Home Birth continued

Radical BC Birth Stats

The number of cesarean sections performed each year in British Columbia is rising. And the probability of having one increases with age: one in five women between twenty and thirty-four years of age can expect a c-section; while one in four women over thirty-five can giving birth in hospitals will have one. And for Moms in the over-35 age range, 45% of all cesareans are repeat cesareans. Who ever said that the line “once a cesarean, always a cesarean” was obsolete? Yet conversely, the youngest mothers can expect the most complicated vaginal deliveries: 36% of all births to teenage mothers had perinatal complications is 1997. They comprised a significant percentage of the one in eleven mothers who had either forceps or vacuum extractors used to get their babies out for them; the uses of which were accompanied inevitably by episiotomies- which led 6% of the women- about 250- to lifetimes of anal incontinence.

One must put heart and feeling behind cold statistics; cesareans are not as efficient and orderly as the logic of their recording would make them seem: who could record on a government information report what a cesarean section actually feels like, or the depth of pain and humiliation women feel when doctors and nurses chat idly over their naked, opened bodies? How can anyone calculate the number of litres of urine leaked when postoperative (even decades postoperative) women sneeze, cough, or laugh at a funny movie?- or the feelings of dirtiness and worthlessness that women who can’t control their own bowels bear so sadly? Who can record the pain and shame women feel for thinking they are incapable of giving birth in their own?

Leilah McCracken has put together a site, informative, but angry. Some women go through the same procedures and go home resigned, grateful, but determined to not go through it again. Others struggle with depression, … but some like Leilah, are angry, angry enough to mobilize and educate and crusade.
Her story,

I had the privilege- and misfortune- of conceiving my first baby at nineteen. Privilege because my body was young and resilient; misfortune because I was woefully ignorant of birth. The usual route was my path- I found a doctor, read lots of books about pregnancy written by doctors, and went to prenatal classes that told me to always obey my doctor.

In the last weeks of my pregnancy, I had increasingly strong contractions- I always thought I was going into labor, but never did. This was to be the seed of my massive self-doubt in giving birth- that my body couldn’t perform; didn’t know what to do when it was supposed to do it. I learned many years later that this is prodromal labor (I wish we could get rid of the word “labor”)- one of Nature’s many different ways of perfectly easing a woman’s body into birth. ……

Brighton Homebirth Support Group in the UK lists their reasons for homebirth:

Eating during labour, if not forbidden, is more difficult in hospital. Yet recent research has shown that this is frequently associated with swifter and easier birth.
Home is also cleaner—or at least the germs are more familiar. A 1987 National Childbirth Trust (NCT) survey found that nearly 22 percent of women in hospital contracted a postnatal infection, compared with nearly 5 percent at home.

Quoting,”It is usually taken for granted that hospitals must be safe because they have the equipment and skilled staff to deal with medical emergencies,” says Sheila Kitzinger, author of Homebirth and Other Alternatives to Hospital, “but sometimes they are the cause of these emergencies in the first place.”

Over-reliance on electronic fetal monitoring makes caesarean section more likely, rather than less, with no evidence that it saves babies’ lives. Induction can mean more painful, more managed labours, and you are much more likely to have an episiotomy in hospital than at home.

“Social differences—education, general health, access to information, housing conditions, nutrition, attitudes to smoking, and ease of communication between care givers and patients—have a powerful effect on the perinatal mortality rate.”-Kitzinger

Indeed, as they have also quoted,”Homebirth has been given such bad press that there now exists the need to redress the balance and challenge the widespread myth that hospital is the only safe place in which to give birth” (Ros Claxton, Birth Matters).

Women are generally afraid to give birth, and the idea of not having a doctor in charge is terrifying to most of them. They often know nothing of the birth process, of the factors that are important, of birth positions, etc, etc.

This is us. Modern women, afraid of our bodies, afraid of our choices, afraid that we can’t do birth “right”.

One of the greatest difficulties in homebirth is the hostile climate against it. That allows for a lack of interaction and cooperation between the doctors, the midwives, and the patients. And the only real reason for the continued cronyism of the legal and medical establishment against women’s self-determination in birth choices is the economic gain and protection of their own propietary rights.

It isn’t for the good of the women or their babies, and the statistics back that up.

From an American study ( and as Kitzinger observed, one should compare matters within a specific system):
J Nurse Midwifery. 1995 Nov-Dec;40(6):483-92.

Outcomes of 11,788 planned home births attended by certified nurse-midwives. A retrospective descriptive study.

Anderson RE, Murphy PA.

“This study describes the outcomes of 11,788 planned home births attended by certified nurse-midwives (CNMs) from 1987 to 1991. A retrospective survey was used to obtain information about the outcomes of intended home birth, including hospital transfers, as well as practice protocols, risk screening, and emergency preparedness. Ninety nurse-midwifery home birth practices provided data for this report (66.2% of identified nurse-midwifery home birth practices). It is estimated that 60-70% of all CNM-attended home births reported in national statistics data during this period were represented in this survey. The overall perinatal mortality was 4.2 per 1,000, including known third-trimester fetal demises. There were no maternal deaths. The intrapartum and neonatal mortality for those intending home birth at the onset of labor was 2 per 1,000; the overall neonatal mortality rate for this group was 1.3 per 1,000. When deaths associated with congenital anomalies were excluded, the intrapartum and neonatal mortality rate was 0.9 per 1,000; the neonatal mortality was 0.2 per 1,000. The overall transfer rate, including antepartum referrals, was 15.9%. The intrapartum transfer rate for those intending home birth at the onset of labor was 8%. Most responding nurse-midwives used standard risk-assessment criteria, only delivered low-risk women at home, and were prepared with emergency equipment necessary for immediate neonatal resuscitation or maternal emergencies. This study supports previous research indicating that planned home birth with qualified care providers can be a safe alternative for healthy lower risk women.”

There are numerous key words and phrases to note. One is qualified care providers. If that means only licensed medical practitioners, I don’t agree, but if that means well trained and accountable attendents, then yes.

Birth is not always a predictable process, and those who have training in the possible scenarios will help with the best outcomes.

Another thing to note is that the better informed a woman is, the better all round. This means prenatal care. It translates into a woman who cooperates with doing what is best for herself and her baby, from decisions on eating to those on weighing the risks for herself. There is nothing wrong with a hospital birth should that be the informed choice of the woman giving birth. This is one area of life where information really makes a difference. To know what to expect.

Birth Research in the USA, or rather the lack of it, shows that there is a bias. “There is simply a dearth of homebirth research in the United States. There is a huge amount of research that has been done in other countries in which homebirth occurs frequently and is acknowledged as safe. The lack of research from the United States indicates a bias by the medical community against the practice and acceptance of homebirth as a viable alternative.”

Because of the polarization and sometimes outright bullying of women who want to choose ther own birth plan, there are those who forego any medical help at all. I find this probably the least reliable, in the sense of safe and sensible, situation.

A helpful comparison chart.

I’ve known many young women who were very enamored with homebirth options, but for whatever reason, had to transfer to a hospital. I don’t think there is any perfect way to give birth. We all want to the same thing and that is not a romantic imagined experience, but a real healthy and happy experience of having a child. We gear all our actions toward that during th epregnancy, and that continues through the birthing process. That is how it should be, not some specific method of giving birth.

It is useful to compare the statistics, and realize that for most women, who are largely low risk…. home birth is, and should be legally, one excellent option.

One woman wrote exactly my sentiments:

Birth is a very culture- oriented affair, and all the evidence ofsafety of homebirth will not matter if deep- down a woman really is fearful on an emotional level of homebirth, as she has been
influenced and indoctrinated in this belief. However, likewise for the woman who is mistrustful of hospital and afraid of interventions and views birth as a normal physiological process . She needs to have the option of homebirth available to her so that she can birth feeling safe and secure at home with her midwife. All births have potential for complications, and neither home nor hospital can
guarantee l00% success for mother and baby. We do know that most
complications do not happen within minutes and there is a sequence of
suspicious events that will allow the homebirth client to transfer in
time to hospital.

In a list of the downside one may have with homebirth:
Disadvantages of home birth…

Clients must assume a greater responsibility for their own health: physical, mental, and spiritual. This requires active ongoing participation in decision making in all aspects of their care, and a willingness to accept the consequences of those choices and decisions.

Since the hospital is currently the socially accepted location of birth, choosing otherwise may result in negative judgments and lack of support.

Cesarean section, forceps deliveries and a neonatalogist are not available at home. Transport to the hospital is necessary for these and other medical interventions.

Personal arrangements must be made for postpartum care, such as meals, housekeeping, child care, etc.

The cost of home birth may not be covered by the client’s insurance.
All this is against a backdrop of rising medical costs, and insurance unavailibility. With legal pressures causing many obstetricians to simply bow out creating shortages of those qualified providers. Homebirth has its place, and it is time the legislatures of each state recognize this.


Corroborating Citations on the Safety of Homebirth

To continue your own research…. Born In The USA Resources