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In 2009 American researchers (Wax, et al.) used meta-analysis of birth certificate data to determine the overall safety of out of hospital birth. They’re conclusions are quite incredible. Foremost was the discovery that to birth outside of the hospital was so much safer for the birthing person in terms of death, morbidity and intervention the number of time safer was actually “unquantifiable”.

However, the initial study did not remove births that had been unplanned, or that were with uncertified or untrained birth attendants. And so these data showed a much higher rate, four times, of death for the baby.

Groups like evidence-based birth and Lamaze international asked independent researchers to re-examine these data after removing births that were not planned to be out of the hospital. i.e.; Twins born early at home by accident, and did not have certified attendants caring for them. Paramedics and EMT’s receive on average less than 1 hours training on childbirth and are not required to be certified in neonatal resuscitation which is different from infant CPR.

Once independent researchers removed those births it brought the safety numbers for baby’s born at home or in free standing birth centers to the SAME as in the hospital. But let’s take a second and just break down the first statement about the safety of the birthing parent/person. Keeping in mind that still over 99% of American births take place in hospital, and that America remains around 50th on the WHO’s yearly published list of maternal mortality world wide. That means that there are 49 nations loosing fewer mothers/people giving birth than we are. Can you even name 49 other countries? I can’t off hand.

To say that it is unquantifiably safer means that the numbers of people dying in childbirth in the hospital in America are so extraordinarily high, that a person could seriously have zero care, and be delivering their baby in what would generally considered be a totally unsafe situation, say the back of a city bus, (this occasionally happens just ask bus drivers) and come away far less likely to experience any intervention, any morbidity or mortality! This was an incredible surprise to the American Congress of Obstetricians and Gynecologists (ACOG) who had previously been eagerly awaiting the results of this meta-analysis as definitive proof hospital birth was best.

Not only did this this meta-analysis prove hospital birth on the whole unsafe for healthy people, but that otherwise known dangerous situations are still safer for mother/person giving birth. That came as a shock to everyone.

So ACOG then, and still do now, put the emphasis on the other statistic that came from those data. That four times the numbers of babies die outside of the hospital. And that is true, if you’re considering all the moving bus births that happen along with planned home births attended by certified professional midwives.

However, 2/3 of the total, meaning the greatest bulk of the out of hospital births on the birth certificate data were from unplanned out of hospital births. And so that’s why birth researchers, and those professionals working in out of hospital birth who knew this  couldn’t be true for planned births with trained attendants asked independent researchers to review these data on their own, removing all births that were either unplanned, or done without a certified midwife or doctor in attendance.

Here’s how they did that, and the full scoop of what they uncovered as reproduced by Lamaze international.

I’ll have more to discuss about this revolutionary meta-analysis, and why a decade and a half later it still still not sparked a revolution. But that will be in future posts. Also, still to come will be data collected by Betty-Anne Daviss a breech birth expert and midwife from Canada who has spent two decades studying out of hospital birth across North America, and how her data suggest even higher safety rates for babies born in planned out of hospital settings with experienced and certified professional midwives. So look for those post coming soon!

Mother Earth Midwifery