By Lach De Crespigny and Julian Savulescu
Windsor Coroner’s Court has heard that a mother died within hours of giving birth at home after a private midwife committed a horrifying catalogue of errors . According to reports, the woman had previously delivered twins by emergency caesarean section, one of which later died. Her husband said his wife was ‘brainwashed’ into having a home birth by the midwife, who insisted it was safe. The Royal College of Obstetricians and Gynaecologists advise delivery in hospital after caesarean section so that an emergency caesarean delivery can be carried out if necessary. The midwife denied trying to persuade the couple to have a home birth. However she has greater responsibilities than this; as professionals we should try to persuade women to deliver in hospital if this is a safer option. But the midwife seems to have prioritized homebirth over life itself when she reportedly stated:
“Claire had a great pregnancy, she had a really lovely spontaneous birth at home and I hope Simon in time will remember that”
The midwife is also accused of multiple errors in management including failing to realize around a third of the placenta was retained in the uterus and missing a vaginal tear which would normally be stitched immediately in hospital under anaesthetic. The midwife is said to have performed CPR on the bed, where it was less effective, instead of on a firm area such as the floor. She said she attended refresher emergency medicine courses each year and had never been told to move someone on to a floor to perform CPR. ‘My whole practice has always been extremely kind and gentle and thoughtful and caring,’ she added. ‘I did the best I could under the circumstances,’ she is quoted as saying in the Daily Mail. The woman was taken to hospital by ambulance but died later that day. Homebirth perinatal deaths of infants who would have survived if they had been born in hospital are reported more commonly than maternal deaths[1,2].
All such potentially avoidable tragedies are distressing. But the fetus has few ethical or legal rights; maternal autonomy includes the right to risk perinatal death as well as her own death. Ultimately women have autonomy regarding whether to take such risks. Professionals and pregnant women have an ethical obligation to minimise risk of long term harm to the future child; harm to people who will exist is a clear and uncontroversial morally relevant harm. Consistent with this, antenatal care focuses on minimizing the risk of harm to the future child, whether by advocating for alcohol abstinence in pregnancy, folic acid supplementation to reduce the chance of neural tube defect, or minimizing teratogenic risks of medications in pregnancy.
Maternal and perinatal mortality are truly tragic outcomes. Professionals must encourage women to deliver in a safe environment and also practice safe and competent obstetrics. The professional bodies and the law must do all they can to ensure this happens.
Currently the homebirth debate focuses on such disaster. It is a terrible tragedy that Claire died foreseeably and avoidably in this manner. But the silent tragedies are not the deaths, but the long term disability that results from homebirth. And it is this risk that weighs most heavily against homebirth.
What disability? When a baby is obstructed in labour at home, or born with hypoxic brain injury, the delay in transferring to a tertiary hospital may result in permanent severe disability that will persist for the rest of that person’s life. In some cases, that disability was avoidable if the delivery had occurred in hospital. To take an extreme example, a person might be avoidably quadriplegic.
Now what risk could should a parent take to have “a really lovely spontaneous birth at home” that justifies quadriplegia? One in 1000? One in 1000 000? Anything?
We contend that the choice to have “a really lovely spontaneous birth at home” is only justified if exposes the future child to zero risk of avoidable disability. And this is just never the case.
Why else would modern obstetrics have been developed?
References:
1. Johnson S. Home births risky, NSW coroner finds. Herald Sun. 2012 June 28; http://www.heraldsun.com.au/news/breaking-news/baby-died-after-cord-entanglement-coroner/story-e6frf7kf-1226410986230 (accessed July 2012).
2. Keller C. South Australian Coroner wants crackdown on midwives and homebirths. The Advertiser. 2012 June 6; http://www.adelaidenow.com.au/news/south-australia/south-australian-coroner-wants-crackdown-on-midwives-and-homebirths/story-e6frea83-1226386012581 (accessed July 2012).
How does the use of prenatal risk screening (or advances in) impact upon this conclusion? It seems defensible to suppose that sufficiently advanced and precise prenatal scanning to assess likely risks might make the case for low-risk home births more ethically defensible.
Of course, the likely reply to this is that the proximity to professional care is always increased in the case of home births, and even if the likelihood of emergency is low, this represents an unreasonable risk of harm to the infant. This is surely true, but weighing this lower risk against the supposed gains of home birthing appears to be a more difficult moral question.
Note: I plead ignorance regarding the current state of prenatal screening and its ability to give reliable risk-assessments. This is, quite possibly, only a hypothetical scenario.
This is an utterly biased article simply aimed at inducing more fear in women.
The casualties of hospital birth are far more than home birth – if only the medical system could actually be trusted to care about what happens after the birth and publish truthful statistics.
Yes, the woman in question may have survived if she were in hospital – but if she hadn’t – there are incompetent doctors and nurses too – no one would have written about it or spoken about it.
If the medical system was organized differently – to care in a holistic way for mother and baby, use drugs and invasive methods not as standard protocol but only when required; and do a whole lot of little things that retained the bond between mother and child so as to ensure quality of experience instead of bundling them out like biological products, it would be just wonderful and no one need consider home birth.
Sadly this is not the case.
I wish journalists and writers would care to investigate matters thoroughly before publishing such articles.
A woman’s human right to give birth in comfort and with dignity are more important than the position of the medical establishment.
If the medical establishment is interested in saving lives, it should focus on stopping the influx of unnecessary drugs that have become a bigger cause of death than even road accidents in almost every country of the world.
More than anything else, if a doctor says something its called “advice”; if a woman with experience in birthing says something its called “brain-washing”. Both make mistakes regularly.
Try being fair.
The casualties of hospital birth are far more than home birth – if only the medical system could actually be trusted to care about what happens after the birth and publish truthful statistics.
Yes, the woman in question may have survived if she were in hospital – but if she hadn’t – there are incompetent doctors and nurses too – no one would have written about it or spoken about it.
If the medical system was organized differently – to care in a holistic way for mother and baby, use drugs and invasive methods not as standard protocol but only when required; and do a whole lot of little things that retained the bond between mother and child so as to ensure quality of experience instead of bundling them out like biological products, it would be just wonderful and no one need consider home birth.
Sadly this is not the case.
I wish journalists and writers would care to investigate matters thoroughly before publishing such articles.
A woman’s human right to give birth in comfort and with dignity are more important than the position of the medical establishment.
If the medical establishment is interested in saving lives, it should focus on stopping the influx of unnecessary drugs that have become a bigger cause of death than even road accidents in almost every country of the world.
More than anything else, if a doctor says something its called “advice”; if a woman with experience in birthing says something its called “brain-washing”. Both make mistakes regularly.
Try being fair.
Ah yes, Krishna, thank you for trotting out the utterly predictable arguments used whenever a mother or child suffers a bad outcome during a homebirth. This mother was a high risk patient because she had a prior c-section, and an ethical midwife would have done her best to persuade her to deliver in a hospital. And now this midwife has the gall to say, “Claire had a great pregnancy, she had a really lovely spontaneous birth at home and I hope Simon in time will remember that”?! His wife is DEAD! Now he is left to raise two children by himself in the very house where his wife died, yet he is supposed to focus on the “experience?”
The birth experience means nothing if it doesn’t end with a healthy child and baby. Natural childbirth advocates would like us to believe that things were better before the advent of modern obstetrics, but that is factually false. I say this as someone who was hoodwinked into believing that unmedicated birth would be “empowering” and “beautiful.” I found it to be agonizingly painful, and I would not be alive to write this had I not delivered in a hospital. Despite a “textbook” pregnancy, labor, and delivery, I began to hemorrhage as soon as the placenta was delivered. Unlike poor Claire, I had an excellent CNM who took immediate action to save my life. As she directed the nurses to give me pitocin and cytotec, she began a manual examination of my uterus which revealed a cervical laceration that required surgery to repair. Even with prompt care, I narrowly avoided a blood transfusion. While this particular complication is rare, complications themselves are not. To pretend otherwise is both arrogant and foolish, and I find it is disgusting to see NCB advocates so willing to brush Claire’s death under the rug.
not to mention, its amazing that the ideological Natural Birth blinders are so intense that a person can truly believe that the birth was a “great experience” and leave out the part where Claire experienced bleeding to death while asking for help and not getting it. NOT A GREAT EXPERIENCE one must assume. but somehow that is separated out by these fundamentalists…
The casualities of hospital birth are far more than home birth
Krishna this simply isn’t true.
Which is more? 3 in a hundred or 130 in ten thousand?
You might say 130 is many more than 3 but you would be wrong because the issue is in proportion not the actual numbers themselves. So if 3 babies died in one hundred home births then for that to be proportionately EQUAL to the number dying in hospital there would need to be 1300 deaths not 130 so actually the risk of a baby dying at home is substantially higher than in hospital . Not only that the reasons why babies die is also completely different from home to hospital babies dying at home usually die from asphyxia which would have been prevented by hospital care.
Turning to Claires tragic death, just like babies dying differently at home than they do in hospital Claire died in circumstances that simply would not have occurred in hospital , for her midwife to still be trying to offer solace in the place of birth when Claire actually died and the baby will be a constant reminder of that fact is nothing short of disgusting.
The RCOG advises that for most women without complications, home birth is a perfectly safe option which should be encouraged as many women have a far better birth experience at home (and an uncomplicated birth does not need to be “medicalised”).
The problem with this case is that the midwife should have advised the woman to go to hospital. Unfortunately bad advice and bad medical assistance for women in labour is something that happens, both in home births AND in hospital deliveries. I have managed a legal portfolio for Obs/Gyn medical negligence trusts in the past, and I can tell you there is no such thing as a risk-free birth and women who do suffer complications during birth are often left with the most awful problems even with the best assistance on hand.
Limiting women’s choices isn’t the answer. The answer lies in rigorously checking that midwives are properly trained and give the proper advice, so the woman knows which choice is safest.
You should look at Dutch studies of home birth, examine the system of home birth in the NL, and watch a few documentaries on the topic. One third of Dutch babies are born at home, and I don’t think there are many quadriplegic children there. My first child was born “naturally” in a top rated hospital in the US and the experience was very traumatic, for me and for the baby. (Don’t underestimate the impact a traumatic birth has on a new mother!) I then had two wonderful home births, the first in the NL and the second the US (WA State, a very midwife friendly place). In the NL and in WA it is not allowed to have a home birth after a C-Section and so the type of midwife who will perform a home birth under such a circumstance would be risking her license and perhaps jail time. However, the situation in the US is complicated because often hospitals will not allow women to attempt VBACs, even though they are considered safe and are routine in other countries. So, some women seek midwives who will help them attempt a VBAC at home (I know of two women who have done this and had wonderful births!) If you have never given birth, you might not understand the trauma of going through an emergency C-Section and later realizing that this probably happened because of simply being in the hospital. You ask why obstetrics was created, and if you research carefully I think you will find that the answer is not because of the risk of home births, as women have been giving birth at home since the beginning of humans. In addition, some women die after having C-Sections, and many C-Sections are performed because of unnecessary interventions to induce and then medicate labor–standard hospital birthing procedures. For a low risk woman, it is perfectly safe to give birth at home under the care of a competent midwife, within reasonable distance of a hospital.
Yes, we should look at the Dutch studies because they show something very different than what you think they show.
The Netherlands, the first world country with the highest rate of homebirth (27% and falling), has one of the worst perinatal mortality rates in Western Europe. The Dutch government is deeply concerned and has commissioned multiple studies to dtermine the cause.
A 2010 study in the BMJ shows that low risk birth with a Dutch midwife (home or hospital) has a higher mortality rate than HIGH risk birth with a Dutch obstetrician in the hospital. That’s an appalling indictment of Dutch midwifery and hardly supportive of homebirth.
Think about what that means: low risk homebirth in the Netherlands has a higher perinatal mortality rate than high risk birth in a hospital. Yes, the Netherlands is an example … an example of the fact that homebirth is not safe.
Ms Tuteur – could you please publish a link to this BMJ research?
I live in the Netherlands and have not heard this….
Thanks
Ahh the Netherlands should not be looked at as a “good” example of safe homebirth.
http://www.bmj.com/content/341/bmj.c5639.full
Conclusions Infants of pregnant women at low risk whose labour started in primary care under the supervision of a midwife in the Netherlands had a higher risk of delivery related perinatal death and the same risk of admission to the NICU compared with infants of pregnant women at high risk whose labour started in secondary care under the supervision of an obstetrician. An important limitation of the study is that aggregated data of a large birth registry database were used and adjustment for confounders and clustering was not possible. However, the findingsu are unexpected and the obstetric care system of the Netherlands needs further evaluation.
http://www.ranzcog.edu.au/publications/oandg-magazine/doc_view/762-16-trouble-in-paradise.html
In addition to this, an editorial about USA homebirth states…
http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Safe-at-home-Probably-not/ArticleStandard/Article/detail/751425
The rate of home birth is falling due to fear. The study you cited states that it is unclear whether the mortality rates are higher due to the Dutch birthing system, and this study was the first of its kind to compare low risk to high risk women. There were several limitations in the study. It seems unreasonable to jump to the conclusion that homebirth in the NL is unsafe because of one published paper that calls for more research.
Before the 2010 study, in 2009, there was a large Dutch study which showed the perinatal mortality rates to be the same for babies born at home or in the hospital to low risk mothers:
de Jonge A, van der Goes BY, Ravelli ACJ et al. Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births. BJOG,
The NL has a very low maternal mortality rate and most women are under the care of a midwife. The C-section rate is one of the lowest in the world. The USA, on the other hand, has a shockingly high maternal mortality rate under the obstetrician model of care.
How can you argue that one example of what sounds like inappropriate professional midwifery care means that all homebirth midwifery is unsafe?
Perhaps I am being defensive – I am an independent midwife in Melbourne, Australia. The key to safety of homebirth from my perspective is a midwife who understands and recognises potential or developing complications, and who accesses appropriate medical care in a timely way.
I understand that the writers of this article are ethicists. Please reconsider your biases. There is no model of maternity care that offers ‘zero risk’ of any complication. Despite all the machines that go ping, there is still no better way for most babies to be born than the old fashioned, unpredictable, time consuming, and sometime noisy way: the way that women and midwives have used since time began. You ask why else would modern obstetrics have been developed? Obstetricians are not good as providers of primary maternity services – they are not midwives. They are specialists, and their skills are inappropriate and wasted in spontaneous, uncomplicated birthing situations where the woman does the work.
Yup. And there is no better way to make butter than to have Momma hand churn it on the front stoop. Clothes are never cleaner than when they are hand scrubbed on a board. The maternal mortality rate in the US was about 50 per 10,000 in 1939 when it began to show a rather precipitous decline due to advances in anesthesia, blood transfusion and the provision of a safe Cesarean section to where the rate is about 10 to 20 per 100,000. C-sections in the past century have saved more lives than about all other surgical interventions combined in that time frame. It borders on the height of hubris to proclaim a “low risk” pregnancy until 6 weeks post partum. This particular case involved a home VBAC. How is that “low risk”?
Why not focus on why do so many women avoid hospitals and try to make hospitals more homely and maternity-friendly, instead of blaiming women and midwives? I did not experience any home-birth, but I have repeatedly seen newborns being washed and dressed up before being brought to their parents (notice that I am NOT talking about medical exams, which are surely needed immediately after birth) and newborns being kept far away from their mothers (who see them only in order to breast-feed them) in “modern” hospitals.
not to speak of the number of unnecessary cesarians. In some Italian hospitals (and I guess that Italy is not an exception) they are the overwhelming majority. Cf. this statement:
“Another contributing factor for doctor-ordered procedures may be fear of medical malpractice lawsuits. Italian gynaecologyst Enrico Zupi, whose clinic in Rome, Mater Dei, was under media attention for carrying a record of Caesarian sections (90% over total birth), explained: “We shouldn’t be blamed. Our approach must be understood. We doctors are often sued for events and complications that cannot be classified as malpractice. So we turn to defensive medicine. We will keep acting this way as long as medical mistakes are not depenalized. We are not martyrs. So if a pregnant woman is facing an even minimum risk, we suggest she gets a C-section ” (quoted from http://en.wikipedia.org/wiki/Caesarean_section)
So I agree that women should generally give birth in hospitals… That home births seem a little silly in light of all the risks. But my qualm is the risk taking assessment at the end of the article… Really? It has to have zero chance of avoidable harm?
We expose children and infants to avoidable harm all the time. Do we HAVE to bank cord blood? Not doing so exposes the child to avoidable harm. Shouldn’t I really put some protective gear on an infant in case I drop her?
But if we open up the risk slightly, we need to be committed to doing harm to mother and child.. And ultimately I don’t see why that wouldn’t fall under a liberal understanding of respect for autonomy.
“Now what risk could should a parent take to have “a really lovely spontaneous birth at home” that justifies quadriplegia? One in 1000? One in 1000 000? Anything?”
What about hospital birth though? Now what risk could a parent take to have a ‘safe birth in hospital’ that justifies a emergency C-Section due to FTP’/shift change/oxytocin repressing birthing envionment, haemorrhage due to cord tugging/strict 2nd stage time limits/synto or MRSA infection? One in 1000? Anything?
Of course hospital birth is ALWAYS safe, babies don’t die in hospital, neither do mothers.
Why are parents not allowed to make a truly informed choice by being made aware of the risks & benefits of home *and* hospital? When was the last time you wrote an article about a mother and baby dying because of poor care in a hospital? …….thought not.
this article is just stupid. it is obviously so biased and under informed. it was written by young men, right? just putting a bet out there on that. blank judgements and limiting women’s choices and inducing fear are misogynistic and backwards. hospital births are far, far more injurious and risky. i have had both and can speak from experience. i have many friends who have had terrible hospital births with long term injuries to mother and baby, and while i know only one person who had a home birth and it was negative. all others were ecstatic with their choice of home birth. i wonder if these so-called authors checked any facts, did any interviews, looked through any other references than these two articles that they cite. this article is completely sensationalized rubbish. get a clue, guys.
Julie, The midwife was a woman, right?
Julian,
you “contend that the choice to have “a really lovely spontaneous birth at home” is only justified if it exposes the future child to zero risk of avoidable disability.”
What about the risk to the mother? Hospital births are associated with a higher risks to the mother of Caesarean Section – which, as we often seem to forget – is major abdominal surgery – as well as increased risk of forceps, episiotomy, and practically all other complications, interventions and damage. Unlike the risks to the fetus that you mention, these risks run not in the few per thousand, if that, but in the tens per hundred. (Brocklehurst, 2011)
Your position requires the mother not only to sacrifice her autonomy, then, but also that she takes on a considerable load of medical risks herself, to prevent any – literally ANY – risk to the fetus, not matter how small. Do you really want to defend that position?
If you are keen to defend the fetus’ rights, be my guest. But please don’t overlook the risks to and rights of the other entitity involved here, who is definitely both existing and a person: the mother. At best, there is ALWAYS a trade-off involved – I expect your blog to reflect that.
And next time, think about this and do your research before you write the blog. You are a respected philosopher, not a religious nut. I always thought the long line of white men commenting willy nilly, without knowledge, and with complete disregard for the personhood of the mother on what happens in a woman’s uterus consisted only of the latter – it really is rather disappointing to see you end up there.
If you want to know if planned homebirth is safe, it does not make much sense to ask about perinatal mortality in a COUNTRY (read The Nederlands). You need to ask: Who are dying? And are they born at home? In the case of the Nederland’s it is not the children that are born at home that dies. For those children wha are born aplanned at home the Nederland’s have a lower perinatal mortality rate than many other European countries such as my own Denmark. Denmark has only 1, 4 % homebirths (with very good results). The rest of births take places in highly specialized obstetrical departments, despite this we have a higher perinatal mortality than The Nederlands. Ank de Jonge, a Dutch researcher talked about perinatal mortality in the Nederland’s at the Human Rights in Childbirth conference in the Haag in May 2012. see.www.humanrightsinchildbirth.com
What about the risks of hospital acquired infections? Do these have to be 0 before a woman is allowed to even entertain the idea of giving birth in a hospital? Cause that will NEVER be the case either.
There are risks involved with home birth and there are risks involved with hospital birth. The only people who should have any say in the decision of where to birth should be the parents with the mother having the final say. Why? Because in the overwhelming majority of cases, the parents are the ones who really only have their child’s best interest at heart and the mother has more say as it is actually her body AND her child that is concerned here.
And as someone else said, it is utterly ridiculous to assume a 0 risk stand-point. I needlessly risk my and my children’s lives every single day. I let them play in the garden although there is a chance that a spider or snake will bite them (I live in Australia). For what? Just so I can say: “Well at least they had the lovely experience of playing outdoors? Does that seem worth it when your child is dead?
We leave the house and drive to the beach. We could have a car accident, the kids could drown or get bitten by a shark, etc. Every single thing you do has risks associated with it. We need to accept that and then see how we can minimise them without letting them control how we live our lives. And sometimes the unthinkable will happen. It’s harsh, but that’s life.
Life is dangerous, we all die. Pregnancy is dangerous – sometimes babies die, sometimes mothers die. Shit happens, and sometimes it is not the midwife’s fault………… sometimes doctors do things that put the mothers and babies at risk, sometimes the parents actually make the decision themselves……… indeed, with all the information, then something goes wrong, and who is the easiest target? I bet the father in two years has managed to move on?
No life is risk free, everyone needs to be offered informed choice in childbirth by women that really know what birth is……….
It is a natural function of the body and requires the same hormonal mix as making love, not the interference of the money making drugs companies, hospitals and insurance dudes all uninterested the health and happiness of moms and babies. The problems in birth are that our birth culture is fear based it is actually a very safe thing to do like pooing! Most problems are caused BY the medical interference that is rife…leave women to enjoy their process with good midwifery care.
This kind of ignorant rubbish should not be taken seriously.
Blessings Vanessa ( lay midwife of 17 years……..)
“We contend that the choice to have “a really lovely spontaneous birth at home” is only justified if exposes the future child to zero risk of avoidable disability. And this is just never the case.”
From this it can be inferred that if something carries any risk above zero (no matter how infinitesimally small) of avoidable disability to another person then that action is unjustified even if not carrying out that action would negatively affect another’s interests or preferences. Leaving aside that there are barely any medical interventions that do not carry out at least some risk of causing disability, there is a whole wealth of literature on maternal-foetal conflict that rebuts Savulescu’s argument.
If we accept the interests of the person the foetus will become and the interests of the mother count equally, why should a pregnant woman be expected to subject herself to an unwanted intervention (in this instance a hospital birth) in order to avoid something that probably will not happen anyway? Unless Savulescu cares to elaborate why the risk to the foetus/child’s interests should be favoured against the near-certainty of negatively affecting the mother’s interests, his argument fails to work
I imagine that the midwifes comment about lovely birth is quoted out of context.
It paints a picture of the midwife being naive, and aims to shame her.
The article does not serve the fundamental right for women to choose where they birth.
Thank you to those who have commented on our blog.
Thomas Gissing suggests that advanced and precise prenatal scanning to assess likely risks might make the case for low-risk home births more ethically defensible. A range of fetal monitoring tests, including ultrasound scans, may identify pregnancies that are at risk. But many complications of labour are unpredictable so tests have only limited place. Such complications as haemorrhage, acute fetal distress, cord prolapse or fetal blood loss from vasa praevia occur suddenly and are commonly unpredictable.
Lovely Lucy asks for the reference to the study that showed infants of low risk pregnant women who started labour in primary care had a higher risk of delivery related perinatal death plus the same risk of admission to the neonatal intensive care unit as infants of high risk pregnant women who started labour in secondary care. It is Evers et al. Perinatal mortality and severe morbidity in low and high risk term pregnancies in the Netherlands: prospective cohort study. BMJ. 2010; 341:c5639 http://www.bmj.com/content/341/bmj.c5639.full
Joy Johnston says she understands that the writers of this article are ethicists. One of the authors (LdeC) is a (non-practicing) obstetrician and gynaecologist
Several responders raise the question whether homebirth should have a zero chance of avoidable harm? We argue that even if there is a very low probability of some bad outcome, if the outcome is very bad, and there is another alternative with an even lower probability of that outcome, it is rational to take the latter course i.e. take the hospital rather than the homebirth (even if homebirth has quite a low overall morbidity).
Elselijn Kingma says hospital births are associated with higher risks to the mother of caesarean section … as well as increased risk of forceps and episiotomy. Reasons that women choose homebirth include reduced perineal trauma and the wish to avoid medical interventions. But the potential risks of homebirth include far more profound deficits, including life long neurological deficit, which would seem to outweigh such benefits.
Whether hospital births are associated with ‘increased risk of… practically all other complications, interventions and damage’ is less clear. For example, maternal complications from severe shoulder dystocia and acute haemorrhage are likely to be far greater at homebirth.
Vanessa Brooks says it is actually a very safe thing to do like pooing! This is wrong. The danger is that some pregnant women believe this when they hear it from a ‘lay midwife’ and are then at risk of making bad birthing decisions.
This suggests that even women with risk factors are safe to deliver at home. Professional bodies do not agree. In addition, maternal mortality rate in England was 1 in 200 live births in 1800 to 1850 (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1633559/). In 1939 the stillbirth rate alone was 42 per 1,000 of all births (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2808697/).
Improved outcome is as a result of many factors but includes modern obstetric care.
Amid all this noise, I thought the following might be reassuring for any pregnant folks out there who are reading this blog and considering a home birth:
“As with birth centres, planned home birth resulted in significantly lower rates of medical interventions, and higher rates of normal birth. Poor outcomes among ‘low-risk’ women in the Birthplace study were rare in all settings (Obstetric Units, Midwife-led Birth Centres, at home), with over 990 babies in every 1000 being born healthy and well. For low-risk women who have previously had a baby, there was no difference in adverse outcomes for babies between those planning to have their baby in an Obstetric Unit and those planning a home birth.” (Birthplace in England study published in NCT magazine March 2012; Birthplace Research Programme http://www.npeu.ox.ac.uk/birthplace)
This excerpt doesn’t address high-risk mothers, nor first time mothers (as neither are the case for me, 7 months pregnant!). Check it out if you are interested. But how compelling: home births have significantly lower rates of medical intervention *and* there is NO DIFFERENCE in the health of the babe between a multiparious mum giving birth in hospital and one giving birth at home. NO DIFFERENCE.
I love hospitals, drugs, docs & nurses. Truly! My mums a nurse, and I have been very grateful for their care on numerous occasions.
BUT the over-medicalisation of birth and the cascading interventions are RISKY (surgery, forceps, ventouse, sticking needles in spines), unpleasant (yes, unpleasantness matters when you are at your most vulnerable and when someone has their hands literally in you!), traumatic (enter post-natal depression), expensive, and just plain old unnecessary.
There is a culture of fear surrounding childbirth that has the very tangible effect of scaring women into longer and more complicated labours and deliveries. There is almost an idea that ‘someone else’ delivers your baby to you. Yes, bring on the interventions when they are truly needed, but hair trigger interventions are no good. Birth is not a problem to be fixed… it is a natural process, a woman’s body doing its thing, and one that can occur very safely at home if supported by sensitive and well-trained midwives.
There are “Continuing Tragedies” occuring in hospitals, as well, sorry to say. I’m for informed choice, less fear-mongering(!!!), and making improvements to maternal/obstetric/midwife care all ’round.
Many babies, especially from low risk multiparous moms birth easy. OBs and CNMs have easy low risk deliveries in the hospital with no epidural, no episiotomies, and quick recoveries. They probably would admit, “wow, this mom could have easily had this baby at home”. I want a HCP who can deliver a low risk patient and if complications arise, do what is necessary. CPM or other homebirth midwifes cannot give epidurals, perform vacuum or forceps, perform cesareans, have blood products, BAKRI balloons, or tertiary medicines available for PPH. I would rather have a baby in the hospital that could have been delivered at home, than a delivery at home that I wish I would have been in the hospital.
Many of the homebirth “safety” articles deal with low risk moms (NO FTM, previous cesarean, breech, twins, AMA, LGA, GDM, etc) cared for by CNM. As homebirth IS practiced in America, CPMs are taking care of all these higher risk patients and quoting them safety statistics that are really comparing apples and oranges. And the naive moms are believing them. Read any Babycenter or MDC blogs and FTM are having homebirths, HBACs are rampant. These births are not what are included in the “safety” homebirth articles. And yes, the Netherlands are having problems between the midwife and OB collaborative practice and the M&M of homebirth is higher than high risk hospital birth as stated in that 2010 BJM.
Amazing things here. I am very happy to peer your article. Thank you so much and I’m having a look ahead to contact you. Will you please drop me a e-mail?
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