Misadventures with Homebirths

~ Laura

I have two home-birthing-gone-wrong stories this morning. Amy P sent me a story of a midwife who asked her Facebook friends for help DURING a birth. And a terrible story of a mother’s regret about homebirthing.

I had a horrific birthing story with my oldest. And it was in a hospital. If I was homebirthing him, we would both be dead.

I had no clue that I was going to face those difficulties. I come from hardy immigrant stock. The type who squatted in the field, popped out their fifteenth kid, and carried on with the day’s business. I didn’t even read the C-Section chapters of the birthing books. Be careful, people. Birthing is dangerous business.

Homebirthing is regulated in a number of states. In many states, midwives have to work within a couple of miles of a hospital. Hmmm. Maybe I should do a public policy piece on midwifery. My aunt is the former president of the American Midwife Association.

Published by Laura

41 thoughts on “Misadventures with Homebirths”

  1. Careful not to conflate midwifery with homebirths gone awry. Dare I say, don’t throw the baby out with the bathwater?

    Midwives are regulated in some provinces here in Canada and work in hospitals with doctors – you can choose if you want a doctor or a midwife. And the doctors are nearby should they be required.

    The huge benefits of midwifery and slowing down the medicalization of childbirth (for low risk births of course) are a separate issue from home births.

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    1. I too was once caught up in the alt med woo that childbirth was too “medicalized” and there were too many “interventions”. It’s very appealing emotionally. It reminds me a lot of HIV denialism, in that it shares the same idealization of nature in which there is this idea that most health problems are caused by human actions that interfere with the “natural” state of the body. In the case of AIDS, it’s lifestyle, not a virus. In the case of childbirth, issues are attributed to “interventions” rather than inherent risks.

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    2. In the US, we have the problem that while CNMs (certified nurse midwives) are highly-trained professionals who can work in hospitals, there’s also the far shadier CPM (certified professional midwife) credential. They don’t need to be nurses, they don’t need an actual college degree, they don’t have the right to work in hospitals, and they bring pretty much nothing to the table in terms of medical knowledge or making childbirth safer. I believe the CPM credential is no longer recognized in Canada.

      A friend of friends had a birth center birth a year or so ago and (in a nosy moment) I looked up the staff. There wasn’t a single nurse midwife in the entire building–it was all either CPMs or apprentices.

      Homebirth midwives in the US almost never have malpractice insurance and they often have no relationship with a hospital and no back-up OB. They are cowboys.

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  2. I am definitely pre-disposed to thinking that everyone would be safer in a hospital setting. But, I suspect the data will actually break down differently, with there being minor differences, if only a particular group of low risk women: no primapara, no complications, no risk factors) opt for homebirth, and are properly advised in doing so. The cite for this impression is a Canadian study from British Columbia: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2742137/. In that study, the risk of a variety of poor outcomes (including death of the child — I’m not finding good statistics on maternal death rates, but they seem even lower) were comparable in planned home/hospital births.

    The current data from the US, comparing low risk populations suggests a risk of around 0.7/1000 for low risk women in hospitals and 2/1000 for home births. That sounds like a lot, except that the risk of amnio, which many women choose (or at least chose, before other tests for detecting genetic abnormalities appeared), is 2-5/1000. (These numbers reported in a scientific meeting, and the details matter).

    I think we need better regulation and monitoring of home births (which, of course, is what some of the people engaging in the practice *don’t* want), but I think with better regulation (Canada, some parts of Europe), that the risk differences may justify letting the pregnant woman make the decision (i.e. maybe a greater risk, but we are not always required to make the least risk averse choice). I do think we need more data, though, and would never personally have chosen a homebirth (but, of course, I also had all kinds of intervention, which I was perfectly comfortable with).

    (and anecdotes of specific situations are problematic, as they are in cancer screening, where anecdotes can lead you in the wrong direction for public health policy).

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    1. There are also birthing centers, which allow for more of a home birth environment with certified midwives, but they’re attached to hospitals so help is seconds away if necessary. They seem to be the best of both worlds for low-risk births. I know they’re popular in the Netherlands and other parts of Europe. I had a friend who had a birth in one in the US, so they might be spreading here too. When I have kids I’m hoping for a drug free birth “natural” birth* but I definitely want to be in a place where if things get real I can get immediate treatment. The increasing c-section trend is a bit worrying to me, and I don’t want to be a in a place where they push women towards c-sections if labor is taking awhile or it fits in the doctor’s schedule.

      *I don’t like this term, because any birth is natural

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      1. “The increasing c-section trend is a bit worrying to me, and I don’t want to be a in a place where they push women towards c-sections if labor is taking awhile or it fits in the doctor’s schedule.”

        If you have concerns, I suggest hanging out a bit at http://www.skepticalob.com. Dr. Amy Tuteur’s heavy posting schedule can be repetitive and a bit harsh, but the posters in the comments are very well-informed–you have OBs, CNMs, RNs, a vet or two, a cattle rancher, and a lot of other well-informed people.

        The rise in c-sections is not actually a huge big deal, with women having few children late in life. Also, it is what we should expect with an older and a fatter and unhealthier cohort of mothers. There’s a lot of mythology surrounding c-sections.

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      3. The birthing centers in Netherlands are staffed by RN midwives, and I think also obstetricians, as was the birthing center my friend (a European) went to in the US. I would definitely not go to a birthing center not attached to a hospital or without certified medical personnel. I agree that c-sections are on the whole an enormous good, and I would far rather have a c-section than an adverse outcome, no question. I would far rather have a traumatic birth experience with a good outcome for mother and child than want birth to be empowering and have a negative outcome. Except it’s not just anti-science people who have pointed out that c-section rates are increasing for reasons other than absolute need. Atul Gawande had a great article in the New Yorker awhile back about this. The WHO also has noted this. In some countries c-section rates are at or above 50%, and our has sky-rocketed even controlling for health of the mother. I would say there’s more going on there than simply need. A lot of the rise in home birth is frustration at the medical system not listening to women’s needs, and lots of women turn to risky or unsafe home births where a more flexible medical system would allow them to stay in a hospital setting.

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  3. Although I see the analogy, of rejecting intervention on the assumption that natural is better (I would have used the analogy of vaccines), it is also true that sometimes intervention can cause real risks and costs. I am personally convinced of this concern in universal breast cancer screening with mammograms (and, further think that a combination of cognitive bias and entrenched interests — mamograms are a big business) keep the practice in place when it’s of dubious medical value for many women.

    I *don’t* think the data is going to play out that way for home/hospital births, but it is not a theoretical impossibility.

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  4. Having lost my daughter in a Toronto-area hospital for a variety of screw-up reasons including a desire on both a nurse’s and my part to “avoid interventions” this issue hits pretty home for me. (I basically had a disastrous homebirth in a hospital.) I should note that a good midwife would have done a better job, in the same hospital, so I am not anti-midwife…where midwives are trained to behave like medical professionals, and not like vanguards against the patriarchy.

    I’ve been personally into this issue for the decade since. I think this is pretty classic treating women’s health as a lifestyle/moral issue over proper risk management, for the people who agitate against interventions. “Don’t go to the hospital with chest pain in case they do a bypass. Monitor at home.” You just don’t hear it. And yet studies have shown that up to 1/3 of bypasses may be unnecessary. But the results if you don’t have one when you need one can be catastrophic. Everyone gets that.

    My daughter’s brain and other organ damage was catastrophic…and had it been slightly less, we would be raising a child with profound disabilities right now. So why are c-sections under such attack as if “too many” means “none should happen.” If 9/10 c-sections weren’t actually necessary but we don’t know how to tell which ones were, are we willing to lose 1/100 babies to not doing them? 1/10? 1/500? The homebirth advocates make it sound like if 90% of c-sections were unnecessary (not a real stat) then OH NO, but they don’t talk about _how we could tell_.

    Also, why is “the answer” to opt out of the hospital entirely rather than as a society address the hospital practices? Because women’s pain and risk in childbirth is seen as natural and in a sense taking charge is something that strong women do to have a great start to parenting?

    The problem in evaluating the choice for individual women is understanding “low-risk.” Midwives in the US in particular don’t want to transfer care. A single midwife making observations is not the same as multiple eyes on a healthy medical team, catching situations before they become critical. A woman in labour does not necessarily want to switch locations to the hospital. (Also, a few minutes away is really 30 if you think of getting that woman up, into a car or ambulance, and triaged.) And the risks are usually presented as:

    Weight the small risk of a terrible birth injury to
    The larger risk of having a c-section.

    But the c-section is just a surgical procedure. Of course it’s major, but the actual risk is “a serious complication to a c-section.”

    Anyways this is a ridiculously long comment. Where I am with it is I think women need to understand the actual risks, and for that they probably need to talk to women like me.

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    2. Deeply sorry for your loss. It is impossible to imagine, when you haven’t been through it yourself.

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  5. So we had both (one in the hospital and two at home), and got three great kids out of the deal. Some factors from this little bit of anecdata:
    In Germany, midwifery is part of the overall maternal health system and is carefully regulated. (Of course pretty much everything in Germany is regulated, but that’s another story.) In fact, the usual career path for midwives is to start in a hospital and gain experience, and then move to work with a birth center or have an independent practice. Our midwife had about a quarter century experience delivering babies, and boy howdy you could tell.
    All of the important facts from prenatal care are kept in what is basically a logbook, with entries from the medical personnel at each prenatal checkup, ultrasound, whatever. The midwife went over the book more carefully than any other medical professional in the whole process, and found things that the others had overlooked. Some of that will be experience, but a good part will also be the culture/training of the occupation. “Give your complete and undivided attention to the woman you are working with until any and all issues are resolved” is in too short a supply in many places; with our midwife it wasn’t. Regulation probably also plays a significant role.
    One thing that won’t scale, but did play a role in our decision was that our apartment was very close to a sprawling hospital. In fact, it’s entirely possible that our place (outside the grounds) was closer to an intensive-care unit than the maternity ward (inside the grounds).
    Home births are not for everyone, but it was good to have the option, and better still to have the option supported by the system.

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    1. US homebirth midwives likely differ from German ones in a number of different ways. Just to start with:

      1) They are often trained via apprenticeships and online. They can get the CPM (the phony baloney homebirth credential of choice) and hang out their shingle after attending a few dozen births, hence they are often both inexperienced and overconfident.

      2. They aren’t connected to the official medical system, so transfers are often late and catastrophic.

      3. They lie, both to patients and to the hospitals they transfer to in order to cover up negligence.

      4. There’s a lot of use of very iffy herbal preparations, few or none of which have undergone FDA testing.

      5. They fearmonger about the risks of hospital delivery and c-section.

      6. They take on high risk deliveries–twins, breech, large babies, gestational diabetes, former c-section patients, etc.

      5. They encourage patients to skip normal medical procedures: ultrasounds, antibiotics for Group B Strep, testing for gestational diabetes, eye goop to prevent babies from being blinded by herpes, Vitamin K shots that prevent babies’ hemorrhaging.

      I don’t know if Germans are into waterbirth, but US homebirth midwives also encourage water births, which are more and more associated with adverse outcomes.

      http://www.today.com/health/tubs-ok-labor-not-birth-docs-advise-2D79404932

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  6. Put me in that same camp of “thought childbirth would be simple but instead it involved heavy medical intervention and nearly a week in the NICU.” If we had attempted a home birth, neither my son nor i would have survived.

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  7. I’m feeling a certain degree of frustration at the homebirth stories of people who had significant contraindications to home birth (the twitter link is someone who was tying a VBAC, while also having a second child in a short delay, which is known to convey higher risk in a hospital setting, let alone home birth — chances of uterine rupture on the order of 1/200, another story I heard was a 45 year old primapara) are being used to generally argue against homebirths and midwifery, all while we are seeing a significant increase in c-sections in hospitals (1/3 of births, now in the US, significantly higher than in a decade ago).

    My frustration stems from the unwillingness to understand the probabilities (like “Why would I be the 1/200”) or a belief that something irrelevant to outcomes (my hair isn’t even gray or I can run marathons) will mean that “I” won’t be the one with the poor outcome. The Amy Klein series on conceiving after 40 shared the same flaws (the belief that she, at 40, was somehow going to escape the age-related decline in egg quality, because, she felt so young) and in the mamography article in the NYTimes yesterday (some set of cancers might be overtreated, but we can only tell by probabilities — that article ended with the assumption that there would be some test in the future that would tell us who). In fact, probabilities can just be probabilities. It could be that 1/20 people will suffer some consequence, and there’s no way to tell who it will be. Sometimes probabilities result from not knowing the deterministic properties, but sometimes, randomness is the controlling factor.

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    1. bj said:

      “I’m feeling a certain degree of frustration at the homebirth stories of people who had significant contraindications to home birth (the twitter link is someone who was tying a VBAC, while also having a second child in a short delay, which is known to convey higher risk in a hospital setting, let alone home birth — chances of uterine rupture on the order of 1/200, another story I heard was a 45 year old primapara) are being used to generally argue against homebirths and midwifery, all while we are seeing a significant increase in c-sections in hospitals (1/3 of births, now in the US, significantly higher than in a decade ago).”

      Those high risk homebirth attempts are not anomalies, but reflect the risk blindness of US homebirth midwives and their drive to achieve unmedicated vaginal birth at any cost. That kind of risk taking is actually very characteristic of homebirth midwifery in the US.

      There’s also a strong flavor of woo in the homebirth community and among midwives generally, even, unfortunately among nurse midwives (who are the actual educated US midwives). Some midwives will, for instance, tell Group B Strep positive women to use garlic suppositories before delivery at home, instead of doing a hospital delivery with antibiotics, which is the standard procedure.

      Here’s a story of a family that lost their baby to the combination of Group B Strep and homebirth:

      http://hurtbyhomebirth.blogspot.com/2011/03/wrens-story-on-1st-anniversary-of-his.html

      This one hits really close for me, because I’ve always been Group B Strep positive, and until my last pregnancy, I had no idea how dangerous Group B Strep is for newborns.

      There’s a huge problem in the financial incentives. Homebirth midwives only make money when women have homebirths (which only about 1% of US women do), while OB/GYNs have a lot of different services that they provide, and are almost always busy, busy, busy. Meanwhile, a homebirth midwife might consider herself highly experienced after attending only 300 births (meanwhile, an OB/GYN might easily deliver 10X as many), and any particular patient will be a large chunk of her yearly income. There’s a strong incentive for homebirth midwives to encourage women to engage in unsafe practices. Likewise, because homebirth midwives insist on payment before delivery, there’s a lot of pressure on homebirth patients to continue with an unsafe home delivery. If a woman starts a homebirth but then transfers, her family faces double charges–they’ve already paid the midwife, and they’re going to have to pay the hospital.

      I suggest hanging out at the Skeptical OB. Dr. Amy Tuteur can be kind of harsh, but her commentors are extremely well-informed and interesting with a variety of different backgrounds (former homebirthers, loss mothers, OBs, CNMs, doulas, a dairy farmer, a vet or two) and I think they’re your kind of people.

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  8. So why are c-sections under such attack as if “too many” means “none should happen.” If 9/10 c-sections weren’t actually necessary but we don’t know how to tell which ones were, are we willing to lose 1/100 babies to not doing them? 1/10? 1/500? The homebirth advocates make it sound like if 90% of c-sections were unnecessary (not a real stat) then OH NO, but they don’t talk about _how we could tell_.

    There is, actually, a pretty good answer to how we could tell. If you look at page five of this WHO report, it states that there’s no statistical improvement in outcomes for mothers and infants for caesarean rates over 10-15%. What that means, as far as I can tell, is that the practices used in countries with rates in that 10-15% range for identifying who needs a caesarian are just as good as the practices here at identifying who does need a caesarian, but much better at identifying who doesn’t.

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    1. In the NY Times mammogram article, the reporter makes the argument, a valid one to some extent (and, more valid in the mammogram case, where the control population isn’t another country that does things differently), that a statistic alone doesn’t tell us *which* mammograms are the over treated ones.

      Having a control population — other countries — does help in trying to identify which elements (practices, risk factors, . . . .) underlie the difference, and could help in pointing towards identifying which c-sections are unnecessary (I think the mammogram issue is going to be more complicated, ’cause I think there’s some real randomness there) . One practice, that the medical groups have recently issued a directive on, is to allow women a longer time in labor before intervening, especially with those having their first babies.

      I also think bringing more of the comforts of home to the hospital setting would help those who chose home births not as a strike against the patriarchy but because they just want to be at home. I had a view, birthing tub, but didn’t have a big bed or the ability to have my other child come and stay with us — which I wouldn’t have wanted before birth, but would have liked after my son was born. I’d also have liked room service. And I liked other people cleaning up the messes and the access to medical care (And, I unlike L&L was someone who had a complicated pregnancy that resolved into an easy birth. My doctor was surprised each time. It was cute in a good way — there was a backup team ready to deal with complications, and then, nothing was necessary and she, a primary care physician, got to deliver the baby, which she got a kick out of)

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    2. In very low-resource environments, one of the dangers of c-sections is that a mother may not have ready access to a repeat c-section for subsequent pregnancies. I’m a big fan of Jeevan Kuruvilla (jeevankuruvilla.blogspot.com) and a typical situation that they have to deal with in their rural Indian hospital is when a woman who had previously had a c-section comes in with a ruptured uterus and perhaps a dead baby after laboring at home because no one thought to tell the family that she should not attempt any further births at home. Or maybe they were told, but the family ignored the advice either because of poverty or because they didn’t care one way or another if the woman lived or died. If the woman is carrying a baby girl, there’s a particularly high chance that the family will not take a lot of trouble with ensuring a safe delivery.

      Sadly, homebirth after c-section (HBAC) is a major category of US homebirths.

      Here’s a rah rah piece on HBAC:

      http://www.midwiferytoday.com/articles/homebirthaftercesarean.asp

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    3. One of the concerns that OBs have about vaginal birth is pelvic floor damage. Interestingly, over at Skeptical OB, I’ve seen one of the UK posters say that when you add in the risk of pelvic floor damage, CS are just barely more expensive than vaginal deliveries. (This is one of those things it might have been nice to know before having a 10+ pound baby.)

      There are populations that have real concerns about c-sections. On a Catholic forum that I hang out at, one of the predictable issues is the problem of the 4+ c-section mom. At some point, there’s often not a lot of uterus left to work with and further pregnancies are going to be potentially fatal for both mother and baby. In that setting and with other mothers who are planning large families, there’s something to be said for a little more patience.

      Out in the general population, if a woman is older and is only going to manage to have 2 or 3 kids at the very most, a c-section is really not a big deal.

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    4. And just beyond the stats, it really doesn’t matter if you are the one who had the bad call on the c-section.

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  9. a statistic alone doesn’t tell us *which* mammograms are the over treated ones.

    Right. But in the case of one country versus another (if you take as a base assumption that Americans aren’t significantly different in their ability to give birth vaginally than people in other developed countries, which is I think much more plausible than the alternative), you have evidence that doctors in those other countries have diagnostic standards and practices that do let them sort out at least a large fraction of the medically unnecessary c-sections.

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    1. if you take as a base assumption that Americans aren’t significantly different in their ability to give birth vaginally than people in other developed countries, which is I think much more plausible than the alternative

      When you assume, you make a vagina of you and me.

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    2. Yes, I agree.

      The mammogram data is based on screen/no screen populations so isn’t as amenable to the same kind of analysis. And, in the case of mammograms, it’s a real possibility that one can’t figure out which those are, so in the end, it’s a choice about playing the odds, odds that it might be reasonable to play, maybe as an individual or maybe as a matter of public policy.

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    3. elizardbreath said:

      “if you take as a base assumption that Americans aren’t significantly different in their ability to give birth vaginally than people in other developed countries, which is I think much more plausible than the alternative”

      Unfortunately, there tends to be an inverse relationship between c-sections and instrumental deliveries (forceps and vacuum). The rise in c-sections reflects a decline in forceps deliveries, which is, I think, a very, very good thing.

      http://abcnews.go.com/Health/texas-family-alleges-forceps-delivery-crushed-babys-skull/story?id=21410615

      The US is actually not a leader in c-sections. At least going off of the numbers in Wikipedia, the world leader is China, with a 46% c-section rate. The US has a rate in the low 30s, while Wikipedia says UK has 24%, Ireland 26%, Canada 26% and Australia 31%. There’s nothing ridiculous about the US rate compared to other similar countries.

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      3. Yes, in China doctors make much more from c-sections, so it’s a giant financial racket. I’ve researched birthing in China and it’s turned me off from wanting to do it myself. Plus, women generally only have 1-2 children and they want each one to be “perfect,” so there’s little incentive to avoid them. I know multiple healthy, fit young mothers with c-section scars. Not that a healthy 22 YO doesn’t ever need a c-section, but in a group of 10+ you’d assume there would be at least 1 vaginal birth.

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      4. I’ve wondered whether the preference for c-sections in some other countries isn’t due to unavailability of appropriate pain relief for vaginal birth.

        I wonder how easy it is to get an epidural in China?

        For whatever reason, the Netherlands don’t actually have great outcomes for perinatal mortality compared to other European countries.

        http://www.ncbi.nlm.nih.gov/pubmed/23582517

        “Perinatal mortality in Netherlands third worst in Europe”

        http://www.bmj.com/content/337/bmj.a3118

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      5. They do mention concern about pain relief as one of the issues favoring c-sections, in the paper on the China c-section rates.

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      6. bj said:

        “They do mention concern about pain relief as one of the issues favoring c-sections, in the paper on the China c-section rates.”

        Aha! I knew they weren’t doing it for no reason at all.

        It’s actually surprisingly difficult to get adequate anesthesia for childbirth in much of the world. That’s one of the things that the US should be very proud of–we’re actually really good at providing effective anesthesia for laboring mothers. Even a very comparable developed country like the UK is much stingier about epidurals than the US.

        http://babyandbump.momtastic.com/pregnancy-third-trimester/644570-epidurals-uk-vs-usa.html

        http://www.mumsnet.com/Talk/childbirth/1147361-Anyone-else-tricked-out-of-epidural/AllOnOnePage

        From a 2006 British news story:

        “Women having babies in NHS hospitals should pay for epidural injections unless there is a medical need for them, leading midwives said yesterday. The treatment costs up to £500 in private maternity hospitals, and a fifth of pregnant women in the UK have it to help ease the pain of childbirth. But the education and research committee of the Royal College of Midwives council says too many women have epidurals and thinks charging for them may reduce the number given.”

        http://www.telegraph.co.uk/news/uknews/1511243/Charge-women-for-needless-NHS-epidurals-say-midwives.html

        Gah.

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  10. I was just over at Skeptical OB, and theadequatemother (the British Columbian anesthesiologist and excellent medical blogger) wrote this in one of the threads comparing the difference between an early and a late c-section:

    “FYI transfer early in obstructed labour = family friendly cs. One Iv, spinal, dad in the room. Easy peasy. APGARs of 8 and 9 or 9 and 9. I take pictures with parents and infant. Everyone cuddles. Baby (generally) stays with mom in recovery for more cuddles and breastfeeding if desired.

    “transfer late in obstructed labour (say oh, 4 days) = sh*t show cs. Two very large IVs + an arterial line. Blood in the room or the OR fridge. extra nurses. Anesthesia assistant. Dad likely asked to leave as soon as baby is out or not allowed in the room at all bc of likely complications or because we deem it better to start with GA. APGARS of 6ish. Neonatal resusc. Hemorrhage. rapid infuser. conversion to GA if under spinal. 24-48 hours in the ICU, sedated and ventilated. Baby in nursery. Early moments missed. No birth pictures.”

    http://www.skepticalob.com/2014/04/attendant-crowdsourcing-another-homebirth-disaster-in-progress.html

    The adequatemother blogs here (although she hasn’t done much lately due to new baby):

    http://theadequatemother.wordpress.com/

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    1. From that piece:

      “The average C-section rate for countries with low maternal and neonatal mortality is 22%, although rates as high as 36% are consistent with low rates of maternal and neonatal mortality.”

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  12. I don’t know that giving birth at home is regulated in any state (if the baby’s coming out, it’s coming out wherever the mom happens to be, parking lot, hospital, or house) But medical professionals attending a birth in a home setting are regulated in some states. As someone who has experienced a precipitous labor (a labor that is less than three hours long), I’ll probably choose a homebirth for my next child. (I’d much rather plan on having the kid at home than have a very significant risk of having the kid on the way to the hospital).

    In my state, CPMs are ‘alegal’. Their licensure is not recognized by the state, but there aren’t any laws saying they cannot practice. As a consumer, this makes me uncomfortable.

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    1. Try and see if you can find a CNM with actual malpractice insurance. I wouldn’t be comfortable with less than a million dollars in coverage.

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      1. The CNMs are around (they collaborate with the CPMs). The malpractice insurance is not. Out-of-
        hospital birth (even with a CNM) is not covered by some of the biggest insurance companies, so there’s huge incentive to keep costs down when your clients are paying out of pocket.

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      2. In the case of any serious injury to you and/or the baby, malpractice insurance is really important. With a brain injury, a million dollars would be used up surprisingly quickly on extra care and therapy.

        Unfortunately, homebirth midwives do deliver more brain damaged babies.

        http://www.skepticalob.com/2014/04/how-babies-brains-get-injured-during-childbirth.html

        If I were you, I’d talk to an OB about her thoughts on your situation and perhaps getting an early induction. I know that the hospitals have of late gotten very strict about 39 weeks, but it may be possible to reach some kind of arrangement.

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      3. I would take the lack of malpractice insurance as a huge red flag for the entire concept of homebirth. Insurance companies exist to make money. They insure all sorts of medical procedures. If they aren’t willing to issue insurance for homebirths, it’s a sign the risks of bad things happening are really large.

        If the outcomes for home births were better on the whole, they would be pushing measures to encourage home births. They aren’t.

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