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