Home-birthing in the news for the most tragic reasons.

UPDATE: Please note that I have updated this post at 7:55pm on Tues night.

I’m approaching this subject with the extreme caution of a bomb disposal expert. But here goes.
Last time I ventured my opinion on the subject of a particular type of home-birthing called ‘free-birthing’ (which shuns all medical assistance including a midwife) I was pretty much lynched in cyberspace.
It was mid last year when I wrote a feisty criticism of the practice, suggesting those who chose to give birth that way were taking outrageous and self-indulgent risks with the most precious thing in the world – the life of their baby.

Naively, I chose not the best place to publish this criticism. It appeared in the weekly blog I was writing at the time for parenting website Essential Baby. Many of the people who hang out at that website are fairly….strident in their beliefs. About motherhood. About birth. And particularly about home birth.

My piece ignited a absolute firestorm that raged for days and despite several attempts by the site moderator to broker some peace, things degenerated almost immediately to full-on abuse and hate-filled flaming of me. Being called an ‘asshat’ at one point was the nicest thing anyone said. That bad.

In the end, the site moderator had to close comments. That didn’t placate the angry home-birthers who started up new threads to keep abusing me. So then they had to delete my post – at my request. Within a week, we’d decided to part ways (they sacked me at the same time as I decided to quit!) and I haven’t written for them since. I’m sure the Essential Baby community doesn’t miss me. The audience just wasn’t a natural fit – no disrespect to them. We just weren’t suited.

However, I didn’t back down from my stance then and nor do I now. Without going into all of it again in detail, my position is that to shun medical assistance during birth on the basis that it’s a ‘natural process’ is to ignore the fact that ‘nature’ routinely kills mothers and babies during birth. Has done since the beginning of time. I find it a bit…..ironic that women in third world countries would do anything for access to hospitals and trained professionals and yet some women in Australia choose to turn their backs on the help available to them.

If you’ve had a successful home-birth (and if you have you will no doubt be a passionate advocate of it) then I congratulate you. That’s a wonderful thing. But don’t assume everyone else will be that lucky. In fact, don’t even assume you will be that lucky next time because every birth is different.

Look, I will admit that I’ve just never understood how a woman’s desire for a particular birth experience can be so important. Personally? I have uncomplicated labours. Not too long. No need for cesareans. But with my first birth, my son had trouble breathing and needed assistance. With my third birth, I hemorrhaged afterwards and needed an injection to stop the bleeding. I have no idea if either of those things could or would have been dealt with as swiftly and effectively at a home birth as they were for me in hospital. But I’m glad I never had to find out. Me? I would care if a forklift was used to remove my baby through my armpit by a cast of 200 medical professionals. The specifics of birth are immaterial to me. All that matters is the safe delivery of my baby – which in my mind, means the closest possible proximity to medical attention and equipment.

In an editorial in the Tele today, Fiona Connelly has written a strong opinion piece along these exact lines. You can read the whole piece here but in part, she says:

It beggars belief that, given the professional care available to
Australian women, given their accessibility to essential drugs such as
antibiotics and to the equipment needed for the safe arrival of a baby,
that anyone would choose to give birth at home.

These four dead babies may have lived if born under different
circumstances. And the blame for choosing home birth lays squarely on
the shoulders of their parents. No hippie reasoning is able to convince me that parents who home
birth are placing the good of their child first. They are clearly
thinking only of themselves.

Let’s look at some of the reasons given by some of Australia’s high-profile home birth advocates. For Elle Macpherson it was having “a warm and candelit” birthing
room. “This made me feel emotionally safe as I birthed my baby gently,”
she says in a testimonial on the Homebirth Australia website.. For actor Hugo Weaving, giving birth at home was not just about relaxing but being “empowering”.

As long as Mum and Dad are happy.

Imagine what a Somali woman would say to a home birth advocate who
claimed the hospital environment was “unnatural”, that it’s “too
clinical”.

Do these crazy people practice natural root canal therapy too?

Others cited the reason for home birthing is thanks to the “impersonal” maternity system. They’re right, of course. Most women will tell you that in their
hour of need they experienced a doctor with a personality disorder and
a midwife doing a brilliant Nurse Ratched impression.

But they had drugs. And they were only ever seconds from oxygen
tanks and heart monitors and operating theatres complete with machines
that very sick newborn babies might never need but that might also get
their heart starting when stopped.

Of course some home births are unavoidable, especially thanks to the
state’s dwindling regional medical services. Many women simply can’t
last the distance to the nearest hospital.

But for the sake of a bit of Enya piping through the Boss stereo
system and the comfort of your claw-footed bath, it’s a bit rich to
deny your unborn child the medical assistance we so are blessed with,
no matter how “gentle” the little one’s entry into the world might be.

Home births are selfish, irresponsible, anti-reason and
anti-progress. Australia’s maternal mortality ratio is 8.4 per 100,000
compared to Somali where 1400 women for every 100,000 die during
childbirth.

We are gifted with advances in maternity practices that just a few
generations ago would have dreamed of and in Australia we have
obstetrics which are the envy of the modern medical world.

Regardless, like most people, I was devastated to pick up my newspaper yesterday and read that there had been four deaths during NSW home-births in the past 9 months. I really don’t want to dwell on the specifics of who or how  because losing a baby is an unimaginable tragedy and I wish those women and their families nothing but my genuine sympathy. You can go hear to read the original report if you wish to do so.

This is not about I told you so. Heaven forbid.

But can anything positive come of tragedy?
Some of the women on the Essential Baby forums who came out to attack my stance so aggressively are well known for being zealots on the subject of home birth. They often will try to persuade other women on the site to have home births. All I want to say is that if you are pregnant and you are considering it, please think very very carefully……

News Ltd reports:

Westmead Hospital
director of women’s health Dr Andrew Pesce said he was aware of at
least four deaths and another four homebirth babies who sustained
possible brain damage since last July. Dr Pesce said the tragedies showed it was time to reform maternity
services to attract back women who have become refugees from the
hospital system.

Tragic case: Mum in mourning

Dr Pesce said it was time the increased risks of home birth were acknowledged and addressed. “There are one or two extra deaths per 1000 deliveries and I wish people would acknowledge that,” Dr Pesce said. “It’s often presented as if there are no downsides to a home birth only up sides.”

He said obstetricians and the health system had to take some
responsibility and try to attract women back to the hospital system. “In the hospital system we need to get our act together rather than make them refugees of the system,” Dr Pesce said.

Australian College of Midwives president Professor Pat Brodie said more was urgently needed to be done to avoid future tragedies.”We are very concerned about a maternity care system that is so
abhorrent that women choose to do this (give birth without a
midwife),” Professor Brodie said.

She said the maternity services system needed to be re-organised so
women were assigned to a single midwife who they knew and trusted and
who could provide continuity of care throughout their pregnancy. Dr Pesce said that getting continuity of care for pregnant women
into the public hospital system was essential and might attract back
some women who chose a home birth.

Editorial: Why hospital horrors bring birth risks home

A reader emailed me yesterday to say how she had been one of the
angry women on EB who had spoken out against my original column. She’s
had several home births and feels so strongly that it was a wonderful
thing for her family but just recently, she’s begun to question the safety of
some home birthing practices that are more extreme.

She wrote: “I wish I could say something to show people why homebirth is so important to me . . . why it’s not at all about selfishness.  I wish I could but I know I never can & that’s hard.”

I want to very cautiously invite anyone with an opinion or experience around this issue to leave a comment so we can have a civil conversation about it. I am going to ask that everyone PLEASE stay respectful and remind you that the usual commenting rules apply. No flaming. I am genuinely interested to try and better understand the thought process that women make around their birth choices and I think much can be gained from sharing our thoughts and experiences