Statistically homebirth is a safe birthing option for many women.
To begin with, NO BIRTH, regardless of location chosen (home, birth center, or hospital) or caregiver chosen (midwife, Certified Professional Midwife (CPM), Certified Nurse Midwife (CNM), or physician) IS TOTALLY RISK FREE. Each birthing option has benefits and risks. The good news is that the risk is LOW.
Your question should be, "Which birthing option is safest for me?"
Family, friends, neighbors, co-workers, or physicians may say, "Hospital birth is safest." Or you may hear, "What if something goes wrong? You need to be in a hospital." Or you may hear, "Home birth isn't safe." For most women, in most situations, these statements are incorrect.
Midwifery has been legal in Texas since the days when Texas was a Republic. The Texas Department of Health has been maintaining birth statistics for years. These statistics show that home birth in Texas has been statistically safer than hospital birth by a factor of 3 to 6. That is, home birth has, at various times during the period of modern recordkeeping, been 300-600% safer that physician-attended hospital birth in Texas.
Statistics from a six-year (1983-1989) TDH study are (1) :
Doctors' infant mortality rate = 5.7/1000 live births.
Midwives' infant mortality rate = 1.9/1000 live births.
CNMs' infant mortality rate = 1.0/1000 live births.
Other attendants= infant mortality rate = 10.2/1000 live births.
Note that the infant mortality rate for physicians (5.7) is three times higher than the rate for midwives (1.9), i.e., the infant mortality rate for physician-attended, hospital birth is 300% of the rate for midwife-attended home birth.
Note, also, that both rates are relatively low.
Do these statistics mean that childbirth is unsafe? No.
Are there reasons for the difference in the mortality rates? Yes. However, rather than get in to a long discussion of why the rates are different, I simply point out that if you are accepted by a midwife as a candidate for home birth, statistically you are choosing the safer birthing option.
Here are more recent data:
This is the last year for which we currently have breakdown by physician, CNM and Midwife).
Total births in Texas in 1994 = 325,521
Total physician-attended births in 1994 = 310,479 (95.38%)
Total CNM-attended births in 1994 = 8,387 (2.58%)
Total Midwife-attended births in 1994 = 5,318 (1.63%)
Definition: Infant mortality rate - Deaths of individuals less than 1 year of age per 1,000 live births.
Definition: Neonatal mortality rate - Number of individuals dying at less than 28 days of age per 1000 live births.
Physician infant mortality rate = 6.73 (2,091/310.497)
CNM infant mortality rate = 4.65 (39/8.387)
Midwife infant mortality rate = 1.69 (9/5.318) (lower is better)
Physician neonatal mortality rate = 3.95 (1,226/310.479)
CNM neonatal mortality rate = 1.43 (12/8.387)
Midwife neonatal mortality rate = 0.940 (5/5.318) (lower is better)
Ratio of physician infant mortality rate/Midwife infant mortality rate = 3.98
Ratio of physician infant mortality rate/CNM infant mortality rate = 1.44
Ratio of CNM infant mortality rate/Midwife infant mortality rate = 2.75
Ratio of physician neonatal mortality rate/Midwife neonatal mortality rate = 4.20
Ratio of physician neonatal mortality rate/CNM neonatal mortality rate = 2.76
Ratio of CNM neonatal mortality rate/Midwife neonatal mortality rate = 1.52
Ratio of physician infant deaths/Midwife infant deaths = 232 (2,091/9)
Ratio of physician infant deaths/CNM infant deaths = 53.6 (2,091/39)
Ratio of CNM infant deaths/Midwife infant deaths = 4.33 (39/9)
Ratio of physician neonatal deaths/Midwife neonatal deaths = 245 (1,226/5)
Ratio of physician neonatal deaths/CNM neonatal deaths = 102 (1,226/12)
Ratio of CNM neonatal deaths/Midwife neonatal deaths = 2.4 (12/5)
Note that the statistics for 1994 are even more favorable toward Midwives, relative to physicians and Certified Nurse Midwives than were the statistics from the six-year study.
Also, note that almost all physician-attended births occur in hospitals.
Again, this simple listing of statistical data does not attempt to discuss reasons for the differences in statistical outcome. The point to be emphasized is that home birth or Midwifery birth center birth should NOT be considered an UNSAFE birthing option, as it often is. Statistically it is the safest option for mothers who are having a normal, uncomplicated pregnancy (i.e., the majority of pregnant women).
Even if complications arise during pregnancy, if the complication(s) can be corrected (normally with medical assistance), home birth or birth center birth may proceed as originally planned.
References:
(1) Texas Lay Midwifery Program, Six Year Report, 1983-1989, Bernstein and Bryant, Appendix VIIIf, Texas Department of Health, 1100 West 49th St., Austin, TX 78756-3199.
(2) Bureau of Vital Statistics, Texas Department of Health, 1100 West 49th St., Austin, TX 78756-3199.