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The Other Birther Controversy

So, medically speaking, giving birth at home has some advantages. Women are less likely to get infections when they give birth at home rather than in a hospital. Babies born at home are more likely to be healthy (assuming it’s a low-risk pregnancy), and there is less medical intervention. The latter isn’t necessarily an upside, but it is what some women want.

However, according to a new study, home births have one very big drawback: Babies born at home are more likely to die. In fact, infant mortality rates for home births are two or even three times as high as those for hospital births. We’re still talking about a tiny percentage of babies who die (less that 1 percent in both home and hospital births), but that fact is hardly comforting if the baby is yours.

The medical journal The Lancet jumped on board with an editorial titled “Home birth—proceed with caution” that included this guaranteed-to-provoke line: “Women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk.” OK, but when there’s real disagreement about the degree of risk, who has the “right” to make the decision?

Naturally, the report has been criticized by pro-home birthers. They say that the American Journal of Obstetrics and Gynecology, which published the report, is just toeing the official line, that some of the studies cited in the report are out of date, etc.

There are a couple of factors that make studying the safety of home births tricky. One is that you can’t have a randomized trial: Women usually have strong opinions about where they choose to have their babies and are unlikely to allow researchers to dictate that decision for the sake of science.

Also, not all home births are created equal. Fewer than a third of women have a certified midwife on hand for the delivery. Others have a midwife who may or may not be properly trained. And a few don’t have midwives at all. In addition, some midwives are “integrated into the health-care system,” i.e., they have ready access to a hospital should something go wrong. Within the category “planned home birth” there are a lot of variables.

The authors of the AJOG study conclude:

Future research needs to be directed at identifying contributors to and reducing the apparently excessive neonatal mortality among planned home births.

Hard to disagree with that. Though maybe some research also needs to be directed at figuring out why babies and their mothers tend to be healthier when births take place at home.

 

(Here’s the abstract for the study, “Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis.” The authors are Joseph R. Wax, M.D.; F. Lee Lucas, Ph.D.; Maryanne Lamont, M.L.S.; Michael G. Pinette, M.D.; Angelina Cartin; Jacquelyn Blackstone, D.O.)

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