Posts tagged home birth

On the BBC News website today, we learn that British medical journal The Lancet has published an article declaring home births “too risky” for infants and stating that, even though giving birth at home is associated with fewer risks for the mother (“shorter recovery time and fewer lacerations, post-partum haemorrhages, retained placentae and infections”) women should “not have the right to put their baby at risk.”

Well. Ain’t that sweet? It’s as if the women’s rights movement never happened! We are but pods, oh masterful overlords. Guide us in your infinite wisdom so that we may bear unto you the fruit of our wombs, and happily give of ourselves all that will never be granted us in return. Ommm.

But wait, hasn’t planned home birth been found to be just as safe as hospital birth for low-risk women? Yes. Yes it has. But that doesn’t matter because The Lancet has an explanation for those faulty data.

Data also frequently include misclassified cases, since studies usually look at newborn outcomes in relation to the actual rather than planned delivery location…Most studies also rely on different midwifery models for home delivery, which are not generalisable.”

Not generalisable? You mean like the different midwifery models and health care systems used (but not controlled for) in the AJOG study upon which The Lancet is basing its opinion? Comparing home birth in the UK (where trained midwives attend around 90% of births and where there is a free-at-the-point-of-use national health care system) with home birth in the US — where only 8% of births are attended by midwives (some of whom are not certified) and where affordable, accessible antenatal care is not always easy to come by — is like looking at apples and oranges and declaring them the same because they are round.

Putting aside the fact that the AJOG study conflates outcomes unique to significantly different countries with a cohesive, well-rounded, controlled study of planned home birth in nations under similar health care systems, there remains a big problem with any argument that gives ultimate authority to someone other than the mother: human rights. If you believe that all decisions about a competent person’s care should remain with the individual in question and that patients, no matter their ‘ailment’, have the right to take advice into consideration but ultimately reject it, without threat of censure if the desirable outcome does not materialise, then you can’t very well say that women, even those considered high risk, are ‘not allowed’ to opt for a home birth.

The reasons for this are two-fold: one, because the definition of ‘high risk’ is subjective and varies greatly from one trust, hospital and health care provider to another. Some women are told they are high risk because they are obese, or over 35, or because they had a previous caesarean section. Hell, my friend was told she was an unsuitable candidate for a home birth because there was limited parking nearby and her rug wasn’t washable! If parking spots and interior furnishings are enough to deny a woman her right to choose, what would become of those in more ‘sinister’ predicaments, like being old or fat? The concern is that maternity units will begin labelling otherwise healthy women as ‘high risk’ (even if they’re not) and refusing them home births due to their own staffing problems, convenience or biases. It already happens all the time (“If it’s a busy night you’ll have to come into hospital, dear”) so without an NHS-wide list of which conditions and situations would contraindicate a home birth, each woman desiring one would have to hope against hope that she was being correctly assessed by an objective, patient-centred, evidence-based, fully-staffed maternity service which, at the moment, the UK does not have.

Secondly, all of this is beside the point! Even if a woman was pretty unquestionably high-risk and would statistically be safer in hospital, it would be a violation of her autonomy, agency and, yes, her human rights, to be forcibly hospitalised for observation and interventions which she may not have consented to, ‘for the sake of the baby’. Take all of the arguments for being pro-choice and apply them here — until a baby is independent of its mother’s body, it is a woman’s choice what she does with it (and where and with whom).

The vast majority of births proceed normally (or would do if they weren’t interfered with) and need little medical assistance. Many births that would have been fine on their own are tinkered with, sped up or subject to impersonal, litigation-wary hospital policy, creating their own set of complications and crises. Some women, even if they don’t need or make use of the medical assistance, are comforted by having it on stand-by. That is how our current culture frames birth; Better safe than sorry! Just in case!

But some women feel much safer and at ease in their own environment, at home, and believe in their body’s ability to give birth. Punishing mothers for doing what is best for them on the minuscule off-chance of untreatable catastrophe for the baby is akin to berating a parent whose child choked to death on a piece of food while she was at work for leaving him with a trusted care provider who didn’t also happen to be a paediatric surgeon or emergency medical respondent.

Things happen. Tragedy happens. People die, including babies. It’s always horrible. It’s always sad. Sometimes it is preventable, sometimes it isn’t. And some people will never understand even considering taking that risk, no matter how small. I get that. It’s a visceral, emotional reaction to the cultural narrative we’ve become woven into; of harm reduction at all costs, of no child left behind and one loss being one too many.

But the thing is, there is ALWAYS a chance of complications, no matter which setting you choose. Women die in hospitals during or immediately after childbirth all the time, from haemorrhaging, fatal clots (often incurred after caesarean surgery) , infections (often acquired in hospital) or human error. In cases where a woman, or her baby, would have lived if they hadn’t been in hospital — if she hadn’t had the induction that led to the caesarean that led to the her fatal embolism or the baby’s respiratory failure — do we blame them? Do we ban hospital birth and say it’s risky? No. Because ALL birth carries some element of risk. Giving birth is giving life, and life comes with risk. Are we really so terrified of mortality, or so arrogant, as to think we can eliminate it completely?

Ensuring that pregnant women have all of the information and support they need to make the decision best for THEM (not some patronising attempt to strong-arm, scaremonger or strip them of their rights and give them to people who ‘know better’) — and then trusting and respecting that decision — is the only acceptable position on this, as far as I’m concerned.

And I am concerned. I’m very concerned about what this means for pregnant women’s rights. Are you?