Last night we went to my aunt and uncle's in town for boxing day supper. It was delicious and very busy and fun, and my aunt and uncle live in the house that I grew up in from 2 to 13 years old so revisiting their house was very nostalgic. They had family friends there whom I had never met, from Massechusetts. Things were all very nice and friendly and civil, and someone told Mrs. Massechusetts that I had applied for midwifery school next fall. She asked some seemingly interested questions regarding the educational process and my current job, which was nice. But then she popped out, "I'm a statistician in the U.S. and I just finished a big project looking into deaths in homebirths. Is it safer to have homebirths in Canada than in the U.S? Because the home birth death rate is really high."
Uhhhhhhhhhhhhhhh...okay, here we go, and we already know a few things about this situation:
(1) we cannot offend her because she is a guest of my relatives
(2) she has been politely inquiring about midwifery but with a backhanded motivation
(3) she has already decided that home births are dangerous.
How to deal?
My mom is awesome. She jumped in and, rather than directly address the question of comparing U.S. and Canadian maternity issues, she just pointed out that the home birth infant mortality rate in Canada is really low--lower than in the hospital--because women are screened for risks before being attended at home by midwives. High risk births are delivered in hospital. I expanded on this and said a few things about the safe parameters of home birth, but felt kinda caught off guard. I have read from several sources that it is really difficult to gather any kind of statistics on home birth, unassisted childbirth, precipitous birth, and back alley give-birth-at-prom-in-the-bathroom-and-ditch-baby-in-the-trash-can birth, and be accurate. For one thing, unassisted births are underreported AND overreported, because people are trying to get around the institutionalized birth and/or government involvement or control in their lives and still stay off authorities' radar. In states where attended home births are illegal, homebirth midwives will not sign birth documents and the birth is recorded as unattended or precipitous. Some unassisted births with no midwife in attendance will not be reported to vital statistics to avoid government involvement and/or to avoid investigation by Child Protective Services.
But how to get into all of this? How to ask: did you include precipitous births? Did you include taxi births? Unassisted births? Home births with midwives are safer than hospital births, for low risk women. Study after study shows this, and many other developed countries have a homebirth, midwifery based system for low risk births and have far better infant and maternal outcomes, and lower surgical birth rates, than the U.S. (or Canada).
Instead, I thought later I could have said:
Have you checke the infant mortality rate of any hospitals in the U.S.? Infant mortality in America is appallingly high, regardless of the place of birth. America has the highest infant mortality rate of any developed country. The next in line to the U.S. is Kazakstan. I don't think home birth is the problem, because only 1% of U.S. births happen at home.
This was tough. How do you politely get out of that one? In the end it was fine, and the discussion moved on, but I'm not sure we were able to convince her in any measure that home birth can be safe if properly managed.
Maybe YOU don't agree home birth can be safe? I can expand upon this topic in future posts if you want, but I was needing to process this interaction here....let me know if anyone wants more information regarding home birth safety.