Childbirth is Safe for Today's American Women, but Why?

Those who are against homebirth and freebirth often have the same arguments. They say that parents who chose these births are thrill-seekers who don't care about the well-being of their babies. A favorite statistic to quote is the fact that some 500,000 women die yearly around the world from childbirth complications. These arguments are severely lacking in foundation and evidence. There is much that the naysayers purposely leave out and exaggerate. To really understand the dangers of childbirth and the safety of birthing location, we need to examine the most common causes of maternal death across the world and why they are not so rare here in America today.

We need to know more for the number 500,000 to tell us anything about the safety of birth. How many women each year give birth? Where do most of those maternal deaths occur, and what is different about that country from America? What are the most common causes of death? How many of those deaths were truly preventable? The presence of this data would enable us to calculate percentages. Those percentages can give us a far better idea how safe or dangerous childbirth is than a lone number. The truth is, the numbers aren't quite so dismal for Americans.

Less than one percent of maternal deaths occur in developed countries. Most take place in developing nations. Some believe that's only due to their lack of technology. However, there are many differences between the United States and these other places. In developing nations, poverty is very common. There is not always clean drinking water or enough food to eat. Women may spend all day working in fields under the hot sun. Women in these countries are often malnourished and overworked, increasing their risk of complications and death. Poor sanitation is another large factor contributing to how dangerous birth in these places can be. It's not all about technology and prenatal care.

When considering the causes of death, we need to remember a few things. For one, cases where women died after abortions are counted. Moreover, ectopic pregnancy--when the egg implants outside of the womb--is another major cause of death. It can typically be identified by severe pain and bleeding. That causes about 13% of maternal deaths worldwide. Usually these pregnancies don't last very long, and the mother's body makes her quite aware that something is wrong. It has little to do with the subject of freebirth, as rarely do these pregnancies result in birth. Accidental deaths and those from incidental causes, like violence against women, may also be counted.

Women most commonly die during pregnancy or childbirth of infection (13%), preeclampsia (12%), hemorrhage (25%), sepsis, and obstructed labor (8%). Indirect causes make up 20% the maternal deaths, and these include preexisting conditions such as diseases and malnourishment. The last 8% are classified as other causes, some of which are unpreventable like amniotic fluid in the bloodstream. The frequency of these occurrences in the US are much lower than they are around the world. This is because Americans are less likely to be poor, malnourished, overworked, or to have unsanitary living conditions. Puerperal fever sepsis, or childbed fever, is contracted due to lack of sanitation. We've all but eliminated that in America because of our better hygiene.

Maternal mortality ratio is the number of maternal deaths per 100,000 live births. (Now remember, this isn't including stillborn deaths, nor do we know how many of the live births were multiples.) The countries with the two highest rates are Sierra Leone and Afghanistan, at 2000 and 1900 respectively. Iceland and Austria have the lowest ratios, at 10 and 4 respectively. The US MMR is 17. That means that for every 100,000 women that give birth, only 17 die. That's a percentage of 0.017% maternal deaths, far less than 1%, which was maternal death rate in the early 1900s. Back then one mother died for every 100 births; now one mother dies for every 10,000 births. The rate is much higher for African-American women.

This is attributed mainly to C-section usage (which actually triples risk of maternal death), obstetric labor management and prenatal care, as well as better sanitation. However, when we look at hospital birth vs. homebirth, the number of mothers dying after homebirth with midwifery care is even lower. This suggests that the hospital environment and obstetric approach to pregnancy and birth make maternal death more likely. Studies have shown that technological interventions like C-sections greatly increase risk of maternal death. One would have to conclude then that other factors play a bigger role in these better outcomes. We have significantly more knowledge, better hygiene practices, and take better care of ourselves physically, nutritionally, and emotionally. We now know not to smoke and drink during pregnancy, for example.

We know that infection and sepsis, accounting for 13% of maternal deaths, can be prevented with good sanitation. Another 13% of maternal deaths are the result of complications from abortion. Another 20% of maternal deaths are from indirect causes, which are also less likely in our country due to better nutrition, sanitation, and overall healthiness. The remaining 55% of deaths are caused by preeclampsia, hemorrhage, obstructed labor, and other causes such as embolisms. I can't examine those "other" causes, being that there are so many--too many to list and cover! We can, however, take a peek at these more common complications.

A significant number of deaths are because of hemorrhage, which is extensive bleeding. Risk of hemorrhage can be lowered by being well-nourished, breastfeeding after birth, avoiding blood-thinning medication, and birthing at home. Hemorrhage is three times more likely to occur in the hospital. It is even more likely after a C-section or pitocin. Hemorrhage can be treated adequately at home with many herbs, uterine massage, the trendelenberg position, urinating often, and oxygen administration. Sometimes medication or surgery is needed, which requires a hospital. While hemorrhage causes about 17% of maternal deaths in the US, only 5% or less of women will be afflicted with postpartum hemorrhage. Most cases occur after hospital births, particularly interventionist ones--which proves that death because of hemorrhage can't always be prevented.

Worldwide, preeclampsia causes 12% of all maternal deaths. In the United States of America, it affects 3-8% of pregnant women, and most cases are mild. The risk for some is higher than it is for others. Women carrying multiples, smoking, obesity, advanced maternal age, and teen pregnancy are risk factors. Nutrition may also play a role. Preeclampsia is characterized by protein in the urine and high blood pressure. A woman can measure her own blood pressure to determine if it is high. She can also order urinalysis sticks to test her urine for protein. Her pregnancy symptoms can be monitored for signs of preeclampsia. Midwives can do this as well. There are some natural treatment options for preeclampsia. When these fail, women can turn to doctors for medication and/or restrict themselves to bed rest.

Obstructed labor is responsible for 8% of maternal deaths across the world. This is when labor fails to progress, usually when the child cannot come down the birth canal. Some cases can be prevented by using external cephalic version to turn breech and transverse babies. Remaining active during labor and assuming many birthing positions can also help. There are also hand maneuvers that can dislodge a stuck baby. Many natural herbs can be taken to augment labor that are about as effective as pitocin. A woman who encounters this and is unable to correct the problem can go to the hospital for pitocin, C-section, whatever is necessary. Homebirthers and freebirthers are no more at risk of obstructed labor or death because of it than anyone else. You don't necessarily have to be in the hospital to manage this, and hospitals provide no guarantee either. Moreover, hospitals are available to nearly everyone, even those who haven't picked the hospital as their first choice for birth location.

The United States represents only a small percentage of the some 500,000 maternal deaths that occur worldwide each year. Our maternal death rates are quite low compared to most of the rest of the world. This isn't solely due to better health care and hospital birth. We have a better, healthier standard of living overall here in this country. The main causes of death worldwide are far less likely to occur in this country. They claim fewer lives here. In fact, the causes of maternal death in America are different from the rest of the world. That is because the United States itself is so different. Homicide is actually the number one cause of death of pregnant women here!

Maternal deaths are much more likely to occur in the hospital than at a homebirth. This is because risky intervention and hindering restrictions are more common in the hospital. The interventions that are heralded as the reason for our lower MMR actually increase the risk of maternal death. Complications are less likely to occur in homebirth, as the environment and approach are different. Many complications can be treated at home with women very rarely needing to transfer to the hospital. A midwife is as capable as a doctor, and an educated mother can be just as capable as a midwife. The hospital is as available to homebirthers and freebirthers as it is to anyone, and they can transfer if necessary--usually in plenty of time to save all lives involved.

The risk of maternal death is very low in the US anyway, because our standard of living is so much better. Not only does birthing at home in and of itself put a mother at a lower risk of death, it also means a lower risk of postpartum depression. The babies are usually much healthier after homebirths and freebirths. The experience is usually much more enjoyable to everyone, not nearly as traumatic (or as expensive). Homebirthers & freebirthers are protecting themselves from the interventions that make maternal death more likely, while still on the lookout for complications that could put them at risk. They are not thrill-seekers, as these birth choices are no more risky than any other type of birth. In fact, they may very well be more safe.