[public_defender]

I think the first part is correct. There is probably an optimal rate of c-section which is materially higher than "strictly necessary" and optimizes for mom+baby health. What I am concerned about is the scheduled c-sections. For most births, there is not really a medically credible way to determine in advance that vaginal birth will be dangerous (as a relevant corrolary, consider that there is no way to meaningfully determine the weight of a baby prior to birth).

C-sections are scheduled in advance (sometimes over a month in advance) because the American medical system has optimized for cost reduction (which includes extreme risk aversion) rather than patient outcomes.

[doctor_eval]

It's many years since I had children but we were curious about home birth, and what I understood from looking into it was that there is, apparently, no significant difference in overall safety between home births and hospital births.

However, there was a significant difference in the reasons things went wrong. Because in a hospital you're more likely to receive unnecessary treatment due to the "cascade of intervention"; and interventions such as C-sections have inherent risk. While at home, you're more likely to have an actual emergency.

[MandieD]

How well do they control for planned home births having lower risk profiles at the outset? For example, even had I been determined to try labor, I would have done so in a hospital, because I was 40 and have a hiatal hernia that will always be at risk of tearing further. I’d be an idiot to have tried at home.

[public_defender]

Unfortunately there are still very limited services for birth outside of hospitals in the US. Providers have a hard time getting regulatory approval and insurance, so they are selective in who they will take as homebirth or out-of-hospital birthing center clients. Basically, only people with very low risk profiles can make it through all the qualifiers for an attended out-of-hospital birth.

I am speaking from personal experience with births in one of the biggest US cities in the last five years. Anecdotally, I think that some less-dense areas have better CNMW practices and more access to midwives due to traditionally less access to hospitals, but it seems very variable.

[doctor_eval]

I don’t recall. It’s a long time ago. I do remember that there were some other factors like proximity of home to hospital.

Mostly the advice we got was, if you have a medical condition that increases risk, then go to a hospital or a birthing centre. But if not, and you live reasonably close to a hospital, home birth is quite safe.

[russdill]

A c-section performed after several hours of active labor leads to a much higher chance of hemorrhage and danger to the baby than a scheduled c-section.

Additionally, there are many factors that can be used to determine the risk of natural birth.