With Travis Pruitt
You might be surprised to learn that Jesus had a "home birth." He was born during the period of history and location where animals stayed in the home. His father Joseph returned to his place of birth for the census and stayed in his family home (‘inn’) (see more here).
In the USA, home birth used to be the way babies came into the world until the 20th century when increasingly hospital births became the norm. Now less than 1% of births are not hospital births. At the same time unfortunately, the USA has the highest infant and maternal mortality rate in the developed world, so the shift to hospitals has not worked out well for everyone. In other advanced countries, there are many more options for giving birth. For example, in Switzerland, mothers can choose homebirth with midwife, birthing house or hospital births.
The history of childbirth, a risky activity, is a rocky one. It is engagingly described by Tina Cassidy in her book, Birth: The Surprising History of How We Are Born. The USA had a brutal history in the early 20th century, when male doctors aggressively pulled babies out of the womb with unwashed hands.
Marsden Wagner, former director of Women's and Children's Health at the World Health Organization, in his 2009 book, Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First, cited Centers for Disease Control reports indicating that 28 countries have lower maternity-mortality rates and 41 countries have lower infant-mortality rates than the USA. He argues that obstetricians are needed only in a minority of cases when medical problems threaten the life of the child or mother. He points out that in countries where midwives attend to birth, infant and maternal mortality are lowest.
Some people argue that maternal and infant mortality rates are much better recently in the USA. But you have to ask what baseline is being used? Typically it is the brutal history mentioned above, when the medical practice of male doctors controlled the experience of mother and baby plus passed germs from not washing hands between seeing patients, leading to high childbed death and infant injury. This is the wrong baseline of course.
Though it cannot be documented by external observers, our hunter-gatherer cousins are reported to have quick and easy births typically with few complications, alone or with an attendant. But they are very lean and extremely physically fit and typically have cultures that do not alienate themselves from their bodies.
Wenda Trevathan (2011) suggests that humanity’s shift to agricultural, settled societies with the poor diet it provides led to worse health and physiological development may have made childbirth more difficult. But that would be for everyone in settled societies around the world.
Yet some doctors argue that studies in the USA show that births here are much more dangerous than in other countries. How can the data be so conflicting? Safe elsewhere but not here? Could it be that American women have become so unhealthy that they routinely have a higher rate of serious medical issues at the time of giving birth? The “Western diet” of white flour, white sugar, high fat leads to health problems wherever it is adopted, but we have had that for some time. What is more recent are the processed foods that dominate many people’s diets today which offer added nutrients but poor nutrition from a holistic sense. There are probably intergenerational effects of all sorts (poor nutrition of grandparents is known to affect grandchildren’s health). But this does not seem like an adequate explanation either.
Like Marsden Wagner, Michael Odent, an obstetrician, argues that women need to be in charge of pregnancy and birth, not males (ironically, they are both men). Odent has an informative website called Wombecology.
Home births are correlated with reduced obstetric interventions like cesarean deliveries and electronic fetal monitoring (Janssen et al., 2002; 2009). During home births, mothers have been found to be less likely to have an epidural be induced or have their labors augmented with oxytocin or prostaglandins during home births (Janssen et al., 2002). But those who have homebirths typically have fewer risk factors to begin with (MacDorman et al., 2012). When it comes to satisfaction, women who have home births often feel more involved in the decision making process and have a more positive birthing experience overall (Hildingsson et al., 2010).
But there are dangers. Known individual health risks and proximity of the home to a hospital should be strongly considered when deciding whether to have a home birth (Keirse, 2010). One study that found increased risk in home births in its preliminary data emphasized that it was more important who was present at the birth than where it took place. They found that additional health risks were substantially reduced when the home birth was supervised by a nurse or midwife (Cheng, 2012). However, see more about risk factors here,
Despite the fact that there are a flurry of criticisms of midwives and home birth in the USA (see comments), these are common practices elsewhere.
Also, increasingly some of the practices used in home birth that comfort the mother, like water tub birthing, are available at some hospitals. In either case, moms need preparation and support to follow the signals of the baby and their body. For an interesting perspective, see this film, Birth as We Know It, on water birth.
Hospital births in the USA too often are traumatic with longterm consequences on mom and baby. This is unacceptable. It is not clear that home births can solve the problem. If home births in the USA are not as safe in other countries that use midwives routinely, we need to figure out another solution.
Why be concerned about birth when concerned with moral development? Because early experience leaves lasting impressions and affects trajectories for worldview, health and social capacities. Many epigenetic effects take place in early life that cannot be reversed (see work of Michael Meaney and colleagues). For compassionate, communal moral capacities to grow, young children need to be wrapped in an envelope of love so that all systems get off to a good start.
Posts in this series:
1. What if Jesus had been born in the USA? Routine Institutionalized Trauma
2. Home birth: Jesus had one
3. What's the Use of Doulas and Midwives?
4. Painkillers for Childbirth? The Few Pros and Many Cons
5. New Moms Need Social Support
Cheng, Y. (2012) Study Weighs Pros, Cons of Home or Hospital Birth HealthDay News
Hildingsson, I., Radestad, I., & Lindgren, H. (2010) Birth Preferences That Deviate from the Norm in Sweden: Planned Home Birth Versus Planned Cesarean Section Birth: Issues in Perinatal Care, 37 (4), 288-295.
Janssen, P. A., Lee, S. K., Ryan, E. M., Etches, D. J., Farquharson, D. F., Peacock, D., and Klein, M. C. (2002) Outcomes of Planned Home Births Versus Planned Hospital Births After Regulation of Midwifery in British Columbia CMAJ: Canadian Medical Association Journal, 166(3), 315.
Janssen, P.A., Saxell, L., Page, L.A., Klein, M.C., Liston, R. M., Lee, & S. K., (2009) Outcomes of Planned Home Birth with Registered Midwife Versus Planned Hospital Birth with Midwife or Physician CMAJ: Canadian Medical Association Journal, 181 (6/7), 377-383.
Keirse, M. J. (2010) Home Birth: Gone Away, Gone Astray, and Here to Stay. Birth: Issues in Perinatal Care, 37 (4), 341-346.
MacDorman, M.F., Mathews, T.J., & Declercq, E. (2012) (2012). Home births in the USA: 1999-2009. NCHS Data Brief, 84. Washington, D.C.: USDHHS, Centers for Disease Control.
For more information on early experience, see new book:
Narvaez, D., Panksepp, J., Schore, A., & Gleason, T. (Eds.) (2013). Evolution, Early Experience and Human Development: From Research to Practice and Policy. New York: Oxford University Press. Blog post about the book here.