Birthing at Home
By Phillip Thomson
“Many more women want homebirths than are ever able to get them because massive obstacles are put in their way. They’re made to feel guilty, as if it’s a self indulgence that can harm their babies.” Sheila Kitzinger, Birth You Way.
I have an aunty who was born at home and it’s the first thing mentioned when my family speaks of her. Being born at home is a rare and unique event that separates my aunty from her family. It’s always talked about in hushed tones as though she survived some sort of danger.
Why is homebirth seen as the exception? Isn’t it common sense that since the existence of human beings more births have not occurred in hospital? Cavemen didn’t invent the maternity ward the weekend after they invented the wheel.
Eighty five per cent of births are safe births that don’t need the intervention of a specialist doctor and Kathleen Fahy, Professor of Midwifery at the University of Newcastle says there’s no evidence woman or babies are safer if cared for in a major hospital.
“Research shows that the best birth outcomes and postnatal adjustment happen for women who are cared for by a known midwife who labour in a protected home or home like environment where the woman feels like she is in charge of what happens to her,” said Professor Fahy.
But what if the birth is drawn out? Wouldn’t it be better to be in hospital then? Childbirth educator Sheila Kitzinger says in her book Birth Your Way that a prolonged birth in hospital is more difficult because doctors and nurses are hovering over the mother watching for something to happen.
Slow birth in a hospital could be a bit like a group of people standing around a kitchen biting their fingernails and waiting for the kettle to boil.
What the hospital does provide that the home doesn’t have is apparatus that mother and baby probably don’t need.
Professor Fahy says this hospital environment creates fear because it’s set up to deal with surgical emergencies and scientific investigations of the baby and that this interferes with the normal hormonal regulation of labour and can also inhibit the mother-baby bond.
Hospital based maternity care is fragmented, with often 10 –15 different people involved. Women are not usually able to form relationships with the midwives or doctors, yet a trusting relationship is essential to feeling safe in labour.
Professor Fahy likens the woman not in control of her birth environment to checking into a hotel knowing you might want service from the staff but finding that strange staff members walk in and out, chat to each other, do things to you, and that you have no control.
For women this lack of control happens at a profoundly intimate and supposedly private time. No wonder women are fearful.
“Fear can lead to unnecessary surgery, sometimes with associated complications,” says Professor Fahy.
Mothers are more likely to be relaxed at home because they are in control of their space, who enters and what they may do and there are no strangers present because it’s already a place of retreat.
Phillip Thomson is a second year communication student at the University of Newcastle, majoring in Journalism. He writes articles on all subjects and would like to tell his two nieces, Chloe and Sarah, to go to bed. Now.
Benefits of homebirth
Kathleen Fahy explains safety needs to encompass short, medium and long term physical and emotional safety for both mother and baby. Her summarised research findings apply to well women who go into labour close to term who are carrying a baby with no known medical problems.
1. There’s no evidence women or babies are safer if cared for in a major hospital, indeed there’s evidence to the contrary.
2. There’s no difference in terms of women dying (an extremely rare event anyway in Western countries) based on whether they had midwifery care or standard hospital care.
3. There’s no difference in terms of babies dying based on whether they had midwifery care or standard hospital care.
4. Women who have caseload midwifery have the least medical and surgical interventions in birth (inductions, injections, infusions, epidurals, forceps, episiotomies, vacuum extractions and caesareans).
5. Since each of the procedures above have complications and side effects (some minor, some serious and some life-threatening) women who experience caseload midwifery have the best physical health outcomes.
6. Women who have caseload midwifery have higher self esteem after birth the lowest rates of postnatal depression and post-traumatic stress disorder. This is directly related to having normal births regarding surgical deliveries.
7. Women who feel good about themselves and their birthing experience have the highest success with breastfeeding and the best mother-infant attachment and interaction – setting the scene for happy children and happy families.
Is homebirth available to all Australians?
Homebirth isn’t accessible to many Australian mothers. This is because of a shortage of homebirth midwives. A lack of indemnity insurance and fear of prosecution by the authorities if something goes wrong prevents many midwives from practicing. Cost also restricts accessibility by many families.
Funding is needed to establish more midwifery-led free standing birth centres near, but separate from hospitals, which are places for sick people. The Maternity Coalition is proposing a 1:1 midwifery care model that could ease the shortages in obstetric services in some hospitals and provide greater access to the broader community.
In Holland 38 per cent of all births occur at home. Professor Sally Tracy from the University of Technology Sydney explains that in other countries midwives are respected. “In New Zealand the midwife is recognised as the most appropriate caregiver for women in childbirth. This is known as the primary health care model, that ensures that women don’t give birth with strangers,” said Professor Tracy.
Midwives need funding and Justine Caines, acting national president of the Maternity Coalition, says Medicare is an obstacle to midwives. “Medicare gives an effective monopoly of community based prenatal services to medical practitioners. Medicare unfairly prevents midwives from providing primary care services to women during pregnancy and therefore most women from choosing this option,” Justine Caines said.