Hospital Birth vs. Home Birth: A Debate on Choices

Dr. DiLeo's Response, ACOG's Stand

Dear Mr. Henderson,

Thank you for your interest in my book and your dedication to your vocation. Below is from the The American College of Obstetricians and Gynecologists (ACOG) news release dated December 2001, which was reaffirmed in a statement made in February 2008.

ACOG's position on home birth:

"Labor and delivery, while a physiologic process, clearly presents potential hazards to both mother and fetus before and after birth. These hazards require standards of safety that are provided in the hospital setting and cannot be matched in the home situation. ACOG supports those actions that improve the experience of the family while continuing to provide the mother and her infant with accepted standards of safety available only in hospitals that meet the standards outlined by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists."

The current thinking is that the risk of neonatal mortality, while low in home births, is still triple what it is in a hospital delivery. It is a personal decision of prospective parents whether they would want to take even a minuscule risk increase or not. My position is that it's not worth it and unfair to the baby who may have to pay the price for this decision. 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.

I do not feel people choose to home deliver out of ignorance or stupidity. In fact, such persons usually are more thoughtful and knowledgable of the whole process than your average hospital delivery parents. It's just regrettable that if you need a blood bank or a Cesarean rescue as an emergency, you can't say you did everything you could to stack the deck in your favor if you home delivered and there were a time-sensitive complication. Philosophically, I can understand the beauty of a home delivery, and I so wish it could be done with the same, exact precautionary support that a whole hospital provides ... but it doesn't.

As far as attending this year's conference of MANA, I'm afraid I would get shot! Not everyone who disagrees with me is as eloquent and fair minded as you. (You should see some of the letters I get.) This is a shame, because I think this subject would make a fascinating discourse in vehicles such as BabyZone.com and others. If I thought a civilized discussion could be carried out, I'd love to participate. Unfortunately, such topics garner the same amount of fireworks as abortion and gun control.

Thanks again for your letter.

Sincerely,

Dr. Gerard M. DiLeo, MD, FACOG

Mr. Henderson's Response

Dr. DiLeo:

First of all, I would like to express my appreciation that you responded to my email letter. My interest in writing to you, and in my pro bono advocacy, is to have an intelligent exploration of the issue of birth outside the hospital setting. You and I are both professionals: I rely upon the law to be my guide in my work, and I trust that scientific findings are yours. With that as our basis, let's begin.

As I mentioned previously, there is a body of scientific research that, quite objectively, supports the hypothesis that birth outside the hospital can be safe. Rather than copy an entire bibliography here, I would like to direct you to a dissertation written by a doctoral student at Stanford University in 1999, which cites the prominent research on this topic.

I would welcome your critique (or the critique of any member or committee of ACOG) of this dissertation or any of the underlying science. To date, I have not been presented with any science-based argument that presents conflicting evidence.