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.
Reply With Quote
Creator of 
Bookmarks