August 28, 2014

The Myth of a Safer Hospital Birth for Low-Risk Pregnancies

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home births The Myth of a Safer Hospital Birth for Low Risk Pregnancies

By Dr. Mercola

Do you believe that a hospital is the safest place to give birth to a baby? Society certainly paints the picture this way, portraying the hospital as the savior of sorts where women must rush off to in the middle of the night at the first sign of labor.

However, a growing number of women are choosing to buck the status quo and deliver their babies right at home.

And wouldn’t you know it … this isn’t a new fad, it’s a return to the way women have been birthing babies for ages – and the research shows it’s often the safer way, too.

Home Birth is Safer for Most Low-Risk Pregnancies

In an article written by Judy Cohain, CNM, she highlights 17 studies conducted over the last 15 years that show attended planned home birth is safer for low-risk women than hospital birth. In 12 of the studies, rates of perinatal mortality (deaths that occur before, during or immediately after birth) were either lower or similar for home birth, while rates of maternal morbidity were significantly lower, compared to hospital birth.

She pointed out five studies that appeared to show home birth as less safe, but this was because they included high-risk cases in the mix. Cohain stated:1

“Another 5 studies claim home birth to have a higher perinatal mortality rate compared to hospital birth but they all include high risk births in the planned homebirth group.

Instead of excluding the high risk births from both groups, they include the home birth outcomes of premature births at 34-37 weeks gestation, breech and twins, lethal anomalies incompatible with life, unattended home births, unplanned home births, or women who became risked out of home birth by becoming high risk at the end of pregnancy, had hospital births, but are included in the home birth group.

These 5 studies conclude that home birth is less safe than hospital birth, when what these papers actually found is that low risk births are safer at home but premature births have better outcomes in hospital.

Possible explanations for the false conclusion of these studies could be paternalistic power games over women or hospital birth being not only the most common but also the most profitable reason for hospitalization. Remove the high risk births from those studies and they also confirm that home birth is safer for low risk women than hospital birth.”

What Makes Hospital Births Risky for Low-Risk Women?

When you enter a hospital setting, birth, an inherently natural experience, is automatically turned into a medical condition. Many women are given the drug Pitocin, a synthetic form of oxytocin, to jumpstart labor and intensify contractions, or their membranes are artificially ruptured, which then can set off a cascade of biological changes that increase the need for more medical interventions, and ultimately Caesarean section (C-section).

C-section is the most common operation performed in the United States, and accounts for nearly one-third of all births. According to the World Health Organization, no country is justified in having a cesarean rate greater than 10 percent to 15 percent. The United States’ rate, at nearly 32 percent, is so high that even The American College of Obstetricians and Gynecologists admits it is worrisome.

This is actually the highest rate ever reported in the United States, and a rate higher than in most other developed countries. One study in the British Medical Journal found that a woman’s risk of death during delivery is three to five times higher during cesarean than a natural delivery, her risk of hysterectomy four times higher, and her risk of being admitted to intensive care is two times higher.2

C-section rates are lower among home births, as well as midwife-attended births. At one small hospital run by the Navajo Nation, where midwives deliver most babies born vaginally, the C-section rate is only 13.5 percent. According to Cohain, these are some of the factors that may make a hospital birth more dangerous for a low-risk pregnancy:

Planned delivery in hospital indicates women fear a bad outcome, which can be a self-fulfilling prophesy Increased fear releases adrenalin and other adrenergic neurotransmitters which can slow down or even stop the birth process Unfamiliar environment, strangers, people in uniform, unfamiliar smells during labor counter mammalian birth instinct Hospital staff reservoir of bacteria, which the mother/baby lacks immunity to Lower access to food, drink can cause hypoglycemia and dehydration
Car accidents on the way to hospital Fear and unfamiliar environment increase pain level, which sends stress signals to fetus, provoking negative influence on fetal heart rate Collusion among hospital workers takes precedence over commitment to client and safe protocol Lack of accountability of staff to patients contributes to poor outcomes Laying on back compresses the aorta and vena cava decreasing oxygen delivery to fetus
Continuous fetal monitoring increases pain, decreases oxygenation of fetus, decreases mobility and increases anxiety Hourly vaginal exams push bacteria up into uterus, causing increased rate of infection after 3 exams Overuse of antibiotics kills healthy flora, lowering immune system capability Artificial rupture of membranes (AROM) can cause cord prolapse, increased infection and pain Induction can cause cord prolapse, uterine rupture, amniotic fluid embolism, increased postpartum hemorrhage
Epidural causes fever in 15% of women, which increases neonatal seizures, which can cause brain damage Episiotomy can cause hemorrhage, third and fourth degree extensions, permanent disability. Vacuum increases rate of third and fourth degree tears, causing life long incontinence of urine and feces and sexual disability and increased hemorrhage and for the baby: intracranial hemorrhage, scull fractures, and, rarely, brain damage or fetal death Shoulder dystocia because of delivering in a hospital bed instead of on all 4s Cesarean can cause maternal and perinatal death, and increased maternal and fetal morbidity, lifelong scar pain, infertility, adhesions, decreased nursing success, increased stillbirth and placenta accreta on subsequent pregnancies.

What Conditions are Better Dealt With at the Hospital?

Ruptured uterus and placental abruption most often occur in high-risk cases, which ordinarily should not be considered candidates for home birth, which leave essentially only two acute conditions that have better outcomes in the hospital versus at home: cord prolapse and Amniotic Fluid Embolism (AFE). So while there are certainly cases where a hospital birth is preferable, this typically applies to most high-risk cases, along with the four emergency situations:

  1. Cord prolapse
  2. Ruptured uterus
  3. Amniotic Fluid Embolism (AFE)
  4. Placental abruption

As home births have been increasing (by nearly 30 percent from 2004 to 20093) it is common for the media to highlight the rare home birth tragedies, when a baby might have been saved had the birth taken place in a hospital. This does occur, but it is rare … far more rare than babies who end up dying due to unnecessary medical interventions or hospital errors.

Cohain concludes:

“The deaths caused by rare acute condition at planned attended low risk home birth that might have had a better outcome in hospital are outweighed by the deaths and morbidity due to common acute conditions caused by hospital interventions. Planned attended home birth outshines hospital birth for low risk women in every category of acute emergency.

Today research wrongly considers hospital birth as the gold standard. Bias towards hospital births causes the majority of researchers to ignore the fact that women could achieve even better outcomes than hospital birth, at planned attended home birth.”

Are You Interested in Having a Home Birth?

In the United States it often takes a lot of diligence and determination to go against the norm and find a physician or midwife who performs home births. It is rare to find an obstetrician that will agree to a home birth in the United States, and while certified nurse midwives (CNMs) can legally attend home births in any state, most do not and choose to practice in hospitals instead.

Only 27 states currently license or regulate direct-entry midwives (or certified professional midwives (CPMs), who have undergone training and met national standards to attend home births. In the other 23, midwife-attended births are illegal, however women often end up finding a midwife on the “black market,” who because of a lack of any type of regulatory oversight may or may not have adequate training.

It is certainly possible to find highly qualified and trained midwives practicing on the underground market. These women often believe strongly in women’s right to choose home birth, and risk being arrested and prosecuted for practicing medicine or nursing without a license to offer their services.

There are also people practicing as midwives who have not received adequate training that can also be found in this underground home birth market, so if you do go this route it’s imperative that you thoroughly check out and reference the person you are working with. A campaign is currently underway to expand state licensing of CPMs so that women who want a home birth can choose from a qualified pool of applicants, but until that happens you have a few legal options for home birth:

  • Find a certified nurse midwife (CNM) who attends home births in your state or in a nearby state (then travel to that state to give birth)
  • Find a CPM who is either licensed by your state or in a nearby state (then travel to that state to give birth)
  • Use a CNM but give birth in a hospital or birth center (a compromise). If you decide to go this route, make a detailed birth plan. This is a document that states the expectant mother’s or couple’s interests or desires for their birth experience.

It is not a legal document but is an important way of letting the doctors and hospital staff know of your wishes regarding medical interventions for mom and baby. Discuss your birth plan with your doctor or midwife ahead of time, and also be sure your nurse and any other hospital staff receive a copy upon admittance.

To find a midwife in your area, try:

  • Midwives Alliance of North America
  • Mothers Naturally
  • American College of Nurse-Midwives
  • Midwifery Today
  • BirthLink (Chicago area)

References:


 

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