Aw, man, you totally glossed over the Dutch system! We have so many home births, yet a very low rate of infant death compared to both the UK and US and no difference in infant mortality or morbidity between home and hospital births.

In Africa do they tell med students "When you hear hoofbeats, think zebras, not horses"?

Thanks for covering this. I know women who had children at home who should have gone to the hospital and friends who went to the hospital and had unnecessary c-sections with induced labor. Of course, I know good stories of both home births and hospital births. I personally wanted to have my deliveries in a birthing center, but my state made the centers illegal as well as midwives not allowed to have certification. I personally had my first son induced without consent and the procedures in hospitals are very uncomfortable. You're not allowed to walk around during pregnancy, you must lay in the bed, you're not allowed to drink, and I cannot count how many times I told nurses not to give me certain medications when they were not needed. Having a natural birth becomes very difficult in a hospital and I feel that's what many women want. I wanted to give birth naturally without any medications, but at a hospital, it becomes nearly impossible from my experiences. That needs to change.

The huge gap in this video involved the choice of attendants for these homebirths. Huge difference in training and education for certified nurse midwife than the uneducated, untrained 'midwives' out there. Depending on the State you live in , the quality of care and number of deaths is massive. Without this discussion, this video can easily misinform.

I wanted hospital, my wife wanted home birth. We compromised on a birth hotel. Best choice ever. She had a problematic moment and the fact that she was 5 minutes from the OP made me able to not freak out at that moment.

Birthing centers are a happy medium. The one my wife went to was less than 5 minutes from a hospital. If the mother was at risk or had any complications help was REALLY close.

thank you for being so candid about your biasses. We chose to have both of our children at home partly because of the prevalence of unnecessary procedures in hospital births. The births went well, but we were prepared for transfer to the nearest hospital if it was needed. I should also say that the home births were also significantly cheaper than the equivalent hospital births would have been. That's not why we did it that way, but it could be a factor.

Hey I got something that polarizes people more than home births: CIRCUMCISION! *ducks*

Do any of these studies mention who the birth was attended by, if anyone? Unattended births vs lay midwife vs certified midwife could make a huge difference.

Both my children were born at home. Including my daughter being born BREECH at home. No problems at all.

Birth centers are the best of both worlds, it's like being at home but you have nurses to keep everything safe. plus they are right next to hospitals so if something does happen your right there.

If we consider in-hospital birth as a "treatment", then the number needed to treat (NNT) to prevent a death for that particular intervention is 500 (as per the study cited in your video and column). The NNT to prevent a death by using toddler car seats? A back of the envelop calculation puts it somewhere around 100,000 (within an order of magnitude). Yet somehow, deciding against an in-hospital birth is a totally acceptable choice, while deciding against using a car seat for your kid is both illegal and will generate endless scorn from every other parent you know. I'm not arguing in favor of one or the other position, but rather pointing out the inconsistency.

I can certainly understand why a mother might want to give birth at home. Birth can be an incredibly scary and traumatic experience- not having any control whatsoever over what's about to happen, and that even with the perfect pregnancy and delivery things can still go catastrophically wrong in the aftermath is terrifying. After all that, being in a familiar environment and surrounded by people who care about you, can be an incredible source of comfort, especially (I imagine) for mothers who have anxiety about giving birth or who have experienced sexual trauma or birth trauma in the past.

I was delivered in a home birth in Canada, when it was still technically illegal, my mum had had 6 kids before me, and her labour times were shorter and shorter with each delivery, I was under 3 hours. My mum would not have been able to get everything together to deliver me in a hospital, in fact two midwives were planned to attend but only one made it, because I was so fast. The options for my mum really weren't home or hospital, they were home or car. And in that choice, home is always better. I intend to have hospital births first, like my mum did with my brothers, and then if I have complication free births and short labour times I will most likely follow my mum's same pattern. The difference is our GP wasn't allowed to attend the birth because planned home births were illegal, but nowadays, you can have more support from the system allowing in more safety for all.

I just want to make a small point about the NICE guidelines because there's a lot of internal politics involved which might not be particularly obvious to people living outside the UK. Here, the National Health Service (NHS) has always been under pressure to lower its costs because it is an expensive and inefficient (but much-needed) service. This pressure has increased since 2010, and even more so since 2015. NHS hospitals are more and more being persuaded to become trusts, which means that the government gives them a set amount of money and the trusts are given autonomy in how to spend this money, as opposed to the Department of Health making this decision. While this sounds like a good idea in principle, and to some extent I'm sure it is, it is also a way for politicians to avoid responsibility for any negative outcomes in hospitals: if something goes wrong, they can always say that the trust should've managed its resources better instead of admitting that perhaps the government's policies and/or insufficient funding are at fault. Apologies for the long-winded response. All this to say that the NICE guidelines should be taken with a grain of salt: it is possible that part of the motivation behind their recommendation of home births is that it will save the NHS some money*. *While NICE is technically an NGO, it still is influenced to some extent by the desires and biases of the Department of Health.

The UK guidelines are pretty widely supported by the general public. First time mothers generally plan to have a hospital birth so that doctors are on hand if anything goes wrong, and then are encouraged to have a home birth for subsequent children if they'd like to and if everything went well the first time. My mum had both me and my sister in the hospital because I was breech and she needed a caesarian section, but her second birth was totally fine and normal. Personally I'd probably choose hospital birth over home birth because I trust the NHS to only advise interventions if they're necessary, but I get why people might choose to give birth somewhere less clinical.

While I am having my second child at the hospital just like my first, this issue of use of unnecessary birth procedures is too prevalent. With Daniel, my water broke at home at 11pm. I had requested several times that the use of pitocin would be saved for when it was really needed. Daniel was born at 12pm the next day (first birth, first pregnancy, 13 hours is exceptionally short). Still, the doctors asked for permission to use pitocin shortly after my husband (the only person with me during the process) fell asleep. Exhausted, alone, and knowing the I am not an expert, I expected the drug. I was in labor for 13 hours as a first birth, spent less than 30 minutes pushing, where was the need for pitocin? I am still not an expert, but in everything I've learned before and since, I just don't see where it was close to being needed, especially since I had requested not to have it except in response to complications.

Before watching this video, the concept of home delivery seemed like a very improbable thing. The idea that if something were to go wrong while giving birth at home, there would be major effects; such as death, child health complications and so on. Upon watching this video, it makes the statement that when choosing to have an in hospital birth the mother is more likely going to have a c-section and furthermore the child is more likely to go into the ISU. These two outcomes may take place not because they necessarily need to, but because they can. The fact that some physicians will placed a child in the ICU in order to occupy the space just seems absurd. It is in a way taking away from what the patient would have wanted for her care of the child. Some doctors believe that their way is the only way with the birthing of a child. A family member of mine wanted to go forth with an all natural birth, and when the time came the doctor who just happened to be on call that night did not believe in this type of procedure. If a patient's wishes are undermined, then what is the point of us to even express our opinion on what we want for a procedure? To further this example, if this family member would have chosen an at home birth the outcome would have been completely different. The physicians who are along side you at an at home birth seem to be more in tune with what the mother really wants. There is a strong connection because the two have more or less been through the whole process together. There is no middle man of who is doing the check ups and so forth. To answer the question, I believe at home birth are the safest possible. Every scenario is mapped out with an at home birth, whereas a hospital birth you are not sure as what is going to happen.

Would have been nice to have taken a closer look at the dutch birth system. Home births are very common here (~30%) and really arent too dangerous, but there is a concern in the government that the mortality rate among mothers and children during the birth are too high. Also it is rather common practice in the Netherlands to refrain from using anesthesia in general as the view is that it is for intolerable pain, and while having a kid (I'm a guy so cant say from experience) may be painful, I don't think it should automatically fall under the intolerable category.

I had my firstborn in the hospital and it was a pleasant experience. I went into labor on my own and home then i went to the hospital they broke my water and i only tore a little bit. I liked being in the hospital cause i got a few days of help and more rest.

When I was born (late '80s, early '90s) all pre-diagnostics suggested I would be a healthy newborn of an average size and would probably have no problems surviving delivery. When I was born I had to be deliver through C-section after 12+ hours of labor. My nose was busted and I had two black eyes. It was very hard to get me to turn from purple to pink. In the end it was discovered I had had a stroke during development and as a result of cerebral palsy I was unable to, as a fetus, manure correctly even though my mother's body was going through the process normally. If I had not been born in a hospital the odds are pretty good that my mother would have survived but I would have died or I would have had a second stroke and would have become a vegetable. Even though this is an individual case, the point I'm trying to covey is that many troublesome, complicated deliveries have no pre-natal indication of possible issues. So planning on a birth at home based on pre-natal testing isn't a solid assurance what so ever. Please place your baby's life and their quality of life over your personal preferences. Please.

Dr. Carroll, I'm curious if there's any data on the risk of drug-resistant infections in hospital delivery wards. I know this is a growing issue in other parts of the hospital, but are the delivery wards isolated enough to prevent contamination from other areas?

I'm a zebra and I find this video offensive.

Excellent! I'm happy to see a physician who will weigh the science even if there are elements contrary to his biases. Well done!

We had baby one in a birth center (when we lived in an apartment), and our other two at home. We practice evidence-based medicine, don't do alt-med, and my wife had textbook low-risk pregnancies each time. All our children are strong and healthy. We like the way we did it, but we don't fault our friends who choose otherwise. Not everyone will do it our way, and that's fine.

I would find a comparison of birth centers to hospitals and birth centers to home births more interesting. It seems strange to me that home births and birth canter births are lumped in together, when birth center deliveries are more likely (speaking anecdotally, I don't have a source on hand) to have immediate access to healthcare professionals and equipment and to have easy access to hospital admission if needed. Are there good studies that break these groups down more than the studies mentioned?

Thank you, that was a helpful, unbiased and informative video

You talk about interventions being more prevalent among hospital births, but has that been corrected for times that an intervention was (arguably) needed, but they weren't able to transfer to a facility where these interventions were available?

I always thought that at home births were interesting. I knew that there would still be some kind of pros and cons to at home births. I think my biggest thing about an at home birth is the intimacy you get to experience with your significant other and child. Securing the mother and child bond I feel like is so important, I believe it's a bond that is stronger than just the pregnancy alone. But it can also come with many downfalls such as potential child and mother death during delivery because they were in the proper hospital care to be taking care of the mother and the baby. Also another thing the baby can experience outside of death is neonatal seizures which can lead to death if the baby doesn't get to the hospital fast enough. But I believe that these experiences are rare because the ICU rates are lower with at home births, so that means that the midwives are doing something right while the mothers are giving birth. While mothers who are giving birth in a hospital, supply induced care are using ICU's just because they exist and need to be filled not because something is actually wrong with the baby. In 2012 more than 35,000 births in America were at home births so they are popular. If mother's are choosing to have at home births they should be in good health because if there not healthy they're putting themselves and their child in danger. It's many factors I believe should be accounted for before a family decides to have an at home birth, but it's an beautiful experience if the mother is able to do it safely!

I can see and understand both the advantages and disadvantages of hospital births and at home births. I believe that this decision should be left up to the parents and that they should thoroughly research the pros and cons of each. I can completely understand after hearing about some of my friend's experiences with hospital births why a person might choose to have their baby at home. Often hospitals births result in induced labor or a c-section. Many women are skeptical of c-sections because of the alarming statistics of complications that arise during the delivery. When deciding to deliver your baby at home, the chances of a c-section are considerably lower than if the mom was already at the hospital. Many women choose to give birth at home where they are comfortable. It makes a big difference for them to feel at ease while bringing a new baby into the world. On the other hand there are many reasons why a parent might choose to give birth in a hospital. A main reason that would persuade me is the risk of complication at home. If complications arise during the delivery, I am a lot more confident that a hospital would have the necessary resources to help safely deliver the baby more so than if I were at home and something were to go wrong. Both of these options have their good points and not so good points, but an important thing to keep in mind is that every pregnancy and delivery is different and this is a decision that should ultimately be left up to the parents to be.

This channel is fantastic! I love you HCT!

Hey Aaron, Do you know if there was any difference for home birth complications/death based on what kind of medical team (or lack thereof) was attending the home birth? I had both my kids with planned home births. Had some complications with the second, but everyone made it through without a trip to the hospital in part because I had 2 experienced nurse midwives, an L&D nurse who was in training to be a midwife, and my husband was a paramedic. I got jabbed with a number of needles as I started blacking out, so it wasn't the ideal low intervention delivery, but I don't think it had anything to do with being at home versus the hospital. Just curious though if the study that had increased risks included or excluded not medically attended planned home births. More out of morbid curiosity. 😀

My mom's best birth experience was in a hospital, attended by a midwife.

In my opinion, it seems hospital births are the safer way to go when planning the birth of a baby. While this is not always a possibility, it is the better option. Many mothers choose an at home birth, or out of hospital birth, in order to avoid the at times unnecessary intervention by medical personnel. They prefer to have a natural birth, without surgery, without an epidural, without being inducted, etc. However, it is still possible to do this in the hospital. Mothers can work with their doctor to create a birth plan that will allow them to have a natural birth. However, by choosing to do so in the hospital, they are surrounded by trained professionals that will be there in case something goes wrong. While it is unlikely that birth complications will present themselves, it is best to prepared. Things do not always go as planned, but when it comes to something as important as bringing a new human being into the world, it is best to take as little risks as possible. By planning on a hospital birth, the best possible care is given to both mom and baby. This does not mean that moms wishes of a natural birth have to be ignored, an important fact that must be acknowledged when determining a birthing plan.

I've also heard of interesting inbetweens. Like birthing homes which are cozier than a hospital room and staffed namely by midwives but theses homes are located right next to a hospital for easy transfer should a complication arrive.

Don't the Netherlands treat premature births differently as well? I seem to remember something that they would let the mother hold the baby and see if it survived the first few hours instead of treating it right away.I can see something like this changing the way they see birth/death

Dr. Carroll, who is a pediatrician, has a very strong initial opinion against home births, and in this episode of Healthcare Triage goes on to explain his notion of - “When you hear hoofbeats, think of horses, not zebras.” In this quote, zebras being the home births. His personal example of his wife’s and his decision to have hospital deliveries for their own children can sway the audience to go with the credibility of a practicing physician. In an ethical lens, I think the construct of coming on so strongly to discuss the risks of home births before explaining the mechanisms can be dangerous to viewers making these choices for themselves. About halfway through the video, Dr. Carroll switches to the opposing viewpoint of the benefits of home deliveries, such as decreased additional procedures, complication mortality rates, and decreased intervention. He also refers to the fact that women are more likely to get induced, a cesarian section, and spend more time away from their baby after birth due to ICU admission stays when choosing to have hospital deliveries. He uses the example of British data to demonstrate the importance of preparedness during home deliveries with access to medical facilities should something go wrong, but with the opening of this video being so transparently swayed towards one argument using Dr. Carroll’s personal opinion and practice, I believe viewers would be inclined to naturally create first impressions towards what option they should pick which may decrease space for autonomy through unintentional biases.

can we have a video talking about magnetic therapy?

I wonder how the Oregon data set handles births without planning, unexpected births, early births ect. I'm not doubting the conclusions drawn from the data, but in my understanding sometimes people aren't planning for or expecting labor for one reason or another, I don't know how common this is and if the frequency is enough to skew any data, but it does make me curious.

I'm so sorry. I have delivered over 350 babies at home without issue yet as a nurse from 1987 I learned a healthy respect for high risk. Most Good Midwives spend more time prenatally and prevent and support the family in the hospital 8-10 inductions delivery at 330pm with 7 babies sent to Nicu and higher maternal outcomes. I feel the practioners and their philosophy and experience home or hospital has to be researched and interviewed which I feel is an essential aspect to safe parenting either way. Parenting I found was much more difficult overall then the birth was, just getting started to the one of the most important callings to our future.

You didn't mention hospital acquired infections and antibiotic resistant bacteria. Is that too rare (I Hope) too mention?

Is there any evidence that the deaths that do occur for babies/or mothers would have happened regardless of the birthing location? Or the better pre-birth diagnosis would have prevented them?

I believe that in home childbirths can be the right way to go, depending on their personal views. Hospitals these days charge too much for a delivery. The parents end up having to pay for this “necessity” for a long time after. While an in-home birth is more painful, due to no drugs, but also it happens in the quality of the mother's own home. I have heard good things about both in-home births and also in the hospital. I also think that when a woman decides to have a hospital birth, she is almost unable to make it natural. Many soon-to-be mothers end up saying they don’t want drugs but end up getting them when they are unnecessary. Some mothers also end up having to have a type of procedure or surgery and have the baby taken away from then as well. I also think that because are unable to walk around (which can be comforting and help the mother with the labor) and drink water, women choose to do it at home, this way they are able to do it on their own rules. Many would argue that an in home birth is the best way, due to the fact that its natural and this is the way god intended. He made this world where women were forced, and very able to ignore labor without medicine or in a hospital with all the tools and technology we have today.

The reason there are so many home births here in the Netherlands is that we are one of the few industrialised countries who still view giving birth as a natural procedure, not a medical one. You can have your opinions on it, but it's the case here. A rational thought behind giving birth at home is the fact that our country is very densely populated, and there are many hospitals close by. Giving birth in the hospital here is still not closely monitored by an obstetrician, but by a midwife (which means it's free, apart from the stay in the hospital itself). Therefore, if there's a problem, it takes time for the doctor to get there. That's about the same time it takes to get to the hospital (at least for people who live in the city). That is the main reason my mother gave birth at home three times. I couldn't really find any good statistics for the Netherlands, so it's hard to judge.

What botters me is that you tell is that 10% of births in the UK are home birth, and that it is much higher in the netherlands. But you don't tell use the actual rate. So when you say much higher what do you mean?

I agree that this is polarizing. As someone who is focusing on maternal-infant care from a social support standpoint I've seen a lot of this. I don't like how standard American hospital deliveries are typically handled. I also would not encourage women to have an unassisted homebirth under any circumstance other than in an emergency. I think having access to qualified, well-trained mid-wives makes a huge difference. I think having access to hospitals that operate more like a birthing center until there's a problem would be a great option. I think encouraging women to trust their bodies before and during labor is more important than EFM. I think teaching doctors a more open minded viewpoint on labor and delivery would improve the system. For example, let women have something to drink, if not even eat, during labor. Let women get out of bed and move. Forbid any staff from asking mothers to restrict their movements because the monitor doesn't work if it slips out of place. Let women be as comfortable as possible in the hospital and the scale of the problem can decrease. Respect women's choices. Don't forbid practices that aid in labor. What harm is the birthing ball really going to do? Is showering during labor going to hurt mother or baby? Don't just look at written policy; look at what's really happening to real people. Encourage informed decisions but don't make choices for women, and recognize the risks for all the options. Understand that there is no one-size-fits-all solution. Since your a pediatrician I'm curious to hear your thoughts on infant feeding? There seems to be some zebra seeing there too. Do you believe breast is best? Is quantification of individual feedings important for normal, healthy infants? Or is it quality/overall health and growth that matters to you? Do you believe in extended breastfeeding? Is there an age that you believe is the absolute cut-off for breastfeeding at which a child must be weaned?

A thing to keep in mind is new research on the microbiome shows that babies born via C-section don't get their mother's microbiome, and end up having more health problems later, like increased risk of asthma, etc. So if you're more likely to get C-sections at the hospital, it will end up making your baby less healthy. As doctors become aware of microbiome research though it'll become better, it's an easy fix to take samples of the mom's vaginal microbiome and inoculate their baby with it if they knew enough to try. But not right now.

I used to be totally tokophobic, and knew that I couldn't be so daring as to give birth at home, away from medical professionals if I desperately needed them, which I probably definitely would (thanks, tokophobia). But my other problem was, I don't trust doctors and hospitals freak me out. I don't want any medical interventions; medical procedures of any type right down to having a shot or blood drawn were my worst fear my entire life. At about 18 I very nearly passed out after getting a routine shot. Now that I'm pregnant and have had more medical experiences, both of these fears have been reduced somewhat, but I know that I CANNOT have a relaxed and peaceful birth in a hospital. Being in a hospital will heighten my anxiety, which can in turn stall labor. And then you can end up at my personal worst outcome - a c section. So, even if there's a 50% chance of transferring to hospital, I have to try for a home birth. It's ok if things don't work out as planned, but I know that is my best-case scenario.

Don't get me wrong but I can't help but wonder if the cause of the increased risk of getting a C section or other procedure in hospitals when compared to at home births is the fact that most high risk pregnancies are scheduled to occur in hospitals and not homes. Don't know if I'm making any sense but whatever 😕

Can I get an epidural at home?

I feel like a lot of the difference in icu/c section rates is because you are looking at things backward. If you have a baby who is likely to need icu care, the chance you would give birth at home is far lower than if you didn't. This kind of skews the stats.

To be really nitpicky, it's the National Institute for Heath and Clinical Excellence, and yes it is even more of a mouthful than what you said.

It's worth noting that in the UK virtually all home births are attended by at least one - usually two - experienced registered nurse midwives (they must have completed either a very competitive bachelors degree in midwifery or a competitive bachelors nursing degree, had clinical experience and then an even more competitive post grad in midwifery) . I may be wrong but understand that in the US a "midwife" is not necessarily a highly trained professional as in the UK. Something to consider when comparing the % of home births and the % of home births with negative outcomes.

I believe that all births should be done at a hospital. Even though there are disadvantages of giving birth at a hospital (being separated from your baby after they are born, expenses, etc.) you are with doctors and nurses who are experienced with child birth. If you choose to be at home, who is the one where talking your way through birth and making sure it is healthy after it is born. Maybe there is a midwife there to help you, but he/she only has limited equipment to help you deliver and care for the newborn baby. At the hospital, if your baby is in a serious life threatening condition they can care for your baby right away. If you are at home and there is no equipment to help save your baby's life, then you would have to go to a hospital anyway. Hospital deliveries are a safer way to go and there is a less likely chance of death for the mother and the newborn baby.

I love the show, so I hope you don't think I'm just being annoyingly nitpick-y, but the Union Flag @ 2:10 is wrong. The horizontal white lines shouldn't intersect the central red cross like they are doing. :(

I'm 21 and nowhere even remotely ready to have kids, even though I'd like to have 2-3 of them in the future. As it stands now, for my first kid, I would probably do a hospital birth and have a midwife or birth doula in the room with me. After that, if all went well, I would consider a home birth or a birth center.

Is there data that splits at home birth as a whole and at home births with a Certified Nurse Midwife (CNM)? How much of the increased risk is do to the fact that the parents had no qualified person at the birth vs what ever increased risk of having a birth outside of a hospital. The idea of having at home birth seems far more reasonable with the help of a CNM and if in close proximity to a hospital, so if anything goes wrong someone is their to say so and the mother can get help very quickly.

yeah home births! My mom wanted a home birth for all her kids but ended up needing C-sections for all four of us. She had a well-trained midwife who knew the right time to advise her to change strategies. After her first two though, it was clear she needed a C-section outright...

The problem is in Obstetric "normal" could go so wrong so fast Just the fact that you have medical help of all kind few feet away just in case even if you tried a "natural" birth as much as possible

I would love to hear your thoughts on "The Business of Being Born" :)

I don't have an opinion either way on where women give birth. Do so where you're comfortable and feel safe. What I *don't* get is the idea that seems to be expanding of basically scheduling the delivery. That's weird and not, I think, a good idea. That's one of those risk increasing interventions that were mentioned. In certain cases, like high risk pregnancies, it makes perfect sense that for the safety of the mother and child maybe delivery should be induced at a certain number of weeks, but for the average, low risk pregnancy, it's not a good idea to force nature before it's ready. :/ ...I always think of that Gilmore Girls episode where Rory'e step mom had scheduled her c-section, but she went into labor two weeks early, and she was freaking out trying to work while in labor in the delivery room. SO crazy.

I wish I had this in 2009. I foolishly planned an unassisted homebirth. Luckily I wasn't too scared of intervention when things didn't feel right. He was flipped over and needed a little help getting past the cervix. But he we most definitely stuck and could have died if we were too stubborn to go. I was as low risk as they come. I know it's a zebra but when the zebra is death it's not worth risking.

I think that labor is not a simple thing and also involves personal choice. I’m Brazilian and I would never feel safe delivering at home. In Brazil, in the private sector, more than 80% of births happens due to C-section. It is a very, very common practice there, and even when you put together private and public healthcare sector, C-sections represents 55% of the delivery methods. Today I live abroad and I was never in favor of the indiscriminate use of C-section in Brazil, but I notice they use a lot the induction here were I live, and I have to say that I don’t feel safer. Actually, I feel like the public system here (we only have access to the public healthcare sector here) tries to push the natural labor even in cases where C-section would be recommended, and that’s why I feel unsafe. I’m not sure if they will put me and my baby in risk just to save some money (due to the public healthcare system) and to avoid a C-section at all costs.

We had three homebirths under the care of our very talented midwife. It was great, even though one was pretty hard on my wife. Highly recommended if you're healthy and have a good midwife!

Having dealt with many doctors and hospitals throughout the years, I strongly believe at home births are just as effective and safe as those performed at a hospital. I say this cautiously though because those births that take place at home need to be performed with an experienced midwife or someone in the medical field. Though there are not the sources at home that there are at a hospital, at home births can be just as successful. Like he said in this video, there are less intensive critical care admissions regarding at home births and this was an example of "supply induced care". He suggested that though the infant is taken to the ICU at times, there was not a critical need for it rather than just using the facilities because they were available. He also stated that births taken place in a hospital had a higher percentage of procedures done than those that had in home births. 30% more women that gave birth in a hospital had a higher chance for a procedure to take place than those 1.5% at home. Cesareans are more common in the United states than there needs to be as said in the video and those can come with an abundant of risks. C-sections can cause infections to both the mother and infant and risk of heavy bleeding. Holistic ways are becoming more and more prominent as time goes on. Many people with fatal diseases turn towards holistic ways instead of medicating with chemicals. Although I do strongly advocate for holistic ways, I still understand some holistic medications cannot 100% rid the body of certain things where chemicals and medication need to step in. That being said, if it was safe and a low-risk pregnancy as he said in the interview, than I believe at home-births are just as safe and as effective as in-hospital births.

Home births and hospital births each have their own advantages and disadvantages. Hospital births for example are good because there is a direct access to medical care if needed, and you have the support of doctors and nurses completely dedicated to the mother and the baby. There is access to life saving technology and the professionals capable of caring for each person since it is their specialty. Home births offer the safe feeling and comfort of being in a known surrounding. It can be more comfortable for a mother to give birth in an area she is familiar with and may help with speeding up delivery. With that being said, home births also have midwives to help the mother and baby, and there also can be the support of any family member a mother may want present since hospitals usually only allow two to three people in the room while giving birth depending on the size of the room. Some of the disadvantages that come with giving birth in a hospital is the amount of random people that a mother may not know that can be present during delivery. That can make for an extremely uncomfortable situation which can cause complications while giving birth. Another downside is the unfamiliarity of a hospital room. This can once again cause a mother to feel uncomfortable or awkward and can cause complications. Some disadvantages to home births is that there may not be a direct access to any medical care necessary for survival of both the baby and the mother. This can cause many problems that could be avoided in a hospital. Another issue may be no access to pain medicine that a mother giving birth could potentially want to have.If a mother knows that there is a risk of having life-threatening complications while giving birth, that may lead her to chose a hospital birth. That is because no one should want to risk their child's or even their own life. With that being said, home births should be considered after having a completely healthy pregnancy and when there are no immediate risks. Also it would almost be a suggestion to have a hospital birth for the first child considering a mother can never know what may or may not happen while giving birth. Both places have their disadvantages as well as their advantages and whether one is better than the other is completely up to the mother giving birth and her partner.

You kind of forgot to address that an American CPM is drastically less educated then midwives in all other developed countries. It's the difference between a post high school certificate heavily based on apprenticeship rather then a four-five year collage program dedicated to studying midwifery. Heck in my own state there are no licensing or education requirements at all. Many of the CPMs I've personally talked to dismiss things like gestational diabetes or risks to breech births,post-maturity or twin deliveries. When I did doula training the midwives teaching were assigning books suggesting the brewer diet for pre-e or just willing yourself to stay pregnant in cases of preterm labor. People including myself being pushed into thinking their c-sections were unnecessary, which is almost impossible for laymen to determine because they frequently don't have all of the facts,but it pushes that you were somehow victimized and now need to take bcak your birth by doing something stupid like home trial of labor after multiple c-sections. Multiple books saying that your water breaking is only an infection risk if you go to the hospital otherwise it can be broken for days or that Rhogam was unneeded if you just didn't go in for those evil interventions. I've had good friends who nearly bled to death and then just accepted that it was somehow their fault by diet or exercise or lack of some kind of herb. The mindset that currently exists around homebirth is unhealthy to put it mildly, but if they just regulated it like any other medical profession it could easily be an acceptable risk for many patients. Homebirth midwifery with very few exceptions is in the stage that the practice of medicine went through prior to real regulation. It still REALLY needs to work out the quacks.

My mom had three of her four kids at home and had no difficulties, but she does not recommend it for everyone.

You covered planned home births accompanied by a health care medical professional. The higher risk of death from home births is probably (if scientific studies on this didn't differentiate) from deliveries not accompanied by a medical professional or accompanied by some naturopath quack. This is the problem with some home births: as long as a medical professional will be present the risk will still be very low but if someone chooses to do it alone or assisted by some quack the risks increase substantially.

Could the money that a birth implies be a factor?

There are a lot of mothers who would rather have their babies be born at home, and there is no problem with that. But you have to think of all the things that could possibly go wrong and how those things might effect your babies life, as well as your own life. There are plenty of studies that show that woman who give birth in hospitals have a higher chance of undergoing some type of surgery and have a longer time away from their child after birth; but that is only because they are at a hospital where those things are possible, at home you cannot do those things. Woman who give birth at home have a higher risk of losing the baby due to unseen complications or even infections. There is no right answer to whether you should give birth at home or at the hospital, but you need to carefully, rationally weigh all of your options before hand so that you fully are prepared for the birth of your child. There is also the money to think about in these situations, if you go to the hospital it is going to cost you a boat load of money to pay for them to deliver your baby and then take care of you and the baby, you'll also have to pay for any tests that need to be done or heaven forbid any procedures that need to be done. Now I don't know about the rest of you but I do not have that extra kind of money. At home births are far less expensive because you are not needing to pay any hospital and medical bills.

I was looking at the numbers in other countries and it isn't the same as the US. Considering how badly the US does in infant mortality compared to europe or canada, maybe this is the actual problem?

Is a higher NICU rate really an indication of more success in home births, or is that how you explain all the dead babies?

I'm a brazilian woman who wanted to count on a hospital for birth when it comes to it. But maybe it won't be a good idea. Vaginal delivery is treated as painful and too long and very often procedures and drugs are used even when the woman says explicitly they don't want it and don't need it (4 hour labors are often considered too long, even if there is no sign of fetal distress ^^"). Many doctors here induce its patients do have a scheduled c-section and not to wait until natural labor starts. And yes, the word is induce because they don't just recommend it, they terrify women and say they won't be available so that's their problem or that a c-section is needed, even if it isn't. A couple years ago a polemic case heated the discussion. When interviewed, a doctor said he knew it was possible to do a vaginal delivery if the baby is in breech position, but he didn't know how to, he hadn't studied it since med school and so he wouldn't risk it. And he bet most obstetricians didn't know too. "/

When Healthcare Triage talks about how having an in hospital birth can lead to having unnecessary procedures I don't agree. Having a child in a hospital is very important because having medical professionals nearby is something you want when your life and the life of the baby are at stake. Lots of things can go wrong quickly when it comes to child birth so if you are prepared and are in the appropriate setting it can make it much easier if a problem were to arise. When Aaron talks about all the statistics of all the home births that can go well and how it can stop things like inducing labor and c-sections I don't understand how it can stop things like that. If you are in the hospital as an expectant mother and the trained professional suggest something in the best interest of you and your child why would that be considered unnecessary? I don't think doctors would be suggesting major procedures like this unless it was one hundred percent needed. When mothers are in labor they need the machines to monitor all things that could potentially go wrong, when you are at home you don't have all that stuff. Although some home births happen with no problems I wouldn't support it. The statistics wouldn't change my mind because it's a personal decision and no matter what information is given it's all up to the expectant mother.

Personally it doesn’t matter to me whether a woman gives birth in her home or in a hospital bed. The thing I don’t agree with is if a child dies because of it, the infant mortality rate is so ridiculously high that it is becoming an issue. If you don’t have correct surroundings of the environment then you should go to a place that is going to benefit the child, people say they want the best for their children however don’t care enough to ensure the safety of them, it should be required for children to go to the hospital after being born to check all of their vitals. Something that doesn’t really click in my head is the scheduling of the delivery, it is an increasing intervention that was mentioned. In high risk situations during pregnancies, it makes sense that for the safety of the mother and child so delivery should be induced at a certain number of weeks, but for the average low risk pregnancy, it’s not the best idea to force nature before it is ready. If someone expects that parenting is going to fit perfectly into their schedule, then maybe they weren’t actually ready in the first place to get ready for birth. The healthcare system is probably something to take in effect of the mortality rate between home and hospital births. One has to think of the low risk pregnancies and their effects on home birth versus hospital which pose close to nothing that would change. There is nothing wrong with home births unless they are putting the safety of the child at risk.

What does the evidence say about home births attended by Certified Professional Midwives as opposed to Certified Nurse Midwives? I know that a lot of people are confused when it comes to the practice of midwives and what the different titles mean.

I had twins at home and everything was great.

Oh god that Zebra quote annoys me so much, yeah zebras are less common, but that whole 'rare diseases are so rare it's unlikely you'll encounter them' is crap that keeps people sick with rare diseases from receiving proper treatment!

Why should having a C section be considered bad? I get that women recover more slowly from a C section but I have not heard of it leading to deaths (unless of course it's in a third world where hospitals are not fully sterile).

The Uk has a National institute for Healthcare Excellence in France?

This is a repost, right? Or am I having wicked deja vu...

As I grew up within a culture that actually supports and mostly prefers home births, I would actually prefer home births. why you may ask? well, I only think so only, and only if the mother was taking care of herself and her baby. it would reckless if not; and with all of those studies and numbers that just proves my point. I mean if the mother was not comfortable doing so, then she should obviously go to the hospital. I do not have much knowledge about all of the extra care that she would get. but if they are truly worth it and lessen the risks of the child or the mother of being in danger of any way, then they should check the hospital. obviously giving birth cannot be completely planned because, well. you cannot tell the baby to get out now, unless needed of course.

Jim Gaffigan has a great comedy routine about having home births for his 5 kids

First, let’s get something out of the way, I am an OB/GYN. I do not have anything against an informed decision to deliver at home but we need to be honest and admit that there is no reliable data to support the safety of that option. 100 years ago, going to a hospital to have a baby was not always the best choice. In the pre-anesthesia, pre-antibiotic era, hospitals did not offer any real advantage to a home birth and a majority of women would deliver at home. Neonatal and maternal mortality was at a level that would be unacceptable by today’s standards. Nowadays it is significantly safer to go through labor at a hospital, and most everyone assumes a good outcome should be the norm. I like the videos on this channel enough that I usually refer them to my patients. But this one in particular, leaves a couple of key issues out. First, there is no reliable data to evaluate the safety of home births. All available studies are observational and anecdotal and suffer from a huge selection bias. Women planning a home birth are very unlikely to agree to be randomized to a hospital birth and those expecting to deliver at a hospital would likewise refuse to deliver at home. Additionally, certified midwives routinely refuse high risk patients asking to deliver at home if proper criteria is not met. This leaves us with a paucity of reliable data to refer to when counseling our patients. The most critical element left out in this video is the differences between home delivery providers. A CNM is a certified nurse midwife, who has gone through years of academic training to obtain their credentials. They can get hospital privileges and usually practice in that setting alongside obstetricians. They tend to offer a more patient centered approach to care but within the safety of an accredited hospital. Lay midwives, on the other hand, do not require any academic training. They are not able to get hospital privileges and are not legal in most states. These last group now uses the credentials of CPM and sadly are the most common providers of home deliveries in many places. I say sadly because it is more difficult to verify their credentials and word of mouth may be the only way to have any idea how good they are. Even with the limited amount of data available, it is clear that a home delivery will not be able to approach the safety of a hospital in the United States with our current system. Also keep in mind that both Certified Nurse Midwives and present day Obstetricians are more and more willing to provide care based on your beliefs as patient. I was trained in the era of episiotomies for all deliveries and have not done one in about a decade now. The real question a patient should ask is how do they would feel if their labor and delivery happens to be the zebra. Remember this should be ultimately about the health of your baby not about you. It may be very empowering to deliver successfully at home, but what happens if that is not the case. Any woman that becomes a mother should be admired regardless of the way or place they delivered.

Are the trends about the amount of procedures that women have during in-hospital births reflected in countries that don't have a private healthcare system? Could it be that hospitals are performing unnecessary procedures on women because they want to make more money out of them?

I was born in my house and im very healthy and may even be healthier than anyone in my house who was born at the hospital. im not vaccinated at all and have no allergies yet my brothers who have been born in hospitals had allot of allergies and were vaccinated. never do a at home birth if you do have a good midwife.

that's a lot of percent

Birth is a natural process. The majority of us can do it with no medical help in the right environment, or in other words where each woman feels most secure, whether that be a hospital, birth centre or at home, and with the right support.

Please note that this is about home birth not unassisted birth!!!

home births are weirdly common in the Netherlands.

What is the meaning of saying that women giving birth in the hospital are more likely to get procedures? Of course they are, that's why their babies are less likely to die. The hospital has the resources to make a safe delivery, and of course it involves performing procedures (either on the woman or on the baby). The NEJM study is a very high-quality one, and clearly shows that giving birth at home means unnecessarily risking the baby's life.

I think part of the problem (at least in America) is that pregnancy and early motherhood is more and more considered a disability or sickness. So if you don't have a hospital birth *omg you're going to maybe kill your baby*!! Except that majority of pregnancies do not come with a risk of complications, so it's perfectly fine to have your child wherever you damn well please. Especially with more and more single child homes, mothers may prepare but don't inherently know when something is medically wrong, so they trust a doctor who may have protocol to give them these procedures/drugs. I think it makes sense to have the first line of defense as a midwife for any new mothers (or any who request a midwife) who can oversee the birth and call a doctor when they see something wrong. I think for many mothers, it would mean the world to have someone there who has been through a million of these saying yes I know this part sucks but it's normal and you are ok.

I wonder if the BBC's 'Call the midwife' has anything to do with the UK's home birth rates...

This may be incorrect, or the law may vary by location, but I was under the impression that people who assist with home births aren't regulated and that because of this some home birth services might be done by people with batshit stupid ideas.

Infant Mortality rates in america are very high(# 159 in the world according to cia.gov fact book) if evrey baby was a homebirth this number cant get much worse...a home birth with a mid wife is very safe and the standard for many countrys

I liked this episode, then disliked the episode, then liked the episode right near the end... Gah... I am going to continue to advocate against home births until improvements are made to the American health care system.

I was about to make a deal that I'll use “data” as plural if you stop saying “biaseez.” Then I noticed even *you've* given up on “data.” There goes my leverage … time for plan B: Get people to start saying “scienceez” as revenge.

Born at home :)

This might be the first HCT video that really changed my mind on something. If I were a pregnant woman I'd really consider a home birth!