Yesterday reader Becca alerted me to an article in Ms. Magazine from the author of the twitter feed Feminist Hulk. Feminist Hulk is a bit of a feminist icon around the Twitterz, smashing patriarchy 140 characters at a time. What seems to have attracted Becca is the fact that Feminist Hulk had a home birth. Becca asked:
@drisis is it wrong that I now wanna have a home birth if I’m every crazy enough to do it again?
After reading the article in which Feminist Hulk says:
While I value the ways that obstetrical science has made birth safer for women with high-risk pregnancies, mine was a low-risk pregnancy and I was compelled by the many studies that show the midwifery model of care is as safe as hospital birth, often with fewer interventions and post-birth complications. Unfortunately, though Certified Nurse-Midwives legally practice in all 50 states, I gave birth in one of the handful of states which still does not license Certified Professional Midwives. I am active in attempts to push midwifery licensure through our state legislature. I still chose home birth, though, and am so lucky to have labored in an environment that made me feel relaxed and safe, with a birth team that gave me tons of love and support. And for anyone who asks, “What if something goes wrong?” all I have to say is, “Something did go wrong.” I suffered a postpartum hemorrhage and lost about a quart of blood. My birth team responded with speed and skill to stop the bleeding (and they would have transferred me to a hospital without hesitation if they encountered a complication that required additional resources). I owe them my life, and I have nothing but faith in the quality of their care.
Home birth as a way to find a loving supportive environment and fight the enslavement of the patriarchy is absolute, utter nonsense. It’s one of the only medical scenarios I can think of where women place health and welfare in jeopardy in order to feel “in control” and avoid intervention.
Amy Tuteur wrote a great piece in 2009 at Science Based Medicine on the increased neonatal mortality rate associated with home birth. According to 2004 data from the CDC, comparing midwife-assisted births, infants born at home were 3x more likely to die than infants born in a hospital setting. Similar data were discussed in 2010 by Harriet Hall. A meta-analysis of studies of planned home births versus planned hospital births reveals that infants born at home, with a midwife in attendance, are 2x more likely to die than infants born in hospital with an MD or midwife in attendance. That is fascinating given that it is typically the ”lowest risk” women who are advised that they may be good candidates for home birth. Let me say it even more clearly…
Infants born to the lowest risk women at home are 2x more likely to die than a cohort of infants delivered in hospital, which includes some of the highest risk pregnancies.
Apparently these interventions some women try to avoid have some benefit. Even more interesting, up to 37% of home births result in emergency transport to a hospital. But what is the overall neonatal mortality risk? The overall risk of neonatal death is 0.3%, or 3 in 1000 live births. That risk increases to 0.6%, or 6 in 1000 live births, if you deliver at home. As a comparison, the risk of developing cervical cancer, which we are all screened for annually ad speculum, is only 8.1 in 100,000. An increased neonatal mortality of 0.3% represents 12,948 dead babies (based on this). My mind is boggled.
If you can look at those data and still decide that you’re still sufficiently dedicated to your own empowerment to choose home birth, then I say “You go get ‘em, Gloria Steinem!” But, you should know that I’m going to judge you. Choosing to deliver at home because it makes you feel empowerful isn’t a feminist act. It’s a selfish one. It’s no different from the attitudes of the anti-vaccine mothers who choose delayed vaccination schedules, or no vaccines at all, because it makes them feel safe and in control of their children’s well-being. You might feel empowered, but the data tell us that you are hurting your children with your choices. I can think of no other women’s health area – Pap screening, breast cancer treatment, HPV vaccination, in which forgoing a treatment shown to improve health outcomes would be flown on a feminist banner.
Only the choices that affect our children. Because we are powerful women and we know what’s good for us and our children. (snark?)
If feminists care about empowering women during child birth, they should do so in an evidence-based manner. The data demonstrate that the safest place to deliver is in a medical environment. We should be continuing to ask how can we make women feel empowered in an environment that offers the best chance of survival for their offspring. This home birth talk is shenanigans.
And if you still insist on a home birth, you should have to do it as it was truly intended to be done…