We've debated this in my livejournal before but my most ardent homebirth enthusiast reader unfriended me, and it's been a couple years, and my perspectives have shifted... more against it I'm afraid. So what the heck, let's do this again.
I will say I have one debate rule in my world though: no two-person back and forths. It's not worth it. If you post a comment, and someone replies, don't reply right back to them. Give it 24 hours to see if someone backs you up. That way you're not wasting time and energy on one person, when there are so many million more on the internet.
Okay? Here goes. The five reasons why I don't trust homebirth.
1) I trust professionals. This is probably because I'm an engineer - I want to make very safe airplanes, because I fly in airplanes, and my family flies in airplanes. So I assume doctors want birth to be safe because they give birth, and their family members give birth. When I hear people accuse doctors of caring more about making it to their golf games than doing what's best for their patients, I'm stunned, because I picture someone saying that about me and my airplanes. When you dedicate your life to something, attend years of school, live it every day, you're not doing it just for the comfy wardrobe. When we criticize medicine we act like it's some faceless entity - but it's humans.
2) I had two good experiences giving birth at my hospital. I realize not everyone's experiences are good, but in all things, the dissatisfied are bound to be the most vocal. And the very popular documentary "The Business of Being Born" paints a picture of NO ONE being happy in hospitals - that's what I didn't like about it, it was very black and white. Either you have a homebirth, or you end up with a Cesarian section. I had a natural hospital birth, surrounded by very supportive nurses. Luckily I saw the documentaries after my birth, otherwise I might have thought that would be impossible.
3) I don't think Cesarian sections are that bad. The homebirth movement says "Our c-section rate is way too high!" Is it? What's "too high"? I looked around at some other countries cesarian rates compared to their perinatal mortality rates and found mixed results... countries like India, South Africa, and the UK all had lower c-section rates than the US, but higher mortality rates. On the other hand Italy, Korea, and Switzerland all had higher c-section rates but lower mortality rates. The World Health Organization dropped its recommendation years ago that implied there was some ideal rate. All my friends who've had c-sections are fine with the births they had.
I am much faster to blame the lack of access to health insurance in the US for any death rate issues we're facing as a country. Until we make basic prenatal care a human right in this country we need to check our privilege when debating whether seeing a doctor is a "choice" a woman should make.
4) I do not "trust birth". I read a wonderful book called Brought to Bed full of fascinating stories about the lives of women 100, 200, 300 years ago - who lived under a shadow we cannot even imagine today. The statistics were mind-numbing. Left to have babies over and over at home with the help of just the village midwife, about 1 in 30 women eventually died in childbirth. 1 in 10 babies didn't survive. I do not believe people who say that nature made us perfect, or doesn't let babies grow too big, or kept us alive for centuries. Nature cares about a batting average, not you as an individual. The human race survives just fine with 9/10 babies surviving birth... but if I'm going to go through pregnancy I want a better than A- odds of holding my healthy baby. I like all sorts of other "unnatural" things - eyeglasses, filtered water, poly-cotton blends. Modern medicine fits right in.
5) Now the real controversy - I said in my tips that I thought Dr. Amy of SkepticalOB.com deserved a read, and I stick by that claim. She's anti-homebirth. Somebody's gotta be. She's not a crazy fringe activist in the woods - the American Congress of Obstetricians and Gynecologists has invited her to speak at their conferences. She reported last month that the Midwives Alliance of North America's own statistics showed the homebirth death rate was over four times as high as the one for hospital births when you compare apples-to-apples: they got to throw genetic abnormalities and high risk births out of their statistics so we should too. When she was accused of "bad math" she posted a video showing her work. And if that's not enough, she runs another blog called "Hurt by Homebirth" full of tragic stories of babies hurt or killed by obviously preventable issues... why in 2013 would any baby die of group b strep?! It's such a routine test! Do doctors and hospitals make mistakes? Sure. But a lot LESS, and they have a LOT more training to avoid them, and they circle around and look at their errors and have systems to get rid of bad doctors. What happens when a homebirth goes wrong? If you believe someone is qualified to be a midwife because they've been to lots of births, they don't have to tell you about mistakes they've made. If you believe birth is inherently safe and nothing to fear, there's no reason to even ask.
And I guess that's my thing with homebirth: people outside The System are saying they have a better way to do things. I believe in systems. I believe in following procedures, going to college, going to grad school, peer reviewed research, academic papers. If you have a better idea than that I think you should have to answer a lot of questions about it.
As for mothers: if you want to have a homebirth, fine, that's your choice. I might be more supportive if you're low risk, and if you choose to follow the advice of a certified nurse midwife (CNM) because they have a lot more training than certified professional midwives (CPMs) which in some states have very very few requirements, they can basically just call themselves that. I will be much less supportive of your unassisted birth, VBAC home birth, multiples at homebirth, or anything else that the homebirth movement considers a "variation of normal". If you try this and it's successful, my reaction will be wiping the sweat off my forehead, not a "woohoo go women!" and a high five.
That's really what got me. I joined groups of "crunchy moms" in 2010 after I had my natural birth and was breastfeeding and I thought I might have some things in common with them. It turns out, I didn't, because they were too busy throwing conspiracy theories at doctors, watching documentaries that I thought were seriously flawed, and "trusting" birth. Doctors are so busy being doctors that they don't have time to jump on mommy forums and defend themselves, there's just this internet tide of DIY-ers who think they can get all the information they need from googling. You'll never convince me of that.