Hidden beneath all the excitement surrounding names and birth weights, Meghan Markle’s labor brought another topic to the forefront of the media: homebirth safety. After much anticipation, the newly royal Duchess of Sussex had a homebirth at Frogmore Cottage. For those who want to follow in her footsteps, this may seem like a green light to give birth away from a hospital setting.
Although homebirth safety has improved in recent years, this isn’t the case for all developed countries. Aside from Markle’s social status acting as a protective factor, she gave birth in a country with a different type of midwifery system to the United States. As such, it’s worth considering some of the key homebirth safety differences before writing your birth plan.
What is homebirth safety like in the U.S?
Homebirth safety largely depends on a trained professional attending the birth. Depending on the state you live in, you may find your access to such professionals extends to doulas only. Unlike certified nurse midwives, doulas are not well-trained in protecting maternal and neonate safety.
In comparison, the term midwife in the United Kingdom is a protected title. Much in the same way that you can’t falsely advertise yourself as a doctor, you can’t claim to be a midwife when you are not. UK midwives benefit from a rigorous professional training course. Although they primarily focus on normal and healthy births, their training helps them know when to get a doctor at the earliest possible stage.
Many independent midwives in the U.S who oversee homebirth safety are traditional midwives. This means they have no formal training in their practice. They’re also don’t need to answer to a recognized professional organization.
As a result of inconsistent regulation, this means there’s no certainty surrounding a traditional midwife’s ability to spot signs of fetal distress. It’s also worth acknowledging that most don’t have a formal agreement with local hospitals for accepting patients. In the case of Meghan Markle, her UK midwife would have the power to make a direct referral to a local obstetric unit. At that unit, her midwife would also have a strong professional relationship with the OBs working there and could provide a safe and thorough handover accordingly.
Does this mean homebirth is a safe option overall?
Although homebirth safety is better than ever, that doesn’t mean it’s the safest option. One study that reflected this as The Birth Place Study. Initially, the study was used to demonstrate how homebirth safety eclipses hospital birth safety. However, the initial analysis was flawed and exaggerated. Clinicians were quick to highlight that the following confounding factors weren’t assessed:
- The number of births managed at each hospital unit.
- Too much focus on the place rather than mode of birth, which ignored the natural tendency for women requiring interventions to eventually deliver in a hospital setting.
- The media didn’t focus on how first-time moms delivering at home were more likely to give birth to a baby with encephalopathy.
Unfortunately, although homebirth safety is better than it was 30 years ago, it still carries risks. In the absence of a fast transfer to an obstetrician and all the equipment they can use, emergency scenarios soon turn disastrous. When a healthy baby is an overall goal, hospitals are undoubtedly safer.