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But What if Something Goes Wrong?
Many people question the safety of homebirth along this line of thinking: "Most births are okay, but things can go bad quickly, and when they do, don't you want to be in the hospital?"
Here are some expert responses to this question:
"Midwives are trained to recognize problems before they become emergent, and to stabilize the emergencies that come without warning, namely hemorrhage and fetal resuscitation. But the most powerful answer is really the Daviss and Johnson study, which looked at CPMs, (who were both licensed and unlicensed) and concluded that babies were born just as safely in their hands. So the argument that "things can go bad really quickly and it's better to be in a hospital" just isn't borne out by the data. Things can go bad and that's why it's important to have a trained birth attendant and *access* to emergency care." -- Jennifer Block, author of "Pushed: The Painful Truth about Childbirth and Modern Maternity Care"
"Hard things happen in life. Birth is no different. Are there things that could "go bad" at home that would be better handled in the hospital? Yes. But the surprising thing is that there are things that happen in the hospital that either wouldn't happen at home, (like hospital acquired infections, the complications of inductions or cesarean section) or would be better managed at home (shoulder dystocia, need for most newborn resuscitation). The honest truth is that the same number of hard things happen at home or in the hospital. Whenever hard things happen in the hospital, everyone presumes that "they did all they could" and so the outcome was inevitable. When hard things happen at home, everyone presumes it was BECAUSE they were at home and that the outcome would have been better in the hospital. Nobody can really play God--not doctors, not nurses, not hospitals, not midwives. The data is clear--the outcomes are equivalent (but different) in hospitals, birth centers, and homes (unless you count an unnecessary cesarean as maternal morbidity, then we really should be legislating that women ALL stay home)." -- Elizabeth Allemann, MD
"Here's the other thing I say--most of the emergencies that are handled during birth--whether in the hospital or at home or in a birthing center are managed with HANDS. Not machines or surgery, but with hands. Shoulder dystocia--turn the mother over, turn her again, ask her to stand, then the list of maneuvers (from the latin for hands) done with hands. Cord around the neck--removed or cut with hands or baby birthed through. Hemorrhage--manual removal of the placenta(again from the latin for hand), bimanual uterine massage, THEN drugs. Prolapsed cord--presenting part held off the cervix with a HAND until an emergency cesarean can be performed. Any one with average intelligence, clear intention, and enough experience can have skillful HANDS. The initial training--medical or midwifery or nursing or osteopathic or naturopathic--is important but fades quickly as the years of experience add up. I love to say in the right place when the "cord around the neck" thing comes up that there is no "remove the cord around the neck machine"." -- Elizabeth Allemann, MD
Here are some expert responses to this question:
"Midwives are trained to recognize problems before they become emergent, and to stabilize the emergencies that come without warning, namely hemorrhage and fetal resuscitation. But the most powerful answer is really the Daviss and Johnson study, which looked at CPMs, (who were both licensed and unlicensed) and concluded that babies were born just as safely in their hands. So the argument that "things can go bad really quickly and it's better to be in a hospital" just isn't borne out by the data. Things can go bad and that's why it's important to have a trained birth attendant and *access* to emergency care." -- Jennifer Block, author of "Pushed: The Painful Truth about Childbirth and Modern Maternity Care"
"Hard things happen in life. Birth is no different. Are there things that could "go bad" at home that would be better handled in the hospital? Yes. But the surprising thing is that there are things that happen in the hospital that either wouldn't happen at home, (like hospital acquired infections, the complications of inductions or cesarean section) or would be better managed at home (shoulder dystocia, need for most newborn resuscitation). The honest truth is that the same number of hard things happen at home or in the hospital. Whenever hard things happen in the hospital, everyone presumes that "they did all they could" and so the outcome was inevitable. When hard things happen at home, everyone presumes it was BECAUSE they were at home and that the outcome would have been better in the hospital. Nobody can really play God--not doctors, not nurses, not hospitals, not midwives. The data is clear--the outcomes are equivalent (but different) in hospitals, birth centers, and homes (unless you count an unnecessary cesarean as maternal morbidity, then we really should be legislating that women ALL stay home)." -- Elizabeth Allemann, MD
"Here's the other thing I say--most of the emergencies that are handled during birth--whether in the hospital or at home or in a birthing center are managed with HANDS. Not machines or surgery, but with hands. Shoulder dystocia--turn the mother over, turn her again, ask her to stand, then the list of maneuvers (from the latin for hands) done with hands. Cord around the neck--removed or cut with hands or baby birthed through. Hemorrhage--manual removal of the placenta(again from the latin for hand), bimanual uterine massage, THEN drugs. Prolapsed cord--presenting part held off the cervix with a HAND until an emergency cesarean can be performed. Any one with average intelligence, clear intention, and enough experience can have skillful HANDS. The initial training--medical or midwifery or nursing or osteopathic or naturopathic--is important but fades quickly as the years of experience add up. I love to say in the right place when the "cord around the neck" thing comes up that there is no "remove the cord around the neck machine"." -- Elizabeth Allemann, MD