It’s more dangerous to deliver a baby in the United States than anywhere else in the developed world — and the risks for mothers are climbing.
Childbirth-related fatalities in the United States have garnered national attention from numerous media outlets, including NPR, ProPublica and USA Today. Most of the reporting focused on preventable mistakes in hospitals, where more than 98 percent of babies in this country are born.
But hospitals aren’t the only place women give birth or face fatal risks. More mothers are choosing to deliver their babies outside the hospital with the assistance of midwives. The number of such births has nearly doubled in the past decade alone.
We at GateHouse Media and the Sarasota Herald-Tribune wondered how safe this practice is by comparison, how well-regulated it is, and what kind of data and records we could get to help us answer the questions.
In addition, two of us have personal connections to women who experienced adverse outcomes from out-of-hospital deliveries.
A friend of Herald-Tribune reporter Josh Salman’s wife lost her baby in a 2016 home birth in Florida. The infant got stuck in the birth canal and died during delivery. Riva Majewski agreed to talk on the record about her experience and is featured in one of the stories in this series.
GateHouse editor Emily Le Coz knows two people whose out-of-hospital births ended with emergency transfers. Her sister-in-law’s newborn was rushed to the hospital with fluid in the lungs after delivery at a freestanding birth center in Wisconsin in 2015. That same year, one of Le Coz’s friends was rushed to the hospital for severe blood loss after the home birth of her son in Florida. Both sets of moms and babies are fine, but the experiences rattled them.
The other journalist working on this series has family ties to the practice, too, but on the other end of the spectrum. GateHouse reporter Lucille Sherman’s mother is a natural childbirth advocate and doula.
Our personal connections inspired us to learn more about this practice. We kept hearing from media reports and documentaries about how safe it was, but we had these stories from friends and family members who felt like it wasn’t as safe as it could have been. We wanted to know why.
To answer our questions, we first obtained 10 years of data from the CDC’s Period-Linked Birth and Infant Death records. The records contain information on millions of births and related deaths from 2006-2015. We used them to analyze neonatal fatalities during or within one month of deliveries in hospitals versus deliveries at homes and in freestanding birth centers.
We based our analysis on previous statistical research done by obstetrician-gynecologist Amos Grunebaum and his colleagues that was published in the peer-reviewed American Journal of Obstetrics and Gynecology. Their analysis looked at records from 2006-2009. We replicated the study with the inclusion of six more years of statistics.
Our analysis showed infants are three times more likely to die with midwife-assisted home births than midwife-assisted hospital births. The risk climbs for babies of first-time mothers, who are four times more likely to die. When restricting the analysis to one week, the risk for first-born babies climbs eightfold.
This contradicts a statistic many U.S. midwives cite, which is that home births for low-risk women are just as safe as hospital births. That statistic is true for other countries, like Canada and the Netherlands, which have different systems of midwifery than the United States. But it’s not accurate here.
The problems plaguing U.S. midwifery and out-of-hospital births are many, journalists found during the course of their nine-month investigation. Among them: a lack of consistent educational and training requirements, a lack of consistent laws and regulations, a lack of consistent accountability, and a lack of collaboration with hospitals and physicians.
Some may accuse us of being against out-of-hospital deliveries, against the profession of midwifery or even against the right of women to choose their own caregiver and place of delivery.
We are none of those things.
As investigative journalists, our job is to tell in-depth stories that make communities safer, healthier and more knowledgeable. When we invest many months in stories like this, it’s because we uncover information that we think the public needs to know and can’t find anywhere else.
Our aim was always to determine whether the rising trend of planned out-of-hospital births offered women and babies a safe alternative to hospital deliveries. Our investigation shows it’s not as safe.
And many of the midwives we interviewed acknowledged these problems hurt the entire profession, and that out-of-hospital deliveries would be safer if they were addressed.
“There has not been effective oversight,” said Christina Holmes, a licensed midwife in Florida. “There’s no recourse. It’s hard to get action against any type of practitioners … I agree there are flaws in the system.”
In addition to doing our own statistical analysis, we wanted to talk to as many people as possible and read as many documents as we could find. So we crisscrossed the country interviewing more than 100 mothers, midwives, physicians, attorneys, lawmakers and researchers. We scoured through disciplinary reports, lawsuits and scientific studies.
Sherman even went to Oklahoma to follow a mother through her home birth journey.
We also filed more than 150 requests under the Freedom of Information Act with agencies from all 50 states for data on midwives and birth centers. We used that information to build a first-of-its kind-database allowing mothers to track and background more than 23,000 U.S. midwives. In Florida alone, we created databases of 911 calls, birth center transfer logs and fetal fatalities.
We believe women need to make informed choices about their decision of where and with whom they deliver their babies. We hope our investigation provides them some of that information.
“I do think (midwives) serve a very important need in the community, because they can be a safe choice for the right patient,” said Kyle Garner, an obstetrician and chief of staff at Sarasota Memorial Hospital. “The biggest obstacle we have to overcome in this is to trust everyone’s judgment. The patient and midwife need to trust my judgment that I’m not C-sectioning you out of convenience. And I’m trusting that these midwives are not steering their patients down a false road of safety.”
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Failure to Deliver team:
Emily Le Coz | GateHouse Media National Data Projects Editor
Josh Salman | Sarasota Herald-Tribune investigative reporter
Lucille Sherman | GateHouse Media National Data Reporter
Development and Design
Tony Elkins | GateHouse Media Director of Innovation
Tyson Bird | GateHouse Media Product Strategist
Mara Corbett | GateHouse Media Projects Designer
Aubrey O’Neal | GateHouse Media Projects Designer
Connor Leech | GateHouse Media Innovation Intern
Photography and Images
Mike Lang | Sarasota Herald-Tribune Director of Photography
Dan Wagner | Sarasota Herald-Tribune Staff Photographer
Jennifer Borresen | Sarasota Herald-Tribune Design Editor
John Clark | Gaston Gazette Staff Photographer
Kelly Lyon | The Register-Guard Staff Photographer
Dak Le | GateHouse Media Web Developer
Kat Dow | Sarasota Herald-Tribune multimedia editor