The XX Factor

Fun With Statistics, and Other Thoughts on Home Birth

The numbers, as reported by ABC News today , are pretty astonishing: “Using birth certificate data, researchers from the National Center for Health Statistics report they saw a 20 percent rise in home births between 2004 and 2008.” Holy cow! Are labor and delivery rooms emptying out? Are OB-GYNs able to make a living anymore? Only later down in the story do we learn that not all 20 percents are equal. “[H]ome births still account for less than 1 percent of all deliveries” – 0.67 to be exact. In other words, if you take a really small number and increase it by 20 percent, you wind up with … a really small number.

Which is not to say that this isn’t an interesting development. The popularity of home births appears to be due, in great part, to increased interest by non-Hispanic white women , and particularly women with college degrees. In other words, while cost may be an issue for some women choosing home birth, as well as accessibility to hospitals (states like Montana and Alaska have higher rates of home delivery ), the (modest) growth in home births also appears to be due to a broader cultural push toward natural childbirth by a small subset of the American population.

Here’s the part that’s unreported: Many of these home deliveries are being overseen by midwives who are not licensed in their states, and therefore not accountable to the sort of professional regulation that nurses and doctors and other medical professionals are subject to. Why? Because, as I wrote recently in a story about a midwife indicted for involuntary manslaughter in Virginia, “only 27 states currently offer licensing or formal recognition to certified professional midwives, the biggest group of midwives trained to perform home births.” This means that when something goes wrong in a midwife-assisted home birth in one of these nonlicensing states, the only recourse is the legal system – “prosecution rather than regulation,” as Susan Jenkins, legal counsel to The Big Push for Midwives , told me recently. Prosecution is “not only not a very efficient way to protect a consumer, but it’s the most expensive way,” she points out.

The mindset that prevails because of this legal gray zone is “buyer beware.” In one case, in Chicago, about 10 years ago, a midwife who delivered a baby in the breech position was accused by prosecutors of delaying a call to 911 because she feared getting in trouble with the law. The baby died. Whether or not the prosecutors in this case were right, the lack of state licensing does put parents who want home births in untenable positions. The response of the American College of Obstetricians and Gynecologists has been to come out against home birth , most recently by pointing to a study on the dangers of home birth that’s been the subject of some controversy .

This stand-off will not stand. Doctors and midwives and states are going to have to put their heads together and work out some compromises, and this will only become more apparent if, in coming years, home births continue to rise, and .67 percent becomes 1 percent, or more.

Photograph by Hemera/Thinkstock.