Annalisa Barbieri: I gave birth at home – and here's why
A hospital is not a natural environment for a natural event
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Independent Minds
This week a study – the largest of its kind – was published in BJOG: an International Journal of Obstetrics and Gynaecology. It showed that giving birth at home was "as safe" as giving birth in a hospital.
Periodically, we get studies like these. They come, they make a bit of a splash and then they go again. What they're saying however is so fundamental that we can't ignore it. Because a woman's experience of labour can shape her entire life, even the relationship she then forms with her child.
I'd go further than these studies and say that giving birth at home, these days, is safer than being in a hospital. A woman in labour needs to be confident and relaxed. Fear is the enemy of labour progressing because it causes the woman's body to release adrenalin which inhibits oxytocin – the hormone needed to make the uterus contract.
A pregnant woman needs to build a relationship with her midwife so that she feels confident and the midwife can anticipate problems before they actually occur. Despite popular scare-mongering, a woman or her baby don't just die without warning in labour. There are signs that something is amiss, and these signs can be missed in a busy hospital.
All of this is difficult to achieve in a hospital where you're in a strange place, with people you may have only just met coming and going ("how are you getting on?") and with the almost constant threat of induction (which ironically is when they administer artificial oxytocin – having inhibited the natural stuff – to speed things along) if your labour doesn't conform to their timetables.
In The Father's Home Birth Handbook (a quite brilliant book, as dads are often more fearful than women of homebirths), it asks which would you prefer? Having sex at home, all low lights and candles; or in a hospital with bright lights, and where everyone is monitoring your every move. A hospital is not a natural environment for a natural event.
Eight weeks ago I gave birth to my second child. She was born at home. I had no drugs. Easy for you, you may be thinking: you were obviously low risk, brave and had a high pain threshold. I was none of those things. I was 42, my previous labour had ended in an emergency C-section and I'd spent five years grappling The Fear. But, crucially, since I'd last given birth, I'd been a lay representative in a major maternity hospital (so I had also seen the wonderful things hospitals could do) and spent four and a half years as co-founder of a parenting board. I learned that the majority of problems with childbirth weren't solved by hospitals, but introduced by them.
When I hear a woman say, "If it wasn't for the hospital little Johnny would be dead" and trace the story back, nine times out of 10 you see little Johnny would never have got into distress if his mother hadn't been in a hospital in the first place.
Home births aren't for everyone. But then, neither are hospital births, which also carry risks. We're in a unique position now in that we have more medical knowledge than ever before and most of us are near a hospital in case we need to transfer. Yet women are still told of all the risks of a home birth, and none of the benefits. The latter far outweigh the former.
Annalisa Barbieri is co-founder of www.iwantmymum.com
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Comments
May I direct your attention to UNICEF data for maternal mortality in sierra leone from 2005-2007 (http://www.unicef.org/infobycountry/si
No, this is not the way research into home birth outcomes is conducted. In virtually all recent studies, and certainly all those worth considering, outcomes for the home birth group **overall** are given, regardless of whether the woman eventually delivered at home or in hospital. Thus you will get c-section and forceps delivery rates for the homebirth group compared to the hospital group. In addition, any study worth its salt will match participants for obstetric risk - for instance, the comprehensive National Birthday Trust Fund study of home birth in the UK (pub 1997) matched 6,000 women planning homebirth at 37 weeks with paired women of similar obstetric risk level from the same area. There have been a number of such studies in Europe in the last 20 years and there is a striking consistency in the results. Generally the caesarean section rate for the planned homebirth group is around HALF the c-section rate for the planned hospital birth group. The assisted delivery (forceps and ventouse) rates are also roughtly halved, and similarly the proportion of babies born with low APGAR scores or with birth injuries (eg due to forceps) is greatly reduced. You can find references and a list of studies at www.homebirth.org.uk . One interpretation of these figures is that the price we pay for having hospital facilities immediately available, is a roughly doubled rate of serious problems in labour, due presumably to the environment not being conducive to labour, and/or to interventions becoming necessary in hospital that would not be at home, eg greater mobility at home assists descent of the baby, and the woman is more able to use coping mechanisms to manage labour pain which do not have an adverse effect on the labour, unlike an epidural, for instance, which can increase the risk of instrumental deliveries, with their attendant serious risks for the woman's pelvic floor. Another issue is hospital-borne infections, which of course are not an issue at a homebirth. The rate of postpartum infection in women after a homebirth is roughly 4%, as opposed to 25% after a hospital birth. And because of the reduced need for hospital bed-days and reduced complication rates, it has been shown that homebirths cost the NHS less than hospital births, even when transfers are accounted for (Henderson and Mugford, 1997).
Incidentally, NICE did not state that "if disaster should strike the outcome is likely to be far worse than if the woman was in a maternity hospital" - they said that the outcome " could" be worse, which I think is quite different; note that the evidence did not support a stronger statement on this subject. See the full NICE guidelines on Intrapartum Care at www.nice.org.uk and p38 for the Place of Birth statements. And what if labour does start to go wrong? Midwives at home monitor women closely, normally using a hand-held Sonicaid to check the baby's heart, just as they would for a low-risk birth in hospital. At the first sign of a complication, the woman can transfer to hospital, with the midwife phoning ahead to allow the hospital to prepare. The idea is to transfer *before* a situation gets serious, not just to wait at home and cross your fingers. Clearly if a dire emergency occurs, the best place to be is in an operating theatre. The point is that, by starting off at home, you are drastically reducing the chance of this emergency happening in the first place - and the excellent outcomes for homebirth in the UK and Europe show that such nightmare scenarios must be very rare, or we would expect to see a difference in the mortality rate between planned homebirths and planned hospital births - which we don't.
Nobody is suggesting that homebirths are right for everybody, or that women should be forced to stay at home. But women who are interested in homebirth can be reassured that there is a good body of evidence in support of their choice.
Angela Horn - www.homebirth.org.uk
Congratulations Annalisa on the birth and thanks for a sound and informative article. If more women insisted on a home birth then the authorities might provide a decent midwifery service. This would be to the benefit of all pregnant and labouring women.
I have successfully given birth at home twice (son aged nearly 4, daughter aged nearly 2) and had fantastic support from my local NHS midwife service (Reading, Berkshire) from the moment I first mentioned having a home birth.
My two labours were virtually identical, (twelve hours / ten hours) and followed text-book descriptions with no complications to report. Why was I so lucky? Well, I'm in my early thirties, fit and healthy, fairly well informed but above all I let my body get on with what nature had intended it to do without fear and medical intervention.
Why more women don't have home births is beyond me. Hopefully more articles like Annalisa's will encourage women to trust in nature and go the non-intervention route, after all it's what we're designed to do and most women are entirely capable of it.
So all should go home and deliver.
I thank you
Firozali A. Mulla
Not one of my home birth midwives ever got rich, they do this because they are true professionals, highly trained and they love their jobs ! What a pity they are still hounded by the so-called medical " proffession" ~ come on, share the births out, there are still enough to go around without making paupers out of doctors who have invested years in their eduatcions.
Thank you Midwives!
Hilary
Thank you for mentioning Leah's book. I had the honour of having a sneak preview before it was published and I knew that it would fill a void - reassuring fathers that birth is, at best, an integral part of family life and therefore more naturally part of home life. For it to work for the many, we need midwives who have faith in womens' bodies and a change in the cultural attitudes that have become instilled in us in only a generation - that birth is a disaster waiting to happen.
You are applauded by the UK Doula community and all those mothers who understand the immense pleasure and tangible benefits of birthing at home.
All my love, Maddie xx
Early signs to me meant that things were not right, admittedly it took the hospital slightly longer to reach the same assumption - lets just assume that is to try and let the mother give birth naturally. Only after an emergency caesarean - only available in hospitals - were mother and baby deemed to be fine. I applaud any mother-to-be opting for a home birth given all the care and knowledge we have today but never ever under estimate how important a role hospitals play when 'things are not ok' and don't undermine those who state this.
Just for the record - for anyone open minded enough to bother reading it - here is the tale of my son (who thanks to expert medical attention is doing just great). It was an easy, healthy pregnancy, no complications, I was 28, non-smoker, non-drinker, walked every day. For no reason known, labour came on 5 weeks early. After more than a day of soul destroying pain without drugs (and yes, I do have a very high pain threshold, thanks), and an hour and a half of pushing, the poor wee devil was born, nearly choked to death with his cord wrapped round his neck 3 times. He had a grade 3 sub-arachnoid brain haemmorhage, which can't be blamed on anything but wonderful Mother Nature.
The next few weeks included my tiny infant getting 5 agonising lumbar punctures (which thankfully meant we were able to avoid a shunt by the skin of our teeth) and intensive neo-natal care including being tube fed (as he had no sucking reflex) and round the clock monitoring by ourselves and the medical staff at Mission Viejo hospital, Orange County, CA. For the next 18 months Jacob was considered at risk of developmental delay. Amazingly, though, (with much thanks to the developmental specialist, neurosurgeon and visiting nurses) my son, now 11, is bright, funny and fantastic and though he has some mild nerve damage, looks and acts like a "normal" child. Nobody would know that if not for excellent medical intervention we would both be dead. I also haemmorhaged after he was finally born, but thanks to immediate drug intervention did not bleed to death.
Good luck to anybody who is going to have a homebirth, but just be aware that complications CAN and DO arise for no reason whatsoever. It might not happen often, but it does happen. Anybody who is in doubt should watch the Australian documentary called "Losing Layla", the true story of a mother who lost her baby Layla shortly after birth due to complications that could have been prevented by medical intervention. Before that Vanessa Gorman was also a huge advocate for all natural birth and no medical intervention and the documentary takes us from start to finish of her tragedy.
What it boils down to is this, babies need to be born safely. I don't care if where you have the baby or if it comes out through your nose, so long as mum and baby are both healthy and safe. If you can manage that with a home birth, good for you. However, I will not allow you to minimise what I went through or belittle those of us who genuinely needed medical care just to survive. If you have a safe, easy labour a large part of that is simple good luck. Nothing more. And by the same token complications in childbirth are usually just down to nothing but bad luck, whether you care to admit it or not.
I wouldn't wish what we went through on anbody. Wishing all prospective parents and babies the very best of luck, whatever they choose.
Let me ask you all a hypothetical question, If you knew you were going to be shot at and you could choose the location, would you choose the middle of an emergency room or the middle of forest on the hopes you wouldn't get hit? If you were going to get in a car crash would you rather be on a street front of a hospital or miles away?
If you're going to give birth at home and something goes wrong, where are you going to go?,,,, The hospital??? I say skip the middle man and start at the end.
Pregnancy is safe. Modern medicine and Hospitals have contributed substantially to that. Why do we always look at the past with rose colored glasses? I don't care if it's Sierra Leone or The Netherlands, I think we can all agree that the death rate for mothers and children has fallen as health care has improved.
My wife gave birth to our first son in a hospital the same day friends of ours gave birth to their daughter. Our two experiences could not have been more different. My wife scheduled her birth. We showed up at our appointed date and time to the hospital and they induced her. There was nothing stressful or scary about any of it. She gave birth to a healthy 9 pound 3 ounce boy and I wouldn't change a thing about it.
Our friends are a bit different than us. They say they're a little more in touch with the earth and all things "natural" (we lovingly refer to them as "granola"). She decided to have her birth at home because it would be a more "natural" and "peaceful" introduction to the world and family for the baby. The baby was breached and that's where all the "fun" began. Ambulances were called, sirens were sounded, paramedics whisked them away. In the end, their baby girl almost died despite the herculean effort by countless paramedics, nurses, and doctors. If they'd started at the hospital, this whole thing would be of little note.
Trust me, skip the middle man and start at the end.