Death rate from homebirth higher than from SIDS

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It’s a scourge that haunts the nightmares of new parents and prospective parents.

I’m talking, of course, about SIDS (sudden infant death syndrome), which takes the lives of approximately 2000 infants each year. SIDS is so frightening because apparently healthy infants die suddenly for no discernible reason.

But the death rate from SIDS is only a fraction of the death rate for American homebirth. The SIDS death rate is 0.4/1000. In contrast, the best data we have (from Oregon in 2012) shows that PLANNED homebirth with a LICENSED homebirth midwife has a death rate of 5.6/1000 approximately 1300% higher. Deaths at homebirth are frightening because apparently healthy infants die during labor or immediately after for reasons that are not discernible to homebirth midwives. The reasons are all too apparent to obstetricians and to the pathologists who perform autopsies on these dead babies.

Apparently healthy infants die unexpectedly during homebirth or immediately thereafter.

Homebirth advocates, to the extent that they acknowledge the increased death rate, dismiss it as trivial (“14X a small number is still a small number”). Yet no one dismisses the SIDS death rate as trivial. Why the difference? It’s because homebirth advocates have difficulty with the concepts of absolute and relative risk. Therefore, comparisons can be helpful in getting homebirth advocates to understand the terrible extent of the problem.

Everyone knows that SIDS is a tragedy. No one tries to dismiss it by claiming that babies who die of SIDS were “meant” to die. Similarly, babies who die at homebirth represent an equally terrible tragedy that is much more likely than the tragedy of SIDS. And the babies who die at homebirth were no more “meant” to die than those who die of SIDS.

We have made remarkable strides in combatting SIDS, even though we don’t yet understand the cause. We’ve found that putting babies to sleep on their backs can cut the rate of SIDS by two thirds. Once we became aware of what we could do to prevent SIDS, we instituted massive public health campaigns to warn every parent and caregiver and thousands of babies are saved each year as a result.

Every study of American homebirth and every dataset, including the data from the Midwives Alliance of North America (MANA) shows that homebirth with an American homebirth midwife (CPM or LM) has a dramatically higher rate of death than comparable risk hospital birth. In contrast to SIDS, we do understand the reasons for this: American homebirth midwives are counterfeit midwives, laypeople who awarded themselves a credential that doesn’t meet international midwifery standards and is not recognized by the UK, the Netherlands, Australia or any other industrialized country.

Midwives can save lives; counterfeit midwives cannot. They claim to be “experts in normal birth,” but no one needs experts in normal birth. We need birth attendants who can anticipate, prevent and manage complications in childbirth. CPMs and LMs cannot do those things and babies die preventable deaths as a result.

Do you view SIDS is a health problem? Then you ought to consider homebirth a much bigger health problem because it has a death rate 1300% higher than the death rate from SIDS.

Thinking about homebirth? Think again.

  • Bryn

    Just running some numbers real quick, and discovered that infant (this isn’t including maternal mortality rates) mortality rates in US hospitals are roughly 12X higher than SIDS deaths in the US (~1,100% higher). In this specific reaponse, my intention is not to advocate for one birthing method over another, but instead to point out that stats and numbers can pretty easily be highlighted so as to prove a fairly biased point. In other words, I’m playing “devil’s advocate.” I think it’s vital for each of us to do the research and make the best, most informed decision for ourselves and those directly involved : )
    *Again, I just did this pretty quick, on my phone…not by any means an *extensive* effort…and mainly out of curiosity, but I think it’s interesting enough to provide some added perspective.*

    • Bryn

      Oy, maybe I was a little more lenient than I thought. The US infant mortality hospital death rate I referenced was 6.3/1000, which is actually higher than that listed in the article for home births. Regardless, my point still stands that we really need to do our own research and make our best, informed decisions

      • Bryn

        So that stat was from 2007. The stat from 2013 would be 5.961/1,000

      • Amazed

        Which would mean not listening to anyone who clutches infant mortality like a pearl to their breast and is unable to understand why it isn’t applicable here.

        If that’s your definition of a “best, informed” decision, it doesn’t do much credit to your decision-making skills.

        • Bryn

          No need to be hostile. Like I said, I ran some quick numbers out of curiosity and admitted to not doing the most extensive research. I’m also curious, why compare homebirth mortality rates to SIDS deaths? Why not compare homebirth mortality rates to hospital mortality rates? Again, my intention is not to be hostile or obnoxious…but rather to be curious and provide a different perspective

          • Who?

            Just in case you’re sincere, rather than a parachuter about to spout hellfire.

            Homebirth carries 4 times the risk of mortality that hospital birth does, according to MANA’s own statistics.

            Why compare? Because more than 20 years of work has gone into reducing the SIDS rate, whereas homebirth advocates can do nothing to improve homebirth safety, while pretending it is safer than hospital birth.

          • Bryn

            I’m being sincere; no intention of hellfire, I promise! Is the stat that I used from a 2013 CDC reference stating that US hospitals have an infant mortality rate of 596.1 deaths per 100,000 live births (5.96/1,000 right?) NA in this case? Could we not compare that to the rate in the article for home births? I guess what I feel would be more beneficial would be a comparison of stats between home and hospital birth outcomes? (I’ll check out the MANA info.) Again, sincerely curious and just trying for an educational dialogue.

          • Amazed

            Again, infant mortality rate is the WRONG measure. If a baby dies after birth from a botched delivery, it’ll be included in the stats and that’s fine. If a baby dies on their 364 day of birth because they were dropped on their head, it’ll be included in the stats as well – but the death would have nothing to do with the mode of birth. If it’s a preventable stillbirth, it won’t be included in the stats at all since infant mortality only includes live births.

            The right measure is perinatal mortality which encompasses the outcomes of prenatal and postnatal care.

            And when we’re talking homebirth, only low-risk pregancies should be taken into account since homebirth midwives insist that they only take on low-risk women. The fact that they insist that every problem is “a variation of normal,” aka low–risk, has nothing to do with the fact that they lure women with promising that they’ll send them running to an OB the moment they stop being low-risk.

          • Roadstergal

            “their 364 day of birth because they were dropped on their head”

            Or because they were in a car crash, or got shot by a neighbor’s toddler, or whatever. Any of a whole host of reasons that have naught to do with their site of birth.

          • Amazed

            Indeed. Infant mortality strives to encompass the deaths of all children that were born alive, up to their 1 year of age. That’s it. It gives free pass to every incompetent provider (or any UC moron who popped her baby headfirst in the toilet and then lol-ed about it on Facebook) who preventably lost a baby months or weeks before due dates, or even during labour. And, not surprisingly, those incompetent providers tend to be homebirth midwives. Overwhelmingly so.

          • Angharad

            Also importantly, the vast majority of SIDS deaths are included in the infant mortality rate, as it mostly strikes children under 1 year of age. Saying that the infant mortality rate is 12x higher than the SIDS rate means that 1/12 of infant deaths were due to SIDS.

          • Bryn

            Thank u all : )

          • Amazed

            Homebirth death rates have been compared to the same risk hospital deaths, many times, including the post about MANA’s study on them right on the home page. Just go right and up, and you’ll see it. This post simply isn’t about this. Sorry if I come across as hostile, I really am not trying to be. But your posts showed lack of understanding coupled with the implication that your hastily conducted numbers constituted a best, informed decision. It simply doesn’t. You might have run the numbers but you ran the wrong numbers.

            Many women feel that they are making an informed decision while in fact they believe MANA – and MANA blatantly lies about the result of its own “study” ( a self-selected survery with about 1/3 of all “professionals” taking part without even being forced to include ALL of their outcomes. They could simply let the bad ones out if they so chose).

          • Bryn

            I appreciate your honesty and patience. I apologize that my hasty attempt at making comparisons coupled with remarks about the importance of being an informed individial/patient may have lead anyone to believe that I might have been any sort of guru on the matter. I was curious, and took a chance at being quite vulnerable by posting, in hopes of gaining some understanding myself as well as compell others to research, be informed, and not necessarily take everything at face value. Again, thank u for the more respectful dialogue : )

    • Amy Tuteur, MD

      Infant mortality is a measure of PEDIATRIC care (death from birth to one year of age). The best measure of obstetric care is perinatal mortality (late stillbirth + death until 30 days after birth).

      Perhaps you hadn’t noticed, but the dataset that I discussed DIRECTLY compares women of the same type. It doesn’t include high risk or premature births among other things.

      Nice try at attempting to dismiss the findings, but your attempt is a total failure.

  • Allie P

    Nothing scares me more than SIDS. I had an uncle who died from it, and I don’t think my grandmother ever recovered. I spend half my life checking on my sleeping baby to see if she’s still breathing.

    Then again, I also had planned inductions in hospital with continuous fetal monitoring and an epidural, so I’m not the audience for this message.

  • An Actual Attorney
    • The Bofa on the Sofa

      Gotta love the comments. The “Party of Family Values” shows its true colors. You hear the accusation all the time that Republicans only care about the baby up until the point where it is born, but you won’t see it demonstrated so blatantly very often.

      • Allie

        This was never about babies
        .Conservatives want to keep women out of the public sphere, the workplace, and politics. The most efficient way to achieve that is making her a mother as young as possible and as many times as possible. It’s hard to advocate for yourself while running after a couple of preschoolers with a big belly and a toddler on your hip.
        The GOP tries to make this happen by

        – Keeping youngsters ignorant about how their bodies work by teaching abstinence only and creating a huge taboo around the lower half of the human body and its functions

        – Demonising and restricting access to birth control

        – Demonising and restricting access to abortions

        Once the baby has served its purpose, Republicans couldn’t care less about what happens to it.

        • Bugsy

          Your abstinence-only comment is spot-on.

          When we lived in rural Florida, a local study showed that kids in the neighboring towns believed that a can of Mountain Dew before intercourse would prevent pregnancy. Mind-boggling…

          • FormerPhysicist

            I’ve heard that one. At least when I heard it, you weren’t supposed to DRINK the Mountain Dew. ICK.

          • Bugsy

            Lol – I don’t remember the exact details, not sure if I ever heard what you’re supposed to do w/ the Mountain Dew.

          • The Bofa on the Sofa

            I remember when I was young, it was emphasized that douching with Coke after sex did not prevent pregnancy. I figure the only reason they’d have to point that out is because some people apparently were claiming that it did.

            While I never actually heard the claim, I did here the rebuttal, which told me enough.

          • Bugsy

            Ouch. Even if it worked, it’s a bit too painful of a birth control method for me!

          • DelphiniumFalcon

            Well sure it won’t get you pregnant. You wouldn’t want anything in there thrusting around after douching with either of those! So I guess it’s true if you use Obi Wan Kenobi logic?

            We had the banana and a condom demonstration at my school my sophomore year. Parents were still outraged by this obviously vulgar display. To fifteen and sixteen year olds. Where half of them had already done the whole deed if my count of boasting peers was accurate.

            Ah, high school in a town with a church, as my friend who was once part of it said, was so holy roller the Baptists through them out. And about half the town was part of the congregation.

          • Roadstergal

            I got that admonition, as well – post-coital Coke douche does not prevent pregnancy, no matter how refreshing you find it. I liked how specific it was. “Try Tab.”

          • Azuran

            Quick internet search: Apparently the myth is that if you have the man drink 2L of mountain dew before sex, it will lower his sperm count and make him sterile.
            The myth does not say how long it lasts.

          • KeeperOfTheBooks

            Well, he might be so jittery from the caffeine and sugar that he can’t hold still long enough to put Tab A into Slot B… :p
            Still, I’d have to say questionable efficacy at best, and teenage hormones being what they are, he’d be pretty determined to get Tab A into Slot B…

          • Sarah

            Presumably he’d spend the next few hours constantly peeing. There wouldn’t be time to do the deed between toilet trips.Voila, no unwanted pregnancies or STIs. #science

          • demodocus

            My father would joke about a dime being an effective birth control method, as in hold tightly between your knees. …I may have teased back that all 12 of my kids would be conceived through immaculate conception.

          • An Actual Attorney

            A friend was given that piece of wisdom from her father. She assured him she could still bend over, as she stood up, turned away from him, and bent at the waist. Wonder if that guy ever recovered?

          • Tiffany Aching

            Ok, I have to ask : where are you supposed to put the mountain dew can ?

          • Bugsy

            No idea…not sure I want to know!

        • Roadstergal

          – Demonising and restricting access to birth control

          – Demonising and restricting access to abortions”

          That’s what says it all. If you want to reduce the abortion rate, fund birth control. It’s been proven over and over again to be the only reliable way. If you want women to either be forced to have big families or die from botched abortions, do what’s quoted above.

      • Azuran

        I love how in the comment, people are complainant that this will destroy the USA.
        …..Which is like, the only industrialized country where paid maternity leave is not a thing yet. And all the other countries are doing just fine with it. No country has ever exploded because of paid maternity leave.

        • DelphiniumFalcon

          I love the comments from far right, usually male, members saying “I don’t want to pay for some slut to have a baby!”

          Hey genius? If you don’t let “some slut” have a baby whose going to go into the work force years from now and pay into your social security that you have no issues drawing from and in fact seem to believe you’re entitled to.

          • The Bofa on the Sofa

            If you don’t let “some slut” have a baby whose going to go into the work force years from now and pay into your social security

            Mexican immigrants.

          • DelphiniumFalcon

            Those damn Mexican kids born in the US with a social security number and everything that makes their future jobs taxable!

          • Azuran

            Not with Trump as president.

          • Azuran

            I don’t think he understands that those who get paid maternity leaves are people who are working (Duh).
            So no, you are not paying ‘some slut’ to have a baby. You are helping a productive member of your society to start out a family and be an even more productive members of society.
            It takes a ridiculous amount of money to be able to take 12, 6 or even 3 months off from work without any pay. Me and my SO are planning to buy a house and start a family next spring. If I didn’t have the right to paid maternity leave, I’d have to push off either having kids or buying a house for another 2-3 years or go back to work right after giving birth. (and actually, since I plan on having more than 1 child, I’d probably have to wait even longer to buy the house.)

        • An Actual Attorney

          I hope most of those folks aren’t DC voters.

      • Megan

        Yeah, it’s not like people are asking for 16 weeks paid leave to spend with their new pet cat. It’s a baby that will one day be a tax-paying member of society. I’m sure none of these Republicans have any issue at all with collecting social security or Medicare as is “their right.”

  • Cartman36

    Horrifying. That’s all I can say about this. If someone could read this and still want a homebirth I doubt anything could convince them it is unsafe.

  • Jessica

    Sort of OT: Just saw this story in the newspaper from my hometown: http://union-bulletin.com/news/2015/oct/04/unlicensed-midwife-under-investigation-after-lengt/

    Absolutely and utterly unnecessary and maddening.

    • Cartman36

      How is this “midwife” not in jail? Also, and I don’t mean to sound cruel but it seems like the parents and family didn’t do what they thought was necessary (going to the hospital earlier, going to the closer hospital, etc) because they were “scared” to talk to the midwife. Really???

      • Jessica

        It really sounds like an abusive dynamic: a charismatic individual draws you in, promises all sorts of things, and finds ways to make you question your judgment and the judgment of others around you. You end up totally dependent on her and her judgment when you are absolutely at your most vulnerable (in labor, watching your partner labor, watching your own child labor).

        • Chi

          What scares me is how she LOOKS like a benign elderly authority figure. Like a grandma who’s seen it all and you can trust absolutely.

          Sadly for that couple, they trusted her and their baby died as a result.

          • Who?

            I thought that too-she looks sweet but clearly has a broad streak of something quite dark and abusive. How devastating and frightening for that family. Grandma couldn’t even get past her, which really shows just the hold she had on the couple.

          • Chi

            Exactly. She worked hard to gain their absolute trust and then worked to ENSURE that they didn’t get any information that conflicted with what she was feeding them. The biggest example of that being that she insisted that the mother NOT take the antenatal class at the hospital.

            Home birthers are continuously going on and on about informed consent, but what happened here is the absolute opposite of informed. If the mother had taken that class, if she had been more informed about the dangers, about what to look for, maybe she would have insisted on transferring sooner. Maybe the baby would have survived.

            It breaks my heart to know that the mother is probably thinking those things to herself and the guilt is likely eating her alive. She made a bad choice, but that midwife is the one ultimately to blame. And I hope she goes to jail.

          • Bombshellrisa

            Her website looks impressive but only to people who don’t know otherwise http://sherrydressmidwife.com/about-sherry/2753429

          • Chi

            Homeopathy is NOT comprehensive prenatal care >_>

          • Who?

            To be fair, homeopathy isn’t comprehensive care for anything at all, except possibly dehydration.

          • Chi

            Well yes, there is that. But saying that she gives comprehensive prenatal care is the biggest pile of crap I’ve ever heard.

            In order to provide ‘comprehensive prenatal care’ you first need to be able to COMPREHEND exactly what sort of care women need during pregnancy. Hint, it’s NOT magic water and ‘good vibes’. It’s a healthy diet, possible iron or folate supplements if needed, and of course, those evil evil scans to ensure things are developing the way they should be.

            Also, I think in the interests of full disclosure and ‘informed’ consent, she should say how many of those 2700 births she attended ended in a live, healthy baby >_>

            But then I’m a bitch who regard women like her who prey on vulnerable new mothers to line their own pockets and fulfill their god complex to be the lowest level of scum.

          • DelphiniumFalcon

            If her website building skills are anything to go by I certainly couldn’t trust her with something more complex like delivering a baby.

            That Blue Screen of Death color pallet is…oddly appropriate I suppose.

          • Roadstergal

            If you’re curious as to whether the website was designed by a Certified Professional Webmaster, CLICK HERE.

          • Bombshellrisa

            She does look sweet and kind. But is she in the birthing pool in this pic? http://drive2.subaru.com/Spr04_OwnerSpotlight.htm

          • Who?

            Well that’s a horrible photo.

            I don’t think it can be water she’s in because that appalling dress (or should I say ‘frock’) doesn’t seem to be sticking to her under the water. And it’s either a really old photo or she’s still dressing in what she was wearing in the 80s.

            And how is driving around in the snow for 24 hours between three labouring women providing any kind of proper care?

            BTW how does one have 12 cars in 25 years and still be driving the 1999 model?

            None of it makes sense, and that’s before you even get to the baby bit.

          • Bombshellrisa

            What concerned me was the fact that she was driving 130 miles to this patient and believe me, the route she would take is treacherous even in summer. I have driven it and been a passenger and it requires you to be alert. You can also be held up by other cars or the passes being closed. I can’t imagine laboring, waiting for the midwife to show up and getting increasingly more anxious because you are in pain and there is nobody there who can monitor you.

          • Who?

            But doesn’t monitoring cause lazy eye or something?

            This goes back to one of the fundamental challenges of the homebirth movement-if birth is, overwhelmingly often, painless, straightforward and beautiful, why have an outsider there at all? What can she possibly be doing that is of value, overwhelmingly often.

          • Bombshellrisa

            There are CPMs who teach unassisted childbirth classes. I have never been to one, but I do know someone who attended the series and the CPM also mentioned that she could serve as the doula for the woman. Guess someone has to “hold the space”.

          • Roadstergal

            “Dress insisted her patients use the homeopathic remedies she sold out of her health food store, Magill and Marin said. She also informed them sunscreen is poisonous, vaccines kill children and cause autism, and that ultrasounds disrupt unborn babies and cause Aspergers syndrome, they added.”

            What a heartless bitch.

            I have to admire the couple for realizing what went wrong and speaking out. It must be devastating to realize you made decisions that contributed to your child’s death.

    • Bombshellrisa

      This is disgusting. It saddens me there is baby who should have lived. It makes me crazy that it’s probably the same type of people who were so impressed with “how calm” Sherry Dress is even delivering footling breech babies at home (I personally heard this story while at the local Starbucks). How did anyone think a midwife who has to drive through the mountains for over an hour to get to them was a good choice? Trying to find alternative ways out of my Eastern Oregon town, I have taken the pretty but long and scary drive through the mountains down into Walla Walla. There is a homebirth CNM in Walla Walla, she recently started offering home births but she has always had hospital privileges. It’s been a long time in coming for Sherry Dress and I am sorry another family has to endure the heartbreak but I hope she is done catching babies and doesn’t come near a pregnant woman again.

      • NO midwife, not even the best qualified and experienced CNM has ANY justification in delivering a breech at home. If the mother did not have ultrasounds, the midwife should be [1] able to determine breech from palpation, or [2] immediately know that there is malpresentation when she does a PV exam [which she should do at least once, initially, for diagnostic purposes]. Should there be evidence of malpresentation, the midwife should transfer the patient IMMEDIATELY to hospital. Full stop. No excuses.

        • Fallow

          It makes me catch my breath when you talk about how homebirth midwives should not be delivering breech babies. I know several people who have homebirthed, and half of them delivered “surprise” breech babies. When these babies were born, I knew it wasn’t a great idea. I didn’t know it was a horrible display of incompetence though. And it sickens me that these women and their babies were in the hands of midwives like that.

    • Kelly

      So incredibly sad but I like the fact that the mother would have rather been pumped full of drugs in order to have her baby alive. I feel so bad for that mother as she knows she drank the kool aid and she lost out.

    • attitude devant

      You seem not to be aware that Sherry Dress attended her own daughter’s delivery…and that the baby died

      • Mel

        She killed her grandchild…that’s sick.

        • attitude devant

          Right out of Euripides….or Wes Craven….

      • Jessica

        I was not aware of that. Horrible. Absolutely horrible.

      • Bombshellrisa

        That was never mentioned by her fans at the Starbucks. That would leave any reasonable person shaken to the core.

        • attitude devant

          EXACTLY! Because someone who won’t take reasonable precautions to protect her own grandchild is not going to take precautions to protect yours.

    • The Bofa on the Sofa

      I appreciate how the parents have admitted that they made a bad choice, and realize they should have known better. That is such a good lesson. The best comment:

      “We should have known not to trust someone who is in such conflict with modern medicine,” she said of Dress’ methods. “A prudent midwife, or health professional of any sort, should be working with doctors, not against them.”

      EXACTLY!!!!! That’s exactly what it comes down to. Pushing the limits of what modern medicne can do is one thing, but actively working against doctors should be a huge red flag.

      I would add that they should have also known better when she tried peddling homeopathic crap. Another sign that you are working with a quack.

    • Allie P

      “Dress did not relent, Thayer added, chiding Magill for not pushing hard enough and insisting she reach full dilation before considering hospital options.”

      Wait, so she was pushing for three hours on a cervix not fully dilated?

  • swbarnes2

    My point is that if the home birth and hospital birth death rates were the same, citing death rates from something else isn’t all that relevant to deciding between homebirth and hospital birth. And doing minor, effective things like “back to sleep” makes sense no matter what the death rate from other things is, because back to sleep is effective in its own right at dropping the rate of SIDS.

    I think the point of the article is that stuff like back to sleep IS a good idea, because it does effectively make the rate of baby survival a tiny bit higher, and that choosing home birth increases the odds of baby survival even more than that, so it’s silly to do the behavior that helps a tiny bit while ignoring the behavior choice that would help way more, but you can’t draw those conclusions from only the two numbers cited above.

    • Daleth

      She does say in the post that “Every study of American homebirth and every dataset, including the data from the Midwives Alliance of North America (MANA) shows that homebirth with an American homebirth midwife (CPM or LM) has a dramatically higher rate of death than comparable risk hospital birth.”

      Are you just saying it would strengthen her point if she included the actual number for hospital births? If so, I agree.

      • swbarnes2

        Yes, that’s what I’m saying. I suspect if a pro-home birther was say, drawing attention to the rate of interventions in hospital births, and didn’t include the number of home labors who get rushed to the hospital and get the same interventions, everyone here would cry foul, because not including that figure implies that it’s zero, which is wrong. Presenting the figure prevents home-birthers from saying “‘Dramatically higher’ is an exaggeration, most babies who die at home would have died in a hospital, the death rates must be close to each other.”

        • Chi

          Not necessarily. Dr Amy has said time and time again that it is estimated that 2 out of 3 babies who die in homebirth could have been saved with timely and appropriate interventions in the hospital.

          She has written about that many times before. Here is one such article:

          http://www.skepticalob.com/2011/12/2-out-of-3-babies-who-die-at-homebirth.html

          The problem with homebirth, and again, she’s said this MANY times, is that the midwives attending the majority of these births ARE NOT TRAINED. They have NO idea how to recognize danger signs and what to do when they DO recognize them. When they decide to transfer those women to the hospital, it is often too little too late.

          So saying that babies who die at homebirth would have died in a hospital anyway is disingenuous and insensitive to those who lost a child that may still be alive if their mother had birthed in a hospital.

          Maybe they would still have died, BUT YOU JUST CAN’T KNOW. But certainly the odds are better in a hospital with trained nurses and obstetricians who CAN recognize the warning signs and deal with them appropriately.

          But home birthers fail to acknowledge this of course because that would mean admitting that their way is of course way more dangerous.

  • swbarnes2

    Those numbers don’t seem quite fair…if the death in hospitals was 5.5999/1000, then it would be wrong to say that homebirth was irresponsible, and the SIDS rate is immaterial to that. You really need the hospital death rate in there too, to get a proper comparison.

    • MaineJen

      No…the HOMEbirth death rate is 5.6/1000. The rate of death from SIDS is much lower, .4/1000. She’s saying that whereas SIDS is seen as a major health concern, homebirth is celebrated in some circles, even though homebirth has a higher death rate. (And FTR, the hospital death rate of otherwise healthy infants during labor/immediate postpartum is much, much lower).

  • Mel

    The huge difference between SIDS and home birth deaths is that is that babies who die of SIDS – absent probable accidental suffocation – die for reasons that no one is entirely sure of.

    Home birth deaths are from reasons that have been known for centuries and treatable in hospitals for decades.

    Babies who die in home births generally die from:
    -Suffocation from prolonged labor restricting oxygen from the placenta
    -Suffocation/starvation from placental failure
    -Suffocation from head entrapment during a breech birth
    -Suffocation from shoulder dystocia
    -Suffocation from failure of neonate to initiate breathing after birth
    -Suffocation / exsangunation from placental abruption
    – Neonate suffocation/pnuemonia from meconium inhalation
    – Complications of infections from contracted during prolonged rupture of membranes

    Bluntly, home birthing is giving birth like a cow. We lose calves due to suffocation prior to birth every week. Monthly, we lose a calf that is too weak to breathe after birth. Yearly, we lose a calf or two from pneumonia so soon after birth that it was probably contracted during labor.

    What kills me is that we’d treat the cows more like hospital births if we had a method of CFM for calves and a form of CS that works well. Crap, I’d just take a CFM so we’d know when we needed to intervene faster.

    I like our cows….but cows aren’t people. The fact that women CHOOSE to give birth like cows……I can’t wrap my head around that.

    • KeeperOfTheBooks

      I just wanted to say that I always love your cow posts. 🙂 Keep ’em coming!

      • Empliau

        Another vote for the cow-positive posts!

  • Azuran

    I don’t have kids yet, but SIDS is already what is scaring me the most. Just about everything else you can work to reduce the risk as much as possible­. You can have prenatal care, give birth in a hospital with extremely competent people, super baby proof your house. But with SIDS…..you just wake up to find your baby dead without any warning signs. All of my friends and family who had kids all talked about how panicked they were whenever they woke up and realized the baby slept longer than usual without crying.

    • Montserrat Blanco

      I was terrified of SIDS… You somehow end up sleeping… You are SO SO SO tired… But I strongly recommend to follow all the guidelines… My own baby is right now sleeping on his back, inside the crib, with nothing else inside the crib, with a sleeping bag with armholes, nobody has ever smoked inside our house, he got offered a pacifier, etc, etc. I must admit when he started to turn around himself I spent a couple of nights turning him on his back until I gave up after reading the guidelines a hundredth time and making sure if HE turned around it was OK. I still put him on his back every single night, a position that he keeps for about three seconds. You somehow make it through that first year.

      • KeeperOfTheBooks

        Yup. Same here, except that DD had been swaddled until she hit three months. Then I woke up in the middle of the night and found her sleeping flat on her face, with her arms still swaddled to her sides so she couldn’t push herself back over. Horrible moment, that, ’til I realized she was still breathing once I flipped her over.
        And yes, when I brought it up with the pediatrician that week, she agreed that a) the swaddle needed to go ASAP and b) that while I should put her on her back, it seemed exceptionally pointless to fight her all night to keep her there.

      • Who?

        ‘Back to sleep’ was huge in 1992 when my son was born, unfortunately he had missed the memo somewhere along the line and simply could not sleep on his back-couldn’t get to sleep, couldn’t self settle after stirring, couldn’t stay asleep after being put down on his back asleep. I tried explaining it really carefully but nothing worked.

        So the health visitor, having seen and heard all this, agreed that tummy was the way to go for him. Once he was a bit older he would sleep on his back strapped into the stroller when we were out, but otherwise, always on his stomach.

        He still sleeps on his stomach-or at least that’s how I find him asleep in the living room-and sleeps very soundly.

        • Chi

          My daughter was the same because she had a hyper-sensitive startle reflex. And her arms dropping while she was on her back would be enough to wake her.

          So we invested in a set of foam supports designed to wedge her into a safe side-sleeping position. And that worked for her. She didn’t startle herself awake any more, she slept longer and was much happier.

          Once she outgrew the supports, she started sleeping on her tummy. So I would just check on her, make sure nothing was obstructing her face.

          She’s a healthy, happy 18 month old now 🙂

          • Who?

            How interesting-I wonder if that was his thing too?

            It’s great that over the years people have worked things like that out and found ways around it. Glad you got it worked out for her.

          • Chi

            Could be. I only know she had hypersensitive startle from actually observing it seconds after I had put her down. She had been sound asleep in my arms and the moment her arms hit the mattress, BOOM she was awake.

            And unfortunately she was one of the few children who HATED and I mean HATED being swaddled. She would scream blue murder every time we tried.

            Each child is different. What works for one parent well will be an absolute disaster for another. All you can do is try different things until you find what does work for your child. And then do it as safely as possible.

          • Who?

            I don’t recall seeing that with him, and he loved being swaddled, the tighter the better. We did that for the first couple of weeks and once it was time to stop-don’t remember why now-the not sleeping on the back started.

            Trial and gradual improvement seem to be the keys to parenthood, that’s for sure. And then just when you think you have it nailed, along comes the next little rugged individual!

          • EmbraceYourInnerCrone

            My daughter was born in 94 when Back to Sleep was still new,we got some foam triangle supports because she would not stay on her back… She then taught herself to wriggle up out of the supports onto her tummy, also wriggled all the way to the corner of the crib and squished her head into the corner. ..fortunately we all survived her sleeping weirdness.

        • demodocus

          mine’s a front sleeper as well. Really tough early one and when he had the spica cast on in August.

  • demodocus

    I still check on my toddler on the rare occasions he sleeps in. I also plan on going back to the hospital in case my current nausea means something. Am I slightly paranoid? Yup. Do I care? Nope.

    • seekingbalance

      I still check on my 6yo and 3yo before I go to bed each night, and listen for their breathing. And I worry on those rare days when they’re sleeping later than I expect (though I usually hold back on checking on them those mornings, since that’s guaranteed to wake them up!)…

    • Chi

      I check my toddler every night before I go to bed. I cannot sleep unless I’ve looked in on her. She’s usually out cold, lying on her tummy, butt in the air, face turned to the side. That’s been her preferential sleeping position since she learned how to roll over. And I can’t stop her doing it, so I just try to roll with it.

      But the first time I went in to check on her and found her face down scared the everlasting crap out of me.

      • Medwife

        Oh I love the stinkbug position! So cute. My son quit sleeping that way at about 3 years, but he was a very cooperative back sleeper until about 8 months.

    • Froggggggg

      My kids’ ages are in the double digits now and while it’s rarer these days, I still check every now and then. And I even check on the dog!

  • Angharad

    Every time I see a ncb advocate say “some babies just die” I think of SIDS. Those babies died unpredictable and (with our knowledge now) unpreventable deaths. It’s disgusting to try to apply that to babies who die because they didn’t receive proper medical care.

  • Dr Kitty

    SIDS is an umbrella term for all unexplained sudden infant deaths.
    The risk factors for SIDS suggest than many SIDS deaths are suffocations.
    Hence the advice not to bed share with pillows or duvets, to put babies toe-toe in a cot so that they can’t smother in the bed sheets , not to bed share if you have been taking alcohol, sedative medications or drugs and not to fall asleep with your infant in a chair or sofa- all of this is “SIDS prevention”.

    Some SIDS deaths will be cardiac arrhythmias or apnoeas, but others, while not conclusively proven by autopsy, have clearly been tragic accidents.

    We’re obviously improving the SIDS rate by reducing deaths from suffocation and overheating, while doing little to prevent other causes.

    Home birth likes to pretend all the deaths and poor outcomes couldn’t have been prevented or foreseen, rather than the tragic outcome of ignoring all obvious common sense safety advice.

    • Anne Catherine

      I hate to kind of change the subject to breastfeeding, but it seems as though quite a few lactivists like to encourage co-sleeping —which I think is a little irresponsible. I can’t find a whole lot of examples of this right now, except for this academy of breastfeeding medicine post that felt the AAP was wrong to discourage bed-sharing in order to prevent SIDS.
      .
      Even without alcohol or sedatives, I think that bed-sharing/co-sleeping is a little risky.

      https://bfmed.wordpress.com/2014/04/09/should-the-aap-sleep-alone/

      • Roadstergal

        My lactivist/LLL-member friend was certainly evangelistic about co-sleeping, and encouraging EBF was integral to that. It also went along with AP and her ‘sleep training is abuse’ mindset, but I got the feeling that the LLL group was 100% pro co-sleeping, and they often bitterly complained that the NHS and NCT weren’t pro co-sleeping. The Venn diagrams of lactivism, NCB, and AP seem massively overlapping…

        • Blue Chocobo

          If only they treated cosleeping with half the “caution” they apply to formula.

      • Dr Kitty

        Eh…
        I’m not going to be hypocritical here.
        My babies both started the night in a Moses basket, came into bed for a feed and either stayed in bed if I fell asleep while nursing, or went back in the basket if I didn’t, and they were deeply asleep enough to transfer without waking them.
        More than once, when very sleep deprived I went to bed with full breasts and a baby in a Moses’ basket and woke up 8hours later with empty breasts and a baby sleeping in bed beside me and NO MEMORY of waking, taking them into bed and feeding them, although I clearly had.

        I struggle to stay awake while nursing at 3am, and figure it is safer to fall asleep side lying with the baby out of the bed clothes in bed than with them in my arms in a chair or sofa.

        Co-sleep, don’t co-sleep; do whatever works and you feel comfortable with, but do it as safely as possible.
        Which means following all the current guidance.

        The first baby went into a cot in her own room as soon as she outgrew the Moses’ basket, this one will too… I probably have another eight weeks of co-sleeping.

        • Ceridwen

          But there’s a difference between “when the choice is cosleeping or something worse, cosleep, but understand that the ideal scenario of baby next to the bed exists for a reason and is still what you should try for” and “ignore all that advice about what’s safest and cosleep, because breastfeeding is more important than your child’s safety”.

          I’m able to breastfeed and stay awake to put baby back in the bassinet when he’s finished, and did the same with my daughter 99% of the time. I doubt you would argue that I shouldn’t bother and should just cosleep, even though I’m easily able to put baby in the bassinet instead. But a lot of lactivists do argue that.

          • Roadstergal

            I wholly agree – compromises are part of life for sure. It’s just different, to me, to say “I’m doing this because it’s the best thing for our particular circumstance, cognizant of the risks” and “co-sleeping FTW, always.”

          • Joy

            I have been told it is impossible to ebf and not co-sleep. So obviously you are a miracle or something.

          • FEDUP MD

            I EBFed both kids and we never coslept. They also both night weaned on their own, at 6 months and 2 months respectively. AP people look at me like I’m lying and must have been stuffing them full of formula/rice cereal or something. Nope, and I was EBF and my mom says I night weaned at 2 months old. Of course, I had enough milk supply to feed two babies or more, the oversupply of which lasted for 6 months with my first and 7 months with my second. But of course, that can’t be possible either, because everyone “knows” your breasts only make as much as needed, and frequent feeding is necessary to keep your supply up, and babies only take 2 ounces or so at a feeding. Nope. I once pumped 20 ounces AFTER a feeding postpartum with my second. Trust me, they weren’t taking 2 ounces at a time. They took a good 4-6 ounces every 3 hours or so during the day- hey, just like a bottle fed baby, and slept all night. I guess I am just a magical unicorn then,but I found most online and book breastfeeding advice completely useless for me. But I know from talking with other women that my experience was not that unusual. One of the nurses I worked with could pump even more than me! I wish a range of breastfeeding experiences could be discussed and problem solved, rather than toeing the party line. Not every woman and baby is the same. I would have liked to hear more advice about my situation rather than being told that my supply would tank (it didn’t) because I wasn’t doing the “right things.”

            The good news is by my second, I knew exactly what to do. When the nurses harangued me to pump immediately postpartum to “make sure my milk supply would be good,” I just laughed and went to sleep. I had such bad engorgement without pumping with that one that I literally could not put my arms down all the way due to the swelling of the breast tissue in my axillae, and I actually got a transient sensory brachial plexopathy in both arms from that tissue being so swollen. If I had pumped, I wonder actually if the skin would have just spilt open from the swelling (I have horrible stretch marks anyways from thAt time),

        • demodocus

          I did that too. We tried to put him back in the bassinet, but both of us would fall asleep before the baby finished. Fortunately, we had a good sleeper, so after a couple months when hunger didn’t wake him up so often, he transitioned pretty well.
          Edit to add: we really didn’t want to do it for long, since we’re both heavy sleepers.

        • Nick Sanders

          It was the nursery gnomes.

        • Inmara

          In the first weeks I was nursing my baby lying sideways so he would fall asleep while feeding – nothing else worked at that point. Often I fell asleep too (hello, sleep deprivation!) but I woke up terrified every time because I was sure that baby is under my blanket and suffocating (what I thought is baby’s head was actually my engorged breasts, but that feeling before waking up was horrible). Now we are not within guidelines because he’s falling asleep better if there is heavy blanket on his legs (otherwise someone has to place arm there and keep him in place). I’m not happy with this and will be looking for sleeping sack or something similar but at least we’re at the point where pacifier is better to get him to sleep than nursing in bed.

          • Monkey Professor for a Head

            I’ve never coslept, and I still used to wake up convinced the baby was in bed with me. I used to panic and start searching for him – my poor husband got woken up a few times.

            I can understand why people cosleep, but for me personally the idea scares me. Thanks to the Irish healthcare system I have quite a bit of experience with sleep deprivation and when I’m sleep deprived I tend to sleep on my own arms (sometimes both) to the point of waking up with an ulnar nerve palsy. If I can roll on my arm and not notice, I figure I could roll on my baby.

            I do have my own breach of SIDS guidelines though. We moved mini monkey into his own room at 3 weeks old as hubby and I couldn’t sleep with him in our room. All 3 of us sleep better, I’m no longer at risk of falling asleep while doing night feeds and hubby can function at work and won’t fall asleep at the wheel.

          • KeeperOfTheBooks

            Heh. My mother told me once that when I was a baby, she walked and walked and WALKED me one night, and I just wouldn’t sleep. Finally, I passed out, but she kept walking until she was sure I’d stay asleep. At some point or other, she walked past the crib, saw it was empty, and flipped out because “WHERE’S THE BABY?!?!!” And yes, I was still on her shoulder, sleeping. :p
            Gotta love sleep deprivation…

          • Blue Chocobo

            I tried to feed the diapered end of one of mine somewhere in the 3 am fog of weeks 4 to 7. Couldn’t figure out why they wouldn’t just take the milk and stop screaming.

            Not my best moment.

          • KeeperOfTheBooks

            *howls with laughter and commiseration*
            😀

          • Kelly

            We never co-slept either but my husband would wake up a few times a week grabbing my leg and asking where the baby was. I had to tell him each time that she was in her room in the crib. We also have never had any of our three in our room longer than the first two weeks. We just could not sleep with them. SIDS still scares the ever living crap out of me still. I try to have them in our room for longer but then I just give up.

          • Chi

            Sometimes though you NEED your own space back. My daughter slept in our room in a separate bassinet for the first 4 months. And I DIDN’T because every little move she made, every little lull in her breathing made me wake up and check on her.

            I slept SO much better when she went into the big cot in her own room. The baby monitors only pick up the big stuff like crying, snoring etc. So basically the stuff you probably need to respond to.

          • Amy M

            Yeah, we did similar–moved the boys to their own room around 3weeks old. They didn’t care either way, but husband and I slept better. We had a cosleeper at the end of the bed, but it just wasn’t working, and the dog ended up in there a few times. Never when the babies were, but it worried me. (She wouldn’t have bitten them, but she might have stepped on them or lay on them.)

          • Blue Chocobo

            I got a lot of those middle of the night panicky “where’s the baby”s from my husband, too. I’d automatically freak out and start rummaging through the bed while he got the light, at which point we’d both look up at the crib in the corner and realize the baby was in there, safe and sound asleep, prepared to sleep through a feeding. Or was…until we started shouting and turned on the lights.

          • FEDUP MD

            My husband would do the same too. Wake up in the middle of the night throwing blankets off in a panic asking where the baby was. We never bedshared, although we used a cosleeper for birth until they moved to their own rooms around 4 months old.

          • Joy

            My husband had night terrors before the baby and now they are all linked to the baby being in bed with us.

        • Blue Chocobo

          The risks of extreme sleep deprivation are real, too, and have to be balanced against the risks of bedsharing. As you point out, it’s probably a good bit safer to do a bit of planned, as-safe-as-possible bed sharing than to get struck with involuntary couch sharing when your brain shuts down from exhaustion.

          • KeeperOfTheBooks

            Couch sleeping *can* be safe…ish. It depends on the parent and how they handle it, and can be the best option given certain circumstances. Definitely not ideal, but an option.
            From the time she was born until she was about 6-8 weeks old, DD would *not* go to sleep from 2-6 AM unless she was held, and she wouldn’t stay asleep unless she wasn’t put down. I finally set up on the couch where I was lying in a semi-reclined position with DD on my chest. I only had a blanket up to my waist, no higher. Arms locked over DD. Then I’d doze for a few hours, never really quite sleeping, but at least resting. I didn’t sleep deeply enough to roll over or anything, but it got me enough rest that I could (barely) function the next day. Gotta say, I was SO glad when she outgrew that…
            DH’s work schedule is such that he couldn’t have taken her, and he’s a *really* deep sleeper who needs a lot of blankets and pillows to sleep, so cosleeping wasn’t an option–even by dedicated cosleeper standards, it would have been patently unsafe.

          • Blue Chocobo

            It’s the planning and conscious risk management that’s important, versus involuntary collapse. The couch is usually the riskier option, but every situation should be evaluated on its specific merits and risks, not just the blind guideline.

            It’s like breastfeeding. Yeah, “breast is best” IF… Any individual’s particular “ifs” might make breastfeeding anything from amazing to difficult to deadly.

          • KeeperOfTheBooks

            Precisely! 🙂

      • Amy M

        What I disagree with is that a lot of those pro-sleeping lactivists seem to think that their babies are totally immune to SIDS because they breastfeed. I don’t think that’s a good message to spread, because its just not true.

        Also, as Dr.Kitty points out below, a lot of SIDS (at least in the past) used to suffocations, which is still a risk, no matter how the baby is fed. Done following the guidelines, its probably a low risk, but breastfeeding doesn’t magically allow an infant to breathe if its face is smushed under a pillow.

  • Megan

    “We have made remarkably strides in combatting SIDS,”

    I think you meant remarkable.

    Great article. It’s true that most people do not really understand the concept of risk. It helps to see it in numbers people can understand.

    • Amy Tuteur, MD

      Thanks!

      • seekingbalance

        Yes! I’d never thought to draw the comparison between SIDS and homebirth. Brilliant and relevant and thought-provoking…..

  • sdsures

    The spectre of SIDS is terrifying.