Home Birth and Hospital Birth are Equally Safe

In this time where many question the safety of home birth and use hospital birth as our standard,  there is growing data that home birth and hospital birth are equally safe for healthy women and babies, with well-trained midwives, good transportation, and an integrated approach that facilitates good communication and team work between health care providers and women. When I was recently at Childbirth Connection’s Transforming Maternity Care Symposium, a midwife made a point that really resonated with me. She stood and shared that even our terminology  - “out of hospital birth” uses the hospital as a standard, when has the hospital been the standard for normal, healthy preventative care?”  I would agree that home birth and birth center births should be used for our measure of what is normal for undisturbed birth.  It is time we all take a critical look at the data and the responses some maternity care systems are having. It should be a woman’s right  to choose where and with whom she has her baby, including home, birth center or a  hospital with midwives and/or a full medical team, especially given the data on the safety and cost effectiveness of home and birth center births. I was excited when Jennifer Walker a doula in the Netherlands  translated and sent me a press release about the new study of more than 500,000 women who participated in a seven-year Dutch study, undertaken by the TNO (Dutch Research organization), the AMC hospital in Amsterdam and the Maastrict University Medical Centre (MUMC) who determined that it doesn’t make a difference; homebirth is as safe as hospital birth.  You can also say: “birth in hospital is just as dangerous as giving birth at home”, says TNO researcher Simone Buitendijk. “The hospital doesn’t react quicker if you are giving birth there, it doesn’t influence mortality rates. In hospital, there is not a sterile team waiting in the operating room in anticipation of an emergency, it takes them about a half hour to be ready. In principle, if you are giving birth at home, it is the same.  The moment the midwife calls to say a medical transfer is necessary, the gynecologist brings the appropriate team together.” The full study is published in the BJOG at: http://www3.interscience.wiley.com/journal/122323202/abstract?CRETRY=1&S... Prior to this study the largest and most cited home birth study  included 5,418 women in U.S. and Canada who intended to give birth at home as of the start of labor.  “Outcomes of planned home births with certified professional midwives: large prospective study in North America.”  Kenneth C Johnson and Betty-Anne Daviss.  BMJ  2005;330:1416 (18 June).   This article is available at http://www.bmj.com/cgi/content/full/330/7505/1416 along with related letters to the editor (http://www.bmj.com/cgi/eletters/330/7505/1416). Both are available online for free and can be downloaded in English, German, French, and Spanish. A short BMJ editorial about the study and 5 additional letters to the editor are available at http://www.bmj.com/cgi/content/full/330/7505/0-a.   To read more from these researchers visit their web site Understanding Birth Better that shares original research on home birth and home birth safety http://understandingbirthbetter.com/index.php?ID=1&Lang=En   In  the BIRTH journal, March 2008, Letter From Europe: Home Birth Reborn, Sheila Kitzinger wrote: In September 2007 the UK National Institute for Health and Clinical Excellence (NICE) issued clinical guidelines on intrapartum care of healthy women and their babies during childbirth. Under ‘‘key priorities’’ it stated: ‘‘Women should be offered the choice of planning birth at home, in a midwife-led unit or in an obstetric unit.’’ Information suggests that for ‘‘women who plan to give birth at home or in a midwife-led unit there is a higher likelihood of a normal birth, with less intervention’’   She continues…”Maybe home birth would not have been reevaluated if cesarean delivery rates had not soared and research evidence revealed morbidity and long-term side effects that have shocked many obstetricians, not only health activists and mothers, into asking how, in a culture that attempts to regulate childbirth with prompt intervention and sophisticated technology, we have got into this mess.”   Diony Young, Editor of BIRTH says in her guest editorial December 2008; Home Birth in the United States: Action and Reaction “Most recently the American College of Obstetricians and Gynecologists (ACOG) and the American Medical Association (AMA) joined forces in a sharp new offensive. Following ACOG’s statement reiterating its long-standing position against home births in 2007 , the organization introduced a resolution before the AMA House of Delegates in June 2008, asking them to join in and support development of legislation in opposition to home.  Why do they continue to spend such energy and resources on opposition efforts?  Why do professional medical groups in the United States feel that they have to regulate and legislate on this issue of the mother’s choice about where to give birth to her baby and which professional should attend?"   It is not surprising the American Medical Association and the American College of Obstetricians and Gynecologists are silent on the growing data on the safety of home birth.  To see the flurry of media from  the UK and Australia in response to the Dutch study visit http://news.google.com.au/news?pz=1&ncl=1333882869&topic=m> I welcome your thoughts and comments on this issues. Why is the U.S asking for policy that clearly ignores the data and violates a woman’s right to choose the safest place for her to give birth?