Let's face it, there are two aspects to labor and delivery: 1) the thinking part, and 2) the mechanical part.
The thinking part is addressed during prenatal care. High risk conditions will prevent planning a home birth, and I think even the most ardent supporters of home delivery have no problem agreeing. The mechanical part is addressed at delivery. At this point, obstetrics is easy; a woman is either going to deliver vaginally ... or she's not. Dysfunctional labors are the very things that midwives handle very well. Unfortunately, obstetrics is a condition in which an emergency can crop up suddenly, progress rapidly, and hurt or kill a baby or mother. If delivery is natural, so is still birth, placental abruption, fetal distress, shoulder dystocia, etc.
This is the problem with home deliveries. If a baby is suffering hypoxia, every minute counts. On a baby-by-baby case, a home delivery that cannot provide immediate Cesarean rescue is unfair to the unborn should a problem occur. Every birth I've attended has been in a hospital. It's been rare (approximately three to four times a year), but I've been in the uncomfortable position of needing to deliver a baby within moments. To put a new life at higher risk, even the slightest higher risk, of jeopardizing his or her intellectual potential is too selfish to justify. If you think not having the birthing experience you want is a bitter disappointment, try to imagine brining a special child to physical therapy every day or to Children's Hospital every month, or having to learn how to thread feeding tubes. Suddenly the romance of the hearth flickers out.
In my book, a main philosophy is that it's not how you have the baby, but how you raise the baby. Having the perfect delivery memory is silly if you won't put seat belts on your children, if you smoke, or if you lose it and inflict physical or emotional abuse on them. If you're looking for fulfillment with children, get it from raising them. Sure, it would be nice and important to have the birth memory you desired, but most of all you want a normal child who will give you the expected fulfillment in raising him or her.
OK, so far I've been philosophical about the whole thing what if this and what if that. Home birth enthusiasts feel that under the right conditions normal pregnancy a home birth is just as safe as a hospital delivery. They quote statistics that compare the neonatal and maternal complication rates with those of hospitals wherein there seems to be no difference.
You can use statistics to argue your side just as legitimately as the other side can use them to their own advantage. This is why all of the studies in the prestigious medical journals follow such stringent guidelines to eliminate any polluting aspects and ensure a verifiable conclusion. Another warning about studies: They generalize the population. If there's only a one in a thousand chance of a complication happening, that's pretty good odds against that happening to you. But if you ARE that one, it might as well be a thousand out of a thousand, right? The point here is that studies are conducted academically on vast numbers of people by physicians who don't have to face those ones out of the thousands in their private practices. Your doctor, on the other hand, wants the best guarantee that everything that could be done to protect your baby is in fact being done. Because he or she would have to face you if the unthinkable happens. This is an awesome responsibility. And you can't say you've done everything you could to protect your child from sudden, bad surprises unless you have anesthesia immediately accessible, a blood bank nearby, and surgical rescue readily available. Your home can't do that. Only a hospital can. Even with it's bigger, badder germs that are thrown up in the pro-home birth arguments.
This is not to say that statistically significant studies aren't meaningful they're what move medicine forward. Another thing that moves medicine forward is the professional specialty organizations that oversee the studies, as well as the training and continuing education of the respective specialists. The American College of Obstetricians and Gynecologists (ACOG) is one such organization. It above all represents the highest scientific authority in determining the most prudent protocols in assessing, administering to, and preventatively managing women's health and pregnancy. ACOG assumes this responsibility with the highest of ideals. I myself follow the ACOG guidelines, so if one challenges its expertise, then I really don't have an answer to that.