Safety of Alternative Approaches to Childbirth

This study examines the obstetric profession''s claim and society''s belief that the hospital-based obstetric approach to childbirth is safer with respect to perinatal mortality than the natural approach to childbirth as administered by midwives and some physicians in free-standing birth centers or at home. Using merged birth certificate and hospital discharge data for California for 1989 and 1990, the data show that low-risk women who opt for a natural childbirth in an out-of-hospital setting will experience a slightly though not significantly lower perinatal mortality than low-risk women who opt for a hospital birth. For these approximately 70% of all California birth, hospital birth is thus not “safer” with respect to perinatal mortality. The study suggests significant advantages for the natural childbirth approach with respect to reduced mortality and morbidity from unnecessary cesareans and other obstetric interventions, and significant benefits from avoiding negative downstream consequences from unnecessary obstetric interventions and procedures. The maternity care cost for a natural childbirth system would also be significantly lower.