Hospital stay not part of process for some moms
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For Angela Hirsch, the decision to give birth to her second child at home was fairly easy. Her daughter was born in a hospital, and the experience had left her feeling that she wanted a more comfortable setting.
… “All the prenatal care was done at home,” says Ms. Hirsch … [I] had leisurely visits, I made tea, and they answered all my questions. You really got the sense that they love what they do,” she says.
Home birth has become a hot topic these days … but the question of home birth itself, whether it is safe, better for the baby or simply a recent fad, is contentious.
“There is definitely a resurgence of interest in home births,” says Alice Bailes, a certified nurse midwife …
Both the American Medical Association (AMA) and the American College of Gynecologists and Obstetricians (ACOG) have reiterated their opposition to home births, citing safety concerns and the expertise of the midwives who attend them. Nevertheless, a recent study of 13,000 births published in the Canadian Medical Association Journal, which prompted a number of the most recent news stories, says home births are as safe as hospital births for a low-risk population. Other studies make similar claims.
Both sides acknowledge that home births are not for everyone, especially if a woman has had a previous Caesarean section, is diabetic, has high blood pressure, or has given birth prematurely. But even low-risk pregnancies can have unforeseen complications.
“Everyone knows, and everyone understands, that there needs to be a mechanism to transfer a mother to a hospital setting,” says Ms. Bailes, who notes that about 11 percent of her clients end up being transferred to a hospital.
To be sure, a hospital experience can be daunting, especially these days when procedures such as episiotomies and enemas, IV hookups, and fetal monitors are routine. So are C-sections, once seen as a last resort, now performed with increasing regularity.
“The picture of birth in America today is startling,” …
As it is in Australia. We have very high intervention rates that are, at times not warranted.
“One in three women are being surgically delivered. The maternal mortality rate has experienced a slight rise in the last decade, and the premature rate is going up.”
That rate is the same in Australia. Maybe higher now.
Yet Ms. Davis notes that the atmosphere around home births has changed as professional medical organizations “ratchet up” the rhetoric against birthing at home.
“The connection between home and hospital should be seamless,” she says. “There should be a flexible network of care that adjusts to women’s needs.”
And these services are safest for women – when they can move seamlessly between home and hospital, and hospital and home, all with continuity of care from the same midwife who was chosen by the woman.
Having babies in the hospital was not the choice for most women as recently as 70 years ago … According to Ms. Leavitt, as late as 1938, only about half of American births took place in a hospital. Before 1920, only about 5 percent did. By 1955, fully 95 percent of Americans were being born in a hospital.
What moved women into the hospital, and made the hospital birth experience routine … was safety, along with the availability of medicines and procedures not accessible to the midwives of the time. Today, she notes, many home birth advocates opt out of the hospital because there is “too much medicine.”
… For Emily Scherer … a home birth was a more natural experience than the ones she had seen in the delivery room during her labor and delivery rotation.
“I was convinced that that was not how I wanted my baby to be born,” she says.
… Both Ms. Hirsch and Ms. Scherer ended up with healthy babies and a very positive birthing experience …
… Physicians … question the data that touts the relative safety of home birth, noting the small size of the samples and the fact that because the home birth population is self-selecting, it may already include factors that make home delivery safer.
I’m not sure of their definition of “small size of the samples” as one recent study had over 500,000 women in it.
Melissa Maimann, Essential Birth Consulting 0400 418 448
“Both sides acknowledge that home births are not for everyone, especially if a woman has had a previous Caesarean section…”
Hey Melissa, this is your blog and you do a fantastic job of compiling and commenting on these news stories.
BUT, in Canada 1 previous LSCS is still considered low-risk and women are routinely offered HBA1C.
This is a fact that cannot be emphasized enough as the rules around homebirthing are tightening like a noose. I would hate to see HBAC disappear in AU and the US just because OBs want to unjustifiably make it seem high risk, especially as the VBAC rate is so dismally low that to try for a VBAC in hospital is just asking for another surgery, with or without a private midwife.
Here is a link about the new Ontario study published in “Birth”.
http://www.medicalnewstoday.com/articles/164804.php
Please note that this is another Canadian study, this time compiled by midwives, and please note that women with MORE than one previous cesarean were excluded-meaning low risk HBA1C mothers were included.
“Almost 6,700 planned home births in Ontario were assessed in the study. Results indicated that newborns and mothers were no more likely to suffer complications than their counterparts in a clinical setting.”
…
“The criteria for home birth are set by the College of Midwives of Ontario. Ineligible women for home birth include:
• Twin pregnancy
• Breech or medically complicated pregnancies
• Women with more than one previous cesarean section
• Women with gestation less than 37 weeks
• Women with gestation more than 43 weeks at the onset of birth”
Any guidelines established for homebirth must allow HBAC.
Hi there,
this was from the original article. It’s not my words. VBAC was agreed in the criteria in Canada. It’s sad that it’s not the case here and we need to present our own data to show that HBAC is a safe option. Interestingly in the Canadian study, the only ruptures were in the OB group, and they were not in VBAC women!
As far as the Aussie data goes, we had a HBAC this August, so one more safe birth for the home team. Other families who want this choice deserve the opportunity, and private midwives deserve to be able to attend. I’m done having children now, but that’s no reason to turn away from these issues.