice has another midwife that accidently [sic] fills in the black hole, she can go her entire life not knowing about something. For example, I just reported on a study that showed “Heat Wave May Make Womb a Dangerous Place,” that heat was positively associated with congenital cataracts. When I reported on it, I noted that I’d not known babies could have congenital cataracts. Another midwife was surprised (understatement) that I didn’t test for them, looking in the newborn’s eyes with a flashlight to look for the “red reflex” (you can bet I know about it now!). I’ve had at least ten midwives teaching me how to do newborn exams and I can’t remember even one of them telling me about the red reflex. Clearly, this was a black hole in my education… and one I passed on to my apprentice as well. Hopefully, she’s learned about it since then. As an aside, I’m reading the new edition of “Heart & Hands: A Midwife’s Guide to Pregnancy and Birth” to review it here on the blog. H&Hs was a staple in my midwifery education, we nearly memorizing it for our NARM exam. I’m assuming Anne Frye’s replaced H&Hs, but know this is still an extremely important text for student midwives. In here it says:
“Check the eyes for red spots, hemorrhages of the sclera due to pressure in the birth canal. Also look for evidence of jaundice: (sic) the whites of the eyes should be white, not yellow. Check to see if the pupils are equal in size and reactivity when exposed to light. Check for tracking by moving your finger back and forth close to the baby’s face. Check the shape and spacing of the eyes, noting any irregularities.”
Then it goes on to erythromycin in the eyes, but nothing about red reflexes. It bothers me that it isn’t in there and disturbs me that I never checked a baby’s eyes for cataracts. I can only pray none of them had one or the Pediatrician found it if there was. That was a roundabout way to explain a black hole, but there you have it. It is unlikely this would happen in nursing and midwifery school…the more I know and the more I hear, the less I like the CPM education. It scares me in many ways. Most of what scares me is the arrogance of the groups behind the education process. Instead of seeing the gaping holes and trying to fill them, they pretend to fill the hole with a teaspoon of dirt. Why can’t NARM see that Biology, Anatomy & Physiology and other science classes should be required for the CPM license? Why, when they had the chance to add classes, they chose a class in cultural sensitivity?"
Home birth advocates often say that midwife care is so personal, and that OBs don't have personalized care at all, but it is really the complete opposite. OBs care about your medical history and current health status, and recommend different courses of action based on your individual situation. For homebirth midwives, it's all the same. No matter what your previous history is or what complications your current pregnancy has, their advice is always the same - homebirth! GBS positive? No problem! Don't mind the babies who die at homebirth from GBS. Breech? No problem. Don't mind the babies who die at homebirth because they're breech. Twins? No problem. Don't mind the twins who die at homebirth. Post dates? No problem. Don't mind the babies who die at homebirth from postdates complications, like placental calcification and meconium aspiration. Low amniotic fluid? No problem. Don't mind the babies who die at homebirth from low amniotic fluid. Previous c-section? No problem. Don't mind the babies who die at homebirth from uterine rupture.
Midwives are either too stupid to realize that these are all serious problems, arrogant enough to believe that they can deal with them themselves with no equipment and no education, or too wrapped up in their pro-nature, pro-vaginal-birth-at-all-costs ideology that they truly believe "some babies are just meant to die."
If you think homebirth is as safe as hospital birth, you are willfully blinding yourself to the truth.
What are the odds you want to choose for your child surviving birth?
