Tuesday, February 19, 2013

Why is OOH Birth Risky Business?

If your midwife told you the truth about the "true emergencies" that can creep up during labor and delivery, you may think twice before you choose to pursue your dream home birth. The point of this post is not to scare you away from home birth, nor is it meant to scare you heading into labor.  The point is to be honest about what can and does come up during labor and delivery, so that women can make a fully informed choice about where to have their babies.

Safer Midwifery for Michigan is advocating for women to have a safer options in out of hospital birth, but we're honest that if this is truly a choice that a woman is to make, she deserves to be informed that OOH birth is inherently riskier than being in a hospital.  If a midwife only tells a mother how her body was made to give birth, that babies know when/how to be born, and that if she (the mother) believes/tries hard enough, things will be fine...she is very much misleading her client.  

Instead, what every midwife should be telling every mother is to appreciate the beauty of birth, but to also know it doesn't go perfectly for every mother who "opens herself up to let birth happen".  For too many of mothers, the result is devastating when they convince themselves the chances of things going wrong are slim, and it won't happen to them.  Mothers deserve to know the truth, no matter how scary it is, because that is the only way they can make an informed choice about where to have their babies.  Ignoring the risks, and pretending that birth is always natural, and peaceful, is misleading and wrong.  Filling a mother's head full of fear and lies about what awaits them if they go to a hospital, is also maliciously wrong. 

In any birth, regardless of location, "true emergencies" come up in an instant.  "True emergencies" are those that cannot always be detected ahead of time, but need immediate medical attention.  (Note: Immediate in this case does not mean an ambulance ride to a hospital that is "only" minutes away.)   

Placental Abruption
Uterine Rupture (Primary)
Uterine Rupture (HBAC ~ Story coming soon)
Uterine Rupture (VBAC @ hospital) 
Cord Prolapse
Shoulder Dystocia
Post Partum Hemorrhage
Neonatal GBS Sepsis
Vasa Previa 
Amniotic Embolism

I think the lacking transparency in what can go wrong, is largely why so many loss moms feel as though they have been duped, swindled, fooled, or manipulated.  They are only told how great home birth can be, convinced that it is superior because they are "educating" themselves, and told that it is safe.  They were not told about "true emergencies" that can come up, or how their lack of immediate care will impact the outcome, likely because the midwife doing the "informing" didn't want to scare her client.  The problem lies though, in the fact that a woman cannot possibly make a "choice" to have a home birth, if she does not have all the information she needs to actually make a choice.  The illusion that home birth is somehow safer than anything else, regardless of risk factors, is being perpetuated to the most vulnerable... pregnant mothers who only want what is best for their babies.   

"But wait a minute, OBs don't tell their patients about everything that can go wrong!"  True, often they don't.  The difference though, is that an OB is medically and surgically trained, working in a facility equipped to handle those true emergencies at a moment's notice.  A home birth midwife is not, yet she is knowingly advertising her services as safe without discucssing accurately those added risks a mother is choosing when she decides to have her baby outside a hospital.  It seems to me that midwives have even more of an obligation to be forth coming about increased risks and limitations for addressing emergencies, if they are supporting women in out of hospital birth.  

Usually a midwife's informed consent reads VERY general, and that's intentional.  It's a blanket "You agree that by having a home birth you are assuming any & all responsibility for the outcome of your birth".  They make you sign that it's on you no matter what.  Then  they don't HAVE to tell you what you don't know, because, "Mama...you should have done your research".

I trusted birth.  I believed my body and my baby could do it.  I trusted my midwives, and did every bit of homework I could to choose the "right" midwives.  Believing it was safe, we chose to have our baby at a freestanding birth center.  My baby died.  So how does anyone look me in the face and tell me that "birth works"?  The truth is we cannot "trust" birth, because it doesn't always magically work.  Maybe if midwives told their clients that usually birth works, but sometimes babies die in the end, and we have limited options for how we can help you when an emergency arises, it would be a more accurate statement.  It's more about respecting birth, appreciating/assessing risks along the way, and fully understanding that emergencies can and do come up.  Where you are birthing your baby matters in an instant, often in a way that cannot be detected ahead of time, and cannot be handled with any kind of fighting chance if you happen to be without immediate medical care.

If you're considering an OOH birth, you have every right to do so.  We hope this post has at least helped you better understand that there are risks involved in that choice, and those risks are magnified by the environment in which you choose to birth.  No, birth doesn't always end well, no matter where you have your baby, but there are many life saving measures that can and do happen at the hospital, that cannot be done at home no matter how wonderful your midwife might be.  It's the preventable deaths and injuries that don't get prevented that make home birth especially risky business. 

Please also consider the following links: 
Questions to ask your midwife
The Complicated Task of Choosing a Safe Midwife
Checks and Balances
The Delicate Risk Between Assessment & Safety
Routine Care During Pregnancy
The Importance of Defining Risk 
Is Your Midwife Insured?


  1. Here is a happier emergency birth story... I mean, it's obviously still not ideal but has a happy ending: a placental abruption (and sounds like cord prolapse, too) but the mother was in the hospital and she and her baby are very much healthy and alive thanks to quick action from the hospital staff:


  2. May I add fetal distress and post-date still births to the list?

    This is incredibly sad... a postdate baby born still:

    As for fetal distress, some times it just happens for no known reason. I was a part of an emergency home birth transfer due to fetal distress. Reasons unknown why the baby stopped tolerating labor. It just happened.

    1. Doula Dani,
      I should have noted that this is by no means an exhaustive list. Thank you for contributing. I know way too many post dates babies that did not survive for a variety of reasons. And yes, fetal distress can happen at any time for unknown reasons, and without proper monitoring, can lead to disaster. I appreciate your links and thoughtful contributions.

    2. "I know way too many post dates babies that did not survive for a variety of reasons."

      And I never would have guessed that, not even now. Just hearing one story was too much for me, it is just horrible that there are many more. So sad. :(

      I love this blog, keep up the good work.

    3. Thanks Doula Dani. The feeling is mutual:)

  3. Thanks for your question! We forget that not everyone is immersed in midwifery language. OOH means "out-of-hospital" - it's a term to cover home births and births that occur in freestanding birth centers.