It was a tough decision for me but in the end a no brainer. Experience had taught me what hospitals could do. my choices inclided risking unknown careprovider with unknown beliefs in a system where they routinely practice care that is not only not evidenced based but contrary to the evidence or, birth in my home trusting that my body was designed to birth my baby and that I was under the care of a much higher power. My Unassisted birth was my most beautiful and my safest. I am not suggesting that it is optimal, when given the choice between another unassisted and birthing with an IM for my 4th child I choose the IM for Gold standard care. But When #3 was born I made the best decision I could with what was available to me.

Great article on the perceptions of risks - I agree with the author.
My own experience of a hospital birth for my first child (I was never in the high risk category, although there were attempts to fabricate a 'risk') was complicated and prolonged by several issues particular to the hospital system (a shift change midway through which disrupted labour, not being allowed to use the warm bath during labour - although provided to begin with - and after the disrupted labour, pressure to intervene (speed things up), a strange obstetrician and not being able to voice my own preferences, a nasty post AB resistant infection).
All of these led me to carefully plan a midwife assisted homebirth for my second child which led to a wonderful, relatively painless (no drugs) and smooth birth which saw me recover very quickly without any of the issues experienced in the hospital birth. I would do the same again if no risks of complications were present. It was a good decision and my only regret is that I didn't have the fortitude to withstand outside/professional pressure and do the same for my first birth.

A combination of errors and omissions in this study makes the conclusions questionable. Firstly, it is not true to say that home birth with midwife is as safe as hospital birth. The recent large "Birthplace Study" from teh UK showed that, even with a very high transfer rate, outcomes were still poorer for first-time mothers. As midwives,t eh authors should be aware of this data.

Secondly, the authors have not mentioned the unpredictable and catastrophic complications that can occur during labour and delivery, despite a perfectly healthy and uncomplicated pregnancy, and no identifiable risk factors. These problems are largely mechanical - consisting of the baby getting "stuck" (footling breech, shoulder dystocia) and various cord accidents (cord getting compressed or stretched by part of the baby. Then there is the issue of uncontrollable bleeding in the mother. There is no mechanism to "risk out" for these complications - and they can be rapidly fatal for both mother and baby. IN hospital, however, these lives can be saved.

Dahlen and Jackson appear to be concluding that mothers are taking these sorts of risks while fully informed. On the contrary - it appears that the misudnerstand risk because they are not fully informed.

And lastly, with only 3 per thousand Australian women choosing home birth, it appears that women ARE voting with their feet. The vast majority of women prioritise safety over the birth experience.

30 years ago I went along with the home birth because I had blind faith in the mid-wives.
After 20 hours of labor we finally drove 20 kilometers toward the nearest hospital but stopped off at another midwifes house instead. 3 hours later I finally took responsibilty by insisting we get my wife to the hospital.
There the doctors did a great job of completing the delivery of a healthy daughter. Only later did I realise that my wife and daughter were put in mortal danger because of a power struggle between midwives and doctors. It doesn't seem that much has changed since then.

I have had 2 hospital births and one unassisted VBAC at home. My HBAC was my least traumatic and I dare say safest birth. With my first, I was induced at 37.5 weeks for suspected PUPPS rash... which doesn't warrant an induction that early. Had I been given adequate information on the risks of induction, especially at 37.5 weeks gestation verses PUPPS and my discomfort at the time, I would have made an informed decision and said no, we'll wait. It turned out to be a food allergy. Thankfully my baby was born without complications but I suffered. Lets ignore the unnatural pain of Pitocin induced contractions and focus on the things I didn't agree to like that I was manually stretched without consent or even warning, my water broken and internal monitors put in without consent and then given Demerol even after I said no (not that I was asked). I ended up with a mild hemorrhage, either from Pitocin (which is a side effect listed on the label) or traction on the cord within 3 minutes of birth. My second birth was an unnecessary c-section 39.2 weeks for FTP at 3 cm. I wasn't even in labor. The only reason I was kept was because I was GBS+ and I "had" to have antibiotics. Pitocin was ordered later in the day and even though I had progressed some, it was 8pm and my OB wanted to be home. My water wasn't broke, there was no distress, there was no medical reason. Thanks to a blanket consent form when I checked in, I was not given a choice. I have even had another OB say that from my medical records, he would have never performed a c-section at that time. It was a traumatic experience for a multitude of reasons which makes me want to cry just thinking about it. I suffered physically and still do today from an unnecessary surgery and spinal. I suffered from depression and PTSD for over 3 years after that because I was violated by a system that does not have mothers and babies as their priority. It is a business and first and foremost, providers cover their own ass. It is a system that does not practice evidence based care. It is a system that does not allow for anything that is outside of the cookie cutter model of care. We are individuals with individual needs and body chemistry. That is simply not respected or recognized.
You can not tell me that 1 in 3 babies has to be born via c-section or that over 80% of hospital births has to be augmented in some way for babies to be born. History does not support our current statistics. We would not have the population we have today if this were true.
With my third, I tried to find supportive providers to assist me so I could have a successful and safe VBAC. It didn't happen and because my state has very few licensed midwives who can support a home birth, I trusted my body to have a baby the way it's suppose to. It was uncomplicated and beautiful but had I been in the hospital I have no doubts it would have been very different; another nightmare.
To reiterate the fact that evidence based medicine is not in practice today, I had one OB tell me that he would rather induce me, a VBAC, rather than allow me to go into labor on my own just so he could watch me the whole time in case of uterine rupture. Pitocin has been proven to increase the risk of uterine rupture. It is things like this that tell me hospital birth is not as safe as many would like to believe. That an OB would still use Cytotec after the many deaths that have occurred because of its off label use. All the "life saving" technology might be wonderful when it is not abused the way it is today. I believe a natural birth is best until it's not but you can't get that in the hospital the vast majority of the time. You are at the mercy of assembly line care.
In regards to doing your homework for things like shoulder dystocia... there is a highly effective way to deal with it and it requires no tools at all. You simply squat and open up your pelvis by as much as 30% and move to help the baby move. It's called the Gaskin maneuver. And if we apply some common sense to that, wouldn't squatting to give birth possibly prevent a shoulder dystocia to begin with. Again, something that is not typical in hospitals. There are a number of herbs to help with hemorrhage along with uterine massage. Knowing when you need to go to the hospital is also part of that homework. No one is saying home birth is risk free, birth itself is not risk free. But many women, like myself, who have been abused by the system feel safer out of the hospital. And it's not just about the experience although I feel many people ignore what kind of long term effect the experience has. It is about what we feel is best and we feel a natural birth without common place, overused intervention is best. It's best for mom and baby. And there is research to back that up. The question, which the author brought light to, is how can providers support their clients in making informed,safe choices and respect them when they choose to see it differently. Women need this. And if the medical system would work together respectfully and work with their clients instead of getting in pissing contests over whos' territory we're on then maybe maternity care would not be in the shambles it's in (and there are statistics supporting that as well).