Is homebirth safe? That has been a heavily debated question for almost a century. So, what do the studies say? What does the research say? What do the women who have experienced high quality midwifery care say? That, with the right parameters, yes! Homebirth can be a very safe alternative to planned birth in a hospital. When I say parameters, what do I mean? Women who wish to have a planned homebirth should be low-risk and find a provider that has the skill and experience to care for her particular health, background, wishes, needs, etc. There should be access to advanced medical care in a timely manner, if the need arises. Her midwife should have skill in emergency medical management while waiting on emergency services to arrive and take over.
It should be a partnership between a woman and her midwife - one where she is willing to build a relationship. openly communicate and take responsibility for following good advice, as well as commit to take good care of her herself and her growing baby, etc. All that being said, it is consistent across many studies and reviews, including a large systematic review and meta-analysis in 2019 that, "The risk of perinatal or neonatal mortality was not different when birth was intended at home or in hospital." 1
A large (16,924 women planning a home birth) study by MANA (Midwives Alliance of North America) was conducted and had fantastic results..." Low-risk women in this sample experienced high rates ( 93.6% ) of normal physiologic birth and very low rates of operative birth and interventions, with no concomitant increase in adverse events." It is not comparing apples to apples though. The key is that these were women who chose out of hospital birth, were low-risk, and chose providers appropriate to their situation.
So are the machines that go beep...necessary? For some, yes! Some women feel safer with all of the technological advances right near by. Sometimes a woman's health or pregnancy is not safe or appropriate for out of hospital birth. Midwifery uses age-old, time tested methods and skills. These have been lost in modern maternity care and replaced with reliance on machines and strict medical protocol. This protocol does not take into account each individual woman's particular situation. Midwifery skills include: relationships with the mother, her unborn baby and support circle; intuition; tuning in to the mother and what she feels is happening with her body and baby; and, of course, our hands. Most midwives do utilize modern medical tools such as lab work and ultrasounds, but I believe that those should not take the place of the invaluable tools midwives possess. Women who seek out midwifery value these tools and the lower interventions that they facilitate. That doesn't mean, however, that midwives are not trained how to handle serious situations such as a hemorrhage or the baby needing help making the transition to breathing after birth.
Somewhere along the way midwifery fell out of favor and became taboo. The only culturally accepted place for birth was in a hospital. Midwifery became misunderstood and a woman's right to choose where she felt safe to give birth came under fire. Here we are a century later and we are still arguing the same thing. IS homebirth safe? IS hospital birth safe? Of course there can never be a black and white, simple answer. The bottom line is that women should feel safe with the environment and care providers they choose. That is a HUGE factor in birth safety overall. Some women feel safest in a hospital with the high level of medical interventions that are right there. Some women feel safer at home where they have focused one on one care and are not in an unfamiliar, medical environment. Safety is not just physical, feeling safe can not only lead to a more positive emotional experience, but also a faster delivery.
Where and with who a woman gives birth should be her choice.
Also see the page, Safer Birth In a Barn?
1. Perinatal or neonatal mortality among women who intend at the onset of labour to give birth at home compared to women of low obstetrical risk who intend to give birth in hospital: A systematic review and meta-analyses
Hutton, Eileen K. et al. , eClinicalMedicine, Volume 14, 59 - 70