Hi, it’s Josh.. some of you old timers may remember me as the guy who used to write the newsletters and most of blog posts around here.
You may have noticed that it was about a year ago (exactly), that I stopped.
The reason was that my wife and I had our first child, a baby boy we named Wren on that day. March 9th, 2010. He was 3 weeks early, 7 pounds, 20.5 inches, and delivered at 12:12pm. It was honestly the best day of my life. It was also the worst.
About 11 hours after his birth, Wren stopped breathing. We were at home by ourselves in Santa Monica (we’d had a home birth, and the midwives had left about 3 hours after the birth), so we called 911. They arrived within three minutes and rushed him off to the hospital just one mile from our house, but after about three hours of nothing working they had to pull the plug.
I won’t get into all the details here. You can see everything over at wrenjones.com or Group B Strep International or Hurt By Homebirth. Since then, it’s been a pretty shitty year for me and my wife, and our families and friends. There’s been a lot of crying. A lot of looking for answers. A lot of trying again (no luck so far).
When we got the autopsy back and found out for sure that Wren had died of a Group B Strep infection, it seemed like none of our friends or family members knew anything about it. I was like “people need to know about this!” But after doing a little bit of research I realized that although most parents and lay people have never heard of GBS, everybody in the medical world already have… and it’s basically been solved. Since the 90s there’s been a straightforward protocol on how to prevent GBS, that is over 99.8% effective.
Which left me floundering. What happened? Why us? Were we really just that unlucky?
Finally, it dawned on me that the GBS infection was really just the symptom of the deeper “disease.” The home birth itself.
When we had decided to do a home birth, I was skeptical at first. It just intuitively seemed like a risky proposition.
But… after visiting a couple different home birth providers around LA, as well as our HMO-provided OBs, I developed an analogy I could accept. “Home births are to hospital births what Whole Foods is to Safeway.” (A rich people place that probably isn’t actually any better, but at least isn’t any worse.)
I’d long ago given in to shopping at Whole Foods even though I gag at the site of Nature’s Path Organic Love Crunch.
This epiphany struck me when I saw that home births were actually more expensive than hospital births… ours was $5,200 (and they don’t take insurance), compared to basically free with our HMO. The home birth specialists stated that as long as these three key components held true, home births were actually safer than hospitals:
1. You’re low risk. No complications of any kind; no medical conditions, no twins, no premature labor, no breech, no nada.
2. You have highly trained professional midwives assisting you.
3. You have pre-arranged a backup hospital that is very close by, just in case.
I didn’t buy that it was safeR, but it did seem somewhat reasonable that if you carefully followed these rules it could be as safe. And if the experience was nicer than the HMO (and the checkups definitely were), the $5,200 seemed worth it.
I now know the flaws in each of those three components:
1. You’re low risk.
Even if you’re low risk, that doesn’t mean you’re no risk.
The math basically works out like this.. let’s say a “high risk” person has an 80 in 10,000 chance of a life-threatening emergency during childbirth and a “low risk” person has an 8 in 10,000 chance. Let’s say the survival rate of such emergencies is 25% at home and 50% in a hospital.
If that’s the case, when you’re “high risk,” you’d be adding a 20 in 10,000 chance that your baby will die. And when you’re “low risk” you’d be adding a 2 in 10,000 chance! It’s better than if you’d been “high risk”, but why add any extra chance your baby will die?
Secondly, what is “low risk”? Early on, our OBs detected GBS in my wife’s urine. They dealt with it fine (although they could have told us about the higher risk of infecting your child during birth when you’re heavily colonized!).
To them, we were still low risk because GBS is so easy to treat… the mother just gets an antibiotic IV when she goes into labor… except they forgot we were planning a home birth. For our midwives we were also considered “low risk” … mostly because they held a certain complacency about GBS, I guess because they had never experienced it personally.
You never really know if you’re low risk (especially with your first pregnancy!) until after the fact, plus when you’ve decided to go the home birth route, there all of the sudden becomes this (typically) unspoken pressure to go through with it, even if “high risk” warning signs start to appear, because to deliver at the hospital would be some kind of a failure.
2. You have highly trained professional midwives assisting you.
In the U.S., there are basically two types of certified midwives: CPMs and CNMs. What you want is a CNM: Certified Nurse Midwife.
Everything else (CPM, LM, MPH, LLC, direct-entry, state licensed, etc..) is a Professional Midwife. The differences between the two are quite large.
A Nurse Midwife is required to graduate from nursing school, and works in the health care system with real medical doctors.
A Professional Midwife needs only a high school degree and to get certified by a midwifery association.
To go back to my analogy theme, a CPM is to a CNM as a real estate agent is to a district attorney.
It is currently illegal in 23 states for CPMs to deliver babies. Unfortunately it is legal in California.
In fact, there are some studies that show that births attended by CNMs have survival rates even slightly higher than those attended by MDs. However, almost no CNMs will do a home birth… they all deliver in hospitals.
I can only assume something they learned in medical school scared them.
3. You have a hospital very close by.
That almost all Certified Nurse Midwives will only deliver in a hospital says a lot.
Being close to a hospital is not the same as being in a hospital. Believe it or not, babies can die very suddenly during labor, delivery, or even the first few days afterwards. You’re never completely in the clear of course, but the most likely day for any human to die is the day they’re born.
Our story alone should prove that being close (we live literally one mile from the new UCLA medical center NICU, one of the best in the world) is not always good enough.
Clearly, being close to a hospital is better than being far from a hospital.
So it seems pretty logical that being in a hospital is even better than being close.
And again, why add any extra chance that your baby would die?
The Sad Thing
There seems to be a teensy bit of the beginning of a trend towards home births right now, maybe it goes with the green/local/organic/global warming craze. It may seem harmless, but the problem with the whole culture of home birth though is its intense focus on the process of childbirth rather than the result.
I wish I could somehow get everybody laser focused on the most important, nay, the only important thing in childbirth. Getting a healthy baby out of a healthy mommy. I wish I could impart this to people without them having to go through what we’ve been through.
I know it’s near impossible to change somebody’s mind once it’s been made up. I also know that the vast majority of home births are always going to go fine; the numbers we’re talking about are all pretty “small”.
The sad thing is, many people will still choose to have a home birth with a CPM even if they know that they are adding a 1 in 1000 chance that their baby will die.
(That’s the actual odds! For comparison, there are an estimated 85.5 million drunken drives a month and about 11,000 fatalities a year in the U.S. That implies that in America having a home birth with a CPM is 93 times more dangerous than driving drunk.)
I’m okay with that. I just want people to make their decision educated with the best possible information.
(Personally, my advice would be to not.)
If you’re considering having a home birth, please… you owe it to yourself, your spouse, your friends, your family, and your unborn child to consider the “unthinkable.”
Before you decide, try checking out The Skeptical OB blog by Dr. Amy Tuteur. She’s been doing this way longer than me and is much more qualified than I am to talk about this stuff.
And if you do still decide to have a home birth, please, find a CNM! (And if you’re GBS positive, get the antibiotic IV for crying out loud!)
Finally, have you ever heard (or can you even imagine hearing) somebody say, “If only I’d had a home birth, my baby would be alive.”?
Because if only I hadn’t.