Education And Debate

Has the medicalisation of childbirth gone too far?

BMJ 2002; 324 doi: (Published 13 April 2002) Cite this as: BMJ 2002;324:892

Is home midwifery-attended home birth a good option?

This response comes rather late, but I thought it might be of interest to those
who believe that home birth is unsafe and hospital birth is the "obvious

Infant Mortality Rate (IMR) data, from the Texas Department of Health, Bureau
of Vital Statistics:

Year M.D. IMR Midwife IMR M.D./Midwife IRM Ratio
1990 7.6 3.0 2.5
1991 7.3 3.0 2.4
1992 7.5 2.3 3.3
1993 7.3 1.8 4.0
1994 6.8 1.7 4.0
1995 6.5 2.1 4.0
1996 6.3 1.1 5.7
1997 6.1 2.8 2.2
1998 5.7 1.7 3.3
1999 6.0 1.2 5.0
2000 5.5 0.3 18.3
Average (1990 - 1999) excluding year 2000 data
  6.5 2.1 3.5

What does this mean? It means that home birth, by Direct Entry Midwives, according
to the midwifery model of care, is statistically safer (for those women who
are candidates for home birth) than physician-attended birth in Texas.

Look at it another way. Examine the infant mortality rate for MOST world countries.
From “The CIA World Factbook – 2001” estimated infant mortality
rates (1 year):

United States - IMR 6.76.

This IMR places the United States 40th on the World Facts Book’s list
of 234 countries ranked by infant mortality. The IMR in Texas is better. Texas
would rank about 26th, but if Texas Midwives were included on that list their
IMR would place them FIRST.

True, at times there are medical complications that require a physician's services.
When they are really needed they provide a wonderful birthing option. Granted,
physicians often get the "harder births," but not all of their births
are the difficult ones.

Since the C-Section rate in Texas is 25% on average for the year 2000, we might
assume that 75% of women are likely candidates for "unremarkable"
births. Many, if not most of those women have not been told that there is a
statistically safer birthing option and that, by the way, it is cheaper as well.

However, don't fault the women too much. Insurance companies often refuse to
pay for home birth and justify their policies on home birth by stating that
it "isn't safe" or it isn't recommended by physician guidelines

Gail Johnson, CPM

Competing interests: No competing interests

18 July 2002
Gail W. Johnson
Eden Song Maternity, Inc. 76054