What's So Scary About Home Birth?
Originally posted on RH Reality Check
"The Perils of Home Births" screams the title of the segment at the bottom of the screen in a Today Show attempt to cover the realities of homebirth in the United States.
"Is avoiding the clinical nature of a hospital setting for a homebirth worth the risk?" asks the reporter. Never mind that the question seems in part to answer itself with the presumption that there is greater risk inherent in a home birth. The answer further seems rooted in the devastating story of a young couple expecting their first child. As the story is reported, the couple employed a certified nurse midwife ("CNM") to birth at home. After a four-day labor, the frightening voice-over tells viewers, "overseen not by doctors but by the midwife's staff..." the baby is born without a heartbeat, rushed to the hospital and dies from suffocation, a result of becoming entangled in her own umbilical cord. A devastating story with which we all sympathize, to be sure.
Should this story, however, be used as a reason to employ scare tactics and to encourage non evidence-based decision making for pregnant women looking into their childbirth options?
As Alison Cole, midwife-in-training, notes in her RH Reality Check reader diary on the segment, "My heart aches for this family, but their experience does not shed light on the safety of birthing at home, just as the story of one family mourning the loss of a hospital-born baby is not evidence that all births should be removed from the hospital."
Coincidentally, the same day, I receive in my inbox a notification of a newly released study out of Ontario, Canada published in the most recent issue of Birth journal. The study examines the outcomes associated with planned home-birth compared to planned hospital birth, facilitated by midwives, in Ontario over a three-year period (from 2003-2006). The authors find that, in fact, there is no difference between planned home and hospital birth when comparing perinatal and neonatal mortality rates (or maternal mortality rates, either).
This is not the first, nor will it be the last, compilation of data confirming the safety of homebirth facilitated by midwives. The results of a study will never comfort a crushed-hearted couple dealing with the death of a child whether born at home, in a birthing center or in a hospital. But the evidence as to the safety of planned home-birth and midwifery care is clear and getting clearer everyday. Unfortunately, with a tremendous lobbying effort and biased agenda, the American College of Obstetricians and Gynecologists (ACOG), continues to use its power to quash access to this kind of care for women in the United States.
Midwifery care, in Ontario, Canada, is regulated by the College of Midwives of Ontario and is widely accepted as optimal care for low risk pregnant women. In fact, in many ways, it is the kind of system many midwifery practitioners and advocates are pushing for in this country in hopes of providing women and their babies with the highest-quality prenatal, perinatal and postnatal care.
According to the authors of the published study,
Midwives are well integrated into the Ontario health care system; they have admission and discharge privileges at their local hospital(s), and access to other health care providers for consultation or transfer of care as required. Two midwives are in attendance at births either in the home or in the hospital.
Ontario is not alone in its support for homebirth - nor are the findings an anomaly. The UK's Royal College of Obstetricians and Gynecologists fully supports planned home birth for "women with uncomplicated pregnancies." Canada's Royal College of Obstetrics and Gynecology pursued research which concluded that planned homebirth results in positive health outcomes for both mother and baby:
"Women planning birth at home experienced reduced risk for all obstetric interventions measured, and similar or reduced risk for adverse maternal outcomes," writes Dr. Patricia Janssen from the University of British Columbia and coauthors. Newborns born after planned home births were at similar or reduced risk of death, although the likelihood of admission to hospital was higher.
The evidence being uncovered regularly - from around the world - suggests that there is great benefit (for mother and newborn) to ensuring access to midwife-care, homebirth and other out-of-hospital birth options. As well, as Jennifer Block notes, there is a cost effectiveness to increasing access to a range of chidbirth options. When women are subjected to increased, unnecessary medical interventions, costs rise for all involved - families, insurance companies and hospitals.
Unfortunately, there are significant obstacles to accessing this kind of care for many women in this country. Without regulation and licensure of certified midwives in all fifty states, birthing out-of-hospital with a midwife may be illegal or financially out-of-reach for most women, severely restricting a woman's freedom to choose to birth in the way she sees fit and forcing midwives into difficult, sometimes career-jeopardizing situations.
In an attempt to address the reality of how and why midwifery care is out-of-reach for many women, the Today Show segment quotes a source citing the "elite" nature of out-of-hospital childbirth, comparing it to a "spa treatment." And while there is some truth to the idea that access to midwifery and homebirth remain options only for those who can afford to pay out-of-pocket, this is by far the whole story.
While The Today Show is busy running tabloidesque segments on childbirth, advocates and providers are hard-at-work attempting to expand safe, evidence-based options for maternity care for U.S. women and their families . If campaigns like The Big Push for Midwives are able to successfully ensure licensure and regulation of CPMs (and legislation to do this is currently pending in 18 states, according to The Big Push), the demand for this kind of care - no matter what a woman and her families' economic situation may be - can be met. It means that midwifery maternity care can be covered under various health insurance plans - including Medicaid. In some states, it's already happening - with impressive results.
In Washington state, for example, all births regardless of health care provider or location, can be covered under any insurance plan including Medicaid. As Miriam Perez writes for RH Reality Check, in Washington state, "around 45% of out-of-hospital births attended by midwives in the state are Medicaid births." Midwifery care becomes accessible for all women, and makes good economic sense, when we ensure safe and regulated care through licensure. A cost-benefit analysis performed by the Washington Department of Health showed that licensed midwifery care saves the state $3.1 million per biennium.
Despite The Today Show's insistence on painting midwife-provided maternity care as a cause-celebre, a growing number of U.S. women are choosing to birth out-of-hospital under a midwife's care. Professional medical associations like the AMA (American Medical Association) and ACOG are feeling the pressure. An ACOG representative's blinders were practically visible when she declares in The Today Show segment that "childbirth decisions shouldn't be dicatated by what's fashionable or trendy" -- as if pregnant women who meticulously and thoughtfully prepare for a home birth, with the support throughout pregnancy from a midwife, are simply making their decision after flipping through fashion magazines, spotting a star's story of her homebirth and deciding to just "go for it" to be cool or hip.
Last year, in fact, the AMA went on the offensive, targeting celebrity Ricki Lake's documentary, The Business of Being Born, in a resolution stating its opposition to homebirth. The outcry, however, was so great that the organization amended its resolution and deleted all references to Lake and her film.
The Big Push for Midwives has this to say about ACOG's focus on homebirth as simply another celebrity led trend:
"ACOG clings to this ridiculous fantasy that women choose to deliver their babies outside of the hospital because they want to be like Ricki Lake, Demi Moore or Meryl Streep and that if women would only watch enough fear-mongering stories on morning television they'll be brainwashed back into hospitals," said Katherine Prown, Campaign Manager of The Big Push for Midwives. "Insulting our intelligence and promoting policies that deny us choices in maternity care are not exactly winning strategies for stemming the tide of women seeking alternatives to standard OB care."
The Today Show segment does include an interview with a former head of Women's and Children's Health at the World Health Organization, Marsden Wagner, who talks about the tendency hospitals have to treat even low risk, healthy pregnancies as medical emergencies. The reporter also acknowledges the rise in unnecessary medical interventions -- including a 50% meteoric increase in cesearean sections over the past decade. Jill who writes the blog TheUnnecesearean.com notes that according to the latest statistics from the CDC almost 32% of all births are via c-section in this country.
What is most important to highlight, ultimately, is that women in the United States are increasingly seeking alternatives to hospital birth for a variety of excellent reasons. For some women it's a desire to experience their low-risk, healthy pregnancy not as a medical condition but as a natural state - a healthy state - with a provider who encourages them to trust their bodies. Maybe a woman doesn't wish to expose herself to potentially unnecessary medical interventions, but wishes to create an environment and experience that speaks to the ways in which she and her family envision welcoming their baby into the world - in a way that seems most compatible with midwifery and out-of-hospital care. Other women are distrustful of our health care system's tendency to treat pregnant women (or any seeker of health care) as merely a consumer or a number without a name, on the receiving end of depersonalized care. Some women view the mainstream medical establishment as patriarchal and demeaning, in general, and reject the idea that "doctor knows best" in any and all situations regarding pregnancy and childbirth. This is not say that ob-gyns cannot be excellent, loving and responsive care providers. There are millions of us out there who are indebted to these kinds of ob-gyns, undoubtedly. Midwives understand the value and importance of a trusted, respectful physician as a partner in a woman's care, should she need it.
The midwifery model of care may be an appealing option for many women because it starts from a place of empowerment - if you can envision it, you can do it. Start with an intention of the kind of birth you wish to have, my midwife and doula told me, and we'll go from there. Maybe you have a vision of birthing outside but never dreamt it was possible -- as one woman on Ricki Lake's web site writes of her own desire: "I told my midwife of my dream. Her exact words were, "Mmmmmm, that sounds beautiful. Is that something that you would like to do?" That floored me since I wasn't at that point asking to have an outdoor birth." Or maybe you'll plan for the homebirth you've been expecting and midway through your pregnancy, or after hours of labor, your midwife tells you you'll need an emergency cesearean section, in a hospital. Birth doesn't always go the way we plan - no matter where or with whom we choose to birth. The issue at hand, however, is not that we can possibly know exactly how it will end up but why we wouldn't think that we deserve to do everything we can to experience pregnancy, childbirth and the days and weeks postpartum in a way that feels best and right for us - most importantly, winding up with a healthy newborn warm against our chest, asleep next to our body. The Today Show may present homebirth as an option to be feared but that's only because the unknown is often times a scary venture. If you look at the evidence and listen to women's experiences, It doesn't have to be that way.
Follow Amie Newman on Twitter: www.twitter.com/amienewman
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Although it is no surprise, it is still a disgrace that the ACOG would use fear and tragedy to secure their numbers. And how methodical to air it on 9/11. I have hope that truth and knowledge will out weigh ignorance and fear. I would only have a child in a hospital setting if it were absolutely necessary. My son was born at home without complications. It seems a miracle that our species as well as other mammal species have survived this long being that hospitals have only had their hand in childbirth for the last century. Medical interventions during childbirth can be a lifesaver and the ability to exercise those interventions when truly necessary is great. The over use of these interventions however, is a real problem. It is rare that a mother laboring in an American hospital will be given the chance to allow her own body and baby (who is also an aware participant) to do the work that is so inherent and as natural as ingesting food, digesting food and expelling the remains of that food. The ACOG does not connect this with the idea that mom and baby may never of experience a problem if they were given the time, respect and modesty needed to complete their birth process.
We carry loads of equipment, monitor closely and it is always our goal to transport long before a complication. Since we don't routinely inducing women, do unecessary interventions, etc. complications arise rarely.
There is misconception that somehow complications don't arise in hospitals or that immediate surgery is available. If you want to argue and throw the guilt card about choosing the healthiest option then you should be looking at the U.S. mortality rate which is horrible and our cesarean rate which is the highest it has ever been. Most hospitals have a goal of 15-20 minutes to surgery. Many hospitals do not have a NICU or 24-hour anesthesia. Because you're there, it doesn't guarantee you'll be "saved." When we transport, we call ahead, usually we are there within the same amount of time it would've taken them to ready the OR. Really, is the potential to maybe save a few minutes for 1 mom or baby out of hundreds worth the scars, emotional damage, deaths, etc. for other moms and babies?
OB practices are NOT EVIDENCE BASED. Many have NEVER been proven to save lives. Many were debunked decades ago, but malpractice insurance says they look better in court.
Homebirth is just as safe. When will people start to look at what the research is saying instead of the fear mongers and people who are set to gain financially by keeping birth in the hospital (where it is a HUGE aspect of hospital income)?
Amie, thank you for the links to TheUnnecesarean.com and for continually bringing the discussion of childbirth options to the forefront. As one of the many women who never considered that I would one day give birth somewhere other than in a hospital, I think it’s important to continue to educate the public on WHY many of us choose to avoid the aggressive practice of defensive medicine in maternity care.
I know it’s hard for people (like mredder4) that a major issue is the systemic failure of doctors to practice evidence based medicine or even follow established practice guidelines. Without a rudimentary understanding of maternity care in this country, the tendency is to accuse women of being selfish. Wouldn’t it surprise mredder4 to read about how doctors put their self-interest first?
mredder4 doesn’t have to take my word for it. ACOG has taken several steps over the last week that show that the organization is understanding of the perils of medicalized birth. A recent ACOG press release stated that OB-GYNs are “ultimately hurting patients” out of fear. Earlier this week, an ACOG spokesperson told USA Today that “[p]roblems are infrequent in childbirth, no matter where it takes place…”
While ACOG will undoubtedly hold on to its “hospital is safest” PR mantra, many of us applaud their efforts to publicize that women’s health care is suffering at the hands of its members and we look forward to hearing more honest news like this.
"In an attempt to address the reality of how and why midwifery care is out-of-reach for many women, the Today Show segment quotes a source citing the "elite" nature of out-of-hospital childbirth, comparing it to a "spa treatment." And while there is some truth to the idea that access to midwifery and homebirth remain options only for those who can afford to pay out-of-pocket, this is by far the whole story. "
I find it interesting the idea that homebirth would be for rich women since the cost is so much lower.
You make a good point about that medicaid even covers it sometimes (depending on the state).But, in Florida they will only cover a birth center, not at home (which cost twice as much - but it is pretty nice. The one we went to was like a bed & breakfast and was on Dunedin beach) Even if you have to pay out of pocket it is well worth it.
My homebirth was covered in the state of Florida - and with those lovely women I think you're talking about, too! :) Homebirth is actually required to be covered by insurance in our state! If you have private insurance you may still have a co-payment, but that would just be like normal for your insurance if you were having a baby anywhere. But I believe its fully covered under things like Medicaid.
It would be wonderful if there were a more solid, consistent "middle way" open to expectant mothers who favor home birth b/c of the comfort level, lack of institutionalization, etc. that provided access to the medical back-up of a hospital staff.
Camanokat mentioned a birthing room at her OB/GYN's office. That would seem, to me, to be a good option for a middle way. Or for hospitals to provide the option of a birthing room and midwife services with the accessibility of a doctor in an emergency. All parties would be included in pregnancy education and labor preparations and made aware of impending delivery, but the choice would remain with the mother unless / until an emergency occurred.
There is a "middle way" option. Many midwives work out of birth centers like this one where I had my youngest daughter : http://laborluv.com/ and they work closely with a traditionsl OB/GYN in case they have to transport due to an unexpected emergency.
When a birthing experience goes bad, it's like falling off a cliff; it goes bad very quickly; my experience speaks of how important it is to know this before you deliver at home.
When my first child was born, he didn't breathe for 22 minutes. The horror was lightning quick, as was the neo natal team. Although he passed at 6 months, at least I had him for a little while. If I did a home birth, he would have been a still born baby. It happens. If anything, my physicians did too little rather than too much medical intervention.
If he had been born at home, I would never have been able to sleep in that place again.
For my second child, I committed to a intense medical experience. I made a point of seeing the same ob-gyn for every natal visit, who indulged me with as many tests as I wanted, made great suggestions and was with me when I delivered my healthy daughter.
I understand the passion with which people embrace home births, but I don't endorse it.
No one discusses bad births. Not physicians, midwives or nurses. There are reasons for this reticence, of course; yet to me I feel they are lying by omission. If one wants to make a fully informed decision on where to have their baby, one needs to know how to keep from falling off this particular cliff.
You make a very good point. In the old days, childbirth was a common cause of death for women and babies. Having ambulances on call reduces this risk considerably for home births, but still some emergencies can happen so quickly that they require immediate medical intervention.
Our experience was a birthing center in a hospital, and it was a wonderful, private experience.
Why listen to doctors when you can make life-altering medical decisions based on stuff you found on the internet, right? REAL Americans couldn't be bothered with things like education, knowledge, and science when it stands in their way of making life one big Burger King experience, "havin' it your way". I've seen dozens of episodes of the baby shows on TLC where they do almost the same thing. After something like 7-10 years of schooling in medical knowledge, what does some doctor know that I don't? They did a home birth on my favorite medical TV drama, so it must be this awesome experience that I can recreate, even without my own lighting crew, makeup staff, or the ability to cut and do a retake when something goes wrong.
Yeah, those stupid women! Don't they know they should leave all their decisions to the smart doctors. REAL Americans don't take charge of their health care! All the evidence says that low risk births should be allowed to progress without intervention is hooey because its on the internet. Millions of years of evolution ain't got nuthin' on 7-10 years at Texas A&M. *eyeroll*
Nature does not care whether or not an individual mother or baby survives.
Is there something wrong with Texas A&M (1972)?
Home birth is not "taking charge of your health care". It's a selfish expression of I-Know-Best-ism-(Despite-No-Education). It's a fad for trendy moms looking for a great "birth story" to tell their other yuppie soccer mom friends. And as HaroldStone points out, it's millions of years of evolution that have brought us to a state as a species where women can still die from giving birth. As someone who's brother survived a cord around his neck during birth because of the labor taking place in a hospital, my family knows the risks. Home birth is a completely unnecessary one, when combined with all the other problems that might occur during birth.
Also, your 4th sentence makes no sense, since it appears that you lost your train of thought halfway through it and started a completely different sentence out of nowhere. I'd settle for you volunteering for even 1 year at TA&M if it meant you learning some grammar.
Scary, it actually depends on your point of view. If your someone who makes up to $40,000 for a C section, then the Idea of home birth might be a little scary.
Since those that have home births actually have a much lower rate of C Sections. Home births are also much less expensive, because there isn't as much technological intervention. Technoligical interventions that can interfere with the birth process and actually increases the rate of complications in both the mother and the infant.
Then theres the control element, families who have babies in the hospital are more easy to control, and to steer toward other costly and un necessary medical proceedures, that are financially rewarding to those that run hospitals and doctors offices.
Instead of trying to scare people into having a hospital birth, traditional medicine should be trying to understand why America, has one of the highest infant mortality rates of all the worlds industrial countries.
I would find it interesting to see a study of women 20 - 25 years later comparing home births vs hospital births and how healthy their female organs are. I have a scary theory that doctors are making work for themselves in more ways than one.
Maybe the overall percentages indicate that there is little risk. But there are times when no one in their right mind would want to be anywhere but a hospital.
When my wife had our first, she was find after the birth for a while. Then she began bleeding at an alarming rate. I don't know if a midwife is able to administer the drugs that stopped the bleeding, but I was very glad she was in a hospital. As it was, she lost a lot of blood before they got it under control.
Catothemuchyounger- I am certain that your situation was alarming and left you feeling helpless. I am happy to tell you that the frightning situation you encountered would have been handled in a similar way at home. I work with homebirth midwives and what most people don't understand is that to begin with the risk of a bleed out is deminished simply because labor inducing drugs are not used. The majority of the time (the rare) post partum hemorrhage is handled in the same way as it would be handled in hospital. Medications are carried in case of emergency. Midwives are trained to detect when the appropriate use of medication is called for and more importantly they are trained in the proper way to "manage" (read:observe) a labor which leaves the mother and baby pair with fewer risks to endure.
If you read up a little on obstetric history you would find that most hospital interventions are designed to keep women quiet and in their beds during labor-- not as a safety precaution. In fact many medical interventions that are supposed to speed up or facilitate labor (breaking of waters, pitocin drips, epidurals, being chained to fetal monitors) often lead to delivery by c-section.
Giving birth has the potential to be the greatest acheivement-- physically, emotionally and spiritually of a woman's life. I take great offense when people accuse mothers of being "selfish" because they want the most joyful birth experience possible for themselves and their families. I think our culture's tendency to say that "all that matters is a healthy child" is to take a very narrow view of the miracle of birth.
In the end there are different personalities-- those who are afraid of being away from the surgery and those who are afraid of hospitals. Homebirth has a "boutique" feeling because many women who would like to do it choose not to because their insurance doesn't cover it, or not as fully as a hospital birth-- which is crazy because homebirths are less expensive overall. I had one hospital birth and two home births and there is no comparison. Its the difference between dinner at McDonalds and a meal cooked at home by someone you love.
I know I would not want to have a baby in a hospital unless I was high risk . I think people need to be free to do what is right for them. Some people feel safer in the hospital and they want medical interventions, others like myself would prefer the natural approach. I like your analogy about the meal.
things can go wrong at a hospital just as it can go wrong at home. women gave birth at home for thousands of years before hospitals existed... the survival rate was lower, yes, but that was true for many reasons. i have many friends who have chosen to give birth at home with no complications, i also have a few friends who have had problems in hospitals. an umbilical cord can be wrapped around the baby's neck at home or in a hospital, the qualifications of the person delivering are what is important.
Thank you, Amie, for countering the Today Show's ridiculous fear-mongering with evidence-based research. I really appreciate your informative and thoughtful analysis. Empowering women in every step of the pregnancy and birth journey is central to improving this country's troubling maternal and neonatal health outcomes.
My first child was born in a hospital and was a cold, institutional process. For my second, I chose a midwife/nurse married to an OB/GYN who had a homey birthing room in their office across from the hospital. It was reassuring to know that if there were any complications, we could be admitted to the hospital quickly.
The midwife was with me the entire time and labor went well. I wasn't given meds that obstructed the birth process ( as had been done with my firstborn). We went home when my baby was about an hour old. It was a much better experience than the assembly-line hospital birth.
I have no idea why anyone would choose to give birth anywhere outside of a hospital. It isnt' about having an "empowering experience" and "choosing to not have medical interventions." Those interventions are not designed to be inconvenient or to make the mother's life difficult. They are there to potentially save the mother's and/or the baby's life, or in the case of optional interventions like pain relief, to make the experience better for the mother, because she has asked for that. Doctors really don't put a gun to a mother's head and force her to get an epidural. I had two children in a hospital, and no one forced me to do anything. I was treated with great respect and received wonderful care by a doctor and team of registered nurses. Bringing a baby into the world is a giant responsibility, not something to be treated like a spa day, with soft music and candles and the proper "ambiance."
Please look more into hospital policies and how women are coerced into medical treatments that are not for their or their babies benefit.
Jennifer Block's "Pushed" is a good place to begin. There is also a wonderful blog called "Nursing Birth" that is written by an L&D nurse who often has to fight for her patients
http://nursingbirth.wordpress.com/
I am glad you had a good experience but I was not comfortable giving birth in a hospital. I didn't want my baby potentially exposed to drugs, vaccinations, germs, overworked nurses, hurried OB's etc. A homebirth is hardly a spa day, they call it labor for a reason. Women who give birth at home do far more preparation than the average mom who goes to the hospital and puts it all in the hands of their doctor. Those who would keep women in the hospital give people the impression that its all about the empowerment, but for me, I don't understand how anyone could risk their babies or their lives by giving birth unnecessarily in a hospital.
People who don't understand home birth , don't get how much better prepared you are. The prenatal care that you get from a midwife is intense compared to with a doctor. It's like training for a marathon. Everything you do is for a reason and you know what that is, and everything is closely monitored. For example: How many doctors have a record of what you ate for luch last Tuesday ? (but if you are under a midwife's care, she probably does).
I totally understand the desire to experience a birth as a nonmedical event. It's true that most births can happen at home under the care of experienced midwives. But it's also true that when things go bad they can go very bad. The risk of hemorrhage is very real and cannot be treated at home. The sudden need for a cesarean delivery when the baby is in distress or the need for oxygen or other surgery on the part of the baby or the mother, while statistically small, are very real to the few who are in the emergency situation.
I have been present at a home birth where a warm, nurturing family-centric experience went suddenly and horribly wrong. That mother was an intelligent woman who chose a home birth because it "felt right." She would never do it again, and neither would anyone who was in that room.
How slight does the risk of emergency have to be to make hospital birth unacceptable?
Thanks, Julie, for the kind words!
Sixtyfivepercentwater, thanks so much for the comment! I personally don't think a hospital birth is ever "unacceptable"; nor have I ever heard a midwife - CPM or CNM - claim this either. The central idea that I was hoping to communicate is that women and their families should have the option to birth out-of-hospital, with a midwife, if her health allows for it.
The evidence-based assertion comes in when we talk about risk. The fact is that there is risk associated with bearing a child in this country and around the world - whether one births in a hospital, at home, in a free-standing birth center or a birthing center connected to a hospital. However, what we know, based on the research and studies done thus far is that planned home birth in this country is as safe as planned hospital birth. And what many advocates, providers and consumers are working towards now is a system whereby midwives and physicians can work together, legally and cooperatively - in service to pregnant women and newborns to ensure not only optimal health care but support for a range of women's maternity care options.
I'm so sorry to hear about what happened at the home birth you attended - I can't imagine what that must have been like. But I also want to make sure that we're giving all women the best chance at birthing their babies in a manner that honors their own vision for childbirth.
I just wanted to point out something you said that was incorrect...
Hemmorahage can be treated and is often at home births. Also midwives are equipped with essentially all the medical equipment available in the hosiptal room short of c-section materials...Midwives carry oxygen, anti-hemmorhage drugs, drugs to stop labor if necessary etc...The difference is they don't keep them lined up next to the bed like some veiled threat.
I myself suffered an intense postpartum hemmorhage and was using a midwife in a birth center. She also performs home births and told me she has the exact same equipment available to her at a homebirth if I had found myself at home in the same situation...
Sorry, but if an artery ruptures it's out go the lights. A patient has a fighting chance in the hospital, but none at home. The risk is very small, but it's not one I'd care to take, and it's nothing I want to watch again.
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