Homebirth: The great debate

Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448. Link

IS giving birth at home a positive experience or and unnecessary risk?

ASK any expectant mother what she's hoping for when she gives birth, and she'll probably tell you the most important thing is to deliver a healthy, happy baby. But in recent years there's been great debate about the best way to do this.

Is the ideal to have a child in the relaxed comfort of your own home, or does the medical expertise provided in hospital far outweigh the notion of giving birth in your own living room?

Although homebirth advocates argue the former, it appears the choice may soon be taken out of their hands.

Reports last year revealed that four babies in Sydney died in homebirths in the space of nine months, the NSW Government responded with a strong announcement: from July 2010, independent midwives will be unlikely to gain professional indemnity insurance - effectively making it illegal for them to assist at homebirths. The consequence? Homebirths are facing extinction.

Obstetrician Dr Pieter Mourik believes the ruling will stop women taking unnecessary risks.

"Women who choose to give birth at home expect everything to be normal, but they often don't consider how far they are from expert help ..." he says.

"Eighty per cent of women can have their babies in a paddock - but the problem is choosing these women. You just never know what will happen."

However, Justine Caines, spokesperson for Homebirth Australia, says putting a blanket ban on homebirths will simply drive the practice underground.

... "Many mothers have had bad experiences in hospital and won't repeat that."

She continues: "Why does the government fund women who are choosing to have C-sections, but not women who are choosing to give birth at home?"LAST month a study of over 500,000 women in the Netherlands who gave birth at home ... showed there was no significant difference between planned hospital births and planned homebirths in terms of babies dying during labour.

It's important to note when making a comparison between Australia and the Netherlands, that the Netherlands only has low-risk home birth. If there are any complications in the pregnancy or labour, women see an obstetrician and birth in hospital. This is not the case in Australia at present, but it's the system that the Govt is trying to set up.

... Dr Mourik says the study is misleading. "Firstly, we must remember Holland has very well-trained midwives who act almost like Australian GPs," he says.

"It's also a small country with maternity units often within 10 minutes of someone's house. The conclusions of this study are based on the availability of well-trained midwives through a good transportation and referral system - and that simply isn't the case in Australia."

It's not currently set up in Australia, but there's no reason why it couldn't be. A positive approach would be to set in place a system that supports women to birth at home, and a system that protescts the midwives who support women to birth at home. Home birth has always been and will always be. We can set it up so that it is safe, or we can hope it just goes away ... it won't.

However, despite warnings from obstetricians, women are still choosing to have their babies at home ...

"Women should have the right to give birth wherever they feel safest - it's up to them whether that's in hospital or at home. But taking away our choice isn't right. If there were more options within the hospital system, then perhaps more women would feel comfortable going to hospital."

I disagree that women should make the decision: it should be made within the midwifery partnership. This debate is not about the right of women to bitrh at home: this right is protected by law. This debate is about the mdiwife's responsibility to pracice safely.

The Health Minister is putting in place a system that will enable more women to access continuity of midwifery care with their chosen midwife in and out of the hospital system. Once this is in place, there will be more options within the hospital system, and hopefully fewer women who are traumatised by the hospital system.

So is there a way to keep everyone happy?

"Homebirth Australia would like the government to present a package for pregnant women that works a bit like the baby bonus," ... "Every woman would be given a sum of money to spend on her pregnancy treatment, then it's up to her whether she sees a midwife at home, or an obstetrician in a hospital. It's putting the choice back into women's hands."

What about the option to have a baby in hospital with a midwife, or the ability for an obstetrician to attend a woman at home?

However, Dr Mourik believes that when it comes to choice, the only factor to consider is the mother and baby's health.

"Only a tiny minority of foolish women would risk their own lives and that of their precious babies for an ideal," he says.

"How many doctors support homebirth? None I know - it's too bloody risky."

Many studies opint to the safety of home birth for low-risk women who are attended by a midwife. Women who birth at home are amongst the most health- and safety-conscious people I know. It is offensive to comment that women who birth at home are risking their own lives and that of their babies, especially when the evidence is to the contrary.

Melissa Maimann, Essential Birth Consulting 0400 418 448