Although my thinking was still, well, ‘bottom line is that hospital births are probably safer’ I decided that given NHS advice and the reassurance of our midwives and, most importantly, the wishes of my girlfriend, I wouldn’t interfere. Even if something did go wrong an ambulance could still get us to hospital in 15 minutes, just as if something had gone wrong in hospital it’s not like the woman can instantly go into surgery anyway.

The midwives who came to our house were both NHS trained, and went well above and beyond their remit in the service they provided. What struck me the most was that because we were at home my girlfriend was much more relaxed than she (probably) would have been in a more medicalised environment and as such her adrenaline levels stayed low. I’m no expert here, but as we were told higher adrenaline levels interfere with the body’s production of endorphins which in turns raises the chances for medical interventions, which in turns raises the chances for a c-section – correct me if i’m wrong on this.

To cut a long story short the baby was born without any interventions beyond gas and air, and there was no tearing afterwards. Importantly it was a happy experience for all involved and whatever risk was taken by having a home birth *seemed* outweighed by its tremendous physical and mental benefits. Also if you don’t want a home birth but the mother does, then discuss the situation but ffs let the mother decide! Having seen what they go through it’s really not a man’s place to dictate how a woman should experience birth.

I’m about as far away from an anti-science, anti-vaccination type idiot as you can get, and i’m certainly not anti-hospital birth. However I thought I’d throw my own anecdote onto the pile just for the record.

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Actually, yes, they do. That’s exactly the nature of the evidence that we’re discussing: in the event of complications, where are the better outcomes? And my point is now and has always been that the better outcomes are at a hospital.

You are making the point that complications are uncommon. I have acknowledged your point repeatedly. I just don’t think that the fact that complications are uncommon completely negates the fact that in the event of complications, a pregnant woman is better off in a hospital than at home.

Your original point was that safety should not carry much weight, because complications are unlikely. I think that is a reckless attitude to take.

You criticized the choice of home births based on evidence that hospital births are safer. My comment about practical significance applies to that criticism and nothing else.

You refuted my comment using hypothetical anecdotes of specific cases in which only one factor matters, whereas the data discussed in the SBM post are very, very general and averaged across many other factors, which is exactly the point I made and defended.

This is the statement I am trying to support: “In the unlikely event that something goes wrong, you are unambiguously better off at a hospital.”

I had no intention of arguing this point and I don’t doubt that it is likely true, but you have presented NO evidence to support this statement thus far. The CDC data do not provide information that would allow you or anyone else to determine the effects of complications at birth and anecdotes, “what if” statements, and “it’s a no-brainer” are not evidence.

I am not trying to support the statement you think I am trying to support. This is the statement I am trying to support: “In the unlikely event that something goes wrong, you are unambiguously better off at a hospital.”

It is clear from an even cursory reading of anything that I have written on this that the statement you are making is not what I am trying to support.

This is not in doubt or questionable, and there are not a hundred other cases that are more clear cut.

As I said: “The quality of care is better at a hospital. That is a risk factor. An individual can control it. They can choose to ignore it in the belief–largely justified–that complications are very rare. But only if they are comfortable accepting a vastly higher risk of losing the baby should complications occur.”

That has nothing to do, in any way, with ignoring risk factors. You are constructing a straw man–at best–of my actual argument.

I think it is. The difference is in the statement you are trying to support. If you are attempting to support the statement:

“Without controlling for other factors (i.e., averaging across providers, locations, underlying conditions, age & education of the mother, method of delivery, and so on and so on) hospital births are safer than home births.”
… well, then, you’ve got me.

However, if anyone is making a decision about their birth experience without considering any other factors,then IMO they shouldn’t be having children at all… I’m sure you’ll agree

The quality of care at some hospitals is better than one would get from some home birthing professionals. The opposite is also true. It is clear from the evidence, however (I’ve analyzed the data myself; it is readily available as the Tuteur stated) that the differences in mean quality are small and variances of both distributions large, making the differences between them not practically significant for most situations. If all other factors are equal, the choice is clear. That is rarely the case.

Just for the record – I would never choose home birth myself. Just not my style…

And as I pointed out before, and will again: the relative safety of a midwife versus a hospital is absolutely relevant to individuals. The quality of care is better at a hospital. That is a risk factor. An individual can control it. They can choose to ignore it in the belief–largely justified–that complications are very rare. But only if they are comfortable accepting a vastly higher risk of losing the baby should complications occur.

@Jan Andrea

My hospital is located in the same fantasy world where a woman, in the midst of giving birth, could be transferred out the front door in 5 minutes, much less to a nearby hospital.

My point was that the time spent getting to the hospital is time lost, and that time might not be insignificant. You were betting on no complications, and reassuring yourself that proximity to a hospital would matter. I submit that your bet was a reasonable one to make (complications being rare especially in candidates for home birth) but that your emergency plan was not one.

With regard to home birth, I don’t have any personal stake in it either way. I didn’t choose it for myself, and even if I met the criteria for it, I probably wouldn’t choose it anyway (I don’t make the grade at this point, because I’ve had a cesarean section) – though I wish there were more trained nurse midwives working in Canadian hospitals. However, judging from literature I’ve read, it seems home birth can be as safe as hospital births if a.) the woman is not at high risk of complications (ex. breech position of the fetus, post-date), b.) the birth attendant is trained (ex. certified nurse midwife) and c.) if anything does go wrong, there is quick transportation to a hospital. Again, this wouldn’t cause me to give birth at home even if I met these qualifications, but I am forced to concede that home birth can be safe in certain situations, just as even though I’m 100%heterosexual I have to admit that lesbians can be as good (and in some studies, even better) parents as heterosexual women.

Practical significance refers to the extent to which a statistically significant difference matters in real-world application. In this case, it may be an important finding for public health (large samples), but insignificant in regard to individual risk/choice, especially when risk factors (such as quality of care) can be controlled.

For example, men score higher on math and science tests than women. Therefore, we should ensure that only men are appointed heads of organizations like the NSF, right? OR, we could recognize that the differences between men and women in this area are not practically significant and control the risk factors (i.e., check references).

Mine was thinking of transferring me when my second was born, because the placenta was taking its time detaching. Of course, it was only about 30 minutes after the birth, which is perfectly well within normal limits, and it delivered on its own about 10 minutes after that. I wasn’t bleeding unduly, nor was I experiencing any other problems; but she (like a good midwife) wished to err on the side of caution.

So, practically speaking, the question is whether you are comfortable giving birth without a net or not. The only reason I can think of for going home birth would be if you were supremely confident that nothing was going to go wrong. Possibly, such confidence is justified in the typical birth.

But the idea that home birth is “just as safe” is a false impression brought about by the relative safety of giving birth in general.