I’ve already gotten some fairly vehement criticism for being party to a home birth. So far, I’ve been told that I was a “wack” who had “subjected your children to unnecessary risk so it could be a subjectively prettier event,” “an aesthetic decision that put others at risk needlessly and recklessly.” And that any other viewpoint was “sophistry” and “rationalization.” Needless to say, beforehand there were a number of people who told us their, similarly critical, opinions of home births.
Opening yourself to criticism is the cost of offering a public account of anything. And making a choice can be taken as an implicit critique of anyone who chooses otherwise. I did not intend to criticize much of anything when describing the birth of our children – in fact, I left out our reasoning on why we chose home birth entirely, because I was not (and am not) attempting any kind of polemic here. I’m interested in the experience of birth – the one I attended was in a home, but a birth in a hospital I’m sure I would find to be quite an experience as well.
But I do want to offer some data, so others can evaluate whether or not home birth is reckless, first of all in absolute terms.
The best data I’ve seen available – a study dealing with millions of births – did indeed find that home births were more dangerous. In fact, on Webmd you can find the sum of the data: “The risk of a baby dying is nearly four times higher when delivered by a midwife at home than by a midwife in a hospital, according to a new study.” Four times higher is a pretty significant amount – an overwhelming amount, in fact.
But that’s only because the risks are so low, in general. The raw numbers are:
The researchers found that the absolute risk of a baby dying at birth or in the 28 days following delivery was 3.2 per 10,000 births when a midwife delivered the baby in a hospital, compared with 12.6 per 10,000 births when a midwife delivered the baby at home.
The death rates are, therefore, .032 percent, and .126 percent. Hospital birth, in other words, is just under one-tenth of one percent safer than a home birth. Hospital birth is 99.97 percent safe, and home birth is 99.87 percent safe.
Now, this is uncontrolled (“absolute”) data. My guess would be that controlled data would favor hospital birth even more – because hospitals have to deal with all pregnancies, whereas midwives can be picky, and high-risk births probably overwhelmingly take place at hospitals. There could be some factors to offset things – certain religious groups who eschew all medical treatment might bring mortality numbers up for home births – but in general I accept that controlled data might look even worse. But the numbers are still there: home birth is 99.87 percent safe.
The numbers were enough to convince us that home birth is generally safe. Then the next question was whether or not it was wise for us. That we based on Catherine’s health, the position of the babies, the fact that the pregnancy had been without difficulties, family history of successful home birth, our comfort with the midwives, and the availability of secondary options in case of emergency. Categorical claims were not enough for us: we used our judgement. Could Catherine, specifically, do this safely at home? There were no specific and credible reasons why she could not. We determined that home birth was right for us.
And of course, it worked out well, which for many people constitutes an argument in itself. But even if it had not – the risks were part of the calculus – I felt all along that our decision-making was sound. There was never a time when either one of us sensed any specific danger to our children: just a general sense that we were involved in something difficult, which could not be taken lightly, and which we were going to do as well as we could.
That might be worth reading, before moving on to the actual account of the birth. Because human birth is an intense experience. It is 99.87 percent safe even at home, we learn, but for most women there is nothing breezy about it. This appears to be true no matter where it occurs.
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