REWARDS VS. RISKS
by JOHN STARR, M.D.
MOTHER worries at the thought of a reader trying to
deliver her baby at home with nothing but a recommended
book propped beside her and I do not, in any way, suggest
or encourage such a foolhardy practice. On the other hand,
I am increasingly aware that numerous readers of this
publication have had—or are planning—"natural"
or home deliveries . . . often with only the sketchiest
information and large amounts of wishful thinking to guide
Perhaps this brief review of natural and home
deliveries and the risks involved—while not to be
interpreted as a guide to nor endorsement of the
idea—will at least offer you some honest information
on the subject. I suggest that—after you digest this
feature and the books recommended by the various
authors—you contact THE AMERICAN SOCIETY FOR
PSYCHOPROPHYLAXIS IN OBSTETRICS, 36 West 96th St., New
York, N.Y. 10025 and THE INTERNATIONAL CHILDBIRTH
EDUCATION ASSOCIATION, P.O. Box 5852, Milwaukee, Wisconsin
for more information. Then, after consulting further
with your own doctor and local childbirth organizations,
you'll be in a firm position to make your own decision in
As recently as 1935, 65% of all babies born in the United
States were delivered at home. At present, slightly less
than 5% of this country's mothers deliver at home. Maternal
deaths, during the same time interval, were cut from 60 per
10,000 to 5 per 10,000 and—as might be
expected—the medical profession generally seems to
feel that there's a direct correlation between the two sets
Some of us are not so easily persuaded by that reasoning,
however. We know that much of this reduction in risk to a
mother is due to the discovery of antibiotics and the
widespread adoption of prenatal checkups (which detect and
ward off complications of pregnancy before the actual
We also know that few medical people are apt to seek out
and publicize the ways in which home deliveries actually
reduce the risks involved in childbirth. For
example, a mother at home will usually be watched and
attended far more faithfully than she would if she were in
a hospital; she will be less anxious in many cases; she
will be much less likely to receive drugs which might
poison the baby; her delivery will not be rushed by an
obstetrician who is anxious to get on to something else;
the baby will not be exposed to the virulent staphylococcus
germs which breed in hospital nurseries.
On the other hand, serious complications can develop during
any birth and such complications can definitely represent a
larger danger to both mother and child in a wilderness
cabin than when encountered in a hospital. If you decide to
have your baby at home (after having gone through
properly-supervised prenatal care) with an experienced
nurse, midwife or MD in attendance, the odds are about one
in 50 that something will happen during labor and delivery
to send you to a hospital. Once in every 200 home
deliveries that "something" will be potentially
Yes, this is entirely "natural". Even wild animals
occasionally have trouble delivering and any farmer can
tell you of complications he's had delivering a cow of her
calf. It is pointless to deny—no matter how good your
"vibes"—that problems can occur. It's much better if
you know about these potential complications
before than after they happen and the
following description of some of the worst is not meant to
scare, but to inform.
TWINS, TRIPLETS, ETC.
One in every 89 deliveries results in twins and only 60% of
twin pregnancies are recognized as such prior to the actual
birth . . . so they can be quite a surprise.
A mother may suspect that she's carrying twins if her
abdomen is much bigger than seems normal and, if you have
sensitive hands you can sometimes distinguish two hard,
round baby heads instead of one when you touch the mother's
abdomen. If you want to make a more professional check for
twins, get a stethoscope at any physician's supply house
and listen for the rapid tic-tac of the unborn baby's
heart. If you hear two heart beats at different points over
the abdomen (and particularly if there's more than 10 beats
a minute difference in the pulse count) you can practically
assume you have twins coming. The diagnosis can be
confirmed by X-ray if there's any doubt.
Now twins, triplets and other multiple births are great to
have in the family once they're delivered but,
unfortunately, they frequently are born hind end first
(breech birth) and that's a difficult form of
delivery. They're also smaller in size (hence weaker for a
time) and are more apt to get sick following delivery.
Twins could be delivered at home and everything might go OK
but, if I was called upon to supervise the delivery, I
would be jumpy until both babies were out and doing well.
Any twin (any baby, in fact) weighing under four pounds
would have a better chance if taken to a hospital nursery.
MOTHER'S PELVIS TOO SMALL
In about 1-2% of hospital deliveries the mother's pelvis is
too small for the baby to be born. This is usually caused
by rickets (vitamin D deficiency) which resulted in a
misshapen pelvic as the mother', bone structure was being
A doctor or midwife generally suspects this complication
(called cephalopelvic disproportion) early in
pregnancy and can advise against home delivery. In some
cases, however, the condition is not noticed until labor
has persisted longer than normal with no progress of the
baby's head through the birth passageway.
The usual duration of labor for a first baby is about 12-14
hours. Labor lasts about 6-8 hours for subsequent children
and, if a mother has already had one child, you can
generally assume that her pelvis is of adequate size for a
In the event that a mother's pelvis is too small (or the
baby's head is too large), labor will simply continue for
days and a Ceasarian section (the operation which
removes a baby through a surgical incision into the
abdomen) will have to be performed. A hospital is
definitely the best place for such an operation.
When a part of the baby other than its head comes out
first, the birth is known as an abnormal presentation and
most knowledgeable people worry a great deal about
delivering an abnormally presenting baby at home. The odds
of such a birth are about one in 20 hospital deliveries.
Get your M.D., nurse or midwife to show you how to feel the
baby's head and wiggle it just above the pubic bone to make
sure your baby is presenting its head first.
BLEEDING FROM A MISPLACED PLACENTA
This complication occurs in about one of every 200 hospital
deliveries. Instead of growing on the side of the uterus
where it should, the placenta grows over the mouth of the
uterus, interfering with the passage of the baby. The
symptom to watch for is continuous bleeding from the vagina
either before labor or after labor begins. A "mucus plug"
which is passed with a small amount of blood (called a
"bloody show") early in labor is normal and should not
Misplaced placenta (placenta previa) is a very serious
complication because of the rapid and severe bleeding which
occurs. It is usually necessary to do a C-section to avoid
catastrophe in the event of a misplaced placenta and, if
bleeding occurs during labor, you've got some hard thinking
to do in a hurry.
BLEEDING AFTER DELIVERY
At the time the placenta is expelled from the uterus, what
seems like an amazing amount of blood is also expelled.
This is normal but it's a good idea to have someone on hand
who knows how much bleeding is OK and how much is too much.
Sometimes a fragment of placenta is retained in the uterus
following delivery. When this happens, the uterus does not
flex its muscles to stop bleeding and you will notice
thatinstead of feeling like a firm orange when you massage
it below the belly button—the uterus is large and
flabby. Blood loss from this condition can be rapid.
If the complication develops, the baby should be placed at
the mother's breast and her blood pressure checked
frequently. If the bleeding continues, the mother's pulse
becomes rapid and weak or her blood pressure starts to
fall, you've got a problem. The mother needs qualified help
immediately to evacuate the retained placental fragment and
start a blood transfusion . . . and that means a hospital.
The average amount of blood lost during a normal delivery
is about a cupful. Loss of over two cupfuls is worrisome
and occurs in about one in 20 hospital deliveries.
If labor begins a month or more before the baby is due to
arrive, it can be predicted that the child will be small
and weak (a premature infant). Such deliveries are tricky
and should not be conducted at home. Certainly, any baby
which weighs less than four pounds at birth is much more
apt to get seriously sick in the days following delivery
than is a baby of average weight. Low birth-weight babies
also chill rapidly and should be put in a warm place as
soon after birth as possible.
COMPRESSION OF THE UMBILICAL CORD
If the umbilical cord (which carries blood to the baby)
slips past the baby's head and into the vagina, the cord
will be compressed during the passage of the baby. This
causes a shutting off of the baby's blood supply and the
complication is estimated to occur about once in every 300
Although cord compression does not threaten the mother, it
will frequently result in a dead baby unless a rapid
delivery of the child (usually by C-section) can be
A trained person would feel the cord by doing a vaginal
examination, would place the mother in the knees-to-chest
position (have nurse, midwife or M.D. show you how) to
reduce pressure on the cord and would rush the mother to a
Compression of the umbilical cord is much more apt to occur
during breech deliveries; less likely when the baby's head
is presenting. The complication is one of several
conditions which may make the baby's heart rate (listened
to over the abdomen) drop below 100-per-minute and which
may cause the passage of watery and greenish baby stool
from the mother's vagina during labor. Another possible
cause of such symptoms is medication which a doctor
sometimes gives the mother for pain.
INFECTION OF BABY AFTER DELIVERY
If you run a test on any 100 women, 5 will probably have
gonorrhea germs even though they have no symptoms. If a
baby is infected with gonorrhea during delivery, that
infection can cause blindness. This is prevented by putting
either silver nitrate drops or penicillin drops in the
baby's eyes immediately after birth. You should obtain
these drops at the prenatal clinic and always apply them
following a delivery at home.
In those instances where the bag of water breaks before
labor pains begin (dry labor) there is increased risk of
fever and infection in both the mother and baby. This is
particularly true if the bag breaks and no labor pains
begin for 24 hours or more (premature rupture of the
membranes). In such cases (estimated to occur in about
1 in 80 hospital deliveries) the mother may develop a fever
and the baby may be born covered with foul-smelling
amniotic fluid. Such a baby must be watched carefully by
experienced persons, since it may develop a
life-threatening infection during the first week of life.
CHILDBED FEVER AND KIDNEY INFECTIONS
Both childbed fever and kidney infections can occur in the
mother at any time during the eight days following
The symptoms of childbed fever are a high temperature,
smelly vaginal discharge and abdominal pain. The condition
is caused by germs getting into the uterus during or after
delivery. Usually these germs are introduced into the
vagina by the person doing the delivery. Always use sterile
gloves (available from a physician's supply house)! Kidney
infections are identified by a high fever and pain on one
side of the mother's back.
In general, if significant fever occurs in the postdelivery
period, you have reason to consult an M.D.
Almost all other possible childbirth
coniplications—including blood incompatibility,
anemia, swelling of the feet, blood pressure elevation,
diabetes and syphilis—can be detected by prenatal
check-ups. Some of' the complications I've
mentioned—twins, small pelvic size and abnormal
presentation—are also frequently detected in such
examinations. Additionally, problems such as a bad heart or
bad kidneys in the mother would probably be noted and home
delivery properly discouraged.
I'm sold on regular prenatal examinations, in other words .
. . don't wait until the last moment to sign up.
In England, where high risk deliveries are handled in
hospitals and normal deliveries are performed either at
home or in the hospital, a 1968 study done in the city of
Wolverhampton produced this interesting comparison: Of
7,133 home deliveries under midwife supervision, there were
54 stillbirths (babies born dead) and no maternal deaths.
Among 12,163 hospital deliveries, there were 369
stillbirths and four maternal deaths.
Although it would be unfair to take these figures as
evidence of the greater safety of home
deliveries—since, admittedly, the higher risk
deliveries are shunted to the hospital—they do
indicate that home delivery following adequate prenatal
care and attended by experienced people is not as risky as
our medical profession would have us believe.
COMMONSENSE CHILDBIRTH, by Lester D. Hazell, Tower
CHILDBIRTH MANUAL, by Gregory J. White, (available from the
Police Training Founda tion, 3412 Ruby Street, Franklin
Park, Illinois 60131).
HUSBAND-COACHED CHILDBIRTH, by Robert Bradley, Harper and
PAINLESS CHILDBIRTH, by Marjorie Karmel, Dolphin
TEXTBOOK FOR MIDWIVES, by Margaret F. Myles. 6th edition,
1968, E. & M. Livingstone Ltd., Edin burgh, London.
Printed by Darien Press, Great Britain.
Other text books on Midwifery usually available at the
library of any school of nursing.