"Mindy Bizzell decided to have her second son at home partly because of money and partly because of faith...."
This is the start of all home birth horror stories: pseudo-hippy or upper-class white mom-to-be wants to have an orgasmic birth experience and maybe save a little cash in the process. She labors with a midwife and a doula and patchouli candles aglow. Something goes horribly wrong. She regrets her selfish choice. The end.
This is also the start to Michelle Goldberg's Daily Beast/Newsweek story, Home Birth: Increasingly Popular, But Dangerous and it's just the latest salvo in the war between home birth advocates and critics.
In the last two years, there have been over 270,000 stories in English-language publications on home birth - some positive, some negative, but almost all falling into the same basic pattern of a religious conversion tale. Critics highlight the stories where women sin by choosing homebirth and are punished with a painful, scary or even deadly experience; advocates highlight the come-to-Gaia stories where women embrace their physical and spiritual power.
Neither side can cleanly "win" the argument, because it can't really be studied in a rigorously scientific way. The available statistics can be read to support either position.
Even if there was a clear scientific consensus the battle would continue, because it transcends science or health or safety. Instead, it's become a war over our perception of pregnant women and the nature of pregnancy. Is it a potentially deadly medical condition requiring massive intervention to produce a "good outcome" or is it a beautiful, natural moment of bonding between human souls? How you answer that question says as much about how you view the world as how you view childbirth.
What are we missing when we obsess on this philosophical question? Perspective, for starters.
In her story, Michelle Goldberg cites CDC statistics of 29,650 home births reported in 2009 and notes that this was an an increase of 29% from 2004 figures. What she does not mention that that even with that growth, home births still make up just 0.72% of of the whole. While figures have fluctuated over the years, it's accurate to say that around 99% of all American births each year since 1969 have taken place in a hospital.
A blistering 2010 Amnesty International report illustrated dozens of ways American women are being denied quality prenatal, birthing and postpartum care. The short version: we're behind just about every industrialized nation on the planet. The longer version: if you are poor, if you are black, if you are Native American, if you are Hispanic, if you are on public assistance, if you live in a rural area, if you don't speak English, your chances of walking away from a pregnancy, much less walking away with a healthy baby go down. . .and go down dramatically.
Here are some more CDC statistics to ponder: pregnancy-related maternal deaths in the United States bottomed out at 7.2 per 100,000 live births in 1987 and by 2003 more than doubled to 16.8 per 100,000. In 2010, the mortality rate for white women was 9.5 per 100,000; for African-American women, it was 32.7 per 100,000. (All these figures may be much higher. Reporting requirements vary from state to state, and most only look at maternal deaths that occur within around 40 days of birth.)
American women are not dying of strange and exotic afflictions. The Amnesty International report found that 75% of reported maternal deaths were attributed to embolism, hemorrhage, pre-eclampsia and eclampsia, infection, and cardiomyopathy. These are the same things that have been killing women since the dawn of humanity. They aren't always survivable, but survivability would increase if more women were educated on the warning signs of common postpartum killers.
Part of the problem is a shortfall in medical professionals who can impart information. High malpractice insurance rates and low government reimbursement rates are driving health care providers away from those that need them most, or even out of the field. A 2009 American College of Obstetricians and Gynecologists study found that 21% of their membership reported reducing the number of high-risk patients they would accept, 10% reported reducing the number of births that they attend, and 6.5% had stopped practicing obstetrics altogether. Understaffing of both doctors and nurses, particularly in lower-income areas, is a serious and growing problem, and we have the lowest number of midwives in the industrialized world.
Then there is the ubiquity of the Cesarean section in U.S. hospitals. The World Health Organization argues the C-section rate should be, at most, 15% in any given country. Last year, the United States rate topped 33% of all births are by Cesarean, with rates of almost 40% in Louisiana, New York and New Jersey. (In 1965, by comparison, it was 4.5%) It's the most common major surgery performed in the United States today, and it is major surgery. . .with all the risks that a go along with it.
A C-section will, in most cases, result in a live baby, but we're hardly setting world records in infant mortality, either. A 2007 CDC survey found a infant mortality rate - defined as death before the first birthday - at 6.75 per 1,000 live births overall. Again, where you are who you are make a huge difference. In Utah, the infant mortality rate was 4.5 per 1,000 in 2008. In Mississippi, it was 11.4 per 1,000.
Every single one of these issues affects some four million American women, and their babies, each and every year. Is this in the headlines each and every day? Nope. Hospitals are the safest place to have a baby and all American receive equal care. We love babies. (They are people, after all, from the moment of conception.) No need to discuss those that get culled from the herd. Call it God's will, call it poor lifestyle choices. Just don't call it malpractice, because that just raises our insurance rates.
It's much easier to focus about the 30,000 or so women who opt out of the system and the handful of them who lose their babies, or their lives, as a result of that choice. After all, they got what they deserved.
But the question is still there, even if we don't want to ask it: what do the rest of us deserve?