We know that it’s possible. The US neonatal mortality rate is 4/ 1,000 with approximately .75% of births taking place at home with midwives while the Netherlands has a 2/1,000 neonatal mortality rate with approximately 25% of births taking place at home with midwives.
But how do we get there?
Well the American Congress of Obstetricians and Gynecologists has outlined the things that they have found (based on research) to be most concerning about homebirth in the United States*:
Selection criteria of mothers
Low APGAR scores
TOLAC (Trial of Labor After Cesarean)
And so, this year I am going to do a series of posts on these issues, weighing the merits of ACOG’s concerns and uncovering ways that the home birth community can improve outcomes on each of these fronts. Some of these issues are going to be grayer than others. ACOG themselves state that home birth research is a difficult thing because of the small sample size of women who choose a planned home birth and because randomized control trials are nearly impossible. (Raise your hand if you would be OK being assigned at random to have a home birth or hospital birth. Yeah, didn’t think so.)
Maybe you’re wondering why you as a birth professional should even care. If you’re a doula or a childbirth educator maybe you figure that you can’t actually do anything about these things. If you’re a midwife maybe you’ve never lost a baby.
But imagine with me for a minute if we really did achieve safer birth outcomes than American hospital births. ACOG would have to reverse its position on home birth. Eventually, the media would get wind of it and would have to stop publishing stories about how inherently risky home birth is and how inherently safe hospital birth is. Entire blogs devoted to the dangers of home birth would implode. Pretty soon, obstetricians would be asking how they could get their mortality numbers for low-risk pregnancies down. This would be a good thing because the United States has persistently high neonatal mortality rates for a developed nation with the highest costs for care. A woman here in the US could hop a boat to Cuba and be twice as likely to have a living baby than in the US. Yes, Cuba’s neonatal mortality rate is half that of the United States!
We should be willing and even eager to find out where we can improve. If that means finding out what ACOG is concerned about, let’s do it. As we listen to our critics and carefully mine their comments for realistic concerns and feedback and disregard the emotional hyperbole, we can make birth better here in the US, at least for the small number of women and babies in the home birth community.
*ACOG acknowledges that research into outcomes has been difficult because many studies have not adequately controlled for things like trained vs. untrained attendants, transfers, etc.
** We will include some discussion on malpractice and practitioner skills of OB-GYN’s here because there are some big issues at play on their side as well.
*** Yeah, no one wants to talk about this, but I think it’s important. In the interest of understanding neonatal mortality in America, I’m going to examine this issue within both in the obstetrical and midwifery communities.