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Home Birth and Hospital Birth Statistics

By KateTietje |

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

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About KateTietje

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KateTietje

Kate Tietje is a food blogger who focuses on natural food and cooking. In addition to Modern Alternative Mama, she has contributed her writing to the Parenting and Pregnancy channels on Babble.

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13 thoughts on “Home Birth and Hospital Birth Statistics

  1. Amy Tuteur, MD says:

    You left out the most important statistics:

    What is the death rate for CPM attended homebirths? Perhaps you could persuade the Midwives Alliance of North America to stop hiding their death rate and share it with the rest of us.

    How does their death rate compare with the comparable risk hospital death rate of 0.37/1000?

    How can anyone be expected to make a decision on the safety of homebirth without comparing death rates?

  2. KateTietje says:

    Amy,

    I could not find an unbiased source for that data, so I did not include it. If I had been able to find a reliable source I would have. Also, you’re misquoting…that .37/1000, at least from the sources I found, was specifically for CNMs in a hospital setting. OBs were nearly twice that.

  3. Amy Tuteur, MD says:

    “Also, you’re misquoting…that .37/1000, at least from the sources I found, was specifically for CNMs in a hospital setting. OBs were nearly twice that.”

    I never said it was MDs. Of course I used CNMs; I am trying to match risk profiles. The MD numbers include all the women with pre-existing medical complications and pregnancy complications as well as all the CNM and CPM transfers.

    By the way, that same CDC dataset shows that homebirth with a CNM has double the neonatal death rate of hospital birth with a CNM. Homebirth increases the neonatal death rate even when attended by highly qualified practitioners. That’s another statistic that American women deserve to know.

    Why don’t you call MANA and ask them for their death rates? I don’t think we can assume that they are so biased that they would give you false numbers. I suspect that they’d give you no numbers at all. Even that is worth knowing.

  4. Lahurongirl says:

    Please just stop, Kate. You’re never going to win this. The numbers are against you and no matter how you sway it, it’s not going to compute. Risk your own childs life as you see fit, but please stop trying to tell other women that it’s safe.

  5. Mary's mommy says:

    Neonatal mortality doesn’t tell you much because it has nothing to do with obstrical/orenatal healthcare. The perinatal mortality rates tell you about the prenatal/obstetrical care. If you actually look through the CDC Wonder site, you would learn more than just finding a chart with some numbers. Did you know that the chance of your baby dying from a congenital defect is double than it is in the hospital. There is a 10X higher risk of your baby dying from an infection at home than in the hospital. Your baby is 6X more likely to suffer a deadly birth injury at home, 6X more likely to die from respiratory distress, double the risk of severe birth asphyxia, 3X more likely to suffer birth asphyxia, 4X more likely to aspirate on meconium, etc. Do I need to go on?? Oh, for full term infants in singleton pregnancies, born to mothers between 20 and 34, the perinatal mortality rate IS 3 times higher! If you factor in ALL deaths (meaning high risk mothers/babies), the perinatal mortality rate in the hospital is 4.77 while at home it is 7.84. Interesting!

  6. Jenifer says:

    I’m not sure I’d agree that your bibliography salad is “preliminary research at best” as you say. You’re list is remarkably unhelpful. No context for any of the numbers, no statistics on homebirth even though that was supposedly the point of the post, and not really much in the way of studies. You’ve apparently confused neonatal and perinatal mortality. The few studies you’ve actually linked to don’t seem to have much to do with your argument. The one on epidural complications is from a physiatry practice, not L&D. You point to studies from Jordan and Australia when there are perfectly good, larger studies to reference from the US. You spent a lot more space commenting on CPM training and not much on OB. How many births do OBs attend during their residencies? And obviously, the lack of statistics on homebirth statistics is a pretty big oversight. Thanks to Mary’s Momma for the data from CDC Wonder – that’s a great resource.

  7. Heather says:

    LOL, you sure did your “research.” Anyone that takes advice from you is an idiot. Reading a couple of abstracts is not equal to reading a couple of scientific studies, especially if you can’t even read that the epidural study you linked to refers to epidural steroid injections and not labor epidurals. I can’t stop laughing.

  8. Heather says:

    Ahahahaha, still laughing here, and I’ve only made it a third of the way down your bibliography salad, as Jenifer so eloquently put it. You left out the part where the authors of the oxytocin study say, “Therefore, routine active management of the third stage with an oxytocic drug is strongly advocated. Because of the fewest side-effects oxytocin is regarded as the best drug available at this moment.” It just gets more hilarious as you read on. You apparently think your readers can’t read and are going to take your word for it.

  9. Heather says:

    Also, I love how you present the CPM training as hours and the OB training as months. You also neglected to mention that the 3 years of schooling for CNMs doesn’t include their four-year undergraduate degree, where they were required to take courses like anatomy and physiology, organic and biochemistry, and microbiology, and actually understand how a body works, even to gain entry to a CNM program. In fact, you didn’t bother to add up that the total hours of OB clinical experience for an OB/GYN is around 2400. Do you have any idea how many babies a resident or student nurse-midwife delivers in their clinicals. Far, far more than 40. In fact, one night I volunteered on a hospital OB floor last month, the student CNM delivered four babies in one night. A student CPM is lucky to get four in four months.

  10. Mary's Momma says:

    Oh, the CPM clinicals being at least 1350 hours is supposed to be massive. Funny, the OB residency (that thing after 4 years of pre-med and 4 years of med school) gives the obstetrician 15 months of clinical experience in just obstetrics. If residents are there for an 8 hour “shift”, you’re looking at 2400 hours in just obstetrics. There are also 4 months of maternal-fetal medicine (roughly 640 hours). CPM’s don’t even have to have a high school diploma (yep, this confirmed by NARM), let alone attend any type of school! As long as you know the answers to NARM’s exam and have some births under your belt, you get your certificate! Boy, OB’s should just save the money and create a certification program so they can skip those 12 years of learning for 1!!

  11. Clinical risk manager in uk says:

    Reviews of safety of home births have occurred many times. Time and Time again it has been agreed that home birth is a safe option provided that the appropriate risk assessments occur both antenatally and throughout labour. These assessments need to be based on most current evidence available. The emphasis has to be on risk assessment and correct analysis of the information available. Homebirth is a safe option for the right cohort of women. It is not safe for all women.

  12. Heather says:

    Clinical Risk Manager — You are right, when you are talking about homebirth in the UK or Canada or any of the other places where ALL midwives actually have the education and knowledge to provide competent care. Here in the US there are two different kinds of midwives, and most of the ones that do homebirths are inadequately trained.

  13. Lahurongirl says:

    “especially if you can’t even read that the epidural study you linked to refers to epidural steroid injections and not labor epidurals. I can’t stop laughing.”

    Me either!

    Clinical Risk Manager–The US has a totally different Midwife than what you are dealing with in the UK. CPMs and DEMs don’t even have to finish high school, man. Whole different world.

    We do have real midwives though! They’re called CNMs and the CPMs slide by on that good name :/

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