''If I Had A Homebirth I Would Have Died''

We often hear these kinds of declarations from women who had very difficult births: ''I would have died if I had a homebirth'' or ''my baby would have died if I had a homebirth''. However, there is absolutely no way to know how a birth that didn't go well in a hospital setting would have gone in a homebirth seting. It is true that in some cases, births can go wrong, emergencies can happen, and in these cases we are grateful to have access to emergency maternity care to avoid dramatic outcomes.

But there are many, many elements to take into consideration before making these declarations, and, sadly, many women are scared to try for a homebirth because of this.

First of all, it is important to know that within our actual maternity care system, women who present the slightest sign of risk during her pregnancy will be denied acces to midwifery care, and will not be elligible for a homebirth. Women who are under the care of midwives are considered «low risk», and so the chances of something going wrong are very slim. Then, if the mother or the baby shows the slightest sign that something might go wrong during the labor, the midwives are well trained to detect these signs, and will know when to transfer the mother to the hospital.  Most of the time, when there is a hospital transfer, it is by precaution because of a some warning sign, and not because there is an actual emergency.

I am grateful for obstetric services and the possibility to give birth at the hospital and get appropriate care if things don't go as planned. However, the modern medical system is concieved for complications and emergencies, and not for normal, physiological, low intervention natural birth. Too often, a woman who is having a perfectly normal labor will have various interventions done to her, which will result in more interventions, and end up causing complications that would not have happened if there hadn't been interventions in the first place. Here is a common scenario:

A woman arrives at the hospital in labor. Her labor is going steady and she is a few centimeters dilated. At one point, her labor slows down a little, and she is not dilating fast enough for the medical stafff. She is given pitocin (or syntocinon) to speed up her labor. Pitocin causes very strong and painful contractions, closer together, so the mother asks for an epidural because it hurts too much. Once the epidural is on, the mother has to stay in bed, and the aneshesia slows down the labor. The dose of pitocin is augmented, and the contractions get stronger again, but the mother can't feel them. The baby, however, is feeling all the intense, hard pitocin contractions and pressure. The baby goes into foetal distress, and an emergency cesarean section is performed. We'll thank the medical staff for saving that baby's life, when it was the medical interventions that caused the complications in the first place...

Here is another scenario: A laboring woman arrives at the hospital. Her labor is stalling and we give her some pitocin. She eventually gives birth. As soon as the baby is born, the cord is clamped and cut early, the baby is not given to her right away, she is given more pitocin to contract the uterus, the precious first moments after the birth are not respected and she is not encouraged to breastfeed right away. All of these things disturb the mother's hormones, and the placenta doesn't come out right away. After a few minutes of impatience, her placenta is manually extacted, and she hemorrhages. She gets a transfusion, her life is saved, and she goes home thinking she would have died otherwise.

I do not wish to disparage the difficult birth experiences that some women might have had. They probably had very hard experiences and are grateful to be alive today and to have a healthy baby. What I am suggesting is to look at the facts when a woman tells her story in a ''I would have died otherwise'' perspective, and not to get scared by her experience. So many facts have to be taken into account when we are talking about a birth that didn't go as planned. Ask yourself (or her) the following questions: Was she induced? Did they let her move around during her labor? Was she given pitocin, cytotec, or any other drug? Did she get an epidural, and when? Was she allowed some privacy? Was she scared, or did someone say something to scare her? How was the baby's arrival handled? Did they let her push in the position of her choice? Did they cut the cord right away? Was she able to hold and breastfeed her baby right away? How long did they wait for the placenta to come out,  did they use any other means (drugs, massage?) to stimulate it's expulsion and did they do a manual extraction?

Many, many factors have to be taken into account to try to explain why some complications arise during a birth. In some cases, they are inexplicable, and can happen to anyone, no matter where the birth is taking place. But in most cases, like I explained in the previous paragraph, are caused by too much useless interventions, which end up causing a cascade of interventions.

One of the arguments we often hear in favor of hospital birth is that in the olden days, when women all gave birth at home, there were a lot of maternal and neonatal deaths. It is true to some extent that the creation of maternity wards and obstetrics contributed to lower the death rate. But we have to take into account that in most cases, back then, women gave birth with ill-formed midwives, who didn't really study, or sometimes only the neighbour or a grandmother came to assist if there were not any midwives around. The qualifications to be a midwife were almose nonexistant, and anyone could declare themselves a ''midwife''. On top of that, most people lived in rural areas, where there was no medical help available in case of complication. After the implantation of new hygiene mesures and qualifications to assist births, it is logical to see a lower maternal and neonatal death rate. Nowadays, midwives have to go through a very serious and long college training, and have in their possession many reanimation and emergency tools, emergency drugs, and sterile instruments.

On top of that, I have to mention that even if maternal and neonatal death rates are significantly lower than at the beginning of the XXth century, the abuse of medical interventions has caused the number of death to go up and up since the beginning of the 1980's. Since 1982, the mortality rate has more than doubled in the United States ( 7.5 maternal deaths/100 000 live births in 1982 VS 17 maternal deaths/100 000 live births in 2008). And we cannot blame homebirths for that, because they barely represent 0.72% of all births (in the USA, in 2009) . In British Columbia, in Canada, miwife-assisted births represent 6% of all births, and in the province of Quebec, it is barely 2% for homebirths (2011).

We also have to take into account that the way to manage the birth is very diffiernt when it is a homebirth. Hospitals function by prevention, action, risk precentages and often treat birth as a medical condition that they have to cure. The woman in labor is a patient, and all the little details of her labor are analysed as risk factors, and they will oftern do interventions just in case. During a homebirth, or birth center birth, the philosophy is: it is not necessary to repair something that is not broken. It is useless to try to cure or repair things that have not happened. During a birth, complications always come with warning signs beforehand, and midwives are trained to pay very close attention to these signs. During a homebirth, we watch, listen, and support. In a hospital, we anticipate and act.

Another thing to keep in mind to put all the chances on your side for your birth doesn't have to do with where you will give birth, but with how you will prepare yourself. A good preparation can make all the difference in the outcome of the birth, no matter where it takes place. I am not talking about more prenatal visits or exams, but psychological preparation. The importance to identify your fears and to get rid of them, to be confident with your body, and prepared for the intensity of the labor to come, and understanding the process. Inform yourself on the various protocols of your care provider and know the different interventions
that might be offered to you, as well as what are their risks. Write a birth plan to clearly explain your values and what you want and don't want to the medical staff that will be at your birth. All this preparation CAN make a huge difference. And, of course, hiring a doula to guide and help you in all of the process can make it all much easier and enjoyable!

Finally, it is true that sometimes births can be catastrophic and that only medical help can save the situation. But in most cases, there are a lot of things to take into consideration before concluding that ''If I had a homebirth I would have died''.

I leave you with a few intresting articles and stats:
Maternal Death in the United States: A Problem Solved or a Problem Ignored? by Ina May Gaskin
The Farm Midwifery center statistics (1970-2000)
US Birth Statistics
Maternal health in the US: The Maternal Health Accountability Act of 2011
Outcomes of plannes home birth with registered midwife versus planned hospital birth with midwife or 
Home Births in the United States, 1990–2009

GASKIN, Ina May, Spiritual Midwifery, Book Publishing co., 2002, 480 pages.