Although the overwhelming majority of women in the United States believe childbirth should only happen in well-appointed hospitals, there is a group of people who see things differently.
I believe babies ought to be born in a hospital.
When I'm on-call, walking the well-lit hallways between clean and spacious patient rooms, I find it reassuring that there's an operating room down the hall, a blood-bank on another floor, and a host of well-trained nurses and anesthesiologists nearby.
During the eight years I trained to be an obstetrician, I learned how to handle the rare complications -- massive hemorrhage, separation of the placenta, rupture of the uterus -- that occur in an instant and can cause lifelong disability or even death. I learned to depend on teamwork and the massive and expensive resources available in a well-appointed hospital. It is anathema to everything I learned that childbirth would occur anywhere else.
Although the overwhelming majority of American women see childbirth like I do, there is a group of women and their partners who see things entirely differently. Childbirth, to them, is a natural event that women have managed at home for all of history (until the past several decades). Hospital births are unnatural and 'medicalized,' and much more likely to lead to a cesarean delivery. A whole 'home birth' movement has grown up to support these women.
I was responsible for Laura and her fetus, and it was my job to deliver a healthy baby and keep Laura safe as well. I felt set up for a calamity.
Published evidence suggests that while women who deliver at home are less likely to suffer the consequences of medical interventions -- everything from c-section to maternal infection -- babies born at home are nearly three times more likely to die than babies born in the hospital.
On a recent morning, a woman expecting her first baby began having uterine contractions and, instead of calling an obstetrician, called her lay midwife. The woman, who we'll call Laura because she didn't want her name used, planned to labor at home. Soon, the midwife arrived and supported her through labor, intermittently checking to make sure she could hear the baby's heartbeat using a hand-held Doppler ultrasound device. Besides the Doppler and a thermometer she used occasionally to check Laura's temperature, the lay midwife focused on keeping Laura as comfortable as possible through the unremitting contractions.
By afternoon, Laura's cervix was fully dilated and she began to push. Two hours -- the time-frame most obstetricians allow before they begin to worry -- came and went, and still Laura pushed. Except for the prolonged and arduous process, everything else seemed fine. Laura's baby's heartbeat was normal and there was no evidence -- based on the temperature readings -- that an infection was setting in, so Laura pushed on. But when eight hours had passed, Laura's lay midwife began to worry that perhaps Laura's baby wouldn't be born -- at least not at home. So she picked up the phone and called 911.