Why do women who embrace technology opt for home births?

Why do women who embrace technology opt for home births?
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With National Midwifery Week following so closely on the heels of the fanfare surrounding the release of the iPhone 11 — I am reminded, once again, of the contradictions our society embodies, namely pregnant women who embrace technology in their daily lives but eschew it when it’s time to give birth. 

Every year, approximately 35,000 births per year occur in the mother’s home. About a quarter of them are unplanned. That leaves 26,250 women every year who choose to forego the technology and expertise of a hospital setting to have their babies at home.

Approximately 80 percent of these planned home births are attended by midwives. 

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Midwives can do a lot, even outside a hospital setting. But 23-37 percent of expectant mothers end up getting rushed to a hospital because home birth attendant care isn’t always enough and the offerings of a hospital can save their lives.

Admittedly, almost all newborns (90 percent) successfully transition from intrauterine life to extra uterine life without requiring technology but 10 percent of newborns will require resuscitative efforts at birth and less than 1 percent will require extensive resuscitation efforts at birth. These efforts may require equipment and personnel that won’t be present at a home birth and when a newborn is in trouble, minutes count — and the time it would take to transport a newborn to a hospital could result in devastating effects and even infant death.

This might explain why home births have higher mortality rates. Studies have shown that planned home births in the United States have a 2 -3 time higher rate of neonatal mortality — approximately 1 to 2 additional fetal and neonatal deaths per 1000 births —and an increase in neonatal seizures — approximately 1 additional neonatal seizure per 1000 births

Understandably, a population with the highest rate of home births is the Amish. Lancaster County Pennsylvania, where a large Amish population lives, has the highest rate of home births in any county in the United States at 12.7 percent.

These families, particularly in the more traditional groups, honor slightly different traditions and may not permit electricity or telephones in their home. While home births may be more dangerous, health-care providers should respect the consistency of their belief system and their actions. 

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The same is not true for other people, though. In the United States, people of all faiths kneel at the altar of tech. It makes our lives easier, makes us safer. Our devices are practically appendages. According to a survey conducted by the Pew Research Center, 79 percent of women have a smartphone; 95 percent of them have some type of cell phone.

While we don’t know the exact overlap between smartphone toting women and the ones who are pregnant, it stands to reason that many smartphone users must reject the technology they rely on for one of the most important days in their lives. That doesn’t make sense.

And that might be the whole point. The fact that 67.9 percent of home births are paid for out-of-pocket suggests that home births are not a phenomenon of limited resources or lack of insurance. Families who give birth at home are exercising their privilege rather than doing what's best for their child.

The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists have issued an opinion that hospitals and birthing centers are the safest settings for birth in the United States, but they do recognize the mother’s right to informed decision-making. Any woman considering a holistic, tech-free home birth should research this opinion.

Carrie Drazba, M.D., is an assistant professor of Pediatrics at Rush University Medical Center.