If I had a nickel for every time a homebirth advocate claimed that a “risk” of hospital birth is a 1 in 3 chance of having a C-section, I’d be a very rich woman indeed.
What’s the real risk of having a C-section? A lot lower than you’ve been told.
I’ve written in the past that homebirth midwives have a one size fits all approach to childbirth. It makes no difference who you are, what your past medical history, what your test results in this pregnancy show, or what complications you’ve experience in this and previous pregnancies, all women are treated as if they are identical, and homebirth is nearly always prescribed as the correct course of action. That refusal to personalize care (the exact opposite of obstetric care) is used to scare women into believing that because the C-section rate is 32%, the average woman’s chance of having a C-section is 32%.
To understand why that is foolish, it helps to consider other examples, like lung cancer.
The lifetime risk of developing lung cancer is slightly less than 7%. Does that mean that YOUR chance of developing lung cancer is nearly 7%. No it does not. The lifetime risk of a specific individual developing lung cancer depends greatly on whether or not you have ever smoked or still do. The risk of developing lung cancer is more than 20 times higher for smokers as for non-smokers. So if you are a smoker, your lifetime risk of developing lung cancer is much higher than 7% and if you are a non-smoker, your lifetime risk of developing lung cancer is much less than 7%.
The same principle applies to C-sections. The personal risk of ending up with a C-section in any given pregnancy is dependent on your personal situation. For example, if complete placenta previa is diagnosed at term in your current pregnancy, you chance of having a C-section if you go to the hospital is not 32%, it is 100%. A C-section is always performed because attempted vaginal delivery through a complete placenta previa invariably leads to the death of the baby and mother.
As I discussed recently, the chance of having a C-section after a previous C-section is dependent on your personal situation. For the average woman with one previous C-section, the chance of a woman attempting a VBAC ending up with another is 39%. However, the chance of ending up with a C-section falls to only 10% if you’ve had a vaginal delivery since you’ve had the C-section.
So what is the real risk that someone contemplating homebirth would actually end up having a C-section if she went to the hospital instead.
No one should be having a homebirth after a previous C-section. The risk of a severe complication is simply too high. Therefore, any one who meets the low risk criteria for homebirth has never had a C-section in the past. For them, the risk of having a C-section in the current pregnancy is NOT the same as the total C-section rate. To determine that risk, we must look at the primary C-section rate.
According to the paper Primary Cesarean Delivery in the United States, the chance of having a primary C-section is 21.9%. Does that mean that a specific individual’s chance of having a C-section is 1 in 5? No, it does not, because the risk of a primary C-section is dependent in large part on whether you have given birth in the past. The primary C-section rate for women who have never given birth in the past is 30.8%, but the primary C-section rate for women who had given birth to at least one child was only 11.5%.
The typical woman who chooses homebirth has had at least one child in the past, so her actual risk of having a C-section if she has a hospital birth is NOT 1 in 3, but slightly higher than 1 in 10. That’s a very big difference.
How does that compare with the primary C-section rate at homebirth. According to the MANA study, the overall C-section rate was 5.2% and the primary C-section rate was 4.3%. Unfortunately, MANA did not break down the primary C-section rate by parity. Of the overall group of women attempting homebirth, we do know that 77.7% had given birth to at least one child. The primary C-section rate among parous women is likely to be lower than 4.3%. Nonetheless, for women who have given birth before, the risk of having a C-section after attempted homebirth is around 4%, while the risk of having a C-section in the hospital is 11.5%. At the same time, the risk of having a baby die at homebirth is dramatically higher than the risk of perinatal death in the hospital.
Most women who choose homebirth have had a baby in the past. Therefore, they are trading a small risk of having a C-section in the hospital (11.5%) for a dramatically increased risk of having a dead baby. Is that really worth it?