We have a secret in our culture...

Myth #1 — Hospital births are statistically safer than homebirths.

Studies indicate that homebirths are safe.

Safety in childbirth is measured by how many mothers and babies die and how many survive childbirth in less than perfect health. 

Studies done comparing hospital and out-of-hospital births indicate fewer deaths, injuries and infections for homebirths supervised by a trained attendant than for hospital births. No such studies indicate that hospitals have better outcomes than homebirths. 

While maternal death rates have vastly improved since the turn of the century, factors like proper nutrition and cleanliness have played a big part in the change. 

Overall neonatal death rates have also improved since the 30s, but homebirths appeared to be safer even then. In 1939, Baylor Hospital Charity Service in Dallas, Texas, published a study that revealed a perinatal mortality rate of 26.6 per 1,000 live births in homes compared to a hospital birth mortality rate of 50.4 per 1,000.[1]

Since the 1970s, research done in northern California, Arizona, England and Tennessee all point to the relative safety of homebirth.[2] The only matched population study, comparing 1,046 homebirths with 1,046 hospital births, was published in 1977 by Dr. Lewis Mehl, a family physician and medical statistician.[3]

While neonatal and perinatal death rates were statistically the same in Mehl's report, morbidity was higher in the hospital group: 3.7 times as many babies born in the hospital required resuscitation. Infection rates of newborns were four times higher in the hospital, and the incidence of respiratory distress among newborns was 17 times higher in the hospital than in the home. 

A six-year study done by the Texas Department of Health for the years 1983-1989 revealed that the infant mortality rate for non-nurse midwives attending homebirths was 1.9 per 1,000 compared with the doctors' rate of 5.7 per 1,000.[4] Certified nurse midwives' mortality rate was 1 per 1,000 and "other" attendants accounted for 10.2 deaths per 1,000 live births.[5]

A study of 3,257 out-of-hospital births attended by Arizona licensed midwives between 1978-85 shows a perinatal mortality rate of 2.2 per 1,000 and a neonatal mortality rate of 1.1 per 1,000 live births. 

In testimony before the U.S. Commission to Prevent Infant Mortality, Marsden Wagner MD, European Director of the World Health Organization, suggested the need in the U.S. for a "strong independent midwifery profession as a counterbalance to the obstetrical profession in preventing excessive interventions in the normal birth process."[6]

Wagner states that in Europe midwives far outnumber physicians: "In no European country do obstetricians provide the primary health care for most women with normal pregnancy and birth." He states that the U.S. has the highest obstetrical intervention rates as well as a serious problem with malpractice suits and concludes that a strong, independent midwifery service in the U.S. would be a most important counterbalance to the present situation. 

1. The Five Standards of Safe Childbearing, 1981, Stewart, p. 241. 
2. Ibid, p. 115-116, 127, 243-246. 
3. Ibid, p. 247-253. 
4. Texas Lay Midwifery Program, Six Year Report, 1983-1989, Bernstein & Bryant, Appendix VIIIf, Texas Department of Health, 1100 West 49th St., Austin, TX 78756-3199. 
5. Labor Pains: Modern Midwives and Homebirth, Sullivan & Weitz, 1988. 
6. Mothering, Jan/Feb, 1990. 

  Myth #2 — You can get more professional attention in a hospital than you could get at home.

Midwives Are Trained Professionals

In the hospital, obstetricians do not routinely sit at the bedsides of their laboring patients but rely on machinery and others for information — then appear at the last minute in the delivery room. Most physicians do not build a relationship of supportive rapport with each patient or offer much encouragement to give birth naturally. 

Labor and delivery room nurses by and large enjoy giving support to women during childbirth. Hospital life, however, involves a great deal of paperwork, personnel changes by the clock and wild fluctuations in how many women each nurse must be responsible for. And nurses have no authority to stop an impatient doctor from trying to "speed up" a slow-but-steady, normal labor. 

Over the last few decades, women have protested against the cold and clinical atmosphere of birthing wards, and many hospitals have bent under popular pressure to make their sterile environments more home-like.[1] Most allow women's partners into labor and delivery rooms, and some even accept the presence of a professional labor coach. 

But for many women, the natural act of giving birth does not belong in a clinical environment when all is well. 

While statistics indicate that unplanned or unattended homebirths have worse outcomes than hospital births, planned homebirths with a trained attendant present have good outcomes.[2]

There are a variety of trained and experienced homebirth practitioners from which to choose — physicians, certified nurse midwives and direct-entry, or non-nurse midwives. A small number of doctors, some of whom are members of the American College of Home Obstetrics, maintain homebirth and/or clinic practices. Several birth centers in the U.S. are physician-owned and operated.

Certified nurse midwives are registered nurses who have continued their education in the specialty of obstetrics. Most CNMs work only with physician backup in a hospital environment, but a few have homebirth practices. 

Midwifery is basically a system of wellness care given by professional midwives to women and infants during the childbearing year, and in many other countries midwives are the primary care givers in maternity systems with better neonatal mortality rates than ours. Midwives are trained to watch for deviations from health throughout the pregnancy and labor and refer their clients to a physician if necessary. 

The number of direct-entry midwives has increased in the last twenty years due to more demand for their services. Most non-nurse midwives have completed a course of study and then furthered their education by apprenticing with a more experienced midwife. These midwives practice legally in only 12 states, some of which require them to be licensed. Where midwifery is illegal, the states have declared these time-honored professionals to be "practicing medicine without a license." 

Midwives practice freely in all but 20 states. They do so either under statutory regulation or in states with no specific midwifery laws. [Ed. — Information about the current midwifery legal situation in individual states or Citizens for Midwifery Grassroots Network.] 

Prenatal visits to an obstetrician's office or public health department usually involve long waiting periods before seeing a doctor or nurse for a very brief checkup. By contrast, each prenatal visit with a midwife is usually relaxed, friendly and can last from 30 minutes to an hour. Midwives traditionally use this time for teaching the benefits of good nutrition, exercise, hazards to avoid and how to prepare for a natural birth. 

Though the educational background of midwives varies widely, many collect laboratory specimens, monitor the baby's heart rate for signs of fetal distress during labor, carry oxygen equipment and are trained in cardiopulmonary resuscitation. 

1. A Good Birth, A Safe Birth, 1990, Korte & Scaer, p. 8-21. 
2. Ibid, p. 64-68. 

   Myth #3 — The more modern technology you have on hand, the easier the birth will be.

Technology Can Complicate a Normal Birth

In a sincere effort to catch complications early and produce healthier babies, medical science has changed the atmosphere surrounding birth from one of a circle of loving support around laboring women to one of space age technology in a laboratory setting. 

Though technology can save lives in a crisis, the routine use of technology can interfere with the normal birth process. 

It is common in hospitals to use intravenous fluids and electronic fetal monitors to ensure that the mother stays well hydrated and that each contraction and beat of the baby's heart is recorded. However, many women dislike being confined to a bed with needles in their arms and belts around their abdomens. 

Women who are allowed to move about freely during labor complain less of back pain, and many childbirth authorities feel the motion of walking and changing positions can enhance the effectiveness of the contractions. 

Some hospitals still require women to birth lying flat on their backs with their legs held high in stirrups. Because the position defies gravity and makes pushing less effective metal forceps are sometimes used to pull the baby out of the vagina. Research shows that forceps are rarely used when women are allowed to assume a position of comfort during the bearing down stage. 

Obstetricians frequently rupture the bag of waters surrounding the baby in order to speed up the birthing process. This procedure automatically places a time limit on the labor, as the likelihood of a uterine infection increases with each passing hour in the hospital after the water is broken. 

Once the protective cushion of water surrounding the baby's head is eliminated, the belt monitoring the baby's heartbeat may be exchanged for a scalp electrode — a tiny probe that is screwed into the baby's scalp to continue monitoring the heart rate and to collect information about the baby's blood. 

Each of these interventions in a normal labor has its own set of risks, and none of the above procedures has ever been proven to be more advantageous in eliminating complications or to produce healthier babies. 

A recent study published in a medical journal states that the routine use of electronic fetal monitors, compared to the old-fashioned method of listening to the baby's heartbeat after contractions with a fetoscope, may actually cause more problems than it prevents.[1] In eight randomized clinical trials, perinatal mortality was not reduced with electronic fetal monitoring. And perhaps because electronic monitoring can lead to unnecessary cesareans, birth outcomes were mostly superior in the groups monitored by fetoscope.[2]

Today at least 25 percent of all birthing mothers are delivered surgically. This compares to an average c-section rate of about 10 percent in other countries with better mortality rates.[3] These numbers indicate that we are not getting better outcomes with more c-sections. 

Several decades ago, in an effort to lessen the pain of childbirth, physicians routinely gave laboring women pain-killing and anesthetic drugs. Over the years the use of most of these medications has subsided somewhat after studies revealed that drugs given to the mother had adverse effects on the baby, including asphyxia, hypoxia and even brain and central nervous system damage.[4]

Drugs are still available to laboring women in the hospital, though no drug given in childbirth has been proven to be safe for the baby.[5]

Women who have taken drugs in labor report decreased maternal feelings towards their babies and an increase in the duration and severity of postpartum depression.[6]

The artificial hormone pitocin, a drug given to intensify labor and to contract the uterus after childbirth also has potential side effects, including rare cases of uterine rupture and a slight increase in jaundice in the newborn.[7]

Interrupting the natural process of birth with technological wizardry can cause more harm than good. 

1. New England Journal of Medicine, March 1, 1990. 
2. The Cutting Edge, Feb. 1990, p. 4, P.O. Box 1568, Clayton, GA 30525. 
3. Birth Without Surgery, Carl Jones, 1987, p. xii. 
4. The Five Standards of Safe Childbirth, 1981, Stewart, p. 185. 
5. Ibid, p. 175 
6. A Good Birth, A Safe Birth, 1990, Korte & Scaer, p. 18, 201-209. 
7. The Five Standards of Safe Childbirth, 1981, Stewart, p. 300. 

Myth #4 — A hospital is a more sanitary place to have a baby than at home.

Normal Household Germs Do Not Affect Mother or Baby

Childbed fever killed thousands of women in the 19th century — about the time physicians, who also cared for the ill and dying, began to attend births in clinics. As hospitals became the places to go for birth and death, infections became a plague upon childbearing women and other hospital patients. 

About 100 years ago, in Austria, a doctor named Ignaz Semmelweis attempted to lower the number of maternal deaths from infections — as high as 40 percent of those delivering at the Vienna maternity hospital.[1] Semmelweis discovered that simply by washing their hands between performing autopsies and attending births, the rate of infections caused by doctors dropped dramatically. Semmelweis was ridiculed by his colleagues, and it wasn't until five years after his death that his findings began to gain acceptance. With the advent of aseptic technique in the late 1800s and the development of antibiotics in the 1940s, gradual improvement was seen. [Ed. — As antibiotic-resistant bacteria have evolved so that they are unaffected by antibiotics, it can be expected that this trend will be reversed, and we can expect to see an increase in deaths from hospital-acquired infections.] 

In the 1930s, studies in New York City and Memphis, Tennessee, show that fewer women died from infections and hemorrhage during homebirths than died from the same complications in the hospital.[2]

Today, strict and expensive infection control procedures have still not eliminated nosocomial, or hospital-caused infections from common and dangerous organisms, like resistant strains of staphylococcus. 

According to a report in the Wall Street Journal, the nation's hospital-regulating agency, The Joint Commission on Accreditation of Health Care Organizations, is failing to enforce infection control standards — compromising the health of hospital patients: "The Joint Commission allows dangers to health and safety to go uncorrected for weeks, months and even years. Sloppy, irresponsible hospitals have little to fear from the Commission: punishment in recent years has been nearly nonexistent."[3]

Each family becomes accustomed to its own household germs and develops a resistance to them. Since fewer strangers are likely to be present at a homebirth than at a hospital birth, the chances of acquiring foreign germs are less likely in a homebirth situation. 

Every effort is made to provide a clean environment at homebirths. Midwives and homebirth doctors wear sterile gloves and use sterilized instruments for cutting the umbilical cord. 

Homebirth research studies indicate much lower rates of infection in the mother and the baby than is likely in the hospital. In a 10-year study (1970-1980) of 1,200 births at the Farm in Summertown, Tennessee, 39 mothers suffered postpartum infections, and only one baby developed septicemia.[4]

Calling the hospital nursery a cradle of germs, Dr. Marsden Wagner, European Director of the World Health Organization, warned doctors at an international medical conference in Jerusalem in the spring of 1989 that hospital births endanger mothers and babies primarily because of impersonal procedures and overuse of technology and drugs.[5]

1. The Birth Gazette, Fall, 1987, review of The Cry and The Covenant, p. 32-33. 
2. The Five Standards of Safe Childbearing, 1981, Stewart, p. 240-241. 
3. The Wall Street Journal, Oct. 12, 1988. 
4. The Five Standards of Safe Childbearing, 1981, Stewart, p. 127. 
5. Mothering, Oct/Nov/Dec, 1989. 

Strict and expensive infection control procedures have still not eliminated hospital-caused infections.

The idea of being comfortable during childbirth may strike many mothers who have delivered in the hospital as impossible. They remember being confined to a hospital bed, denied food and water, separated from their other children and supportive family members and friends, enduring frequent internal examinations and vital sign checks, being transfered from one room to another on a stretcher at the peak of labor's intensity and having their legs strapped into stirrups. 

Birthing rooms and their homey furnishings are an effort to eliminate some of the stress and discomfort that comes from being in the strange surroundings of the hospital. 

Studies show that labor can be compromised by an unfamiliar environment. Discomfort and fear can actually increase the pain experienced in childbirth, while relaxation can diminish maternal stress, improve oxygen flow to the baby and facilitate labor. 

In her own home a laboring woman has "the home court advantage." She can move about freely, wear what clothing she chooses, sip on energizing juices, continue caring for other children as she is able, relax in a warm tub of water, have her feet rubbed by loving friends and try different birthing positions. Normal labor is a healthy stress for the baby, clearing the lungs of fluid and preparing it to take its first breaths. 

After the birth, the baby is never taken from its mother's side. The entire family can climb into a clean bed for a much needed cuddle and nap. The emotional bonding that takes place in the moments after birth between mother and child and between the baby and the entire family promotes well being, encourages breastfeeding and speeds recovery of the mother.

In 20 other countries, more babies survive their first months of life than in the U.S. 

While discussion over the pros and cons of homebirths and who should attend them continues in medical circles and around supper tables, thousands of healthy babies are being born in their own homes each year. 

Homebirth is not for every woman. It takes a high degree of commitment to health and learning and a high level of responsibility to go against the majority who believe hospital births are better. 

As you consider where to give birth, read the books listed in the Resource Guide. Talk to women who have given birth at home, in birthing centers, in birthing rooms and in hospital delivery rooms. Discuss your concerns with your physician and your midwife. 

Interview several alternative birth practitioners in your area. Assess the level of skill, integrity, knowledge and philosophy of each to discover if they are compatible with your expectations. Whereas obstetricians deliver the great majority of babies in hospitals, some are operating alternative birthing centers. Family practitioners who attend births can still be found, but their ranks are decreasing because of the soaring expense of malpractice insurance. 

Certified nurse midwives are located in many metropolitan areas, and in some hospitals offer primary maternity care in a clinic and birthing room setting. Well-educated and trained direct-entry midwives are specialists in normal childbirth. Some operate birth centers, and many have homebirth practices all across the country. 

In 1989 the average family in the U.S. paid about $4,334 for an uncomplicated hospital birth, according to a Health Insurance of American survey of 173 community hospitals, 70 childbirth centers and 153 licensed midwives.[1]

Breakdown of costs for a hospital birth include an average physician's fee of $1,492 ($2,053 for a cesarean), and hospital costs (not including other fees like the services of an anesthesiologist) of about $2,842. 

The average fee charged by a midwife was $994, a price that usually includes prenatal care, childbirth classes and supplies, while a physician's fee does not. 

Which setting and type of birth attendant is right for you? In some states, your choices are limited based on laws that restrict the practice of midwives. Friends of Homebirth was founded in 1989 with the goal of working to ensure your right to choose homebirth with a trained attendant. Homebirth is a reasonable choice for many families, and restrictive legislation must give way to the Constitutional right of responsible parental choice. 

To find alternative birth attendants in your area, contact childbirth educators and your local La Leche League group. You might also check with health food stores, well-woman health centers and your public health department. 

For more information about birth practitioners in your area, write or call the organizations listed in the Contact Guide. 

1. Health Insurance Association of America, 1989, 1025 Connecticut Ave. NW, Washington D.C., 20036-3998. 

Cabhan David and Aile Amber, born at home in the water on 8-8-8 at 40w3d.

In the past, most Americans were born at home with lay midwives attending. The mortality rate for both mothers and babies was higher in 1900, at 700 maternal deaths per 100,000 births (Korte and Scaer 97), than it is now. Babies also died at a significantly higher rate at that time, which decreased to 28.9 births per thousand by 1960 (Korte and Scaer 98). Obstetricians tend to emphasize that many women used to die in childbirth, implying that we should be grateful for current obstetric practice. However, even in 1900, the percent of women who died giving birth was only 7/10ths of one percent! One has to wonder how this percentage compares with our country’s current cesarean section rate of 22%. Are the surgeries performed on these mothers actually saving them from imminent death? Maternal and infant mortality are lower now than they were 40 years ago. But the assumption that hospital birth is safer for mother and baby has never been supported (Jones 6). Prenatal care, better nutrition, antibiotics and blood transfusion have played more of a part in the relative safety of birth now.

Sheila Kitzinger, British childbirth expert, states that planned home birth with an experienced lay midwife has a perinatal death rate of 3-4 babies per 1,000 births (51). Hospital births, by contrast, carry a perinatal mortality rate of 9-10/1,000. [Perinatal death rates include fetal deaths on and after 28 weeks gestation, whereas neonatal mortality rates only include deaths occurring in the first 28 days after birth (Jones 96,98)].

• A study in Australia found a perinatal mortality rate of 5.9/1,000 out of 3400 planned home births (Kitzinger 41).
• Joseph C. Pearce states in his landmark book Evolution’s End that homebirthed babies have a six to one better chance of survival than a hospital-birthed child (117).
• A study in the Netherlands done in 1986 on women who were having their first babies showed these results: out of 41,861 women who delivered in the hospital, the perinatal mortality rate was 20.2/1,000. Of 15,031 women who delivered at home with a trained midwife, the rate was 1.5/1,000 (Kitzinger 44). I know, I thought it must be a typo too.
• Marsden Wagner, formerly of the World Health Organization, states that every country in the European Region that has infant mortality rates better than the US uses midwives as the principal and only attendant for at least 70% of the births (Jones 2). He also states that the countries with the lowest perinatal mortality rates in the world have cesarean section rates below 10% (Jones 13). How does this compare with the US rate? Miserably.

Cesarean section and hospital birth is not doing for women and their newborns what doctors and hospitals claim it is! Ask for statistics and studies when your doctor claims hospital birth is safer than planned (not accidental, unattended) home birth. I would be interested to see them. If your doctor says, "That’s common knowledge," you would be wise to seek another health care provider. I have only heard of one study done that claimed hospital birth was safer. It included deaths caused by unplanned, unattended births which occurred at home, and was backed by (guess who?) ACOG (The American College of Obstetricians & Gynecologists).

Other studies:

• Dr. Lewis Mehl did a study comparing home and hospital birth with mothers from California and Wisconsin with matched populations of 2,092 mothers for each group. Midwives and family doctors attended the homebirths; OBGYNs and family doctors attended hospital births. Within the hospital group, the fetal distress rate was 6 times higher. Maternal hemorrhage was 3 times higher. Limp, unresponsive newborns arrived 3 times more often. Neonatal infections were 4 times as common. There were 30 permanent birth injuries caused by doctors (Jones 99).
• Dr. Mehl did another study comparing 1,046 home births with 1,046 hospital births. The groups were matched for age, risk factors, etc. There was no difference in infant mortality. None! However the hospital births caused more fetal distress, lacerations to the mother, neonatal infections and so on. There was a higher rate of forceps and C-section delivery and nine times as many episiotomies (Jones 110).
• Robert C. Goodlin reported in the Lancet on 1,000 births, half occurring in a hospital, half in a birth center. There were no IVs, monitors or anesthesia used in the birth center, but the babies were born in better condition. Besides that, three times as many cesareans were performed in the hospital (Korte and Scaer 37-38).
• In 1982, Anita Bennett and Ruth Lubic evaluated 2000 births that had happened in 11 freestanding birth centers. The neonatal death rate was 4.6/1,000. The authors were denied information on low-risk women delivering in hospitals (Korte and Scaer 45). One wonders why....
• I found these comments very interesting. A British research statistician, Marjorie Tew, did long term studies of the safety of birth in various settings during the 1980s. She found that among a sample of 16,200 births, the perinatal mortality rate was lower for out-of-hospital births, even for very high risk mothers! At a relatively high risk level, perinatal mortality was three times higher in hospital (Korte and Scaer 49). Tew then expanded her research by using information from the Netherlands, a nation where both obstetricians and midwives practice. The perinatal mortality rate was ten times higher in the hospital births there, even though the risk status of the mothers at the time of delivery was not much higher than that of mothers who chose midwives (Korte and Scaer 50).
• In the Netherlands, which has a significantly lower infant mortality rate than ours, the C-section rate is 7% (Jones 20). The episiotomy rate is 6%, whereas ours is 90% (Jones 19). Midwives attend most of the births in the Netherlands. (Midwives tend to allow time for the woman's tissues to stretch and to use perineal massage, warm compresses, and good head flexion to avoid both episiotomies and tearing; hence the lower Netherlands rate.)
• In 1988, the US ranked 19th among industrialized nations for low infant mortality rates. By comparison, Sweden, where all mothers receive midwifery care, even when they are high risk and may also require physician care, ranked second (Jones 95).
• Between 1978 and 1985, licensed midwives in Arizona had a perinatal mortality rate of 2.2/1,000 and a neonatal mortality rate of 1.1/1,000 (Jones 96).
• This stat is priceless. Read on: In Madera County Hospital in California, where there is a transient, high risk population, midwives did the best job. In 1959, when doctors did the deliveries the neonatal mortality rate was 23.9/1,000. During 1960-1963, midwives had a rate of 10.3/1,000. When OBGYNs took over again in 1964, the rate skyrocketed to 32.1/1,000 (Jones 98).

Carl Jones says, and I concur, "No one can tell a mother she is perfectly safe giving birth at home. Whether she is safer at home than in a hospital, however, is another question" (113). There is always going to be some risk when giving birth, as in all of life, and women should be carefully screened for any health problems that could be dangerous during labor and delivery. For certain women in rare instances, obstetric care is essential. However, for most women, better, healthier results are seen when mothers chose birth centers or home births. As far as the risk of home birth goes, Our Bodies, Ourselves states, "The times when hospital care unexpectedly becomes instantaneously necessary are rare" (341). In A Good Birth, A Safe Birth, Diana Korte and Roberta Scaer quote Tew, the research statistician, who says, "The danger of home as a place of birth does not lie in its threat to the healthy survival of mothers and babies, but in its threat to the healthy survival of obstetricians and obstetric practice" (50).

Another factor that is important in making the choice about where to give birth may surprise you. It makes common sense, but has also been documented by several studies. Women who give birth in a hospital are much more likely to experience postpartum depression or even post traumatic stress disorder. Kitzinger states that the more interventions a woman experiences, the more likely she is to be depressed, with C-sections obviously carrying the greatest risk of depression (193). She quotes 5 or 6 studies documenting the effects of this "institutional violence."

Aidan McFarlane, a British physician, notes that while 68% of hospital mothers experience postpartum depression , only 16% of home birth mothers do (Jones 24). On the Farm, a self-contained, alternative lifestyle community in Tennessee, the rate of postpartum depression was .03 percent (Korte and Scaer 183). Almost all mothers on the Farm had both a homebirth and a supportive, loving community of women to assist them postpartum. Depression, in itself, would be a major reason for mothers to consider giving birth in their own homes, if that is where they are most comfortable, especially if they had previously experienced postpartum depression and thus were at high risk for a repeat episode.

Aspects of hospital birth that may strongly contribute to the incidence of postpartum depression in our country are the way the moment of birth is handled and the routine separation of baby and mother. In a study which appeared in the New England Journal of Medicine in 1972, Marshall Klaus, the "bonding" expert, found that holding the baby close released "dormant intelligences" in the mother and caused "precise shifts of brain functioning and permanent behavior changes" (Pearce 115). In other words, bonding is not just an emotional thing that only mothers think happens. It is a biochemical process that forever changes the mother, so that she knows more instinctively how to relate to her baby. In the hospital, baby cannot see mom with all the bright lights and is often inspected and observed for several hours before mother can hold it for any length of time. This is not to say love can’t make up for this loss, but motherhood might come easier if we had those natural body changes to help us. Then babies are still routinely kept in the nursery, if not most of the time, at least part of the time. The routine separation of mom and infant makes baby frightened and mom depressed (Pearce 124). This may be why postpartum depression and difficult adjustments are so common in the US and rare elsewhere. Japan moved from midwifery to obstetrical handling of births approximately 25 years ago. When older Japanese recently asked Joseph Pearce why their mothers no longer "know what to do with their children," (129) one has to wonder how much the new hospital setting has to do with it.

Most homebirth studies also show a significantly lower rate of C-section than hospitals have. Most stats I have seen show a rate between 1-5%, with the above quoted lower mortality rates as well. Cesarean sections themselves carry a far greater risk of additional illness or death than most people realize. I think because they have become so routine in our society, everyone feels "It’s no big deal." However, C-sections carry a 2 to 4 times greater risk of death than do vaginal deliveries (Boston Women’s Health Book Collective 341).

Several studies on the risk of death from the surgery alone (i.e. factoring out the conditions the surgery was done for) have shown varying, yet consistently depressing, results. Errard and Gold found with eleven years of statistics that the risk of death from cesarean section was 26 times greater than from vaginal birth (Cohen and Estner 26). Cohen and Estner also cite a study done in Georgia showing a maternal death rate of 59.3 per 100,000 women who had cesarean section versus 9.7/100.000 for women who delivered vaginally (26). A California study showed a maternal death rate 2-3 times greater from C-section. Korte and Scaer state that obstetricians admit a maternal death rate four to six times higher with cesareans (162), and add that many believe the rate is higher, giving 1 in 1,000 as the true odds of death for a c-section mother (163). You should also be aware that death is not the only complication caused by cesareans; mothers commonly experience infection after a section. Infertility problems, organ damage, and paralysis from anesthesia complications are rare but possible risks. The pain at the incision site is no picnic either.

Another thing to think about is how a surgery like this will affect you, your child, and your society in the long run. When mothers "fail" to give birth naturally in hospitals, as they so often do these days, their self image is harmed despite well meaning friends telling them it doesn’t matter how baby came out. Especially if mothers are not certain their sections were absolutely necessary, there is often a hidden anger that can’t be overtly expressed in our culture. Mothers may take this unacceptable anger out on the only people they can--their children. "In 1979, the government of California funded the first scientific study ever made of the root causes of crime and violence. Their first report three years later stated that the first and foremost cause of the epidemic increase of violence in America was the violence done to infants and mothers at birth" (Pearce 126). The "little things" really do matter, just as a small pebble thrown in a pond makes ripples that travel a long, long way.

If you are a woman with no health problems or contraindications to safe labor and delivery, consider very carefully your place of birth. Your chance of having major surgery is one in four (Sarah notes: It is now one in three) if you choose a hospital, regardless of your current health status. Those are very good odds. If you had the opportunity to buy a million dollar lottery ticket with odds that good, you would, wouldn’t you? Don’t assume that it won’t happen to you. Since the risks to you and your baby are lower at home, and your risks of having surgery are greater if you go to a hospital, please consider homebirth as an option.

Wherever you decide to give birth is up to you; just remember that you can make the decisions that need to be made when you have true information. It is your body, your baby, your money, and your life on the line, not the doctor’s or anyone else’s. You have the right to accurate information and the right to decide what is best for your baby. Don’t let anyone tell you otherwise. Also, when you ask for information, beware of health care providers who say they judge each case individually, so they can’t really give you their statistics. It probably means either they don’t know or they don’t want you to know. You will have to live with the consequences of decisions made during your labor, for better or worse. For more information or support, call me at 606/625-0185 or email me at griebenow@iclub.org

The author disclaims any liability resulting from the use of this information, and strongly urges you to use your own mind.

References

1. Boston Women’s Health Book Collective. The New Our Bodies, Ourselves. New York: Simon and Schuster, 1984.
2. Cohen, Nancy Wainer and Lois J. Estner. Silent Knife: Cesarean Prevention and Vaginal Birth After Cesarean. New York: Bergin and Garvey, 1983.
3. Davis, Elizabeth. Heart and Hands: A Guide to Midwifery. 2nd edition. Berkeley: Celestial Arts, 1992.
4. Jones, Carl. Alternative Birth. Los Angeles: Jeremy P. Tarcher, 1990.
5. Kitzinger, Sheila. Home Birth. London: Dorling Kindersley, 1991.
6. Korte, Diana and Roberta Scaer. A Good Birth, A Safe Birth. Boston: Harvard Common Press, 1992.
7. Mitford, Jessica. The American Way of Birth. New York: Dutton, 1992.
8. Pearce, Joseph Chilton. Evolution’s End: Claiming the Potential of Our Intelligence. San Francisco: Harper, 1992.
9. New Our Bodies, Ourselves. New York: Simon and Schuster, 1984.
10. Cohen, Nancy