Scrutiny
After spending much of my time looking at studies, researching different statistics, and making lists comparing references and outcomes, I've arrived at a different conclusion regarding homebirth safety.
I feel much more educated now than I was previous to the homebirth debates. I'm not where I would like to be, but I certainly feel more confident in my opinions.
I've reviewed countless studies, and what I've found can be summarized thus: Some studies show a slightly lessened risk of mortality for home birth. Some show a slightly greater mortality rate. Often, when the hospital and home group comparisons are restricted to similar risk profiles, the homebirth group shows a slightly lower risk.
The data is spread out, ranging for both homebirth and hospital mortality to all numbers between 0.5 and 3.5, according to many studies.
In all studies, the mother and baby had fewer interventions (instrument delivery, episiotomy, etc.) in the homebirth group, regardless of risk profile (meaning, the low-risk hospital groups had many more interventions than the low-risk homebirth groups).
This brings me to a good question. What is the definition of safety in childbirth?
Does "safe" just mean that no one died?
I believe it's broader than that. I believe that we must include the whole person, the whole mother and baby. We must examine their physical well-being as well as their psychological and emotional health as a crucial factor for a good outcome. If mother and baby are both alive, but the mother bears an unnecessary cesarean scar and feels violated and deprived of her womanhood, that is not necessarily a good outcome. She may be less likely to bond well with her baby, less likely to continue breastfeeding, and more prone to postpartum depression.
For care of the entire person, addressing all issues of wellness for both mother and baby, which I believe is an essential part of safety, homebirth is far superior. This is well supported in everything I read.
The mortality numbers are basically inconclusive, but honestly, I can't say that they lead me to believe there is anything inherently more dangerous to birthing at home. (I cannot say enough that in my area, laboring women are far safer, in every aspect, at home than at the hospital here...but that is another topic.)
I feel much more educated now than I was previous to the homebirth debates. I'm not where I would like to be, but I certainly feel more confident in my opinions.
I've reviewed countless studies, and what I've found can be summarized thus: Some studies show a slightly lessened risk of mortality for home birth. Some show a slightly greater mortality rate. Often, when the hospital and home group comparisons are restricted to similar risk profiles, the homebirth group shows a slightly lower risk.
The data is spread out, ranging for both homebirth and hospital mortality to all numbers between 0.5 and 3.5, according to many studies.
In all studies, the mother and baby had fewer interventions (instrument delivery, episiotomy, etc.) in the homebirth group, regardless of risk profile (meaning, the low-risk hospital groups had many more interventions than the low-risk homebirth groups).
This brings me to a good question. What is the definition of safety in childbirth?
Does "safe" just mean that no one died?
I believe it's broader than that. I believe that we must include the whole person, the whole mother and baby. We must examine their physical well-being as well as their psychological and emotional health as a crucial factor for a good outcome. If mother and baby are both alive, but the mother bears an unnecessary cesarean scar and feels violated and deprived of her womanhood, that is not necessarily a good outcome. She may be less likely to bond well with her baby, less likely to continue breastfeeding, and more prone to postpartum depression.
For care of the entire person, addressing all issues of wellness for both mother and baby, which I believe is an essential part of safety, homebirth is far superior. This is well supported in everything I read.
The mortality numbers are basically inconclusive, but honestly, I can't say that they lead me to believe there is anything inherently more dangerous to birthing at home. (I cannot say enough that in my area, laboring women are far safer, in every aspect, at home than at the hospital here...but that is another topic.)
posted by jenn at 11:48 AM
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