How does having a homebirth compare to not using a car seat?

Mother Putting Baby Son Into Car Travel Seat

In the last 30 years we have engaged in a huge public health campaign to increase the use of car seats. Not only have we spent millions, we’ve enacted laws that actually make it illegal for parents to drive infants without buckling them into car seats.

The campaign has been spectacularly successful. According to the Insurance Institute for Highway Safety, from 1975 to 2013, infant fatalities fell from 6/100,000 to 1.3/100,000 while car seat use rose to 99% of children under age 1. Of course car seat use is the not the only reason why infant fatalities dropped; cars themselves are safer, but the use of car seats has played an important role.

[pullquote align=”right” color=””]Out of hospital birth has a death rate more than 50X higher than failing to put an infant in a car seat.[/pullquote]

Forgoing car seat use for infants is not merely illegal, it is social anathema. Who would defend a mother who chooses not to use a car seat for her infant. No one, right? Who would claim that the risk of not using a car seat is so small that it should be left to the mother’s choice? No one, right?

Yet, as I wrote last week, a paper in The New England Journal on out of hospital birth suggested that the increased risk of giving birth outside a hospital was small.

Small is a relative term. That’s why it is instructive to compare the risk of refusing to use a car seat with the risk of giving birth outside a hospital.

I’ve attempted to do that in the graph below:


The graph reflects information from the Insurance Institute for Highway Safety and the data from the NEJM paper.

Even a cursory glance reveals an inconvenient truth (inconvenient for natural childbirth advocates that is). Childbirth, even for low risk women with singleton term babies in the head first position is inherently dangerous. Infants who are unrestrained had a death rate of 4.6/100,000 whereas the infants of low risk women faced a death rate of 106/100,000 even in a hospital. Childbirth is 100X more dangerous than failing to restrain an infant in a car seat.

The graph actually dramatically understates the risk. The automobile fatality data reflects deaths per 100,000 children, most of whom rode in cars multiple times. The per trip mortality rate is substantially lower. Furthermore, the birth data is from low risk women. The true gulf between automobile infant deaths and deaths from childbirth is probably another order of magnitude.

The graph also shows that the risk of death for an infant riding in a car is actually very small, whether riding in a car seat or not (1.3/100,000 vs. 4.6/100,000). Nonetheless, we value the lives of our infants so much that we are willing to spend millions of dollars and enact laws in all 50 states to protect them from this small increase.

In contrast, there’s a much larger difference between delivering a baby outside a hospital vs. in a hospital (258/100,000 vs. 106/100,000). If 100,000 mothers of infants chose to drive with their infants unrestrained, there would be an absolute increased risk of 3 infant deaths per year. If 100,000 low risk women chose to give birth outside the hospital, however, there would be an absolute increased risk of 152 deaths!

That doesn’t change the fact that it is up to each woman to decide for herself where to give birth. But it does suggest that the increased risk of death at out of hospital birth isn’t small after all.

Simply put, no one could call the failure to buckle an infant into a car seat a safe choice. If no one would call that choice safe, no one should call the choice to deliver outside a hospital, which has an absolute increased risk of death that is 50X higher, a safe choice.

133 Responses to “How does having a homebirth compare to not using a car seat?”

  1. meglo91
    January 5, 2016 at 9:48 am #

    OT, sort of, but this past New Year’s weekend I was sitting around with some friends having brunch, and I mentioned how little I was looking forward to the hospital stay for my new baby’s birth. The responses I got were “Look into a midwife!” (No.) And also “Talk to my wife!” This from a dear friend whose wife is a homebirth doula. I explained that a homebirth for me was a poor idea because I will be AMA when this baby is born and I have a history of pre-e and PIH. (I did not mention that I think home birth is generally always a poor idea.) I need to be in a hospital. He shrugged. “Sure, but still, talk to her — people with those problems are like 70% of the people she sees.” My eyes bugged out of my head. Was he joking? He had to be. I said, quite firmly, “No. I know someone whose baby died that way.” (This is true. It is the reason that I turned away from the natural birth industry.) And that shut him down. But for real — these people are educators, lawyers, social workers. How can they not see the danger of what they’re advocating? It boggles the mind. I think I may have damaged my relationship with my good friend, but I can’t just smile and nod when such outrageous things are said right in front of me.

    • Madtowngirl
      January 5, 2016 at 10:01 am #

      I’ve definitely strained a few relationships over this, too. A friend of move, who has no intention of ever having a baby, tried to convince me that homebirth is safer than the hospital. Her reasoning was “stuff she’d seen on Facebook.” This friend is an otherwise intelligent individual. I don’t think she appreciated me laughing in her face.

  2. yentavegan
    January 5, 2016 at 7:04 am #

    proponents of homebirth rationalize their position by saying birth is a natural process, riding in a car isn’t. Apples to oranges….

    • The Bofa on the Sofa
      January 5, 2016 at 7:32 am #

      Dying is totally natural…we all will do it someday

      • Anonymous
        January 5, 2016 at 10:58 am #

        To quote my dad, who’s been an MD for 35 years:

        “We all die eventually. Drag the survival time out to 200 years and you’ll find a surprisingly low number of survivors.”

    • Montserrat Blanco
      January 6, 2016 at 4:19 am #

      Vultures are absolutely natural too and they definetely need feeding too!

      Somehow, even as a climate change conscious person I still do not want me or my baby being part of their diet… Which is what would have happened eventually if we had let Nature take its lovely course.

      It is the same with organ donation. I am registered as an organ donor. All my family knows I do not want to carry my organs to the tomb, but I happen to do all within my power to avoid becoming an organ donor… Yes, even doing some very unnatural things.

  3. Valerie
    January 4, 2016 at 3:41 pm #

    I’m waiting for the attachment parenting proponents to tell us how we should drive with babies in slings because the psychological harm of crying alone and restrained in the backseat outweighs the tiny risk of carseat-preventable death from a collision.

    • Roadstergal
      January 4, 2016 at 3:56 pm #

      We already had that WA state woman for whom breastfeeding was more important than the kid being properly restrained while driving on the freeway…

      • Valerie
        January 4, 2016 at 4:42 pm #

        Terrifying. Apparently some people also breastfeed their babies in carseats by leaning over them. My carseat directions said not to feed infants at all while the car is moving- I assume because of the risk of choking.

        • Mishimoo
          January 4, 2016 at 5:52 pm #

          Or smothering, depending on the angle.

          • asrai
            January 8, 2016 at 7:07 pm #

            Because if you are in an accident your body weight will be thrown into baby.

      • sdsures
        January 4, 2016 at 6:44 pm #

        I remember a story about a woman who was pulled over and possibly arrested for BREASTFEEDING WHILST DRIVING. Holy ****.

    • AirPlant
      January 4, 2016 at 5:04 pm #

      There was a lady on an attachment parenting forum who swore that she pulled over every time her baby started crying. She claimed that some days it would take her an hour to do a 10 minute drive but it was worth it because her baby did not cry alone. I don’t want to be a bitch but a big part of me wonders how that is going to work when the kid is a toddler and figures out the boring car rides turn into mommy time every time they cry.

      • yugaya
        January 4, 2016 at 5:13 pm #

        I think the kid already figured that out.

        • sdsures
          January 4, 2016 at 6:43 pm #

          Kid classically conditions Mommy to pull the car over and cuddle it whenever it cries. Smart kid! 😉

      • Roadstergal
        January 4, 2016 at 5:19 pm #

        Real AP moms take public transit, so they don’t have to let go of their bairns for a second.

        • Roadstergal
          January 4, 2016 at 5:20 pm #

          (Not knocking public transit for a second, BTW – I’m a big fan.)

      • Dr Kitty
        January 4, 2016 at 7:07 pm #

        Ummm.,. Am I the only one who has had kids that no matter how cranky or hungry will fall asleep within 10minutes AS LONG AS YOU JUST KEEP DRIVING?

        They may cry in the driveway or parking lot, but five minutes later they’ve been blissfully sleeping. Long drives with babies saved my sanity, both times (I have nice scenery to drive through and BBC Radio to listen to).
        This time around my husband would occasionally text me “I’ve been tracking your iPhone…why are you 50 miles from home?”

        • Megan
          January 4, 2016 at 7:12 pm #

          My daughter is great as long as we’re moving. A red light will bring on tears unless she’s already asleep though. But that just started recently as she’s become a toddler. Prior to that the car was a total snoozefest (for her, not me!)

          • Allie
            January 4, 2016 at 10:43 pm #

            Yeah, my problem isn’t red lights, but the odd time she does fall asleep in the car, we can’t make the transfer. She’ll usually wake up the moment we park (she knows the difference between red lights, parking lots and home, even though she appears to be asleep), or she wakes up during the attempted transfer from car to house. A few weeks ago, she fell asleep on the way to the store after I picked her up from preschool, and she seemed so out I took her home instead of shopping, but she was wide-eyed and bushy tailed the minute I parked at home : /

          • Bombshellrisa
            January 5, 2016 at 12:35 am #

            Same with my son. He is good at falling asleep during a drive but he will wake up as soon as the car turns off unless he is really tired, then he will wake up just as I pick him up out of his car seat

          • Phoenix Fourleaf
            January 5, 2016 at 1:02 pm #

            I used to hate it when my kids would ruin their naps with a 10 minute car snooze. I really wanted a car seat that would vibrate or make noise when a kid started to fall asleep.

        • The Bofa on the Sofa
          January 4, 2016 at 7:40 pm #

          Am I the only one who has had kids that no matter how cranky or hungry
          will fall asleep within 10minutes AS LONG AS YOU JUST KEEP DRIVING?

          Our kids didn’t, but our dog does. My wife (the vet) calls is “autonarcolepsy.”

          • BeatriceC
            January 4, 2016 at 7:44 pm #

            My father called it “automotive induced narcosis.”

            Dr. Kitty, I fear what might have been found out if Find My iPhone was available when my middle child was a baby. That kid was awful when it came to sleeping. There were times I’d load up the kids in the car and go on a driving adventure (that’s what I called it to keep the oldest kid interested), and would occasionally wind up 100 miles from home, deep in the Everglades (Tamiami Trail westbound was one of my favorite routes).

          • Roadstergal
            January 5, 2016 at 11:31 am #

            Our dogs used to get riled up by car rides – then we got a soft carrier/kennel, and they chill out much more in there.

        • Valerie
          January 4, 2016 at 7:50 pm #

          My nephew is the same. He cries almost every time somebody straps him into the car seat but gets over it more or less as soon as the vehicle is moving.

        • StThomas
          January 4, 2016 at 7:55 pm #

          I tried driving my eldest t the next town and back again in desperation; it quickly becames the go-to technique for grumpy crying without distress.

        • momofone
          January 4, 2016 at 8:21 pm #

          How I wished for that! I had/have the kid who NEVER sleeps in the car, no matter how long we drive or how late it is. My brother and his family do a lot of their distance traveling at night; quicker since the kids all sleep. Mine has an “on” button that is apparently pressed when he buckles his seatbelt.

        • Kelly
          January 4, 2016 at 10:34 pm #

          Two of my kids pass out, one does not all the time. It is super nice but it tends to screw up their night schedule if I take long trips.

        • Allie
          January 4, 2016 at 10:36 pm #

          You’re not the only one, but unfortunately it doesn’t happen for me. Recently, my LO stayed awake the entire 2 hour drive from Seattle to Vancouver although she was so very tired after an almost 6 hour flight from Tampa, she just couldn’t fall asleep. We were both so glad to be home and slept within minutes of crawling into bed, which is very unusual for her.

          • Bombshellrisa
            January 5, 2016 at 12:32 am #

            I can’t even do that-I prefer to be asleep by Everett and wake up just as we get to the Peace Arch crossing.

        • Amy M
          January 5, 2016 at 6:50 am #

          Mine usually slept in the car too. Every so often, they would cry, if they’d been in the carseats for hours (driving to visit grandma and grandpa) and got bored. Once they were old enough for the travel dvd player, life was good.

        • LovleAnjel
          January 15, 2016 at 12:38 pm #

          Lol, my daughter would SCREAM in the carseat – for the five minutes before she fell asleep. She hated the idea of falling asleep and the feeling of being tired. If I just drove on she’d be out like a light.

    • Amy
      January 4, 2016 at 5:30 pm #

      You’re not that far off. Granted, my younger child is almost 8, so this is a few years old, but I remember posters on MDC and other AP groups posting about how cruel it was to drive with a crying baby, how you should pull over every time the baby cries, if someone else is driving mom should attempt to nurse the baby while the car keeps going.

    • ElaineF
      January 4, 2016 at 6:39 pm #

      I always wanted to troll the MDC forums by posting something about the toxins in car seat covers, but I was worried someone would take me seriously and stop using their car seat.

      • Roadstergal
        January 4, 2016 at 6:42 pm #

        Tim Minchin – “The day they discover yoga mats cause cancer will be the happiest day of my life.”

        • Dr Kitty
          January 4, 2016 at 7:14 pm #

          White Wine In The Sun was what my husband and I kept singing to each other this Christmas. We heard him do it live the year before our daughter was born, and at the time were not impressed with the sentiments.
          Two kids later and both of us get teary by the last verse.

          • Sue
            January 5, 2016 at 12:53 am #

            Storm is a gem:

          • Who?
            January 5, 2016 at 3:46 am #

            Love the Kate Miller-Heidke version.

          • Roadstergal
            January 5, 2016 at 11:30 am #

            I’m fortunate to have seen him perform live twice in San Francisco – at the end of the first performance, he did a wonderful version of Leonard Cohen’s ‘Hallelujah,’ and afterwards made a joke about getting a room full of atheists to sing hallelujah…

    • Kelly
      January 4, 2016 at 10:43 pm #

      Please. If I had to hold a kid every time they cried, I would be holding one of my three at all times and I would be the one crying.

      • AirPlant
        January 4, 2016 at 10:47 pm #

        Hey, since when does your psychological wellbeing matter?

      • Sarah
        January 5, 2016 at 2:13 am #

        Just the one?

        • Kelly
          January 5, 2016 at 3:28 pm #

          True that. They do try to all crawl in my lap at one time.

      • BeatriceC
        January 5, 2016 at 2:37 am #

        And it doesn’t get much better even when they get bigger. I can’t count the number of times I’ve sat with or held the hands of my teenagers when they’ve been upset about something or sick. Even the nearly six foot tall 14 year old that towers over me still occasionally needs to (proverbially) crawl into mommy’s lap when life gets overwhelming.

      • guest
        January 5, 2016 at 2:51 am #

        I used to pick up my colicky baby to soothe him and he cried louder and harder.

        • Kelly
          January 5, 2016 at 3:53 pm #

          That sounds rough.

          • guest
            January 5, 2016 at 6:31 pm #

            It was for a while. Eventually we figured out a few things that worked – mostly putting him propped stomach down over a boppy.

    • critter8875
      January 5, 2016 at 10:59 am #

      I recall 30 or more years ago when states were implementing car seat laws, there were letters to the editor saying that everybody knows that the safest place for a baby is in its mother’s arms.

      • demodocus
        January 5, 2016 at 12:18 pm #

        This makes me snicker, since if we had a car, i’d be the only driver; my husband’s blind. ‘Course, 30 years ago the old folks were telling MIL to send the boy to blindy school since “he had to learn to live with other blind people” That still confuses me.

  4. Gatita
    January 4, 2016 at 3:03 pm #

    Totally OT but this headline in the NY Times Health section is killing me:
    Ask Well: Is Day-Old Kale Salad Less Nutritious Than Fresher Kale?

  5. Amy Tuteur, MD
    January 4, 2016 at 2:49 pm #

    Put another way, the NNT (number needed to treat) to prevent 1 death from out of hospital birth among low risk women is 500. The NNT to prevent 1 death of an unrestrained infant is 30,000.

    • Roadstergal
      January 4, 2016 at 6:12 pm #

      And that’s just death. I wonder what the NNT is for prevention of death and/or brain injury for the baby? The number could get awfully small, and that’s not even getting into pain relief and pelvic damage for mom.

  6. Brooke
    January 4, 2016 at 2:27 pm #

    All you have really shown here is that childbirth is drastically more dangerous than riding in a car.

    • Meredith
      January 4, 2016 at 2:30 pm #

      …Did you miss the part where giving birth in the hospital reduces the rate of neonatal death from 258/100,000 to 106/100,000?

    • Roadstergal
      January 4, 2016 at 2:34 pm #

      Sorry, let’s try this in a format you’ll recognize.

      36: “Car Rides In A Car Seat” are to “Hospital Births” as “Car Rides While Unrestrained” are to:

      A: Veganism
      B: Out-Of-Hospital Birth
      C: Rick James
      D: Dunning
      E: Kruger
      F: All Of The Above

    • yugaya
      January 4, 2016 at 2:46 pm #

      Well we knew already that your numeracy skills warrant intervention, so it comes as no surprise that your visual literacy is also close to zero.

      You’re like the best example of how an individual suffers intellectual lobotomy once indoctrinated with the NCB cult dogma.

    • EllenL
      January 4, 2016 at 2:58 pm #

      That you have used the words “childbirth” and “dangerous” in the same sentence is encouraging to see.

    • The Bofa on the Sofa
      January 4, 2016 at 3:01 pm #

      Yes, yes it is. So why would you carelessly choose a situation that increases that danger?

    • Commander30
      January 4, 2016 at 3:37 pm #

      Isn’t that the point? We put so much effort into car safety, including mandatory seat belt and child car seat laws, but with the statistically much more dangerous childbirth, people are just “hey, it’s the mother’s choice!” Dr. Tuteur is pointing out the disparity.

    • Montserrat Blanco
      January 4, 2016 at 3:58 pm #

      I know that you are not going to write anything else in this post, as you have done in like 5? 7? posts in the last few weeks.

      Even knowing that I am going to try.

      Yes, giving birth is more dangerous than riding a car. That is exactly why you should do it at a hospital, something that cuts the risk of giving birth to less than a half. Does that make some sense?

      In any case, and just when you have the time, we are waiting for:
      – your statistics analysis of the PROBIT study
      – why the right CS rate is 5%
      – your analysis of the NEJM paper published this week about the risks of homebirth

      I know, I am “completely insane”, but I have good memory.

    • Zoey
      January 4, 2016 at 4:13 pm #

      *Yawn* Boring troll is boring.

    • sdsures
      January 4, 2016 at 6:45 pm #

      And driving in a car is more dangerous than flying in an airplane. What’s your point?

    • mythsayer
      January 4, 2016 at 7:05 pm #

      Your posts are getting more and more illogical. Let’s review: Dr. Amy has shown that childbirth is drastically more dangerous than riding in a car (for a baby). So…WHY BRING ON MORE RISK THAN NECESSARY? If childbirth is dangerous even for low risk women in the hospital, why in god’s name would you take on MORE risk???

      If you wouldn’t drive without a car seat, why would you risk your baby in another way? Go on. Explain. We are waiting.

    • Sue
      January 5, 2016 at 12:56 am #

      Well done, “Brooke”. And what else have you learned?

      Read a bit further, and you’ll discover that having professionally trained providers in a hospital setting mitigates the risk, but non-professional providers and non-equipped settings don’t. Good girl.

    • The Computer Ate My Nym
      January 5, 2016 at 9:12 am #

      I agree, more or less. Childbirth is quite dangerous. Therefore, shouldn’t we treat the risk of childbirth with the respect it deserves instead of downplaying it and pretending it’s “as safe as life gets”? Perhaps we should make sure that women in childbirth are carefully monitored so that we know if things are starting to go wrong before any permanent damage is done and have experts available to intervene on a moment’s notice if something does start to go wrong? You know, conditions like in a hospital?

    • MaineJen
      January 6, 2016 at 4:51 pm #

      Yes, congratulations. That is the point. If you think about it a bit more deeply (just humor me…), you will realize the sad irony of being strictly militant about car seat safety, but then turning around and defending home birth.

  7. EllenL
    January 4, 2016 at 2:22 pm #

    For a long time, home birthers have gotten away with claiming
    that home birth is no riskier than hospital birth. That’s not going to fly
    anymore. And that is a very good thing.

    Now they will say “the absolute risk of death is small.” It’s not really, but that will be their claim.

    The problem with that line of reasoning is the incredible importance of what is at stake – your child’s life. Everything else pales in comparison. If parents truly understand that a child’s life is in the balance, most won’t want to take risks they don’t have to take. Equally important is the irrevocable nature of the decision. What happens at home birth can’t be undone. Death is final, disability is for life. You can’t ask for a replay.

    Home birthers have taken a life-or-death issue and reframed
    it as a quality-of-experience issue. I think we need to turn this around and
    ask the question, “Is the baby you’re carrying replaceable?”

    • Roadstergal
      January 4, 2016 at 2:31 pm #

      “Is the baby you’re carrying replaceable?”

      More specifically – Is the baby you’re carrying a disposable prop in your narrative of mom-hood?

      • EllenL
        January 4, 2016 at 3:01 pm #

        Sadly, it’s come to that. Home birthers (and natural childbirth advocates in general) are expert at elevating the trivial and downplaying what’s crucially important.

  8. Zoey
    January 4, 2016 at 2:12 pm #

    These statistics put a whole new perspective on the woman I know that spent hundreds of dollars importing a not-strictly-legal higher weight limit rear-facing car seat from Sweden for her toddler, after choosing to have her second baby unassisted, completely by herself in her garage (I wish I was joking).

    • guest
      January 5, 2016 at 2:59 am #

      Oh my god. Are we supposed to be important Swedish car seats now as well as following an all-kale diet and breastfeeding to age 12? I am once again dismayed to find I am doing it all wrong because I did not know better.

  9. Amy Tuteur, MD
    January 4, 2016 at 2:04 pm #

    Thanks! Fixed it.

    • The Bofa on the Sofa
      January 4, 2016 at 3:03 pm #

      Personally, I like the concept of Chile Birth

      Although Chili Birth would be even better

      • Gatita
        January 4, 2016 at 3:03 pm #

        As long as you get fries with that.

        • The Bofa on the Sofa
          January 4, 2016 at 3:04 pm #

          When my wife and I open our restaurant, one thing on the menu will be chili-(mac-n-)cheese nachos.

          • BeatriceC
            January 4, 2016 at 3:09 pm #

            Can you come up with a tomato free recipe for that chili? I like breathing, so tomatoes are off the menu for me.

          • Amy M
            January 5, 2016 at 7:45 am #

            White chili? Turkey chili? I haven’t made either, but I’m pretty sure there are no tomatoes in at least one of those.

  10. Angharad
    January 4, 2016 at 12:20 pm #

    I love this because so often homebirth advocates say it’s more risky to drive to the hospital to give birth or drive home than to give birth at home. They’ll say getting out of bed in the morning has risks. This clearly shows that we take pains to reduce risks when driving or getting out of bed and that we’d never accept the level of risk inherent in a homebirth in any other area of our life.

    • demodocus
      January 4, 2016 at 12:24 pm #

      *snort* Maybe if the woman in labor is the one driving, during a blizzard…

      • LaMont
        January 4, 2016 at 12:26 pm #

        Pretty sure I saw that episode of “I Didn’t Know I Was Pregnant”, actually!

        • demodocus
          January 4, 2016 at 12:33 pm #

          I think I saw that one.

        • demodocus
          January 4, 2016 at 12:35 pm #

          i think i saw that one, too

      • An Actual Attorney
        January 4, 2016 at 1:19 pm #

        I just watched season one of Sense8…

    • The Bofa on the Sofa
      January 4, 2016 at 12:51 pm #

      Recall Pablo’s Scenario:
      Term pregnant woman and her husband go to a party. He drinks enough to be legally drunk. She goes in labor and they have to drive 8 miles to the hospital. She can’t drive, so he has to.

      She is 50 times more likely to die in childbirth than she or her husband is to die in a car wreck.

      If she is a low-risk pregnancy, the chance of her baby dying is about the same as the chance that they either get into an accident or get a DUI (assuming the cop gives them a DUI). Assuming the cop is nice, that means that the chance her baby will die is three times has high as the chance that they even get in an accident on the way to the hospital.

      The risk of driving is not in the absolute risk, it is in the prevalence. How many miles do you need to drive to get a child-death risk of 1/100K?

      As far as single events go, childbirth is easily one of the riskiest things we ever do routinely. It’s not as dangerous as climbing Mount Everest (about 1/75 die), but then again, we don’t do that routinely.

      • Roadstergal
        January 4, 2016 at 1:14 pm #

        And those who do don’t get Certified Professional Sherpas and eschew interventions such as climate-appropriate clothing and tents, cramp-ons, etc.

      • yugaya
        January 4, 2016 at 1:35 pm #

        Natural maternal mortality is 1 in 100, but thankfully most who attempt to forego all obstetrical interventions and play against those odds still make it in time to hospital.

        • The Bofa on the Sofa
          January 4, 2016 at 1:39 pm #

          Note that in Pablo’s Scenario, we are talking about the risks of childbirth in a hospital, with all modern interventions. Out-of-hospital approaches just make it even worse.

        • araikwao
          January 4, 2016 at 3:13 pm #

          And that’s for each pregnancy, so multiple pregnancies and no interventions means awful stats like 1 in 16 maternal mortality in South Sudan (I think my stats are right, but that lecture was 2 yrs ago..)

          • The Bofa on the Sofa
            January 4, 2016 at 3:22 pm #

            A net 1/16 mortality for multiple pregnancies would be about 1/100 per pregnancy over 6 – 7 pregnancies. So if they average 6 – 7 pregnancies, each with a 1/100 chance of dying, it would be 1/16 for a lifetime.

          • araikwao
            January 5, 2016 at 12:59 am #


      • mythsayer
        January 4, 2016 at 7:09 pm #

        Half the people who attempt Annapurna die. Something like 70% plus of those who attempt nanga parbat die. But as you said, most people aren’t doing those types of things. I’d be really worried if every started doing an activity with a 70% death rate.

        • The Bofa on the Sofa
          January 4, 2016 at 7:36 pm #

          And that 70% death rate is among experienced, fit climbers.

          Then again, you have to be that experienced and fit to even attempt such a thing. Normal people like me would never die in those situations, because we wouldn’t even try it in the first place.

      • Who?
        January 5, 2016 at 3:53 am #

        Isn’t the day of birth the riskiest day (in terms of risk of death) until well into old age?

  11. mostlyclueless
    January 4, 2016 at 12:19 pm #

    The graph is an excellent visual. Thanks for this Dr. A.

  12. demodocus
    January 4, 2016 at 12:17 pm #

    Some hospitals insist on having someone come check your carseat before you leave. Even though you don’t have a car. The hospital we were originally supposed to deliver at was like that. We ended up at a hospital on the other, poorer, side of town, where they don’t assume you have access to a car or money for a taxi. Buses have no latches for car seats.
    (Fortunately, my sister was visiting, so we did get a ride home. My aunt got us the car seat for the occasions we get rides).

    • Amy M
      January 4, 2016 at 12:50 pm #

      Ours did that—we couldn’t leave the hospital until the babies had a car seat test.

      • Dinolindor
        January 4, 2016 at 12:54 pm #

        My hospital had the same thing, but to clarify this wasn’t a car seat test for the babies. This test is for the parents. The nurses had to check to make sure we knew how to properly buckle in the baby before we were discharged.

        • Amy M
          January 4, 2016 at 1:08 pm #

          Oh..we had both, I think. I think the baby test was because my boys were pre term, and they wanted to make sure the boys could be in the seats without their heads lolling to the point of cutting off their air supply. Unless that’s a test for all newborns?

          • Dinolindor
            January 4, 2016 at 1:20 pm #

            Nope, not done for all newborns, at least at the hospital where I delivered.

          • Sony2382
            January 4, 2016 at 7:37 pm #

            Just done for babies born before 37 weeks or under 5 pounds or discharged from the NICU where I work

    • Zornorph
      January 4, 2016 at 1:22 pm #

      At my hospital, they are used to having to wheel the mum out in a wheelchair. They didn’t know what to do with me – obviously there was no need to put me in a wheelchair, but strictly speaking, my baby had been a patient so he did need to go in one. Rather than make the poor nurse’s head spin (they’d been very nice to me), I was a good sport and just said I’d ride in the wheelchair down. They were so happy, they forgot to check my car seat, which they were supposed to have done.

      • Angharad
        January 4, 2016 at 4:26 pm #

        I didn’t want to go in a wheelchair, but the nurse told me it was part of their security protocol- nobody could leave the hospital with a newborn unless they were in a wheelchair being pushed by a nurse, so anyone trying to kidnap a baby would be easily identified.

        • Megan
          January 4, 2016 at 6:05 pm #

          Our hospital too. Baby had to be strapped into the car seat on my lap in the wheelchair. Not sure how they handle it if you have a convertible carseat rather than an infant seat.

        • Dr Kitty
          January 4, 2016 at 7:26 pm #

          UK hospitals you just put the baby in a car seat, sling or buggy and walk out- they assume you will arrange some sort of transportation.

          Our friends have a picture of dad doing the “jumping in the air heel click” holding the baby in the car seat in the hospital corridor on the way out!

        • guest
          January 5, 2016 at 3:08 am #

          What a strange protocol. My hospital had no such rule just to bring babies home. I believe they did make me ride in the wheelchair when I was released after surgery, but the babies came home over a week later, and I just carried them in their car seat and no one accompanied me. I distinctly remember setting my son down on the elevator floor in his car seat and being bemused over how absurdly small he was.

    • BeatriceC
      January 4, 2016 at 3:04 pm #

      The car seat test was a requirement to graduate from the NICU where two of my kids stayed (the oldest was in a different NICU in a different state). Since it was a large, urban teaching hospital with a huge number of patients in poverty, I asked what would happen if a baby’s parents didn’t have a car seat because they chose not to buy one because they took the bus everywhere. The staff said they had a car seat program to give carseats to Medicaid eligible families. They weren’t the fanciest seats but they met all the safety requirements. I thought that was kind of neat.

      • demodocus
        January 4, 2016 at 3:34 pm #

        That’s rather awesome of them.

    • guest
      January 5, 2016 at 3:05 am #

      Yeah, my hospital insisted that as a single woman with a twin pregnancy and no car, when I went into labor I was to bring not only my go-bag, but the two car seats they required me to have so they could test them before releasing us from the hospital since I wouldn’t have someone to bring them later. As it happened, I had an unplanned induced birth so those car seats did not make it in that day, but can you imagine me trying to carry all that WHILE IN LABOR? But the L&D tour nurse was adamant that that was the only acceptable thing in my situation. I was apparently not allowed to take them home on the subway? I mean, it wouldn’t be my first choice, but when you have no money it’s the sensible choice.

      • BeatriceC
        January 5, 2016 at 3:25 am #

        I recall hearing snippets of conversations when my boys were in NICU where nurses and social workers were helping car-less parents arrange appropriate rides home. In more recent experience, the hospital my two boys with the bone disease are treated at has arranged for a shuttle for me when I’ve been temporarily without transportation. Different hospitals do different things, but it’s not out of the question that the hospital would have helped you get home safely if you didn’t have a suitable option on your own.

        The whole thing about the L&D tour is ridiculous though. Somebody wasn’t thinking things through.

        • guest
          January 8, 2016 at 1:32 am #

          I suspect they would have helped if things had been different. Actually, the NICU even offered me the choice of bringing both babies home at once, or staggering their release dates. One twin was borderline, I’m sure they wouldn’t have done the same in all cases, but it was a great boon to me to only deal with taking a taxi with a fairly fresh surgery scar to and from the hospital and installing the car seat, etc., etc. I also felt more confident doing the first overnight with one baby. They worked with me where they could. But I was really stressed after the l&d tour.

          • guest
            January 8, 2016 at 1:33 am #

            That should say, ‘only installing the ONE car seat” – I did it twice, but on two different days. For me, that was easier.

    • Liz Leyden
      January 6, 2016 at 2:20 am #

      We had to leave the hospital without my son because we didn’t have a car seat for him. It was at home, 250 miles away. We didn’t have much money, it was right after the big 2014 Graco car seat recall, and he weighed less than 5 lbs, which further limited our choices. Hubby and I embarked on the Target Run from Hell, and managed to find the last suitable car seat in the greater Boston area.

  13. SporkParade
    January 4, 2016 at 12:06 pm #

    I’m really enjoying these comparison graphs.

  14. Zornorph
    January 4, 2016 at 12:05 pm #

    And those homebirth mamas would be the first ones to judge you if you rode around with your baby not in a car seat.

    • Amy M
      January 4, 2016 at 12:07 pm #

      Rear facing for life.

      • demodocus
        January 4, 2016 at 1:47 pm #

        A college roommate was 4’11” and 84 pounds in college. What kind of car seat would they recommend for her to continue driving the Bug? /sarcasm

        • Medwife
          January 4, 2016 at 4:51 pm #

          I know you jest, but if I were her, I’d turn off the airbag!

          • Roadstergal
            January 4, 2016 at 5:04 pm #

            5’1″, and the one time I had an airbag experience, it left me with burns over most of my face, two black eyes, and a concussion.

            Of course, this was an older generation of airbag, but still, they’re not fluffy pillows.

          • Gatita
            January 4, 2016 at 5:11 pm #

            Yeouch!! Not fun.

          • Who?
            January 5, 2016 at 3:56 am #

            I’m scared of the airbag. Despite having the shortest limbs in the land I drive sitting-and leaning-way back.

          • Medwife
            January 5, 2016 at 1:29 pm #

            My husband had an accident that triggered the airbag and permanently lost some vision in one eye. And he’s an average sized American guy. But like you, this was quite a few years ago; hopefully they’ve worked out some bugs.

          • demodocus
            January 4, 2016 at 5:46 pm #

            She did.

        • Amy
          January 4, 2016 at 5:37 pm #

          I weigh a bit more than 84 pounds, but yeah, as a fully grown adult with two kids I still meet the height and weight limits for my kids’ carseats.

      • Megan
        January 4, 2016 at 8:20 pm #

        I still rear face. Makes it difficult to drive at times…

    • crazy grad mama
      January 4, 2016 at 1:49 pm #

      They’d be the first to judge you for having even one strap fractionally out of place on your fully-car-seated baby!

    • Roadstergal
      January 4, 2016 at 1:51 pm #

      It’s like the anti-vaxxers who will not tolerate any food for their snowflakes other than ‘organic’ and ‘non-GMO.’

    • Megan
      January 4, 2016 at 6:07 pm #

      Let’s face it, they’d be the first to judge you for a lot of things.

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