Home births at highest level since 1990
May 20th, 2011
05:32 PM ET

Home births at highest level since 1990

The number of women having babies at home increased 20% between 2004 to 2008 according to a new study in the journal Birth: Issues in Perinatal Care.  The change is mainly due to a 94% increase in home births in white women, the authors said.

Home births increased significantly in 27 states during this period; only four states saw declines. Montana had the highest increase. Reproductive statistics expert and lead author Marian F. MacDorman of the National Center for Health Statistics at the Centers for Disease Control and Prevention says home births are at the highest level since 1990.

"Women may prefer a home over a hospital birth for a variety of reasons including a desire for a low intervention birth in a familiar environment surrounded by family and friends," MacDorman said. "Cultural or religious concerns, lack of transportation in rural areas and cost factors may also play a role as total costs for home births are about 1/3 those for a hospital birth."

MacDorman said risks associated with home births also went down during this period. "It might mean home birth midwives and practitioners are doing a better job of selecting low-risk women for home births."

Women with a high risk of complication and therefore not good candidates for a home birth include those over 40 years of age, weighing 300 pounds or more and have high blood pressure or diabetes, MacDorman said.

The American College of Obstetricians and Gynecologists issued a statement in January that says although the risk of planned home births is low, evidence shows it does carry a two- to three-fold increase in the risk of newborn death than hospital births.

"As physicians, we have an obligation to provide families with information about the risks, benefits, limitations and advantages concerning the different maternity care providers and birth settings," said Richard N. Waldman, M.D., ACOG president. "It's important to remember that home births don't always go well, and the risk is higher if they are attended by inadequately trained attendants or in poorly selected patients with serious high-risk medical conditions such as hypertension, breech presentation, or prior cesarean deliveries."

ACOG says the best available data show hospitals and birthing centers are the safest place for labor and delivery.

soundoff (424 Responses)
  1. Happy Mom

    There is a middle ground. I delivered two healthy (and big!) baby boys in the hospital by Certified Nurse Midwife. They bridged the two worlds artfully. They consulted a midwifery expert (who once was anti-hospital) and worked within the hospital setting with autonomy. I gave birth in a hospital birthing room with all the advantages of being in a home with a midwife giving me one-on-one attention and the security of the world's best technology available within seconds if needed. The "obstetrician-on-call" never interceded nor would she unless the midwife called for her. The births were unmedicated and all on my terms. I was able to relax and focus on the process without worry. The best of both worlds!

    May 22, 2011 at 22:29 | Report abuse | Reply
    • Bob C.

      This is the best of both worlds. The majority of OBs now have mid-wives as well. Hospitals have realized this and are now offering modern birth centers. The rooms look just like home - even most of the medical equipment is hidden. But the equipment, OB, and the ER are available if something suddenly goes wrong.

      May 23, 2011 at 12:36 | Report abuse |
    • HH

      This is proof that doctors don't get it. The "home-like setting" isn't what most homebirthers want. We said, "We don't want routine episiotomies." Doctors replied, "We'll put a rocker in your room." We said, "We want to labor so long as we're comfortable. Don't try to speed it up with pitocin." Doctors replied, "We'll put pretty wallpaper in your room." WE WANT NATURE TO TAKE ITS COURSE. THIS MEANS – STAY OUT UNLESS YOU'RE NEEDED. They aren't willing to do that.

      May 23, 2011 at 13:48 | Report abuse |
    • Susie Bennett

      I agree, that is ideal. However, from my understanding, not many hospitals offer that kind of service (at least not in Los Angeles). If the ACOG recommends hospital births, then the ACOG should take steps to make the hosptials more respectful of the mother's wishes, and not being so eager to intervene, not railroading exhausted mothers-to-be into last-minute procedures that aren't really necessary (such as inducing), and not whisking the baby away from the mother the minute he/she is born.

      May 23, 2011 at 15:46 | Report abuse |
    • Happy Too!

      I agree! There is a middle ground. I had an unmedicated birth in a birthing suite at a hospital attended by a certified nurse midwife. I could'nt have asked for it to go any better!

      May 25, 2011 at 14:39 | Report abuse |
    • Rain

      I'm not sure what Susie is talking about I lived in Los Angeles and the UCLA midwives are very much like this. The UCLA midwives have an 11% csection rate and are completely supportive of natural birth if that is what you desire. In San Diego the UCSD Birth Center is staffed by midwives and you can walk around, eat and you don't have to have an IV and there are tubs you can labor in. There is a great birth center called South Coast Midwifery in Orange County staffed by midwives and in San Diego there is a great birth center called Best Start Birth Center. If anywhere has natural birth friendly hospitals it's Southern California.

      August 7, 2011 at 14:10 | Report abuse |
  2. Home or Not

    I've had both my children at home with a trained and experienced midwife, and it is in part a leap of faith and a great deal of trust in those midwives you select to take you through the birthing process. With my first child, I had insurance and an O.B. and desired to have a natural birth. After taking natural birthing classes I made the decision at 37 weeks to ditch my O.B. and have a home birth with a midwife. Leap of faith....most certainly! It was a good thing I'd taken natural birthing classes to prepare for what was a physically grueling labor, but with a safe and fulfilling ending. With my second child I did not have insurance, could not get it because it was considered a pre-exsisting condition. I had all of my pre-natal, delivery, and post-natal care provided by the same midwife. AlthoughI hemorrhaged quite heavily, thanks to the skill of my midwife all ended well. I can say from my personal experience with the care from both an O.B. and a Midwife, the pre-natal and post-natal care provided to my by my Midwife were far superior to that received by my O.B., which is not to say that there isn't outstanding care at the service of OBGYNs. There are pros and cons with both, and making the choice to birth at home most certainly requires a great deal of mental preparation, complete confidence in your midwife and your own tenacity, and undoubtedly a willingness to accept the risks.

    May 23, 2011 at 03:19 | Report abuse | Reply
    • Ashley

      It's great to hear that you had such a supportive mifiwde. I was the same so very happy with my mifiwde AFTER the birth. We were saying to everyone we saw afterwards I'm so glad we had such a wonderful mifiwde with us but it was something we didn't really consider before the birth (we knew she would be awesome but didn't realise how awesome until afterwards). Thanks for your comment Alexandra recently posted..

      July 1, 2012 at 14:25 | Report abuse |
    • Diahdifanacikempotarieustia

      I don't know your special siauitton. Maybe you have other reasons that I never had and that I can't understand.I'm not saying you shouldn't do it. But I do say If there is the tiniest chance you would regret it in the middle of everyting.. if there is any possibility you will doubt you did the right thing you shouldn't do it.But if you are 100% sure and have the confidence to convience both yourself and the people around you that this is how you want it I think you can do it and you will probably have a wonderful experience.I know this is a very long reply.. but I'll just add about the pain relief.. I have always wanted to give birth without. But at the first one I gave up on the midwive's recommendation after 15 hours and only two tiny centimetres open. I was exhausted and nothing happened. So I ended up with epidural.The other two I gave birth to without even considering taking something.. it just went a lot smoother..From now on your blog is in my RSS.. I wanna see how everything goes. 🙂

      July 3, 2012 at 03:04 | Report abuse |
  3. Rob near DC

    This sounds like an increasingly good idea – it may be that children born "off the grid" are going to be the only ones able to thrive and prosper under the expanding autocracy that the US has become.

    May 23, 2011 at 07:18 | Report abuse | Reply
    • Chad1980

      What does that even mean? An autocracy is a system of government by one person with absolute power. What does having a baby at home have to do with an autocracy? And what in the world makes you think the US is an autocracy? I swear these comments get more off the wall every day.

      May 23, 2011 at 16:52 | Report abuse |
  4. Guin

    Perhaps if more and more women opt for home births, OB's might actually start to practice evidence based medicine.

    May 23, 2011 at 09:25 | Report abuse | Reply
    • Lisa

      *LIKE x 1000*

      May 23, 2011 at 09:49 | Report abuse |
    • Julie

      You are so right! They take a blood sample from every newborn to store in their database and have been doing so since the 1970s.

      May 23, 2011 at 11:29 | Report abuse |
    • Katie

      It's easy to blame the OBs in general for treatment that doesn't align with a woman's desires. Births are so risky and so fraught with emotions before and after, it's a better idea for pregnant women and their significant others to SPEAK UP well in advance about their expectations and to keep communicating. ASK QUESTIONS, and if you don't like the answers, start doing your homework about how to safely fulfill your needs and desires. Patients MUST learn to stand up for themselves and take responsibility not just for their bodies but for their own decisions. What if you wanted a natural childbirth but ended up with hypertension and need a C-section? What if you decide on a home birth and an emergency occurs and your midwife can't handle it or won't handle it? These are things pregnant people need to consider. It's a HUGE decision and has HUGE responsibilities. Home birth and hospital births can both be terrific experiences – YOU make it happen by being prepared and being prepared to change your expectations when the need arises.

      May 23, 2011 at 12:43 | Report abuse |
  5. Dawn

    To the islander...did you REALLY say out loud that you think the birthing center is a new age thought and a money making program to entice those easily persuaded by fears? WOW. I'm surprised you live on an island. You sound like every other naïve uneducated American mother. Of course your babies cord was wrapped around their neck. You had been in labor long enough. They were tired of you. That means the dr wants to "wrap it up".Literally. Coincidentally most "cords get wrapped around babies necks" right around 4 or 5 pm and again around 10 pm. Either your Dr. needs to go home for dinner or its a shift change in the day. Too bad you didn't have a midwife, they could have averted that "horrible situation" of the cord wrapped around the babies neck in five seconds with their pinky finger. And the hospital baby factories....that's a multi BILLION dollar company. They make thousands of dollars off of your c-sections. They do NOT make thousands of dollars off your "natural hospital birth". Now are you all understanding why over 50 percent of births in America are c-section? If your going waste their time with all your labor hours, just for a natural birth, hell no, they are going to make their time worth it. Cut you open. Perform surgery and make loads of money off of you....I mean they did wait for you in your hours of pain, the least you could do is let them cut you open and make a few dollars off of you. You must get more educated. America is the only place where narrow minded Dr's make you lie on your back to deliver a baby. Do you lie on your back when you go poop? How come? Oh that's right, it MAKES NO SENSE. You can't really push it out...but these brilliant American Dr's were trained in med school that you as a mother should lie on your back and push out an 8 pound human....drugged up...on your back, good thing they gave you drugs though, that's going to hurt like hell. And if you try to get up to deliver in a different position...they will encourage more drugs to get you back down. In order to have a successful labor and delivery with a Dr in America, you need to do exactly what the dummy mannequin did in their med school training. Lie there numb and not move. You want to move around? Deliver on all fours? No way. Doc can't handle it. Its like asking a Mcdonald's worker to make a cheeseburger with no pickles....its not happening. Way to confusing and totally against the book they read in training. Remove the pickles yourself /get drugged and lie on your back. Medically controlled labor is the most selfish thing a mother can do to their unborn child, get the baby all drugged up before they have even come out of the womb...so mommy can have a 'less painful' labor. THAT IS PURE SELFISHNESS. Do you know what the definition of LABOR is? I do want to thank all of you moms that deliver in the hospitals though, thank you for being the test tube monkey, I'll stick with my midwives though.

    May 23, 2011 at 10:42 | Report abuse | Reply
    • Miriam Hamsa

      Amen sister!

      May 23, 2011 at 11:28 | Report abuse |
    • jim

      Gee, Dawn, I'm sorry you didnt get into medical school, but after reading your little diatribe, the reason brecomes pretty clear.
      But just to appeal to that tiny little part of your brain that may yet be undamaged, I would like to point out that the "natural" state of affairs is that either the mother or baby will die in about 10-20% of childbirths. Go visit the cemeteary in any smalll town. At the turn of the last cetury, families that did not lose at least one member from com;lications of childbirth are few and far between. And somehow I dont think it was impovements in "home birth" techniques that have made the situation what it is today. I think a lot of it was from doctors practiciing that non-evidence based science to which you refer.
      Another thing- there is NO pain involved in natural childbirth. Huimans are the only species who suffer significatn pain duruing labour, simply because increased brain size was such a huge selective advantage during our evolutrion, that the head became very large relative to the female pelvis. Hence, it hurts like Hell, and is anything but the "natural" process it it supposed to be, and is in other species. Pain has a very negative influence on mother and fetus. High catecholamine levels (adrenaline), and hyperventilation with resultant low CO2 levels cause the uterine arteries to constrict, reducing blood flow to the baby. Thats why it is desirable not to let labour continue past a certain point. Because studies have proven that the babies become progressivley more asphyxiated after a certain time.

      May 23, 2011 at 14:02 | Report abuse |
    • Cathy W

      Jim, you are makiing up statistics out of ignorance. 10-20% of all births would end up with a dead baby or mother?? 300 years ago, the deathrate was no more than 1-2% with midwives. We know this from diaries and records left behind by the midwives of the time. 1-2% was enough that nearly everyone would know of a situation with a dead mother or baby, and would approach childbirth with some worry. For whatever reason, people have decided that childbirth was a lot more dangerous that it was. The death rate skyrocketed in the victorian times when doctors started moving women to hospitals to birth, yet didn't understand hygeine – they'd come from a gangrenous amputation to a birthing without washing hands.

      As for your cemetary comment – the vast, vast majority in old cemetaries were graves of old people and children. Most babies (around 99%) survived birth, but many many babies didn't survive 2 years.

      May 23, 2011 at 16:54 | Report abuse |
  6. keng

    Everyone looks at their own personal "success" stories rather than the whole scope. It's not about the 90% of the time where everything is ok, it's about the 10% when everything goes wrong. There are many things that could go wrong in a delivery.

    Personally home birthing is a risk I would never take; It has to do with safety. The birthing period is one of the most critical and traumatic phases in a child's life. Why even risk it?

    May 23, 2011 at 10:43 | Report abuse | Reply
    • mother of four

      Because the risks of giving birth outside of a hospital are significantly lower than 10% and the benefits are huge. Hospitals all too often create emergencies that wouldn't exist if it weren't for their "interventions". Twenty-one years ago, my oldest son was born after a mostly natural child birth, but not before battling with a doctor to deliver the way I wanted to (he wanted to induce on the due date. I said no. He threatened me with legal action. It was not a pretty scene).

      Meanwhile my friends and acquaintances were giving birth as well. I did the math once. Out of ten women, eight were induced, 6 of those became C-sections. The two who didn't did the smart thing and didn't show up at the hospital until the last minute. They all delivered at a different hospital than I did–using the same doctor. These were all young, healthy women and only one of them had health problems. The primary excuse for the C-sections were "failure to progress". Three of those babies were born jaundiced and required more medical intervention which involved bottles and undermined the breastfeeding relationship. At least two of these infants wound up allergic to their formulas and had trouble gaining weight. This meant more trips to the doctor. Are you getting the picture now?

      As I've mentioned in other discussions here–after two hospital deliveries–one of which a doctor wanted to turn into an emergency and another that became an emergency after the birth– due to their incompetence–I determined that there had to be a better way. And there was. An out of hospital delivery. No emergencies–normal, easy births.

      May 23, 2011 at 11:43 | Report abuse |
    • HPNIII

      Because people are tired of being black mailed by a medical system that is filled with a bunch of arrogant, mindless, thoughtless money hungry thugs. People would try to take out their own appendix if they thought they could. The medical mafia has a monopoly on your life and they know it, what they don't know is just like the auto, steel, and other unions that priced themselves out of business so shall the medical profession, as it is not a question of will we have socialized medicine, it is just a matter when.

      May 23, 2011 at 11:49 | Report abuse |
    • @keng

      This is exactly why women chose to give birth at home. In the hospital you're subject to a plethora of routine interventions, many of which have NO benefit to the mother and baby, yet come with plenty of other risks.

      For example, take external fetal monitoring. This is one intervention among many that isn't optional in the hospital anymore. You may be able to opt for *intermittent* monitoring, but by golly they're gonna get their readings! They say this is so they know if the baby is tolerating labor alright, but the actual evidence based studies that they ignore say that since we've introduced fetal monitoring outcomes for babies HAVE NOT gotten any better, and outcomes for mothers have gotten MUCH worse. Of course, as long as you have a healthy baby, everything is alright... right?

      So why do they continue to use this practice even though the studies very clearly show it's not of benefit? Because if they get sued they have a strip of paper to clearly point to that says "I did everything I could". Forget the mothers and babies maimed by unnecessary surgery, it's there to cover THEIR butts, not provide better care for you.

      For every person that tells me they're scared to give birth at home, I tell them I'm scared to give birth in a hospital. I know what goes on in there, and the majority of it is not for my, or my baby's safety.

      May 23, 2011 at 11:58 | Report abuse |
    • CJEH

      one third of women delivering surgically is not "10% going wrong"- it is over use of life-saving birth technology, all for the sake of liability coverage.
      Fact: Although the surgical birth rate in the US has gone up by over 20% in the last 10 years, the maternal and infant mortality rates have not decreased at all.

      May 23, 2011 at 12:09 | Report abuse |
    • Cathy W

      First of all, please look up the actual risks before quoting numbers. Second, there are risks no matter where you chose to birth your baby, including in the hospital. It's really not like home=unsafe, and hospital=safe. People don't get hospital-born infections (which are very serious, and can result in death, or the loss of limbs) at home. The rate of complications is actually LOWER at home. And when complications do arise, you transfer to the hospital. You are so concerned about number; how about these? My Certified Nurse Midwives who did both home and hospital deliveries have delivered over 3000 babies in 20 years, and never lost a single mother or child. They would deliver the baby in the hospital if the mother chose, and would attend her there. But about 80+% of their mothers plan homebirths. Their transfer rate for first-time mothers is 10% (transfer might include failure to progress, breech presentations, +42 weeks, meconium in the fluid, or the moms wanted painkillers, etc), and 6% for moms who have done it before. Their overall c-section rate (ie, the women that go on to need a c-section by an OB) is only 6% TOTAL (compare that to the national average of about 30-40%). They only deliver at home if everything is going well, otherwise they have you move to the hospital, where they go on to attend you there. Remember, they take ALL mothers. Good candidates for homebirth, which they will do at home if eveyrthing looks good, and the higher risk moms, which they handle at the hospital, with OB backup if needed. No dead babies, and no dead moms.

      May 23, 2011 at 12:10 | Report abuse |
    • Katie

      If mothers-to-be make informed decisions every step of the way during their pregnancy, if they are willing to advocate for themselves and be very clear with their physicians and midwives and significant others about their desires, expectations, and willingness to accept responsibility for their decisions, there is no reason why birth shouldn't be a wonderful experience, even if you happen to be one of those 10%. People need to stop criticizing people who have C-sections – both my children were delivered that way, not my initial choice, though I was very much pressured by medical personnel to have a VBAC despite 72 hours of non-progressive labor because the baby was too big to descend into the birth canal – and they need to stop pretending home births are safer or better than hospital births. I have a friend who had a bad experience with home birth – the midwife brought along an apprentice who brought her own music and insisted on playing it, and the midwife kept rebuking the mother, albeit gently, for screaming while in the throes of painful labor. Another friend had a midwife who remarked that her calm demeanor and constant inquiry as to the wellbeing of everyone else attending her was indicative of abused women, greatly upsetting the father. Both types of births can be great, both can be less than that – all mothers-to-be need to make informed decisions, need to have clear, constant communication with their deliverers, and everyone involved, parents especially, needs to know what to do in an emergency and to take the responsibility for the outcome

      May 23, 2011 at 12:57 | Report abuse |
    • @katie

      I agree with everything you said – except "...they need to stop pretending home births are safer or better than hospital births."

      It's not pretending if the majority of studies hold it up. Home birth is as safe or safer than hospital birth.

      I'm sorry your friends had less then stellar experiences with their midwives. Just as I'm sorry for women with less than stellar experiences with OBs. Birth can be better, but it takes providers who *listen* no matter the location.

      May 23, 2011 at 13:03 | Report abuse |
    • CP

      I agree! Thank you for posting.

      May 23, 2011 at 13:50 | Report abuse |
    • jim

      I really wonder where all the people in this blog get thier "facts" from. The book of wishfull thinkiing I suspect. Anyway, I am an anesthesiologist with 24 years experience in obstetrical anesthesia and analgesia. I personally have seen at least 5 cases over the years of babies who needlessly died because of home birth, and several other cases of severe asphyxia. That many over 24 years may not seem like many, but remember I am but one person. A couple of these cases were from very poor patient selection and judgement (eg doing home delivery with twins in a vertex-breech presentation), but several were also low risk, "normal" prengnacies. One turned out to have a placenta accreta (where the placenta grows into the uterine wall), which of course was not diagnosed as the mother did want any "unnaturall" interrventions such as ultrasound pre-op. She bled to death. Arrived at hospital at 8 am on deaths doorstep, too late for any interventions to save her. If she had been in hospital this would NOT have happened. An another one, the umbilical cord prolapsed-came out first- and the babies head occluded it and cut off its own blood supply. Althought the midwife did the proper manouver to try to prevent this, by the time an ambulance was called, the hospital reached, and a c-section set up and performed, it was too late. The baby suffered severe brain damage and will spend the rest of his life a vegetable. Wouldnt have happened in hospital.
      And I know, I know, there are many posts here from women who had happy uncomplicated home deliveries- as the vast majority are. Great. But thats not the point really, is it? Talk to the mothers I refer to above about what they would do if they could do it all over again.
      Few and far between are the professionals-obstetricians, GPs, anesthesiologists- the ones with real experience (having 4 heatlhy home births doesnt really qualify you as an expert) who will agree that home births are better or safer. And no, its not because of the money. That concept is a complete insult.
      One final point that most people dont realize regarding the "statistics". If a midwife brings a labour gone bad to hospital and there is an adverse outcome, it goes on record as a HOSPITAL complication. Also, remember that high risk labours for whatever reason are done in hospital, not home. So the complication rate for homebirths should be much lower, as only low risk pregnancies are delivered there.

      May 23, 2011 at 14:24 | Report abuse |
    • Austin CPM @ Jim

      Yet when you look at the apples to apples comparison studies (low risk, good candidate home birth moms vs equally low risk hospital moms) the outcomes are THE SAME, or possibly better on the side of homebirth. Even the gold standard: the Cochrane Review found that with all things being equal there was no difference in outcomes.

      During your 24 years as an anesthesiologist, how many baby deaths have you seen, total? I'm sure the 5 you use anecdotally weren't the only ones. How many were a result of iatrogenic complication? I'm also sure, that being familiar with statistics and study design, that you understand that the plural of anecdote is not data.

      May 23, 2011 at 14:35 | Report abuse |
    • jim

      You are kind of missing the point here. Dead babies caused by homebirths gone wrong are not anecdotes, they are dead babies. No one denies that carefully selected births tended by a competent midwife, or whatever, would have the same outcome as similar hospital based births (by the way, everyone who posted saying hospital births are more dangerous shoud heed this statistic). The point is, things can and do go wrong. And they go wrong with the same frequency in and out of hospital. If you are at home and there is significant delay getting help, the outcome will be affected. This is rocket science.
      The frequecy of it is low enough (in properly selected patient groups) that huge numbers of patients would neet to be examined over long periods of time to reach statistical sigificance. Its like looking at a group of people who started smoking one year previosly and concluding thier cancer rates are the same as a group that didnt start. Wasnt it Mark Twain, who said something about lies, damn lies, and statistics?
      To my knowledge I have never seen an iatrogenic death. I have seen plenty of iatrogenic complications in any area of medicinel . I have seen lots of c-sections that turned out IN RETROPSECT, to have been unnecessary. They were done with the best intentions based on the best eveidence at the time.
      Why would I lie to you?

      May 23, 2011 at 14:49 | Report abuse |
    • Cathy W

      And Jim, you missed HER point. There are babies who died BECAUSE they were born in hospitals. One example is the recent MSRA infection that killed the baby and caused the mom to lose limbs. There are other examples of stupid hospital policies that CAUSED complications. Routine Fetal monitoring is one example. If they had been at home, those "non-anecdotes" would be alive.

      No matter WHERE you give birth, you have risk. It is not an example of home=unsafe, and hospital=safe. You are also using the rule of small numbers – 4 babies in 24 years? That is incredibly rare. Just as the babies who died due to complications caused by hospital policies are also very rare. Given how rare it is, assuming it to be unsafe or irresponsible is just nuts. Perhaps people shouldn't get in their car, because that's WAY WAY more likely to cause neonatal death than home birth.

      May 23, 2011 at 15:18 | Report abuse |
    • DP

      There's a 10% transfer rate from homebirths to the hospital. Most of those are "abundance of caution" transfers, hardly "everything goes wrong" as you say. Maybe you're thinking of just those medically managed births where "everything goes wrong" because there are so many more complications in a hospital environment.

      May 23, 2011 at 16:29 | Report abuse |
    • Meghan CNM

      There are no reliable data that planned home birth, with an appropriate candidate, an experienced provider and adequate backup, is less safe than hospital birth. Being in the hospital has taken on almost mythic qualities in American birth culture. Being in a hospital is not necessarily safer for low-risk women. Being in the hospital - particularly one without 24-hour OB and anesthesia coverage, which is the case for many community hospitals - is no guarantee of a healthy mother or baby. What we do know is that being admitted to the hospital significantly increases the risk of postpartum hemorrhage (pitocin use for induction is a risk factor) and major surgery, among other complications.

      Hospitals and physicians can be lifesaving for some women and some babies. But the US has the worst birth outcomes of any peer nation, with the highest use of technology and intervention. The Netherlands has a 30% home birth rate and better outcomes, for mother and baby, than the US does with its 30% cesarean rate. I spent ten years as an OB nurse and saw some of the least evidence-based care I've ever seen in health care, and as a CNM have had to do some myself to conform to community standard of care, which is a requirement of malpractice coverage. We induce women at 40 weeks, without evidence it improves outcomes. We section women for breech because we've lost the skills to do anything else. We use bed rest as a treatment for preeclampsia in the absence of any data that it does anything but create risk of iatrogenic DVTs. We induce for ruptured membranes when the data tells us it does not prevent infection. We create a climate of fear where respect is more useful.

      There are no guarantees, in life or in labor, and as much as we would like it, the hospital does not guarantee us safety. Nothing can do that. Birth at home is not an option for all women, but we need to keep it as an option for low-risk women, and to create the structures needed to keep it safe. We need backup physicians and hospitals. We need skilled assistants for resuscitation. We need access to uterotonics and antibiotics and safe, timely transport, and we need to stop asking physicians to handle a role they are not trained to fill.

      May 23, 2011 at 21:39 | Report abuse |
  7. Julie

    I had a wonderful home birth experience. There was a little glitch when the baby's shoulder got stuck. If I had been in the hospital I would have gotten a huge episiotomy and a forceps delivery. But the midwife just had me change positions and she reached in a twisted him out. I was so comfortable at home. I wasn't tethered to an IV pole. I could soak in a hot bath to relieve the pain. And I could eat when I got hungry. The whole thing cost $1,500, INCLUDING prenatal care and breast-feeding assistance.

    May 23, 2011 at 11:28 | Report abuse | Reply
    • Katie

      Good for you. Not everyone is so lucky. My son became stuck in the birth canal and changing positions didn't do anything to help him. The doctor tried manipulating him (with fingers) to turn or to go back and re-descend but he remained stuck. Forceps and suction were presented as options, along with all their risks – possible skull fractures, massive bruising – as well as an episiotomy. I was the one who asked about a C-section instead, which they did not want to do unless they had too. Forty-five minutes later, with my resting on hands and knees, butt up in the air, our son made the decision for us – he went into distress and his heart rate dropped. We had an emergency C-section and delivered a healthy, big boy. For me it was absolutely the right call and my only regret is that there are people out there who think I took a lazy way out.

      May 23, 2011 at 13:03 | Report abuse |
  8. Gabor47

    Explaining would take thick book, so I just state it in one sentence: having a baby at home is significantly more dangerous than having it in a hospital. Yes, I am a retired (thus I have no financial advantage saying so) obstetrician, delivering babies for four decades.

    May 23, 2011 at 13:45 | Report abuse | Reply
    • Austin CPM

      Gabor, explain the studies that say otherwise? References, please.

      May 23, 2011 at 14:17 | Report abuse |
    • Susie Bennett

      So, even though you may not have any financial gain at stake at this point, you still are biased (your friends could gain financially from it), and you just make your proclamation, expecting us to take it seriously, without backing it up? How patronizing is that!

      May 23, 2011 at 17:05 | Report abuse |
  9. shady

    statistically speaking, medical students who end up entering OBGYN are the bottom of the barrel of the medical school class. think i'm wrong? look at average USMLE scores by specialty. fewer people are going into the specialty, but the reason is all money – they get sued so much that their insurance premiums are thru the roof. why do they get sued? because every mother with a mentally handicapped child blames the OBGYN, not their own unhealthy prenatal habits. still, don't stoop even lower and hire a midwife who has even les of an idea what she's doing. but even if you do, the government shouldn;t use my taxes to pay for the kid's bills.

    May 23, 2011 at 14:59 | Report abuse | Reply


      May 23, 2011 at 15:06 | Report abuse |
    • Cathy W

      I'm one who uses the high premiums as a reason to question the ASSUMED safety of hospital births (the malpractice rate is an example of there being a problem – OBs make mistakes, and babies die or are damaged because of that – fortunately this is rare.)

      But I also think you are being really, really unfair. The reason fewer docs are becoming OBs is that they cannot afford to pay the premiums – so yeah, it's a money issue, but not because they can't get rich, but because they can't make a living. They pay those premiums for 18 years after they stop delivering babies. I think this is a tragedy, frankly, that qualified, passionate doctors are being scared off from OBGYN. As much as I valued my homebirth and my wonderful CNMs, they had wonderful OBs who backed them up, checked the moms at 35 weeks to see if they agreed that we were still a good/safe candidate for home birth (requested by the midwives to double-check and see if they missed anything in our history or whatever), and then if something did go wrong, helped out or took over once we transferred to the hospital.

      OBs ARE necessary to the safety of birth in the US. They are the ones we want around for anything more complicated or high risk (although my midwives were known to train OB candidates how to deliver breech babies, as it's often not taught in med school anymore).

      May 23, 2011 at 15:29 | Report abuse |

    JIM- Midwives aren't professionals now? How many actual births without intervention have you seen? I'm guessing not that many. EVERYWHERE ELSE IN THE WORLD, MIDWIFERY IS THE STANDARD OF CARE! Our newborn mortality rate is disturbingly high for being the United States. Look at Europe- safe babies, safe mothers –> is it a coincidence that 80% of births are attended by midwives, and many are done at home? Seriously, stop sucking AMA.

    May 23, 2011 at 15:05 | Report abuse | Reply
    • Grasp of the Obvious

      If a woman gives birth at home and the baby dies, does that get reported?


      May 23, 2011 at 15:20 | Report abuse |
    • Austin CPM @ Grasp of the Obvious

      Yes, actually. Any birth (and death) must be reported by law. Where do you get the idea that it wouldn't be?

      May 23, 2011 at 15:27 | Report abuse |
    • Grasp of the Obvious


      If there is not a cop in the room and nobody knows the difference, then a lot of those stillbirths are not going to be reported. Why did you think they would be? Oh, because there's a "law", right. The midwife does not benefit from telling people about all the babies that died.

      May 23, 2011 at 15:31 | Report abuse |
    • Austin CPM @ Grasp of the Obvious

      Letsee all of the reasons to report a death:


      I know you wont believe those 2.. so how about these:

      Because the grieving parents want to bury their baby properly, and need a death certificate to do so?
      Because the parents know their baby is dead, and want it reported?
      Because my assistants know and know it should be reported?
      Because I could lose my license if I don't report?
      Because it's a criminal offense if I don't report?
      Because I care for my family and wouldn't want to spend time in jail over something as minor as reporting a death? (not that the death is minor – reporting it is)

      I'm sure there are other reasons, but in my time as a midwife, I've never had a baby die, so it's not a process I'm intimately familiar with.

      May 23, 2011 at 15:40 | Report abuse |
    • Grasp of the Obvious

      Yeah Austin:

      People lie. Especially when their incomes depend on it. Welcome to Earth.

      May 23, 2011 at 15:43 | Report abuse |
  11. Grasp of the Obvious

    It's because they can't afford to pay the greedy doctors. Doctors are for executive billionaires only; it's pain and filth for everyone else.

    May 23, 2011 at 15:19 | Report abuse | Reply
  12. Austin CPM @ Jim

    I don't believe I ever called you a liar, Jim – so I'm not sure where that part of your post came from. I am debating that your use of anecdotes is appropriate. I can cite several cases that have made it into the media where mom, or baby have died as a result of iatrogenic complication (one being fairly recent where there was a mix up in epidural medication that resulted in death)

    Here's the thing epidural complications are fairly rare (I'm sure you'd agree), but should we remove all epidurals on the off chance you hit the statistic and have a lethal reaction? I think you'd agree that this would be an over reaction to a small statistic – much as you are over reacting to the small statistic of poor outcomes in homebirth.

    A well supported midwife who can confidently transport mothers/babies in need will have better outcomes (and will transfer sooner!) than a midwife who is facing a hostile hospital environment for her client. Do you support the homebirth mothers who transfer to your facility, or do you tell them how foolish they were to take such a risk? Do you accept the midwife's charts and history, or do you treat her as an "unprofessional" or "untrained" attendant?

    May 23, 2011 at 15:21 | Report abuse | Reply
  13. jim

    Actually I am in Canada. SO i dont know your midwife situation. But the good, well trained ones, are absolutely professionals.
    What we are tending to do here now is set up the "birthing rooms" in hospitals to be just like your bedroom at home. There is "normal" furniture, fetal monitoring only when indicated (yes, the medical professions recognizes it was overused in the past-because it was new and the facts were not yet know-not bevcause of an ulterior motive).All medical equipment is behind curtains out of view. Mother can have an epidural, opiates, or nothing if she chooses. Many labours are tended to exclusively by midwives, if the mother chooses.
    So whats wrong with this option?

    May 23, 2011 at 15:27 | Report abuse | Reply
    • Grasp of the Obvious

      American hospitals have had home-like birthing rooms for decades now. The only real issue is the cost. Doctors used to charge reasonable rates. Nowadays, thanks to government-enforced, employer "provided" health insurance, doctors can get away with charging $8-20k per birth. That's right. $8k if you're lucky and go with only the cheapest options. $20k if you're not.

      May 23, 2011 at 15:34 | Report abuse |
    • Cathy W

      Jim, the problem with that option is that they are still IN HOSPITALS, which are full of sick people and diseases that mothers and babies should not be exposed to. Free-standing birth centers across a parking lot from the hospital proper are quite a bit better in that respect. The birthing centers are still going to be run by insurance companies or hospital admins that will demand certain rules, regardless of whether there is evidence to support the safety (many hospitals will not support vbacs, despite the fact that as long as pitocin is not used, the risk of uterine rupture is about the same as it is for a first-time mother). And, finally, if a woman is uncomfortable in her birth environment, the outcome is likely to be less good. (I mean that both ways – a woman terrified to give birth at home should not do so – she's likely to be so tense, her labor won't progress as it should. Ditto for me – I find hospitals to be creepy, public places full of sick people – I'm much more able to relax at home, where I can be naked and walk around if I want)

      Either way, if the statistical outcome is the SAME for home vis. hospital, why wouldn't and shouldn't the home be an option, without the mothers being called irresponsible?

      May 23, 2011 at 15:44 | Report abuse |
  14. Cathy W

    @ grasp of the obvious:

    It's not all about poliics. Birth is much safer and less expensive in Europe than in the US, and it's mostly government-mandated socialized healthcare. Regardless, I don't think it's fair to condemn all doctors. There are plenty of wonderful, passionate and dedicated doctors. I suspect hospitals and insurance companies are more of the culprit for the expense of birth.

    May 23, 2011 at 15:50 | Report abuse | Reply
    • Grasp of the Obvious

      Alright Cathy, the doctors can cut their fees whenever they like. So can everyone else. Hospital administrators, nurses, everyone. But as long as most people still have "free" health insurance (paid for by their employers), then the doctors, nurses, and hospitals are not going to cut their fees. They don't have to because the insurance company will always pay.

      May 23, 2011 at 16:01 | Report abuse |
    • Cathy W

      Grasp, can you point to a common break-down in fees during a typical birth? I believe the lionshare is going to the hospital, not the doctor. Even if the doc does it for free, it would still be really expensive. FWIW, my inurance would have paid for a hospital birth if I'd wanted one. And, they paid for my homebirth, much to my surprise. I had paid the entire fee by breaking it up during my pregnancy and paying about $400-500/month. Then the insurance company came through, so my midwives reimbursed me for everything except the tiny part not covered by insurance. It was weird – insurance had told me they wouldn't pay, so it came as a surprise when the midwives submitted it, and it went through.

      May 23, 2011 at 16:12 | Report abuse |
  15. shady

    no idea what i'm talking about, you say? i'm a surgical resident who has delivered many babies in my time as a medical student. OBGYN is an awful field tho, so i didn;t go into it. anyway, delivering a baby is easy in 95% of cases. the reason you should do it in a hospital and not in a barn with a midwife are the 5% of cases where things go wrong. what if your membranes rupture more than 2 hrs before the kid comes? there wont be any amoxicillin, do you want to die of endometritis?? did you know the gravid uterus receives 25% of the the blood pumped with each heartbeat? if the placenta doesnt come off, wouldnt you want a little pitocin IV to stop the bleeding?? you could bleed out in 2 or 3 minutes. does a midwife come with all those supplies?? Boom.

    May 23, 2011 at 16:18 | Report abuse | Reply
    • Austin CPM @ Grasp of the Obvious

      In the vast majority of hospital births, shady, membranes are artificially ruptured more than 2 hours before birth. Often times it's one of the first things done as part of an induction. You have 24 hours from that point (not 2) before infection becomes a concern. At home though, things are different – first of all, we don't break the membranes – they release naturally on their own. Following that, once membranes have been released there is a lack of cervical exams. The fewer you do, the lower the risk of infection. Believe it or not, it is possible to go through a woman's entire pregnancy and labor without ever once putting your fingers inside her to examine her or her cervical progress!

      As a midwife, I do in fact carry IM Pitocin with me, but I have other tricks in my bag that I prefer to use first. There are MANY things that can be done prenatally to help reduce the chance of hemorrhage, and many more things that can be done in management of the 2nd and 3rd stage to help prevent hemorrhage. Not manually delivering the placenta is a huge one. Not inducing and having an overly stressed uterus helps too. It might surprise you to know that among other things, I am NPR certified (and must maintain my certification as part of my license) and carry o2 as well, though recent studies show that positive pressure ventilation is better.

      Midwives don't show up to a birth empty handed expecting roses and fairy tales. While the majority of births are non-issues, we are trained and prepared to handle complications at home. Part of our training includes knowing WHEN things have moved beyond our scope and it's time to transfer.

      May 23, 2011 at 16:34 | Report abuse |
    • Austin CPM

      oops that was supposed to be @ shady, not grasp of the obvious.

      May 23, 2011 at 16:35 | Report abuse |
    • Cathy W

      The standard for ruptured membranes is 24 hours, not 2. Regardless, I was on IV erythromycin (yes, an IV CAN be done at home – weird, I know) Because I was GBS+, so yes, my CNMs carried antibiotics. They also carry pitocin and oxygen and a few other emergency supplies. Generally, home births are carried out in houses, not mangers

      May 23, 2011 at 16:39 | Report abuse |
    • Cathy W

      Shady, you may be a surgeon, but you don't seem to know much about the practice or risks of either homebirth, hospital birth, or midwifery. How many women die during c-section surgery? Does it compare to the maternal death rate of homebirths? How many women wind up with complications from their epidural, which then necessitates a c-section? How many mothers or babies died in that situation? Doe sit compare with the dangers of home birth? What about episiotomies? How many serious 3rd-degree tears did women get because it was a supposedly "safer" practice? (oh, and what is the average length of labor for a women with an episiotomy vs, one who didn't have one?) What are the infection rates amongh home births vs. hospital births? My guess is that you don't know. And neither do most people. Without knowing those questions, and many others, how can you know with such certainty that the hospital is so much safer?

      May 23, 2011 at 17:11 | Report abuse |
  16. musheded

    There is a happy medium actually, and they are specially certified 'baby friendly' hospitals...yes that's what they're called look it up, though they are mainly concentrated in the north east and on the west coast. There are only over 100 such hospitals in the entire U.S., but wow does it make all the difference. These hospitals encourage exclusive breast feeding, and actually require you to give them a birth plan of how you want your birth to go before you go in! Our experience was awesome at the one hospital in our area that happened to be part of our health plan. My wife decided what she could handle, and they let her labor for much longer than most hospitals before intervening in any way she labored for approximately 56 hours from start to our beautiful daughter being born. It was nice that they didn't try to force anything on us and we tried to make the experience as comfortable as possible, though we won't have them break her water when we have our next child since she likely wouldn't have needed an epidural had the pain not gone from manageable before the water break to so intense that she could barely sit up. These hospitals truly are baby friendly and they leave you alone with your baby for an hour after they're born and then only come in after that when asked to. Then a few hours later they move you to another private room to stay the night (if you need or want to) and really only help you with things if you ask and your baby sleeps with you until you go home...kind of like being at home.

    May 23, 2011 at 16:22 | Report abuse | Reply
    • Cathy W

      I liked my homebirth, but I think I'd prefer – rather than one of these hospitals – a free-standing birth center across the parking lot from the hospital. That way, you dont contaminate the OB ward with illness-causing germs.

      May 23, 2011 at 16:41 | Report abuse |
  17. Cathy W

    When I was planning my home birth, I interviewed a doctor (who was also pregnant) about being my baby's doctor. She was more supportive than most – her sister had had a homebirth. She said something very telling: "in medical school, I learned about all the things that can go wrong in a birth – which makes me too paranoid to do it at home." But, she didn't scare me or tell me I was irresponsible and taking terrible risks with my baby's health. I liked that doctor.

    May 23, 2011 at 17:15 | Report abuse | Reply
    • Yubraj

      The Diaper Champ! Now that's funny! I love it. The one of her lnguhiag is great I also like the one of the two of you lnguhiag at the foot of the couch. Just seems like a natural shot of you two.Congrats on the babes. Birth is an amazing journey enjoy the ride! Carolyn Fitz

      July 1, 2012 at 18:01 | Report abuse |
  18. Cathy W

    I've also found that medical personnel are terrified of pregnancy and pregnant women. When I was 37 weeks pregnant, I had some visual disturbances. My husband rushed me to the hospital where I was tested for preeclampsia etc. My midwife told me she thought I was fine, but had her backup OB look me over, and that doctor told me that I was probably having an ocular migraine, but that I should see my general praciticioner the next day to check for a detached retina (very unlikely).

    So I went to my regular doctor, who went nuts when she heard I was under a midwife's care, thinking that they should have done a ton of blood tests and liver tests, etc., I looked at her, and said that the OB had ruled out preeclampsia, too, and that neither thought I had the symptoms of of something serious. She grugingly agreed that an ocuclar migraine was most likely given my symptoms. I was upset and freaked out, and considered calling my midwife to ask for the extra tests. But then I thought "the OBSTETRICIAN," who is an expert in the field didn't think I had it, and who am I going to trust – the GP or the OB? I didn't care for that doctor much. But then, after my daughter was born, that doctor ended up being her doctor for the first 2 years of my daughter's life, and she was a GREAT doctor for that. She just freaked out unnecessarily, over a topic she didn't know much about.

    May 23, 2011 at 17:21 | Report abuse | Reply
    • Austin CPM

      I think it's in large part because doctors aren't familiar with midwives and what they do. I think they kind of envision this sort of wild, cowboy birth where everything is out of control and there's no understanding or training when things go wrong. I think in large part this is confirmed for them because they often see the worst of homebirth transfers without ever seeing the best of births that stay at home. If all you ever see is the worst of something, how can you ever believe it's safe?

      I think another twist is they are intimately familiar with what goes on in an L&D ward and try to imagine that at home, and that just doesn't happen.

      I really do think there needs to be more collaboration, communication, and cooperation between homebirth midwives, and OBs. The result can only be clarification of roles, and better support for mothers – which in my opinion would be a good thing.

      May 23, 2011 at 17:37 | Report abuse |
    • Jhumel

      Hi Alexandra what a great post, I think it is so important to get this topic out there for diiosssucn. I was very lucky to have a wonderful midwife who really supported (and, in fact, encouraged) me to have a water birth. During my labour, she brought in an older midwife to assist the older midwife had never seen a water birth before. I was a bit busy at the time to think about it but afterwards, I was really glad she did that as I think it is important for as many midwives as possible to see the benefits of water births for themselves Suse recently posted..

      July 1, 2012 at 10:47 | Report abuse |
  19. Jessica

    Please make at least a cursory effort to give balanced information. ACOG has an obvious interest in squashing the rising trend toward more home birth. The meta-analysis that showed an increase risk of newborn death with home birth included ACCIDENTAL and UNATTENDED home births. There is absolutely no data to indicate any higher risk with a skilled attendant present. CNN, please consider talking with an organization like the Midwives Alliance of North America to balance out the skewed perspective of ACOG. Isn't that what journalists are supposed to do - present BALANCED information?

    May 24, 2011 at 14:40 | Report abuse | Reply
  20. Carol Parker Stein

    I don't understand this 94% figure. that doesn't seem possible. I had 4 home births in the late 70's and 80's, and it was a time of it being more popular, as the birthing centers started to appear. it was the best choice for me, and I am so grateful for my midwives who attended me. Absolutely the highlights of my life!

    May 24, 2011 at 16:28 | Report abuse | Reply
  21. Adelvise

    I personally think that the best place to have a baby is where you feel confident, comfortable and safe. For some women that is at a hospital, some a birth center, and some in their living room. If people are informed and smart about it, I say have your baby where you want! http://www.growhappybabies.com

    June 9, 2011 at 12:37 | Report abuse | Reply
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    Look Here for more information about having a home birth.

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    Go, midwives, go! Good lay midwives. I like you.

    July 3, 2011 at 21:35 | Report abuse | Reply
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