On the Recent Homebirth Statistics Fracas
If you’re a reader of Grounded Parents or the Skeptical OB, you’ve likely seen the recent guest post by Jamie Bernstein, Dr. Amy’s responses, and the hundreds of heated, emotional, intelligent, not-so-intelligent, and everything in between comments on both blogs.
Early on, the debate hinged mostly on the interpretation of statistics. I’m not here to re-do anyone’s calculations or to side with one statistical interpretation. Not because I can’t do the calculations (as one of the commenters on the Skeptical OB put it, “Is there NO OTHER Skepchick who can math?”) Yes, lots of us can math. For real. But while I would consider myself relatively knowledgeable about life science and genomic data and am really into crunching those types of numbers, I have the wisdom to know that my unrelated profession/hobby, while really science-y, does not make me an Obstetrician, social scientist, or statistical expert.
To paraphrase Jamie’s stance, the relative risk of death from homebirth for low-risk mothers is very small, and the sample sizes too minute to derive a meaningful comparison to hospital births. Essentially, the cohorts are not fairly comparable. Dr. Amy asserts in her typical, callous way that her analysis is correct, and that the absolute risk of death at homebirth is manyfold higher than at hospital birth. Several commenters vehemently contend that one or the other is being a grossly misleading jerk. I stopped reading the comments early on for fear of the quicksand/whirlpool/quagmire that frenzied comment sections can become.
Dr. Amy asked Jamie to correct her math, and for Grounded Parents to apologize. While Jamie did revise her error, I am not going to comment on whether or not she did it correctly. I will say that Skepchick Network is not a hive mind, and therefore none of us can apologize on anyone’s behalf regardless of our stances on the topic. It has been made clear in both the comments and the back channels that we have differing notions on this and most issues.That said, I would like to address Dr. Amy and her readers, and Grounded Parents readers directly. Why not just add a comment to the threads? Because I have been an avid Skeptical OB follower since after my daughter was born. I also love writing for Grounded Parents. The dissonance is interfering with my ability to sleep, so this is an endeavor of catharsis.
Here goes. I am a staunch opponent of anecdata. I’m also a lover or Walt Whitman, so I’m going to go ahead and contradict myself by responding emotionally with my story.
I am almost certain that the beautiful baby girl in the picture above, my firstborn, would have perished or been left with dire health consequences if I had attempted a home birth. I was perfectly healthy, in good physical shape, exercised often, and was as low-risk as they get. My water broke on the due date before contractions started, and so we attempted in vain to rest, and finally headed to the hospital. After waiting for 8ish hours with nary a Braxton-hicks in sight, we decided on a Pitocin induction. After stalling out at 4 cm, I got a wonderful epidural and dilated to 10. By this time, it was almost seventeen hours after membrane rupture. For me, pushing was so much more painful than any of the contractions, and the epidural was no longer helping. I continued to push, and it was absolutely excruciating. In the meantime, my temp started rising. After almost two hours of this, baby had barely budged, and was showing signs of fetal distress. I was a wreck. Maybe I’m weak, but I thought I was going to die. At this point, my doctor strongly advised a forceps delivery, and I agreed. To this day, my husband recounts his horror at seeing the size of the evil, gleaming, claw-like forceps. Let me tell you, no epidural could block out that level of pain. As I screamed bloody murder, my angelic nurse told me to get myself the hell together. With a push from me and the skilled surgeon wielding the forceps, my daughter emerged into the world (with barely a scratch on her head) and directly to a massive team of medical professionals. My first sight of her is forever etched in my mind. Her nostrils were triangular. Her hair was thick and black. She had a double nuchal cord and a true knot. It turns out I was unknowingly pushing with little to no slack in her cord. I was so traumatized by the pain that, in that moment, I barely wanted to look at her. Perhaps the awful birth experience contributed greatly to my postpartum OCD/anxiety/blues amalgam (along with my predisposition to this type of thing). Still, we bonded fine, I breastfed her for 14 months, and, for now, we are the loves of each others lives. She loves to hear the story of the doctor pulling her out of mommy in a moment of adventure and chaos, while her little brother was simply pushed into the world with relative ease. I wouldn’t have had it any other way.
Maybe a stronger version of myself in another universe was more successful and pushed her out at home with a midwife, and that version of baby A was fine. In yet another universe, I attempted a home birth, I couldn’t push her out, and she didn’t survive the hospital transfer. Who knows? I do know that in comparison, my second delivery was a piece of cake à la mode. Baby J would have been fine at a home birth, although I would have dearly missed out on the wonderful care we received at the hospital for the next two days, as well as a decent epidural, among other things.
So back to the conflict at hand. Maybe the sample sizes skew interpretations. Yes, there are myriad factors that confound the numbers. I have no doubt that Jamie Bernstein is being as objective as she can, and that her heart is in the right place. And perhaps, as Jamie says, Dr. Amy is “calculating relative risk by using two completely non-comparable data sources in order to scare readers away from homebirths.” I’m remaining agnostic on this, and not because anyone is compelling me to. I will say that Dr. Amy is one SOB. Her harsh persona was arguably a necessary evil to thrust a previously under-visible issue into the spotlight. Some say that she’s too harsh, even insensitive and cruel. I agree, I don’t always like her tone, and feel that at this point, her less-than-kind front undermines her message (and I say “front” because I don’t think she’s a mean person). Nonetheless, I admire her devotion in trying to prevent the suffering caused by even one more unnecessary homebirth death. Because when someone’s baby dies at home, those parents don’t feel like a data point. I have no doubt that Dr. Amy’s heart is in the right place and that her motives are transparent.
Confounding factors aside, if you’re a risk-averse individual like me, then go with a hospital birth. Not because Dr. Amy says it’s safer. Not even because the data suggests it might be a little bit safer. But because even if you’re low-risk, something could go wrong. And if it does, data and statistics aside, you’ll 100% want to be at a hospital. If you’re not extremely risk-averse, and you want a birth experience in the comfort and familiar environment of your own home, that is totally up to you. You’re an autonomous, sensible individual, capable of making your own informed decisions. Until, of course, you have a newborn.
All images, © 2014 Kavin Senapathy