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Home birth Safety - some clarification

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Netherlands, which I referred to in my last blog and which are still so often bandied about, are actually hopelessly out of date.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……..

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