Some serious shit can go on while giving birth (see the bottom of the article for a little list). It's 2012, and we aren't living in the jungle in mud huts. Have your baby in a hospital.

I have to disagree with you on this one. Yes, things can go wrong - life is a risk. A well-trained midwife can deal with all but the most serious of problems - which can also happen in hospitals. If you are healthy, expecting a normal birth, and have had good prenatal care, the chances of life-threatening problems are very small.

What's the benefit of giving birth outside a hospital, attended by a midwife instead of a doctor? Having been involved in both, it's very clear. Doctors want to use their tools. They want to use anethesia and medications, want to use their cutting shears, want to have you hooked up to machines that go "beep". The whole atmosphere in a hospital is one of illness. This is just plain unpleasant.

As with any area of life, it's about tradeoffs. You could avoid a lot of risk if you locked yourself inside your house and never left - but maybe you don't want to live that way. It's the same here: if you don't want the hospital atmosphere, don't want to argue with the doctor about unnecessary medications and treatments - then you accept a small increment of risk.

It's my understanding, and I don't remember where I saw the stats, that if you are a low-risk birth (under 35, not breach, no diabetes, etc) the mortality rate is lower for home births than hospital ones. You can still die, of course, whether or at home or at the hospital. Giving birth is still a risk.

Giving birth at home usually means less chance of something going horribly wrong. The down side is if something DOES go horribly wrong, you are less equipped to deal with it. So it is a trade off.

I signed up for a natural birthing center located in the same buidling as a hospital. That way if something went wrong (and it did, nothing serious, everything ended up fine) I just had to take the elevator one floor up.

I have had 4 home births. I transferred with my 2nd because he had his cord wrapped around him. All the other 3 went fine and if they hadn't we would have taken the 5 minute ride the the hospital. And I didn't give birth in a mud hut. It was in a huge tub.

And yeah the doctors want to us all their toys on you. And to use the bands for monitoring contraction and babys heartbeat you have to lay on your back. This compresses a major vein and cuts oxygen to the baby. The reason for the majority of c-sections are a result of over intervention and not for pelvis issues.

I am safer at the midwives and so is my newbie, thanks anyways.

What's wrong with planning for a natural birth (must educate oneself, it's a crazy process, and you must be STRONG) and having a doula or midwife present at the hospital? Things can go wrong and can't always be planned for, so why take the chance? Oh my gosh, banging my head against the wall, why take the damn chance when there are life-saving measures available at the hospital? No good doctor would force a woman to do something she didn't want to do, and if that's what women are afraid of then there are many midwives who offer birthing classes so they will know what to expect and what it means when the body does a, b, or c; this can also help with the choices that may be available when things potentially veer off course. Doctors don't tell women to lay on their backs anymore, most beds are set up to accommodate a hands and knees birth, and there are birthing tubs available at many hospitals as well.

If a woman has the right to choose to abort her baby for whatever reason, then she should certainly have the right to risk her life and that of the innocent child by deciding on the conditions of giving birth.

Besides, what's seen here is an opportunity for these two practices to merge. I know many midwives, doulas, and Obstetricians would love to see women with exactly the type of support they choose. If hospitals started employing midwives I imagine women and babies would get the best of both worlds. Ina May Gaskin's books are a wealth of information, but in this day and age it doesn't seem prudent to take such a huge chance with a new life, or your own for that matter.

I can see both sides. My (recent) birth at the hospital was miserable. The whole thing was absolutely unpleasant, from admittance to exit. I can see the appeal of home birth much clearer, because what some of the commenters have said is true. The docs don't really care, they want to cover their asses and do as much "intervening" as possible to prevent a lawsuit. Hence, the immense rise of C-sections (I believe they've risen 30%ish since 2002). And once they're out of the room, they don't give a fuck.

However, home births are dangerous. If something goes wrong, there just may not be time to fix it. And it's a huge risk, and one I could never convince myself to take. Not with the fragility of a newborn. And not with what a monumental undertaking giving birth is. After all, there's a reason why "died in childbirth" was a common epitaph.

Jess said: "Doctors don't tell women to lay on their backs anymore, most beds are set up to accommodate a hands and knees birth, and there are birthing tubs available at many hospitals as well."

As someone who has recently given birth, I beg to differ. Out of the three hospitals I toured, ALL were "lay on your backs" births. Only one had a birthing tub, and apparently, to use it, you basically had to hope that no one else had called dibs.

If I have a second child, I will definitely employ the services of midwife or doula. My hospital experience was incredibly unpleasant, and I want someone with a level head to fight for our preferences before, after, and during the birth.

You're your best advocate. The information is out there. It's funny to me that if a woman is giving birth, and she knows she's the one who's going to have to do the work, that she wouldn't educate herself first and tell that doctor that she's giving birth on her hands and knees if she wants to, damn it! I did. You don't need a special bed for it, but some are set up that way. I have to wonder what the medical care is like where these people live who feel they have "no choice" at their hospitals. Hire a doula for support.

If a child has no rights until it is actually out of the mother, then it stands to reason they absolutely do have the right to risk a home birth.

A hospital is a place for the sick and the dying, pregnancy is not an illness, nor for the vast majority is there a significant risk of death.

Yes one should be checked and familiar enough with their medical history to know if they are high risk, and in that occasion a home birth would be unwise. But otherwise, I see no reason why a home birth should not take place.

My wife had both of our children at home, no complications, no problems.

A doctor arguing against a home birth is as shocking and convincing as a car salesman arguing for the extended warrenty or a life insurance salesman arguing for premium whole life coverage. Its in his best interest for women to go to him and his hospital. Look I'm not saying he has no legitimate concerns...both the hypothetical insurance and car salesmen have good points also in their arguments.

However the medical institution is the same force that tried to prevent the parents of hemopheliac children from learning and performing basic treatment services themselves...something they now have the legal right to do, and that the vast majority do quite safely.

The very argument they use on this one, is the same one that used to be used to keep parents from seeing to their children. This isn't so much about "safety" however much they crow about the issue, the real issue is arrogance and control. As if absent them all sorts of terrible things will certainly, even likely, happen. Fact is, most of the time, nothing will go wrong. It may be a trade off, but it is a trade off that parents have every right to make, and neither the doctors, nor the state, have any business forcing.

The best thing hospitals can do, is offer training courses so parents can learn how to respond appropriately to the most basic problems that may occur.

Home birth is a foolish risk, but people should have a right to be fools. Actually, going into a UK hospital is also a foolish risk but that's another story.

I could save a truck full of money if i had a veterinarian take out my appendix on the kitchen table and still have a 92% chance of survival for a cost of $400.

I could have the vet and an RN to it in an out-patient clinic for $1000 and have a 96% survival chance.

Adding an anesthesia guy and having the cardiac machine standing by will make it 98% and cost $15,000.

But we are required by law to use real, accredited doctors with licensed surgical teams that buy us that last marginal 99th percentage for $40,000.

People ought to have the right to take a chance with their own lives and finances and call the veterinarian and the lady with the alligator purse if they want to. As for their kids, well, Darwin lives and stuff happens.

I was going to have my daughter at home, however she came early and was basically standing up inside me. I knew that it would likely have to be C-Section, so when water broke I hightailed it to the hospital. It was as I knew, however, I had postpartum high blood pressure. First they had me on pain killers which made me loopy. Told them to take me off of that, they argued with me about it. Finally they had to do what I asked. The blood pressure meds I had an allergic reaction to and the doctor actually had the nerve to yell at me for bothering him on a Sunday morning. Then proceeded to let me know the lady down the hall on the same meds is not having a problem and I needed to quit questioning them. He threatened to send me home. I said please do as I may survive this there. It is a good thing that I am strong within my self to stand up for myself, otherwise I would have died from the meds.

My experience having a baby in the hospital was pretty unpleasant, too. My (female) doctor was great, it was some of the hospital's nursing staff that I had the problem with. I had a c-section, but that had been discussed ahead of time. A friend who had her son at the same hospital a month before me had a similiarly unpleasant experience with the staff. If I have another child, I will do it in a hospital again*, but I can see how someone who was going to have a traditional birth would want to avoid that whole experience. I really felt like some of those nurses (and the hospital's staff pediatrician) were just plain MEAN to me.

Also, I can see even more people opting for home births if the government makes certain testing or procedures mandatory in hospitals. (certain gentic test, drug tests, paternity tests, required counseling, etc...)

Plus, even with pretty good insurance, it cost me about $7,000 out-of-pocket to have a baby... And the hospital didn't want to let me leave. My blood pressure was through the roof- from the stress of being there- and they didn't want to release me.

We're good friends with a Perinatal Obstetrician, and his ex-wife had their first two daughters at the hospital with a regular OB. The third she had at the hospital with a midwife, and the last she had at home with a midwife. He was there, of course, so even though it was a home birth, it wasn't all that risky.

*I'd have another cesarean section and get my tubes tied at the same time.

If this had little impact on the family and daughter (or society as a whole), I could joke about the inescablable consequences which await abject stupidity in the animal kingdom...

Amy:

You're being too dismissive here.

" No, pregnancy is not a disease, but it's not just a sneeze, either. Things can go wrong."

Yes. They can.

And as several people who have been through it commented, it just depends.

My daughter's L&D was _horrible_. Because of the doctor - and no, you can't use another one at that point, you're stuck with the on-call. What, you're gonna pack up from the hospital after the water's broken and go.. where?

The doctors who are dismissive of non-medical interventions are in my experience, the most clueless of the reality of the situation.

I can opine on this with a LOT more experience now that I've been through this wringer. Before, I thought the home birth sorts had some points (both my grandmothers were finally done in by incompetent idiot doctors who could memorize a lot of stuff, but couldn't synthesize thought to save, well, my grandmothers lives) but that they were overblowing their case excessively.

Not anymore.

If we have another, it will be in the L&D, don't get me wrong (we immediately left that OB practice, and have been blackballing them since - finding out that they were already well-blackballed, just nobody _told us_).

But let's not let 1 freak case freak us out. Wasn't that just what we were saying was a bad idea with Sudafed yesterday?

so the most obvious thing would be to have doctors that come out to your house to assist, with low risk births, and high risks should be done in the hospital. Unfortunately in many states, this is actually illegal. For #1son 17.5 years ago, we lived in Illinois, and there is a group of doctors called HomeFirst [15,000 babies since '73] that specialize in Doctor Assisted home birth. Kid even had is umbilical wrapped 2x around the neck. Doctor commented amusingly: "this is where they freak out in the hospital" while he calmly unwrapped the cord with his finger. There were 2 nurses in the room assisting, as well, right at the birth.
BUT. They don't do they unless the Doctors feel you are a good candidate for home birth. Most importantly at the time for a new family with no insurance? It cost less than 1/2 the price of hospital. AND, we started paying forward from the first prenatal visit, so when the kid was born, he was free and clear.

When it was time 5 years later for my daughter, we had moved to a state where a Doctor is not allowed to practice in that way. We thought about the midwife route, but insurance won't cover it, and I couldn't afford that. The hospital was newly remodded and nice, the doc was pretty cool too. But I had to be there on top of them all the time because they were pushing drugs and stuff on my ex. If she had been a first time mother, and not knowing what to expect, it would have been more problematic.

Importantly: THIS IS NOT ROCKET SCIENCE. For what percentage of human existence have babies been born? Oh, wait. ALL OF IT.

This shouldn't about a law for or against a specific style of birth, without some science behind it. Until the mid 20th Cent. births were at home, often. But you can ALSO die in the hospital in birth. You can pick up MRSA from being in the hospital too. It's a place sick people go.

So my question is WHY would a country that has an infant mortality of 7 per 1000 or so, but only has about 5% of births attended by midwife, have MORE of a problem, than a place with infant mortality*** rate of 5 but a midwife attendance rate of ~75%

Care to guess which one is the US and which one is the EU?

***Full well knowing that mortality is for the first year, I couldn't find the number just at birth, BUT the at birth number is contained within the whole.

IF miswifery and home birth was a real problem, we would expect the mortality rate to be 10 TIMES as high as ours, base on the difference in percentage of births attended by midwifes.

Empirically, I don't see that. So, would someone care to explain where the numbers are wrong?

There are likely several reasons for the infant mortality rates mentioned above, several right off the bat being that overall people in the U.S. specifically don't eat very well, are de-conditioned and overweight, and don't educate themselves on what they need to do to have a successful and safe birth, "But I have a doctor so I don't need to do anything for this birth!" That mindset is a problem itself for any health reason. Like many commenters are claiming here, they seem pissed that their specific experience was terrible, and it's all the doctor's fault - and that certainly may be the case with some people. But you're the one giving birth, so it is your job to make sure that you're healthy enough to do that in the first place, and that you educate yourselves on the entire process, natural and medical, and if your doctor doesn't have time for that then it's up to you to do the work and learn, OR choose another doctor or practice. I'll give anti-hospital people one thing, the pre-birth classes that are given at the hospital are not informative regarding the birth process, rather they focus on hospital procedure for checking in and that kind of thing. But again, it's the mother's responsibility to learn about the different stages of labor, and what you can do to support the process. Part of this is being strong mentally as well - this kind of support can be found with a midwife or doula. The doctors don't cockblock anyone from taking any kind of birthing class they want, or from hiring a midwife or doula to be present, or maintaining an exercise regimen throughout the pregnancy. There was an article recently in one of our local magazines here, a prominent midwife and an obstetrician were asked several questions about birth, and the obstetrician mentioned the dramatic rise in unhealthy mothers, from being overweight and weak, to smoking and not eating enough protein - how can we not consider these factors? How can we sit here and try to claim that OB's are evil and so are the nursing staff on the maternity ward? I feel like saying that we all need to take some responsibility for ourselves - no one stops you from doing what you need to do. I say, hospitals should start hiring midwives, then maybe we can put this argument to rest.

ahw, sounds like you and I went to the same hospital. My experience was very similar.

SwissArmy, having a doctor at an At-Home birth sounds like heaven. A perfect medium.

And, yes, Jess, next time I'll have a doula for support. The doctors and nurses on staff can be bullies. They scared the shit out of me more than once.

Has anyone seen the documentary "The Business of Giving Birth"? I keep meaning to watch it, now that I understand first-hand how its done. But I heard its a great de-thronement of the way we give birth in hospitals.

So Jess, while what you say about unhealthy mothers may be true... d'ya think that mothers in the US are less healthy than Slovenia, Croatia, or the Czech Republic? The Croats are close to us in numbers at 6.6, but the Czechs and Slovenes are 4.1 and 4.18 respectively... while the Cubans are almost identical to us. Oddly, in Puerto Rico it's 8.88... the numbers don't tell the whole story, for certain.

OTOH, I can't imagine why a hospital would want the insurance headaches of having midwives. From their perspective, the Doctor is always going to be the gold standard of care, since they can take care of emergencies, so from a liability perspective, they would prolly have to have a doctor available even if you were using a midwife, so I can't really imagine what advantage they would see in that.

From the patient perspective there are advantages, but from a business perspective, I don't see how a hospital gains, AND the midwives would probably see a lot of control exerted over what they do, with procedures they would prolly never use, so it might be a loss of autonomy for them as well...

As a health care worker, I am all for people taking charge of their health and their treatment, provided they are informed.

Most pregnancies are normal. Most L&Ds are normal. For mothers who have been throughly examined, and have been given a clean bill of health - fine - do the home delivery if you choose.

Here's the problem. More and more mothers are obese because more and more Americans are obese. Obesity during pregnancy can cause high blood pressure, preeclampsia, gestational diabetes, and serious complications when attempting a vaginal birth.

Also, more and more women are giving birth in their late 30s and early 40s. And YES, an older mother is absolutely at a higher risk for things like high blood pressure and placenta previa, which makes vaginal delivery unsafe. The March of Dimes reports that women in their 40s are three times more likely to have placentia previa than women in their 20s.

But most importantly, there are no NICU specialists standing by at a home birth. And folks, we still cannot predict with 100% accuracy if that baby is going to come out and hit a 10 on that APGAR. What if the baby has breathing problems? You're going to call an ambulance? Because if you think the average EMT is highly skilled at intubating a newborn, think again. Some are, some aren't. You want to roll that dice?

A couple of people have posted about birthing centers attached to hospitals. Those are great options for mothers who really don't want a typical hospital birth.

Quite obviously this is a very personal decision. I just wish that people understood that when things go wrong during childbirth, it can be catastrophic.

And @Jess, thank you for defending OBs and the OB nursi g staff. I don't personally work on the OB unit, but the men and women I know who do work there are there because they genuinely love babies and taking care of families. It ain't about the money. Trust me. The nurses I know who work OB have been screamed at, peed on, pooped on, vomited on, bitten, and a couple have been hit. And they're still there, because bringing healthy babies into the world means everything to them.

Sadly women don't always get a full range of choices when it comes to childbirth.

I was so upset by my experience that I contacted the ACLU. I felt that my rights had been violated. Evidentially, I was told that I didn't have a case. He told me that when I chose the doctor, I consented to any treatment. My choice was to stay out of the hospital and go to a midwife or go along with the doctor's decisions.

Back then, midwives were not permitted in our local hospitals for "liability reasons." Now welfare patients Must use a midwife. The last I heard, patients with insurance could have a doula but not a midwife. Due to a shortage of midwives of course! It couldn't have anything to do with money could it?

Doctors and hospitals routinely do things that are uncomfortable and stressful -perhaps even dangerous. It is just sad.

BTW, my sister had a very large baby. Her doctor said that she had to pay $7,000 cash upfront because she had to have a C-section. The doctor would not let her try a vaginal delivery. She hired a midwife and delivered a 10 pound baby at home in only 4 hours. Yes, she was lucky. Thank goodness more hospitals are some choice.

People should know that some hospitals "talk a good talk" but fall into the same old routines. For instance, I wanted to use a birthing chair. The hospital said that was no problem. They had something even better - a convertible birthing bed that converts into a chair. Although it was in my birth plan they would not convert it. They kept telling me that it was very comfortable to bring my knees in to my chest. This was not my problem with the hospital - just one of the 12-20 things that were less than optimal.

I think people who homebirth are stupid. I would never do it. But I don't think you can tell women they CAN'T do it, unless you want to say the state owns a pregnant woman until she gives birth. Once she's given birth, if they don't seek medical help for the baby I think that should be chargeable.

I have given birth 3 times with 4 babies here in Austin. All 3 times were great, at Seton downtown. Great nurses, great Drs, great great great. I chose nursing school because of how great all my nurses were and what a big difference they made. They were also all 3 very medically intervened. For different but very necessary reasons each time. The twins would be dead if not and possibly me too, but I definately would have died along with #s 3 and 4.

Women died FREQUENTLY in childbirth before hospitals. I assure you if some peasant in some village in England could have delivered in a modern hospital with modern drugs, she would ahve. Wy on earth women want to give up hundreds of years of medical progress is beyond me. That peasant would have thought natural childbirth advocates were INSANE.

The issue with problems in childbirth is oftentimes there is no time for a 5 minute ride to the hospital, and how many people live that close to one? A mom here in Austin a few years ago homebirthed triplets in a baby pool. What wasn't widely reported was the EMS team and ambulance tied up for hOURS waiting on standby for her. Who paid for that wasn't reported either, but I'm betting it wasn't her and I knew her (even gave her some of my pumped breatmilk) and they had very little money. You can see her video on youtube somewhere.

And my last opinion-if you don't have the balls to tell a Dr you don't want an episiotomy and do want to squat, you probably don't have the balls to raise kids. Grow a little responsibility for yourself and your own care.

Sorry for the typos, DH is yelling at me to hurry up so we can watch Dexter.

I did tell the doctor that I wanted to squat and I did want want an episiotomy. The doctor agreed - until 3 weeks before the birth. Then he laughed in my face and told me I was unrealistic. I tried to get another doctor. It was too late.

On my due date, he asked me about inducing labor. I was appalled. I said no way. I thought I said it a little too harshly because I am strongly against it. I backed up and said that I would consent to it if the life of my baby was in danger. He laughed again and said I was just afraid of childbirth. He then proceeded to strip me membranes without my consent or ant warning. This causes a small hemorrhage. The uterus contracts to stop the bleeding which often spurs labor. I was appalled. He sent me home without even a sanitary napkin. By the time I got home, I was wringing blood out of my socks. I spent most of the next 3 days in bed. I could barely eat. By the time I had the baby, I was anemic, dehydrated, and exhausted. I could barely sit up or stand in a shower long enough to get clean for 6 weeks.

My second child was not induced. I was in labor one hour and forty-five minutes. By 6:00 the next morning, I could have practically run a marathon. I had showered, put on street clothes and makeup, and was ready to go home.

I know that the second birth is easier, but I don't think all of the rules make things better. I think that woman should be able to take of their needs like going to the bathroom and drinking water if they are thirsty. Hospitals prevent this "in case something goes wrong. " With my second child, this was not an option. I was drinking a glass of water when I went into labor. I worried when they asked my when I last had food or beverage. They told me not to worry because there are medications that can be used on a full stomach. If so, why do they torture women in labor?

Jen, you had a crappy doctor. There are crappy everything in this world, I'm sorry you got stuck with this one. It took me a week to be in street clothes, even after #4! You are pretty hardcore.

There are routes to take when someone does something to your body without your consent and not trying to save your life. That should not happen to you. But then again I went a little mental after every birth and might have just killed him. That would be satisfying but not really productive to my life.

I recommend the business of being born. It's a good documentary on modern medical births vs home births.

I did my birth at a birth clinic. Two minutes from a hospital. It was comfortable and quiet. I wasn't being poked and prodded by random people I didn't know.

Thanks momof4. The doctor was crappy, I first talked to him to make sure that there wasn't another side of the story. Perhaps he saw some signs that indicated that I had a need to be induced. Then I went to the hospital. Then the ACLU. Finally, I went to the state medical board. They doctor refused to give up records until the investigator subpoenaed them and flew to Lubbock to get them in person. They were not released for 6 months - the last day legally allowable. Surprisingly, stripping my membranes was not included in those records.

Yes, there are routes to take, and I did fantasize about murder - well more like him having a heart attack right in front of me while I did nothing. Does that count? I thought about bringing it to the media, but my husband was embarrassed by my level of upset and zeal as it was.

The Business of Being Born is a CRAPPY documentary full of cheesy, feel-good cliches, however the book by the same people, "Your Best Birth" is not bad.

Again, the odds of something going wrong (assuming a low-risk birth) are HIGHER in a hospital. But if something DOES go wrong, it flips.

It's not "stupid" to homebirth, it's lowering the odds of risk. However, those odds aren't lowered to 0, and if something goes wrong, then you're really screwed.

The choice is minimize your risk of something going wrong and accept that if something goes wrong it goes REALLY wrong, or accept a higher level of risk knowing if something does go wrong it won't be as bad as if you were at home. Unless, of course, you or your baby gets in infection, which is more likely at the hospital.

C sections tend to peak at the hours at the end of the shift, the theory being the doctors don't want to stay beyond their shift and want to get home.

Drs not wanting to stay is a good reason for time-coverage Drs, and not patient-specific ones. The average OB in a decent sized city would literally NEVER be off work if they attended every birth of their clients. That, or Drs need a lot fewer patients. Which means you'd pay a lot more, and it simply wouldn't work unless malpractice insurance rates came way, way, way down. It's not all Drs fault. I had 3 csections and have decided that's simply the only way to go. All 3 were medically necessary for life, not just someone's convenience or failure-to-progress. I'm quite happy my kitty is till the same as it was in college. To each their own, though. Women who really don't want one shouldn't have to have one. And again, all it takes is the woman saying "no". They can't csection you against your will unless you're unconcious and dying.

"Wise comments here suggest having a midwife/doula and going to a hospital with a natural birthing center. No, pregnancy is not a disease, but it's not just a sneeze, either. Things can go wrong."

My girlfriend had a midwife in the hospital, and her baby still died. The midwife let her labor too long after her water broke before calling in a doctor. The baby distressed and was born dead.

So, even being in the hospital doesn't guarantee a smooth outcome. Nothing does. No matter where you birth.

I would personally feel more comfortable with a practitioner who had the capacity to re-start my heart, which would've saved this mother, and I don't see why they can't have that kind of life-saving equipment. My husband has something like that on his commercial dive boat, so why can't a midwife have it?

The problem seems to be that the medical establishment wants to prevent home births from being safer. Women must choose between a kind of primitive experience and the overreaching hospital. Seems to me that there could be a middle ground. For centuries in this country doctors came to the home to deliver babies and presumably had what they needed to address emergencies.

Also, nurses do all the work anyway, at least in my experience. Those nurses were wonderful when I was in labor with my daughter. The doctor came in for maybe 5 mins to catch the baby and sew up the episiotomy. I'd feel totally comfortable at home with a well-trained nurse practioner with the proper emergency tools...or on a dive boat. lol

"For centuries in this country doctors came to the home to deliver babies and presumably had what they needed to address emergencies."

Which was precious little back then. You simply can't carry an anesthesia machine to someone's house-not practically, anyway. So yes, a Dr could attend your birth but the csection would be really unpleasant if a crash one was needed. I had to have a crash csection for preeclampsia that decided to show up, nice and severe, in about 2 hours time one morning at week 37 of what had been a perfectly normal and healthy pregnancy. Good thing my Ob office was attached to the hospital.

The portable machines to chock someone's heart only work with certain rhythms. It can take CPR and drugs to get the rhythm needed to use a shock. The machines will tell you if you can shock or not, but not what to do if you can't. I still find it dumb.

Like I said, I wouldn't really do it. Probably they could get you to a hospital in time, but why take the chance?

But I do find it absurd that my husband's crew is better equipped to save a life in a medical emergency than a midwife. Of course, people die diving all the time, so they should be, but childbirth is also life-threatening.

Still, no one ever says that diving should be banned because some people die (I just had an upcoming guest die last week in a scuba accident, at 47, and we have at least 10 diving deaths here a year). Don't know the stats, but I would guess that more people probably die scuba diving than in childbirth.

So, you have folks who are aware that they are taking a risk (there's no way they can carry a decompression chamber on a dive boat and the emergency medical equipment is limited ), yet they are free to make that choice - take a calculated risk - and the odds are still with them. The odds of dying in a home birth are probably even less than that.

Essentially, what I see here are a lot of truisms unsupported by facts, so I went diggin' for them.

Check this study out of ALL low risk women commonly midwived in 2000:
http://www.bmj.com/content/330/7505/1416.full

and note this little fact:
"The intrapartum and neonatal mortality among women considered at low risk at start of labour, excluding deaths concerning life threatening congenital anomalies, was 1.7 deaths per 1000 planned home births, similar to risks in other studies of low risk home and hospital births in North America. No mothers died. No discrepancies were found for perinatal outcomes independently validated."

Getting back to the stats I put in upthread about the 75% of births in Europe attended by midwives, versus 5% in the US, AND YET THEIR INFANT MORTALITY RATE IS LOWER>

IF having a midwife was a bad outcome, then THEIR MORTALITY RATE WOULD BE MUCH HIGHER.

Instead of truisms and anecdotes, let's talk NUMBERS. Maybe my numbers are wrong or whatever, but then show your work.

For what it's worth, Momof4 your twins were never a low risk birth anyway, and depending on your medical history, you may not have ever been a candidate, regardless. I am glad you and the kids are all healthy.

OTOH? There are only ~3500 CNM's in the US anyway... nowhere near enough to be a common thing.

"Getting back to the stats I put in upthread about the 75% of births in Europe attended by midwives, versus 5% in the US, AND YET THEIR INFANT MORTALITY RATE IS LOWER>"

Interesting, Swiss. Is that attended by midwives in a hospital setting or at home though?

"Who's having children in Switzerland versus here? The USA is a big country with a diverse population -- including very poor people. What are the demos in Switzerland. These comparisons are associations and aren't worth much."

I think that's the point. Our higher mortality rate is caused by a lot of factors, none of which have much bearing on home births, which are usually undertaken by older, better educated, and more financially stable mothers, who get good prenatal care and have lower risk pregnancies - probably more similar to mothers in Switzerland than a teen mother from the inner city.

I don't know that many women who've chosen a home birth, but the few I have fall into the higher income/better educated/good prenatal care category.

My sister-in-law birthed her third child at home with a midwife, but she also had a helicopter standing by just in case (her friend was a pilot; she was a flt attendant).

These types of women who have babies at home have very little in common with poor women who are more likely to have high risk pregnancies.

The question really is what are the odds of mortality during a home birth in the US? I'm guessing it's comparable to Europe, but is there a study?

My first child was born very premature and my second was an emergency C-Section (due to a botched induction--they gave my wife the drugs without checking first if my daughter was breach. They probably could have turned her.)

For the third child, the birth was horrible. The room was so much like that in Meaning of Life, it shocked me. I also realized the doctor really wasn't doing a damn thing--the nurses were. The nursery was very badly run.

Fourth child; the head nurse delivered it because the doctor decided to get another hour of sleep. (And she let him and the entire hospital know what she thought of his behavior when he finally arrived and tried to get her in trouble. Oh, and they botched my wife's epidural, giving her a spinal headache [due to spinal fluid leakage].)

So, we had the fifth child at home and it was a great experience. My wife recovered much faster than with any other child and we didn't have to deal with an awful nursery.

The only issue was a woman from the La Leche League who got upset when I decided to supplement our daughter's breast feeding with formula. My wife was disappointed since our last was the only one at all interested in breast feeding, but she just wasn't getting enough nourishment. The La Leche League lady seriously said it didn't matter and our daughter would eventually get hungry enough to feed more. I told her to f**k off.

"Giving birth at home usually means less chance of something going horribly wrong."

Not demonstrated.

"The problem seems to be that the medical establishment wants to prevent home births from being safer."

You're not looking closely.

These sentiments are not specific to the people who have said them here - and they are anecdotal, the plural of which is not "data". Fallacy after fallacy appear above because of the severity of the difference between events as they occurred and as the person imagined they might be. In many cases, there wasn't much evidence of preparation.

Birth is naturally violent. While it is progress, the mother is totally defenseless. Yet many are still open-mouthed with surprise that it isn't a pleasant, pink, cotton-candy party, wherever it happens.

Now, if you're omniscient - if you have the ability to declare you're in top physical condition and that the infant you will produce is in robust good health - good on you. But guess what? You're still at risk.

But don't substitute emotions for evidence about the process. If you screw up, the hospital gets to see you after all...

...and declare one or both of you dead.

If you take the risk, the entire story is that the result is ALL YOURS.

I really do hope it's rewarding. I love to see success.

I think that's the point. Our higher mortality rate is caused by a lot of factors, none of which have much bearing on home births, which are usually undertaken by older, better educated, and more financially stable mothers, who get good prenatal care and have lower risk pregnancies - probably more similar to mothers in Switzerland than a teen mother from the inner city.

I dont know LS, you ever see that show "I dodnt know I was Pregnant"?

You suppose all those 'unkown' babies found in the toilet count as home births?

Raddy and LS both, I'd point you to the study of Midwived births in the US and Canada, vs. regular births I linked to:

http://www.bmj.com/content/330/7505/1416.full

the numbers of death are equivalent percentages. So no it's not safer in hospital.

Amy, I wasn't talking Switzerland, but the whole of Europe, including places like Slovenia, Czech Rep and Portugal.... check out mortality listings from here, and note that there are plenty of places where hospitals are sketchy things, that have lower infant mortality than us. AND? a LOT of variation in people.

http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate

Naturally Infant Mortality, isn't the same as BIRTH mortality, but it rolls up.

"Yes, people have delivered babies at home for centuries. They've also used toilets they dug in the backyard. "

Indeed. Let us not forget that, not so long ago, childbirth was a leading cause of mortality among women.

And Swiss: The reason European countries have lower infant mortality than North America is because their statisticians cheat. They have all kinds of circumstances in which they consider a live-born baby who dies a "stillbirth". The big one is that they don't count as a live birth any baby who dies within 24 hours of birth. They also totally ignore mortality among preemies. When you make everyone count the same way, the U.S. actually has lower infant mortality than most European countries. Source

Have to weigh in here on a factor that's going to influence the course of how babies are delivered in this country. (BTW: Have one son, delivered at home 31 years ago by a GP and a midwife. Wonderful experience.)

Over the past decade or two the cost of obstetrical malpractice insurance has gone through the roof, which has been discouraging medical students from pursing obstetrics. I know one fine obstetrician who changed specialties in order to be able to net more than $4,000 a year. No joke - and this guy had the best insurance rates you can get.

Unless we can reverse the above trend I believe in the future we are looking at more deliveries by midwife, not doctor, simply because of what will be available. I also think we will see the rise of more home-like birthing centers attached to hospitals, but with less medical intervention - unless it is really needed, in which case it will be available. This ideally should address the best of both worlds.

"Don't know the stats, but I would guess that more people probably die scuba diving than in childbirth."

Yeah, but how many of them take their little kids with them when they go that way? I scuba dive and prekids I went skydiving and rockclimbed pretty seriously. I'm not risk-averse, I just don't see risking those who have no choice in the matter.

I agree, M4, but a year or so ago, my girlfriend was working in the emergency room when they brought in a young girl who had been diving with her dad. She died, and my friend had to tell the family.

The father was absolutely devastated, of course, but he had done everything right. He paid for a certified dive course for his daughter, took it with her, went along on her first dive, but still, against all the odds, she died.

At what point do we stop doing anything potentially dangerous, even when the odds are in our favor? So many here have had positive home births, just as thousands have gone diving with their kids without incident.

In both cases, we can focus on a few freak events and determine that these activities are just too risky, but I suspect that view isn't backed up statistically.

What you have are super cautious people (like me), who don't dive or give birth out of hospitals, and less cautious people, who dive, give birth at home, and maybe even bungee jump.

The risk averse people assume they're always safe and the the risk tolerant people assume they're probably safe.

The truth is that some small number in both groups will be wrong.

"Doctors want to use their tools. They want to use anethesia and medications, want to use their cutting shears, want to have you hooked up to machines that go "beep""

Yes, what's wrong with risking potentially higher probability of mother or child death, in order to avoid that goldarn *beeping*. I mean, BEEPING I tell you. Don't you understand? Those machines *beep*. When my wife gave birth, oh my G-d ... that beep, beep, beep. A machine, I tell you. And it went "beep". Don't you see how bad this is?

"I did tell the doctor that I wanted to squat and I did want want an episiotomy. The doctor agreed - until 3 weeks before the birth."
;
"And my last opinion-if you don't have the balls to tell a Dr you don't want an episiotomy and do want to squat"
;
"My (recent) birth at the hospital was miserable. The whole thing was absolutely unpleasant, from admittance to exit"

My wife and I recently had a hospital birth. And you know what, it was awesome. Every moment. Most amazing experience of my life. Loved it. Loved the anasthesia. Loved knowing doctors and medical personnel and equipment are right there in case of emergency. Loved that an experienced doctor could help (induced natural labor, very mild vacuum-assistance, no problems). Loved the little imperfections of the experience.

"Sadly women don't always get a full range of choices when it comes to childbirth."

Oh bullsh-t. Sorry, but I think a bit of bashing is in order here ... because jesus, you people can whine. We have far more access to by far the safest, most comfortable methods for childbirth, and widest range of choices in both breadth and scope, than ANY humans EVER in the entire history of our species, in the entire history of this planet ... there has NEVER been a time where we have had such incredible 'options'. Our pregnancies are informed by bodies of scientific knowledge, they are handled by trained experienced doctors, and we have modern hospitals dotted all over the planet, ready to chip in and deliver by e.g. cesarian in cases where literally just a couple generations or so back, you or baby would have died. And you flipping bitch and whine about "not getting all your options" because Miss Princess can't get Absolutely Everything Exactly Her Way for Her Special Delivery. Puh-lease. This is what some of you sound like: "OMG! I specifically asked for 'erbal camomile tea and the hospital brought me regular tea - it RUINED my WHOLE birth experience!" Bull! You just had the privilege of giving birth to a healthy baby in a modern hospital (or at your home with an experienced midwife with access to hospitals in case of emergency), so WHAT if you didn't 'get to squat' or 'get exactly the right type of birthing chair you wanted' - have some frikken appreciation for all the incredible things in front of you, and the incredible experience and privilege of successfully having a healthy baby with 10 fingers and 10 toes, instead of acting like huge grownup spoiled entitled brats. Who the f-ck cares that you 'didn't get to squat, oh noes' - you just had a baby, for G-d's sake, it's an incredible precious joyous miracle ... I'm so happy about our healthy precious bundle of joy, I would have been happy and appreciative if we had to bathe in raw sewage to have her delivered. You know how many people experience horrific tragedy at this time? You know how many people end up with babies with chronic health problems that are a lifelong burden to take care of? If you are whining about things like 'not getting to squat', then really, you need some real problems in life in order to get some perspective.

If you want to see what it means to 'not get the full range of choices', go check out some third-world impoverished areas where maternal death rates are 100 times higher. If you want to check out 'not getting your full range of choices', just go back in time 50 or 100 or 200 years and see how incredibly primitive it was then, when we didn't even have things like epidurals to make the experience much more pleasant and less painful. Then go back 500 years, 1000 years, 10,000 years, 500,000 years. Then please, come back here and whine away on an Internet forum about how "sad" it is women don't get "all their choices".

Well said, Lobster. My opinion is that for us, in the Western world, this is a lame debate. We don't know the exact stats, but one thing is certain: they're extremely low.

Bottom line, it's personal preference - a luxury no mother in a third world country has. Stats may show that it's actually 2% more dangerous to give birth in a hospital than at home, but will that stop those who want to birth in a hospital? No. They'll never believe they'll be in that 2%.

Same is true of those who want to birth at home. The 1% or whatever isn't going to deter a woman who is more comfortable trying it at home. None of them, including the subject of this blog article, would ever believe they'd be in that percentage. And that's because Western women, of good health and with good prenatal care, don't die in childbirth anymore, in a hospital or at home.

It's RARE, just like having a child kidnapped is. So, how much should we play into the fear?

"...So no it's not safer in hospital."

Did you even read the study?

There are a lot of flags, but the "tell" for me is this: when someone birthing at home has a problem, they go to the hospital.

That's the trump card. Nobody with serious health problems stays at the house. Nobody's doing a Caesarian on a kitchen table.

It's probably safer in the hospital, but it's still pretty safe at home too. Plus, with the prenatal care we have, many problems and risks can be assessed ahead of birth, so mothers who have those risks would go to the hospital anyway. And even in cases of unforeseen problems, the mother can usually be taken to the hospital in time.

It's not for me. I'm a scaredy cat. Risk averse. But, like I said, the odds are low either place, so I think it boils down to personal preference.

Just because I wouldn't let my kid walk to school alone (there's 100 "child predators" lurking in a 5 mile radius of just about every neighborhood in FL) doesn't mean that other moms who feel differently are being wildly irresponsible. People can say that, but the odds of anything happening to any individual child walking alone is still extremely low, as Amy often posts.

Nobody wants to be in that low percentage, and we all try to take steps to assure we're safe, but, in reality, bad things happen unpredictably to a few unfortunate folks.

And hindsight is always 20/20. I'm sure this mother's family wishes she'd been in a hospital, just as the mom of the missing child wishes she'd driven her to school, but the question is whether it's reasonable, based on the low odds, to project that these bad things will happen and live life from that state of fear.