I want to immediately make it clear that I support a womans right to choose homebirth. I also maintain that every effort should be made by our society to ensure that women who do choose this route are not inhibited by law or selfish interests.

That said, our discernment about homebirth has become much clearer. There are several practical factors that must be considered which have us almost certainly choosing the hospital route.

We are setting aside the hopital intervention question as it is a seperate issue from the general homebirth safety question. Feeding the hospital intervention information into the queue as if it is relevant is clouding the issue. First off, it presumes that it is near impossible to have a natural delivery in a hopital setting which is simply not true. Everyone knows of people who have done it.

There are several of what I consider to be valid criticisms of almost all of the homebirth safety studies that exist. For example, in one frequently cited study (Johnson & Daviss) even excluding outlying conditions like midwives who try to deliver babies of higher risk (breach, twins etc), we see higher mortality rates in the homebirth group than the hospital group. Second, it is impossible to eliminate bias, as has even been pointed out by midwives

... because the women who choose homebirth tend to have a higher level of education, and higher socioeconomic status, than the general population. These and other traits are also associated with a lower risk of dead or sick babies. Sometimes it's hard to tell whether it is homebirth itself which gets the good results, or the women who choose homebirth.

Third, considering outcomes in other countries pertains to the unique situations that exist in THOSE countries. I have said this in a recent post ... The United States is not the UK. The Netherlands has a lower mortality rate than the United States. They also have high homebirth rates. These are all well and good and show how things SHOULD be in the US, but they are not. Quite simply, for our location, I can see no real evidence that PROVES that homebirth is as safe or safer than hospital birth when including the outcomes of both the mother and the baby.

At best, the studies simply suggest (that is, NOT prove) that under certain conditions home birth is as safe as hospital birth. The evidence is NOT overwhelming and more study needs to be done -- especially in the US where conditions are far from ideal both legally and practically.

Back to those certain conditions -- Every study purporting to show the safety of homebirth generally does so under the following conditions:
- Low risk pregnancies
- Well trained attendants
- Established channels for emergency care

The simple fact is that we do not meet two of these requirements.

Low risk pregnancies: VBAC is not low risk so even using the studies that do exist to make our decision is dubious at best. In fact there is a recent study suggesting that VBAC at home is substantially less safe than in a hospital setting. With the risk of uterine rupture, fetal monitoring is typically required as it is one of the first signs it is going to happen. This type of monitoring is not typically present in your average homebirth situation. Second, uterine rupture can happen quickly and it can be catastropic and result in the death of the mother and the baby.
Established channels for emergency care: Our path to the nearest hospital is not ideal and our nearest hospital is not equipped to deal with the situation we could be bringing them. Our transfer time is anywhere from 20-45 minutes to the nearest hospital. It would be catastrophic to be caught in rush hour traffic with an accident on the interstate for a transfer even with a police escort. Using an ambulance would delay our transfer by as much as 15 minutes (we sadly know this from experience). Accidents on the interstate are NOT uncommon during rush hour. Our two primary paths to the nearest hospital are significantly delayed under that circumstance.

We are an outlying case. In our circumstance we feel it is difficult to justify a decision to homebirth.