Sunday, October 29, 2006

The inherent risks of childbirth: perinatal mortality

We have already seen how natural childbirth advocates grossly underestimate the inherent risks of childbirth to the mother. The inherent risks to the baby are much higher.

Death of babies is measured in several different ways, and it is very important to understand what statistic is being used. Death can be described as intrapartum (during labor), perinatal ("around" the time of birth, which may include stillbirths, deaths during labor, deaths immediately following labor, and deaths up to 7 days after birth), neonatal (during labor and up to 28 days after birth). This is in contrast to infant mortality, which usually measures deaths up to 1 year after birth.

Modern obstetrics has had the biggest impact on deaths of babies in labor, to the point where death in labor is virtually non-existent in first world countries. Indeed, largest share of the risk that homebirth poses to babies appears to be due to deaths in labor. When a complication occurs during labor, immediate delivery (usually C-section) is required. That simply cannot happen at home, and some babies will die as a result.

To understand tremendous risk that labor poses to babies, it is instructive to look at statistics from third world countries where there is limited access to modern obstetrics. Perinatal mortality attributable to complications of childbirth in Matlab, Bangladesh is a study that was specifically designed to look at the death rate of babies due to labor complications, the number of such deaths and the causes. The study found that the overall perinatal mortality rate was 71.4/1000. In other words, 7% of all babies died during labor or in the immediate period thereafter.

The statistics are even more dramatic when you look at the death rates in specific situations. The perinatal death rate for obstructed labor was over 60%! Compare that to a death rate of essential zero for obstructed labor in the US. The death rate from breech presentation was over 20%. In other words twenty percent of all babies who started labor in the breech presentation died, as compared to essentially zero deaths due to breech delivery by C-section in the US. Of the women who developed eclampsia (seizures) during labor, 40% lost their babies. Compare that to the US where eclampsia is almost unheard of.

Around the world, the day of birth is the single most dangerous day of childhood. More deaths occur on the day of birth than on any day in the subsequent 18 years. Birth is not safe because it is natural. Birth in nature is among the most perilous stages of human life. Modern obstetrics has changed all that, but birth has never been, and probably will never be inherently safe. Anyone who tells you otherwise does not know even the most basic facts about childbirth.

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