The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

What If Something Goes Wrong?

Interchange about a Situation where Something Did Go Wrong

One thing people always say is, "what if something goes wrong?". The fact is, that even if an emergency arose while you were in the labour ward, it would take at least 20 or 30 minutes to prep an operating room and assemble the necessary staff for an emergency c-section. So if you live within a half-hour drive of a hospital and you call ahead, you are just as close to that operating table as if you were in the labour ward.

Of course complications can occur, and hospital is the place to go when serious complications do occur, and this is what happens. No midwife is going to endanger the life of her client by attempting to treat a problem for which she lacks the necessary technology or expertise -- like any practitioner, when the need for a specialist arises, she refers clients to the appropriate specialist. That's what hospitals are there for, handling emergencies.

But midwives ARE trained medical personnel and often have far more practical expertise than their M.D. counterparts. Their training and internship is just as long and rigorous as any doctor or nurse's, and indeed, many of them are nurses as well. (anyone with nurse friends has undoubtedly heard horror stories of situations where the nurse on the case knew more than the doctor and just barely averted a bumbling disaster caused by his/her ignorance!) A medical degree does not guarantee competence.

I agree that some C-sections are indeed needed. There are some situations in which c-sections save lives, specifically cases of placenta previa (placenta is covering cervix, so baby can't come out), or placental abruption (placenta pulls away from uterine wall before baby is out, severing its oxygen supply and causing mother to haemorrhage). Certain breech positions (footling breech) for larger babies might also be an indication for Caesarean, or twins where one is lying transverse. And there are very very few cases where women have deformed pelvises due to childhood polio or congenital defect, where a baby really can't fit through (true cephalo-pelvic disproportion). But all these kinds of cases taken together should amount to c-section rates of around 3%, and the rate in the US is nearing ten times that! In some hospitals, their c-section rate is over 50%!

But 97% of births are NOT emergencies, and yet by having your baby in the hospital, you are treated by the same protocols as those 3%, and that is wrong wrong wrong and the source of many many problems and complications. Most caesareans performed today are due to iatrogenic causes -- that is, the doctor's previous treatment regime has CAUSED the c-section to be (or at least be deemed) "necessary". If the baby had been born at home, this would not have happened. And make no bones about it, a c-section is major abdominal surgery and carries a significant risk of death for the mother, no matter what the "causes" of it were.

So one must always balance the relative risks involved -- the risk of maternal or fetal death due to an unnecessary iatrogenic c-section in the hospital (and your risk of an unnecessary c-section is about 1 in 4, and in some places much higher) versus the risk of having an emergency that could have been dealt with within the hospital faster than you could transport there (actually very very small). And unnecessary c-section is not the only risk of a hospital birth -- hospitals are full of sick people and sick people's germs, and rates of perinatal infections of both mother and baby are orders of magnitude higher in the hospital than at home.

There are many many scientific studies which confirm not only the safety of home birth, but many find that it is actually SAFER than a hospital birth in all but the highest risk cases (see http: for quotes from various studies). Check out the British Medical Journal (BMJ NO 7068 Volume 313 Saturday 23 November 1996) for some of the latest research (it is available on line at http:

When discussing my choice of a homebirth, someone once told me "yeah, I know what the statistics say [that homebirth is safe] but you're not just a statistic, and even in there's only a one in a thousand chance of something going wrong, don't you want to be in the hospital?" "Not when there's a 20 in a thousand chance that something will go wrong in the hospital!!" I said. This is how we make rational informed choices, by reading the scientific evidence and weighing the risks. And it seems to me that the fundamental mistaken assumption (propounded of course by doctors and OBs who work in hospitals) is that the hospital is the safest place to be -- study after study has shown it quite simply is not. So the rational choice 97% of the time is quite clearly homebirth.

But even if all the iatrogenic problems which arise in hospitals could be eliminated (and I honestly am not in the least hopeful about that), there are many other reasons why people choose to give birth at home.

If you look at it historically and globally, it is only in the last 50 or 60 years, and only in the industrialized west, that birth in hospital has become the norm. The common myth may be that is was this movement into hospital which reduced infant and maternal mortality, but careful studies have shown this not to be true -- that the drop in infant mortality occurred PRIOR to the shift in location, and that the improvement in the infant mortality rate actually dipped or even reversed itself in a given region when hospital births became the norm. Most medical historians now agree that the overall improvement in infant mortality rates occurred primarily because of improved maternal nutrition (same reason people are getting taller and menarche is getting younger) and has absolutely nothing to do with location of birth.

People have always given birth at home, and still do in most parts of the world. It is fundamentally not a medical happening, but a familial one. At home, a woman is in control. She is free to move and act as she wishes, and is not inhibited by being in a public place, but rather is content in the place she is more at ease, in the bosom of her family. The effect on the progress of labour of psychological factors cannot be overstated -- a woman who is tense, anxious, uncomfortable and feeling out of control will have a much more difficult labour and birth than one who is calm, relaxed, in control and comfortable. Hospitals, no matter how nice, aren't as comfortable and familiar as your own bed.

I firmly believe that women who WANT a hospital birth should be able to have one, but I also believe that homebirth is the rational and best choice for the vast majority of women.

Some useful references on the safety of homebirth and the lack of scientific basis (and indeed harmful nature) of common obstetrical practice :

A Good Birth, a Safe Birth
by Diana Korte, Roberta Scaer
Harvard Common Press 1992
ISBN: 1558320415 

Obstetric Myths Versus Research Realities : A Guide to the Medical Literature
by Henci Goer
Bergin & Garvey, 1995
ISBN: 0897894278 

Intrapartum Care : A Research-Based Approach
by Jo Alexander (Editor), Valerie Levy, Sarah Roch (Editor)
Univ of Toronto Press 1993
ISBN: 0802074510

Interchange about a Situation where Something Did Go Wrong

I'm quite new here, I've only posted my "horror story" about my labour. Now I just want to say that statistics may often be misleading. The fact is that in my country (Poland) newborn death rate has only recently been reduced to 9 /1000 due to health service reform and easier access to medical services (we are a post-communist country). Homebirth used to be popular in Poland rather because there were places that the ambulances couldn't reach within reasonable time. Now it's changed a lot.

I agree that for many non-risk pregnancies homebirth might be the easiest and most relaxed way of giving birth. however, my pregnancy was a non-risk one as well. I continued working up to the 9th month. I was healthy and perfectly ok, and as such a perfect candidate for homebirth.

I know if I had tried homebirth both of us, me and my son, would have been dead by now. I don't understand the urge to proceed "naturally" where sometimes medical intervention is necessary. And what statistics show is that all risky labours end up in hospital, and healthy babies are born at home. Gosh, some healthy babies have been born in taxi-cabs, on trains or airplanes!

I believe it is always safer to choose hospital, because in labour the situation can change within seconds.

I don't remember you're story, so I'm not sure what happened to you. But here in the US, I have to disagree.  Many things are done in the hospital which CAUSE things to go wrong.  These are called iatrogenic (Dr. caused) complications.  Many things done in the hospital are not actually  proven safe for baby and mom.  For example pitocin can cause unnaturally hard contractions that can deprive baby of oxygen and cause a distressed baby.

Pitocin is not given in a labor at home.  Home birth monitored by a competent midwife is safe here, because the midwife can intervene and immediately transfer should a truly dangerous situation occur.  Ironically most of the transfers from home to hospital  happen for non-emergency reasons, ie failure to progress.

It is true that there are certain risks involved in choosing a home birth, but it is a mistake to think that a hospital birth is risk free or even less of a risk. 

Our experiences so very often determine the way we think about things despite  whatever contrary things we may read.
Yes, complications can develop within seconds.
Yes, a baby can die in utero on the 38th week of gestation for no apparent reason the day after being checked by US and seemingly in perfect health.
Anything can happen at any time.

IF I felt that a hospital was a GOOD  place to have a NORMAL and PRODUCTIVE labor I might consider laboring there.  But from the birth stories I have read in many  many places I am finding that hospitals to often create the problems that they eventually save mother and baby from.

I  also know that most times  it takes 30 minutes to  get staff and prep for  an emergency c-section, so whether at home or the hospital you still have to  wait.  When babies get stuck I rarely hear of changing postions; rather they try  to pull or suck the baby out.  You know I could go on about the "bad" things  done in a hospital, but I doubt it would change your opinion.  And that is okay  for I know your experience has shown you how dangerous birth can be for you.
My experience thus far has shown that while birth never goes as we "plan" and  while complications do occur, sometimes those "complications" are not as  severe as others would make us think. I believe it is always safer to birth where and with who one feels the  safest, most relaxed, and the most confident in ones ability to birth.  If any of  these are lacking the birth process is nothing but extremely prolonged with  anxiety and fear; both of which cause ineffective contractions and decrease O2  to the fetus thus leading to complications.

We also must be comfortable with taking responsibility for the choices we make  regarding birth.  It IS  so much easier to place all the responsibility in the  hands of MP's, so if something were to go wrong we have no personal guilt (the-  I wish I would have....).  It is easier to live with the idea that someone else  made the mistakes (though of course still utterly painful to lose that longed-for perfect child).

I guess what I am trying to say it what you think is okay for you, but not for  me.  And I know you would never birth the way I do, but I would hope that you  could somehow see that for me home IS better than a hospital.  And that as  painful as it is I DO (and did) accept the consequences of my choices.

There is so many things to fear-injury, diseases, death..... but I do not want to live in fear.  I found it so unpleasant to live in fear of  "what could go wrong" during my pregnancy.  To go from test to test in fear as  they wanted me too.  It was such a great peace to  put away the OB medical  books, refuse all the tests, and just be pregnant and be HAPPY about it day  after day.
I knew about the complications.  Knew how they were dealt with.  But I did not  dwell on them.

I think that we are having a bit of a misunderstanding that is based upon the differences of our experiences.  Homebirth hasn't been popular in the U.S. for a very long time and most normal healthy women end up having unnecessary interventions that *cause* injuries either to them or their babies.  Interventions can be life-saving when they are necessary, but when they are used routinely on healthy, normal women they can cause more problems than they solve.

From what I remember of your story, you had a pretty bad hemorrhage at the beginning of your labor.  I think we would all agree that a woman who is hemorrhaging in labor ought to go to the hospital *immediately*.  You said that though you went to the hospital, your labor was then induced (or augmented?) there, I assume with pitocin, and it wasn't until about 8 hours later that you were sectioned.  I remember being surprised when I first read your story that you weren't sectioned *immediately*.  I don't think you would have been induced under these conditions in a U.S. hospital.  I don't think anyone here would disagree that c/s is necessary when the placenta abrupts, and I for one am grateful that we have this procedure when we need it.

Like I said before, anyone who knows anything about birth would agree that in your situation a transfer to the hospital was the right thing to do.  I don't think anyone here would disagree that hospital transfer is sometimes appropriate, and that in your case intervention certainly was necessary.  According to general wisdom around here, you should be within 30 minutes of the hospital in case you need a crash c-section.  It takes about 15 to 20 minutes for hospital staff to prepare the OR for the operation.  In your case, you weren't sectioned until 7 hours after transfer, so there was plenty of time to get you safely to the hospital.

Actually, in the U.S. over 90% of all babies are born in the hospital.  I don't know what percentage of labors are "risky" but I know it's less than 90%. And what statistics also show is that when women with normal healthy pregnancies, and uneventful labors give birth in the hospital, the interventions done in the hospital result in higher rates of birth injuries than those born at home.
Forget about "high-risk" women for a moment.  Let's agree that all high risk women should birth in the hospital (that includes complications *during* labor).  And let's assume that those who need to transfer during labor do (10-15% from stats I've seen).  If you look at the rest; ie those who don't need to transfer, don't have any risk factors, and  don't have any complications during labor.  In the U.S., most of those women will still receive routine interventions during labor (pitocin, epidurals, episiotomy, IV, narcotic drugs, forceps and vacuum extraction) and what statistics show is that these women have higher rates of injury both to themselves and their babies.

Usually when something goes wrong there are indications for a long time before it gets to the point of emergency.  I've also heard stories of women telling hospital staff that something was wrong, and being ignored.  I read a story of one woman who had  a rupture while in the hospital (with pitocin and an epidural).  The nurses were too busy to pay attention to her, and the baby died.  Had she been sectioned immediately, the baby probably would have been okay.  My point is that being in the hospital is not a guarantee of good medical care.  In fact, there was a story in the news recently that upwards of 80,000 people a year die in the U.S. as a result of medical mistakes.  Also many people die every year from infections they acquire in the hospital. I don't think that any of us believe that women should always give
birth at home, or that interventions are always inappropriate.  I think we all would agree that interventions should be used in a reasonable and appropriate manner.  C/s can be a life-saving and God sent intervention when it is necessary.  It can also be a completely devastating experience when it is unnecessary.