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The increased demand to give birth outside hospital has increased the rate of home delivery. In the Netherlands, a third of women now have home births. In the UK, 3% of total births occur at home, while in the USA home delivery accounts for 1% of births or 25 000 deliveries per year.
In Australia, 0.6% babies are born at home. This rate has increased in past years.
Home birth rates have been increasing in the USA partly because of the increasing proportion of births by caesarean delivery … because doctors and hospitals opt not to do a vaginal birth after a caesarean to avoid liability lawsuits …
Although home birth seems to be safe for low-risk mothers and, when compared with hospital delivery, is associated with a shorter recovery time and fewer lacerations, post-partum haemorrhages, retained placentae and infections, the evidence is contradictory for outcomes of newborn babies delivered at home … The problem arises when planned home births become hospital births when complications arise, and this can then lead to an underestimation of the risk and overestimation of the benefit of home births. Data from the Netherlands, for example, suggest that up to 40% of nulliparous women who start labour at home are transferred to the hospital. Most studies also rely on different midwifery models for home delivery, which are not generalisable.
Professional organisations … have issued contradictory policy statements regarding home deliveries. The Department of Health of South Australia has a detailed policy for home birth among women with low-risk, singleton term pregnancies, while the UK’s Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives jointly support home birth in women with uncomplicated pregnancies. By contrast, ACOG does not support home birth, citing safety concerns and the lack of rigorous scientific evidence. Choosing to deliver a baby at home, states ACOG, is to show preference for the process of giving birth over the goal of having a healthy baby.
A recent meta-analysis … provides the strongest evidence so far that home birth can, after all, be harmful to newborn babies. The research incorporated 12 studies and 500 000 births from several industrialised nations … The data show that planned home births to healthy and low-risk mothers compared with planned hospital births in the same group of women doubled the risk of neonatal deaths (0·2% vs 0·09%). And when infants with congenital defects were excluded, the risk of neonatal mortality tripled. The main attributable factors for the increase in mortality were the occurrence of breathing difficulties and failed attempts at resuscitation—two factors associated with poor midwife training and a lack of access to hospital equipment. In the USA, for example, only a third of home births are accompanied by a certified midwife.
Analysing the outcomes of these studies, what we can learn from this meta-analysis is that homebirth is safe for low risk, healthy women, whereas high risk homebirth translates to mroe complications for mothers and babies.
Women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk. There are competing interests that need to be weighed carefully. Hospital delivery should be the preferred method of delivery for high-risk pregnancies … Home delivery is an option for mothers with uncomplicated pregnancies, provided they are advised of the risks involved, have one-to-one midwife care (that includes good resuscitation skills and accreditation by a local regulatory body), and live in a location that allows quick access to obstetric care.
The situation in Australia is that fetuses do not have any rights until they’re born and breathing, therefore, the woman’s preferences are supported in pregnancy. An ethical stance would hold that the duty of care to the fetus increases as it reaches term.
Melissa Maimann, Essential Birth Consulting 0400 418 448
“Women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk.” ***but OBs, and now private midwives, do.
In this line of reasoning lies the low road.
It is OK for women and babies to be subjected to interventions which “put the baby at risk” (just choose your poison) based solely on often wrong tests like sonograms, and on pure “policy” with little or no informed consent, AS LONG AS THE ONE MAKING THE DECISIONS IS A MEDICO OR A POL.!
If midwives see mothers as antagonistic and dangerous to their unborn babies, just like OBs do, then why on Earth should we support more autonomy for midwives? At least the OBs have light years more training on which to draw.
Sounds like the midwifery movement needs more oversight to me. You have changed my mind.
” An ethical stance would hold that the duty of care to the fetus increases as it reaches term.”
This is filth and strips away women’s rights in favour of the Nanny State.
A few more dead babies is worth women keeping their right to bodily autonomy.
Hi Marge,
thanks for your comments again. The parts you refer to are actually from the article, not my words. The italics didn’t come out as I had intended.
” An ethical stance would hold that the duty of care to the fetus increases as it reaches term.” – this part is my words. It is how things are at present and accounts for the changes in practices as a baby reaches term, eg PROM is “actively managed” (ie induced) at term, but not prem; prem labour 24 weeks etc.