The very contentious and hotly debated topic of home birth is back in the news today, after the South Australian coroner found that three newborns died as a direct result of being born at home rather than in a hospital.
It’s very interesting that this topic keeps coming up across all forms of media, since very few women in Australia currently have their baby at home. Less than 1%.
I am a supporter of home birth. I am a supporter of a woman’s right to make an informed choice regarding where she feels safest having a baby. In my opinion you can’t support women’s rights on contraception and abortion and then say we shouldn’t have this right too. However, to be clear, I support home birth for low risk women, with a highly qualified HOME BIRTH midwife, and close proximity to the nearest hospital. While I love birth to be all music, candles, and no intervention, I am also very aware that some of the time this is just not possible. And while the current western hospital/maternity system has a lot to answer for, there is also no doubt that it’s the best, indeed the only place to be when things go awry.
The problems arise when women are choosing home birth out of a fear of the hospital system. They may have had a bad experience having a baby before, they may feel like they are just a number and are not heard or understood, or they may just feel that hospitals are for sick people and not really necessary for a healthy mother and baby. But what we need to remember is that with so few Australian babies being born at home the natural result of this is that not a lot of midwives have experience of it. You simply CAN NOT take a midwife trained and experienced in a hospital and put her in a home setting. It’s a ridiculous notion. Home birth is very different to hospital birth and a midwife would have to be trained in the home birth environment with its unique challenges, one being a very hands-off philosophy.
Lots of people like to use the Dutch home birth system as an example of how safe it is. The Netherlands has a home birth rate of about 30%. In a midwife-run system pregnant women have the choice of where to give birth, they only see a doctor if they are high risk, are only given an epidural if they have a caesarean, and the recommended carer is subsidised by the government. In other words, very different from Australia with it’s private/public decision, more specialist carers than midwives, and epidurals on tap (up to 75% of women in some labour wards). The Dutch midwives are trained in the hands-off, stand back, watch, and be alert style. Dutch women are given the message that birth is a family affair, something straight-forward and safe. They know that they will only see a doctor if there is a need to see one, if there is a clear complication. They know labour is manageable without numbing drugs. Again, very different from the messages we get in Australia. So in short, while the Dutch model of birth is brilliant, it can’t be applied in most other western countries unless long-term changes are implemented from the ground up.
The core of the debate and all the news stories is, and should always be, healthy babies and healthy mothers. Women and babies die in hospital births yet there is never public condemnation that they shouldn’t have been in a hospital. Death as a result of home birth is a different matter though. The news story I mentioned involved a registered midwife responsible for the deaths of three babies. (She is no longer registered). As a home birth midwife is it wrong to deny a woman a home birth due to her being classified high risk? Let’s remember that high risk can include everything from a suspected large baby to gestational diabetes, breech, twins, pre-eclampsia, and previous c-section. This has been a hard question for me to answer in my own heart because I am totally on the midwife-led side of the debate that birth is normal, natural, and safe. I have read countless stories of successful home births, some with risk factors. Some were close calls, and not all had a happy outcome. But after weighing it up I really believe that home is not the place for risk factors. Home is not the place for emergencies. A hospital is unquestionably going to have the means to save a life better than any home. What I would love would be if more low risk women were encouraged to think about home birth with qualified midwives, and the obstetricians were there to deal with complications.
What concerns me is that a few people making irresponsible and dangerous decisions taints the whole notion of home birth, which is not fair. In almost every instance home birth is sacred, empowering, and safe. Families who have experienced home birth speak of it in ecstatic terms. But the public voices of journalists and obstetricians are far louder. And unfortunately one midwife being responsible for three newborn deaths is impossible to ignore. But we still deserve the right to choose, and parents who safely go ahead with a home birth should not be condemned.
What we do need to remember is that a healthy outcome for everyone is the real prize. Let’s not forget that women and babies do still die in childbirth. Not as many as a hundred years ago, but it still happens. Let’s not ridicule women for wanting to make their own decisions, whether it’s her choice of carer, hospital or home.
Maybe it was all simpler a hundred or so years ago. There were no drugs to choose from, and no doctors to decide on. You had your baby at home with the local midwife, you knew it would hurt but you would be okay, and were grateful just to have a healthy baby and not feel too shabby yourself.
Hmm, food for thought.