When the New York Times published a profile on pioneering American midwife Ina May Gaskin back in May, the online comments poured in on the Times’ site; and I wrote here about those comments, rather than about the article itself (although it was very good). The feedback that article generated represented a huge range of opinions on the subject of childbirth, home birth and midwifery, and hospital birth. Although some were clearly extreme and not really applicable to reality (no, midwife-assisted home birth is not comparable to prehistoric childbirth in caves), others represented a middle-ground mindset that’s shared by many; lots of people – moms included – don’t dismiss home birth’s appeal, or perks, entirely, but they nonetheless feel safer giving birth in hospitals.
I totally get this. I do. I’m all about Safety First, and my mind can drum up the most gruesome of worst-case-scenarios. Which is why I find the statistics around home birth and midwife-assisted birth super compelling; countries in which women give birth with midwives, at home – rather than in the hospital – as a matter of course do so with stunning success. (The Dutch system is famous for its childbirth practices and super-low infant and maternal mortality rates.) Gaskin herself has a staggeringly impressive record, too; before even looking at hospital-birth statistics, home birth statistics certainly don’t appear threatening. Of course, some people argue that midwife-assisted childbirth numbers look good only because most midwives accept only low-risk, normal pregnancies into their practices, while hospital statistics include all emergency and high-risk births; at first blush, any comparison of the two is between apples and oranges. I think it is safe to say, however, that since the vast majority of US births take place in hospitals (seriously, home births only account for 1.09% of US deliveries), the vast majority of those deliveries also involve healthy, ‘normal’ babies and moms. Comparing our maternal death rates with those countries in which the vast majority of births take place at home – rather than to American home birth statistics alone – makes for an even more level playing field, and can really tell us something.
Spoiler alert: hospital births in America are definitely not more safe than home births in the Netherlands. In fact, hospital births in the United States aren’t very safe at all when compared to home or hospital births in other developed counties in general. Ours is one of only a handful of countries in the entire world whose maternal mortality rates are rising. And they’re doing so rapidly. Our maternal death rate has doubled over the last 25 years. In California, it tripled in a mere decade (1996 to 2006). Given that a great many maternal deaths aren’t even reported to the CDC (Gaskin herself goes into this in more detail here), these numbers probably actually look better than they really are. And, well, they don’t look good.
Our maternal mortality rate lands us 50 places from the top when it comes to safety in this department, despite our spending $98 billion a year on hospital births (more than any other nation). Hospitals’ C-section rates (also on the extreme rise) don’t nearly reflect real ‘emergency’ rates – many hospitals are well over 50% -- and are a driving force behind the maternal death rate problem. But there are driving forces behind those C-section rates, too.
When asked for her perspective on this issue, Gaskin noted that because insurance companies drive the modern medicine bus right now, many obstetricians aren’t even allowed – or trained – to perform procedures most midwives are qualified to handle, intervention-free; delivering breech babies, for example, ends up turning surgical far more frequently than it needs to (resulting in more complications, and more deaths). And since many other countries are copying the American medicalized childbirth model, our insurance system – although we are the only developed country involving profit-driven insurance companies in our population’s health care at all – is also now affecting childbirth practices overseas.
I don’t mean to be depressing here, people; and I’m not saying everyone should give birth at home. (I gave birth in a hospital, though if I do it again I'm totally taking off for Gaskin's farm!) I’m saying women deserve to not only feel, but also to be, safe, whether they’re in hospitals or at home. It’s important that we analyze and recognize what about our approach to health care, and our health care system, isn’t working, despite its being such a money pit. And it’s important that we have good information, and good choices, at every crucial health-related juncture. As our choices are placed on the chopping block nation-wide (birth control, really? What year is this?) , we should value and explore them more than ever, and make informed decisions in our own, and our familes’, best interests.
When I asked Katherine Brady, a doula and soon-to-be-midwife here in Austin, Texas for her advice, she said, “When I was pregnant with my twin boys in 2000, the only birth and labor education I could find was in my hospital at a hospital sanctioned birth class. Today all women have to do is Google local labor and child birth education classes and they will have hundreds of options. I encourage women to seek out as much information as they can absorb; go to classes, find a doula, and ask questions.”
The up-side, at least for now, is that we do have options. If we choose to give birth in a hospital, we can choose an obstetrician that we trust. We can choose to advocate for our own safety. We can get our partners on board with our preferences, so we have people advocating for us, too. In an increasing number of hospitals nationwide, we can choose low-intervention pain relief, and even water births. And if we find the statistics persuasive enough, or if we simply prefer to give birth at home, we can make the decision to go for that – more and more women are – even if we are Safety First types.
Are you as shocked as I am by how rapidly the American maternal mortality rates are rising? Why do you think this is? Considering how we compare with so many other developed countries (not very well), do you feel safe giving birth in a hospital? Would you consider home birth? Why, or why not?