Natural childbirth I: is home birth more dangerous than hospital birth?

July 1, 2011 in Fertility, Pregnancy & Childbirth, Myths & Truths | 77 comments

picture of newborn babyIn this series we’re going to explore natural childbirth (home birth) as an alternative to industrialized childbirth. Industrialized childbirth could also be called “disturbed birth”, which Australian family physician Sarah J. Buckley, MD defines as follows:

Anything that disturbs a laboring woman’s sense of safety and privacy will disrupt the birth process. This definition covers most of modern obstetrics, which has created an entire industry around the observation and monitoring of pregnant and birthing women. Some of the techniques used are painful or uncomfortable, most involve some some transgression of bodily or social boundaries, and almost all techniques are performed by people who are essentially strangers to the woman herself. All of these factors are as disruptive to pregnant and birthing women as they would be to any other laboring mammal – with whom we share the majority of our hormonal orchestration in labor and birth.1

Buckley embraces an evolutionary perspective on pregnancy and childbirth. Such a perspective affirms the natural process of gestation and birth and recognizes a woman’s genetically inherited capacity to give birth without medical intervention.

In the same way that we evolved to eat a species-appropriate diet (i.e. paleo), we evolved to give birth in an undisturbed environment.

This innate system of birth has been refined over 100,000 generations. It involves a complex, finely tuned orchestration of hormones that prepare both the mother and baby for a successful birth and catalyze profound neurological changes that promote the bond between a mother and her new baby.

And just as we experience health problems when we stray from the evolutionary dietary template, women are more likely to experience complications and difficulty in labor when they stray from the evolutionary template of “undisturbed birth”.

Natural childbirth is in our genes

Throughout the vast majority of human history, women have always given birth in a familiar place, with family members or other trusted companions.

Even now, babies are still born at home in most places around the world. And although the move from birth at home to the hospital began in the 18th century, home birth was the norm even in westernized countries until the 1950s.

Think of it this way: humans have been giving birth at home for 999,998 generations, and it’s only in the last 2 generations that hospital birth has become common.

This means that women have given birth at home for 99.998% of human history.

Yet in the U.S. today, fewer than 1 percent of births happen in the home. This abrupt and almost complete transition from natural childbirth toward industrialized childbirth has had profound repercussions on mothers, babies and the culture at large.

My wife Elanne and I have chosen to have a home birth with our first child (who is, as of this writing, due in about 2 weeks!) It has been fascinating to watch people’s reactions – outside of our close friends, who have almost all had home births – when we tell them this.

Some come right out and say “that’s brave!” Others are more suspect, using words like “interesting” or maybe even wondering out loud if it wouldn’t be a better idea to use a hospital midwife. Still others are more direct in their opposition to our choice.

This is evidence that the medical establishment has done a fantastic job convincing people that hospital birth is “normal”, in spite of the fact that home birth has been the default choice for 99.998% of human history.

Doctors and the medial have also managed to convince most people that hospital birth is safer than home birth. But is that really true?

Another myth bites the dust: hospital birth is not safer than home birth

In the Netherlands, where 1/3 of babies born at home under care of midwife, outcomes for first babies are equivalent to those of babies born to low-risk women in the hospital, and outcomes of second or subsequent babies are even better.

A UK analysis found that birth at home or in small family practice units is safer than birth in an obstetric hospital for mothers and babies in all categories of risk.

Other studies have shown that modern obstetric interventions have made birth more dangerous, not safer.

In fact, in terms of outcomes for mothers & babies, studies show that planned home birth has perinatal mortality levels (the numbers of babies dying around the time of birth) at least as good as – and often better than – hospital figures, with lower rates of complications and interventions.

A landmark study by Johnson and Daviss in 2005 examined over 5,000 U.S. and Canadian women intending to deliver at home under midwife. They found equivalent perinatal mortality to hospital birth, but with rates of intervention that were up to ten times lower, compared with low-risk women birthing in a hospital. The rates of induction, IV drip, episiotomy, and forceps were each less than 10% at home, and only 3.7% of women required a cesarean (c-section).

Other studies have shown that women who plan home birth have around a 70-80% chance of giving birth without intervention. And because of low use of drugs, home-born babies are more alert and in better condition than those born in the hospital.

Contrast this with the 2002 and 2006 Listening to Mothers surveys which examined 3,000 births in conventional settings. They found “virtually no natural childbirth” in either survey.

In the 2006 survey, around 50% of women were artificially induced; almost 75% had an epidural; and 33% gave birth by c-section.

Finally, in a review of the safety of home birth by the esteemed Cochrane collaboration, the study author states:

There is no strong evidence to favour either home or hospital birth for selected low-risk pregnant women. In countries where it is possible to establish a home birth service backed up by a modern hospital system, all low-risk women should be offered the possibility of considering a planned home birth…

I agree with the author’s conclusion that hospital birth is no safer than home birth. But if you consider the statistics above which suggest that having a natural, undisturbed birth in a hospital setting is exceedingly difficult, I would argue that there is strong evidence to favor a home birth.

Birth complications are more likely to occur in a hospital environment

A common defense of hospital birth by medical professionals and laypeople is the assertion that it’s necessary to be in a hospital during birth in case something goes wrong.

While it is certainly true that complications may arise during labor that require medical intervention, what is often ignored by proponents of hospital birth is the fact that such complications are more likely to occur in the hospital environment.

In other words, the distortion of the process of birth – what Buckley calls “disturbed birth” – has come to be what women expect when they have a baby and in a way has become a self-fulfilling prophecy.

As Buckley states:

Under this model women are almost certain to need the interventions that the medical model provides, and to come away grateful to be saved no matter how difficult or traumatic their experience.2

TV shows almost always depict birth as some kind of medical emergency, with the woman being rushed down the hallway on a gurney or connected to machines and wires in the delivery room surrounded by medical personnel. Since most people have never witnessed a home birth (or any other birth) before giving having a child themselves, their impression of what labor is like comes almost entirely from television.

It’s easy, then, to understand why people are afraid of birth and feel the need to be in a hospital setting in case something goes wrong. But that doesn’t mean giving birth in a hospital is safer. The studies I’ve presented in this article demonstrate that it’s not.

I want to be clear: no matter where birth takes place, complications may arise that require medical intervention and I am 100% in support of it in these cases.

When the mother or baby’s life is at risk, we are fortunate to have access to surgical techniques that can save lives or prevent serious complications.

The point I am making in this article, and will make in more detail in the articles to follow, is that the scale of medical intervention in birth today is not only far beyond what is necessary, but is contributing to the very of the problems it attempts to solve.

If you’re interested in learning more about natural childbirth, I highly recommend Buckley’s book Gentle Birth, Gentle Mothering. I’d also suggest checking out her free eBook called Ecstatic Birth and her eBook/audio package Giving Birth At Home.

Note: this series will very likely be interrupted by the home birth of my own child. Elanne is due on the 17th of July, so the baby could be coming anytime. When that happens, I’ll be taking some time off to spend time with my new family. I’ll pick this up again when I return from paternity leave.

  1. Buckley, Sarah J. Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices. Celestial Arts, 2009. pp. 96
  2. Buckley, Sarah J. Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices. Celestial Arts, 2009. pp. 96

{ 77 comments… read them below or add one }

SB July 1, 2011 at 9:25 am

Thanks for the article – I hope all goes well! Congratulations!


Noon July 1, 2011 at 9:41 am

I’m keeep 90% paleo and do believe in the basic philosophy behind it but this is just ridiculous. Most people in the world have natural birth most people in the world, in 3 world countries do not have access to hospitals. Are you seriously trying to say that they do it by choice??? what kind of dumb thing to say is that??

“I want to be clear: no matter where birth takes place, complications may arise that require medical intervention and I am 100% in support of it in these cases.”

DUH!!!!!!!!!!!!!!!!!!!!!! well wouldn’t it be nice to do it in a hospital where you do have access…JEEZ…no wonder paleo has a tough time catching on, because of dumb things like this!!

You can argue that you shouldn’t use drugs but what is the advantage of not being in a hospital? there is always a risk…when my baby was born his umbilical cord was wrapped around his throat thank god we had a doctor…


Chris Kresser July 1, 2011 at 9:45 am

I guess you didn’t read the article. I listed several advantages of not being in a hospital, including fewer complications, lower rates of induction, lower rates of forceps use and c-section. In the articles to follow, I’ll be explaining several other advantages in great detail. You are clearly misinformed, and haven’t provided any evidence to support your objections. You’re just spouting off conventional wisdom, with nothing to back it up.


Chris Kresser July 1, 2011 at 9:46 am

And, in the Netherlands, where people do have access to modern medical care, 33% still choose home birth and perinatal mortality rates there are as low or lower than low-risk births in hospitals.


Chris Kresser July 1, 2011 at 10:05 am

A nuchal cord (the umbilical cord wrapped around the baby’s neck) doesn’t necessitate medical intervention, except in extreme cases. A nuchal cord occurs in 20 to 30 percent of births, and is usually easily loosened, or the baby can be “somersaulted” through, as described by Mercer et al.. Cutting a nuchal cord removes the baby’s blood and oxygen supply, which can have devastating effects (such as cerebral palsy) if the baby’s first breath is delayed by shoulder dystocia or other birth difficulties.


Jill July 1, 2011 at 10:50 am

I think you can voice your opinion without being so rude. It’s a sign of maturity to show respect for the author of this post – whether you agree or not.


Sheva July 2, 2011 at 11:39 pm

Having the cord wrapped around the neck is a very common thing (approximately 1/3 of babies are born this way). It is almost never a danger to the baby. I caught one baby unexpectedly in a very non-traditional setting (very fast labor and second stage) in the caul with the cord wrapped and a hand presenting with the head. In a hospital this scenario would have been considered an emergency. Yes, we were lucky. But this scenario is just a variation of normal birth, not an anomaly, and doctors are just too narrow minded to see it that way.
Great article, can’t wait to see the rest! And best of luck on your child’s birth!


Noon July 1, 2011 at 9:43 am

or just watch this:


Karen P. July 1, 2011 at 9:48 am

It’s also telling that OB/GYN insurance is the most expensive to obtain and maintain, due to the high legal risks. This will undoubtedly affect practice style. When your goal is to produce an alive baby, the mother’s wishes and opinions can suddenly seem beside the point.

I feel very fortunate to have a hospital locally that encourages natural birth, provides access to water births, provides doulas free of charge, but also has the ability to perform interventions when needed.

I encourage all potential mothers to do their homework, and your primer here, Chris, seems like a good complement. And to contrast the popular imagery of childbirth, as you mentioned, I highly suggest reading examples of mothers giving birth in natural ways and settings. Ina May Gaskin’s books, while a bit giggle-inducing due to the hippie language, are also full of birth stories that gave me confidence I could have an undisturbed birth. And I did.

Thank you for contributing to the wealth of information out there about birthing without interventions.


Elanne Kresser July 1, 2011 at 10:15 am

Dear noon,

I’m a glad that you have a healthy child and were satisfied with your hospital birth. Your reason for thanking God that you were in the hospital though, the cord around the neck, is one of the biggest birth myths out there. Babies are born with cords around their necks often. Midwives are just as skilled, perhaps more skilled, at dealing with this as doctors. Often the cord around the neck is not a danger at all as the oxygen supply is still coming to the baby through the cord and baby does not yet need to breathe through the nose, trachea etc. My niece was born at home with only my brother and her two grandmothers in attendance. The cord was wrapped around her neck and it was very simple to unwrap it and watch that little one begin to breath easily on her own. No problem.

Women are told in the hospital that the reason their baby is having troubles is that the cord was wrapped around the neck. This is just not seen in home births. Babies in hospitals have troubles breathing because they are doped up on the epidural drugs and pitocin.

As for women in many countries around the world not having home birth by choice, this is true. Sadly and to their detriment much of the rest of the world is eager to follow in our “advanced” footsteps. And it is also true that in many non-industrialized countries perinatal mortality rates are much higher. This is likely due to malnutrition and poor health. We know that how a woman is nourished through her pregnancy has a great effect on how she will give birth, her own health and the health of her baby. Weston A Price and others who studied traditional peoples eating their traditional diets noted how easily mothers give birth, often simply wandering off by themselves and returning hours later with a healthy baby. For much of the non-western world people are no longer able to eat their traditional diets and are in very poor health.

There is a lovely African saying, ““The goat has no midwife but delivers with ease, the sheep has no midwife yet brings forth a live offspring, and you, little mother, will give birth to your baby.” To me this indicates a true understanding of how birth can be.


Consuelo July 1, 2011 at 10:33 am

I had all my kids naturally and 2 of them at home. I’m having my fourth in December, as a child I presenced many births at home and helped once or twice. I had the chance to go to Holland where almost 80 % of birth are at home. Women need a private, quiet setting, with minimum interruptions. Congratulations! your wife will do wonderful! great article!


Dawn Gifford July 1, 2011 at 10:38 am

I had a homebirth 3 years ago, and it was the best choice I ever made. I have a huge fear of hospitals and allopathic doctors, so I would surely have had a stalled labor, just because of fight or flight hormones pouring out of me in such a frightening setting. But I also had a 63 hour labor, with my water breaking 2 days before delivery. No U.S. hospital would tolerate laboring for more than 4-6 hours, especially after the water breaking (despite the fact that it is natural for women to labor longer, especially on a first birth), and I would have surely been induced and very possibly c-sectioned unnecessarily, at grave risk and cost to me and my family.

At home, on the other hand, I was allowed to labor in the peace and comfort of my home, bathe, walk, and eat as I pleased, and finally give birth to a beautiful baby girl that really needed NO medical intervention to come into the world happy and healthy. In fact, my husband and I labored alone for all but the last few hours of it, truly owning what should be a transformative, if not spiritual, process for families. I was also able to rest and breastfeed in my own bed, within just a few minutes of delivery, while the cord was still attached and giving up its last pulses of blood and oxygen to my child. There is no way to describe this experience, it still makes me cry in joy to think about it.

I cannot say enough good things about home birth for low-risk women.


Rikke July 1, 2011 at 10:41 am

Hi Elanne and Chris!

Congratulations with the soon delivery; I was born at home myself (20 years ago), and thought for many years that it was the normal procedure. My friends were always stunned when I told them I was born in my parents’ bedroom.
Birth was quick and completely free on complications. There was a midwife present (oh, and the rest of my family; my siblings at age 4, 6 and 8 years – they thought it was VERY exciting).
I believe it’s much easier for the woman to relax in familiar surroundings; not that I really know, but it would seem natural to me.

I believe you’ve made a wonderful choice, and I hope the birth of your son/daughter will be (relatively) smooth.


Dawn Gifford July 1, 2011 at 10:45 am

Oh, and my baby was born with the cord was wrapped around her neck, twice. My midwife didn’t even flinch, just calmly removed it, and my baby was fine.


Ink July 1, 2011 at 10:45 am

Hi Chris, great article.
I too had my first baby at home with an incredibly experienced midwife. the birth was smooth and amazing, if not also really painful :) Its so interesting to see the venom spewed at people that are proponents of natural birth or choosing to homebirth, as exhibited by Noon. She attacks your personal opinion on this subject and then holds you accountable for her observation about how popular the Paleo diet. It is sad to say that this behavior is very common. The fear that people now associate with birth, and seeing it as a medical condition instead of a natural part of life, goes to show how well the medical community has been able to manipulate people around this subject. In a situation like this one where “noon” felt it was appropriate to insult you directly and call you and your decision stupid, it is clear that no amount of information can educate a person on this topic. In my case some of my family members were so opposed to homebirth that we outright lied to them and told them our baby was born in a hospital. It is then ironic to me that all of my births have been fast and problem free while ALL of my relatives who have birthed in the hospital have ended up with major intervention, complications from the interventions, and about 50 percent of them have had c-sections (because the doctor felt that 12 hours was too long to birth.)
I applaud and support your decision to birth at home, I wish that more of the west would engage in real conversation and thought that might help us return to a place where our children enter this life in a gentle, natural way. The subtle processes of human birth have been evolving for 100s of 1000s of years. The hospital births I have attended appear to me like the medical staff is constantly picking at a scab and then getting mad when it wont heal.
Blessing on the birth of your child!


Justin Ross July 1, 2011 at 10:54 am

Yes, we’ve been giving birth “naturally” for millenia. Infant mortality rates were also stupidly high for most of that time. This is often cited as one of the main reasons that paleolithic life expectancy is so low, even when humans making it past adolescence had a pretty decent chance of living into old age.

Here’s the thing with home birth: Even *if* there are more complications at a hospital, they’re better-equipped to deal with the unknowns that can arise.

Eliminating “distractions”, “disturbances” and “interruptions” isn’t as important as giving your child every possible chance to make it past their first 48 hours. Whether the experience is “peaceful” or “traumatic” or somewhere in-between doesn’t matter. What matters is that you leave the hospital with a healthy baby. That’s all.

“There is no strong evidence to favour either home or hospital birth for selected low-risk pregnant women…”

Home birth is perfectly-safe… if you’re low-risk for things they can easily deal with in a hospital. The problem is, most people don’t know whether they’re low-risk or not.

While I don’t trust the medical industry (and it IS an industry) to prevent sickness/maintain health, they have the tools and knowledge to deal with emergencies as they arise. The odds are, you’ll never need those tools/experience. If you did, though, could you really say you wouldn’t rather have them and not need them than need them and not have them?

Related post:


Chris Kresser July 1, 2011 at 11:23 am

Here’s the thing with home birth: Even *if* there are more complications at a hospital, they’re better-equipped to deal with the unknowns that can arise.

So what? If there is a serious complication, you transfer to the hospital. Problem solved. That’s not a reason to invite more complications by giving birth in a hospital environment to begin with.

Eliminating “distractions”, “disturbances” and “interruptions” isn’t as important as giving your child every possible chance to make it past their first 48 hours.

We’re not talking about touchy-feely “distractions” or “disturbances”. We’re talking about real consequences – some of which I already pointed out in this article, and others which I’ll be covering in detail in the articles to follow. They include: interfering with the delicate hormonal interplay between mother and baby (which has real and measurable long-term effects), increased risk of maternal death (even among healthy mothers) and a traumatic birth experience.

I agree completely that it’s most important to give a child every possible chance to make it past their first 48 hours. I linked to several large studies demonstrating that perinatal mortality rates are equal for home and hospital births for first births, and actually lower for home births for the second and subsequent children. So I’m not sure what your point is here. Having a hospital birth does not increase the chances that your baby will survive the first 48 hours.


Justin Ross July 1, 2011 at 12:07 pm

Since I don’t have time to read through all of the articles posted (and several are subscription-only, so I could just see abstracts), I’ll just ask:

The studies you refer to that show hospital births to have higher PNMR’s… How do they count situations where (for example), a home birth is planned, but the child/mother end up going to the hospital? That is, if there’s an issue with a home birth, I would imagine most of the time, the child would get taken to the hospital before it dies, in an attempt to save it. Is that being counted toward the hospital’s PNMR, or the home birth?

When you say “distraction”, I don’t know what way it could be defined other than the “touchy-feely” sense. Is it a medical term I don’t know about?

As for transferring to a hospital, sometimes you don’t know there’s a complication until it’s too late (like in the link I posted originally). What, then? Fault of an unskilled midwife?


Chris Kresser July 1, 2011 at 1:53 pm

It varies from study to study. The situation you refer to is called a transfer and it is often taken into account. But keep in mind with a home birth rate of 1% in the US, transfers as an overall percentage of hospital births are extremely low. Most of the studies on home birth in the developed world have taken place in the UK and the Netherlands, where home birth rates are much higher (>30% in the Netherlands).

I explained the negative consequences of home births (above and beyond “distraction”) in my previous reply to you.

Yes, babies do die in childbirth. If you think that doesn’t happen in the hospital you’re kidding yourself. As I’ve pointed out repeatedly, the PNMRs are the same in hospital and home births.


Margy July 2, 2011 at 12:05 am

So I’ll jump in with a little perspective. I am a licensed homebirth midwife. I have personally had three home births. I have worked in the hospital as an employee and attended about 40 births as a labor doula. Home birth midwives monitor mother’s vitals and baby’s heartrate, amongst many other responsibilities. We protect the laboring mother’s space and bodily integrity so she can labor without disturbance and develop effective coping techniques. We are trained in resuscitation and management of hemorrhage. We can accomplish a transport to hospital, in most cases, in less time than a community hospital can call in an OB, CRNA, and Ped for a c-section for an on-site labor. (Please realize that almost no community hospital has the on-site staff for continuous on-site surgical staff for cesarean surgery. Does this mean these hospitals are unsafe for laboring women?) If my client lives farther from the hospital than 20 minutes, we discuss conservative decisions. When I have to transport, I always call ahead and give the hospital staff as much notice and information as possible.

The biggest issue with the hostile atmosphere that divides home and hospital birth is the fact that hostile receptions lead to delayed transports and worse outcomes. Homebirths, even unattended births, will continue no matter the vitriol of critics. Many, many of us believe that we can have the best of safety and normal, undisturbed birth with midwives as primary care providers. I participate in the US’ largest homebirth prospective (as opposed to retrospective) research study, conducted by the Midwives Alliance of North America, which does account for every client that begins care with a midwife and tracks her story… healthy home birth, transfer to an OB for prenatal complications, or labor/ postpartum transport for medical care.

About “distractions” and “touchy feely”: It takes a lot of effort for a laboring mother to maintain effective coping when hospital procedures mandate frequent EFM fiddling because “it just isn’t picking up well when you are in that position”. I have had many clients who were also veterinarians… and commented that no mammal would be able to give birth without surgery in the conditions of a hospital LDR room. The hormones just don’t work.

And finally, a loop of cord around baby’s neck is extremely common! It’s one of the safest places for the cord to be… it is protected and MUCH less likely to be compressed in the course of labor and can be easily unwound after the birth.


Barbara July 2, 2011 at 6:40 am

The related post tells a tragic story that doesn’t support the argument against home birth because that mother should have been informed of the risks, and advised to deliver in hospital. Being positive for strep B makes you high risk. If the obs/gyn had forgotten to order antibiotics before or during the labor as he or she forgot to inform the parents of the significance of the positive strep B result, the outcome would have been the same. Babies die in hospital the same way from the same thing when staff miss the dx. There’s no time for an emergency because no one knows anything is wrong until it’s too late.
In hospital, healthy, low risk women are routinely induced. Under the influence of the drugs used for induction of labor, there is no time for the mother’s levels of endorphins to rise to the occasion. Labor is more painful, and epidurals are usual. Labor can stall after an epidural, and intervention becomes necessary. Intervention HAS resulted in injury to and deaths of too many babies.
Unfortunately, hospital isn’t a place where a woman is permitted to deliver in peace and safety with the security of professional health care just outside the door in case she needs it. In hospital, delivery is often pathologized and the medicos can take over, just because they can.
For low risk women and their babies, the risks of unnecessary intervention in hospital are real.
The negative effects of trauma from a bad birth are real, too. What you dismiss as touchy feely disturbance can contribute to post-partum depression. As post-patum depression is rife, and suicide seems to be the greatest cause of perinatal maternal mortality, you’d think more attention would be paid to whether the mother’s experience was peaceful or traumatic.


Elanne Kresser July 3, 2011 at 10:01 am

Ricki Lake the maker of the film The Business of Being Born lays out very clearly why undisturbed birth is important for the health and future health of of our children and our relationships with them.

I want a home birth because I want a healthy child. One who didn’t receive drugs during birth and one who’s hormonal and neurological template are set and attuned to mine because our communication during the birth process was allowed unimpeded. A very complex cocktail of hormones are released during birth that help the birth process along. Disturbances, as any person who has worked with animals will tell you, interrupt the proper release of those hormones and the proper functioning of neurological processes. Animals interrupted in birth will halt the birth process or have difficult births. Many times they won’t bond well with their offspring after this happens.

Those hormones that get released in undisturbed birth are there to facilitate not only the birth but the process of bonding and breastfeeding after the birth, both crucial to the physical and emotional health of a child and a mother.

Proponents of industrialized birth are often thinking of health in extremely limited terms. As is true of industrialized medicine as a whole.


Jesse July 1, 2011 at 10:55 am

In general I have no argument, though I did think it was somewhat misleading of you to quote the Cochrane review the way you did. You implied that the review was saying that, despite a body of evidence that is large enough to draw conclusions from, the evidence does not lean strongly either way. What it was actually saying was that the authors did not find enough solid evidence (they included only a single study of 11 subjects) to make any conclusion. Big difference.

On the other hand, what do you think of this recent meta-analysis that found that, while perinatal mortality is comparable in either situation, neonatal mortality seemed to be three times higher?
It is a meta-analysis, but it seems worth considering.


Rachel July 1, 2011 at 10:00 pm

The Wax meta-analysis has been pretty well torn apart as poorly done research. It doesn’t really tell us anything, except that ACOG is bothered enough by the growing popularity of homebirth to print and support weak research if the outcome is in their favor. And clearly it worked because headlines everywhere said that homebirth has 3xs the neonatal deaths of hospital births. It doesn’t matter if it’s not true because it’s made the headlines and people remember it.

For critiques of Wax’s study see here:

and here:


Jesse July 2, 2011 at 5:55 pm

So it would seem! Good to know.


labortrials July 1, 2011 at 11:06 pm

Plenty ‘o critiques of the faulty Wax analysis available on the web.


Jill July 1, 2011 at 11:02 am

I totally agree that having a baby in a comfortable/safe/home environment is best – I’m also glad that we have a hospital 3 minutes away in case something happens. My 1st son was born in a hospital and with pneumothorax in both his lungs. Without medical intervention he would have died.

Still, we didn’t know he was sick until 6 minutes after he was born. I had a horrible experience with my doctor and nurses. Nobody said “good job” “keep going” “you’re doing great” … My doctor told me to shut up! And I wasn’t even screaming. My husband never got to cut the cord and my dr never held up my baby for me to see. I understand soon after they discovered he was sick and I COULDN’T see him. But before those 6 minutes? Why? I was pushing out my son and was reminding the dr between pushes, “make sure Mike cuts the cord.” …. nobody listened to me. I really felt like a nobody.

I felt like I was a slab of meat on a convener belt. There were no personal connections, no calmness…it was very sterile. I hated giving birth in the hospital. It took me over 5 months to recover from the episiotomy.

If I wasn’t so afraid about what may happen with my next child, I would consider giving birth at home. I’m about 50/50 at this point. I can tell you my insurance would not cover anything that may happen to my child if it were born at home. That’s another consideration – the “system” basically forces you to the hospital because god-forbid something happens. who has $100,000 cash to pay for medical expenses in case the newborn needs medical care? Our bills for our 1st were around $80,000 – glad our insurance payed for it all …. just because we were in the hospital to begin with.

It’s all about the money now…and not about the woman or her comfort or her baby. So disappointing. Interestingly, about 80% of my friends had c-sections… why? I think they are so quick to do those. And that’s a whole other post…lol.


Sheva July 2, 2011 at 11:52 pm

I’m so sorry you went through all that! Try hiring a doula to advocate for you and be your support – and go with a midwive’s practice, if you can. And interview them thoroughly – some of them are ‘med’wives and aren’t all that great.
Best of luck!!


Mary July 1, 2011 at 11:18 am

Thanks for your article. I just want to point out that “people” don’t give birth, women do. Women do not need any more blame or shame thrown at them for decisions involving child birth but I do appreciate how you laid out the options of home birth and hospital birth. Spreading knowledge and information is the foundation for empowerment. It is an extremely personal decision to have a child and a decision made considering numerous contextual factors. For example, having a midwife can often be a privilege for those in a stable financial position. The topics of pregnancy and childbirth need to be discussed with compassion and understanding, perhaps even gratitude.


Susan July 1, 2011 at 11:22 am

Two months ago, I gave birth to our seventh child in the grass beside the highway under cover of darkness. This wasn’t Plan A, of course, but it was my favorite birth by far. I don’t know if any studies have been done on outdoor birthing, but I recommend it. :-)

This was our first non-hospital birth. It’s given us confidence so that maybe next time we’ll try it at home. Maybe in the back yard.


Chris Curley July 1, 2011 at 11:23 am


A premature Congrats and Best wishes for a healthy and happy birth. Eagerly looking forward to an upcoming post where you put the smack down on the barbarous process of injecting science fiction like ingredients into newborn humans, soon after they leave the safety of the mothers womb. (I am of course referring to vaccinations)



Peggy The Primal Parent July 1, 2011 at 11:24 am

Congratulations on your up coming delivery!

My daughter’s dad was adamant that we have our baby in a hospital. I had a terrible feeling that everything would go wrong if we did. I totally hate hospitals and doctors (no offence, of course, you are an unusually awesome doctor). Within the first 5 minutes of entering the doors (maybe 3 minutes) nurses told me they were going to cut the baby out. It was so weird. It was exactly, well actually quite a bit worse, than I had imagined.

I will definitely have my next baby in my home where I am comfortable, with a midwife who cares about me and isn’t off-call when the baby is born.


Rachel July 1, 2011 at 11:27 am


I am a huge fan. I ordered The Healthy Baby Code and love it and was hoping that you would be discussing this matter in that material as well. I think even more importantly then where you have the baby, is the support you receive while preparing and during the actual birthing. Obviously, at home you have more control over who is there and what they are doing (or not doing). If you plan to futher this topic in future posts, I think covering doulas (I like to think of them as birthing angels) could be helpful to those who, for whatever reason, choose to birth in hospitals. The most important thing I did to prepare for my natural childbirth (that took place in the hospital, no intervention or any kind just raw, beautiful birthing) was surround myself with a community of women who had done the same. For whatever reason, people like to tell pregnant women all the birthing horror stories they know. I found my oasis at Blooma, a wonderful prenatal yoga studio in Minnesota. Every week I would go and the teacher/owner, who was also a doula, would tell us about all the amazings births she had been to since the last class. Then she would teach us how to move through yoga big bellies and all, with lots of tips about what movements she had found helpful at recent births. I always left there feeling very powerful and knowledgable about my body. The birth of my son was one long, intense yoga practice where the ending was the most amazing shavasana with my new freshly born baby lying skin-to-skin with me. On that note, please also cover the importance of skin-to-skin contact with the baby.

Birthing Blessings to you, your wife and your baby!


Chris Kresser July 1, 2011 at 11:35 am

Hi Rachel,

The last article in the series will cover “third-stage labor” and the importance of skin-to-skin contact after birth.


Joan July 1, 2011 at 11:27 am

I had all 3 of my kids at home. I had to laugh when people called me brave because to me the hospital would have been so much more frightening. With my first I had to push for 4 1/2 hours…no way I’d have gotten away with that in a hospital. I’d have been cut one way or the other for sure. That was 23 years ago, my youngest is 14 now. Probably hospitals are even worse nowadays. I think you have the right idea. Go for it. Best wishes to you…


Jenni July 1, 2011 at 11:47 am

This is a great article, and obviously there are many people who are stuck in believing what the hospitals and OB’s want them to. OB’s are surgeons who are very minimally trained in natural vaginal birth, they would much rather be in and out in 20 minutes vs. waiting and responding to the natural birth process. I love it when people say ‘Im glad we were at the hospital’ when most times the problem arose because of medical interventions which were uneccesary. sad. i had my son at the birth center and my midwife has everything she needs in case of emergency, and takes NO risks. ya, the cord was around his neck, normal really considering how the baby moves through the birth canal. He was born at 42 weeks, with lots of meconium in the amnio fluid. he had no problems, was breathing very strong at birth, and was not ‘too big’ to fit through me. Most people think you have some witch doctor chanting over you as you birth, when actually you have the most qualified in natural childbirth person there making sure everything turns out wonderfully. Midwifes are very relaxed, childbirth is an everyday occurence and really no big deal to them! My midwife never lost a mom or baby(who would have lived) in over 4,000 births. bet there arent any OB’s out there with those kind of numbers!
Baby coming anytime huh?! that’s what I thought! then i found out it’s very normal for 1st babies to go to or past 42 weeks! it’s a guess date, not an actual due date. really are we telling these babies when they are ready???? as we soon find out, everything is on their schedule! best wishes to your family, I’m sure your child birth will be everything you expect it to be and more!


Jenni July 1, 2011 at 11:49 am

And I think people who birth in the hospital are the ‘brave’ ones! keep me the heck outta there, I hate those places! talk about being uncomfortable and feeling uneasy! whew


J July 1, 2011 at 12:07 pm

I recently heard a podcast with Dr. Art Ayers ( ) where he discusses gut flora and bacterial infections in hospitals. Patients and babies in hospitals get invasions of Clostridium Difficile (CD) as they spend more time there. If you don’t need to go to the hospital, perhaps it is a good place to avoid.


Kit Perkins July 1, 2011 at 1:46 pm

I hate to play devil’s advocate here, but it seems to me that people choosing home births are more likely to have an interest in health – so it’s no surprise that their births/babies are healthier.

Of course, this doesn’t mean that there’s any benefit to industrial birth, just something to think about.


rowan July 2, 2011 at 8:07 am

You are right Kit. As a traditional midwife the families who call me are very health conscious and very connected to their bodies. They eat well, exercise, do yoga, meditate and usually have done lots of research on their own. They are very self-directed in their own well being.


Michelle July 1, 2011 at 1:59 pm

Thank you for posting this. I gave birth for the first time last year. I was determined to have an unmedicated and low intervention birth and spent my pregnancy preparing for that. I chose to give birth in a hospital under midwife care. Never again! I am not sure Whether I would choose a home birth or some kind of birthing center. But I will definitely not do it in a hospital a second time. Even under midwives the monitoring, the bright lights, the shift change right before I started pushing, the monitoring of the baby after birth, being separated from my child for routine procedures like weighing and measuring, I could go on! And then they forced us to stay despite us both being perfectly healthy for 36 hours because of a policy! I was so upset and longed to be in my own bed at home. I am convinced my labor (8 hours start to finish) would have been faster and easier on me had I not gone in to the hospital. I did have a drug free birth – didn’t even have an IV even though the nurses insisted on it because the nurse placed the cath in my hand and completely misses my vein! I was howling in pain not from my labor but from them trying to run saline into my flesh! But i also think it’s important for a woman to birth wherever she feels safe and comfortable even if that is the hospital. Anyway congrats on your upcoming birth!


Kara July 1, 2011 at 2:15 pm

I had my youngest two children at home with a midwife and it was an amazing experience both times. I can’t imagine ever choosing to give birth in the hospital again, unless of course there were complications.

And by the way my daughter had the cord wrapped around her neck. It was no big deal- the midwife just unwrapped it.


Joann July 1, 2011 at 2:35 pm

If you are the mother of a child that died during a home birth you have a totally different opinion. Your child died and society views you as the evil mother who killed her child. It destroys all your family relationships, sometimes it ends in divorce. Family members point fingers and whisper. If you are the “ONE” that this happens to, you have a whole different opinion of the dreaded “hospital”. Statistic speech, only works when it’s not you.

Mothers like me who have lost the child, we don’t usually speak, because we are so consumed with guilt and grief. Ask a mother that’s lost her child what she would do and then act on that.


Chris Kresser July 1, 2011 at 2:44 pm

Joann: I’m so sorry that happened. I can’t imagine anything more difficult to go through.

Unfortunately, babies can and do die in the hospital, so the same rationale could be used to avoid hospital births. The idea that you are 100% protected from bad things happening when having a baby in the hospital is exactly the myth I am debunking in this article.


cary nosler July 1, 2011 at 3:00 pm

We were fortunate to have a wonderful home birth room experience at a local hospital. I would like to think that it may be the best of both worlds for those who choose to be closer to medical help if needed. I was also wondering if people who want home births might be better informed and practicing positive lifestyle habits that would influence having fewer complications.


Sara July 1, 2011 at 3:01 pm

I had 3 homebirths and 3 hospital births. It was the intervention in the first that drove me to have the next 3 at home. I hated being invisible; they only wanted to look at the monitor, not take care of me. The third at home came quickly and was unattended by the midwife, though she was there to take care of my massive hemmorhage, and she did an amazing job. My last 2 births in hospital stalled both times because of the constant interruptions and my fear of hospitals. They both involved pitocin, but the first midwife watched me and saw how little it took to do the job. With the next, they paid absolutely no attention to me and just kept turning up the dosage every 15 minutes until I put a stop to it!

I know bad things can happen, and we were within 10 minutes of a hospital in case of emergency, but I would never say everyone should birth at home or vice versa. Every mother should give birth where she feels safe and comfortable. Unfortunately, that’s too often a hospital with an astronomical c-section rate!

I wish there were more birthing centers where you could have all the comforts of home and the skills of a well-trained midwife, but emergency equipment seconds away.

I wish you luck in your birth, Chris and Elanne. I hope it will be beautiful!


Melissa July 1, 2011 at 5:45 pm

What about birthing centers? I guess I wish I could have backup access to medical intervention AND am environment supportive of natural methods.


Kara July 1, 2011 at 8:19 pm

I just posted a response to this article on my blog.

It’s about my positive home birth experiences.


Julie July 1, 2011 at 8:46 pm

Thanks for the post. I agree that the most important outcome of birth is to have a healthy mother and healthy baby. Both of my births were at home and afterward I felt strong and empowered. I feel that the mental/emotional aspect of a woman’s birth experience is so important. Have you come across research comparing the rates of postpartum depression in women after homebirth vs. hospital or c-section? I personally know of many women whose traumatic hospital experiences seem to have contributed to postpartum depression. Best wishes!

ps- sleep will soon be your weakest link!


Laura July 1, 2011 at 9:01 pm

Great article! I wish you and your family the best for your upcoming birth. Home birth is amazing. I had my second at home and it was unbelievably fulfilling and beautiful. If you’re interested in reading my birth story, go here:


BK July 1, 2011 at 9:08 pm

I have had all three of my babies naturally (no inductions/drugs/forceps/etc). The first was born in an ambulance (on the way to the hospital -long story) while the second two were born in a hospital. I had a doula with all three and I was fortunate to be able to labor and birth exactly how I wanted with minimal monitoring/intervention. I was mobile right up until delivering and was able to deliver in the position of my choosing as well. Perhaps this isn’t the case with some hospitals, but I felt wonderful about all my deliveries and did not feel they were “disturbed”. I think with a good doula and a good birth plan – it is possible to have a great “natural” child birth in a hospital.


Liz Downunder July 1, 2011 at 9:08 pm

All the best for a wonderful peaceful birth, Elanne and Chris. As someone who fell victim to ‘the system’ with my first child, then had a wonderful VBAC at home 3 years later, attended by wise women who understood and trusted birth, I totally support anyone’s choice to home-birth. One thing my husband noted was the amount of medical equipment the midwives brought with them (none of which needed to be used) – they are very astute at observing, and dealing with, complications, rather than creating them by interfering with the process. Unfortunately, changes to the maternal healthcare model here in Australia mean that it will soon be against the law to birth at home with an independent midwife.

The ‘Paleo’ diet gets a lot of press, but pregnancy, birth and childrearing is a whole other part of the picture – something which the likes of Sarah Buckley, Michel Odent etc have shared so much on. Carrying the baby, co-sleeping, baby-led and gentle introduction to (REAL!) food, full-term breastfeeding etc. Babies have not evolved beyond needing these crucial elements, and neither have we, no matter how clever we think we are in our priveledged Western society. Looking forward to more posts in this series, Chris.

Happy birthing and baby rearing – a wonderful journey awaits.

PS being at an ‘alternative’ school we are surrounded by home-birthing families and only one transferred to have the baby in hospital.


Sara July 1, 2011 at 10:19 pm

This is a response to distractions being touchy feely:
A woman giving birth is very vulnerable, and often the positions she wants to be in or is forced to be in, anyone would find vulnerable. Strangers coming and going in your space, uncomfortable temperatures and clothes, all the loud noises in a hospital; these things all make it hard to relax, which is exactly what you need to do during birth. The vagina is a sphincter, would you find it easy to use the bathroom laying flat on your back with your feet in the air, people coming in and out, bright lights in your face and cold air blowing on your nether regions? I have known people that couldn’t pee if someone might hear them.
“Distractions” can slow the pace of labor, then the interventions start, such as pitocin, and more risk is introduced.


Chris Kresser July 2, 2011 at 8:32 am

For the record, I don’t view distractions as being touchy feely. I was responding to an earlier comment. As you point out, distractions can lead to medical intervention, such as induction, epidurals and c-sections, which have real, measurable and lasting physiological and psychological consequences.


Long Term LC Dieter July 1, 2011 at 10:35 pm

I went in having read the pros and cons. I didn’t want pain medication, went to Lamaz classes. I read 13 books about pregnancy and labor (my OB/GYN said, “it’s not a test” when he walked in and saw me highlighting the book).

At the time, I was fully aware that 25% of births resulted in c-sections, so I refused the epidural. I was really sorry I did, because when I needed it the anesthesiologist was not available. I thought I was going to die of pain. No one talks about this, and no one even in the family would let me talk about it. It was unbearable, and after it was over, my mother told me she thought she was going to die in childbirth too.

I would much rather have had a c-section than go through that bloody, horrible, hell. I was angry that my mother didn’t warn me about how bad it was going to be.

So, I had natural childbirth. What are the consequences of this? Think about this. It’s called incontinence. No one talks about this either. Now in my 40′s, I’ve had surgery to “correct” this, which helped only a little for two years, and now it is almost as bad as it was.

If I could do it over, I would ask for a c-section. Seriously.


Margy July 2, 2011 at 12:13 am

I am so sorry that you feel so obviously traumatized by your experience. I never advocate suffering, only coping with effective support from loving people. Labor is incredibly hard work, and can be intensely painful. Anyway, I wanted you to know that incontinence is common even with women who have cesarean births and also women who have never born children at all. I hope you find both physical and emotional healing.


Terry July 2, 2011 at 7:34 am

Apparently your Lamaze classes were not very good! I teach natural childbirth classes and we discuss everything you mentioned in great detail!


Sheva July 3, 2011 at 12:08 am

Natural childbirth does not only mean un-medicated. It means natural in every way – the support, the treatment, the respect, and the trained care. It doesn’t sound like you had that.
Incontinence is not an effect of vaginal birth. It also afflicts nulliparous women. In women who have given birth, it is usually because of being coached to push in an unnatural and prolonged way. I don’t have the names of the studies, but I was just reading an obstetrics textbook on the subject. And surgery to correct it, according to this book, is unsuccessful at least 25% of the time.
I wish you the best of luck in finding a good doctor who can successfully help you.


J July 1, 2011 at 10:35 pm

Having a home birth will be a fantastic experience for most who opt for it. However for the few who have a medical emergency good outcomes are measured in minutes and even seconds. That shouldn’t stop people from making the choice to home birth but it should be taken very seriously and planned for as well as possible.


J July 1, 2011 at 10:41 pm

Long term LC dieter,

I have had 5 children. 2 unmedicated deliveries, 2 epidurals, and one unmedicated emergency c section.

The pain of labor is more intense than the average c section [mine excepted obviously] but the recovery from a c section is just dreadfull. I’d take a vag delivery any day. However I’d take it with an epidural if I had my ‘druthers.


J July 1, 2011 at 10:54 pm

PS during my 2 unmedicated L and Ds I would have gladly received an epi when those contractions got “for reals”. There comes a point where pain is so intense and unrelenting for such a long time that all philosophies fly right out the window leaving me to admit fully and unblushingly that I would not care one whit if they had to stick that needle in my eyeball as long as there were sufficient drugs on the other end of it.

It’s a bit of a western notion that drugs are to be avoided, tribal people certainly make good use of them and have for a very long time. YMMV


Sarah July 1, 2011 at 11:52 pm

congratulations on your upcoming birth! I’ve had 3 hospital births, but wish they could have been home births. My most recent birth (feb) was a gorgeous experience, until the Dr decided for no reason at allt hat ten minutes was long enough to push and pulled my baby. The pain was excruciating. The damage was horrible, and preventable. Recover was long. This was my best hospital experience yet.

A CNM is the way we’d go if we had a chance, but it is important a person does their research prior to choosing a homebirth. Knowing what could possibly go wrong, and what they want done. For us there is very little that could go wrong at home that couldn’t be resolved at home as well – in the small chance that a hospital was needed, we’d transfer. We also know that in the majority of cases there are indications prior to delivery that something is amiss.

In the case of GBS it is easily treatable, it is highly unfortunate that a family did not receive proper care, but IMO that is an omission of that individual care provider and not an over all picture of home birth. Of course, here, only CNM are allowed to practice and standard protocol is that all women are screened (and if mom isn’t screen, then baby is deemed positive), if mom is negative, then no worries, if mom is positive, then she is treated, if she is not treated IN LABOUR, then baby is deemed positive and treated – or if parents refuse initial treatment, then baby is monitored closely, with antibiotics standing by. In other words, as long as the midwife follows protocol, then GBS is no more of an issue than in the hospital.


Evan July 2, 2011 at 5:17 am

My random thoughts

In preparing for the birth of our first of two my wife and I really enjoyed reading Ina May’s Guide to Childbirth. Birth in Four Cultures by Bridgette Jordan is also very interesting.

The most alarming thing to me related to this whole topic is the growing rate of c-sections. At our local hospital it’s nearly 50%!

Despite our prejudice towed natural childbirth, we know plenty of mothers who had perfectly acceptable birthing experiences at hospitals.

Bear in mind that in industrialized countries the average age of first-time mothers is increasing which means those moderate to high risk pools are growing too.

One thing we really liked about the birthing center we used is that we didn’t have to clean up after the birth!


Miranda July 2, 2011 at 11:28 am

@ LC dieter – sorry to hear about your experience. I had a vaginal birth and have no incontinence issues whatsoever. I even had a 2nd degree episiotomy but was downhill skiing 3 weeks later. Everyone is different, but most vaginal birth recoveries are much less heinous than a c-section recovery. Then again, some people recover from c-sections quickly too. You can never know which you’ll be. I guess I’d just rather go through that pain again than have my abdomen sliced open and baby ripped out of me, but that’s just me.

That’s the thing about childbirth. No matter how much you prepare for and educate yourself, it is so totally unpredictable. I knew from the beginning of my pregnancy that I really wanted a natural, unmedicated childbirth. I checked out every book from the library on the subject, spent countless hours researching online, practiced the Bradly method exercises, kept working out and eating healthy while being mocked for not just indulging in cravings because I was ‘going to get fat anyway’, etc. . Well…I won’t go into the full story, but I did end up getting medical interventions, and the moment of her birth was more of a drugged up fog with a room full of NICU staff and others than the moment of love I had really dreamt of. I don’t know how it would’ve gone had I tried a home birth or birth center, if it would’ve been alright and the hospital staff were just making it more dire, or if I would’ve been one of the emergency hospital transfers. In the end, I guess I don’t believe it’s fair to say any one birth choice is ultimately ‘safer’ or ‘better’. Whether you’re the type to schedule your c-section in advance to work for your life, or have a homebirth with a doula + midwife attending, the safest birth is the one where mom and baby both end up healthy. You just have to decide what is right for you, but also be open to the possibility you may get a wild card.

To Elanne and Kris – I think your choice is an awesome one and I can’t wait to read your birth story. Hopefully you will post about it. =) It is really such a beautiful experience.


Long Term LC Dieter July 2, 2011 at 11:31 am

The way incontinence statistics are presented varies. There is a lower rate of incontinence with c-section. You might find that the way you feel about it depends on your problem and how it progresses as you get older.

Women are expected to bear the pain and be silent about it.


Elanne Kresser July 2, 2011 at 1:32 pm

This is one of the best approaches to healing incontinence. It’s an excellent program. Also good for general recovery after childbirth.

Through her own experience Deborah Bowes has become one of the leading authorities in the functioning of the pelvic floor.


Matt July 2, 2011 at 1:49 pm

My second daughter was just born at home last weekend, and subsequently rushed to the community hospital, and then airlifted to another hospital (where she is now), because of a variety of lung-related issues (number one: not breathing on her own). Definitely not the original plan!

Was it scary? Yes… incredibly. Would we do homebirth again? Yes… not because we’re crazy and “committed to the cause” but because we’ve gone over and over everything during those long hours watching our child fight determinedly as we stood helpless, or driving back and forth to the hospital that’s an hour away…

We believe that we did the best we could have for our child – that she wouldn’t have received better care anywhere else. We are grateful for the midwife who helped provide the best birth environment and immediate care possible, as well as all the skilled doctors and nurses who provided the best emergency and intensive care possible.

I wasn’t worried about the “what-if” before this birth – I knew that there was a 99.5% chance we’d have a safe homebirth and stay at home. Well, we hit the 0.5% – but it was still not only “OK” but as good as it possibly could have been.

I pray that your experience is what we wanted for ours… and for what it is worth, though it is hard to think of now, the 4-hour labor (yes… just 4 hours) that my wife had went EXACTLY as she wanted, and it was truly an awesome (in the full sense of the word) experience rather than an awful experience.


Emily Deans MD July 3, 2011 at 8:36 pm

I had two hospital births – I am obviously very comfortable in hospitals having spent many years in them. Decent hospitals nowadays really focus on you having your choices, I was asked about a detailed birth plan prior to the deliveries, skin to skin contact right at birth and immediate nursing were highly encouraged. I spent quite a lot of labor unmonitored, the rooms included a birthing tub if you wanted to go that route. My only issue was a pushy nurse after the delivery of my first who kept critiquing the breastfeeding. After my second the nurses pretty much left me alone, which was fine by me – I was out of the hospital kid in hand about 36 hours after each one. We were strongly encouraged to room in with the baby also. Neither child had complications (knock on wood) – mostly I was glad that after a hospital birth I wouldn’t be the one doing the laundry ;-) (I’m hopeful laundry is arranged for a home birth – I’m sure it is, oddly enough that is what I think about though!) In medical
school I participated in the delivery of many babies so was very familiar with the hospital process. Having also seen many complications (I worked in an inner city southern hospital where many of the mothers were ill or had no prenatal care at all when they showed up in labor) – that it obviously a skewed sample but that sort of training does bias doctors against home births. It is not a fair sampling or a cochrane review by any means. Even in that hospital there was a midwife ward and a doctor ward – there are over 15,000 babies a year born there so everyone is exceedingly experienced and of
course there would be complications with so many… but when I had a child I was glad to be minutes from a NICU though more glad it was never needed. However, hospital germs were a concern of mine as well!


Liz Downunder July 4, 2011 at 5:15 pm

I fully support hospital birth if that is where the birthing woman feels safest, assuming she understands her options and has made an informed choice. Just wanted to say, though, that here in Australia, trainee midwives complete their course having never even witnessed a natural birth (unless they are one of the few who train with an independent midwife). So what are they learning exactly??? How to interfere and then how to mitigate inevitable complications (usually more interference). They do not learn what a natural, unhurried, unintervened birth (and labouring woman) looks like. They do not learn to sit back and observe, they do not learn about the hormones etc. Their training is medical in nature, which, as we know, ignores the very nature of birth.


Oregano July 4, 2011 at 3:18 am

Chris, I really love your research usually, but it seems to me you dropped the ball on this one. You sound as if you have swallowed the homebirth propaganda without your usual skepticism. You say if there’s a problem, “just transfer to the hospital” – it is really not that simple! If you are with a laboring woman with a catastrophic problem (for example, placental abruption) you have to get her into the car, drive to the hospital, get checked in at the hospital with paperwork, be examined by an OB and nurses there, and finally transferred for a c-section. Even if you live 5 minutes from the hospital, transport can be a very time consuming process and unfortunately can end with tragic consequences.

I highly recommend you check out the blog “The Skeptical OB” – the web site is – her tone is unpleasant but the information there is invaluable. She addresses so many of the exact homebirth lines you throw out in this article, and backs them up with studies too, for example, the claim the Netherlands statistics show it’s safer to homebirth.
No, the Netherlands has, and has had for some years, the HIGHEST perinatal mortality rate in Western Europe. It also has a high and rising rate of maternal mortality. The Dutch government is deeply concerned about these high mortality rates and a variety of studies are underway to investigate.

The most recent study published in the BMJ is early November 2010 revealed and astounding finding. The perinatal mortality rate for low risk women cared for by midwives is higher than the perinatal mortality rate for high risk women care for by obstetricians!

Her “10 things” article rebuts many of your claims point-by-point:
But there is a lot more to read than just that snarky summary. Please get past her tone, because the information is important, and I think you are doing women a disservice by downplaying the risks of complications, and the ease of solving problems during homebirth.


Chris Kresser July 4, 2011 at 8:45 am

I started to write a point-by-point rebuttal to Dr. Amy’s ridiculously biased and myopic post, but after scanning the comments found that someone (Ellie) had already done that. So I’ll reproduce it for you here:

1 – Perinatal mortality is lower still in western Europe where obstetric care is a last resort and midwifery is the default method of care.

Central America is behind all of Europe and South America.


2 – The Netherlands are in Northern Europe and experience lower rates of perinatal mortality, neonatal mortality and stillbirth than Central America. The fact that the Netherlands are experiencing increasing issues with maternal and infant deaths coincides with the very recent rapid decline of home births (from two thirds in 1965 to less than a quarter today). The rise in maternal death is still less than half that in Central America.


3 – I happen to agree, there are many obstetricians who are actively in favour of normal birth with surgery being an absolute last resort. They aren’t all, however. I’m not sure what the history behind point three is, but it’s very heavily loaded with contempt. Calm down!

4 – This is little more than statistical manipulation. Looking at the data, in the neonatal period, 9 babies died. 3 died from congenital abnormalities and 2 (possibly 3) died from SIDS – which has nothing to do with where a baby is birthed as far as current medical evidence is concerned. The case of vasa previa was handled as quickly as any hospital could have done. You cannot, realistically, know whether or not this or the remaining deaths would have happened in a hospital. Furthermore, non of this considers the possibility of death via unnecessary interventions.

5 – There is no conclusive evidence stating that it is any riskier to transfer from home to hospital, should a complication arise. All available statistics suggest that, actually, trained and qualified midwives are indeed very capable. And again, calm down.

6 – Obstetrics has, undeniably, contributed greatly to lower mortality rates. However, that doesn’t necessarily mean that it is correct in all areas. Midwife led care, when practiced properly, is demonstrably safer than obstetrician led care.


7 – Quite right. Obstetrics certainly has its place. Sanitation and Hygiene, however, have played an undeniably important role.

8 – Essentially, you’re just speculating here. Since the evidence you’re looking for isn’t solidly available.

9 – As with the above point and point 4, there’s an awful lot of being selective with available statistics taking place here. Looking at unnecessary induction, while the risk of neonatal death may be no different (and that’s important from all angles) the impact of birth upon childrearing is not to be underestimated.

10 – Indeed. Modern Obstetrics certainly contributes to the lower levels of infant and maternal death. 7% and 1% are, however, somewhat lower than one would consider to be “inherently dangerous”. Hence, even 50 years ago the population of this planet was greater than could comfortably be sustained via natural resources.

11 – So, it’s not rising – it’s just higher than had previously been known? Right.

12 – Again, quite right. Evolution isn’t perfection, sometimes obstetric intervention is very much needed. Over time, however, as a result of these important interventions, women with this issue will become steadily more common so it is important that this is known in advance and measured. After all, I think we can all agree than elective C-Sections are safer, calmer and can emulate a natural birth in many respects in order to achieve the optimum birthing conditions for the baby.

In all, I found this to be somewhat bizarre… “Natural childbirth advocates make up their “facts” as they go along. They don’t read the scientific literature. They don’t interact with science professionals. Indeed, professional natural childbirth advocates take special care to never appear in any venue whether they might be questioned by doctors or scientists.” – It reads very much like a paranoid conspiracy. As though it is impossible to be a natural childbirth and scientifically minded.

As somebody who studied astrophysics at degree level, amongst other things, I am hugely interested in the scientific evidence available but, I am also painfully aware that, often, science doesn’t have all of the answers. It also cannot always be used to prove what we logically know to be true. Theoretical physics is responsible for a great deal of describing our casual observations of the universe, and yet it remains largely theoretical, interspersed with empirical data.

Biology, and more importantly the science of child birth, is no different. I take issue with statistical manipulation of the few pieces of evidence based research that we do have.

On top of that, I will be explaining several other ways that “industrialized birth” can negatively impact not only birth itself, but the baby’s health during infancy and for the rest of his/her life. As an example, we are now beginning to understand that early changes in the gut flora of an infant can predispose him/her to lifelong health problems like obesity, diabetes, asthma and allergies. These changes are far more likely to occur in a hospital environment. The comparison of hospital vs. home birth goes far beyond perinatal mortality rates, as I will demonstrate in future articles.


Nora July 4, 2011 at 4:08 pm

I had one child in the netherlands, and one in the US. The baby in the Netherlands was a planned home birth with a totally excellent midwife. I pushed for half an hour on a birthing stool before the midwife called a halt and proceeded to drive me to the hospital for a vacuum extraction (baby was 9lb 9 oz and I could not push it ’round the corner’). She stayed with me the whole time, and was the one who visited the next 10 days (Dutch perinatal care is very good). I was grateful for the hospital, but I would have opted for a home birth again with the second, as I thought my midwife was brilliant.

However, with the second one we were in the US. I had to fight very hard not to get a preemptive IV, the nurse told me to push in the wrong direction, (resulting in a bruised sacral nerve which took 12 months to heal – the midwife in NL had indicated in which direction to push by touching me in the correct place), the doctor was at lunch when it came time to deliver so there was panic in the room when push came to shove (heh), it was not a great experience. (I also don’t get the insistence on rough cotton open-backed, short-sleeved hospital gowns designed to freeze many parts of the body here, what is that all about?)

Overall though I agree that people have to go where they are comfortable and feel safe, but then they have to be prepared for the environment they choose.

BTW the perinatal mortality in NL could be higher due to a different policy on the very very early preemies. There is not an automatic “keep it alive at all costs” policy. The parents are told the risks of serious disabilities of various kinds with these barely viable infants, and I believe that many parents choose to let the child go. I’d have to look up the reference on that, heard it during a lecture on preemies and developmental disabilities.


Barbara July 4, 2011 at 11:25 pm

Kris, I enjoy your podcast and posts very much and am learning so much. This one really resonated with me as I was going to have a home birth 28 years ago after participating in both of my sisters home births with their children. I didn’t have to be convinced, I just instinctively felt that it was the right thing to do for mother and baby. But dangerously high blood pressure and no progress in dilation forced us to the hospital for an emergency C-section. I was glad my midwife had insisted on a doctor back-up but at that time not even my husband could go into surgery with me. Except for a very compassionate nurse who missed her son’s little league game to stay with me through the whole ordeal, I felt so completely alone. I had to fight for the doctor to let me stay awake to greet my new son and was heartbroken to not be able to hold him for almost 4 hours! After they brought him into my room, I had to fight to keep him with me and let him nurse as he pleased. Yes, I was glad we were both alive but the psychological damage was long lasting and took me by surprise. It took a bit of therapy and 5 years to have the courage to try again. Longer story than we have room for here, but my second and third were also C-sections but planned so the experience was a bit better. Still, I couldn’t wait to get home and have my babies to myself despite the pain and long recoveries. Your last comment about the infant’s gut flora hit me like a ton of bricks since my first son born so traumatically has been a type 1 diabetic since he was 5 with absolutely no family history and a fairly good diet with what I knew at the time. I will look forward to reading your future articles as you go into more depth. Sincere best wishes for you and your wife to have the home birth experience you all deserve. I still believe it is the best way to welcome your most precious gift.


Kari W July 5, 2011 at 4:41 am

Chris -
Another GREAT post!
I’ve taken your Healthy Baby Code course (AMAZING!) and wanted to see if you have a good book recommendation for pregnancy. Preferably something more in tune with your philosophies than I’d find on a mainstream “best sellers” list….
thx! Kari


Chris Kresser July 5, 2011 at 9:15 am

Birth & breastfeeding by Michel Odent.


Chris Kresser July 5, 2011 at 9:31 am

Another one would be Gentle Birth, Gentle Mothering by Sarah Buckley.


Adria July 5, 2011 at 10:22 am

Congratulations on your upcoming joyous event!

I just wanted to say that the natural birth of my son was the most beautiful, serene event of my life. I experienced no pain at all–just a sense of pressure. In fact, it took me a couple of hours to even realize I was in labor. Once we got to the birthing center, while I was walking around and around outside the building, I entered a trance-like mental state. My son was born after about 10 hours of labor, where I spent much of the time in a big, comfy tub and my husband, my sister, and my mom in the room with me. My doula was wonderful and made me feel completely safe. I knew that she knew what she was doing, so I could just relax. I did end up with an episiotomy and a third-degree tear, but I didn’t feel a thing and that healed right up after a couple of weeks, so it was no big deal.

I ascribe my glorious experience to big hips, excellent health, fantastic care, a reassuring location (birthing center right across the driveway from the hospital ER), and positive expectations: All of my life my mother told me that my (natural) birth in a hospital was like a religious awakening for her, so I was predisposed to think positively of childbirth.

My experience makes me wonder if the fear of childbirth causes pain, but the rational side of me points out that fear is more likely driven by the pain. I just got lucky. So on the one hand, I am reluctant to tell other women about how easy and painless my birth was, because I don’t want to sound like I’m judging or bragging or telling them they “did it wrong.” On the other hand, I want other women to know that childbirth isn’t always a painful event to be endured, and I hope that openness to the possibility might allow them to experience something beautiful.


Cancel reply

Leave a Comment

Previous post:

Next post:

Designed by Evan Haas & Soy Pak