Friday, November 27, 2009

Home birth - Better safe than sorry?

A topic of much heated debate is the one of birth at home. An option that I myself once considered to be for 'bush-people'. After the birth of my daughter, however, I started to see things in a different light. Even though I learned and heard about home birth in a favorabe light in my Childbirth education class, I couldn't help but think of how unsafe it was, or how 'olden-time' it is... little did I know...

I treasured the experience of childbirth so much that a few months after my daughter was born, at just 19 years of age, I decided to enroll in long distance training to certify as a Childbirth Educator. I loved it, I threw myself deep into the birthing world and as I grew and became more knowlegeable about the birthing process my thoughts and opinions surrounding home birth changed drastically as well. To begin with, I don't view midwives as 'bush-doctors' anymore nor do I view obstetricians as demi-gods either. When some people hear us talking about ob/gyns and birth some may conclude that us birth advocates are 'anti-obstetrician' but as Henci Goer put it, I'd like to think of it this way : " I believe the injudicious use of technology is doing considerable physical and psychological harm to mothers and babies."

A brief history of hospital birth

For years the American Academy of Obstetricians and Gynecologists have officially opposed home birth on grounds of safety. If the argument for universal hospitalization for childbirth is that it is safer, then it is reasonable to ask: Has moving birth into the hospital decreased the risks?

It all began in the 18th century when male midwives (equivalent to today's obstetricians) needed someone, anyone, to practice their skills in childbirth and began offering free hospital care for poor and sometimes homeless women. The first lying-in hospital was established in Dublin in 1745, which then spread to other parts of Europe and the U.S.

Doctors argue that the decrease in mortality and morbidity rate rates as moved into the hospital proves that the hospital is safer.(1)(2) Even if that statement were true, it would not mean hospital birth was responsible for the decline, but the claim is false. In the 1920s middle-class women began having babies in hospitals partly on grounds of safety. By the mid-1920s half of urban births took place there, and by 1939, half of all women and 75% of all urban women gave birth in hospitals. Even though the majority of birth took place at the hospital, maternal mortality did not drop below the 1915 levels of 63 maternal deaths per 10,000 births until the 1930s, when sulfa drugs and antibiotics to treat infection were introduced and more stringent controls were placed on obstetric practices. During that same time period, urban maternal mortality rates, where hospitalization for birth was more common, were considerably higher than overall rates: 74 deaths per 10,000 births (3). Infant deaths from birth injuries actually increased by 40%-50% between 1915 and 1929 (4).

Despite such progress in techniques and technology in the birth field, hospital birth is still not safer than home birth. Contemporary defenders of universal hospital confinement point to statistics showing higher perinatal mortality rates for out-of-hospital births (5)(6)(7), but these were raw statistics and included unintended home births and births without a trained birth attendant. No study has ever shown that planned home birth with a trained attendant who took proper precautions increased the incidence of poor outcomes among low-risk women compared with low-risk women in the hospital. The issue of the safety of home birth cannot be settled by research. While research has failed to show that home birth is dangerous, research cannot conclusively prove it to be safe. It comes down to a matter of individual choice.

Home births become dangerous only when doctors and hospitals fail to provide backup services, thus, their failure converts an imaginary risk into a real one (8)(9) which we all know results from lack of good communication and team-work which stems from the ob's often pompous attitude of always having to 'save their necks' (referring to the midwives).

From personal and others' experiences, the more I hear about births in our hospital ( yeah, any hospital for that fact) the more determination and resolve I have to birth my second and yet-to-be conceived baby at home. I cringe in horror when I hear of women's forceps or vacuum extraction deliveries, and I become more convinced to stay the heck out of a hospital in the perinatal period as much as possible.

 "No study has ever shown that planned home birth with a trained attendant who took proper precautions increased the incidence of poor outcomes among low-risk women compared with low-risk women in the hospital."

In absolute random order, off the top of my head here is why I am having the next one at home with a capable midwife with expertise in home birth and a doula :

  • Decreased risk of cesarean ( honey, just by walking into a hospital for birth increases your chances of c/s)
  • Decreased incidence of unnecessary interventions
  • No back and forth to the hospital in early labor
  • Your home, your rules, no hospital "protocol"
  • Relaxed atmosphere translates into undisturbed birth
  • No pressure to 'hurry up 'cause other women gotta get them babies too'
  • Increased initiation rates and overall success in breastfeeding
  • When openly communicated, undisturbed bonding for at least one hour after birth in the absence of a medical indication.
  • When you're ready you can get up and shower in YOUR clean shower (as opposed to a complete stranger sponge bathing you on your bed as if you were an invalid) and get in your warm bed with baby
  • Free and encouraged to move around and change positions during labor and childbirth
  • No arbitrary visiting hours (though I wouldn't want a crowd at home right afterwards)
  • No having to check out of the hospital, lugging a humongous car seat with a barely 24-hour episiotomy stitched up
  • No strange faces every 8-hour shift change
  • Your wishes for your birthing experience are more likely to be honored in a home birth setting
  • You can eat and drink freely as you wish during labor
  • Most midwives don't carry around any sort of narcotic pain relief so you won't even be tempted to think about it (which is good for me because that in turn decreases more of my risk for an unnecesarean)
  • Any amount (or none) of loved ones and supporters can be there at my opposed to the meager 2 that our hospital is currently allowing

What are my credentials for asserting such things (with accuracy) as the safety of home birth? "I can read" said Henci Goer. I can too, and so can you...

Here are some more trusted sources for information on home birth from all over the world.

  • Campbell R and Macfarlane A. Place of delivery: a review. Br J Obstet Gynaecol 1986;93(7):675-683
  • Murphy JF et al. Planned and unplanned deliveries at home: implications of a changing ratio. Br Med J 1984;288(6428):1429-1432
  • Tew M. Place of birth and perinatal mortality. J R Coll Gen Pract 1985:35(277):390-394
  • Campbell R et al. Home births in England and Wales, 1979: perinatal mortality according to intended place of delivery. Br Med J 1984;289(6447):721-724
  • Burnett CA et al. Home delivery and neonatal mortality in North Carolina. JAMA 1980;244(24):2741-2745
  • Hinds MW, Bergeisen GH, and Allen DT. Neonatal outcome in planned v unplanned out-of-hospital births in Kentucky. JAMA 1985;253(11):1578-1582
  • Schramm WF, Barnes DE, and Bakewell JM. Neonatal mortality in Missouri home births. Am J Public health 1987;77(8):930-935
  • Damstra-Wijmenga SM. Home confinement: the positive results in Holland.J R Coll Gen Pract 1984;34(265):425-430
  • Wood LAC. Obstetric retrospect. J R Coll Gen Pract 1981;31:80-90
  • Shearer JM. Five year prospective survey of risk booking for a home birth in Essex. Br Med J 1985;291(6507):1478-1480
  • Howe KA. Home births in south-west Australia. Med J. Aust 1988;149(6):296-302
  • Crotty M et al. Planned homebirths in South Australia 1976-1987. Med J Aust 1990;153:669-671
  • Woodcock HC et al. Planned homebirths in Western Australia 1981-1987: a descriptive study. Med J Aust 1990;153:672-678
  • Tyson H. Outcomes of 1001 Midwife-attended home births in Toronto, 1983-1988. Birth 1991;18(1):14-19
  • Mehl LE et al. Outcomes of elective home births: a series of 1,146 cases. J Reprod Med 1977;19(5):281-290
  • Sullivan DA and Beeman R. Four years' experience with home birth by licensed midwives in Arizona. Am J Public Health 1983;73(6):641-645
  • Koehler MS, Solomon DA, and Murphy M. Outcomes of a rural Sonoma County home birth practice: 1976-1982. Birth 1984;11(3):165-169
  • Anderson R and Greener D. A descriptive analysis of home births attended by CNMs in two nurse-midwifery services. J Nurse Midwifery 1991;36(2):95-103
  • Duran AM. The safety of home birth: the Farm study. Am J Public Health 1992;82(3):450-453
  • Parrat J, Johnston J. Planned homebirth in Victoria, 1995-1998. Aust J Midwifery. 2002;15(2):16-25
  • Johnson KC, Daviss BA. Outcomes of planned home births with certified professional midwives: large prospective study in North America. Br Med J. Jun 18 2005;330(7505):1416

(1)Phillip E. Planned and unplanned deliveries at home. Br Med J 1984;288:1996-1997
(2) Adamson GD and Gare DJ. Home or hospital births? JAMA 1980;243(17):1732-1736
(3)Dye NS. The medicalization of birth. In The American way of birth. Eakins P, ed.Philadelphia: Temple University Press, 1986
(4)Wertz RW and Wertz DC. Lying-in: A history of childbirth in America. New York: Schoken Books, 1977
(5)Brown RA. Midwifery and home birth: an alternative view. Can Med Assoc J 1987;137(10):875-877
(6)See #1
(7)See #2
(8) Treffers PE and Laan R. Regional perinatal mortality and regional hospitalization at delivery in the Nethderlands. Br J Obstet Gynaecol 1986;93(7):690-693
(9) Ford C, Iliffe S, and Franklin O. Outcome of planned home births in an inner city practice. BMJ 1991;303(6816):1517-1519

Some books on home birth

Gentle Birth, Gentle Mothering - Sarah J Buckley
Ina May's guide to Childbirth - Ina May Gaskin
The thinking woman's guide to a better birth - Henci Goer
Obstetric myths versus research realities - Henci Goer

All Images Courtesy : Google Images

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