pediatrician psa: why i am not in favor of home births

When I hear a pregnant woman say she plans to give birth at home, my heart rate starts to go up-- not in anger, but in worry. During my training in pediatrics, I spent three months working in the NICU (Neonatal Intensive Care Unit), and more than once I saw the outcomes of home births that had gone horribly wrong. Healthy moms, healthy pregnancies-- but something happened and the baby needed something that couldn't be provided at home-- oxygen, medication, IV fluids, a blood transfusion. Some of them were "neurologically devastated" (basically the medical term for severely brain-damaged) as a result. Some died.

This is not to say that bad outcomes don't happen in hospital births, too-- of course they do. And it's not to say that healthy babies aren't sometimes born at home-- of course they are. But if even one baby born at home could have been saved by quicker access to medical intervention, that's serious, isn't it?

Yes, it's true that women's bodies are designed to go through labor and delivery-- "pregnancy isn't a disease," as they say-- but just because it's natural doesn't mean it can't go wrong. Too often, it does. (Even rarely is "too often," in my opinion.) Humans are pushing the limits of what's possible, biologically speaking. Compared to the size of women's birth canals, our babies' heads are HUGE to accommodate our large human brains. This is presumably the reason our babies are born so immature, compared to the rest of the mammals in the animal kingdom, who are often walking within hours of birth (aside from marsupials, who have a second gestational period in their mothers' pouches). If human babies developed and grew any more before birth, they simply wouldn't fit!

I think it's wonderful that women want a good and memorable birth experience-- it is a very meaningful event, something sadly trivialized in our modern culture... but the outcome-- the child that is the result-- is really what counts. I see so many similarities to women who get preoccupied with having the perfect wedding, when it's the marriage that really matters. Instead of bridezillas, we have mamazillas (birthzillas? laborzillas? you know what I mean). Women who have The Perfect Birth planned out and typed up, with no thought to the "what-ifs."

I often hear home-birth advocates cite the need to avoid unnecessary medical intervention. Of course we should avoid unnecessary medical intervention. But we should have ready access to possible necessary medical intervention-- which isn't always foreseeable beforehand. When I was in labor with my oldest daughter-- a totally healthy pregnancy-- her heart rate dropped suddenly and we were taken to emergency C-section. She was fine, but her blood-gas readings at birth showed that she had been getting dangerously low levels of oxygen in her blood for the short time before the C-section. If she had continued getting those low levels for however-much-longer labor would've lasted (hours? I was only dilated to 7cm at the time), she could have had permanent brain injury.

Clearly one anecdote isn't proof. But numerous studies have shown that, generally speaking, giving birth at home is related to an increased risk of bad outcomes for babies. (Note I said "increased risk." Obviously plenty of babies are born at home without any complication. Riding a bike without a helmet increases your risk of head injury but plenty of kids never wear helmets and are totally fine.) See here, here, and here. (Yes, there are some studies that show there is very little difference in outcomes. That's what meta-analyses-- such as in the third link-- are for. Here's an explanation of meta-analyses for the curious.)

Find an OB or midwife you can trust, who knows your preferences, but please please understand the medical reasons for something before you dismiss it. With few (unfortunate) exceptions, medical personnel aren't out to undermine your birth experience for selfish reasons. They just want you and your baby to be safe. And the safest place to give birth is in the hospital.

(If you do decide to give birth at home, please make it as safe for your baby as possible and follow the recommended guidelines for planned home births.)