Monday, December 5, 2011

Sarah Buckley: Is homebirth safe?

Sarah Buckley comments on the question:
Is homebirth safe?
Homebirth has been in the news recently, with reports that homebirth may be unsafe. 
If you read an article that reports this, it is important to note the background of the researcher or commentator, and where the research has been published. As you may be aware, there are many vested interests in the maternity care system, including individuals and institutions who could lose much of their livelihood if homebirth became more popular.

As well as this, many of us enter the caring professions with a strong "need to be needed".

It can be confronting, especially for those with long years of training, to realise that women's bodies are superbly designed for labor and birth (as I describe in my ecstatic birth ebook), and that the vast majority of mothers and babies will birth safely anywhere, without outside assistance. (As my friend, and neonatal resuscitation teacher extraordinaire Karen Strange says, "Birth is designed to work, even if there is no-one else around")

The debate about homebirth safety is not just about home birth. It is the tip of a centuries-old argument that began when medical doctors first entered the birth room: is birth intrinsically safe, or an accident waiting to happen? Can we trust women's bodies or do we need to constantly improve them with monitoring, medicating and otherwise intervening?

This argument continues to rage in other aspects of birth: for example a recent paper argues that routine induction for all women at 39 weeks (as compared to 'expectant management') would be cost-effective and beneficial for all mothers and babies.

However, as my writing and research shows, there are many known safety factors in normal birth, and likely many more that we have not yet discovered. Without a full understanding of these factors, any attempt to 'improve' birth for healthy mothers and babies is unlikely to succeed. For example, we still do not understand the processes that initiate labor, but have identified mechanisms that switch on brain protecting factors. and that do not operate before term in other animals.

You can read more on my website about homebirth safety and benefits (and see an interview with my daughter Emma** ) and my blog post Ten things to love about homebirth.


Thinkbirth said...

Ah, the lovely and knowledgable Sarah! How wonderful to have the voice of reason speaking. Thanks for this post.

The parallel universe is not a kind or good one; breeds insecurity and judgement/blame and is grounded in fear.

This one presented by Dr Sarah Buckley breeds trust and due diligence and is grounded in love.

Anonymous said...

Ah so can you answer the question you pose? Is home birth safe?

Joy Johnston said...

Anonymous, this is a great question, and I think most people would consider it an open question that cannot be answered with a simple 'yes' or 'no'. If you are asking the question as an individual, we would need to consider a lot of general health factors, as well as the specifics of your pregnancy and progress in labour.

If you are asking the question from a broad perspective, there is a lot of evidence that women who are healthy, at Term, with a healthy baby presenting head-first, who come into spontaneous labour, who do not require medication to manage pain or to achieve good progress in labour - these women can give birth at home or wherever they choose with a high degree of safety.

There are a several real hurdles in spontaneous unmedicated birth. It's one of the biggest physical challenges that a woman can take, and you don't get a practice run. Giving birth in your home, with a trusted midwife who understands how to work in harmony with physiological processes in labour in birth, is an optimal situation.

I concur with Sarah's statement that "The debate about homebirth safety is not just about home birth. It is the tip of a centuries-old argument that began when medical doctors first entered the birth room: is birth intrinsically safe, or an accident waiting to happen? Can we trust women's bodies or do we need to constantly improve them with monitoring, medicating and otherwise intervening?"

Anonymous said...

Hi Joy
Thanks for your answer. I actually would like a yes or no answer rather than a debate. The question isn't political, and if you treat it as such, you do women a disservice. This isn't simply an abstract debate, it is a real question fir real women with real babies to think about. Real information and statistics can help them make that choice. Debate doesn't. There should be an answer - is this a safe option for any woman? Yes or no?

Sarah's comment that you quoted about doctors first entering the birthing room shows a lack of understanding of the history of obstetrics. Midwives and doctors have been intervening in births for a long time, and in different ways throughout history. There is no one point in time when medicine "entered" birth and the history of obstetrics cannot be cast a female/natural versus male/intervention.

You can't doubt that medicine improved outcomes of birth. These days we don't hear about babies who got stuck and needed to be carved out of their mothers. You also can't doubt that medicine has changed the ambience and spiritual connotations of birth. Dirty-white hospital rooms and bitchy nurses aren't really conducive to a spiritually transcendent experience. Birth is one of life's great rites of passage, and hospitals certainly don't do it justice.

I'm confused about one thing though. On one hand you say that giving birth at home with a midwife who works with physicological processes is "optimal". On the other, there is the quote about doctors monitoring and not trusting women's bodies enough. What is the midwife doing if not monitoring and intervening if required? How is the midwife contributing if birth is "intrinsically safe"? I don't understand how the midwife's role plays out if they are not attending the birth in the capacity of medical adviser. And if they are, then aren't they representing the untrusting medical fraternity whose role is to monitor and medicate?

treebytheriver said...

Anonymous, I've had 4 homebirths, and attended scores of others. I think it is a lot safer than driving a car. There are ways to make driving a car safer, and ways to make it more dangerous. Research shows homebirth to be safe. But opponents will dispute that and 'torture the evidence' to assert the opposite. So what should the canny consumer think? Homebirth is not for everyone, but it should be a *choice*, an available, accessible choice. This poses no threat to the obstetric model or to those who choose and prefer the obstetric model.

Thinkbirth said...

What a lovely, respectful, insightful response Joy. Thank you.

Anonymous said...

Treebytheriver I agree with you that home birth poses no threat to the obstetric model and yes, choice is worthwhile. As a pregnant lady, I want to know the answer - yes or no, is it safe?

Thinkbirth said...

Anonymous, asking is homebirth safe and wanting a definitive 'yes' or 'no' answer is like asking if sex is safe. The answer depends on context. The environment (both internal and external)of the woman is crucial. You really have to ask yourself what's important to you and surround yourself with those that will support you in how you want things to be. If you don't feel safe at home, then it may not be the safest place for you. Our physiology responds to our reactions to what we think and what goes on in our external enviroment. You may find this article helpful.

Your safest place to give birth is where you feel safe. I wish you all the very best with the birth of your beautiful baby, where ever is best for you.

Rebecca said...

Dear Anonymous, there isn't really an answer to your question because the word 'safe' implies no risk at all. There is inherent risk in all births. Generally though, this is a lot lower that we are taught to believe from horror stories and media portrayal of birth. For low risk pregnancies home birth with experienced home birth midwives has the same risk of mortality as hospital birth, with many many many more benefits. For some theoretically higher risk pregnancies, such as those involving VBACs, the risk may be similar as well. Just don't believe that a hospital birth with obstetrician will always be 100 percent safe though, just because these sad stories never make the news.
Ultimately it depends on where you feel safe and the experience of your birth attendant, particularly with normal birth rather than just emergencies. talk to other home birth mums, talk to some midwives, and you will figure out what is right for you. I know the births of my two boys at home were safe and had a fantastic outcome, the best experiences of my life. As long as this pregnancy goes well, I will be having a home birth for this little one next year too.
All the best!

Joy Johnston said...

Great questions and answers!

This one is very valid in the context of the whole discussion "What is the midwife doing if not monitoring and intervening if required?"

A midwife attending a woman who intends to give birth spontaneously works on 'Plan A' - supporting undisturbed, uninterrupted, non-interventionist, hands off, 'do-it-yourself' principles. The 'monitoring' is predominantly a sensing by the midwife, of the woman's wellbeing, and progress. When the midwife listens to baby's heart sounds after a contraction, the baby tells the midwife how it was during the contraction. This allows the midwife to make objective clinical assessments of baby's condition as labour progresses.

'Plan B' is considered, and the woman makes decisions about interventions, only when concerns exist about the safety or suitability of 'Plan A'. 'Plan B' usually means a change of plan - transferring from home to working with the medical/nursing team at the hospital.

I may not be speaking for all midwives here, but that's the way I understand the line between monitoring and making a decision about the need to intervene.