Is it not safer in the hospital where a woman can be monitored by machines, with surgeons standing by in case of an emergency? Why do women who give birth at home have better outcomes and why do studies show that home is the safest place for healthy women to give birth?

Many people assume that technology means safe. However, this is true only for the few women who need the technology for their survival and for that of their baby.

Home is the premier place to bring a baby into the world because the hospital environment is unfavorable to birth, hospital staff fail to let birth occur at its own pace, Obstetricians perform an outrageous number of caesarean surgeries, and hospitals are a breading ground for germs and infectious which women and vulnerable infants are exposed.

The environment within the walls of a hospital is unfavorable to birth. Hospitals interfere with a woman's natural instincts to find a safe, private, enclosed place to bring her baby into the world. Hospital rooms are filled with the noise of monitors and machinery, there is a constant flow of personnel and interruptions all through the day and night, and the mother-to-be is expose to whoever is in the room as well as those passing.

The uterus works just like other sphincter muscles such as the bladder and bowel. Imagine having to use the restroom with people, perhaps some you’ve meet for the first time, all gathered around the toilet watching you, "coaching you," or yelling at you to push or relax. Odds are you would suddenly loose the urge to do anything and get out of that situation as soon as possible. To demonstrate to the people in her childbirth class what it’s like for women to give birth in public, like a hospital, Lisa Goldstein, a midwife in rural North Carolina showed the group of men and women a $50 bill, she then put a bowl in the center of the circle. She told the men that the first to come to the bowl and urinate in front of the group could keep the $50. She said that no man has ever accepted her offer.⁶ Ina May Gaskin, famous midwife and author describes this phenomenon as the Sphincter Law, which states that for any sphincter muscle to do its job you must be in an atmosphere of intimacy and privacy, which makes you feel safe and relaxed. She directly correlates this phenomenon to the uterus and the birth process.

In her book Ina May's Guide to Childbirth she reflects on a birth she attended where the woman was transported to the hospital. The client was seven centimeters dilated on arrival but her cervix shrank back to four centimeters after a rough internal exam performed without permission by a male doctor. The woman never regained her dilation and had to have surgery to remove the baby. This cessation is a result of adrenaline that is released when a woman is upset, frightened, humiliated, or self-conscious. It can also prevent a woman from dilating at all.⁷

You may visit your local hospital or its website and be mesmerized by the advertised amenities and their similarities to the home setting. It beckons you with the best of both worlds. However, a study by the Royal Infirmary in the United Kingdom concludes that there is no substitute for a real homebirth. The study compared women who gave birth in a hospital room that was "home-like" with those that delivered in a regular hospital room. The study aimed to see if the benefits of homebirth could be duplicated in a hospital setting. They found that there was little difference between the medical interventions and procedures that took place between the two groups of women. There was no difference in the health of the babies and mothers at discharged. The only difference was that the women who were assigned midwifery care reported a higher level of satisfaction. ⁸

Therefore, just because many hospitals advertise home-like rooms and low intervention, their C-section statistics may tell another story. In fact, one hospital in southwestern North Carolina has cesarean rate of 32%! A hospital in the mountains has a rate of 28.5%, one in the Triangle has a rate of 29%, and one at the beach has a rate of 28%. The lowest cesarean rate that I found in North Carolina was 19%.

"Enclosed," "quiet," and "private" are the words that define home. There your body enjoys this atmosphere for relaxation. You don't have to worry about being exposed or self-conscious, you don't have to endure people coming in and out of your room throughout the day and night, because at home, you choose whom you want with you at your birth. You will be supported and encouraged by a midwife who knows you and trusts you to birth your baby.

The point at which nature is bullied by the drip, the forceps or, the blade a woman may hear the words “failure to progress,” “stalled labor,” “small pelvis,” or numerous other negative terms which say, “You’re just not good enough. Your body has failed you and you have failed your baby.”

In his paper The Ideal Cesarean Birth, Dr. Robert Oliver laments,

"For the first time I looked at my work with pregnant women and realized I was doing three very wrong things:

1) I was getting great medical results.

2) I was getting terrible results for the woman with regard to her needs and self-esteem.

3) I was unconscious of the baby, the conceptus to fetus to neonate, and of the effects of standard care on this new person.

I hated it. Really, I hated it. I hated the thought that all my good intentions were wrong. I hated knowing I had not aimed the care-giving at what should be vital in the transformative event of birth - the woman transformed into mother and the conceptus into a new human being. I hated knowing all of the shortcuts I took to long labor - operative delivery by forceps and caesarean section just to get on with it, the inductions of labor for my own convenience not for the safety and integrity of the woman, the application of technique and technology to make my job safer from lawsuit and peer criticism and to meet demands of hospital policy. I remember and recognize the anger I felt at women who wanted "natural childbirth," home delivery, and non-intervention. I am ashamed, and I am also satisfied that whereas I was once stupid but medically sound, I am now awake and profoundly aware that I know nothing about the experience of gestation, birthing, and the transformative experience of becoming a mother. I can only view it, this process a woman passes into, from the outside as a father, a man, and a professional male in obstetrics.

"...As my skills broadened with the new perspectives I was learning, I became aware that to serve truly, skill must include art - creative, imaginative, and insightful art. I needed to become an artist to really support the transformative cycle of womanhood, to celebrate a new life. Michel Odent was the artist and naturalist who taught us through his book, Rebirthing Birth, and the midwife and doula have long promoted the purity and integrity of woman."⁹

A major factor in the unsafety of hospitals is their rising use of abdominal surgery to delivery the baby.

Cesareans have been advocated as early as 1876 by Italian professor, Eduardo Porro to control uterine hemorrhage and prevent systemic infection in women. In France during the mid nineteenth century the Roman Catholic Church, for the purpose of baptizing the baby when it appeared that the mother would most likely die, encouraged experimentation and advancement of Cesarean sections. At the turn of the twentieth century many woman suffered from Vitamin D deficiency and their pelvic bones were deformed due to rickets, which made Cesarean operations a necessity. Even after the addition of Vitamin D to milk, and the elimination of rickets, however, Cesarean operations rates continued to rise and have never been as low as before the rickets epidemic. The increase in anesthesia availability and safety as well as the hospital movement of the 1940s and 50s provided fertile ground for our current Cesarean pandemic.¹⁰

Cesarean operations do not just happen spontaneously. Rarely is there an event where a mother is laboring naturally and has to be opened immediately to get the baby. There is a common progression toward a Cesarean and in many cases it starts with the induction or augmentation of labor.

According to the Center for Disease Control, National Center for Health Statistics, 1 out of 5 women were induced in the United States in 2002 (20.6%). In addition, the number of births with induced labor has more than doubled since 1989.³⁵ 19.84% of the women giving birth in North Carolina in 2002 were induced. 19.78% had "stimulation of labor."¹¹.

Induction is usually the first step along the path toward a cesarean, watch any television birth story program and you will see this play out again and again.To induce labor, a doctor will break the bag of waters and start Pitocin (a synthetic hormone to the natural occurring hormone oxytocin) via an IV drip. Pitocin is also used to speed up the labor of a woman who has already begun to labor naturally. Natural labor is a beautiful dance between mother and her unborn baby. It is designed to be a work effort shared by both. Each contraction is spaced where the baby's blood supply can fill with oxygen and help the baby "hold his breath" through the upcoming contraction. And the duration of each contraction is spaced perfectly for the baby and mother. However, chemical induction or augmentation of labor is an unnatural process that causes the blood supply to the uterus to be reduced, which does not allow the baby to "hold his breath." The time between contractions is also shorter. "For the unborn baby, it can be like being pushed into a swimming pool before he has had a chance to catch his breath," says the authors of A Good Birth, A Safe Birth, “and then having someone push him down deeper, just when he had bobbed to the surface for much-needed air." Therefore, many babies show signs of fetal distress, have low Apgar scores at birth, and some even have permanent central nervous system or brain damage.¹²

A women who is induced is hooked to an IV, external fetal monitor and possibly an internal monitor that is literally screwed into the top of the baby's head, she probably has an epidural to endure the contractions, which may require her to get a catheter. She is restricted to her bed to continue her labor. She must be coached when it is time to push because she does not have feeling in her abdomen. At this point several things can happen. Let's look at two typical scenarios. She starts to push but because she can't feel what is going on in her abdomen, she spends several hours pushing and getting nowhere. So the doctor says, "I'm sorry, you just aren't pushing effectively. It will be best for you and your baby if we just go ahead and get you ready for a C-section. All right?" The other scenario is that of a woman who's baby is experiencing fetal distress from the chemical induced birth. She is sent to the operating room for her baby to be born.

Cesarean section operations are the leading operation performed in the United States. According to the Center for Disease Control Vital Statistics Reports Birth Data, more than one forth of all births (26.4%) were cesarean deliveries in 2002, the highest rate ever reported in the United States; the primary cesarean rate jumped 7 percent, meaning 18.9% of first time mothers had their babies taken from them abdominally. The rate of vaginal births after a previous cesarean delivery plummeted 23 percent, so just 12.7% of women who had given birth previously via Cesarean gave birth vaginally (13.2 per 100 live births, or 1.5% of all live births)^35. In North Carolina the overall cesarean section rate in 2002 was 26.4%¹³ but some hospitals report rates as high as 30-32% in 2002.

To put this data into perspective, the United Nations Children's Fund (UNICEF), the World Health Organization (WHO), and the United Nations Population Fund (UNFPA) estimate that a minimum of 5% of deliveries are likely to required a C-section in order to preserve the life of the mother or infant. Rates higher than 15% indicate improper use of the procedure.¹⁴

You may wonder why people get upset at rising Cesarean rates; they are performed to save women and babies' lives, right? Yes, Cesareans save lives every day, but their overuse puts otherwise healthy women and babies at risk for infection, increased blood loss, reaction to anesthesia, and lifetime side effects. As well, women are four times as likely to die giving birth abdominally than giving birth vaginally.(1 cesarean delivered woman in 2,500 dies, compared to 1 in 10,000 who deliver vaginally)^15. Cesareans may also erode the emotional health of the new mother, leaving her with a feeling of emptiness, self-doubt, anger and regret. It forces a new mother to be cared for, when she should be caring for her new baby. It makes breastfeeding more difficult because it hurts so badly to hold the baby across the painful incision. Every year tens of thousands of women in the US give birth abdominally, most without proper cause.¹⁶

"Cesarean surgery is followed by something I call surgical birth trauma - a group of physical and emotional problems that can affect the entire family." Says Carl Jones in his book, The Expectant Parents' Guide to Preventing a Cesarean Section. "When the otherwise natural event of birth - an experience associated with pride, elation, awe, and joy - is suddenly turned into major abdominal surgery, it can hardly fail to produce trauma. During and after birth, the cesarean family suffers burdens not shared by those who birth naturally."¹⁷

The Physicians Committee for Responsible Medicine list medical conditions that could require cesarean surgery.¹⁸ They are:

However, the most common reasons cited for performing a cesarean operation are a scar from a previous caesarean, "failure to progress", large baby (Dystocia), breech presentation and fetal distress.¹⁸

At home you do not have to fear the use of unnecessary interventions that may lead to a cesarean section. If you start to labor at home and you have complications and have to be transported to the hospital for a cesarean, you will know that you did everything in your power to have a vaginal birth and that the risks of a hospital birth are worth your life or that of your baby.

"Today there are 25 strains of pathogens completely resistant to all known antibiotics and most of these are found in hospitals." Says Suzanne Arms, natural childbirth advocate and author. "Babies who are physically separated from their mothers and do not receive breast milk after birth are at increased risk."¹⁹

According to an article in The Chicago Tribune, hospital-related germs are the fourth leading cause of death among Americans. Hospitals provide a fertile breeding ground for germs because of the number of sick people visiting the hospital each day and the temperature-controlled environments. Budget reductions all across the United States have caused hospitals to reduce their janitorial services by 25 percent since 1995. This cutback has led to "unsanitary rooms or wards where germs have grown and multiplied for weeks, sometimes years, on bed rails, telephones, bathroom fixtures - most anywhere," said Michael Berens, author of The Chicago Tribune article. He goes on to say that a hidden camera mounted outside an operating room revealed that up to half the doctors entering the room did not wash their hands. Most of the doctors were residents from Yale University. The article states, "Infants are among the most vulnerable patients." The Tribune's investigation found that in the year 2000, 2,610 infants died from preventable hospital-acquired infections. Some babies contracted infections and survived. A three-year outbreak in a neonatal intensive care unit at Dartmouth-Hitchcock Medical Center in New Hampshire was linked to health-care workers who failed to wash their hands after petting dogs at home. At least 15 infants were infected from 1993 through 1995 with a rare fungal infection known as Malassezia pachydermatis, commonly associated with ear infections in dogs. All the infants survived.²⁰ An article on the CNN website about a study published in the New England Journal of Medicine, cites the Center for Disease Control and Prevention's investigation that found only 40-50 percent of physicians and nurses wash their hands properly between seeing patients. 16 infants died in a neonatal intensive care unit in Oklahoma in 1997 and 1998. The culprit a bacterium, pseudomonas aeruginosa transmitted from under the fingernails of staff attending to those infants.²¹

If you are considering homebirth, this is a safe option for you if you are healthy, if you have a qualified midwife that you trust, and if you have a back-up plan in the rare event of a hospital transport.

At home you are in the perfect birthing atmosphere where you will enjoy privacy and intimacy. You will not be rushed through labor; however, you may find that because of this your labor may be shorter! You will not have unnecessary medical interventions forced on you and you defiantly won't have a cesarean at home. Furthermore, you and your baby are not at risk for developing an infection from the thousands of germs that infest hospitals.