What Delaware Senators need to know about home births before they vote on HB 194

HB 194 sounds like its "all for the children" in the synopsis that explains why Delaware just cannot allow women in low-risk pregnancies to have their babies at home, attended by a midwife:

This Legislation aligns the penalty for non-compliance with the non-nurse midwives law and regulations with the penalty for practicing medicine without a license.  It imposes civil and/or criminal penalties for violations of existing law.  The increase in penalties is necessary because people are acting in violation of current law and regulations and as such are exposing mothers and newborn infants to significant risk and harm.

What somebody needs to tell our Senators now that our Representatives have whiffed on this bill by the tune of 39-0 is that it's not true.  That's NOT what the research shows.



As covered by Science Daily, the definitive study of home birth risk versus hospital birth risk was completed in 2009 by the University of British Columbia and published in the Canadian Medical Association Journal:

Sep. 1, 2009 — The risk of infant death following planned home birth attended by a registered midwife does not differ from that of a planned hospital birth, found a study published in CMAJ (Canadian Medical Association Journal). 

The study looked at 2889 home births attended by regulated midwives in British Columbia, Canada, and 4752 planned hospital births attended by the same cohort of midwives compared with 5331 physician-attended births in hospital. Women who planned a home birth had a significantly lower risk of obstetric interventions and adverse outcomes, including augmentation of labour, electronic fetal monitoring, epidural analgesia, assisted vaginal delivery, cesarean section, hemorrhage, and infection.

I read the full study (sorry, I found it in hard copy, but I understand it is available on the net; not sure if it's gated or not) and it is methodologically sound.

More to the point, the items in bold above highlight what many researchers find as being wrong with our hospital maternity systems:

[W]e are in the midst of a maternity care crisis. I’ve said it before, but I’ll say it again: our maternity care system is broken. Why? Because our maternal and fetal mortality rates are worse than 40 other countries worldwide, despite the fact that we spend more money than anyone else on maternity care. And where is  almost all that care being delivered? In hospitals. 

More than thirty percent of all births in the United States are through c-section – a rate twicewhat the World Health Organization identifies as a dangerous level of c-sections. Maternal mortality is actually on the rise — more mothers are dying from childbirth-related causes now than thirty years ago. I could go on, but I’ve said this all before. 

I realize that things which are deemed “new trends” often get attention, despite the fact that we are only talking about a small minority of people. But there is another reason I think this crisis isn’t getting the air time it deserves — it disproportionately affects women of color. Black women are four times more likely to die in childbirth than white women. And remember, these are hospital births we’re talking about here. While CDC data showed an increase in home births from 2004 to 2009, non-Hispanic White women accounted for 90 percent of this increase. Women are dying from childbirth in our hospitals at alarming rates, under the care of obstetricians and nurse midwives. Something is wrong here.

Something is very wrong: look at the comparative stats the Canadian study returned about whether it was safer to let a doctor in a hospital or a midwife in your home handle a low-risk birth:

The mortality rate per 1,000 births was 0.35 in the home birth group, 0.57 in hospital births attended by midwives, and 0.64 among those attended by physicians, according to the study.

Gee, that means the study determined it was almost twice as risky to have your baby in a hospital as to have it at home with a traditional midwife attending.

And lest our legislators be unaware of it, Delaware's infant mortality rate [hospital births] is still horrible.  Our Department of Health and Social Services on its official website brags that our infant mortality rate is dropping:

Infant mortality rates are the rate at which babies die before their first birthday. Delaware’s previous five-year infant mortality rates include:

• 2004-2008: 8.4 per 1,000 live births.

• 2003-2007: 8.6 per 1,000 live births.

• 2002-2006: 8.8 per 1,000 live births.

• 2001-2005: 9.3 per 1,000 live births.

Unfortunately, the website also includes this statistic:

The U.S. infant mortality rate is 6.8 deaths per 1,000 live births.

Uh, let's see--we are happy we got down to 8.4 deaths per 1,000 live births, which is still an embarrassingly large number worse than the national rate.

 It should strike most observers that rather than wasting time persecuting midwives and the people who make the informed choice to use their services, our State government ought to be trying to figure out how to get the infant mortality rate of hospital-born babies down to at least the national average.