How wrong could Jennifer Margulis be here??? Enough not to mention the CMAJ editorial that was raising questions about the study she referred to. But let’s look at why her narrative is so wrong. First, Canada offers universalized medicine which means that prenatal care is readily available and that all mothers are fully monitored throughout their pregnancies. This enables optimization of care and optimal management of mother’s and baby’s health. Only those not at risk or zero risk are directed to at-home birth. Should one be reminded that such care, too often, does not exist in the USA for too many mothers. Therefore, the generalization of this Canadian situation should not generalized to the USA or other countries… Second, the editorial raised an interesting question and clearly identified that these mothers were a highly selected cohort. One should state that “Some people consider it unsafe to give birth anywhere other than a hospital with a consultant unit, while others fear the iatrogenic effects of care given in such settings.” In effect, even women at high risk for complications may choose home birth over hospital birth based on previous traumatic experiences. Safety needs to be considered in the context of geographic isolation as well. Access to maternity care is often limited in rural and remote areas. In Australia, numerous rural and regional maternity services have closed in recent years. The safety of home birth is contingent on readily available transport for emergency transfer to the hospital.
Homebirth has been found to be as safe--or safer--than hospital birth in dozens of scientific studies. Data is helpful. Commonsense matters too. The place where a birthing woman is treated with respect, feels safe and comfortable, and is not starved or dehydrated is going to be the best place for her to have her baby. Maybe that will be at home, in a freestanding birthing center, or in the hospital. Every woman is different. We need to respect all choices and stop bullying pregnant women into thinking they're "high risk" so we can profit more off of them.
