or pain relief, or other non-emergency situations. There were no maternal deaths. The initial report was that the perinatal death rate (babies dying in late pregnancy and up to a month after birth) was comparable to that of the hospital, but some suggest that this is where the numbers get murky. There is currently debate over whether home birth does result in a slightly higher rate of death among newborns. The Johnson and Daviss study showed a perinatal death rate of .17% for low risk women, but you will need to read the studies and arguments from both sides in order to decide what you believe is a good risk to take. Giving birth in the hospital increases your chance of having an unnecessary induction (2.1% vs. 21%), episiotomy (2.1% vs. 33%), cesarean section (3.7% vs. 19% in the above study), and a more painful and longer labor. On the other hand, being at home will put more distance between you and the operating room, should there be a true emergency.
ANd what are the possible emergencies? The most common complication of birth is fetal distress, which happens when the baby responds negatively to labor and the heart rate drops and meconium may be passed. If the baby does not respond to treatment at home (maternal position change, hydration, or oxygen by mask) transfer will be necessary. In the Johnson and Daviss study, .9% of mothers were transferred for fetal distress, .6% were considered “urgent”. If fetal distress is not recognized quickly enough, or you are too far from the hospital, brain damage or death of your baby could occur.
The second most common complication of birth is maternal hemorrhage. Excessive bleeding after birth is actually more likely to happen in the shospital due to induction of labor, forced pushing, and other reasons, but occurs in approximately .2-1% of births. Midwives usually carry pitocin, the first line of defense in the hospital, as well as herbal remedies for bleeding, but blood products are not available at home, and if this happens to you, the bleeding does not stop, and you are unable to get to the hospital quickly enough, it could mean long term health problems or even death.
The third most common complication of birth is when the baby does not breath after birth (often preceeded by fetal distress). It is not unusual for a baby born at home to begin breathing gradually, or not cry immediately, because midwives do not cut the umbilical cord as soon as the baby is born to ensure the baby receives a much oxygen as possible. However, in the Johnson and Daviss study, about 2.1% of babies needed supplemental oxygen or (less frequently) resuscitation in order to begin breathing. Only .6% of the babies needed to be transferred after birth for respitory complications. Most of the time babies will respond quickly to midwifery treatment, but rarely, treatment is needed that a midwife cannot offer, and brain damage or death is possible.
Other possible, rare, complications from birth at home, and reasons for transfer to the hospital, include but are not limited to: placental abruption, where the placenta separates from the uterine wall; chorionamnionitis, an infection caused by your water being broken too long; uncontrolled hypertension or preeclampsia; and retained placenta, where the placenta does not come out after birth on its own.
Midwives are trained to recognize symptoms of complications before they become emergencies, and if a complication occurs during your preganncy or birth, you are likely to be transferred to the hospital before injury or death is a possibility for you or your baby, but it is important that you speak to your midwife about her experience with complications and their outcomes, the equipment she has available and her experience in using them, and that you also speak up if you have any concerns about symptoms you are having. Make sure she is certified in CPR for adults and newborns, and in neonatal resuscitation or neonatal advanced life support.
Varney’s Midwifery, Fourth Edition, a major textbook for CPMs and CNMS, recommends adherence to the following four principles 