Hi Gene, your website Birth by the Numbers is really informative. My focus is on home birth. Do you have any numbers on the safety of home birth?
I think there’s a fair amount of literature on it. I don’t have a specific number per se, because there will never be a single number that defines home births as safe or not. The biggest studies thus far were the ones out of the Netherlands that looked at it from the perspective of perinatal mortality and later neonatal mortality, and they found no differences in outcomes between low risk hospital and home births. The other major study was the Birthplace Study in England, which also found no overall difference, but a higher risk for primipara mothers (first time mothers). These all assume a low risk population that they’re screening beforehand. The best summary of this literature now was by Melissa Cheyney and Aaron Caughey and just published in the journal Obstetrics & Gynecology.
When was it published?
It was published in the May (2019) issue of that journal.
I’m going to have a look at that one. I’ve found the medical journals are biased against home birth.
The green journal is not as bad as the gray journal. The gray journal seems to have a serious problem with home birth, and regularly publish articles and commentaries opposing home birth.
How do you look at the bias you find against home birth in these publications?
Two things to keep in mind. One, this is not a question that’s going to get resolved by research per se because there are too many variables that we can’t control that go into the decision to have a home birth. The way we deal with that in other scientific endeavors is to do randomized trials, which is, of course, silly in the case of home birth.
The other factor to keep in mind is that the decisions people make are often made partly for safety. You know when you read interviews with mothers they say they think it’s the safest thing for their baby. But people on both sides bring to this a whole lot of preconceptions and the debate on home birth isn’t an evidence based debate. It’s in many cases an ideological debate that goes beyond home birth to one’s feelings about birth in general. That makes it even harder to sort out what those differences are and with some caution in interpreting the research. I think if you were to say ‘I’m ok on home birth. I’m not always advocating for it, but I would support it in certain circumstances,’ then you could end up with a pox on both houses, which is pretty much where my position is. I support home birth for low risk mothers working with well trained midwives and where there is a whole structure around it and a backup system. Referral to a hospital shouldn’t be something that’s done in opposition to everything the hospital believes in, which is why in England women register for their home births at a hospital.
In judging the research, one of the things about the May 2019 study was they use an external standard for what a quality study is, instead of bringing personal biases to their assessment of the existing research, which at least gives you some things to base your judgment on.
The other piece that’s important is that Melissa Cheyney is a home birth midwife and anthropologist and she does magnificent research in this area. But equally important, the other author is Aaron Caughey is one of the most respected obstetrician researchers in the country, and what makes it an important piece is that it’s jointly written by them.
What do they say? How did they come out?
In the right supported circumstances home birth is a viable option.
Anything else you want to add?
Dr. Jonge from the Netherlands is a great resource and knows more than just about anyone on the research on this topic.
The decision to have a home or hospital birth is a big decision that should not be made casually.
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