My position is changing

I have spent much of my time recently examining numerous studies comparing hospital birth to homebirth and other out-of-hospital birth. I am not a scientist, and I struggle to make sense of a lot of the data.

But in the spirit of intellectual honesty, I have noticed a trend that is disturbing to me. I have found the following:

1. Comparisons of hospital births to homebirths consistently show a marginally greater number of neonatal deaths (that's death of the baby within the first 28 days of life) in the homebirth groups. When perinatal mortality (includes the neonatal rate plus all fetal deaths from 20 weeks of gestation) is calculated in, the mortality rates between hospital birth and homebirth are nearly the same. However, there does appear to be a higher risk of neonatal death in homebirth.
2. To find these figures, you generally cannot use homebirth supporters as resources. The problem is that one person might have used the perinatal rate of homebirth from a study to compare to the neonatal rate of hospital birth, which might make the homebirth group look more favorable but is a misrepresentation of the findings of the study. Then other homebirth supporters quote that person instead of reading the study themselves. When I tried to research homebirth, I found the same unsubstantiated quotes used again and again.

I have said before that I am not at heart a homebirth supporter though I find myself in sympathy with their cause, because they oppose the hospital routines and invasive, unnecessary procedures I also find objectionable. But finding the above to be compelling and, through my unlearned, unscientific eyes, evidently true, I have had to look closely at my position.

Neonatal deaths can occur for a variety of reasons, but it is reasonable to assume that more complications can be addressed favorably in a hospital instead of at home, at the very least because of surgical capacities in the hospital not available elsewhere. So if you have even one childbirth complication that can be successfully resolved by cesarean section, the homebirth group is at a disadvantage.

Does this make homebirth unsafe? I think by definition it makes homebirth less safe than hospital birth.

My position on homebirth is much more cautious now. As a doula I will still support women who opt for homebirth, especially in my current community, because our health care situation is a sorry one, and our single small-town archaic hospital here may very well be doing more harm than good on the whole. But for myself, I find the risk too much to bear.

I support the birth center attached to the hospital option, and that is where my fervent support will henceforth be directed.

Perhaps once I am further along in my schooling and have taken a statistics course or two, I will be better able to analyze the data at hand. As it is, I am disheartened by what I found, but I am committed to being honest about what it says.