Doctors And Home Birth
“Doctors who have never seen a home birth and yet feel competent to argue against it resemble those geographers who give us the description of many countries which they never saw.” — A medical book published in 1668
While 96% of women choose to birth in a hospital or birth centre, there are a growing number of women looking at other settings such as birth at home.
Some women may simply be curious about the safety and experience of home birth. Other women have had a previous traumatic experience and wish to avoid it again. Yet many women face challenges in the current maternity system which seems to actively discourage home birth as a safe and legitimate choice for low risk women.
In Australia, when first finding out about a pregnancy, most women visit their general practitioner (GP) to have their pregnancy confirmed. They also find out about their birthing options. If the woman has private health insurance, the assumption is that she will choose a private obstetrician. If she doesn’t have private health insurance, then her GP will refer the woman to her local public hospital for free maternity care (if she has a Medicare card).
Home birth has been shown to be just as safe, if not safer than hospital birth for a low risk woman. Yet if questioned about birth at home, many GPs demonstrate a shocking lack of awareness and education about the safety of home birth. Many women are discouraged or even upset by their GP’s lack of support, going on to birth in hospital, experiencing the type of intervention-heavy birth they wished to avoid. The few women who are more informed simply stop seeing their GP altogether and proceed with their home birth.
Many of the comments pregnant women have been told about home birth by their GPs are erroneous and even hurtful.
“My backup GP obstetrician (hospital funded home birth program) looked at my feet at the end of our appointment and commented that my feet were small. I say ‘and?’ Then he says there's a link between foot size and pelvis size so I would need to be aware of bub's size and perhaps home birth wasn't suitable.” — Bree
Some GPs are very supportive of women's choices – and for that we are very grateful. It's critical right at the beginning of a woman's journey to parenthood, that she can feel confident (while remaining open-minded) and supported for her choices.
However, here are 10 things doctors have said to women who expressed a desire to give birth at home:
#1: “Home Birth Is Dangerous!”
The evidence showing planned home birth is safe for low-risk women is unarguable. If your GP tells you that home birth is dangerous, make sure they are aware of this study from the UK and this study from the Netherlands. There is no increased risk of injury or death to healthy pregnant women who are able to access trained midwives for birth at home.
It might interest your doctor to know that Britain’s peak body, the National Institute for Health and Care Excellence (NICE), states obstetric care has an increased chance of interventions and risks associated with it.
“My husband suggested I try a home birth after he saw remnant blood in the labour room from the previous woman. I was told by my doctor that I shouldn't have a home birth because I was too fat (I was 85 kilograms). She even called my independent midwife and told her we were both being completely irresponsible to go ahead with it — despite being perfectly healthy. I went on to have my 10lb, 2oz baby at home, and again 20 months later, another big beautiful baby at home.” — Michelle
#2: “Midwives Don’t Know What To Do”
One of the bigger concerns doctors voice regarding birth at home is ‘will the midwife know what to do if something happens’? Midwives who attend home births are fully qualified and trained in the same way hospital midwives are. They are more likely to see fewer problems at a home birth because they are supporting one woman at a time, whom they have built a close relationship with.
Private midwives view pregnancy and birth as a normal event in women’s lives rather than potentially a dangerous one. If your midwife is from a private practice, she is not subject to hospital policies and you are more likely to avoid unnecessary interventions.
Midwives who attend home births may be part of a private practice, or from a public funded homebirth program. The hospital home birth programs do have strict criteria for inclusion and women who fail to meet these can be moved off the program.
“The GP I went to for a referral for my home birth midwife said, ‘It’s so dangerous, what happens if you go into labour and she's in the middle of eating dinner at her house? There’s too many things to take into consideration birthing at home, and I think it's completely irresponsible’.” — Emma
#3: “Home Birth Is Selfish”
Doctors often assume women are choosing to birth at home for aesthetic reasons. ‘You just want to have the oils/doula/warm and fuzzy experience and don’t care about your baby’ is the sort of attitude many women get from their doctor.
No one has more invested in a safe birth outcome than a mother. Her body, physical health and her emotional wellbeing will be affected profoundly for the rest of her life. A positive experience has the power to ensure she is respected and supported to make positive choices for her baby’s safe birth.
Her baby is more likely to be born with beneficial bacteria that will affect the child’s long term health thanks to a natural vaginal birth. Women birthing at home are less likely to experience obstetric interventions such as electronic fetal monitoring, augmentation of labor, assisted birth, c-section, and episiotomy – all of which increase risks of injury to the baby. There is more likely to be a successful breastfeeding experience which has many short and long term benefits for the baby and mother.
“[My doctor] simply told me that “that nonsense is not supported here” and would not talk to me about it at all thereafter.” — Sandy
#4: “Home Birth Is For Hippies!”
Your doctor may not be aware, but people who choose to home birth are often tertiary educated, have researched their options thoroughly, and made their own choices about birth place and care providers. Women choosing to birth at home are seeking a natural, supported experience. Labour in a hospital is rarely natural – it has been suggested about 97% of all births in Australia have interventions of some kind.
In today’s culture, it’s fairly inane to suggest people are choosing a particular birth setting to be trendy or fashionable. Social media is allowing women to become more aware of their birth options and able to connect with others who are like-minded.
“My GP told me that ‘you don't give birth in the water, you’re not a dolphin! You’re a human! Don't be stupid!’” — Brooke-Ariel
“I only saw a single GP in order to get a scan at 30 weeks, and was told I had to come back after the scan otherwise he would get the police to bring me back.” — Sarah
“On my first, when I expressed an interest in a home water birth to my GP, her response was ‘oh god no Aoife, you wouldn't want to be swimming around in your own juices!’” — Aoife
#5: “You Will End Up With A Dead Baby!”
It’s every woman’s goal to give birth to her baby safely. Despite what people think, women choosing to homebirth do care about their babies’ wellbeing and want the best outcome for their baby.
Home birth advocates are aware that natural labour and birth has many benefits for babies and increases the chances a baby will be born well and healthy. Interventions that happen in hospitals, even innocent sounding ones like fetal monitoring, can lead to further interventions that interfere with the birth process.
Sadly babies do die whether in hospital or at home. Arguing that babies born at home could be saved if they were at hospital doesn’t take into account that most babies die because of issues that could not be prevented, such as congenital abnormalities.
“When asked by the GP who confirmed my first pregnancy if I knew where I would like to have the baby, I told her that we were considering a home birth, but were undecided at that point (only 7wks along). After almost rolling off the chair, she rolled her eyes and said, ‘a home birth will end up in a dead baby and you don’t want that! Seriously, they're not safe and I am pleading with you not to have one’. I said that it was also possible for babies and mothers to pass away in hospital and she said that ‘any babies that died in hospital during birth would have died anyway, it's natures way.’” — Rebekah
#6: “You Might Bleed To Death”
Postpartum haemorrhage (PPH) is often held up as a reason to never give birth anywhere without medical assistance immediately on hand. Yet may doctors forget that private midwives carry medications to assist if a PPH does occur.
During a home birth, women are able to access the more primitive area of their brain, increasing oxytocin levels during labour and birth. The higher levels of oxytocin ensure effective contractions to clamp the uterus down once the placenta has detached.
In hospital, women are more likely to be labouring with bright lights, distractions and noise, and very little privacy – conditions that are more likely to suppress oxytocin production.
A study comparing PPH rates between hospital and planned home birth found the rates of PPH were lower in the home birth women – even if they transferred to hospital during or after birth.
“My GP tried to scare me about post partum haemhorrage based on his residency where he saw two [births] and described every detail of how they would have died without immediate surgery (back in the 1970s). He signed my IM referral whilst strongly telling me to reconsider.” — Tania
#7: “Home Birth Is Illegal”
The belief that home birth is illegal is one that demonstrates a complete lack of knowledge and awareness of the maternity system in Australia. Women have the right to choose where they give birth and home birth is very much an option.
Private practice midwives must meet certain requirements for registration with the Nursing and Midwifery Board of Australia. Privately practicing midwives must have professional indemnity insurance for antenatal and postnatal care, but are exempt from requiring insurance for labour and birth care.
As of April 2015, privately practicing midwives must be Medicare eligible in order to renew their insurance for antenatal and postnatal care when it runs out. A Medicare eligible midwife is one who has met the requirements of the Eligible midwives’ registration standard and has a Medicare Provider Number. The exemption for private midwives to hold insurance for labour and birth care has been extended until December 2016.
“I had a GP tell me that home birth was illegal in Australia. Madness. I reported her to the practice manager.” — Elly
#8: “First Time Mothers Shouldn’t Home Birth”
Most women who have a home birth are having second or subsequent babies, but this does not necessarily say anything about the safety of birth at home for first babies. Most women are seeking a more positive and less intervention heavy birth following a previous traumatic birth experience. Those women are more informed about the way hospital policies and active management of their labour contributed to their negative birth experience.
The Australian Institute of Health and Welfare released the Australia’s Mothers and Babies 2012 report, showing that 17% of women birthing at home were having their first babies. The number of women having their second baby at home almost doubled at 31%.
The most common reason given for first time mothers ‘needing’ to birth in hospital instead of home is due to the unpredictability of birth. Birth is unpredictable regardless of how many babies a woman has had and this applies in hospitals as much as in other settings. The likelihood of a woman having an undisturbed, normal birth at home is far greater than at hospital (remember it’s estimated 97% of women have interventions in hospital settings). If her first birth is a normal, positive experience, a woman has an increased chance of her future births being the same.
“When asked by my IVF specialist which obstetrician I would like a referral to, he laughed and laughed at my husband and I when I replied that we'd like a homebirth. My GP was horrified and had to leave the room to find a senior GP to warn me of the dangers and implored me to change my mind.” — Sheree
#9: “Older Women Shouldn’t Home Birth”
Older mothers are defined as women who become pregnant and give birth when they are 35 years or older. The average age women first give birth in Australia in 2012 was 30 years with 22.4% of women aged 35 years or older. Of the women who birthed at home, the average age was 31 years.
The increased risks of older women birthing include things such as miscarriage, premature birth, congenital problems with the baby and bleeding during pregnancy. These occurrences can happen regardless of what setting a woman chooses for her birth and it’s likely she will seek medical attention in a hospital if they occur.
There is an increased risk of stillbirth for women aged 35 years and older, occurring in less than 10 per 1000 births in most industrialised countries. However it’s not clear what way older age increases this risk. Further research is needed to determine the strength of the link between stillbirth and maternal age.
#10: “You’ll End Up In Hospital Anyway”
Yes, transfer to hospital from home does happen. It’s obviously what home birth women hope to avoid but are aware of (and plan for) the possibility in the event of a medical necessity.
What isn’t useful is when medical staff treat home birth women differently. In countries such as the UK and New Zealand, midwives work collaboratively with other health professionals to ensure women who are transferring are provided with safe, respectful care.
The most common reason for transfer during labour is because of maternal exhaustion – labour has gone on for a long time and mama simply needs rest and possibly pain relief. Staff supporting her at hospital can ensure her experience remains positive by being respectful of her choice.
A review of public funded home birth programs from 2005-2010 show around 17% of women transferred during labour or up to a week after birth. If transfer does happen, it shows that the maternity system is working. Midwives are making best practice decisions and supporting women to seek specialist care when needed.
“I already had one home birth, and went to my GP to get a referral. When he asked what hospital I wanted to go to, I said I'm having a home birth again. He replied, “No, I would feel better if you had your baby at hospital,” then went on to tell me how dangerous it could be etc. I had to remind him I had done it before, and I will be doing it again. Then he said, “Well it's at your own risk, and I hope nothing happens, and I will see you after the birth.” I never went back. — Alina
The rate at which women are shamed and coerced into having a hospital birth by their doctors is appaling. If you're treated badly, ridiculed or harassed by a doctor, you're well within your rights to report them. Only when we speak up will anything change. You can make a complaint to your doctor's practice manager or through AHPRA at https://www.ahpra.gov.au.
Do you think doctors should be required to attend home births for their training? Let us know in the comments section below.
For More Information And Facts About Home Birth: