It is interesting to see how different media outlets and different stakeholders are trying to spin the results of the Birthplace Study. Is the glass half full or half empty? Did the study show that homebirth increases the risk of perinatal death and brain damage or did it show that homebirth is safe for rigorously screened women who have had uncomplicated births in the past?
I reviewed the findings of the study this morning (It's official: homebirth increases the risk of death), but there's more to the study than just the numbers. It is valuable to look at the bedrock principles that the researchers used, because there is not much doubt about those.
Specifically, the investigators rejected the bulk of midwifery theory. The underlying assumption of the study is that birth is inherently dangerous, that there are a myriad possible complications with serious consequences and that carefully culling out anyone with even minor risk factors is critical to good outcomes at homebirth.
The real message of the Birthplace Study is this: don't trust birth.
Moreover, the various homebirth midwifery aphorisms that flow from trusting birth are treated as the nonsense they are:
Breech is a variation of normal? Nonsense.
VBACs are safe at home? Nonsense.
Twins are safe at home? Nonsense.
Elevated blood pressure not a cause for concern? Nonsense.
Gestational diabetes not a cause for concern? Nonsense.
Preterm deliveries before 37 weeks safe at home? Nonsense.
History of previous shoulder dystocia safe at home? Nonsense.
Low or high amniotic fluid safe at home? Nonsense.
The investigators have no use for other midwifery theories, either.
Trust your intuition? Nonsense.
Babies know how to be born? Nonsense.
You won't grow a baby too big to birth? Nonsense.
And my personal favorite, including the nonrational is sensible midwifery? Complete and utter nonsense.
The Birthplace Study is predicated upon the fact that complications in birth are common and that various risk factors increase the risk of complications to the point where it is unsafe to give birth at home. Therefore, the only way to assure that there are a minimal number of preventable neonatal deaths is to exclude anyone that had a problem in the past as well as anyone with the merest hint that a problem might develop.
To the extent that the Birthplace Study identifies a subgroup in which homebirth may be as safe as hospital birth, that subgroup is "women who can be relied upon not to experience any complication of any kind." In other words, homebirth is safe if nothing goes wrong. If there is any chance of anything going wrong, homebirth is not safe.
What does this mean for American homebirth midwifery (CPMs, certified professional midwives)? It basically blasts it out of the water.
Given what the Birthplace Study shows, we can conclude that the underlying philosophy of American homebirth midwifery is garbage, the principles that flow from that philosophy are nonsense, the rejection of risk factors is deadly, and the education and training of CPMs is completely inadequate.
Homebirth in the UK for women who have had a previous completely uncomplicated pregnancy, whose current pregnancy has no risk factors of any kind, and who are being cared for by highly educated and highly trained midwives may be safe, so long as those midwives adhere to the very strict criteria in the study. Homebirth in the UK for women who have never had a baby but whose current pregnancy has no risk factors of any kind and who are being cared for by highly educated and highly trained midwives increases the risk of perinatal death and brain damage. Everyone else isn't even a candidate for homebirth.
In other words, this study is a huge blow to Ina May Gaskin and her followers. This study does NOT support the safety of homebirth with an American homebirth midwife (CPM). In fact, it indicates that homebirth with an American homebirth midwife (CPM) cannot possibly be safe.
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