Home birth: a viable and safe option
Excessive gestational weight gain is common in overweight and obese women.
By Dr Meredith McIntyre
Opinion in Australia is divided on the issue of safety related to planned birth at home.
On one side of the debate supporters of women’s right to give birth at home view birth as a normal, natural process and understand that the majority of pregnant women will give birth safely with minimal need for intervention. On the opposite side of the debate supporters of birth in hospitals (and the safety that goes with it) view the act of giving birth as fraught with risk and danger.
The weight of numbers in support of birth being safest in hospitals reflects the ‘no-risk’ society in which we live, where technology-intensive childbirth is equated with high standards of care and the best interests of mothers and babies. In this society, responsible parents are those who understand that a perfectly healthy child is more important than a perfect birth. They place trust in their care providers to keep them safe, willingly doing whatever they have been led to believe might help ensure the birth of a healthy baby.
It is interesting to note then that a large proportion of women who seek to give birth at home are refugees from a previous traumatic hospital birth experience, many reporting obstetric practices that are insensitive and a maternity service that is inflexible and incapable of meeting their needs. In 2008 a survey of 2792 mothers through the Fairfax Essential Baby website highlighted the traumatic or unsatisfactory experiences of women giving birth in an overstretched system providing a ‘one-size-fits-all’ service, in which the special needs of women were dismissed.
Conflicting information and advice is a feature of current maternity services, as is staffing arrangements that cannot secure a known caregiver once the woman is admitted to a hospital maternity service. A constant stream of unknown carers undermines trust women have in the care received and decisions being made.
Despite the very remote chance of a woman dying during childbirth in Australia, pregnant women are reported to be more fearful of the birthing process than ever before. Of concern is women’s high levels of fear being sustained due to a perception of their own birth risk being out of proportion with their medical risk in a maternity service that treats every pregnancy with suspicion, in a process that has been described in the media as “antenatal scare".
In 2009, in response to 832 submissions to the National Review of Maternity Services from women, health services, maternity care professionals and a range of other key stakeholders, the Australian Government announced a major program of reform. The program recognised the need to achieve a balance between safety and improving women’s experience associated with giving birth.
In the promotion of reform, pregnant women are actively encouraged on a number of Government information-based websites to make informed choices in relation to the maternity care they receive. These same women now find themselves labelled by the maternity care professionals on whom they rely as ‘difficult’ or ‘untrusting’. Those who dare to seek more control in the process of giving birth or who choose to give birth naturally are being demonised.
In announcing the change to how maternity care is provided, the Government said they were sufficiently convinced by evidence in support of the safety of healthy women who choose to birth at home in the care of registered midwives with appropriate support services in place. Evidence of the high degree of support for women to make this choice can be found in the two home birth services currently offered by Casey Hospital in Berwick and Sunshine Hospital in the northern suburbs.
Problems arise when guidelines safeguarding home birth are not adhered to. These guidelines preclude pregnant women having twins or a breech baby at home. Sadly it is these circumstances that have resulted in highly publicised deaths of babies born at home. The death of a baby is a tragedy no matter whether birth was at home or in hospital. Having a baby in hospital does not guarantee a live baby, as many bereaved parents will attest.
There is sufficient international evidence to support the conclusion that, compared to standard hospital births, there is no difference in the safety of healthy mothers who give birth at home – and their babies – in the care of qualified midwives working within rigorous guidelines.
Despite excellent safety outcomes for healthy mothers and babies associated with giving birth at home, debate continues to undermine confidence and generate fear.
Dr Meredith McIntyre is a senior lecturer with the School of Nursing & Midwifery at Monash University.