Through the last couple of days, there has been a lot of controversy on the last two posts, Home Birth: What if Something Goes Wrong? and Home Birth: Interview with a Certified Professional Midwife. A lot of “statistics” have been thrown around, and a lot of negativity has ensued.
I’ve done some research now to present, via medical journals, some of the real statistics concerning both home and hospital birth. This piece isn’t meant to convince anyone either way, just to present an accurate and unbiased picture of the benefits and risks in both locations. As always, talk to a qualified health professional before making such an important decision.
Please note that all the hyperlinks will take you to the sources of the data. They are primarily from medical journals.
Neonatal Mortality Rates (please note this is all births from 24 weeks’ gestation on; most babies are preemies who did not survive)
U.S. — 4.54 per 1000 births (in 2005)
U.K. — 3.2 per 1000 births (in 2008)
Midwifery care in a hospital setting is much more common in the U.K. than the U.S., though CNMs in a hospital setting is associated with a lower neonatal death rate than OBs in a hospital setting in both countries.
Rate of complications from epidurals — 2.4% (mostly minor issues, like headaches and soreness)
Each intervention in a hospital setting increases the rate of surgical delivery (c-section).
Oxytocin (pitocin) used in the third stage of labor reduces the risk of hemorrhage from 10% to 6%. (I’m curious if this couldn’t be recommended routinely only in high-risk cases?)
22% of all women were induced in 2006; this has doubled since 1990.
In 2007, the c-section rate was 32%. It has risen for all ethnic groups each year for quite awhile.
C-section rates have risen faster for first-time moms than second- or greater moms. In one study, this change was not associated with increased perinatal mortality rates.
In 2008, 12.3% of babies were born prematurely. This is down from a high of 12.8% in 2006.
“Late” preterm (34 – 36 weeks) rose sharply from 1990 – 2006; the number of babies born due to induction or c-section in this group did as well.
Most midwife training programs — including CPMs — are three years long. Very few midwives choose not to attend a qualified school training program. Nearly all complete some type of apprenticeship. Clinical experience is required for certification.
Clinical experience for CPMs lasts a minimum of 1 year; more typically, 3 – 5 years, and requires no less than 1350 hours. During this time, the student must attend no fewer than 40 births; 20 as an “active participant” and 20 as the “primary midwife” under the supervision of a certified midwife. (This does not include all the births that they must observe prior to participating.) At least 10 of the “primary midwife” births must be in an out-of-hospital setting.
In one program, OB/GYNs spend a total of 19 months directly in OB-related clinical experiences out of a 4-year residency. The rest of their time is spent in GYN-related clinical experiences, emergency medicine (“regular” and neonatal), and some general hospital clinical settings. (After completing 4 years of pre-med and 4 years of med school.)
Please note this is preliminary research at best. Always do your own research before making any decisions. There is no way to account for every possible situation in any type of birth setting; emergencies can occur regardless of prenatal care or birth attendant. There is also no way to address possible emergencies and conditions in such a limited sampling of statistics. This post is intended for informational purposes only.
Tomorrow I will be discussing birth advocacy and ways we can make birth safer for all!
Top image by mbaylor