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Birth Part 2: Why do so many American women die in childbirth?


My first baby was born in Chicago. At  home. When I would mention home birth in that city it was akin to saying: “I like to fly stunt planes–wanna set yourself on fire and take a ride with me?” Mothers were aghast.  I must be nuts, or at least horribly anti-establishment.

My second baby was born in Vancouver, BC. Here home birth is just part of the culture. In my yoga class three out of the four pregnant women were planning home births, the fourth was working with midwives in a hospital. Okay, so it is a yoga class, not exactly a random sampling, but still impressive.

Why home birth?

I like to be in control; I don’t take orders well; and I am a bit of a know-it-all. These are the main reasons I chose home birth with midwives.  “You can’t control birth,” almost anyone will tell you, but at my house I could control my environment.  I don’t like the idea of someone strapping me down, telling me what to do, or making me feel like I am at fault if my baby doesn’t pop out before their 7 p.m. reservation at the Ritz.

Of course, what I really wanted was a healthy baby, a healthy me, and a good birth experience. According to my research, that meant I wanted a natural birth. Natural in this case meaning: being supported with natural pain relief techniques like water, massage, and movement. I also didn’t want a bunch of strangers, loud noise, or machines. And I definitely didn’t want unnecessary drugs.  LIke many other women, my decision about where to birth was further influenced by what I wanted for the baby’s first experiences.  Super germs, formula, and time in a nursery away from mom are things I saw as potential perils to which I didn’t want to unnecessarily expose my baby.

In many states and provinces, and in the towns I lived—Chicago and Vancouver—the options for birthing families are two: home or hospital.  The research I did suggested that I was more likely to get a natural birth at home.

Is home birth safe?

The largest study of planned home birth in North America concluded that for low risk women using certified professional midwives (CPMs), home birth was associated with “lower rates of medical intervention” and “similar intrapartum and neonatal mortality to that of low risk hospital births.”

In case that sounds more like mumbo jumbo than the profound statement that it is, let me say it again: the research suggests that for me (a healthy woman with a low-risk pregnancy) I would be safer at home than in the hospital. In the hospital, I would be more likely to receive unwanted and even unnecessary interventions, including a cesarean section.  In low-risk pregnancies, babies who are born by cesarean section are nearly twice as likely to die as those born vaginally. Low-risk mothers who plan cesarean sections are more likely to suffer severe morbidity as well, including: hemorrhage resulting in hysterectomy, cardiac arrest, and major infection.

Home birth: an elite option?

Home birth isn’t for everyone. In fact, in some places in North America, such as Chicago, it is for the elite only. That is because Illinois is one of the few places that don’t recognize the CPM credential making it illegal for those midwives trained especially in home birth to practice. In that state, there are still up to 1,000 reported homebirth happening every year. Some of the families delivering at home in Illinois are lucky enough to find a Nurse Midwife or a Doctor to attend their birth, but since these are rare (and often denied malpractice insurance), many women are left to deliver unassisted or with an unregulated, underground midwife.

In most states of the U.S., home birth providers are legal and regulated. However, in only 10 are the CPMs that attend homebirths eligible for Medicaid reimbursement.  In other words, if you are poor you have to get a more expensive birth whether you want it or not.

With the average, umcomplicated birth costing three times as much in a U.S. hospital than at home, it seems bizarre that many insurance companies–including Medicaid–won’t cover the cost of a birth planned at home. Birth currently costs the U.S. far more than any other health condition: $86 billion in 2006, nearly half picked up by taxpayers.  

In Canada, access to midwives and home birth vary by province. In some provinces, such as Prince Edward Island, midwifery is not legislated, there are no midwifery educational programs, and there is no health care funding for midwives. In other provinces, like British Columbia, midwives are covered by the health care and a woman can choose whether to deliver with her midwife at home or in a hospital.

Why do so many American women die in childbirth?

As the first part in the birth series details, the U.S. has some of the worst rates for maternal mortality of any industrialized country (rose to 13.3 per 100,000 in 2006). Part of this comes from a high cesarean section rate and an over-medicalization of birth. The country’s with the best rates typically put low-risk births in the hands of midwives and typically allow a woman a choice of birthing at home or in a hospital.

Ina May Gaskin points out another reason why the maternal death rate may be so high in the U.S.: a lack of in-home follow-up care for mom’s that birth in a hospital. Gaskin says that “Maternity care systems in countries with low maternal death rates plan for the certainty that some percentage of previously healthy women will be in danger of a late postpartum hemorrhage, uterine or perineal infection, breastfeeding problem, postpartum depression or some other post-birth complication requiring special attention. These countries— Australia, England, the Netherlands, New Zealand, Norway, Wales, Scotland, Sweden, and Northern Ireland, just to name a few—send specially trained nurses to make home visits for new mothers during the first ten days or so following birth.”

Gaskin goes on to explain that in the U.S. women are sent home from the hospital too early to detect these problems. Women with planned home births are among the few that get routine post-birth visits.

Many countries, the UK being at the forefront, research and publish information on this very question: why are women dying in childbirth in their country? The UK publishes a 400 page detailed analysis of the question every three years. In contrast, the U.S. barely tracks this information and does virtually no analysis and makes no recommendations. In fact, not only does the U.S. have some of the highest reported incidents of maternal death in the industri
alized world, there may be many hundreds more not reported according to a 1998 CDC report.

When was the last time you read about a mother dying from childbirth in the paper? Ina May suggests that a lack of media coverage on women dying from childbirth related complications has further distanced families from an understanding of birth in America and what is at risk.

The take-away

When you mention to someone in the U.S. or parts of Canada that you are having a home birth, they assume this is the risky option. However, the statistics suggest that for most healthy women it is safer to birth at home with a trained midwife than enter the hospital. Women don’t know this in part because of the lack of research and lack of reporting on why women die in childbirth.

To learn more about how you can get the birth you want, read Birth Part 3. For more information on birth in North America read Birth Part 1.

Photos courtesy of Shutterstock.

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