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Archive for the ‘Home Birth’ Category

The imperative of choice

Tuesday, May 18th, 2010

I have been watching Mad Men recently, and quite apart from how fantastic and beautiful it is as a series, it is completely fascinating to see into the (admittedly fabricated) lives of women in the 1960s. It wasn’t that long ago really, and yet sexism was rife, women were only beginning to be liberated and generally you get the sense that their choices were, by design or default, significantly curtailed by the cultural norms of the day. Fast forward 50 years, and we are all superwomen, capable of choosing between motherhood and careers or having both, informed and educated and spoilt for choice. Or are we?

Because the women of New York have just had a huge choice taken away from them ( see article). Last week,  the closure of one of NYc’s most progressive St Vincent’s hospital spelt the end of legal backing for midwives who worked independently. As o that day, there is not a single midwife in New York who can legally attend a home birth. That is millions of women now deprioved of a very basic choice as to whether to birth at home or in hospital. In a country that honours freedom as much as the US does, that borders on the sacrilege.

Not everyone wants a home birth, and not everyone should have one. But for those that do, the lack of choice will feel stifling. The most important thing a woman needs to consider when she is planning her birth is what environment she will birth best in. Security and privacy are two complete essentials - if a woman feesl safe she will birth better. Fact.

For some women, that safety comes from being in hospital, with medical attention only a corridor or two away, and an epidural on hand should she cry out for one. But for other women, safety comes from the comfort and familiarity of their own homes. Research on home birth shows that for risk-free prgenancies birth at home is at least as safe a in hospital, and Holland, where the home birth rate is a whopping 30%, has some of the lowest maternal morbidity rates in the world. According to the science both places are safe for mothers in general, but certain places are better for mothers as individuals. And it is only the women themsleves that can decide what is right for them.

Except in New York they cant.

Birth is hormonally driven, and hormones function best in particular environments. When a woman is denied the right to choose that environment, she is effectively ebing denied the right to a good birth. There is, and should be public outcry about this.

Let us also hope that this particular little development is one that we dont decide in the UK to follow. Birth practice in the US seems to be exported, even when it is found to be faulty. I have never been one for protectionism, but there is a time and a place, and when it comes to choice for mothers, that time is now.

Home birth Safety - some clarification

Monday, April 7th, 2008

I have just had correspondance with Dr Phil Steers, Editor-in-Chief of the British Journal of Obstetrics and Gynecology, who was interviewed last week in response to the new publication on home birth. He kindly responded to several queries I had regarding the study, and so much of what he said was so useful in light of the current debate that I think it is important to pass on some of his wisdom. Firstly ,the statistics for the Netherlands, which I referred to in my last blog and which are still so often bandied about, are actually hopelessly out of date. In fact, it was some twenty years ago that the Netherlands had some of the best outcomes in the Western world. Now, as their home birth safety rates have not fallen in line with hospital rates, they now lie near the bottom of the league table, at 24 out of 25. Many a book and website needs updating it seems!!

Having said that, we should still not be so alarmed as to dismiss the idea of home birth altogether. Whilst on average one in four first time mothers need to be transferred during their labour, that does not mean that one in four come up against serious problems. Often the transfer is precautionary- because there are signs of foetal distress or labour might be stalling- and yet these are rectified with little or no intervention. Similarly, women who decide thay would like an epidural are included in these statistics. Whilst those in the transfer group face considerably more chance of things going wrong, Dr Steers emphasised that it is important to look at these bare-faced statistics in a much wider context. To question the safety and danger of home birth vs hospital births as absolutes is a futile exercise and misses several points. The first is that in either setting the risks of problems is low compared to several generations ago and the developing world. Secondly, risk is everywhere. We take a risk every time we walk out the door. When making dcisions about where it is best to birth, risks need to be weighed up against the benefits, and women- in conjunction - with their carers can then decide what is best for them. As Dr Steers said, ‘When you go for a home birth you might get the best, or the worst. The problem is, we are not good at predicting which’. No birth setting is perfect, and the right place for one woman will not necessarily be so for another. As the overall risks for women and babies are now very low, a woman’s personal sensibilities and her emotional preferences need to also be taken into account, especially when they are based on a good understanding of both the science and the physiological needs of a woman in labour. Whether it is the mother’s first or second birth should also be considered significant- for second time mothers who have had a previously successful spontaneous birth, the likelihood of transfer from a home birth is only 5%. As with many things, the choice as to where to give birth is a balancing act, but one that should be taken from a position of maximum knowledge. I reiterate it is always important to delve beneath the headlines, whoever might be writing them. Balance doesn’t often make for very good stories……..

The Safety of Home Births

Monday, April 7th, 2008

In the most recent issue of the British Journal of Obstetrics and Gynaecology, an article was published suggesting that home births that encountered problems were less safe than hospital births. This was reported in recent articles in both The Telegraph and The Guardian. This is an important finding, not least because it refutes the previous research that concluded that planned home births were at least as safe as hospital births for low-risk pregnancies. It is essential hat we take heed of research such as this, and do not simply refute it because it is not smething hat we want to hear. We also need to be careful not to be reactionary and end up throwing the baby out with the bath water.  Studies like these do, and should prompt healthy debate and further research. And it is essential that we dig beneath the headlines ( note how different they were depending on the newspaper) and work out what the possible reasons for such findings might be. If the conclusion of the research was that home births by their very nature were inherently more risky, then how do we account for the birth outcome statistics in Holland- which are some of the best in the Western world- and thier unusually high home birth rate at around 30%. Equally how does Ina May Gaskin, famed for her birth practice on The Farm in Tennessee manages to have a c-section rate of only 1.4% and a transfer rate of only 13% inlcuding postpartem transfer, when her births are always at home or at her home-from-home centre. ( There is an interesting article on home birth safety on their website)

Instead of simply labelling home birth as dangerous, it is essential that we establish why, if the data is correct, it might be dangerous in some situations and not in others. And based on this, we need to make provisions for the minority who might still choose to birth at home, to ensure that being at home is made as safe as it can be. In scenarios such as these, scare-mogering headlines are not at all useful. What we need is to establish what the science is really telling us, and act accordingly.

Fashion and Fad

Thursday, January 17th, 2008

It seems extraordinary that something as fundamental as birth could be subject to fashion and fads, yet you need only look to Brazil, where c-section rates are a mind-boggling 80% in some urban areas, to see that trends can take hold in the strangest of settings. This flippancy with regard to birth is usually something I lament. Surely, I argue, we should make decisions about the way we bring a child into the world with a little more intelligence?

But I have a confession to make. How loud I lament depends a little on what exactly is on fashion. When women were opting for major abdominal surgery because others were, I heaved a great big sigh of disappointment and disbelief. When I hear the latest fashion is for home birth and the natural way, I have to confess I lament a little less. (observer.guardian.co.uk/woman/story/0,,2237776,00.html)

This is not, however, because I am one of those natural birth teachers who believes in natural birth at all costs. As the grateful beneficiary of an emergency caesarean I have had first-hand experience of the perils of nature and the blessing that is major abdominal surgery. I do not believe a woman has failed if she does not give birth naturally. I do not believe a woman should be cajoled into a particular birth- natural or otherwise- by anyone or anything.

The reason I confess to a small quiet internal celebration, is that when something is in fashion, the general public become more open to it. Whereas the great voices in the world of birth found themselves knocking their heads against a wall 30 years ago when they questioned hospital protocol, now the debate is loosening up. We actually have debate. People are thinking once more about what it means to be born, and questioning the predominance of technology in the birth place. Only 2% of births take place at home now, but ‘home birth’ is beginning to take up a disproportionate amount of column inches. And best of all, instead of being bombarded with horror stories, these zealous celebrities speak of celebration and empowerment and positivity. Just the language we need to begin to develop a more balanced and measured view of birth in our culture. Hail to the fashionistas!