The Real Danger in America: Hospital Birth
As tempting as it is to make emotional arguments against the safety of home birth, as Feministe did recently, it’s not home births that are driving America’s high rates of maternal and fetal death.
It’s hospital birth.
America has among the highest maternal mortality rate of any industrialized country.
Even more disturbingly, in the hospital there are 34,000 “near misses” a year (severe pregnancy-related events that nearly cause death), up 25 percent from 1998.
Our infant mortality rates, as this CIA World Fact book chart shows, are similarly ignominious, higher than in most of the developed world.
But Amy Tuteur, MD, and many practicing obstetricians would like women to believe home birth is dangerous.
“Dr. Amy” is a former physician who let her medical license lapse in 2003 and now spends her time heckling writers on-line. When I wrote a post on reasons to breastfeed, she commented that breastfeeding leads to newborn death and accused me of being anti-feminist.
Despite that she has become a go-to expert for journalists like the Daily Beast's Michelle Goldberg. Tuteur is wrong.
Less than one percent of births in America take place at home; the tiny number of women having home births cannot be responsible for our poor outcomes. (Full disclosure: I've had two homebirths and one unassisted birth.)
As Jennifer Block mentions in her response to the Daily Beast, we know from more than half a dozen large-scale studies carried out in several different countries, including England and the Netherlands (where almost a third of babies are born at home), that planned home birth with competent attendants is as safe as or safer than hospital birth.
It’s devastating when a baby dies in childbirth.
The stories on Amy’s Hurt by Homebirth blog are full of anguish.
They’re worth reading, especially because you’ll see when you do that as of July 10, 2012, the blog had not been updated in more than six months and that some problems in these heart-wrenching stories actually arose from hospital, not home birth, mistakes.
In this story the emergency room doctor denied the woman was in labor and told her to suck it up (“These are pregnancy symptoms. Get used to it”), despite the fact she was 40 weeks and 3 days pregnant, exhausted, and asking for help.
The doctor sent her home.
You’ll also read about neonatal deaths caused by midwife incompetence, which I’ve unfortunately experienced firsthand, which my husband—who serves on our state’s board that regulates midwifery—works to prevent, and which is often more publicized and certainly just as inexcusable as obstetrician incompetence.
A Lack of Evidence-Based Medicine
Still, more than 97 percent of American births take place in the hospital, as opposed to at home or a birthing center.
The question we really need to ask is: What’s going wrong with hospital birth and why?
Three years ago Cyndi Sellers had her son at Oregon’s Rogue Valley Medical Center. After her water broke two weeks before the estimated due date, Cyndi—29 years old, healthy, having a low-risk pregnancy—was induced with Cytotec.
Cytotec, a drug to fight ulcers, has never been approved by the FDA for use to induce pregnancy.
In 2000 when the drug’s manufacturer realized it was being routinely used to jumpstart labor, they issued a warning to doctors against it.
According to the National Institutes of Health, Cytotec should not be used in pregnancy as it “may cause miscarriage, premature labor, or birth defects.”
Cytotec can also cause uterine rupture, uterine hyperstimulation, and amniotic fluid embolism, a rare but often fatal complication.
Then Cyndi was given Pitocin, a synthetic hormone that, according to the manufacturer’s insert, has never been tested for safety in pregnancy.
Going from having no contractions to being slammed with contractions with no break was excruciating. So Cyndi accepted an epidural, dilating quickly after that.
When it was time to push her baby out, Cyndi lay on her back with little feeling in her pelvis or legs.
The two nurses in the room, along with her husband and mom, looked at a monitor to see when Cyndi was having contractions to instruct her to push.
When the doctor on call finally bolted into the room after being repeatedly paged (Cyndi overheard the nurses say Dr. King was taking forever because of family visiting from out of town), she was wearing a Tie-dye T-shirt and her hair was wet as if she’d just been swimming.
The doctor immediately cut an episiotomy.
One cut wasn’t enough so she made a second.
Cyndi’s mom, who was watching, told Cyndi later that she was horrified at the length.
It took weeks for Cyndi to urinate without extreme pain.
Even now things still “don’t feel right” down there.
For over 25 years obstetricians routinely did episiotomies on laboring women.
“A number of observational studies and randomized trials, however, showed that routine episiotomy is associated with an increased incident of anal sphincter and rectal tears,” write the authors of Williams Obstetrics (23rd edition, p. 401, their emphasis), including a four to sixfold risk of fecal or flatus incontinence.
The evidence is abundant and unequivocal: episiotomies are proven to be more painful and more damaging to women than spontaneous tears. But despite the evidence, hurried doctors continue to perform them.
The Real Problems: Skyrocketing Cesareans, For-Profit Medicine, Lack of Choice
Stuart Fischbein, M.D., an obstetrician with 30 years experience who runs a robust home birth practice in collaboration with midwives in Southern California, believes the obsession with home birth is a smoke screen to mask our C-section and maternal mortality rates.
“It’s a distraction from the real problems,” Fischbein says.
The real problems: A dangerously and unacceptably high doctor-endorsed C-section rate (over 32 percent), a for-profit medical system that puts money over moms, and a lack of childbirth choices, especially for women who have had previous C-sections, so severe it drives some families to choose unassisted VBAC birth.
When you do the research yourself, you’ll find the most scientific birth is the least technological, that midwife-assisted birth is actually associated with safer outcomes than obstetrician-assisted birth, and that countries with lower fetal and maternal mortality rates are also places where medicine is not a for-profit institution.
Scaring women from home birth and arresting midwives will not make our birth system safer. Encouraging collaboration between doctors and midwives, practicing evidence-based medicine, and taking the profit out of obstetrics will.
Jennifer Margulis, Ph.D.
Co-author, The Baby Bonding Book for Dads and author, The Business of Baby: What Doctors Don't Tell You, What Corporations Try to Sell You, and How to Put Your Pregnancy, Childbirth, and Baby Before Their Bottom Line (forthcoming from Scribner, April 2013). Learn more at her website, follow her on Twitter (at JenniferMarguli, no "s.")