Hospital vs home birth: making informed decisions

// 18 May 2014

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Journalist Rosie Millard penned an article for The Independent this week (content note for disablist language in the article title), regarding the change in NICE guidelines around home births. The new guidelines state that, for people with wombs who have already given birth, choosing to have subsequent babies at home or in midwife-led centres is as safe, if not safer, than giving birth in hospital.

The Royal College of Midwifes and NCT have welcomed the changes, a view Millard apparently does not share. Making various references to feminism that are less than complimentary, Millard states that hospital births are ‘probably not feminist to boot’ and cites getting ‘pesky (often male) doctors out of the way’ as a motivation for the change in direction. Millard refers to a point in one of her pregnancies where she ‘felt a vague (and wholly untypical) urge to be at one with the sisterhood’, and suggested a home birth to her Doctor. Said Doctor reportedly quashed the idea, telling Millard that she would never forgive herself if anything went wrong whilst giving birth at home. Sigh…

Is this age-old response really going to keep cropping up in what could otherwise be an intelligent discussion about where we choose to have our children? In essence, what the statement means is that if your child died or was seriously injured during home birth you would be regretful and would blame yourself.

Is this true? Yes. Is it a useful statement to make? I think not.

I fail to understand why this emotive statement is leveled at women considering home birth, when it would never be socially acceptable to level the same accusation at women in other contexts. If an article was written that blamed all women whose children had sadly died or been injured in car accidents for choosing to drive rather than walk then there would, rightly, be an outcry.

Millard describes birth as ‘fraught with anxiety and the possibility of life-changing tragedy’, but evidence proves that this type of birth, although it exists, is not the norm. Giving birth does not have to be the medicalised, sterile and terrifying process that some have encountered. We can only use our own birth experiences, alongside empirical evidence, to inform our choices with regards to where we give birth. Such evidence reports that the majority of pregnancies are classed as ‘low risk’ and that, for low-risk pregnancies, (excluding first-time mothers) giving birth at home carries no further risks than hospital birth. Ensuring the safety of their unborn baby is, of course, the primary consideration for most expectant mothers and I agree with Millard that birth should be made as safe as possible.

Given that the issue of safety appears to be equal, based on the evidence we are presented with, are we then allowed to consider other factors also?

Millard would suggest not. She writes that, ‘this time it’s not all about you, or your “experience”, it’s really not’.

But I would have to disagree. I am expecting my second child and planning to have a home birth. I am classed as ‘low risk’ and gave birth to my first child ‘naturally’ although forceps and a ventouse delivery, with a side order of episiotomy, did not feel very ‘natural’ to me at the time…

I read ‘Hypno-birthing – The Mongan Method’ by Mary Mongan during my first pregnancy and, although I was an inexperienced 21 year old, parts of the book resonated with me in a way that left a permanent impression. The explanations of birth as a natural process, and the descriptions of how pain, as we know it, during childbirth is not a necessity are based in common sense and backed with sound physiological evidence. I used the relaxation methods I learned from the book during the first stages of labour and arrived at hospital, met by some surprised midwifes, 8cm dilated and very relaxed. From there on I was poked, prodded, monitored and urged to do things that my body didn’t naturally want to do. I believe this is why, with no pain relief whatsoever, I was subjected to various procedures to pull my baby boy out. And I don’t think that was the way that it had to be.

So, with my next birth I have chosen to give birth at home, and I believe, for me, that it is the best choice. I would not judge anybody for choosing a different venue to birth their babies as this is a very personal choice, so I think that home birth mothers should be afforded the same respect, especially by the mainstream media. Making informed decisions without being subjected to guilt-inducing tactics and whispers of ‘what if’ should be a right of all expectant parents.

[The image is a photograph of a newborn baby being held on an adult’s bare chest, while they are still in the birthing pool. It was taken by Hobo Mama and is used under a Creative Commons Licence]

Comments From You

Saranga // Posted 19 May 2014 at 9:53 am

I read that independent article and one thing that struck me was the idea it was putting forward that a) home births are inherently unsafe, b) the medical profession push women to give birth in hospital, c) the new guidelines will mean that women are pressured into having home births for their second child.

In my experience (1st kid due very soon):

Home births aren’t inherently unsafe – safety depends on a range of factors and pregnant women will be advised on this by their midwives as they plan their birth. You have midwives with you at home births – their job is to spot complications and if things go wrong they’ll rush you into hospital.

No one has pushed me to give birth in hospital. All medical staff I’ve seen have given me info and advice and left me to make the decision – they’ve been incredibly supportive and helpful throughout.

The new guidelines do not mean that women will be ‘pressured’ into giving birth at home. To my understanding, not much will change. If you decide to have a home birth but then a complication occurs you can easily go to hospital. In my experience (limited though it is) birth plans and procedures are pretty flexible and nothing is fixed in stone.

I feel like it’s good to be in hospital for your first birth because you don’t know what to expect (that’s my reasoning for going into hospital), but for your second it’s got to be easier so why not have it at home if it is judged safe to do so and you want to be at home?

It felt like the Independent writer had an agenda and had willfully misunderstood the guidelines.

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