The fact is that deaths happen at home and in the hospital, and it is naive to assume that all deaths that happen at home could have been prevented in hospital, and that all deaths that happen in hospital were unpreventable. I know that story you linked to. I also know of another story at MDC that was a hospital death, likely due to routine management of labor. I have lost count of the stories of women and babies who have been hurt and damaged by the medical establishment’s abominable lack of scientific understanding of physiological birth and what facilitates and interferes with its normality. By your process of reasoning (i.e., if a harm is known to have occurred in a certain setting, that setting is inherently unsafe for all women) then I guess I could conclude that no women should ever give birth in a hospital. I don’t conclude that, though, because I understand the flaw in that reasoning, namely that different women have different needs that are best served under different conditions. Even so, there are still no guarantees, no matter what choice one makes.

In terms of numbers, ACOG is being intellectually dishonest. Matched-population studies show that mortality rates between midwife-attended homebirth and hospital birth are pretty much the same, and that complication rates in homebirth are significantly lower. Further, the one study that has showed a difference in mortality rate was not a matched-population study and had other serious flaws, as the study authors were candid about. It does not inspire trust that ACOG would laud such a study over the many that show homebirth to be a reasonable and even ideal choice for most women. The only way it could possibly make sense would be for there to be some conflict of interest, i.e., the good doctors’ need to protect their standard of living.

Regarding unattended homebirth, the same arguments hold. There are benefits and risks to all choices, and the balance of these are going to be different in each situation. There is NO type of choice in which the risks always outweigh the benefits, and no type of choice in which the benefits always outweigh the risks. There are always going to be stories in which a mother would have been better off with an attendant, and stories in which a mother would have been better off without an attendant. The logically most reasonable choice is never going to be obtained by applying generalizations to individuals.

Thank you for the reminder to open our minds. Perhaps you should do the same!

Thank you for the reference to Home Birth Talk, Grabapple! :)

The point is, I don’t know what happened, and neither do you. And studies–good studies–show that overall risk rates for healthy moms attended by midwives are just as good at home as at the hospital.

There are no guarantees; we all gamble every time we give birth. The answer is not being imprisoned in a hospital, but more resources focused on diagnosing and preventing bad outcomes, instead of just relying on a c/section crutch–which doesn’t always work, by the way.