Tree of Life Midwifery

A 2000 study of home births in the US and Canada concluded that planned home births attended by certified professional midwives resulted in lower rates of medical intervention than their low risk counterparts at hospitals. For example, in the hospital 33% of the women received episiotomies compared to 2.1% of the women who began their labor at home. The caesarean rate was 19% of the low risk births in the hospital. For intended home births in the study, the caesarean rate was 3.7%.

No maternal deaths occured. Neonatal and intrapartum mortality rates were about the same at home or the hospital.

The study followed 5418 women who planned to deliver at home, of which 12% were transferred to the hospital during labor (more than half for failure to progress, pain relief, or exhaustion). Transfer rates were highest for women giving birth for the first time.

In the United States, where birth has become “an economic, medical, and industrial enterprise” costs for an uncomplicated vaginal birth in a hospital are about three times those of home births.

“Our study of certified professional midwives suggests that they achieve good outcomes among low risk women without routine use of expensive hospital interventions. Our results are consistent with the weight of previous research on safety of home birth with midwives internationally. This evidence supports the American Public Health Association’s recommendation to increase access to out of hospital maternity care services with direct entry midwives in the United States. We recommend that these findings be taken into account when insurers and governing bodies make decisions about home birth and hospital privileges with respect to certified professional midwives.”

Q: Is home birth safe?
A: When people ask this question, they are usually asking, “Can having a baby at home be as safe as having a baby in a hospital?” The answer is yes, even more so. Study after study has shown that midwife-assisted births have a lower mortality rate than physician-assisted births in comparable cases.

“Scientists calculate childbirth success rates by examining infant mortality per 1,000 births. Since the 1970s, the United States has had approximately 10 infant deaths per 1,000 hospital births. The mortality rate for planned and supervised homebirth is approximately 5 per 1,000 births. There is no conclusive evidence that hospital births are safer for either the mother or the newborn, and many insurance companies cover a percentage of midwifery service charges.

“Emergency situations can and do arise in home births, just as they do in hospital settings. Sonograms and blood tests can diagnose potential problems in the mother or the unborn child that might require hospitalization or the intervention of a knowledgeable physician.

“However, if a woman delivers her baby in a U.S. hospital, she has a one-in-four chance of receiving a Caesarean section. This statistic has prompted the World Health Organization to advocate that the United States return to a midwifery-based system of prenatal care, labor and delivery. If 95 percent of births are normal, then why do 25 percent result in surgery?

— Reno News and Review Cover Story May 9, 2002

The World Health Organization has affirmed its support for the midwifery model of care.

“A study conducted in the province of Gelderland, compared the “obstetric result” of home births and hospital births. The results suggested that for primiparous women with a low-risk pregnancy a home birth was as safe as a hospital birth. For low-risk multiparous women the result of a home birth was significantly better than the result of a hospital birth (Wiegers et al 1996). There was no evidence that this system of care for pregnant women can be improved by increasing medicalization of birth (Buitendijk 1993).”

“In conclusion, normal birth, provided it is low-risk, only needs close observation by a trained and skilled birth attendant in order to detect early signs of complications. It needs no intervention but encouragement, support and a little tender loving care.”

— Care in Normal Birth

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* How Safe Is That Hospital, Anyway?

Perhaps the better question is “Why give birth in a hospital?” Pregnancy is not a sickness; childbirth is not a disease. In the United States, unnecessary medical intervention in the natural process of childbirth has resulted in correspondingly high incidence of infant injury and mortality compared with European nations, such as Denmark and France, where most births are attended by midwives.

Q: What are the advantages of a home birth compared with a hospital birth?
A: Most women will tell you that the primary advantage of a home birth is autonomy: the power to give birth in any position, to decide who attends, and the comfort of familiar surroundings. These are all major reasons I chose home birth too.

However, in my mind, the greatest reason of all is the baby’s experience and treatment in the first crucial days of life. I believe that our society has created unimaginable problems by not recognizing the newborn as a conscious being. We are only beginning to understand the profound impact of birth trauma through the science of perinatal psychology. How can we ever hope to end violence and drug abuse in the US, when for most of us, our very first lessons in life were being drugged, separated from loved ones and then violated; for boys, sexually violated by circumcision in the first days of life!?

Babies born at home are born in the gentlest way possible, experiencing love rather separation.

Q: What’s the most important factor in a successful home birth?
A: Assuming that you are committed to the idea of home birth, for your baby’s sake and your own, the most important factor is to let go of fear. The second, almost equally as important, is excellent health. These two factors are the primary focus of my prenatal visits.

By learning how your body normally functions, discussing strategies to cope with labor and creating an environment that feels safe to you, we’ll alleviate fear.

Hearing the stories of other women who gave birth naturally is also helpful. On the other hand, watching shows like Maternity Ward pretty much guarantees a transport to the hospital during labor, because you program your body to believe that’s how birth works. That’s why 98% of births are planned hospital births–because American women have been conditioned to believe we can’t give birth without medical intervention.