What does seem clear, however, is that women undergo fewer interventions when delivering at home. A meta-analysis of more than 24,000 births in multiple countries found lower rates of severe laceration, episiotomy and cesarean section with planned home births compared to planned hospital births. Maternal outcomes are likely better at home because the possibility of unnecessary interventions is removed, although those interventions can still be obtained efficiently through transfer to a hospital. There is also evidence from Britain that there are fewer maternal complications, like postpartum hemorrhage, when women give birth at home. Cochrane, a trusted global network of health researchers, distilled these factors to what is most important: the overall safety of home birth is comparable to that of hospital birth for healthy patients assisted by experienced midwives.
[Home Birth Is Growing in Popularity. Is It Right for You? Read more on NYTParenting]
Unfortunately, giving birth at a hospital isn’t universally safe. NPR reported that the United States is the only developed nation with an increasing rate of maternal death, which has more than doubled from 1987 to 2015. According to the Institute for Health Metrics and Evaluation, it is now nearly twice as dangerous to give birth here as it is in Britain, France or Germany, despite the fact that the United States spends more on health care per capita than these countries. ACOG notes that the statistics are even more dire among minorities, with black women being three to four times more likely to die than white women.
No one is immune to this risk. In 2017, Serena Williams almost died of a pulmonary embolism after delivering her daughter when her complaints of shortness of breath weren’t taken seriously at a Florida hospital. Researchers in Alabama and Georgia found that half of maternal deaths are caused by medically preventable complications like embolism, while the other half, including those linked to rising obesity rates and poor access to health care, cannot be blamed entirely on hospitals. Nevertheless, it remains understandable that pregnant women have started to lose trust in the medical establishment.
Marginalizing home birth only endangers patients. There is a better way to handle this, starting with formal accreditation. According to ACOG, approximately 35,000 births occur at home in the United States each year. State governments regulate the education and experience needed to qualify as a birth professional through licensure. Certified Professional Midwives are the only providers required to have training in home birth, but just 33 states license CPMs to practice.
Nebraska is not one of those states — only Certified Nurse Midwives who also hold a nursing degree are licensed, and they are prohibited from attending births at home. This means that there are no birth professionals in Nebraska who are “properly certified” for home birth, making it difficult for patients who want a home birth to figure out who is qualified and how to access services.