Saturday, July 29, 2006

The luxury of homebirth advocacy

It is no coincidence that homebirth advocacy and natural childbirth advocacy exist almost exclusively in countries with very low neonatal and maternal mortality rates. That's not a coincidence. Most homebirth and natural childbirth advocates tend to forget that worrying about an empowering birth experience is a luxury that was created by the spectacular success of modern obstetrics. Prior to that, most women worried about dying in childbirth or the even more likely prospect that their baby would die during birth or in the first day of life.

That luxury does not exist in the developing world. In some parts of the world, the lifetime risk of a woman dying from childbirth is 1 in 8. That is probably relatively close to what the risk of death from childbirth was prior to the advent of modern obstetrics. Think for a moment about what that means. Among a group of 8 young girls in tribe or settlement, 1 of the 8 would likely die in childbirth or of a childbirth related complication like postpartum hemorrhage. In contrast, the lifetime risk of maternal mortality in the US is approximately 1 in 2500.

One of the most irresponsible claims of the homebirth movement and the natural childbirth movement is that childbirth is not very dangerous at all, that "women's bodies have perfect knowledge of how to give birth." The fact that this claim is false and displays a stunning lack of understanding about childbirth is not a reason not to have a homebirth or natural childbirth. However, it does show a remarkable lack of gratitude to the people who make such things possible, the obstetricians who developed modern obstetrics and the obstetricians who practice today.

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