Hospital Birth vs. Home Birth: A Debate on Choices

The ACOG position on home birth, while possibly well-meaning, is an unsupported, self-serving statement. I could just as easily state that the drive to and from the hospital "clearly presents potential hazards" to the mother, father, and baby, yet not even I would argue that that is reason enough not to go to the hospital. ACOG has a vested economic interest in making sure that mothers keep coming to hospitals to birth their babies, so a blanket statement such as the one you cite simply cannot be read by a reasonable person outside of this context.

This statement does not mention that, during labor and delivery in a hospital, mother and child will be exposed to "germs" and other pathogens that are not present in the home (even if they are, the mother and child have already been exposed to them during the pregnancy). In the end, ACOG makes assertions, which you mirror in your book, that only serve to frighten those who might be considering, in good conscience, the option to birth outside the hospital. ACOG does not provide scientific support for its statement; if that is the basis of the reflection in your book, I again challenge you to provide that support.

You say that "the current thinking" is that neonatal mortality is three times as high in the home as in the hospital (even though it is low in the home). First, what is the basis of this "current thinking"? I can think of a lot of things regarding the law, but that doesn't make them right. The Ninth Circuit Court of Appeals recently stated that "under God" in the Pledge of Allegiance was unconstitutional, but I dare say that most Americans think quite to the contrary. In the end, the Supreme Court will have the final say. Your reference to "current thinking," in order to convince me, needs to be supported. If the risk is indeed that great, then show me that this is the case and I will pass that onto my colleagues.

Second, statistics themselves can be manipulated. (I'm sure you've heard the old saying, "There are lies, damned lies, and statistics.") What is the context for the statistics to which you refer? Are the home births planned or accidental? Are the mothers healthy, the babies full term? Has there been consistent prenatal care? These are questions that must be answered in order to put these statistics in the correct context. Even if you are right that the mortality risk is three time as high in the home, if that means that three out of 1,000,000 cases, compared with one out of 1,000,000, then it is simply irresponsible to use that statistic to discredit all practitioners who serve persons who birth outside the hospital.

Third, you mention that "Certainly the risk is low when you take the whole population into account, but on an individual basis, the statistics aren't reassuring if you're that one person out of hundreds or thousands that it happens to." Yet, this approach to life would have us lock up our kids in our home for fear that some stranger might come in contact with them. Or even stay at home because babies die at the hospital, too. The studies to which I refer support the argument that home birth is as safe as (if not safer than) birth in the hospital, even when you consider the additional "risks" associated with not being in the hospital. To be fair and true to the science, your writings in print and online should reflect this, not the fear or anxiety that you profess that expectant parents should have.

You cannot compare home and hospital birth statistics without looking at the morbidity (and, yes, mortality) caused by interventions routinely practiced in hospitals. Home birth outcomes are better partly because the mothers are arguably healthier and more engaged than your average hospital patient (as you appear to indicate); they also have better outcomes because it would be unethical to practice many standard hospital interventions at home. Therefore, even accounting for transports, there are lower Cesarean rates, lower numbers of forceps deliveries, and fewer mothers requiring induction or anesthesia among mothers who planned to birth their babies at home. Although each intervention was created for good reason, with each one offered, the morbidity and mortality rates can rise.