This is just a “still thinking about my last post on neonatal mortality, and wanted to write some more” post.
I’ve tried to remember, and I can think of 23 home births among women I know personally, excluding myself (this doesn’t include those I know by email, but just those I’ve actually been in the same room with). I could be mistaken, because I’m not 100% certain that all of the births took place at home, and there may be some I’m forgetting, but it’s approximately right. All of these births were without incident. Two women had all five of their children at home; several women had their 5th and 6th children at home; one woman had her 11th and 12th children at home; and a few other women had children of various birth orders. Of these 23 births, there were 2 neonatal deaths. Of all the other women in my acquaintance (which would include dozens of women and probably hundreds of births), I know of only one other neonatal death, and it was a hospital birth. So does home birth have a 2/23 death rate while hospital birth has 1/200+? Not exactly.
The one hospital-born neonatal death was to a woman I struck up an acquaintance with years ago, and only knew of her pregnancy and subsequent loss, and could not ask for particulars. I don’t know if there was any inkling leading up to the baby’s birth that something may have been wrong, but just an hour or two after her birth, she was observed having seizures, and was diagnosed as having had a stroke. There was nothing they could do, and she died within a day or two of her birth. Did birth practices have anything to do with that? Possibly — perhaps the mother was given some medication that caused a problem with the fetal brain. For instance, if she was given something to induce or augment her labor that caused the uterus to become hyperstimulated, producing overly long or overly strong contractions, it could interfere with the placental blood supply and fetal oxygen, and perhaps lead to a stroke. Perhaps a vacuum was used to get the baby out and traumatized the brain. I don’t know the particulars of the birth, so it’s possible she had a completely intervention-free birth, and the stroke was completely unrelated to the birth, but “just one of those things” that happened even prior to the onset of labor.
The first neonatal death in the home-birth group was the 11th-born child I mentioned earlier. She had multiple congenital anomalies, and died within a few days. Her oldest sister was a CNM and attended her birth as well as the birth of the couple’s 12th and final child. This death statistically goes against home-birth and goes against CNM-attended home birth, although if you know the particulars, you can see that place of birth had nothing to do with anything. Her parents sought care, of course, with the hospital, but there was just too much wrong with baby Mary.
The second neonatal death was one of the 5th-born children. I am particularly acquainted with this case because I was friends with the baby’s oldest sister, was there within a few days of his birth, and thought something just didn’t seem right. I was in my teens, and had been taking care of another baby for several months, from the time he was two weeks old, and I remember thinking that something was wrong. At first, I passed it off to the baby’s odd color — he had jaundice; but I remember thinking his breathing seemed not right — that it was labored, almost, and shallow. I remember his nostrils flaring out, but thought maybe it was just his nose shape. A week later, after I had already gone home, his parents knew something wasn’t right and took him to the doctor. He discovered a heart problem, and they went to a pediatric cardiologist for more detailed tests. The baby’s heart hadn’t developed correctly — I forget the exact problem, but the doctor said that without an operation, the baby would definitely die within 6-8 weeks, that an operation might help him to live, but he had only a 50/50 chance of surviving the surgery. They had to drive several hours to go to LeBonheur, which is the pediatric hospital in Memphis, where my heart surgeries took place, in order to have the surgery. He didn’t survive it. He was three weeks old.
So, it’s important to know the particulars of cases before making judgments. It might appear from bare data that these two home-born babies might have survived had they been born in the hospital — that perhaps if they had had immediate care — been rushed from the womb to the NICU or OR — they might have survived. But that is simply not the case. In fact, had the second baby been operated on immediately, he probably would have died immediately.
As an aside, his parents were vacillating about whether they should circumcise him. It was the man’s first son, although the woman had a son from a previous marriage who had been circumcised. Finally, they decided to circumcise him, but to wait until the baby’s 8th day, just like in the Old Testament (the father was a preacher, and said that there must be some reason for God to have said that, so if they were going to circumcise, it would be on the day God said to circumcise). The baby was diagnosed before his 8th day, so was not circumcised. The heart doctor said that it was a good thing he hadn’t been circumcised, because the shock might have killed him.