Homebirth, like climbing trees … with a baby in your arms


I guess it’s progress of a sort.

As the evidence mounts that homebirth kills babies who didn’t have to die, advocates are switching gears from denying the increased risk of perinatal death to rationalizing it.

The latest effort, greeted rapturously in the homebirth community, is Climbing Trees by obstetrician Alison Barrett.

was one of those kids who loved to climb trees…

I want to be clear: climbing trees was not, to me, about taking risks. There was nothing about tree climbing that felt risky, in fact, it felt very safe, to be cradled in the canopy of a tree…

Climbing trees is a metaphor for homebirth.

Some people think children should not climb trees. They’ve banned it in school yards. Today some might claim that my parents were irresponsible. Perhaps they would have reported my mother …

There are people who believe that risk shouldn’t be allowed in childbirth either. Since it involves an unborn child, who cannot consent, parents should be made to do the right thing…

So Barrett acknowledges that homebirth carries the risk of death, just like climbing trees carries the risk of death. The important issue for her is that the benefits outweigh the risks:

When I look back, I am sure that climbing trees gave me some immeasurably important gifts. One was a belief in my own body. I’m not a star athlete; I don’t consider myself particularly stoic, or brave, or over-confident. That belief in my own body served me well later on during the birth of my children, and in attending the births of others…

Let’s leave aside for the moment the fact that that argument can be made for any practice, no matter how dangerous. Perhaps drunk driving gives you a thrill and a feeling of self-confidence. That does not rationalize drunk driving.

But the real problem with Barrett’s argument is not its weakness, but its inadequacy. Homebirth is not like climbing trees. It is like climbing trees with a baby in your arms; and the baby makes the risk calculus very different.

1. Carrying a baby in one arm makes climbing a tree much more dangerous. It reduces maneuverability, changes balance, makes it difficult to get a strong grip, putting the climber at much greater risk of falling. Similarly, giving birth to a baby entails many life threatening risks to the mother that simply don’t apply when she is not pregnant.

2. You could climb the tree safely, but drop the baby out of the tree to its death on the ground below. I suspect that we would all agree that climbing a tree with a baby in your arms would be a reckless parenting decision, no matter how much satisfaction it would give the mother to show her child the view and no matter how much pleasure the view might give to the baby. In many situations, homebirth is a reckless parenting decision because it is the baby who is in far greater danger than the mother.

3. Climbing a tree isn’t a metaphor for homebirth. It’s a metaphor for birth itself. Childbirth inevitably carries risk. Regardless of what tree you climb, or where the tree is located, there is always a risk for the climber. But you can make the climb more or less dangerous depending on the conditions. Climb in a hurricane, and you increase the risk. Climb a dead tree and you increase the risks. Climb with a baby in your arms and you’ve dramatically increased the risk. Similarly, give birth in a birth center far from the hospital and you increase the risks. Give birth at home and you increase the risks even more.

4. Climbing the tree holding a baby increases the risk, but climbing a tree holding two babies increases the risk even further. Similarly, giving birth to twins at home (or a breech baby, or after a previous C-section) increases the risk even further.

5. The risk of climbing is completely independent of whether you feel safe while climbing. It makes no difference if you feel safe inching out along dead branches. It makes no difference if climbing to the top of a redwood doesn’t frighten you. And it certainly makes no difference if you trust trees. The risk exists independent of the views of the person who undertakes it. That’s why the claim that feeling “safe” at homebirth is utterly irrelevant. Your safety and risks have nothing to do with how you feel about them.

I’m grateful that Barrett acknowledges the risk of homebirth. Homebirth kills babies who didn’t have to die and that is irrefutable. I find her effort to rationalize that increased risk to be deeply flawed, however. She wants to imply that the increased risk of death at homebirth can be justified by the personal growth experienced by the mother. She conveniently ignores that while the mother is knowingly adopting the risk, the baby is not and the baby is the one with the most to lose.

Homebirth isn’t like climbing trees. It’s like climbing trees with a baby in your arms. It’s the baby that makes the risk unacceptable for most women, not the trees.