“Are home births safe?” This is the headline to the article in the August 26 issue of Maclean's magazine reviewing the debate over home birth versus hospital. This is a highly contentious issue as evidenced by the number of comments the Maclean's website has attracted since publication. The article itself is a well-balanced view of this issue that all women who are considering a home birth versus a hospital birth should read.

The article cites a number of studies and quotes various experts in the field regarding the relative safety of each site. However, as noted in the article, there has been no perfect scientific study yet published which answers the question: which is safest? The studies that have been published – some supporting home birth, some supporting hospital birth - all have flaws, making it hard to know which findings are correct. It must be acknowledged that there will likely never be a definitive study. To do such a study, we would have to randomly assign thousands of low risk women to deliver at home or in hospital and then look at all the outcomes.

There certainly are downsides to hospital births. Even obstetricians feel that there are probably too many interventions – forceps, cesareans sections, etc. But it is precisely the immediate availability of these interventions that has led to the current safety of modern birth. For centuries women feared for their own safety and that of their babies. Women now face birth with much less fear. The situation is similar to the vaccine debate – people no longer fear the childhood infections that were responsible for so much death because they have been eliminated by vaccines. As a result, some people have focused their attention on the potential complications of the vaccines, no longer mindful of their benefits.

It comes down in part to what we value about birth. In general, as obstetricians we value safety above all. We have participated in so many births during our training and careers that we have seen that ‘one in a thousand’ complication. Our goal is to prevent it or treat it quickly when it occurs and we don’t believe that this is always possible at home. Supporters of home birth value other aspects of the birth experience that are not currently provided in the hospital setting.

Whether the article has you convinced home birth is for you or has you heading to the hospital, you should discuss any questions you have about this with your care provider. He or she can help you to decide which aspects of birth you care most about and how your chosen site of birth will line up with these priorities.