Tuesday, January 21, 2014

7 Home Birth Myths: No For Real This Time

photo courtesy of Edward Willett

I recently read a little article about myths about home birth. It was funny. Not so much like funny haha but funny in that full-of-misleading-information type of way.

So I thought I'd take this opportunity to tell 7 actual myths about home birth. The legitimate and dangerous myths, the myths that many home birth moms and advocates (and their family/friends) believe. Because I've been there. If you'd like to read more about my journey and why I am a former home birth advocate, click here to read for the full story. If you have any doubts on how well I researched home birth, that should clear it up for you.

Let's start with the biggest myth of them all.....

Myth #1: Home birth is as safe as hospital birth

While that may be true in countries like Canada or Netherlands or UK, it is actually NOT TRUE here in the USA. Not true at all. Not a single peer review study regarding home birth in the USA supports that idea that "home birth is as safe as hospital birth" -- they each, in fact, show an incredible increase risk for babies born at home versus in a hospital. (Click here for the studies) (and Click here for the *new* MANA study which yet again shows increase risk to babies born at home)

Under certain conditions - similar to the the way home birth is typically practiced in other first world countries (click here) - home birth may be as safe as hospital birth. But that's not how it typically goes here in the US. The US stands alone in our home birth practices -- which is why all studies point toward increase risk at home versus hospital. Even when you take things like rare hospital-acquired infections into account, the risk is still greater at home.

Myth #2: Home birth midwives are experts in normal birth

If you are seeing a Certified Nurse Midwife (CNM) or Certified Midwife (CM) that has current hospital privileges, then yes, you are seeing an "expert in normal birth." Mass majority of home births in the US are attended by a Certified Professional Midwife (CPM), Licensed Midwife (LM) or lay midwife -- these midwives would not be able to practice as a midwife in any other first world country because the requirements for becoming a CPM or LM are incredibly lacking compared to midwives in other first world countries (and especially compared to our American midwives that go through ACNM). And obviously, if you are seeing a lay midwife, who knows what training she has under her belt or what her real track record is.

If you feel like you are the exception and that your home birth midwife is incredibly well-trained and incredibly ethical and would never take chances (especially without you knowing), then you might want to read up on these midwives. Sadly, there is no guarantee and no way to know for certain what your midwife's training consisted of, what her real track record is and whether or not her own birth philosophy will trump what is ethical.

Myth #3: Home birth midwives carry with them everything needed, in case of an emergency

There is a huge difference in what you will find at a home birth versus a hospital birth. To some, this may sound obvious. But to others it might help to see it laid out, the difference what you would find at a home birth and a hospital birth. It's one thing to hear your midwife say "here's what I will bring -- it's everything you need in an emergency," and another to actually see equipment home versus hospital, and even ambulance. So click here to see the full lists and compare. Perhaps the biggest difference is the team you will find at a hospital that you won't have at home - especially if your midwife works alone. If both mother and baby are in need of immediate medical attention after birth, you have many hands and minds - not to mention equipment - to help them both at the same time. When will minutes matter? Read these stories and you'll get an idea of how low risk can turn into emergency in a matter of seconds.

Myth #4: If complications come up, home birth midwives will be able to identify and transfer before it becomes an emergency

There are circumstances when minutes can really be the difference in life or death (or serious neurological and/or physical injury). Shoulder dystocia, cord prolapse, placenta abruption to name a few... how will your midwife handle these situations at home? Ask her. What if what she tries doesn't work, then what? The reality is, those complications can be and have been deadly at home birth. If what she tries does not work, you will be transferring to a hospital and minutes. will. matter. I, unfortunately, know of 3 home births in just the past year that resulted in shoulder dystocias that were not resolved in time and the babies did not survive.

Myth #5: Home birth midwives give better care than OBs

Home birth midwives are afforded a little luxury that OBs are not. The luxury is called: no accountability. OBs must always err on the side of safety. If they do not, they have the hospital, their medical board and lawyers (lawsuits) expecting answers if something goes wrong. If their actions prove they were negligent and/or unethical, they are in big, big trouble.... like Dr. Fischbein or Dr. Biter. Home birth midwives, however, are able to push the envelope when it comes to potential disasters. Why? Because they aren't required to carry insurance and NARM (North American Registry of Midwives -- their governing body) is nothing short of a joke as a whole but especially in the accountability department. Here is one (of too many) home birth loss mom's story of seeking accountability after her midwives were incredibly negligent in the care they gave (which, tragically, ended in the death of their child). What an incredibly sad and frustrating ordeal it becomes for parents who expect accountability. Even if your child requires lifelong medical care after a home birth injury (which means medical bills for the rest of his or her life), without insurance, you won't get a dime from your midwives -- no matter how lacking their care was.

Myth #6: Home birth is more affordable

If you go bare bones home birth - meaning no "extras" - with a midwife who charges a pretty low fee and you do not need a hospital transfer, then yes, it might be more affordable. But if you start adding in some of the typical "extras" recommended by home birth midwives: herbs, supplements, chiropractic care, acupuncture, doula, etc then it can add up and fast. Not to mention if you transfer! Then you pay for a home birth and a hospital birth and maybe even an ambulance, too! And because certain conditions can worsen en route to the hospital, it may be a more complicated delivery, which means higher hospital bill (such as a postpartum hemorrhage that requires a blood transfusion because of all the excess blood lost during the transfer).

Myth #7: Home birth means no interventions

Nothing shocks me anymore in the world of home birth midwifery. Interventions, especially. From home birth midwives (illegally) using vacuums for delivery and Cytotec for induction, to more "natural" interventions like castor oil or black and blue cohosh or breaking the mom's water to home birth midwives even suggesting alcohol during labor (yikes!).... truth is, interventions exist at home births, too. And they can be offered (or sometimes they'll just be done without consent) at home and at hospital. They may seem more "natural" if it's an herb in a bottle versus a hormone in an IV but interventions are interventions. If you can't ask "why is this needed" or say "I'd rather not" at a hospital, what makes you think you'll be able to do so at home with your midwife?

And because it was too hard to stop with just seven:

Myth #8: Home birth means evidence based care

From lack of monitoring during second stage (meaning anything less than checking fetal heart rate every 5 minutes while the mother is pushing) to treating GBS with garlic and/or Hibiclens to VBACs without continuous EFM to breech and twins delivered outside of a hospital, there is a long list of common home birth practices that are not supported by any evidence at all. Click here for a longer list, which still does not include everything.

So there ya go. Those are the real myths about home birth in the USA.


  1. I read the home birth myths article on Huff post and was outraged! Thank you for writing this.

  2. Very nice summary!

  3. Thanks for taking the time to present this side. I am a doula who attends hospital, home birth, and birth center births because I support my clients but I know there is too much misinformation around.

  4. Good post but you have sidestepped the issue. Doctors in the USA (And in Canada, you have far to rosy an outlook on Canadian midwives. Many places such as Manitoba have no midwifery training and no recognition and support for them) have destroyed the practice of midwifery as a profession in order to take over birth. The solution is to bring back full midwifery as a profession, with hospital privileges and proper training and accreditation. Until then the hospital may well be the best option but physician attended birth has a bad record of doing the wrong thing. Ideally we need to meld both.