CB: Heidi, you were saying that prospective parents should think in terms of having two birth attendants.

HB: Yes. There'll be more than two at the hospital, and I personally don't consider home birth safe unless there are at least two knowledgeable birth attendants there. It may be a nurse-midwife and a lay-midwife, it might be a midwife and a doctor. If all goes well, there'll be one person to organize things and make phone calls, while the other stays by the bedside. If there are complications, it's vital. After all, there can be two patients—the mother and the baby. The two health workers should not only be competent, they should work well together.

CB: What are the risks of home birth?

HB: Except for the mother who lives miles and miles from the hospital, I think they're about the same as for being at the hospital. The important thing is who's attending your birth. Are they monitoring the fetal heart tones? Do they have emergency equipment with them? If you have the right people, they can do nearly anything that could be done at the hospital—and in a less intrusive way. Competent attendants at home, with a good attitude, are much safer than less competent attendants in the hospital who are working at cross purposes. Technology is only a tool. It's the people and the attitudes behind the tools that are even more important.

MW: I think that many obstetricians still believe that home births are less safe than hospital births. That may have been true at some time in the past, but with birth attendants who are well equipped and well trained, that's simply not true any more.

CB: When people talk about the complications at home births, the most scary one is excessive bleeding. Can that be handled just as well at home as it can in a hospital ?

HB: Yes, it can. We have intravenous fluids and plasma expanders and oxygen and all the medications right there with us. We use the same technologies and techniques they would use at the hospital. The only woman I ever heard of who bled to death at childbirth did so in a hospital.

MW: The problem is more legal than technical, really. If a mother bled to death at home, the attendants might be charged with manslaughter.

HB: Yes. People assume that if a woman bleeds to death in the hospital, it's justified because the assumption is that everything that could have been done was done. There's a real double standard operating here. If a doctor delivered a woman in the hospital and she died, there would very likely be no recriminations. If a midwife delivered the same woman at home, provided exactly the same care, and the woman died, the midwife would undoubtedly be charged with murder.

CB: How about the risk of infection at home births?

MW: Well, generally speaking the baby comes out sterile and is immediately exposed to bacteria and viruses in the environment—he has to get used to them in order for his immunological system to develop. Babies born at home are exposed to the flora on the parents' skin—and they have antibodies to these germs already. On the other hand, the germs in hospital nurseries are more likely to be the disease-causing kind, and therefore much more dangerous.

HB: In the hospital you're at added risk of surgical intervention—episiotomies, invasive techniques— which increase the risk of infection. Hospital birth attendants are more likely to get tired of waiting and give a drug to induce labor. It may well be safer to wait—as we do when we deliver at home.