Homebirth on the Rise!

105 years ago, 5% of women delivered their babies in a hospital. The rest delivered in their homes under the supervision of apprenticeship-trained midwives. In the time between then and now, we have seen those percentages completely reversed. There are many fascinating reasons why this shift occurred, many of which had to do with “progressive medicine” under the influence of a very prominent doctor who wrote the first textbook for male medical students that purported that the field of maternity/obstetrics was pathological. I’ll save you the history lesson, but Midwifery Today has a very well laid-out timeline, should you want to get the broad overview of obstetrics in the US.

A student recently sent me an article picked up by the Sacramento Bee on the significant rise of home birth in California. We decided to look into it more thoroughly and found that Lassen County has one of the highest percentages of home birth in California! When we looked at the numbers, we discovered that Lassen County has also underreported the home birth numbers by about 2/3, so if the actual number of home births that occurred were added into the central analysis, then it looks like Lassen would have the highest percentage of home birth in California at around 7% of total births occurring at home. How exciting!

The largest planned out-of-hospital birth study was published by MANA and took into account 17,000 women who chose to birth at home. The study showed a 5.2% Cesarean rate for full-term out-of-hospital births vs the 31% Cesarean rate in planned hospital deliveries. Babies also fared very well in the study. Ninety-seven percent of babies were carried to full-term, they weighed an average of eight pounds at birth, and nearly 98% were being breastfed at the six-week postpartum visit with their midwife. Only 1% of babies required transfer to the hospital after birth, most for non-urgent conditions.

Of course, the studies are helpful for providing more data on the safety of having a midwife-attended out-of-hospital birth - but you could also ask any number of women who have experienced the nurturing and nourishing care of a midwife in the comfort of their own home. If you have had a home birth, share your story!

A breast cancer survivor after her home birth.

America! Maternal Mortality on the Rise

The United States is one of eight countries where Maternal Morbidity is on the rise.  In fact, our rate of maternal mortality has tripled since 1980.  Defined as "maternal death that is associated with pregnancy or childbirth", America now has the highest rate of maternal mortality amongst developed countries.  What a thing of horror.   

There are several reasons that this is occurring, including an increased number of surgical deliveries (which are three times riskier than a vaginal delivery), complications from augmented labors, and dietary deficiencies leading to a rise in preeclampsia and eclampsia.  This is only part of the list that we can see and study.  But the particular issue I want to address today is that of rural healthcare, as maternal death is disproportionately high in rural areas.

Living in a very isolated area, I can attest to the state of rural maternal health in America today.  The nearest hospital is 15 minutes away, a larger one is 40 minutes away, and the nearest urban hospital is an hour and a half drive.  Due to the increasing cost of obstetric services in the US, the closest hospital had to stop offering them a decade ago.  This has left people in my community with the option of driving 40 minutes to a hospital where OB services are offered by on-call family practice doctors OR drive the hour and a half to the "city" where there are in-house Obstetricians.  Add into the equation that 5 months out of the year our area is shrouded in beautiful but dangerous driving conditions.  

This situation leads women into a few undesirable predicaments:

• delivering on the side of the road, back of an ambulance, in a  rural unequipped Emergency Department OR
• arriving at the hospital in early labor to find they are 2-3cm dilated and being admitted (they can't very well be sent home!).  Subsequently, for every hour they spend in the hospital during early labor, their chances of interventions and surgical delivery increase.

Let us not forget that rural areas are often very impoverished areas.  Many of these women cannot afford to travel the distance needed to receive prenatal care.  This leads to missed visits (particularly at the end of pregnancy), and therefore, missed diagnoses of possibly fatal conditions such as pre-eclampsia (one of the big killers of mothers), hypertension, and fetal mal-position.

This is a serious problem.  Thankfully, the gravity of this issue has caught the public eye:

• NPR recently teamed up with ProPublica to research and write about Maternal Death
•  AmnestyUSA has published a fantastic piece called "Deadly Delivery"
•  International spokespersons are searching out solutions (such as Linda Robinson, who has an impactful TEDx talk on this topic).

The World Health Organization (WHO) has been one of the forerunners in offering possible solutions to Maternal Mortality.  Along with AmnestyUSA and countless other respectable organizations, the WHO has offered that an increase in midwifery care will improve outcomes for mothers and babies worldwide, particularly in rural areas.  Indeed, they have said that, "Increasing the number of midwives by 25% will reduce maternal mortality by 50%)."  Properly trained midwives are a very feasible and effective solution to the problem of Maternal Morbidity.  As French Obstetrician, Dr. Odent, has said, 

“If we want to find safe alternatives to obstetrics, we must rediscover midwifery. To rediscover midwifery is the same as giving childbirth back to women.” 

We, as Americans, need to re-evaluate maternal healthcare in this country.  For most, birth is normal and natural, not a condition needing treatment. Do not for a moment imagine that interventions are conveniences without consequences. 

 For the 15% of women in this country who have high-risk pregnancies, I am deeply grateful for a medical system equipped to save lives.  But for the 85% of women who are low-risk, having a baby is the epitome of wellness. Whether you deliver in or out of the hospital, be aware of the benefits and risks of both.  We live in a country where we have many choices, be thankful for them and make wise decisions that are the most comfortable for you.  This is your body and your baby and you have been given the intuition to care for both.  Listen to your instincts, don't ignore them even if medical professionals do.  Find care providers that you can trust and that trust you.

“Experiences have clearly shown that an approach which 'de-medicalizes' birth, restores dignity and humanity to the process of childbirth, and returns control to the mother is also the safest approach.” -Dr. Odent, MD, OBGYN