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