Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448.
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Home, as we all know, is where the heart is. It’s where we eat, sleep and raise our families.
Home is the perfect environment for many things, but there’s one thing it’s definitely not right for – and that’s giving birth. For that, there are things called ‘hospitals’ and they are full of lovely people called ‘doctors’.
This week there has been a brouhaha, caused by an article written by Cathy Warwick, the general secretary of the Royal College of Midwives. She … is enraged by a report … [that] indicates that home deliveries can double, or even treble, the risk of a baby dying during childbirth.
Now I don’t know about you, but even the teeniest increase in the risk of death to my unborn child, or to myself, would be more than enough to get me into my car and down the local maternity hospital the second labour started.
We’re talking about the life of two people here – and, by association, the lives of everyone they know – and I value that ever so slightly above the need for comforting personal effects and my favourite CD on the stereo.
And to me, anyone who doesn’t is being not only very foolhardy, but also incredibly selfish. As well as having written three books on parenting, I have given birth three times, and never considered having my baby on the Ikea rug in my living room, even though as a young, healthy, fit woman – I had my first child at 23, and the other two at 25 and 28 – I was in a very low risk category and could easily have opted for a home birth.
But thank goodness I didn’t, because two of my ‘low risk’ labours ended up being more complicated than anyone had predicted. It was lucky I was in a hospital with immediate medical care available, or my babies could have been in real trouble.
‘Where motherhood is concerned, exercising our “right” to have things exactly the way we want is potentially damaging’
The reason for this is very simple: childbirth is not an exact science. It’s not predictable or controllable.
It is a natural, biological process, and like many biological processes, it can outsmart even the best human planner.
… becoming a parent should be the most selfless thing we ever do … It’s the moment we grow as people by giving part of our lives to someone else; the moment we put our child’s needs and wants before our own.
And it’s for that reason that so many women choose to birth at home, where they believe their child will be safer than in a clinical and impersonal hospital setting where they, and their babies, will be handled by strangers.
Not always, of course – it’s vital for mothers to maintain a sense of self, to keep meeting their needs and to teach their children that they are not the most important things in the universe.
I wish more overindulging parents would try this. But where childbirth is concerned, I firmly believe we need to put our self-centred wishes aside, and be in the safest possible place just in case things go unexpectedly wrong.
The best available research supports homebirth as the safer option for low risk women who are attended by a midwife. The study quoted was not the best available research: it was a meta analysis of studies: some good, some bad. the largest study on homebirth supports the safety of it for healthy women, attended by a midwife.
And the word ‘unexpectedly’ is key. All pregnant women are encouraged by their midwife to make a birth plan. Ha! I can tell you now that my first birth plan certainly didn’t include being in labour for 37 hours and having my daughter sucked out by ventouse delivery.
Neither did I plan for my son’s heart rate to slow down to almost zero for long enough that the midwife made an emergency call and got the consultant to run to the delivery room to burst my waters to relieve the pressure around the baby. No, I did not.
Birth plans are not about planning every aspec of a birth; they represent a woman’s intentions for birth, all being well.
Childbirth is unpredictable and therefore inherently risky. We are told it’s a woman’s right to choose where to give birth, and in a way it is. But this isn’t like choosing where to have a facial – it’s deciding where you think your baby, and you, will have the best chance of surviving if things go wrong.
Hmm. What about choosing the best place for birthing, all being well, and moving to an appropriate place if all is not well? Most of the things that go wrong in a labour go wrong with plenty of warning. We don’t all live in a hospital despite the fact that life is risky.
And that ‘if’ is very important . Think about it. The language used in this debate is highly emotive and significant.
Those in favour of home birth speak of it as being a ‘ positive’ choice. Of the journey into hospital being ‘unpleasant’. Of hospitals being ‘uncomfortable’ …
Now, I dislike strip lighting, the clinical smell and not being able to drink a cup of tea out of my favourite mug as much as the next woman trying to get a human out of her body.
But these discomforts seem shamefully insignificant compared with the importance of having a safe, healthy delivery – even if the risk is tiny.
… And I only have to look to all the doctors I know who have chosen to give birth in hospital to know it’s the safest place to be. The other selfish aspect of a home birth is that it requires a fully-trained midwife to leave the hospital and give one woman her undivided attention for the duration of her labour, which can be 24 hours or even much longer.
That’s assuming it’s a hospital-employed, which often it’s not. Often, a woman engages a private midwife to provide her care from pregnancy right through to 6 weeks after the baby is born. And doesn’t every woman deserve one-to-one midwifery care in labour? It’s safest for mother and baby, afterall. And isn’t that the author’s concern?
Websites supporting home births, including the National Childbirth Trust, strongly encourage women to ‘stand your ground’ if a local authority declines a request for a home birth.
There is no mention of all the other women in hospital who might need the midwife’s care during that time. Thought is given only to the right of the woman to choose to give birth wherever she likes.
Thankfully, in the UK, women do have the right to birth at home. This right actually increases safery because no woman has to freebirth owing to the inability to find a midwife to support her homebirth. It’s a mature approach that respects a woman’s right to determine what happens to her body.
How far should we take these rights? Personally, I would much prefer to have all my dental treatment at home, because I think it would be more relaxing and make the procedure less stressful and there wouldn’t be that dentist smell – should I be provided with a dentist who will come to my home and give me a filling? No, I should not.
What if being relaxed and feeling “at home” contributed to a safer outcome for the baby?
It is also, obviously, the case that many home births go perfectly well and many hospital births don’t. It’s not an exact science. What we need is the best of both worlds – for hospitals to provide far better care for women in labour, so that we have the best medical care available immediately, and a comforting environment.
And hospitals (and hospital policies) that are more accepting of homebirth woman and homebirth midwives, hospitals that will “allow” women to give birth to their babies how they see fit: breech waterbirth, VBAC without continuous monitoring, twins without an epidural and so on. When hospital policies are more encouraging, more women will feel comfortable to birth there. How often does a hospital say to a woman, “What would you like to do?” rather than, “we’ll allow you to …”?
For me, the potential benefits of delivering in my kitchen don’t remotely outweigh the risks. I am thankful every day for the care that was on hand within minutes when my babies needed it.
Most women don’t birth in their kitchens. Bedrooms, loungerooms, bathrooms, but not usually a kitchen. Somehow it doesn’t have that cozy feel to it.
Melissa Maimann, Essential Birth Consulting 0400 418 448
