I’ve been waiting to see a response to one of the NY Times latest articles from their opinion section, ‘Why Is American Home Birth So Dangerous’. I’ve yet to see anything substantial, so here I am, hopefully to bring a bit of clarity to the misinformation.
The internet is a funny place. It’s definitely easy to read something (especially something that is bold and “factual"), not seek further information, and simply agree or not. Let’s not do that. We are smart, educated women. Let’s think well and seek out evidence based information before being swept over with fear. My goal is not to engage or bring attention to the author of this specific article (who is known for being inflammatory), but to show mommas how to think critically when reading and to check facts for themselves.
I would like to propose a few thoughts..
Especially to those who believe that we are created beings.
To say that childbirth is inherently dangerous is to say that danger is an inseparable element of bringing babies into the world. To agree with this statement is also to say that our Designer either got the process of birth wrong or that we were purposefully called to reproduce (to multiply), and then flung into an inherently dangerous process. If there were any foresight, surely it would have been known that modern, western medicine would not yet be around for thousands of years to save womankind from this dangerous thing called birth.
So did our Designer mess up? Were women supposed to be removed from the earth, since they and their babies would surely and mostly all die without hospitals or obstetric practice?
I proclaim the opposite.
Childbirth is inherently safe.
If birth were not safe majority of the time, there wouldn't be so many humans left on the planet.
Disclaimer: Of course there is risk involved with birth no matter the location or present care provider. There are risks involved in most of life, but that does not negate what we know to be safe. Of course I also agree that modern and western medical practices can be lifesaving when needed and I am thankful that we live in a day and time where they are usually accessible.
I am not going to touch on every single point made in the NY Times article. There is just so much skewed information. I will simply start you off with one or two early quotes by the author and show you how she misuses data. Let’s check her sources!
“Indeed, in the United States, the switch from home birth to hospital birth over the 20th century was accompanied by a more than 90 percent decrease in neonatal mortality and nearly 99 percent decrease in maternal mortality. Antibiotics, blood banking, safe C-sections and neonatology have combined to change death in childbirth from common to rare."
Ok, did you click on the link, “90 percent decrease” to find out where these statistics come from and if they even match the point being made? It’s easy to read this quote and think, “My goodness, thank God for hospitals! Most of our babies and mommas would be dead by now! Wow.”
This source used in the NY Times article, takes us to a 1999 CDC report titled, “Achievements in Public Health, 1900-1999: Healthier Mothers and Babies”. The first paragraph in the report states that, “from 1915-1997 infant mortality rate declined greater than 90%, and from 1900 through 1997, the maternal mortality rate declined almost 99%”.
What does the report state as the cause of this reduction of death in the US surrounding pregnancy and birth?
“Environmental interventions, improvements in nutrition, advances in clinical medicine, improvements in access to health care, improvements in surveillance and monitoring of disease, increases in education levels, and improvements in standards of living contributed to this remarkable decline.”
Keep in mind that these death rates included “infants” ranging up to a year of age. When we think of including these specific statistics to make a homebirth vs hospital point, we would hope that the given information would be birth related, right? We might think the point is being made that babies usually exit the birth canal to cry and then die shortly after, and if in the care of an obstetrician maybe have a higher chance of survival. Not so. Again, this source for the NY Times article is discussing babies of up until a year of age, whose risk of death was not solely based on birth related injury, but instead, nutrition, environment, hygiene, parents education, access to health care, and monitoring of disease over that year period.
The CDC report goes on the say that, “Efforts to reduce infant mortality focused on improving environmental and living conditions in urban areas. Urban environmental interventions (e.g., sewage and refuse disposal and safe drinking water) played key roles in reducing infant mortality. Rising standards of living, including improvements in economic and education levels of families, helped to promote health. Milk pasteurization, contributed to the control of milkborne diseases from contaminated milk supplies.”
What does this have to do with homebirth vs hospital birth? Nothing.
Ah, now here is a bit of actual information on home vs hospital birthing:
“By the 1920s, the integration of these services changed the approach to infant mortality from one that addressed infant health problems to an approach that included infant and mother and prenatal-care programs to educate, monitor, and care for pregnant women.”
However at this time, majority of birth still took place in the home.
The CDC source we are looking at goes on to state, “The discovery and widespread use of antimicrobial agents and the development of fluid and electrolyte replacement therapy and safe blood transfusions accelerated the declines in infant mortality"
Again, a large number of women were still birthing at home at this point.
To quote again from the source used to "prove" that moving birth from home to hospital is what reduced infant and maternal mortality, "(in regards to hospital birth in the 1930s) Poor obstetric education and delivery practices were mainly responsible for the high numbers of maternal deaths. Inappropriate and excessive surgical and obstetric interventions (e.g., induction of labor, use of forceps, episiotomy, and cesarean deliveries) were common and increased. Deliveries, including some surgical interventions, were performed without following the principles of asepsis. As a result, 40% of maternal deaths were caused by sepsis.”
Wait a second. So which was safer, homebirth or hospital birth?
Back to the babies, “From 1950 through 1964, infant mortality declined more slowly. An increasing proportion of infant deaths were attributed to perinatal causes and occurred among high-risk neonates, especially low birth weight and preterm babies.”
Ok, this is where we move to the misinformation about who C.P.M.s provide care for.
Are women risking the life of their infants by staying home to birth when their babies and or themselves are known to be high risk? Sure, there are a select number of women who may not know better and who may place themselves under unqualified care. But, the majority of home birthing families are educated and well informed on their own health and the qualifications of their attending midwives.
According to the NY Times article, “Another difference between the United States and Canada is that in Canada home birth is governed by strict eligibility requirements that exclude women at high risk of complications (no twins or breech births, for example). In contrast, the Midwives Alliance of North America, the organization that represents C.P.M.s, eschews such standards. Each C.P.M. is apparently charged with deciding for herself what is safe."
Notice that the author does not site a source for this information.
To bring some clarity, the above is simply not factual. I know this from my own research into C.P.M. education for future purposes as well as utilizing the care of C.P.M.s myself.
So, for the actual facts:
Each state is in charge of deciding to license midwives (or not) and develop regulations for their practice. In California, for example, there are laws in place which regulate whom a C.P.M. can provide care for. Specific parameters govern their clientele and exclude them from providing homebirth care for high risk women, multiples, and women whose pregnancies fall outside of the 37-42 week window. Now hold on - Thats not what the NY Times article says. The author states that C.P.M.s “decide for themselves what is safe”. Hmm.
Here in Indiana, C.P.M.s are required by law to work in collaboration with an obstetrician in order to provide legal homebirth care. That is also not what the NY Times article states.
“Why Is American Homebirth So Dangerous”, is full of misinformation. The sources sited are not relatable and most statements are made without any evidence based information to back them (How a C.P.M. is trained, what requirements must be met for them to legally practice, etc).
According to the author, “If American C.P.M.s transfer a patient, they lose control of her. These midwives might also put off transferring a patient because, if they are operating illegally and a baby is injured or dies, they could face criminal charges.” We cannot compare or mix statistics from untrained midwives and their birth outcomes, with legal, educated, and trained C.P.M.s who work in collaboration with obstetric providers and transfer to hospitals when necessary. As a certified birth doula, I have been part of home to hospital transfers. My experience has shown that when this collaboration and understanding of the birthing process is understood by both parties, it works seamlessly.
The NY Times article closes with some fear mongering, “As long as we allow poorly trained laypeople with watered down credentials to perform home births, we are risking the health of mothers, and the lives of babies.”
Sure, there are some midwives who practice outside of the law without sound training, but would an educated woman who cares about her life and her child’s not research whom her provider is and what their education consists of (again, look into C.P.M. education, training, and credentialing)? You’re right, probably not. Just like some women will read this NY Times article and fearfully agree, they will also blindly receive care from specific obstetricians who do not practice evidence based care. These providers also put the life of women and infants at risk.
We now live in a country and time where more than 99% of birth takes place in the hospital. You might be surprised to know that according to the sources this NY Times article uses to “prove” that hospital birth is safer than homebirth, “the United States has higher maternal and infant mortality rates than other developed countries; it ranks 25th in infant mortality and 21st in maternal mortality.” (this is according to statistics from 1999. According to a more recent collection of data from the CDC the US now ranks LOWEST among the worlds other wealthy countries when it comes to how many of our mommas and babies die). If you’re wondering, that’s not good.
Since homebirth only makes up for less than 1% of birth in the US, majority of these infants and women are sadly dying in hospitals under the care of obstetricians.
"No one wants poor outcomes for mothers and babies. No one. Any loss is tragic. But preying on people’s fears and falsely inflating risks is not advocacy, it’s bullying. I’m disappointed that the New York Times would publish a piece like this.
The US doesn't need more division or polarization. What we need are people willing to listen to each other, to look critically at the issues, and work together. That's how we'll improve outcomes for mothers and babies--in all settings."
- Why Not Home (The Surprising Birth Choices of Doctors and Nurses) Blog
Wouldn't it be great if midwives who attend homebirths could work in collaboration with physicians in hospitals? And wouldn't it be even greater if physicians in hospitals respected the education and training of homebirth attending midwives who make transfers when needed? Maternity care would then match other developed countries with better outcomes for mothers and infants and whose birthing takes place mostly under the care of midwives and a large percentage in home locations.
For further research check out the links below:
-According to The American Congress of Obstetrics and Gynecologists (ACOG), C.P.M.s are considered level 1 providers qualified in out of hospital birth
-Meta-analysis of The Safety of Homebirth. This study includes perinatal outcomes of 24,092 low-risk women concluding that "Homebirth is an acceptable alternative to hospital confinement for selected pregnant women, and leads to reduced medical interventions."
-An Evidence Based Look at Why We Chose Home Birth