Posted by: ayrshirehealth | April 15, 2015

Home birth by @gbutcher17

On-call

I begin this blog whilst on-call for a home birth; Easter Eggsit is Easter weekend and Spring looks as if it is finally round the corner. It therefore seems very apt to be thinking about the new life waiting to come into our world. One of the biggest decisions a woman makes is where she will birth her baby. Most babies in the Western world are hospital born but this is a fairly recent event.

In the 19th century hospital birth was relatively rare and women dreaded birthing there as infection rates were very high and many did not survive. maternity on 19CThanks to people like Semmelweis and the introduction of strict hand washing the death rates fell dramatically. The main movement of birth from home to hospital however, seemed to begin in the early 20th Century and progressed more rapidly in the post-war years.

If you view a 1950’s early episode of ‘Call the Midwife’ and the majority of babies are born at home, with one woman was having her 25th baby! Look closely at birth in the 1960’s with the fourth series and you will see that maternity unit and obstetric unit births are beginning to feature more often.

Reclaim birth

By 1963 67% of births were in hospital (Madden 2007). The final blow for home birth came in 1970 with the publication of the Peel report which proposed there should be no home births at all. It was suggested that hospital was the safest place for birth even though much of the report was not backed by evidence. The less experience there is of something the less confident you get and this became true of both midwives and women. Birth arguably lost its social, emotional and psychological context and became a physical process to be managed rather like a disease process than a natural (for most) event. Medicalisation of birth occurred and by the late 1970’s intervention free birth seemed rare. Individuals, and women’s groups (most notably the National Childbirth Trust) began to reclaim birth and decline unnecessary interventions and the place of birth was once again debated.

Is hospital still the best place?

Safety is defined by the Oxford English Dictionary as the condition of being protected from or unlikely to cause danger, risk, or injury; but there is far more to be considered than risk and physical injury. Ayrshire Maternity UnitHospital birth is understandably recommended for women with special considerations (significant risk factors) and it cannot be denied that where appropriate, interventions can be life-saving. More evidence is required in relation to pathways for care however. For healthy women, having normal pregnancies intervention is not medically required (HIS 2009), and has potential to increase risk. Is hospital still the best and safest place for these women to birth?

In 2011 the National Epidemiology Unit published the findings from the Birthplace study which said that healthy women having normal second or subsequent pregnancies had a low incidence of transfer home to an obstetric unit, reduced the risk of intervention for the mother and had similar outcomes for her baby as hospital birth. So why has there not been a significant turnaround in place of birth for this group of women?

Choices are complex

There was a small flurry of media coverage when the Birthplace Study was published which largely seemed to focus on the low, but higher risks to baby, if a first time mum is aiming for a home birth. It could therefore be argued that society on the whole and women in general do not know about these findings. It may be that some midwives remain unaware. My personal view is that even with that knowledge at hand the choice in place of birth is complex:

  • three generations of women have been told it is less safe to birth at home
  • remote and rural considerations in relation to distance to hospital and weather conditions
  • even if home birth seems safe in a research study at an individual level many women will worry about the ‘but what if I am the one with the problems…’
  • women’s choices are influenced by their partners, family and friends
  • midwives in most areas are less experienced in home birth and this may affect offer and uptake of home birth

Where is the safest place to give birth?

So where is the best place for a woman to have her baby? That is a little easier to answer….wherever she feels the safest – physically, psychologically and emotionally. Women need the hormones of labour to flow in the right amounts at the right time to effectively birth their babies and if the woman is apprehensive about where she is then this could bring complications which may not otherwise have arisen (Childbirth Connection 2015). For some women this will be with the use of technology in an obstetric unit, and for others within a calm, relaxing more home like environment of a midwifery unit.

On-call

On-callThe woman I am on-call for believes her best chance of a better birth is at home in her own environment. She believes birth is a normal life event, has home birthed before without problems, and knows that the hospital isn’t far away should the need to transfer arise.

Home birth isn’t for all women but all women should know their options and be able to make an informed choice on place of birth.

Postscript – a beautiful baby girl born at home and visited by her siblings minutes after birth. Mother and baby doing well (kind permission given for references made during this blog)

This week’s blog was by @gbutcher17 (Geraldine Butcher), Consultant Midwife, NHS Ayrshire & Arran.

http://www.sciencemuseum.org.uk/broughttolife/people/ignazsemmelweis.aspx

Midwifery – freedom to practise? Edited by L Reid (2007) Edinburgh Churchill Livingstone

http://www.healthcareimprovementscotland.org/our_work/reproductive,_maternal_child/programme_resources/keeping_childbirth_natural.aspx

https://www.nct.org.uk/sites/default/files/related_documents/NCT%20ACHIEVEMENTS%20SHEET%20final%202012.pdf

https://www.npeu.ox.ac.uk/downloads/files/birthplace/Birthplace-Q-A.pdf

http://childbirthconnection.org/pdfs/CC.NPWF.HPoC.Report.2015.pdf

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Responses

  1. “Home birth isn’t for all women but all women should know their options and be able to make an informed choice on place of birth”: I agree. Thanks for an informative and interesting blog post. Good to hear that mother and baby are doing well.

    I’m now 62 but when I had my babies, in the later 1970’s and early 1980’s, hospital delivery was a given. I don’t remember the choice of having a home birth. So all my 3 sons were induced as they were “overdue”, delivered during the day shift. Born in the afternoon, two of them just past 3pm. Painful births except for the first one when I had an epidural, in Ninewells Hospital, 1976. Being a young mother I didn’t question doctors. Nowadays we have more information to hand and can be more informed. I think this is a great improvement.

    “So where is the best place for a woman to have her baby? That is a little easier to answer….wherever she feels the safest”: another welcome statement. It is encouraging to hear that mothers- to-be are being listened to and have choices.

  2. Geraldine, an uplifting piece reminding us of the importance of really listening to women and being there to support them in their choices.

    The Consultant Midwife role has been instrumental in supporting the conditions for midwives to reclaim their role in supporting women to have good births – which we know is important in giving our children the best possible start. Thank you for reminding us.


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