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A Cost-Benefit Analysis for Giving Birth at Home

Some data to follow up on our story last week about a home birth gone wrong.
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(Photo: Halfpoint/Shutterstock)

(Photo: Halfpoint/Shutterstock)

Last week, Pacific Standard published the story of Danielle Yeager's home birth gone wrong. The opening scene—describing Yeager's emergency C-section, the live birth of her son Gavin, and Gavin's near-immediate death—is heart-dropping. Writer Sarah Watts identifies a number of systemic failures that kept Yeager from going to the hospital as soon as she should have, once it should have been clear that Gavin was in distress and needed more professional care.

This week, the New York Times published a piece that provides a bigger-picture, science-based analysis of the risks and benefits of home births. Like Watts, the Times' Aaron E. Carroll identifies important recent research showing that babies whose parents planned to give birth at home face a greater likelihood of death. The numbers hint that the problems Watts identified may indeed be widespread and important.

Certified professional midwives (CPMs) undergo paltry training, compared to obstetricians and certified nurse midwives, according to Watts' story. Yet in certain states, including Yeager's home state of Nevada, lax laws mean CPMs are given wide license to practice without supervision from a doctor or nurse. Carroll writes about another problem that's in full view in Yeager's story: In the United States, home-birth midwives and hospitals often don't coordinate as closely as they should, leaving parents who choose home births without a safety net in the event that something goes terribly wrong.

But there are risks to giving birth in hospitals too. Carroll explains:

In the hospital, you're also more likely to get a procedure. More than 30 percent of women with planned in-hospital births had labor induced, versus 1.5 percent of those with planned at-home births. Almost 25 percent of those who planned to deliver in the hospital had a cesarean section versus 5.3 percent of those who planned to deliver at home.

It's important to remember that the rates of severe morbidity (permanent harm or significant temporary harm) and death in women are 27 per 1,000 for planned (or 'low-risk') C-section deliveries versus 9 per 1,000 for planned vaginal deliveries. C-sections are probably more common in the United States than they need to be, and being in the hospital increases your chance of getting one, and the risks that come with it.

Such risks are far more common than home-birth deaths, which a recent study found to occur at a rate of 3.9 per 1,000 births. Most of the risks of hospital births, however, are not as devastating as the death of a much-wanted baby.


Since We Last Spoke examines the latest policy and research updates to past Pacific Standard news coverage.