(Ruth Fremson/The New York Times)A friend recently stumped me with a health-related trivia question. Who was the first president to be born in a hospital?
The answer, posted below, left me thinking about what a relatively new phenomenon hospital births really are. My colleague Julie Scelfo explores the issue further in today’s Home section, finding that the home birth appears to be making a surprising comeback. Since the 1950s, she explains, the overwhelming majority of American women have chosen to give birth in hospitals, the place the American College of Obstetricians and Gynecologists says is one of the safest places for childbirth.
But midwives and childbirth educators don’t always agree and have embarked on a national campaign to advocate for regulation and licensure of certified professional midwives. They argue that birth doesn’t have to be a medical event, and that when women do opt for hospital births, they often lose control of the process and many end up with unnecessary C-sections.
“In your home you’re able to move around,” said Élan McAlister, founder of Choices in Childbirth, a four-year-old non-profit educational group that publishes The New York Guide to a Healthy Birth. “If you believe birth is not a medical emergency, it is the ideal place because it’s the place you can really let go and follow what your body wants you to do.”
To learn more about the new trend toward home births, read the full story, “Baby, You’re Home” and be sure to check out the slideshow on home birth.
And to answer the trivia question: The first U.S. president born in a hospital was Jimmy Carter.
What do you think about giving birth at home rather than a hospital? Please join the discussion below.
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Child birth has become entirely too medicalized. For the overwhelming majority of women, child birth is not a medical emergency. If you’re having a normal, healthy pregnancy there is no reason you really need to go to a hospital to give birth. I was tortured for the 3 hours I spent at the hospital in labor, stuck on my back in a bed with an IV I didn’t want or need and continuous fetal monitoring that research has been shown is not a very accurate way to gauge how baby is doing anyway. Next time I’ll opt for a midwife and a birthing center.
BTW, about 30% of women nationally end up with a C-section, but the average midwives’ rate of sending a woman to a hospital for a C-section is only about 5%.
— ElitaBritain has it right: home birth is truly about safety, not some sort of fluffy feel-good whim. The AMA’s 2008 position on home birth is an insult to science-minded women and their families.
Among other benefits, mother and baby are at considerably lower risk of infection at home–especially important with the increasing virulency of antibiotic-resistant hospital-acquired infections.
Current US hospital practices include administering drugs and performing procedures on pregnant/postpartum women without informed consent, often even without knowledge of the patient. A relatively minor example is the routine administration of pitocin postpartum, when in evidence-based practice it would be used postpartum only in case of hemorrhage (in which case it is certainly justified–and available with a homebirth midwife as well).
Current US hospital practices also include administering drugs and formula and performing procedures on babies without informed parental consent. For example, nurses are getting better about not feeding formula without parental consent (though it is still sometimes done behind parents’ backs!), but I have yet to know of a nurse who discussed the implications of formula feeding to gut permeability with a parent. So much for “informed” parental consent.
— Evidence-based care supporterIn 1915, the maternal mortality rate was 607.9 deaths per 100,000 live births. In 2003, the maternal mortality rate was 12.1 deaths per 100,000 live births in the United States. Do you really think we should go backwards?
FROM JULIE SCELFO: The maternal mortality rate has indeed plummeted since the turn of the last century. However, according to Jennifer Block, author of “Pushed: The Painful Truth About Childbirth and Modern Maternity Care,” maternal mortality actually kept increasing for several decades after birth began moving into hospitals in the early 1900s. “It wasn’t until antibiotics and bloodbanking in the late 1930s and 1940s, that maternal death rates began to decrease,” Ms. Block said.
In her book, Ms. Block cites a large study done by the New York Academy of Medicine in the 1930s that found maternal mortality rates were lower for home births attended by midwives and doctors than in the hospital. “One reason was in the hospital, physicians were attending to sick people and then attending to women in childbirth, and then passing infection around. hospitals weren’t sanitary. And once an infection had begun, you had no way to treat it,” Ms. Block said, “so you had more chance of dying if you were giving birth in a hospital.”
— Stephen MeisterAt the risk of being very un-PC, I urge everyone to think twice before having a home birth. If there’s any chance of complications, you want to be where medical professionals are ready to help you out. Yes, people managed to have children before the rise of hospitals, but infant and maternal deaths were much more common then.
I have heard quite a few home birth success stories, which is wonderful, but a friend of mine attempted one with her second child (she felt the hospital had forced her in to an unnecessary c-section with her first). Problems arose, the ambulance didn’t get there in time, and they lost their baby daughter. It does happen. And it’s utterly terrible when it does.
— jFrom Julie Scelfo: In addition to the risk of neonatal death, another benefit of the hospital setting is having the baby examined right away for rare disorders that require immediate treatment.
This is what I feel is another disturbing trend analogous to parents not vaccinating their children, and another example of the success of modern medicine. What used to be the most common cause of death for young women: child birth. What used to be the most common cause of neonatal death: child birth. It is true most deliveries are without complications, but it is impossible to predict all of the potential complications. How many deaths will it take for the pendulum to swing back towards common sense and sanity?
— ErikTo me this is all part of the romantic idealism of the liberal, upper-middle class. Many of them seem to want to turn back the clock to a supposedly better, simpler way of life from the past. Something that formerly was a sign that your family didn’t have enough money for a professional, hospital birth is now a sign of how concerned and caring the well-to-do parents are. To me, this is ironic.
This trend is similar, in my mind, to Michael Pollan’s ideas about how food should be grown, harvested and marketed. And just like with the slow-food folks, this trend is mostly for those with enough money and time to use their home as a birthing place. Such a thing is certainly not for everyone, nor should it be.
Judging from the looks on the faces of the people in the NY Times slide show about home births, I’d say giving birth, no matter where it is done, is a fraught process, with a lot of pain and anxiety in attendance, not only for the woman giving birth but to those around her as well. I am not minimizing what a woman goes through, only saying that the process is sometimes difficult to the point of exhaustion. And infrequently, the birth process can endanger both the new child and the mother.
Obviously, such a decision should be a family matter. Who is for it, who is against it, and whose point-of-view should finally prevail? Any woman with known birthing issues, known health risks such as high-blood pressure, and known psychological issues such as anxiety should get the opinion of more than one doctor before preceeding with a home birth, IMO.
— Rob L, N Myrtle Beach SCThe biggest problem with homebirth is that it has an increased risk of neonatal death. All the existing scientific research to date shows that homebirth has a neonatal death rate approximately TRIPLE that of low risk hospital birth.
Even the studies that claim to show that homebirth is safe (such as the widely quoted Johnson and Daviss, BMJ 2005) study, actually show that homebirth increases the risk of neonatal death. Johnson and Daviss found a rate of homebirth death in 2000 of 2.6/1000. The rate for low risk women in the hospital that year was 0.9/1000. Johnson and Daviss simply left that information out of their paper. Johnson is the former Director of Research for the Midwives Alliance of North America (MANA, the trade union for homebirth midwives) and Daviss, his wife, is a homebirth midwife. Johnson and Daviss deceptively compared homebirth in 2000 with hospital birth in a bunch of out of date papers extending back to 1969.
Since 2003, the US government has been collecting statistics on homebirth. In 2003-2004, the hospital neonatal death rate for low risk women was 0.37/1000 and the homebirth death rate was 1.15/1000. In fact, the single MOST dangerous form of planned birth in the US is homebirth with a homebirth midwife.
Mothering Magazine maintains a message board that promotes homebirth. In the year to date, 13 women have reported preventable deaths of their babies at homebirth, among less than 300 women. That is an appallingly high rate of death.
American homebirth midwives are currently hiding their safety statistics from the public. The Midwives Alliance of North America (MANA) the trade union for direct entry midwives has been collecting extensive statistics on the safety of homebirth since 2001. Those statistics have been publicly offered to anyone who can prove they will use them for the “advancement of midwifery”. Even then you must sign a legal non-disclosure agreement preventing you from revealing any data to anyone else. It does not take a rocket scientist to suspect that MANA is suppressing its OWN data because it shows that homebirth with a direct entry midwife increases the risk of neonatal death, and possibly the risk of brain damage as well.
Homebirth advocates are not honest about the fact that homebirth increases the risk that the baby will die. A woman has the right to choose where to give birth, but unless she understand that homebirth increases the risk of neonatal death by a factor of 3 or more, she is not making an informed decision.
— Amy Tuteur, MDThe dangers of hospital birth are many; infection is the least of them. Unneccessary C-sections harm and kill many mothers and babies; unneccessary drugs given cause babies damage we can’t measure. Safe maternity practices definitely include having low-risk births in midwife settings. The drop in maternal and fetal deaths in the US since the turn of the century has more to do with handwashing than our current system.
— Blanche DevereauxI had my first child in a hospital in England in 1975 and my second child at home in 1982 with a certified nurse midwife in suburban Los Angeles. My hospital birth was a miserable experience, the details of which I won’t go into here. But after that experience I was determined to give birth at home, and after a lot of searching found a midwife who was willing to help me. My baby’s head crowned, but then his shoulder got stuck behind my pubic bone. Fortunately, my midwife knew what to do, and she reached in and rotated my baby about 180 degrees while he was in the birth canal, which freed his shoulder, and he came out.
— ceciliaSince that time I have read quite a bit about this situation and I now realize just how dangerous it potentially is. Even in the hospital it can be very dangerous. I was lucky and my baby was lucky to have such an experienced and competent midwife. I am no longer anywhere near as blase about having a baby at home, and would no longer recommend it to any woman. I now think the solution is to improve what goes on in the hospitals, rather than encourage homebirths.
The umbilical cord was wrapped around my baby’s neck, choking her with each contraction. We knew from the fetal monitor in the hospital monitored by experienced labor nurses. The OB was called in and an emergency C section was performed.
— Ann MillerMy daughter is now one of the top students in her high school class, brilliant and can be accepted in any top college in the country. She could be president or find the cure to cancer.
I shudder to think what would have happened if I would have labored, ignorant, at home.
My great great grandmother died in her early 20s in childbirth with her fourth baby near a covered wagon. How incredibly stupid it is not to TAKE ADVANTAGE OF LIVING IN THE 21ST CENTURY. WAKE UP GRANOLA HEADS! Ignorance isn’t cool!
Ultimately, it is nobody’s right to tell others how to live there lives, or how to birth or raise their kids. I know I do not like being told how to live mine. That being said, it is possible to find a OB-GYN and hospital with which you are comfortable. You can vehemently express your birth plan to your Dr. and be your own advocate. Birthing at home is, simply put, a really bad idea… Many unforeseen events can occur during labor and birth. A hospital is the safest place to be… it is a controlled environment with back up plans available and at hand immediately in case of emergency. So, as to the above comment about people who home birth are the same people who do not vaccinate their kids… I can only say that I believe this to be true, and that is child abuse. Not vaccinating your kid, not only puts your kid at risk but everyone else in your community. We don’t have Polio anymore because we all have to get vaccinated for it.. And, we have many more successful births than we used to, because of modern medicine. Please give birth in a hospital.
— Peter, BrooklynAll three of our sons were born at home in Manhattan.
We were well prepared for the experience, siblings saw siblings born and as the saying goes; hospitals are for sick people, not healthy new born babies.
— Victor SanchezIt’s possible to have a natural unmedicated birth in a hospital! I’ve done it — twice. Doctors and nurses are becoming more and more supportive of this. I am a huge fan of natural childbirth, but if something were to go wrong, I wanted quick access to the best medical care possible. I think having a natural birth in a hospital is the best of both worlds. To read more, see my post:
— Josiehttp://organizedmommy.blogspot.com/2008/11/you-do-not-need-drugs-to-have-baby.html
Please join me in disregarding all postings by men (including fathers who never know what it is like to be pregnant and members of the male dominated medical establishment) because frankly this is OUR issue and unless you have created a human being inside your body and gave life to her you should not get to comment on where and how we, women, the creators of life choose to do this.
— CariFROM JULIE SCELFO: Hi Cari, Without exception, every father I interviewed felt strongly that his wife should have control over how and where she gave birth. Also, fathers value participating in their offspring’s arrival and having an opportunity to bond with them during their first few minutes out of the womb. Dads whose babies are born at home often use the time when the new mom is getting cleaned up to cuddle, bare-chested, with their new son or daughter.
Just a couple of comments to the previous posts:
Midwives are trained professionals that know what to do in the case of emergencies. They carry emergency medications for hemorrhages, oxygen for babies, equipment to monitor fetal heart tones. These women are not giving birth unassisted.
And yes, our maternal and infant mortality statistics have dropped, but it is simplistic to say that it is because birth has moved into the hospital. Dozens of countries where home birth is a common practice rank higher than us on infant mortality.
— Alexis NolanPeanuts was born in a hospital. That explains a lot.
Or does it? Is there a difference between Deliverance and being born the first time?
Children are born everyday all over the world in places other than a sterile, costly and often hostile and unsafe environment. While some will claim this is why we are ranked number one in the world in safety and results in childbirth, the cruel truth is we are actually ranked rather low (38th or 45th depending on who’s counting).
And dulas and nurse midwives births are less expensive especially when done in the home. The process runs towards those little steps we can take by ourselves and the implications must be frightening to many providers.
As a generalization there are fewer discussions of risk and required, recommended and unnecessary tests (ant there are fewer tests) and that alone makes it a safer journey. And it gets capped off with support and encouragement for breast feeding, another simple natural way to start a new life without drugs and formula.
As a father of four, two delivered the hospital way, one born in a hospital based birthing center and one born at home (almost, as the actual final birthing was done at a local hospital), the home birth was preferred, the birthing center birth second. As for the first two delivered in the late 1960s, I can say little other than I was told to leave until called back as everything would be taken care of by the doctor. The message was clear: we own you, the mother to be and the baby.
I had to make a greater effort to bond with the first two, and much less effort with the last two as I attended and to the extent a father could participated in their births.
The difference was self-empowerment or total dependence on others; being there when they were born or being summoned when others felt it was OK for the father to arrive. As for the mother of the first two, drugged totally or or semi drugged to a point that she could not deal with her first two for several days (as she detoxed) versus the second mother of the last two who was fully there without benefit of drugs and could immediately breast feed and bond with our children.
To see where everyone stands on this reversion to natural birth, look at the reimbursement and respective concerns about gain or lost income.
We should seek in a National Wellness Program, 100% coverage for natural childbirth at home, doulas, midwives, breast feeding consultants, breathing and relaxation experts, nutritionists and nutritional supplements and 50% reimbursement for elected hospital Deliverance with a cap of $1,000.
— ed gPosters 3-6 should do some research. This isn’t an issue on which one has to rely on beliefs or politics - it has been studied. The United States has relatively poor infant mortality rates compared to other developed countries where fewer childbirths occur in hospitals. Yes, bad things can happen during home births, but births in hospitals carry their own problems. In obstetrics, medical intervention has an extremely poor record. Many interventions can cause more problems than they ameliorate. Consider unnecessary C-sections (which are far from harmless), episiotomies (which have been shown to increase risk of tearing), use of forceps, problems related to the drugs they use for induction/pain relief etc. It is well established that the AMA doesn’t always adopt evidence-based policy. There is sufficient evidence to suggest that home births can be a safe, and perhaps safer, alternative to hospital births for low-risk mothers.
For a good book on the history of medical intervention in childbirth, check out _Birth_ by Tina Cassidy.
— MI am a labor and delivery nurse who drives miles out of my way to work at a (terrific) hospital, one that has the wisdom to staff CNMs (certified nurse midwives) in-house 24 hours a day. Many of our midwives have birthed their own children at home.
(We also have a Level 3 Neonatal ICU, so we are taking care of many high-risk patients as well.)
Yes, it would be wonderful if home birthing was better supported in this country. For many women, it would be a completely reasonable option. But childbirth is not without its risks, and every family needs to inform themselves about what those potential risks could be. And then it is imperative to select a midwife who isn’t so anti-hospital that she/he wouldn’t get you to us if either you or the baby needed us.
There are some terrific hospitals out here, ones that you don’t have to ‘avoid’. At the end of the day, what all of us want is a healthy mom and a healthy baby. To the long list of things you will do to enjoy a healthy pregnancy, add “I will not stress out about delivering in a hospital!” When you get there, you may just find a nurse and a midwife (and a doctor, should you need one) who will happily support your birth plan wishes, and who really look forward to helping you and your family welcome your new baby.
— Deb FordThere are 2 aspects to my response.
1. safety is in the eye of the beholder
2. choice is paramount
Its all very well to say hospitals are for sick people but what would YOU do if the heartbeat dropped and you were at home? How long would you and your midwife wait? Would even have that time to spare? And if you agree (surely!) that in many instances it is totally necessary to get to a hospital, then why take the risk that you don’t have that time?
Would you even KNOW the heartbeat dropped or would it be like in the 19th century when more babies were simply “stillborn”. How many of those babies could have been born healthy in a hospital with monitoring and intervention? We’ll never know. But those are rarely counted in the stats.
On choice - I would HATE to give birth at home no matter what the safety profile of it against the alternatives. Why should I be guilted into it?
Seems to me that the midwife lobby has hired a publicist who has hit on a really smart strategy. The safety angle has never been used before to advocate for homebirths, it has always been “it is safe enough for low risk pregnancies and so much better in other intrinsic ways that we can’t measure but make us feel warm and fuzzy”. They were losing the battle for clients to obs and hospitals so they changed tack. Smart move. Not necessarily for the good of the patient though because it ignores variation amongst risk profiles of pregnant women. True the OB’s approach did too, but it is better to be OVERmedical than UNDERmedical.
No one ever died because the Dr was on hand in case.
— JillyflowerPeople die every day because the Dr isn’t there in time.
I agree with Cecilia that the best option might be for hospitals to change the way they manage maternity care. But until this happens - if ever - women are going to keep choosing home birth. Right now ACOG is more focused on criminalizing the competition (midwifery) than promoting evidence-based, low-intervention practices that would improve the experience AND outcomes of childbirth. The reason home birth rates are rising (especially among educated women who do their own research) is because women can’t trust OBs and RNs in a hospital to stay the heck out of the way and let birth happen. I hardly blame the individual medical staff - they’ve never been taught anything different and it seems OBs today spend their whole residency doing c-sections. Today, the c-section rate in some NJ hospitals is at 50% (this information is publicly available at the Star-Ledger newspaper website) This means if you give birth at say, Hackensack hospital or St. Barnabas (please don’t!) there is a 1 in 2 chance you will have major abdominal surgery. Does anyone really think that half of all births in those hospitals had emergency life-threatening situations that truly required a cesarean? Or is it more likely that the standard policies in those hospitals don’t support women’s progress through normal labor, and that the OBs in those hospitals aren’t patient enough to let nature take its course, and that insurance liability risk-management policies encourage c-sections to defend against possible lawsuits? My friend was given a c-section because after only 12 hours of labor they decided she had “failed to progress” (baby showed no signs of distress). One woman in this article had 40 hours of labor. Long labor is not rare. But no hospital would let you hang around and take up a valuable bed space for 40 hours of labor. Yes you *can* have an intervention-free birth in a hospital (I’ve had two) but I know first hand it takes a lot of effort, research, self-advocacy, willpower and commitment to work AROUND the system. Why should it be so hard? Every pregnant woman should watch Business of Being Born and read “Pushed” by Jennifer Block…and become an informed consumer. The best outcome would be for all women to demand changes in the way things are done today - and freely choose where to birth without fear.
— MTo Jillyflower (#19), who said “no one ever died because the Dr was on hand in case”: Um, have you given birth? The doctor is often /not/ there while you’re laboring. You don’t have to look very hard to find stories where in fact the doctor is NOT present when something bad happens. You also don’t have to look very hard to find stories about doctor-caused injuries.
It’s interesting. If there’s a bad outcome in home birth, everyone says “if only it had been in the hospital.” If there’s a bad outcome in the hospital, some people still interpret that as a reason to be in the hospital, ignoring the possibility that previous hospital interventions may have actually caused the bad outcome in the first place. Labor inductions and routine rupture of membranes put babies at risk, and yet many OBs continue to use them to “manage” labor.
Highly recommended reading: Pushed, and The Thinking Woman’s Guide to a Better Birth.
— Catposter #10- what might have happened, had you been at home, is that your movement during labor could have been unrestricted and dictated by what felt natural and what your body needed to do at the time- and the cord may not have been pulled by gravity around your daughter’s neck as you lay unnaturally on your back.
— JanaContrary to the claims of commenter #7, homebirth *with a trained attendant* has repeatedly been shown to be as safe or safer than hospital for both mothers and babies. Women in Europe have much greater access to homebirth, and they have much better outcomes in terms of maternal and neonatal mortality.
Being pro-homebirth doesn’t mean that someone is anti-modern medicine; homebirth is actually a best-of-both-worlds scenario. A woman can labor and deliver in a comfortable environment where her body can follow its program for birth, AND she can also have the care of a skilled and well-equipped attendant. We are not talking about granny midwives or nature-worshiping hippies. We are talking about professional, trained birth attendants who carry oxygen and pitocin and can tell a fundus from a fontanel.
The vast majority of Americans live within reasonable distance of a hospital. Homebirth midwives are always prepared to move to a hospital if there are indications to do so. Because they know so well what normal birth looks like, they also recognize the sometimes subtle clues of things going wrong. Homebirth midwives only want a healthy mother and baby, the same as anyone, and they know their limitations.
Women who choose the care of homebirth midwives enjoy hour-long prenatal checkups where they build a relationship and develop trust in the people who will help them birth. Women are much more satisfied with this type of care — which may be part of the reason for better outcomes.
I had one child in a hospital and it destroyed my trust in my body and left me with serious physical trauma (4th degree tear). My next two babies were born at home, under the care of two fantastically skilled and scientifically knowledgeable midwives. Giving birth at home was painful, yes, but also perfect. It was the pain of my body doing what it needed to do rather than trying to compensate for an unnatural situation (what woman would choose to push a baby out uphill?!? Standard hospital position.) My body worked just as it should, as I expected it to the first time. I and my children enjoyed the full complement of endorphins and hormones that we are supposed to get in birth. It was shocking to realize exactly what I and my first baby had missed out on.
Would I have moved from home to a hospital if I had to? Of course. But I am beyond grateful to have had the option of homebirth. It’s an option that should be widely available to US women, as it is for women in other countries.
— swimmermomJillyflower, no one is “guilting” you into anything. What an odd thing to say. Women are advocating for their own individual right to birth at home. I have never seen or heard anyone criticizing a woman who chooses to birth in a hospital.
You make a blanket statement that it is better to be OVERmedical than UNDERmedical. Since all medical interventions have pros and cons, benefits and risks, that statement is not necessarily true. Just as some have died or suffered in childbirth for lack of a doctor, others have died or suffered because a doctor made a wrong medical decision. Its just not that black and white.
— MThe fact that one-third of all hospital births end in C-sections is a disgrace. The AMA is, typically, acting like a bunch of thugs on this issue. Until obstetricians acknowledge that there is something seriously wrong with their model of child birth, their credibility will continue to erode.
— Brian Johnson