On my post about reasons for homebirth, Jamie posted two links to studies (Canada; the Netherlands) about homebirth safety, and I commented that I suspected studies of homebirth safety in, say, the Netherlands don't translate very well to the realities of homebirth in the U.S. (even though I feel very safe birthing at home here, in my current circumstances).
A reader emails:
About the dutch study…I don't think that you can quite compare the safety of a home birth in the Netherlands to a home birth in the States.
I'm an American living in the Netherlands, and I've given birth 4 times over here, twice at home (#1 and #4…#2 was born at a birthing center because the midwife and back-up were busy with another delivery, and #3 was born in the hospital because I was over-due, very uncomfortable, and impatient). The support for home births is amazing, and the health care is excellent, yet natural. They don't run unnecessary tests, just a standard blood test to check the rh factor and iron level, a 12 week ultrasound, and an optional 20 week ultrasound. (I was pregnant for the first 6 months of one of my pregnancies while we were in Maryland, and the standard exams and screenings were much more elaborate and unpleasant.)
I felt very safe laboring at home here in Holland, knowing that if needed, an ambulance can be at the door within 10 minutes. The midwives are trained well, and they have contact with the mother's doctor and with the hospitals in the area. (When one of my children had breathing trouble just after he was born, there was quick communication between midwife and our doctor, and he rushed right to our house.) Everything is covered by insurance, and a nurse stays with the mother and baby for a week, 8 hours per day, keeping a close eye on mother (making sure that she has no infections or too much blood loss, and checking baby's weight and temperature daily and encouraging the breastfeeding relationship, if desired). The nurse also does the cooking, laundry, light cleaning, and watches older children while mother and baby rest.
If I were to give birth in the States, I think I would opt for a birthing center. I really love home birthing, but I'm not sure I would feel as safe birthing at home in the States.
Interesting! The two systems are not, it seems, very similar.
I would think that communication between midwife and doctor, and the establishment of a norm where a doctor can come to your midwife-attended homebirth if necessary, makes a pretty big difference. Because I live in an urban area, I also have the assurance that an ambulance can be called to arrive within ten minutes, but I'm not guaranteed that the EMTs or doctors who would treat us would be cooperative with the midwife. Insurance coverage of homebirth midwifery is spotty — we will be able to pay our midwife out of a tax-free flexible spending account which is part of our healthcare benefits package, but it is excluded from our insurance coverage otherwise.
That visiting nurse thing sounds, um, incredibly expensive. Perhaps if we stopped wasting money on unnecessary cesarean sections we could afford that sort of thing over here… Although it's hard to imagine American professional nurses ever taking on babysitting and cleaning as part of their duties. It's not generally considered part of the job description. (As for me, I don't think I'd want a non-family caregiver of any kind in my house for that long, unless I was suffering from excess blood loss or something. I prefer to be back on my feet pretty quickly…)
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