Yes, it’s a similar scenario in Australia.
Ditto [name]Britain[/name].
Thanks for sharing Blade.
I need to throw this in the mix.
As Blade - I think - was trying to point out, hospital births with midwives are the “lowest” in risk not only because of the midwives skill level but also their proximity to emergancy care. The same midwife-group in a home setting could end-up with very different statistics should emergancy care for mother and child be 5 minutes away.
The idea is that if you are having an uncomplicated birth it doesn’t really matter where you are.
However, should their be a complication or emergancy situation you and your child are statistically better off in a hospital which is equipped to handle such emergencies. (Also something important to consider when doing research early on).
The reason why the hospital-midwife statistics are lowest isn’t necessarily that they are the “best” but because they only get the numbers for the uncomplicated hospital-births while high-risk pregnancies and complications are immediately transferred to a doctor. (So obviously the doctors numbers are skewed because they include almost all of the hospitals high-risk pregnancies).
Yes, these are American statistics but the general findings probably don’t change much (at least for hospital-midwives vs hospital-doctors) in any country with a comparable medical-skill level). This has nothing to do with who the midwife is but purely what location the baby is born in. Saying that home-births in New Zealand or Australia are “safer” because it’s the same midwife as in the hospital is fallacious. It may very well be the case that they are better trained and have higher professional requirements (which is always awesome), but you can’t compare personal numbers to location numbers -> it’s like comparing apples and celery.
Interesting post! I am not very good with all the numbers/statistics but reading your final statement helped keep me in the mind set of why I want to have my first child and all children probably in a hospital with the professionals. I know two people who had their first child at home and it totally freaks me out. [name]Granite[/name] it went well for them. But my thoughts are, do they know what they are truly doing (midwives)? [name]Do[/name] they have machines monitoring my baby, and what if something where to go wrong how much of a window period do you truly have to rush yourself and your baby to a hospital? Too many risky factors with a home birth to ever do it. Great article [name]Blade[/name]!
Very important research! I am really glad someone did an extensive study on this. Personally, I’ve always felt much safer in a hospital than most people probably do (had a parent in healthcare) so I’m gratified to hear that the birth setting I’ve used is probably the safest.
My only question is, from my limited memory of stats, what about the sample size of 14,000 observations? Is that “large” enough to cause issues with p-values and goodness of fit?
I’m not super experienced with big data sets, just genuinely curious about how the info would be interpreted, since I will eventually be doing a research project for my masters.
I think it’s 14 million 
Thanks for making this point. That’s what I assumed from the statistics as well. I had both of my children in the hospital with a midwife. I was really happy with the experience and was glad to know that if something had gone wrong I was near an OR, NICU and everything else a hospital has to offer. I also enjoyed my hospital stay following my daughter. It gave me some time to focus on just her before we went home and I had to balance two kids. She also stopped breathing and turned blue on her second day and while she started again on her own and was fine it was reassuring to have a nurse that came running in when it happened and know that if she wasn’t OK then we were right there in the hospital.
I have seen studies that are studies that dispute safety of hospital births.
Here’s one that suggests that homebirth is MUCH safer for the mother (particularly 2nd+ time moms) than hospital birth: Severe maternal complications less common during home births | The BMJ
I will be having a homebirth with a midwife (certified nurse midwife, not a CPM or DEM). I am well-educated on my options and this is my second low-risk birth. After 2 full days on pitocin in the hospital with an OB for my first (no epidural TYVM), I’m 100% confident that the best place for my baby to be born this time is right at home. I’m a trained doula myself and have attended numerous home births. I have no reservations about them for the right birth and with the proper support. My midwife and her staff are fully trained in neo-natal resuscitation and carry all the necessary supplies such as masks and O2 tanks. I also live about 5 minutes from a major trauma center.
Women need to know their options and know their health history and risks. I also find it critical that parents-to-be prepare themselves with a comprehensive childbirth course over several weeks such as [name]Bradley[/name] Method or Informed Beginnings. Informed consent cannot be given for procedures if mom is not actually informed first and only fear is used to sway her towards the decision that the doctor wants her to make. Hospital classes do not prep new moms as well as they should.
[name]IMO[/name], Posts like this only breed fear and are biased, particularly when it’s unknown what the provider’s credentials actually are.
I am not sure what you mean by “personal and location numbers”, but what I said is not fallacious at all. [name]Blade[/name] said homebirth midwives in the US are all completely unqualified (which isn’t actually true, there are both lay and qualified midwives who handle homebirths there) vs professional, qualified midwives who work in hospitals. Any country which has lay midwives operating is going to have completely different homebirth stats than countries which don’t. And actually, I think it’s a big shame they didn’t differentiate between the qualified and unqualified midwives. I agree that having an unqualified midwife attend your birth is unsafe (wherever you birth), but that doesn’t make homebirth intrinsically unsafe, it makes your midwife unsafe.
From the body of the paper:
“Patients delivering at home attended by midwives were significantly more likely to be
multiparous, non-Hispanic white, ≥30 years of age, delivering beyond 41 and 42 weeks,
and having macrosomic infants over 4,000 and 4,500 grams (p<.0001).”
It seems biased to me to exclude small and premature babies (more likely to be born in a hospital) but not to exclude large and post-dates babies (more likely to be born at home).
Also worth noting:
“The CDC data on seizures or serious neurologic dysfunction include those
of genetic, prenatal, intrapartum, and neonatal origin that might not be related to birth
setting.”
Finally… aside from some basic exclusions (premature, low birthweight, multiple gestations) I can’t find any qualifier about how many of the births were classed as low risk. Given that nearly all health providers only recommend homebirth for low risk pregnancies - but often homebirth stats include high risk women who birthed at home anyway - that seems like a pretty serious oversight. Studies that compare only low risk births often find little difference in outcome between hospital and home.
Yes, nearly 14 million - although home births made up a (relatively) very small proportion at 0.49% of the sample size. I’d be very curious to know what data more balanced sample sizes would have produced.
It seems fairly self-evident to me that giving birth in a setting with medical intervention on-hand is going to be “safer” for complicated births (and of course you never know whether this will be the case until it is too late).
However, I still believe that there are other factors to consider that would sway some mothers towards a home birth, despite the need to travel to hospital if things go horribly wrong: the comfort of being at home, having complete control over the birth setting and the birth. For instance, if you have had an uncomplicated first birth, some women may be willing to trade the risk of a 15 minute ambulance ride for the security of knowing that they won’t receive any unnecessary intervention (I’ve heard that my closest hospital will transfer a woman from the midwife led unit to the delivery suite for medical intervention if her labour is not progressing quickly enough after four hours - I don’t like the idea of being on a stop watch, and all medical intervention carries its own risks).
So, the statistics around safety are only one factor (if arguably the most important) in making a decision about where to give birth.
Besides the Medical data, it’s always going to be a personal decision.
My goal was an unmedicated hospital birth with my son. I went in with a completely open mind. and ended up with an Epidural and a C-Section. And I found out that by comparing my 6 wk post delivery appt and my 1 yr post delivery appt that I would never have delivered naturally. The only way for me and my children to survive childbirth is medical intervention. It would have been nice to know that before 36 hours of labor… but I’ll take it now.
I’m more comfortable in a medical environment, including Birthing Centers, and feel better when friends go that route too… but am still fascinated by women who choose home birth. 
Oops, my bad. Wow, that is a lot of observations.
I’d still trust the results and conclusions, though.
If the research is good I fail to see how the credentials of the provider really matters, the post was actually really useful in explaining the statistics etc in a way that science reporting in the lay press usually fails to do. This information is very relevant to many people on this forum. If what was found in the research is frightening, then that’s just how it is I guess.
Because it DOES matter, in many cases, what the credentials of the attendant of a homebirth is. The OP seemed to imply that all homebirths are being attended by unlicensed or unqualified fly-by-night providers. I can assure you that is not the case. I’d love to see a study that actually looked at the HB provider credentials. Personally, I’m using a certified nurse midwife that has a back-up assistant MW and has attended thousands of births. I have been thoroughly screened to make sure that I’m low risk and qualify properly for a homebirth. I have had all the prenatal tests that any other mom delivering in a hospital with an OB would get, including blood tests, ultrasounds, glucose testing, etc… all with far more personal service (I know because I delivered in a hospital with an OB for my first birth and I’m also a doula). There is no way to know whether the homebirths in this study were provided for in this way or not.
Yes, scary stuff can happen at any birth. I don’t think it’s always rainbows and unicorns, but I also think that if a woman is educated on her options, is low-risk with a healthy pregnancy, and has a qualified provider there is no reason that home isn’t the best place for her to birth.
(And I don’t blame people for fear. 5 years ago, I would have felt the exact same way as most people in this thread.)
I also have to question the agenda of the OP and why this particular study got posted here. I mean, numerous studies about birth and outcomes are published every month. What does the OP have against homebirth that they felt the need to share this particular one? Who was she targeting and what was her purpose for posting it on a board that has little to do with actual birth scenarios?
^This! Precisely.
I have every bit of faith that [name]Blade[/name] has no sinister ulterior motive. In fact, there have been a few threads with productive discussion regarding natural birth, home birth, birth centers, and hospital births over the last year or so. It’s somewhat of an open discussion that some of the moms on the forum have been having. [name]Blade[/name] is a doctor, and she’s very up front about that, so I believe her actual motive is for mothers to make informed decisions, and know the risks involved with whatever birth plan they may choose.
I understand where you are coming from on the credentials of the providers. I would love to see the numbers for just CNMs doing homebirths vs birth centers vs hospital. Regardless, the numbers point to the credentials mattering less than location. It’s the proximity to interventions, should they be needed, that makes these numbers what they are. [name]Even[/name] if the birth center is across the street from the hospital, the 5 minutes that it takes to dispatch the ambulance, load you up, assess you, and get you into surgery can be the determining factor in your child living or dying, or having permanent brain damage. You are right in that home birth is most likely a safe choice for you, in your circumstances, but it doesn’t mean it’s AS safe or SAFER than a hospital birth. The risks due to interventions, etc, at the hospital are less likely to be fatal or cause permanent damage.
I was unhappy with my own hospital birth. I believe there are three reasons that my breastfeeding relationship failed with DD, and they are all the fault of the nursing staff… but that doesn’t change the numbers in this study.
Also, I don’t think that OP was implying that all MW’s are hacks. The problem is that it can be difficult to find a well trained AND experienced MW, and many people don’t even know what certifications to look for or are misled by the provider. Regulations for midwifery as a practice are really still forming in the country - it’s not like [name]New[/name] Zealand where you’re birthing with a MW in most cases, regardless of whether you choose hospital or home. There it’s an integral part of the healthcare system for women. Here it’s a marginal type of practice, though becoming more accepted.
Well, I’m a doctor, too, but seeing as how she’s an MD (I’m assuming) and a surgeon based on her signature and I’m a chiropractor (DC)/acupuncturist/doula that works closely with midwives I can see why we approach birth from very different positions. Knowing the biases of a poster (we all have them) helps understand where they are coming from. And unless she’s an OB or another doc that works in birth settings such as an anesthesiologist, neonatologist, or MFM, I’d be willing to guess that I’ve likely been present at more births - especially more natural, unmedicated births.
Edit to add: This isn’t to say that I discount her opinions entirely. If I need advice on a surgery of her specialty, then I would be all ears. We all have our strengths.