HOMEBIRTH: AS SAFE AS BIRTH GETS
By Yvonne Lapp Cryns 1995
Each year in America, approximately 1 percent of the births occur in home settings. In Illinois in 1992, 1,218 families filed birth certificates that reflected a homebirth. Approximately one-third of the births occurred to Black families. Wisconsin had 591 recorded homebirths for the same year of which 22 were to Black families. It is probable that many more Illinois homebirths actually took place but were not recorded due to a discriminatory birth registration practice that places the responsibility for registering midwife-attended homebirths on the parents and requires a different mechanism than is used for any other occurring births.
One measure of the safety of birth place is infant mortality, specifically, neonatal deaths within the first 28 days. According to the Center for Disease Control, there were 19,098 neonatal deaths for 1990 for babies born in a hospital. For those babies born at home, there were 260 newborn deaths. Infant mortality is figured as the number of deaths per 1,000 live births. The death rate for babies born in the hospital was 5.6 and for those born at home was 11.1, which would seem to indicate that a hospital is a better bet for a baby's survival. However, when the homebirth statistics are further broken down into who attended the birth, the picture changes dramatically. Direct Entry Midwives had the best outcomes with a death rate of 1.9 compared to CNM-attended births (2.9) or physicians - D.O.'s (15.1) or M.D.'s (24.7).
History Until 1900, homebirth was the place of birth for most every American. In fact, over 90 percent of those alive on earth today were born at home! Hospital or institutional birth is a relatively new occurrence which began to gain in popularity during the 1920's due to physician promotion and the increased use of the automobile. As is the case today, it is a much more economic use of a physician's time to attend patients in a single place. There is also an economic incentive since a physician can attend to more than one patient at a time in the hospital and other, less important helpers can attend to the more mundane tasks of birthing.
Part of this shift in birthplace must be attributed to the propaganda denouncing midwives which took place during this same time. With their economic and organized power, physician groups were able to legislatively increase hospital births by eliminating those who still attended homebirths - by eliminating the midwife. From the 1930's through the 1960's state after state changed their laws to either restrict the practice of midwifery or wipe out the legal practice entirely. Yet no valid study then or to date has proven planned homebirth to be less safe than hospital birth.
Many studies have been done in an attempt to prove that hospitals are the safest place to birth. Some of the earlier ones included all births which took place out of the hospital regardless of the gestational age or planned place of delivery. Those studies included miscarriages which took place at home as well as precipitous births and births that were unattended. To be valid, a study must compare equals and change only one item. Lewis Mehl did this when he matched 2,092 women and compared their birth outcomes. The result was that homebirth with a trained attendant was safer than a hospital birth.
WHAT DOES "SAFER" MEAN?
Most families do not want to know the statistical odds of having a good outcome, they want to know more concretely exactly how a homebirth will be safer. Many studies address this by listing criteria and comparing the results. For example, Lewis Mehl's study listed the percentage of mothers with various complications:
COMPLICATION HOME HOSPITAL Number Percentage (%) Number Percentage (%) Forceps Low 10 0.9 205 19.6 Outlet 3 0.3 115 11.0 Mid Rotation 3 0.3 40 3.8 Manual Remove Placenta 15 1.4 15 1.4 Lacerations 1st Degree 18 1.7 18 1.7 Lacerations 2nd Degree 136 13.0 56 5.4 Lacerations 3rd Degree 8 0.7 44 4.3 Lacerations 4th Degree 5 0.5 73 7.0 Lacerations Cervical 3 0.3 32 3.0 Episiotomy 103 9.8 914 87.4 C-Sections 28 3.0 86 8.2 Birth Injuries 0 0 30 3.0 Oxygen given to Baby 13 93
As you can see from the chart, many complications seem to occur with greater frequency in the hospital. Many women are told they will need an episiotomy in order to prevent tears but the data from these births shows that this is not so since there were 9 times as many tears in the hospital group! Fetal distress, often cited as the complication necessitating a cesarean section occurred 6 times more frequently in the hospital group. There were 4 times more newborn infections, 22 times more forceps deliveries, 30 times more birth injuries and 3 times more cesarean sections in the hospital group.
ESTIMATING PREVENTABLE CHILDBIRTH RELATED DEATHS
The following statistics, derived from data accumulated between 1940 and 1980, are conservative estimates of lives lost due to our system of treating pregnancy as a medical event requiring medical intervention and care.
* About 1,000,000 babies died at or before birth that should have lived.
* About 1,600,000 babies died before their 1st Birthday who should have lived.
* At least 1,500,000 children were left severely brain damaged by medical procedures.
* At least 45,000,000 children had minimal brain damage who would have been normal.
Today, it is estimated that 50 newborns die unnecessarily each day whose deaths are preventable if "the five standards for safe childbearing" were employed. This breaks down into a preventable baby death every 29 minutes, every hour of the day, each day of the year. NAPSAC writes, "Since 1940 at least a million babies have died in American hospitals who would have lived were it not for the doctor dominated maternity system that dictates the Standards for American Childbirth."
WHO SHOULD DECIDE WHAT IS SAFER?
Childbirth is not a laboratory project that can be reproduced at will with the outcomes compared with each other. Nor is birth a medical event, like planned surgery, that can be timed, controlled or forced to obtain the desired outcome. Each year, it seems, scientists discover some aspect of birth that had been unknown or unverified. Also, it would seem that the technologies that are initially hailed as the "cure" for a certain problem are found to produce unacceptable side-effects or increase risks for more serious complications. Birth also has a psychological component which can place some women at incredible risk in a hospital.
A recent article in a prestigious magazine looked at homebirth and asked the question, "Is it safe? Is it ethical?" The physician writers concluded that homebirth has a "definite small risk" and that "hospital births entail a wider range of risks". They also felt that since the actual risk factors inherent in a home birth are very small, perhaps 1/1000, and the consequences of the birth decision will be borne exclusively by the parents, physicians should support parents who are willing to accept this risk so as to make the experience as safe as possible. The Oxford Perinatal Project also came to this conclusion after an exhaustive look at every scientifically valid study performed since the 1950's addressing aspects of care of pregnant and birthing women and their babies. Since science cannot prove homebirth to be less safe than hospital birth, I believe that each family has the constitutional right to choose where to give birth. I believe that until science can prove a detrimental effect on those who choose to birth at home, medical personal should support families in their decision. The International Association of Parents and Professionals for Safe Alternatives in Childbirth, NAPSAC, shares this view and asks, "Who is to decide what is the optimal balance between medical and psychological risk?... It must be the parents."
1. Center for Disease Control, "Live births by place of delivery and race of mother, 1992", section 1, Natality, page 246.
2. Center for Disease Control, "United States, Birth Cohort of 1990", Table 43, pages 2 and 5.
3. Litoff, Judy Barrett, The American Midwife Debate, pages 1-10.
4. Mehl, Lewis, "Scientific research on childbirth alternatives and what it tells us about hospital practice", NAPSAC, 21st Century Obstetrics, 1978, vol. 1, pp/ 171-207.
5. Stewart, The Five Standards for Safe Childbearing, pages 137-138.
6. Hoff and Schneiderman, "Having Babies at Home: Is It Safe? Is It Ethical?", Hastings Center Report, December 1985, pages 19-27.
7. Enkin, Keirse & Chalmers, A Guide to Effective Care in Pregnancy and Childbirth, Oxford University Press, New York, 1989.
NAPSAC is a non-profit and tax exempt organization that may be reached at Route 1, Box 646, Marble Hill, MO 63764, Phone (314) 238-2010.
Some may argue that statistics do not tell the entire story, and that is true, but it is the best scientific way to diminish those who promote institutional birth as the only option for everyone regardless of risk status.
by Yvonne Lapp Cryns 1995
MoonDragon's Articles Index
AROMATHERAPY: ESSENTIAL OILS DESCRIPTIONS & USES
Allspice Leaf Oil Angelica Oil Anise Oil Baobab Oil Basil Oil Bay Laurel Oil Bay Oil Benzoin Oil Bergamot Oil Black Pepper Oil Chamomile (German) Oil Cajuput Oil Calamus Oil Camphor (White) Oil Caraway Oil Cardamom Oil Carrot Seed Oil Catnip Oil Cedarwood Oil Chamomile Oil Cinnamon Oil Citronella Oil Clary-Sage Oil Clove Oil Coriander Oil Cypress Oil Dill Oil Eucalyptus Oil Fennel Oil Fir Needle Oil Frankincense Oil Geranium Oil German Chamomile Oil Ginger Oil Grapefruit Oil Helichrysum Oil Hyssop Oil Iris-Root Oil Jasmine Oil Juniper Oil Labdanum Oil Lavender Oil Lemon-Balm Oil Lemongrass Oil Lemon Oil Lime Oil Longleaf-Pine Oil Mandarin Oil Marjoram Oil Mimosa Oil Myrrh Oil Myrtle Oil Neroli Oil Niaouli Oil Nutmeg Oil Orange Oil Oregano Oil Palmarosa Oil Patchouli Oil Peppermint Oil Peru-Balsam Oil Petitgrain Oil Pine-Long Leaf Oil Pine-Needle Oil Pine-Swiss Oil Rosemary Oil Rose Oil Rosewood Oil Sage Oil Sandalwood Oil Savory Oil Spearmint Oil Spikenard Oil Swiss-Pine Oil Tangerine Oil Tea-Tree Oil Thyme Oil Vanilla Oil Verbena Oil Vetiver Oil Violet Oil White-Camphor Oil Yarrow Oil Ylang-Ylang Oil Aromatherapy
Healing Baths For Colds
Using Essential Oils
AROMATHERAPY: HERBAL & CARRIER OILS DESCRIPTIONS & USES
Almond, Sweet Oil Apricot Kernel Oil Argan Oil Arnica Oil Avocado Oil Baobab Oil Black Cumin Oil Black Currant Oil Black Seed Oil Borage Seed Oil Calendula Oil Camelina Oil Castor Oil Coconut Oil Comfrey Oil Evening Primrose Oil Flaxseed Oil Grapeseed Oil Hazelnut Oil Hemp Seed Oil Jojoba Oil Kukui Nut Oil Macadamia Nut Oil Meadowfoam Seed Oil Mullein Oil Neem Oil Olive Oil Palm Oil Plantain Oil Plum Kernel Oil Poke Root Oil Pomegranate Seed Oil Pumpkin Seed Oil Rosehip Seed Oil Safflower Oil Sea Buckthorn Oil Sesame Seed Oil Shea Nut Oil Soybean Oil St. Johns Wort Oil Sunflower Oil Tamanu Oil Vitamin E Oil Wheat Germ Oil
HELPFUL RELATED MOONDRAGON NUTRITION BASICS LINKS
MoonDragon's Nutrition Basics Index MoonDragon's Nutrition Basics: Amino Acids Index MoonDragon's Nutrition Basics: Antioxidants Index MoonDragon's Nutrition Basics: Enzymes Information MoonDragon's Nutrition Basics: Herbs Index MoonDragon's Nutrition Basics: Homeopathics Index MoonDragon's Nutrition Basics: Hydrosols Index MoonDragon's Nutrition Basics: Minerals Index MoonDragon's Nutrition Basics: Mineral Introduction MoonDragon's Nutrition Basics: Dietary & Cosmetic Supplements Index MoonDragon's Nutrition Basics: Dietary Supplements Introduction MoonDragon's Nutrition Basics: Specialty Supplements MoonDragon's Nutrition Basics: Vitamins Index MoonDragon's Nutrition Basics: Vitamins Introduction
NUTRITION BASICS ARTICLES
MoonDragon's Nutrition Basics: 4 Basic Nutrients MoonDragon's Nutrition Basics: Avoid Foods That Contain Additives & Artificial Ingredients MoonDragon's Nutrition Basics: Is Aspartame A Safe Sugar Substitute? MoonDragon's Nutrition Basics: Guidelines For Selecting & Preparing Foods MoonDragon's Nutrition Basics: Foods That Destroy MoonDragon's Nutrition Basics: Foods That Heal MoonDragon's Nutrition Basics: The Micronutrients: Vitamins & Minerals MoonDragon's Nutrition Basics: Avoid Overcooking Your Foods MoonDragon's Nutrition Basics: Phytochemicals MoonDragon's Nutrition Basics: Increase Your Consumption of Raw Produce MoonDragon's Nutrition Basics: Limit Your Use of Salt MoonDragon's Nutrition Basics: Use Proper Cooking Utensils MoonDragon's Nutrition Basics: Choosing The Best Water & Types of Water
RELATED MOONDRAGON HEALTH LINKS & INFORMATION
MoonDragon's Nutrition Information Index MoonDragon's Nutritional Therapy Index MoonDragon's Nutritional Analysis Index MoonDragon's Nutritional Diet Index MoonDragon's Nutritional Recipe Index MoonDragon's Nutrition Therapy: Preparing Produce for Juicing MoonDragon's Nutrition Information: Food Additives Index MoonDragon's Nutrition Information: Food Safety Links MoonDragon's Aromatherapy Index MoonDragon's Aromatherapy Articles MoonDragon's Aromatherapy For Back Pain MoonDragon's Aromatherapy For Labor & Birth MoonDragon's Aromatherapy Blending Chart MoonDragon's Aromatherapy Essential Oil Details MoonDragon's Aromatherapy Links MoonDragon's Aromatherapy For Miscarriage MoonDragon's Aromatherapy For Post Partum MoonDragon's Aromatherapy For Childbearing MoonDragon's Aromatherapy For Problems in Pregnancy & Birthing MoonDragon's Aromatherapy Chart of Essential Oils #1 MoonDragon's Aromatherapy Chart of Essential Oils #2 MoonDragon's Aromatherapy Tips MoonDragon's Aromatherapy Uses MoonDragon's Alternative Health Index MoonDragon's Alternative Health Information Overview MoonDragon's Alternative Health Therapy Index MoonDragon's Alternative Health: Touch & Movement Therapies Index MoonDragon's Alternative Health Therapy: Touch & Movement: Aromatherapy MoonDragon's Alternative Therapy: Touch & Movement - Massage Therapy MoonDragon's Alternative Health: Therapeutic Massage MoonDragon's Holistic Health Links Page 1 MoonDragon's Holistic Health Links Page 2 MoonDragon's Health & Wellness: Nutrition Basics Index MoonDragon's Health & Wellness: Therapy Index MoonDragon's Health & Wellness: Massage Therapy MoonDragon's Health & Wellness: Hydrotherapy MoonDragon's Health & Wellness: Pain Control Therapy MoonDragon's Health & Wellness: Relaxation Therapy MoonDragon's Health & Wellness: Steam Inhalation Therapy MoonDragon's Health & Wellness: Therapy - Herbal Oils Index
For a full list of available products from Mountain Rose Herbs, click on banner below:
MOONDRAGON'S REALM - WEBSITE DIRECTORY
A website map to help you find what you are looking for on MoonDragon.org's Website. Available pages have been listed under appropriate directory headings.