Originally Posted by AstridS
I really have to disagree that thinks like c/s and anasthesia makes (normal, low risk) birth safer. A lot of studies show, that for low risk birth, access to the things you mention is actually making birth less safe. All medical procedures have risks.
The idea, as I understand it, is not that one would put curtains in a hospital room and call it a "homebirth in the hospital" because, lo and behold, we have curtains. Rather, the idea is a revolution in the OB approach to birth, and a massive shift from litigation-centered maternity care to mother/baby-centered maternity care (sometimes called the midwifery model of care). OBs will tell you their care is baby-centered, but all too often, it's a strong combination of (a) fear of litigation; (b) avoidance of inconvenience when possible; and (c) strong priority on the baby.
I also did not say that anesthesia makes low-risk birth safer. I said I want access to anesthesia during labor without having to transport during late active labor or transition, especially since a non-emergency transport for me takes a minimum of an hour and a quarter, or as long as three hours in traffic.
I believe, based on the evidence (which we could disagree about all day), that surgical births do save babies, including for low-risk mothers. Low-risk mothers can have sudden emergent situations or unexpected problems during labor. The numbers are low - no one would argue that. But given the choice, I would much rather be at a hospital where that c-section was minutes away and people already knew where I was and what was going on, than facing an emergency transport situation to an unfamiliar hospital where my midwives don't have privileges and I'll get an OB I've never seen who may be hostile towards the homebirth choice, the sudden appearance of an emergency, etc. Not to mention that it's very likely that decision time to baby out time, in a true emergency, would be faster in the hospital. No fault of my midwives or anything else, just a matter of making the 911 call, the long drive to the nearest hospital (about 20 minutes), anesthesia for me, getting me in the OR, etc.
Other women may be in a different situation and may feel they don't share the same risks, I get that. Or evaluate those risks differently. And heck, I chose homebirth over hospital birth to avoid the highly medicalized manner of birth. All I'm saying is, having my own bed, shower, and birth tub is not why I stayed home, nor would it be reason enough to prioritize that over the accessibility of medical assistance when needed in the hospital. What outweighed the availability of emergency care, for me, was the SOP of hospitals and feeling that that kind of hostile/pushy atmosphere was not conducive towards a healthy birth and that we were likely to be unnecessarily tampered with (intervention). If that were not an issue, for sure I'd hospital birth. I've always said that, for me, homebirth vs. hospital birth is about risk analysis. Change the nature of hospital birth and that alters my risk analysis.
If you're referring specifically to the BMJ study, of course we could talk about statistics a lot, but you might know that there's been some discussion of the data, the authors have talked about some perhaps questionable (or at least, questioned) choices they made with regards to the data set, and the full data that MANA has has not been published and will not be shared with anyone except those who agree to use it to promote midwifery and homebirth. I understand where they're coming from because there are a lot of homebirth enemies out there, but at the same time, if the data was really a slam dunk, I think they wouldn't be so reluctant to share.
Medical procedures do carry their own set of risks, absolutely. However, I know perfectly well that if I have a cord prolapse or complete placental abruption at home there's a good chance I'll lose my baby. My baby is more likely to live, in those rare and unusual circumstances, if we're at the hospital. If I could avoid CFM, restriction of movement, pitocin, epidural (unless I decided I wanted it), unnecessary VEs, etc. AND be in the hospital, I would totally do that. No question. That's what homebirth in the hospital means to me - respect for the patient, lack of strict or rigid policies that can easily derail an otherwise natural birth, continuity of care (i.e. a midwife who stays with me), and the ability to bring along some things from home to make myself more comfortable. Bringing it back to the issue of medical procedures having risks - (1) homebirth in the hospital to me would mean a truly low-intervention birth, like my homebirth; and (2) while I want to avoid those interventions whenever possible, and did so by showing up pushing with #1 and having a homebirth with #2, I would say that when medical intervention is needed, the risk of the intervention is almost always far less than the possible consequence of death, which is what I see as homebirth's biggest drawback (increased risk of baby's death). I know the BMJ study says the risk of the baby dying is the same, but I've spent some serious time looking at that study, and I do have concerns. Logically, it makes sense that some babies die at homebirth that would not die in the hospital. Possibly the reverse is also true, but it almost certainly would more often go the other way (homebirth).
This is in no way a reproach of anyone planning a homebirth or a condemnation of homebirth. I fully support homebirth! But I do think it carries some risks that differ
from the risks encountered during a hospital birth. When a woman chooses her place of birth, hopefully she carefully considers all her options and makes an informed decision that she's comfortable with. I have no regrets about my homebirth.