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Homebirth hits the mainstream, but misses the mark

by lizzi (follow)
Helping plant the seeds of positive birth. www.sproutbirthing.com.au
Homebirth (6)     
I just watched a clip of Hannah Dahlen and a beautiful homebirth mumma on the today show. They were talking about the new evidence out of the UK that homebirth for low risk, second time mums is safer than hospital birth. While it is FANTASTIC to see positive homebirth hitting the mainstream media I found myself quite disappointed with several aspects of the interview and downright angry at a couple of RANZCOG quotes.

Here’s what I loved about the segment:

Acknowledgement of a lack of choice. Accessing homebirth in Australia can be HARD. Many women end up birthing in hospital when they would much prefer to be birthing at home due to a serious lack of availability of homebirth midwives and financial constraints. If ALL women had equal access to homebirth as they do to hospital birth I wonder what the stats would be?

The mum talked about doing her own research. Score for informed decision making as opposed to just doing what you’re told! Also loving that she brought instinct into the mix as I feel that this is an exceptionally important factor when deciding where, how and with whom to birth your baby – where do you FEEL is the safer option for you.



Here’s what I hated about the segment:

Fear mongering! Yes birth can change from safe to unsafe in an instant – however this is exceptionally rare. An experienced midwife will generally be able to understand when birth is going off track and will recommend a transfer to hospital. Also many complications can pop up before labour has even begun – regardless of where you choose to birth your baby. For example: cord prolapse, placental abruption and unexplained still birth can all occur prior to labour even beginning no matter who your care provider is or where you plan to birth, they cannot be predicted or prevented.

Birth centres DO NOT replicate a home environment! You still have to leave your house and travel, in labour, to a new birthing location. You are still at the mercy of hospital policies. This is also rather insulting as it implies that women are choosing homebirth because they want to be able to birth in a “homey” environment rather than looking at the superior care being received from a known midwife and the benefits of not having to travel to a new location in labour. And in many birth centres it would take just as long to transfer across to the hospital in cases of emergency as it would to get from home to the hospital.



Caesarean
Midwives provide superior one to one care to women at home. Image courtesy of Wikimedia Commons


Quote number one from RANZCOG: WOW! Aside from the fact that that was refuted by Ms Dahlen as being from a study that has been seriously criticised I’m wondering where they are going to look at the three fold increase in maternal mortality from caesareans over vaginal birth? If a thee fold increase in death of babies is a good reason to avoid homebirth why isn’t the three fold increase in maternal mortality from caesareans a good reason to avoid hospital? Oh that’s right – all that matters is a healthy baby…we don’t care if that baby has a healthy mum to go home and raise it.



Caesarean
Homebirth is a great way to minimise the risks of ending up birthing in an operating room. Image courtesy of Wikimedia Commons


Quote number 2 from RAZCOG: Again WOW! RANZCOG believe that women are opting for homebirth over the safety of their baby? I am disgusted that RANZCOG can get away with making such a horrid comment! How dare they imply that women who birth at home don't care about safety. Many women choose homebirth for the purpose of avoiding iatrogenic complications - so they are thinking very much about the safety of their baby! And then the presenter goes on to talk about: "Isn’t even the smallest risk too great?” If that were the case then Obs wouldn’t be performing interventions that are not medically necessary, would they. Don’t think they do that? Ask around and see how many women were induced without a medical indication and without even being post dates (past 42 weeks) – induction increases risk of caesarean, risk of foetal distress, risk of infection, risk of cord prolapse; or how many women were told they should just opt for an elective caesarean instead of a vbac – increasing the risk of maternal death, hysterectomy and life threatening complications with any future pregnancies; or how many women were given syntocinon to speed up a normal labour with a healthy baby – increasing the risk of foetal distress. Why is it okay for Obs to risk the baby’s wellbeing by performing unnecessary, invasive and painful procedures on a labouring woman, often without her fully informed consent but women choosing homebirth, knowing the risks and benefits are not interested in the safety of their babies? NO-ONE loves my baby more than me and that includes RANZCOG!

Now I have one other point that I would like to make in regards to the whole “recommend homebirth for low risk women” stuff that has been going on. I really think that in all the hoopla about where we can recommend women give birth 2 really big issues have been overlooked:

1) How about instead of making recommendations to women we just give them information and ask them to make an informed decision? Some low risk women may make an informed decision that hospital is their preferred location and not all high risk women will make an informed decision that hospital is best for them. Women are all individual and will make different choices with the same information. We should not try and deny them that right.



Caesarean
The final decision on birth place should always rest with the mother. No-one loves her baby more than she does. Image courtesy of Wikimedia Commons


2) Most people really have no idea just how few women these guidelines effect. Not that many women are actually considered (by hospital board / RANZCOG definition) to be low risk at the beginning of pregnancy and a huge number of those who are end up being booted out of that category by the time they are in labour. Which is another major factor in the low numbers of women having homebirths in Australia – truly independent midwives are few and far between and a huge number of women are booted out of homebirth programs being run by medicare eligible midwives or hospitals due to not meeting the criteria.


So while it is lovely to see homebirth hitting the mainstream I don’t really see this segment as adding a whole lot of positive input into the debate. Because really there should be no debate – some women will find, after using their B(enefits)R(isks)A(lternatives)I(ntuition)N(ext) that home is best for them and some will find that hospital is best for them and they ALL deserve the choice, autonomy and respect to make the decision that works best for them: My body, my birth, my choice!

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Virtually all of the women I have cared for in a home birth have done so much research on the safety of giving birth at home vs hospital that they put the women who blindly go to hospital to shame. They REALLY take responsibility for the outcome of the birth.
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