The judicious magazine The Economist chimes in this week on the debate over home birth safety, and I must say I was very pleased with the even-handed coverage. The piece, titled, “Is there no place like home? Where women give birth is a contentious issue across the rich world,”offers a pragmatic summary of the issues, including the controversial imprisonment of Hungarian obstetrician-turned-midwife Agnes Gereb, the much disputed results of the 2010 meta-analysis questioning the safety of home birth and the confusing perinatal/neonatal mortality statistics in The Netherlands, where a third of all babies are born at home.
I’m considering saving the concluding lines of the piece on my desktop to help put out future flame wars on the topic:
“A definitive statistical answer to the relative perils of home and hospital births is unlikely. Randomized trials, which are the gold standard in medical research, will be tricky to impossible: women are unlikely to accept a researcher’s arbitrary instruction about where they should give birth. As with many other aspects of child-rearing, birth will come down to parental disposition—whether for a hospital’s bright lights and plentiful pain relief, or for the familiar comforts of home.”
Some more highlights:
On The Netherlands (where a third of all births take place at home): “The Dutch perinatal mortality rate is one of the highest in Europe, though the cause is contested. Supporters of home births say that the numbers are still not all that high, and have to do with poor assessments of how risky pregnancies are. Nonetheless, they highlight how difficult it can be to determine whether a pregnancy is ‘low risk’ and thus suitable for a home birth.”
On home birth as a response to overly interventionist hospital policies: “Nick Thorpe, a Budapest-based father of five (all delivered at home by Ms Gereb) says that Hungarian doctors have never seen a birth that did not involve significant medical intervention: episiotomies are standard and over 30% of births are by Caesarean section. There and in other countries, money may play a role, too. Grateful patients make unofficial payments to their doctors…”
On the “Wax Paper”–a widely publicized meta-analysis published last year in the American Journal of Obstetrics and Gynecology which concluded that babies are three times more likely to die in home births than hospital births– we are advised to “take a deep breath” and listen to the counter arguments from The National Childbirth Trust and British Royal College of Midwives. “Only one of the studies used showed a big increase in neonatal deaths. Including unplanned home births, inevitably more dangerous, may have skewed the data.”
Here’s the piece. Have a look. The tone is hard-edged but the content is refreshingly sensible.