Home births a major risk- *DEBATE today on the herald sun website*

[Olive]

Home births a major risk | Herald Sun

HOW many more kids' lives will be put at risk before home births are banned?
Home birthing experts argue that giving birth at home is just as safe as being in a hospital for women in low-risk categories.

That may be close to the truth, but only if nothing goes wrong.


And the problem is that when it comes to giving birth, you never, ever know what might go wrong.

.
Fit, healthy young women can still unexpectedly have horrible, traumatic births. I should know, because I had one with my first son.

The Federal Government announced yesterday that professional indemnity insurance would not cover midwives who help women give birth at home.

They're signalling that home births are outside acceptable birthing practices and thus midwives who attend home births are basically on their own.

But this will not outlaw home births.

It will just drive them more underground, where women are further away than ever from the medical treatment they or their babies might need in an emergency.

In fact, even supporters of home births say the moves will lead to a rise in so-called freebirths, where women are assisted only by a doula, or birthing assistant, who is not trained to resuscitate babies or mothers.

For this reason, further steps need to be taken to make home births illegal.

It's all very well for a mother to want an earth-loving, feel-good experience while giving birth, but she shouldn't put her child's life at risk.

Surely the announcement by Health Minister Nicola Roxon means it's time for the home birthing movement to consider the safety of the children rather than just the needs of the mother?

Sure, there are only 700 or so home births in Australia each year, but I think that's 700 too many. The issue is gaining the sort of attention the home birth advocates wouldn't want. In an Australian first, the South Australian Coroner decided last week to investigate the death of little Tate Spencer-Koch, who was stillborn in 2007.

Tate was born at home, assisted by a midwife. She became stuck by her shoulders for 20 minutes in the birth canal. She was deprived of oxygen and died. It's the first time an essentially stillborn baby has been subjected to a coronial inquest - and under Victorian law a similar inquest could never occur.

In most cases a stillborn baby would be outside the scope of a coroner because he or she was deemed not to have been living.

But paramedics said there were natural electric pulses around Tate's heart, and that's enough to give the coroner power to investigate.

So let's hope the intervention of the Coroner's Court helps parents to take their responsibilities more seriously.

When I read about home births like this one going wrong, I can't help but think about my first son, Tom.

I was 33 and very healthy when I became pregnant with Tom. Although he was a bit underweight in the womb, he'd been developing normally.

I was induced at 37 weeks because of his small size, but fully expected to have a normal, natural delivery in a private city hospital. What happened next still chokes me up almost seven years later.

After 16 hours of drug-assisted labour, and a lot of pushing and puffing, the real work was about to begin. Our obstetrician began the actual delivery and that's when things started to go horribly wrong.

She discovered that my pelvis was too narrow for the baby's head to pass.

He was stuck.

His heart rate was dropping.

And he was becoming traumatised after such a long labour.

It was 11.30 at night - and there wasn't even time for staff to be prepped for an emergency caesarean.

So our obstetrician called in a neonatal pediatrician, scrubbed up, grabbed two sets of forceps and pulled him out by his head.

I fully believe that it was only her amazing skill that saved his life.

He was rushed into the ICU and given saline and a number of injections to keep him alive.

My husband and I sat sobbing next to his humidicrib for hours, watching his strained breathing as he battled to stay alive.

Tom was so battered and bruised that his entire body was purple, and he was under UV lights for a week.

The entire process was so traumatic for his 2.5kg body (that's just 5lb 5oz) that he stopped breathing a few hours later and the emergency pediatric team had to save his life once more.

Today, he's a vibrant, healthy, awesome six year-old, and a small scar just below his left eye is the only sign of the trauma he endured.

But where would he be if I was a mother who thought more about myself and my needs during labour than the safety of my child?

Sure, babies die in hospitals too, and there is no guarantee that being in a hospital would have saved all babies who die during birth. But surely they have a much better chance of survival with world-class medical intervention close at hand.

I don't want anyone to think that I support doctors taking over birthing totally. I fully support the excellent work done by registered midwives in appropriate venues.

And I totally respect a woman's choice to have a natural, nurturing, non-interventionist birth. But there are ways to get this without the risks associated with giving birth at home.

Birthing centres led by midwives attached to hospitals are an excellent solution, which give women the control they want over birth.

Under the changes announced by Nicola Roxon, it will be even easier than ever for women to take these options.

We all read the amazing story of kidney transplant survivor Katie Field, who risked her own life to have a baby.

If a parent wants to risk his or her own life, that is one thing, but we shouldn't risk the lives of our babies.

[Roryrory]

Didn't anyone tell Susie that the post-natal outcomes for women such as myself (ie: those who have had more than one child) are actually better after a HB than a hospital birth?

Or that in studies from Australia and overseas the death rates for HBs are the same or lower than those in hospitals?

Or that maybe, just maybe, her traumatic first birth was due to a cascade of intervention, rather than some amazingly unexpected happening?

[Calluna]

I dont claim to know much about home birth but even I can see a number of flaws in her arguement.
Argh! Arrogant people p*** me off!! Get off your freaking soapbox and go and do some research!
Ahem... *climbs down of own soapbox*

[Tanya]

I really REALLY hate when women come down on our rights like this!! It is so so sad that she is allowed to write something like this without doing some research!!

She has NO IDEA!!

[Roryrory]

It sells papers and gets trafic on the website - that just means more advertising dollars for the Hun.....

[Olive]

all the more reason to vent at 1pm today ladies!!

its wrong hey tanya!

[Schmickers]

Yesterday, Susie O'Brien, a journalist for the Sun Herald, published an opinion piece labelling homebirths a "major risk" and calling for the practice of homebirth to be made illegal.

First and foremost, this is an opinion piece. It is one woman's opinion, based on her own personal story. It cites no evidence, and make claims that are at best fanciful, and as such, it is terrifying to think that some people might use it to guide their decisions with regards to their place of birth and their choice of care provider.

Secondly, there are some major inconsistencies in what is at its heart a very sad story of a hospital birth gone wrong. True cephalopelvic disproportion (CPD) - a condition in which the head of the baby is too large to fit through the birth canal - is a very rare occurrence. In practice, the usual causes of an "obstructed labour" are poor maternal positioning or interventions which reduce the ability of the woman to labour effectively - the most common one being epidural pain relief, which in relieving the pain of labour, also limits the ability of the woman to push. Unfortunately, Ms O'Brien does not discuss how her labour was managed in her story, which makes it difficult to draw any inferences on whether her place of birth or choice of care provider might have had any effect on her outcomes. It certainly seems unlikely that true CPD would be the cause of Ms O'Brien's obstructed labour given the birth weight of her baby - 2.5kg is on the borderline of bring considered "small for gestational age" for a baby born at term. And if there had truly been a cephalopelvic disproportion, than the use of forceps would have been contraindicated, and in fact quite dangerous to the baby. All of this indicates that Ms O'Brien most likely has not been fully informed by her obstetrician on exactly what went wrong during her birth. This comes down to an issue of trust, and trust is one of the greatest motivators for women who choose to birth at home - their desire to choose a care provider who they can trust to keep them informed during the birth process, to keep them involved, to respect their desires and their wishes, and to make the best and safest decisions for both the mother and the unborn child.

If we are making our decisions based on stories, then perhaps I should tell mine. My first child was born at home, after 15 hours of slow and steady pre-labour and four hours of labour. After those first 15 hours, my wife was still only 1 cm dilated. Had we been in hospital, this would have necessitated some sort of clinical review, most likely by an obstetric registrar - a doctor who might only have had a few years of experience in obstetrics. His role would have been to determine how this labour could be augmented - perhaps an artificial rupture of membranes, which would deprive the baby of the cushioning effect of amniotic fluid, or a syntocinon drip, a drug which would induce artificially strong contractions, placing the baby under much greater physiological stress during the subsequent labour and birth. But at home, things are different. Our care provider - a midwife of over a decades experience, has assessed both mother and unborn baby, and has determined that both are coping well with the labour. She suggests a warm bath, perhaps some homeopathics, if the mother is that way inclined, or some over the counter pain relief, and a rest, to gather strength for the labour ahead.

Four hours later, our first daughter is born into my hands, in a pool of warm water. In hospital, her cord would have been cut immediately, and she would have been rushed to a warmer to be examined. At home, we hold her in the warm water, until her cord has stopped pulsating and she has fed, before she is wrapped and gently examined by our midwife, before being returned to us - to cuddle, to feed, to sleep, and to bond. We are ecstatic, mother and baby are healthy - and our already struggling public hospital system is spared the added burden of another mother and child to find a bed for.

Based on my story, I am as justified in calling for publically funded homebirth services to be extended to all Australian women, as Ms O'Brien is in calling for the practice to be made illegal.

It seems clear then, that stories and anecdotes alone are not sufficient to make sensible decisions about homebirth in Australia. When we turn to the research, however, a much clearer picture of the relative risks and benefits of homebirth emerges. Multiple research studies from various countries indicate that homebirth is as safe an option as hospital birth for women who are appropriately screened. The problems outlined above - poor maternal positioning, poor maternal preparation, and interventions that impede effective labour, such as epidural pain relief - are limited or non-existent during a homebirth. Women who are preparing for a homebirth with an appropriately trained practitioner - a midwife - receive comprehensive preparation for birth. Homebirths are almost always "active" births, where maternal positioning and mobility are encouraged to prevent obstructed labour. Midwifery practitioners are well-trained and experienced enough to recognise potential complications and to transfer their clients to a hospital setting if necessary, and I do not personally know of any midwife who does not require her clients to be booked in at their chosen hospital in advance of their birth in the event that a transfer is necessary.

So, while Ms O'Brien's story is a sad one, it is certainly not without it's inconsistencies, and it is most definitely not representative of the outcomes of babies born at home across this country. A recent Australian study publicised by the Australian Medical Association on homebirth in Australia in the last decade was only able to find a single child who had poor outcomes that were suspected to be due to their place of birth, and even in that one case, they were unable to prove that the child's death was definitely due to their homebirth. And while the authors of that study - all obstetricians - chose to draw their own conclusions from his evidence, the reality is clear - in the last ten years, homebirth in Australia has been as safe for women and their babies as hospital birth.

Decisions about place of birth, and choice of carer, should not be guided by the opinion of one woman. Public policy should not be guided by the opinion of an organisation with a vested interest in controlling and medicalising the "industry" of birth. They should be guided by the evidence available, evidence which overwhelmingly supports the safety of homebirth, regardless of the sad birth story of one woman, or the spin of groups such as the Australian Medical Association, who are by their own admission "anti-homebirth", despire the compelling evidence to the contrary. Until the government understands this, they will continue to discriminate against the women of this country who choose to birth at home, and the dedicated and highly skilled midwives who work with them.

[Roryrory]

I wish they would publish your post as a "reply" tomorrow

[BellyBelly]

She was just in the radio, head to head with Justine Caines. I missed it because my stupid computer probs but apparently Susie kept cutting Justine off and talking over her etc... and seriously, I think Justine knows a bit more about birth than a journalist.

[PumpkinZulu]

First and foremost, this is an opinion piece. It is one woman's opinion. It cites no evidence, and make claims that are at best fanciful, and as such, it is terrifying to think that some people might use it to guide their decisions with regards to their place of birth and their choice of care provider.

Secondly, there are some major inconsistencies in what is at its heart ah very sad story of a hospital birth gone wrong. True cephalopelvic disproportion is a very rare occurrence - the usual causes of an "obstucted labour" are poor maternal positioning or interventions which reduce the ability of the woman to labour effectively - the most common one being epidural pain relief, which in relieving the pain of labour, also limits the ability of the woman to push. Unfortunately, Ms O'Brien does not discuss how her labour was managed in her story, which makes it difficult to draw any inferences on whether her place of birth or choice of care provider might have had any effect on her outcomes. It certainly seems unlikely that true CPD would be the cause of Ms O'Brien's obstructed labour given the birth weight of her baby - 2.5kg is very small. And if there had truly been a cephalopelvic disproportion, than the use of forceps would have been contraindicated, and in fact quite dangerous to the baby. All of this indicates that Ms O'Brien most likely has not been fully informed by her obstetrician on exactly what went wrong during her birth. This comes down to an issue of trust, and trust is one of the greatest motivators for women who choose to birth at home - their desire to choose a care provider who they can trust to keep them informed during the birth process, to keep them involved, to respect their desires and their wishes, and to make the best and safest decisions for both the mother and the unborn child.

When we turn to the research, however, a much clearer picture of the relative risks and benefits of homebirth emerges. Multiple research studies from various countries indicate that homebirth is as safe an option as hospital birth for women who are appropriately screened. The problems outlines above - poor maternal positioning, poor maternal preparation, and epidural pain relief - are limited or non-existent during a homebirth. Women who are preparing for a homebirth with an appropriately trained practitioner - a midwife - receieve comprehensiove preparation for birth. Homebirths are almost always "active" births, where maternal positioning and mobility are encouraged to prevent obstructed labour. Midwifery practitioners are well-trained and experienced enough to recognise potential complications an to transfer their clients to a hospital setting if necessary, and I do not personally know of any midwife who does not require her clients to be booked in at their chosen hospital in the event that a transfer is necessary.

So, while Ms O'Brien's story is a sad one, it is certainly not without it's inconsistencies, and it is most definitely not representative of the outcomes of babies born at home across this country. A recent study by the Australian Medical Association on homebirth in Australia in the last decade was only able to find a single child who had poor outcomes that were suspected to be due to their place of birth, and even in that one case, they were unable to prove that the child's death was definitely due to their homebirth.

Decisions about place of birth, and choice of carer, should not be guided by the opinion of one woman. They should not be guided by the opinion of an organisation with a vested interest in medicalising the "industry" of birth. They should be guided by the evidence available, evidence which overwhelmingly supports the safety of homebirth, regardless of the sad birth story of one woman, or the spin of the Australian Medical Association. Until the government understands this, they will continue to discriminate against the women of this country who choose to birth at home.

Thankyou so much for posting all of this Schmik

I can't even formulate a reply right now, the old brain isn't working...but I'll be back

[BellyBelly]

So true Schmick, true CPD is very rare indeed. More likely in the days and times we had malnutrition and living in unsanitary conditions, or unless the mother has had substantial pelvic damage. Pelvis' were designed to work!!! Just like our digestive system. I bet it's a rare thing that a gastrointestinal surgeon hears of emergency surgery because the small intestine was too small for food to pass!

[~clover~]

The sad thing is that so many women out there considering a home birth will read this & hear the obvious emotion this woman feels & will take this article hugely into account if they don't do their own research & do it properly.
As mentioned, this woman obviously was mis-led IMO with the way her birth actually went.
I wish some people would keep their oppinions to themselves until they had done all the same research most home birthers do, so they can make a factual argument.

ETA - I wonder if she has given birth to any other, bigger babies? Surely that would show that things don't add up?

[Roryrory]

The sad thing is that so many women out there considering a home birth will read this & hear the obvious emotion this woman feels & will take this article hugely into account if they don't do their own research & do it properly.

Clover one thing I think HBing has going for it is that while women who want to HB will probably get riled up emotionally and maybe scared by the "what ifs", I think that most who choose HB are actually very good at doing their own research. Sadly, though, I think the op piece will cement the fears of many others, though.

[Little Chicken]

While homebirth is not for me, I think everyone should have the choice and access to those resources. What ever happened to balanced journalism? The thing is if you only look for bad experiences that is all you will find, same as if you only look for good. As for making home births 'illegal'. what are they going to do, fine you if you give birth at home? Take you to court? I feel sorry for the IM's who will lose their careers over this, or risk de-registration if they continue. I don't know if I would want to go back to the hospital system after working in the community. Seriously though the whole system needs a complete overhaul. Wouldn't it be great if these midwives could work out of a hospital and so be covered by the hospital but still provide the same service they did before? Insurance companies have a lot to answer for in my opinion. AAAHHHH I'm rambling, sorry about that, but this whole situation is slightly absurd. I do agree that I think the piece was publish purely to generate traffic to the website and create controversy rather then inform.

[BellyBelly]

Home births a major risk | Herald Sun

Jump onto the site now - LIVE CHAT with Susie and you can post comments.... QUICK!!!

[Olive]

OMG this chick has my blood boiling...shes there simply to argue her stupid points

[miss kris]

I have never had a home birth, let alone been pregnant ... but this womans article just makes my blood boil!! I mean sure she had a traumatic experience, and (thanks to belly belly) i can say that it was probaby due to the cascade of intervention she recieved; however ... its not her place to push her feelings on homebirth onto everyone else. She is using the same scare tactics some stupid OBs use to get women to be induced that end up being the traumatic births we hear about ... just like hers!!

It makes me mad because although i personally don't think i will have a homebirth, i will fully support any woman who choses to! They shouldn't be banning it and driving it underground, the government should be nurturing it and studying it, bringing updated and current information to the hundreds of thousands of birthing women in Australia!

Its a woman's choice and her perogative ... don't push your beliefs onto someone else, haven't we learnt that from history? Its our right as humans to believe in what we want, and to birth how we want.

[Freya]

Im horrified. For Susie and at her ignorant opinions. I was 5lb 4oz at 39wks and my mother birthed me just fine vaginally - and she was 4ft11 and a size 4! So I fail to see how she could have a pelvis so small that a 5lb 5oz baby couldnt fit out, then they can manage to fit forceps in there to pull him out. For a 37wker I would think 5-6lb would be a good weight? My 37wker was 6lb 8oz. My OB told me he was a pretty decent size for his gestation.