As a midwife of nearly 30 years and doing homebirths for nearly 4 years I will put in my perspective.
Safety is a balance between riskmanagement and faith in the ability of the woman's body to birth her baby. I would not attend a woman at home if she has not self educated herself on birth, including things that can go wrong. Also she (and her support people) need to believe she can do it and that with the right precautions, it is safe.
I would need to know any risk factors in her health and past obstetric and gyanecologic history.
So, I go the birth expecting things to go right but watching for problems and carrying equipment to deal with it. I also have the skills to do emergency care while help comes to transport to hospital if things go wrong.
My main job is in a rural hospital in Australia, in a low risk birthing unit. We are an hour's drive from the tertiary hospital and don't have obstetricians in town. The outcomes for the unit are really good because of the risk management strategies.
Two of the biggest influences are the low risk women only that we book, and the fact that we don't do any high risk causing proceedures such as induction, epidural, membrane rupture or continuous fetal monitoring. All of these things cause problems, don't do them, minimise problems. Works for us. We also look ahead all of the time and if things seem to be going pear shaped we transfer early rather than late. We might transfer and she has a normal birth at the referral hospital but better that than something go wrong in a low risk unit. You will probably find homebirth midwives do the same.
One needs to be careful going too high tech with the training first, one might lose faith in a woman's inherant ability to birth. It then takes a lot of retraining to get it back. Without the faith, one looks for machines that go ping! to try to make things safe.
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