My midwife teaches a childbirth education class that all of her clients are required to attend. We had our first class this week, and I am greatly looking forward to the next four. It is different from other classes in that it is geared toward homebirth and is a heavily research-based attempt to increase our knowledge of birth, homebirth, and the problems within today’s medical model of maternity care. In short, it is right up my alley. My midwife knows that I already know a good deal about these things (perhaps more than anyone else in the class), but I am no less excited to participate.
We spoke in our first class of the general positives and negatives of homebirth, and one class will be devoted entirely to ALL THAT CAN GO WRONG. In thinking of ALL THAT CAN GO WRONG I have been reminded of a study that came out last year, referred to as the Wax meta-analysis, that has been plastered all over the news as saying that babies are three times more likely to die during a homebirth than a hospital one. The study, however, is greatly flawed. Unplanned homebirths were included, statistics were poorly analyzed, incompetent software was used, etc. (Did I ever mention how I got into a disagreement about this with an OB during a panel discussion at the birth fair I volunteered at?) Here is a good critique of the study, which in fact came to the conclusion not that babies are three times more likely to die at home, but that “less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate.” Not quite the same thing really.
So why am I telling you about this? Because my midwife made it clear in our first class that she has dealt with the loss of babies. Nine out of 1700 have died, and I wanted to compare her rate to the national average. Using 1700 “births,” although it could be 1695 or 1737, I don’t know specifically, her death rate is 5.29/1000. I don’t know from what point in the pregnancy she counts it as a death–from 20 weeks? 28? during labor? for up to a week or month after?–so I based my comparison on the CDC’s rate of infant deaths of less than 7 days and fetal deaths with gestation of 28 weeks or greater, per 1000 live births and fetal deaths, as this seemed a reasonable comparison. The number is from 2005 because that is the most recent one the CDC seemed to have. And what is the national average for the United States of America? Drum roll please…6.64/1000!
I don’t think too many folks, i.e. my mom, are as concerned this time around, but it does make me feel better to know I’m in the hands of a caregiver (although I suspect the same is true for most homebirth midwives) whose perinatal death rate is lower than the national average, and by a whole baby. Not only then is there one more living baby under her care, but there are all the other advantages we listed in class along with it: no drive to or from the hospital; freedom to change positions, eat and drink, and have as many people there as you’d like, including the baby’s siblings; being in familiar surroundings with your own bed, bathroom and food (I’d add dog, too, because Scout was such a laid back labor companion); no IV (unless medically indicated) or continuous fetal monitoring (unless medically indicated); water, and I don’t mean to drink; no separation from baby after birth; no procedures done to your baby without your consent (like putting goop in their eyes “for the gonorrhea and chlamydia you don’t have,” as my midwife put it); no bright lights or time limits or “purple pushing” or warnings to not make so much noise; no induction or augmentation with Pitocin; lower risk of c-section with its longer recovery time and all the complications that can come with it (including, what is it, a four times greater risk of maternal death?); and the touchy-feely stuff like intimacy and sacredness. It was a long list.
So there you have it. It may seem as though I’m advocating for homebirth, but I am not. As always, I am an advocate of informed decision-making regarding maternity care.
P.S. Mama Raw has a FB page now!