How Safe is Homebirth? by Yolande Clark
“Birth is as safe as life gets”–Harriet Hartigan
Becoming a parent is one of the most significant life events, and from the moment of conception,
every mother is preoccupied with providing the very best for her child. Birth itself is no exception.
The birth process is the very first experience our babies will have of being in the world, and increasingly,
many of us are becoming aware that in so many ways, the birth event has a profound impact on who we
are, as infants, mothers, fathers and families.
As an independent birth attendant, and as the mother of 5 beautiful kids (all peacefully born at home),
I started writing this article hoping to articulate the safety of home birth, along with links and sources to
studies that prove that birth at home can be as safe, or safer than birth at the hospital.
But the more time I spent researching the statistics of hospital vs. home birth, the further I tumbled
down a rabbit hole of conflicting numbers, interpretation, biases and opinion. I discovered that while credible
studies proving that home birth is safer than hospital birth do exist, there are also studies that indicate that
hospital birth is safer. One of the most recent meta-analyses of home birth, led by Joseph Wax of the Maine
Medical Center (published in 2010 by the American Journal of Obstetrics and Gynecology) gives hospital
birth a small statistical advantage over home birth. This study however, has been lambasted by critics who
point out that the numbers may inaccurate, and that many of the data sets involved in the analysis include
inappropriate confounding factors such as unplanned and emergency home birth, or the home births of
women who are at a high risk for complications. (Read two critiques of the Wax Study Here: http://www.scienceandsensibility.org/?p=4118 and here: http://www.scienceandsensibility.org/?p=2551)
The conclusion that many researchers, birth professionals and women themselves have come to, is that in
the developed world, where women have access to clean drinking water, incredibly high quality nutrition,
and perhaps most importantly, information, birth is very very safe: both at home, and in the hospital.
While statistics comparing the safety of hospital birth vs. home birth are tangled and hotly contested by
both sides of the debate, the stats on hospital birth interventions are very clear: the Canadian national average
rate of Caesarean section births is at almost 27%, (slightly higher in the US), and in many hospitals, the rate at
which babies are born via surgery is between 30-40%. Few on either side of the home/hospital debate would
argue that this is a staggering and inappropriately high percentage. Most women are aware that c-section is
major surgery and that while it can save lives, it also carries significant risks to both mother and baby. What
may come as a surprise however, is that many routine interventions that are standard in the hospital for
*every* birth, from continuous electronic fetal monitoring, to the artificial rupture of membranes, to episiotomy,
to the automatic suctioning of babies’ nostrils as they emerge, to the separation of mothers and babies
immediately prior to birth, may actually go against the most current medical evidence for best practices. (For
more information evidence-based birth practices, check out http://www.improvingbirth.org/the-evidence
-shows/ and www.evidencebasedbirth.com)
Having given birth to my five babies blissfully and safely at home, I am of the personal opinion that many
of the so-called complications that arise during hospital birth are actually caused and perpetuated by a highly
standardized and interventionist approach to childbirth. Birth, for myself and many others, is an extremely
intimate, private event, that involves many of the same emotions and body parts as does the process of conceiving
a child. For some women, the stress and anxiety that the hospital environment can engender is in itself an
intervention that can be enough to stall the birth process, leading to a cascade of unwanted procedures. For
almost all mammals, undisturbed birth is the safe norm, and it is important to recognize that there is certainly a
risk when we interrupt the wild and complex hormonal matrix that creates the delicate dance of birth.
Critics of home birth often accuse mothers of putting their own experience of birth above the health
and safety of their child. But for advocates of gentle birth at home, mother and baby are an inseparable
dyad, whose well-being is inextricable one from the other. Birth is a physiological, emotional and psychological
event–not an inherently medical one–and the bifurcation of mother and baby, or the separation of the
physical, emotional and psychological aspects of the birth process into component parts, is precisely at the
core of why many mothers are rejecting hospital birth in favour of a more holistic approach in which the
mother remains the authority of her own experience, which can sometimes be a challenge in the hospital
As with any aspect of life, the birth process carries some risk whether undertaken at home or in the hospital.
In rare, tragic instances, babies and mothers sometimes die. This happens at home, as well as in the hospital.
As parents, it is so important to not only weigh the statistical risks and benefits of our decision as to where and
with whom to give birth, but also to recognize that women always have a wide variety of options within the rubric
of either home or hospital birth.
When I gave birth to my first son in BC almost 13 years ago, I had originally hired a registered midwife, as at
that time, BC had recently legislated midwifery within the healthcare system. Unfortunately, as she was working
under a regulatory body which mandated certain procedures, my registered midwife was unable to provide the
kind of care that I was comfortable with. I had informed her that, among other decisions, I would not be having
any ultrasounds, and that I would not be induced under any circumstances. She was not able to support me,
despite the oft-repeated rhetoric of informed consent.
In the end, I had to let the registered midwife go, and I hired an independent traditional birth attendant instead,
which was one of the best decisions I could have made! I went on to have a beautiful water-birth at 43 weeks of
pregnancy. My second child was also born at home with the presence of a traditional birth attendant, and my last
three babies were born at home as well with just my husband in attendance, and these were all wonderful
experiences (and all 43 week babies!).
Whether giving birth at home with a midwife, with a traditional birth attendant, having a free birth, or giving
birth at the hospital, I highly recommend that all women read as much as they can about pregnancy and birth,
including statistics and personal birth stories from other women, in order to truly make informed decisions.
And I encourage everyone to recognize that we are all unique, and that while our birth choices may be different,
all mothers love their babies and want the very best for them, during pregnancy, birth and beyond.
Yolande Clark is an artist, a health coach, an independent birth attendant, and a mother.
She lives in rural New Brunswick, and she blogs about freebirth, attachment parenting, sustainable living, health, spirit, outrageousness and dissent at www.bauhauswife.ca
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