Here’s something I’ve learned to be afraid of after spending a lot of time looking at them: Numbers. Oh they can be very useful. But they can also be very, very misleading. Our highly-evolved human brains with these gigantic neocortexes, living in a society where technology, science, and progress are revered, have us subduing every other way we have of knowing to numbers. Flawed numbers.
I love numbers. I want to know them in order to control my surroundings. But the more time I spend with numbers, the more I side with Mark Twain.
There are three kinds of lies: Lies, damned lies, and statistics.
Studies are done by people, almost 100% of the time with a bias, and are not comparable to any other study in any perfectly useful way. I am always looking for data about birth, specifically about natural birth and more specifically about breech birth. This data is good to have. But I don’t believe we should ever make personal decisions purely on the basis of data. Clinical decisions, institutional decisions, maybe. But not personal decisions.
To illustrate the problems with doing this, I have pulled numbers from a recent article comparing infant death rates at home birth to those at the hospital. The comparison is, as the author intends, shocking.
There are too many extenuating circumstances, though. For example, the two compared numbers, which state that your baby is 5.5 times more likely to die in home birth than hospital birth, are not comparing the same thing. The hospital stats are for low risk women with low-risk pregnancies. I know of no hospital, government agency, or obstetrical organization that categorizes breech or vbac women as low risk. The midwives numbers include these women. Many of them. In fact, a good chunk of the home birth deaths (five of the 22) reported by the midwives were breech babies. If you take out all the women that no one else considers low-risk, the comparison is much less shocking.
Still an increased risk, perhaps? There is no way to know because we can’t know the true circumstances behind every piece of reported (or unreported) data, in either study.
We can definitely say that the mothers planning a home birth are wildly safer than women birthing in a hospital. The cesarean rate for planned home births is very, very low. Cesareans carry significantly higher health risks for the mother, negatively impact breastfeeding, and put any future babies she may have at increased risk.
Sometimes it is worth taking a small risk for a good or important cause.
Women who choose to birth at home have their good reasons, as do women who birth in hospital. This article I read quoted absolutely the most ridiculous reasons to choose a home birth I have ever heard–in fact I have never heard any woman mention a single one of these when talking about her decision to birth at home (things such as “I don’t want to have to drive home from the hospital”). It makes home birth women seem empty-headed, when in fact the vast majority of home birthers have put more thought and research into their birth choices than anyone on the maternity ward tonight.
So why do women choose hospital birth? I have made a list in the same style.
Note that I have cherry-picked the silliest reasons and ignored the (many) important ones, because we need to compare apples to apples here.
Various reasons for choosing a hospital birth over a home birth:
1. I look forward to getting that ninja-like thrill from sneaking food when I am exhausted from a 24 hour labor and they won’t let me have anything but ice chips.
2. I don’t want to clean up any mess that might result from birth at home.
3. I enjoy being a patient, prefer to ask permission to urinate, and have people tell me what’s best for my baby.
4. I wish to have all decisions made for me, without having to think things through.
5. I prefer not to be responsible for anything that happens to me or my baby.
6. I prefer the nursery to take care of my baby after it is born.
7. Everyone I know has had a hospital birth.
8. I want a drug-free labor and delivery, and this will be easier to obtain if I know the pain-relieving drugs are only a button press away when I want them.
You are choosing these things when you choose hospital birth in many places, but they are probably not the reasons you do so. Just as the use of ugly hospital gowns is not factored into any woman’s decision to avoid the hospital and birth at home in nothing but a sports bra.
I’m now going to just ignore the part where the author of this same article asks who would want their child to have a tonsillectomy at home, since surgery of any kind is not comparable to birth (unless you go to the hospital–where birth very often is surgery).
Personally, I don’t want to put my baby at any increased risk. I chose home birth three times. None of those choices was easy. One time I even changed my mind, due to my baby’s position and the fact that I’d have to deliver unassisted.
If chosen carefully, a midwife in my home can offer just as safe if not safer birth than a busy hospital can. We choose a midwife carefully, for the safety of our babies and ourselves. The same way we choose an OB carefully–preferably one without a cesarean rate of 67%.
Birth carries risk. Every birth. Let’s not forget that
Women who choose hospital birth are also putting their babies at increased risk.
Exposure to hospital germs and infection.
Loss of 1/3 the baby’s blood due to premature cord clamping.
Exposure to fake oxytocin and resulting hormonal imbalance-perhaps for life.
Forceps or vacuum extraction.
Extensive ultrasound exposure from the fetal heart rate monitor.
Risks to the baby (such as gut flora and respiratory difficulties) in case of cesarean.
Delayed or interrupted breastfeeding.
And yes, driving home in the car.
Where is the safest place to give birth?
It really depends. I’m so glad no one wants me to make that decision for them. I don’t even like making it for myself.