Sassquatch wrote:The numbers don't lie. Home birth is several times riskier. For myself, being a risk averse type, I wouldn't choose it (even if I lived in a place where midwifery was licensed and part of the health care system.)
I'd be curious to know which numbers you're referring to. I chose to do a home birth (living in Canada, with government funded midwifery care) after a LOT of research (on an unrelated note, we ended up transferring to the hospital for a C-section during the pushing phase because baby wasn't turned correctly).
I read most of skepticalOB while trying to make my decision and did a basic (given my limited access to databases) lit review. My conclusion was that skepticalOB might have a point when discussing home birth in the US, because of the way midwifery care is stratified into certified nurse midwives and lay midwives. In mostly every other developed country with midwifery care, however, there is no conclusive evidence one way or the other that home birth is less safe than hospital birth for women with low risk pregnancies.
Basically, the perinatal mortality rate in both hospital and home births is so small, that to be able to determine a significant difference between birth locations would require a much larger sample size than there is data readily available to analyze.
After talking it over with the midwives and several of my doctor friends, I decided that the risks of birthing at home (which I acknowledge are non-zero, we talked to A LOT of people about cord prolapse) outweighed the much more likely negative (as I perceive them) outcomes of birthing at the hospital- namely increased intervention.
One of the things in favour of midwifery-supported home birth where I live is that the midwives mostly deliver in hospital and have a strong working relationship with all of the OBs. They also have to notify the paramedics that there is a possibility of transfer with all of the available information, to reduce the risks involved in an emergency transfer. Our transfer was most certainly non-urgent, but the midwife was on the phone with the OB notifying her of our arrival, and the paramedics had arrived before I really knew what was happening.
My understanding of midwifery care in the US is that certified nurse midwives can't get insurance to cover home births because of a few select cases (Baby Catcher
by Peggy Vincent discusses this, in addition to being a very good memoir). Which means that either CNMs are practicing while uninsured at home births, or lay midwives are performing home births without the backup of an obstetrical team at a hospital in case of complications. Neither of which is a good situation.
I do believe that home birth, in a supportive system (i.e. with hospital and OB backup and well-trained birth attendants who follow evidence-based practices), is a safe and possibly more fulfilling option. But then again, I'm a bit of a hippy.