A Few Home Birth Truths

This entry is more than usually personal, but an article in last week’s Times has touched a nerve and I have found it difficult to respond fully without referring to my own experience – this is one topic which is best approached from a recognition of the myriad of individual experiences rather than generalisation. If you aren’t mad keen on the detail of ladies having babies may I respectfully suggest that you find a different post to read.

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Melanie Reid writes in The Times that women who want a home birth are spoilt and complacent (see Opinion in The Times, 16 April 09). Well, that’s me you’re insulting Melanie, and I’m a little miffy. In fact my baby was only supposed to be born at home, and it was only the onset of pre-eclampsia /suspected HELLP at 39 weeks 6 days – DAMN that bad timing – that prevented me from birthing at home. If I have another child I still plan to have her or him at home.

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Reid equates the low national figure for home births (c3%) with a purported English disinclination to home birth, forgetting that many of our mothers and almost all of our grandmothers birthed all their children at home and that medicalised, hospitalised birth is a really very recent phenomenon. She fails to recognise that many women who otherwise would be suitable and enthusiastic candidates for home birth (i.e. low risk pregnancies) either do not know about home birth or are discouraged from having one. I was only able to get myself booked for home birth after considerable upset and perseverance, and not before I had corrected the medically inaccurate assertion made by my midwife that 2 early miscarriages meant I should be classed as ‘high risk’ throughout (as many as 1 in 4 pregnancies are thought to result in miscarriage).

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Anyone who has researched home birth will know about the commonplace discouragement and guilt tripping that women face when they ask for home birth, and that this is often resource driven or based on poor understanding of risk. Initially I did not believe I would experience the kind of resistance to home birth that I had read about, or that (as an advocate myself) I would find it so difficult to press for my wishes to be listened to or acted upon by the medical profession.

That only 3% of women in this country undergo home birth is an indicator of how little it is encouraged – rather than of anything else. So no Melanie, it’s not because we’re British or naturally squeamish (I’m both as it happens and I still wanted a home birth), it’s because there is a modern day myth that the only safe and responsible place to give birth is in hospital. And now The Times is peddling it too – in the face of a large Dutch survey that demonstrates the opposite. 

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I don’t accept as suggested in the article that there is a ‘mass female consensus [everywhere apart from the Netherlands] that hospital is where they want to be during childbirth’. Hospital is where Melanie Reid wants to be, and no doubt a lot of other women who are – or are not – allergic to sandals or the idea that breasts were made for suckling. That’s fine, but a majority is not a consensus.

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Reid does not acknowledge that many women want to avoid hospital for reasons above and beyond some philosophical antipathy to the male medical profession (the article might make a faux apology for its exorbitant use of stereotype early on but in essence is no more than an attempt to undermine solid research with the notion that the only sandal wearing hemp clad feminist hippie types with wooly intellectual skills and a tendency to over-romanticise blood and gore would ever be insane enough to attempt home birth). Although in itself the dismissive attitude to the gendered medico-patient relationship and the skewed balance of power that creates tells me that she has never been left on an examination table struggling to get dressed whilst a male doctor huddles in the other corner of the room whispering to her husband in order to discuss the state of her cervix out of her earshot as if she were a prize cow rather than a sentient patient (yes, this did happen and yes, my other half did object). Melanie Reid does not recognise that many women (myself included) might choose home birth based upon the knowledge that an increase in intervention (bright lights, foetal heartrate monitors, beeps, drips, epidural and other drugs, high numbers of unfamiliar medical staff) has been shown to increase stress, inhibit the progression of labour (or cause it to stall) and increase risk by prolonging labour and delivery and actually precipitating the need for more intervention (forceps, c-section, ventouse etc). Not true for all – many women are reassured by medical intervention, drugs and a hospital environment – but true for some, including myself.

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The difference between that Reid and this Reed is not that I wear sandals or am planning to breastfeed my child until he is of an age where other people get squeamish (I’ve stopped both of those fetishistic behaviours some time ago) but that I have some fairly good personal reasons for wanting to avoid hospital and (more importantly) some respect for other women’s choices. And whilst I acknowledge the potential of the ‘breast is best’ lobby to make women who find breastfeeding really tough feel guilty and failed (I breastfed and still felt guilty), I also want to rail against the guilt that women are made to feel when they dare to choose birth at home.

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Home birth is as safe for low risk pregnancies as hospital birth. A woman birthing at home in 2009 is not in the same position as a woman birthing in a cave in the dark ages as Reid’s article might have us believe. She will have skilled midwifes with modern training (and limited portable equipment), she will most likely be within spitting distance of the nearest fully equipped modern hospital if unexpected complications develop, and she will have modern monitoring and aftercare.

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Women who would persist in a home birth plan when their baby is breech are few and far between, and particularly because of the modern practice of discouraging vaginal delivery in breech birth cases in favour of c-section the skills required to make breech vaginal delivery safe either in hospital or at home are simply not available. To lump this type of scenario together with straightforward low risk pregnancies in order to justify hospital birth is disingenuous. I was utterly set on home birth and underwent a very painful but successful ECV to turn my breech baby to avoid hospital, but recognised when I was beaten – I could not safely have my baby at home because of my diagnosis and so I was admitted and induced. I climbed the walls for a week, I cried a lot. But I appreciated the skill and care of the staff who had made my birth safe and who helped me to establish feeding. And next time I am told I am a good candidate for home birth.

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For anyone interested in reading more I would recommend the following book on home birth to anyone interested: Home Birth – A Practical Guide by Nicky Wesson. It’s not perfect and I suspect that much of the material is now out of date in spite of the 2006 publication date, but it is informative and helpful for anyone deciding whether home birth might be for them and anyone experiencing difficulty in getting a home birth sorted out.

PS 2 letters in The Times today about this topic, from differing perspectives.

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