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Birth is no reason to go to hospital
A new Cochrane Review concludes that all countries should consider establishing proper home birth services. They should also provide low-risk pregnant women with information enabling them to make an informed choice. The review has been prepared by senior researcher, statistician Ole Olsen, the Research Unit for General Practice, University of Copenhagen, and midwifery lecturer PhD Jette Aaroe Clausen.
In many countries it is believed that the safest option for all women is to give birth in hospital. However, observational studies of increasingly better quality and in different settings suggest that planned home birth in many places can be as safe as planned hospital birth and with less intervention and fewer complications.
"If home birth is going be an attractive and safe option for most pregnant women, it has to be an integrated part of the health care system," Ole Olsen says and adds, "In several Danish regions the home birth service has been very well organised for several years. This is not the case everywhere in the world."
The updated Cochrane Review concludes that there is no strong evidence from experimental studies (randomised trials) to favour either planned hospital birth or planned home birth for low-risk pregnant women. At least not as long as the planned home birth is assisted by an experienced midwife with collaborative medical back up in case transfer should be necessary.
Fewer interventions in home birth
Routines and easy access to medical interventions may increase the risk of unnecessary interventions in birth explaining why women who give birth at home have a higher likelihood for a spontaneous labour. There are 20-60 per cent fewer interventions, for example fewer cesarean sections, epidurals and augmentation among those women who plan a homebirth; and 10-30 per cent fewer complications, for example post partum bleeding and severe perineal tears.
"Patience is important if women want to avoid interference and give birth spontaneously," says Jette Aaroe Clausen. "At home the temptation to make unnecessary interventions is reduced. The woman avoids for example routine electronic monitoring that may easily lead to further interventions in birth."
Jette Aaroe Clausen adds that interventions in childbirth are common in many countries, but also that there is a growing concern internationally because interventions may lead to iatrogenic effects; iatrogenic effects meaning unintended consequences of the intervention. Routine electronic monitoring may for example lead to more women having artificial rupture of membranes which in turn can lead to more interventions.
Evidence and human rights
While the scientific evidence from observational studies has been growing, the European Court of Human Rights in Strasbourg in the case Ternovszky versus Hungary has handed down a judgment stating that "the right to respect for private life includes the right to choose the circumstances of birth". This is quoted in the review.
Thus the conclusions of the review are based on human rights and ethics as well as on results from the best available scientific studies.
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"planned home birth in many
"planned home birth in many places can be as safe as planned hospital birth and with less intervention and fewer complications."
That sentence is self-contradicting.
If home births have "less intervention and fewer complications", then it is surely safer than hospital birth, so in the same time it cannot be "as safe as planned hospital birth".
Kenny - a very good point! I
Kenny - a very good point! I like your thinking. However, safety in this context seeks to counter the shroud waving stance about birth outside the system associated with medical model enthusiasts to whom safety means that both mother and baby emerge from birth alive.
You have to understand that in the medical model view of birth, interventions and complications of those interventions are seen as collateral damage of safe care and of no significance.
So the information that birth at home is safe and means less intervention and less complications than birth in hospital has to be presented in a way that is palatable to those in power, even though anyone with a functioning corpus callosum and an engaged right hemisphere of the brain knows that birth related morbidity and feelings of a lack of control have serious implications for long term health and wellbeing.
Thanks for the reply. We are
Thanks for the reply. We are so relieved. It seemed like "...we are lying" but isn't it a matter of personal choice after all and the right to ... just give them the right to. And accommodate the women to do that. To feel safe giving birth at home.
Thanks for the reply. We are
Thanks for the reply. We are so relieved. It seemed like "...we are lying" but isn't it a matter of personal choice after all and the right to ... just give them the right to. And accommodate the women to do that. To feel safe giving birth at home.
I've given birth 4 times in
I've given birth 4 times in a hospital, and 6 times at home. The two experiences can't compare. The safest birth is a birth where the mother is in control. The word "let" reveals it all. It's the difference between the hospital staff saying, "We'll let you . .' and a birthing mom saying, "I'll let you . . "
I witnessed one birth in a
I witnessed one birth in a hospital, and three at home. The birth in hospital was like 12-hour fight agains medical personel, who had very often some unexpected ideas about hurrying up the whole process, because doctor wanted to be home before evening news.
In previous comment I was ironic a bit, because I know medical standards and what is called safe, since I was working in hospital for an over 5 years. People don't realize, that going to hospital is itself very unsafe, even besides all the harm that can be done by ignorant staff. Hospital is often the only source of very dangerous microbes.
We cannot measure safety
We cannot measure safety when it is only defined in morbidity and mortality terms. Surely the inexplicable benefits of birthing in an environment where a woman feels safe and secure leads to a lifetime of benefits for both herself, her baby and her family. If the beginning is swaddled in confidence, in self-belief, in happiness derived from the relaxation of being in an environment that the woman has chosen, then this will have a flow-on effect for emotional and psychosocial wellbeing for all those impacted by the birthing experience. Safety involves not only physical safety, but emotional and mental wellbeing, impacting the way that families move towards the future as a new unit after the birth of their child.
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