Starting from the wrong placeOne of the fundamental problems with homebirth advocacy is that homebirth advocates start from the wrong place. Like many Americans, they have little knowledge of history and little knowledge of life outside the first world. They erroneously assume that what they see is the way things are everywhere and the way things have always been. Hence, they assume that childbirth in nature is inherently safe and that is the wrong place to start. The fact is that childbirth in nature is inherently dangerous and anyone who does not know that, does not know much about birth. Since homebirth advocates start from the wrong place, it is not surprising that they draw the wrong conclusions about what they see.
In order to understand where we are, it is critical to understand where we have been. As I often point out, in the last 100 years, modern obstetrics has dropped the neonatal mortality rate 90% and the maternal mortality rate 99%. This is one of the greatest public health achievements of all time. This success is primarily due to the application of technology, large amounts of it. As I have reviewed in the past, it is NOT the result of improved sanitation, hand washing or improved public water supplies.
The primary causes of neonatal mortality 100 years ago were congenital anomalies and prematurity. The primary causes of neonatal mortality now are still congenital anomalies and prematurity. The difference is that technology has allowed us to save almost 90% of babies who would have routinely died in the past. That technology includes more C-sections, fetal monitoring, pediatric surgery, neonatalogy and other highly technological innovations.
The primary causes of maternal mortality 100 years ago were eclampsia, hemorrhage, obstructed labor, and infection. With the exception of obstructed labor, they are still among the primary causes of maternal death. The difference is that technology has allowed us to save 99% of the women who would have died in the past. That technology includes improved anesthesia, more C-sections, induction and early delivery for pre-eclampsia, medication to prevent eclamptic seizures, blood transfusions, antibiotics and other highly technological innovations.
Starting from the assumption that childbirth is inherently safe is absurd. Any attempt to understand, criticize or reform modern obstetrics must start from a basic fact: Each year modern obstetrics saves approximately 240,000 babies and 40,000 women who would NATURALLY die. When contemplating ways to improve the experience of birth, we must start by acknowledging that each year 240,000 babies and 40,000 women will otherwise die unless we bring the technology of modern obstetrics to bear, AND that we still aim to prevent the approximately 22,000 neonatal deaths and almost 400 maternal deaths that do occur each year despite our best efforts.
Childbirth did not "naturally" become as safe as it is now, and it did not magically become as safe as it is now. It became safe and remains safe only because of the diligent efforts of obstetricians, nurse-midwives, nurses, neonatologists and other professionals and the continuing application of large amounts of technology. Now that we have achieved this extraordinary feat, we have the luxury of turning out attention to the "experience" of childbirth, but ONLY while continuing to repeat this achievement each and every year.