Miriam Perez, whom I adore, wrote a piece July 17, 2012 entitled “Is it Safe? Asking the Wrong Question in the Home Birth Debate” wherein her contention isn’t that home birth is the issue, but that babies die in the hospital and that is where our focus should be. It’s surprising that Miriam would use the fetal death rate when, in fact, it’s the perinatal death rate that should be being looked at. The fetal death rate measures deaths starting at 20 weeks of gestation and ends at birth, with a stillbirth, whereas the perinatal death rate begins at 20 weeks and ends one to four weeks (depending on source) postpartum. Looking at this, you can see why, without batting an eye, why hospital births have many more deaths than at home; they include deaths before 37 weeks, which is when a midwife would typically begin attending the births. Let’s look at births in the hospital of normal, full-term babies and compare those to home births and see, use the ratio keeping them even and see who has the lower death rate. It’s unlikely anyone will be able to do this, but this would be the way to measure whose perinatal death rate is larger.
Miriam talks about the cesarean crisis and I agree the rate of cesarean sections is far too high, but she quotes the World Health Organization’s recommended rate of 15%, but neglects to mention WHO dropped that statement in June 2010, that statement saying there was no exact number that dictates what the percentage of cesareans should be.
Where we agree is that hospital standards need examining and revising, birth in the hospital should be civil and respectful (which, by the way, I see happening more and more as the years go by) and that those that make mistakes need to be held accountable. She mentions that deaths and accidents are hidden from view in the hospital, but that isn’t my experience. Families readily sue OBs and nurses, whereas that possibility isn’t available to those birthing at home. The most a mourning home birth family can do is go to the press and express themselves there. I believe that’s why it seems we hear more about home birth deaths than hospital ones.
Looking at the way hospitals operate is important, but for those of us who are immersed in the natural, home birth communities, it is those births that deserve our attention right now. Let’s get the non-nurse midwives more education and skills training as well as reign in the risks they/we take and lower our own perinatal death and complication rates. Then we can more evenly review what happens in the hospital and perhaps get that required-for-safety collaboration with the medical system.
I, for one, want it all.