Is it Safe?
Is anything in life ever safe? Here are some facts, followed by some opinions.
Facts: For healthy women with low-risk pregnancies, a major study found that homebirth is at least as safe as hospital birth, due to similar rates of complications in both birth locations, and lower rates of interventions and higher rates of breastfeeding and overall client satisfaction among homebirth families. Most complications in birth can be anticipated in advance with careful monitoring and attention, so that mothers can be transported to the hospital before an emergency develops. Midwives are trained to be alert for signs of possible complications and to respond quickly to complications and emergencies. By minimizing potentially harmful interventions and by practicing holistically, midwives are also able to help their clients prevent complications from developing in the first place. In the rare instances when an unforeseeable complication or sudden emergency develops, being outside of the hospital may create a time lag in getting necessary care, which does pose a danger. However, complications or emergencies that are the result of routine hospital interventions, such as the higher potential for hemorrhage or infant breathing difficulties after a cesarean birth, also pose a danger, and each woman must weigh what is right for her family. Sometimes high intervention hospital care actually causes the rare complications that best belong in a hospital, creating an endless feedback loop.
Opinions: I am fully satisfied that homebirth is safe for low-risk women, or I wouldn’t offer it! I believe that many of the aspects of birth that lead to good outcomes are best nurtured at home. However, I don’t think this makes anything safe, since life itself, in my belief, is an interplay of risk , responsibility and things beyond our control. As far as we have come with medical science and social infrastructure, babies can and do die. Complications can and do happen. Some complications and deaths could be prevented if we as a society invested more in women and babies, made sure that every mother had enough to eat, access to prenatal care and support, and a life free from violence. Many complications and deaths could be prevented if we worked harder to eliminate health disparities and institutional racism in health care and society. But even then, there would still be complications and deaths that are beyond anyone’s control. This is a sad fact, and the basis of much spiritual thought and experience. How do we live with this knowledge?
The medical model seeks to eliminate risk, and makes promises of a healthy outcome every time. I’m grateful to medical science for many things, and I find it invaluable when a woman really does need interventions such as cesarean birth, which happens. However, I have trouble with the implied promise that nothing bad will happen, ever. I don’t think it’s true; we all know times when medical science has failed, even with the best care possible, because of the sad fact discussed above. Since no amount of technology will ever eliminate risk, I question our willingness to go to such extremes. Despite the fact that some cesarean births are truly necessary, cutting open almost one in three birthing women without regard for the higher rates of complication that they will suffer is over the top. I think our cesarean rate reflects the arrogant claim that medicine will always make birth safe, and the reality that this is just not possible. I don’t think we can ever promise that birth, or anything else in life, is safe, and I don’t want to make that promise to you.
I can tell you that all the facts and studies you read about are true and accurate, and most babies are born healthy. Most births go just fine, and I do truly believe that nurturing homebirth care supports the birth process. I also think its important to understand that, because homebirth is not the norm in our culture, you are making a decision that puts more responsibility in your hands. You are stepping up to uncertainty, and resolving to be the one most in control of your own health and experience. While you could do this anywhere, for some people homebirth is a statement of these values. Other people choose homebirth because they feel it is their best shot at having a natural birth, or because they like the midwifery model’s faith in the birth process, or because they don’t want to leave their cat out. The point of all this information is that you get to make your own choice, and as Suzanne Arms says, birth is as safe as life gets. Which is to say safe and risky, all at once.
Please see the resources and links section of this website for additional resources discussing the relative safety of homebirth.
Nechama Wildanah, CPM