While on a visit to Dublin I read your article ‘Giving birth at home isn’t bad per se. What’s bad is being miles from the ER if anything goes wrong
Your article opens with the comment from a coroner that midwives should go to home births in pairs. While it may be tempting to think that two midwives are better than one, there is no research evidence at all to support that view. Indeed, this recommendation was first adopted in the UK when it was realised that home births were cheaper than hospital deliveries and in order to increase the costs this recommendation was made.
When deciding whether or not to birth at home the parents need to balance the risks of home birth with the risks of hospital deliveries. The chances of a baby dying at a home birth is exceedingly small and that risk is far too often the focus of warnings about the dangers. For first babies it is slightly more risky than in hospital (but not significantly different) but for subsequent babies it is far safer to birth at home or in a free-standing midwifery unit. While transfer to hospital in labour is often painful and very stressful, particularly if there is concern about the baby or the mother, the majority of women who do transfer from a home birth to hospital are not doing so because there is an emergency, but because circumstances may have changed and the midwife is recommending the hospital – just in case. Furthermore, every women booked for a hospital delivery transfers to hospital in labour, and no-one has assessed the risks of doing that. Those babies born at the roadside are held up in the press as something wonderful, no-one suggests that the mother and baby would have been far safer not moving but giving birth at home instead.
Very few journalists write articles about the risks of hospital deliveries, particularly for the mother, or about babies who are induced far too soon and end up spending time in special care units. You mentioned the rising caesarean section rates. I would suggest that if there was a similar rise in major abdominal surgery in the rest of the population there would be a parliamentary enquiry and public outrage yet, because it is childbirth this often unnecessary and avoidable major surgery is accepted and rarely questioned.
In the Confidential Enquiry into Maternal Death suicide was the leading cause following childbirth, and in the latest edition it is still a major problem. AIMS had persuaded the Enquiry to look at maternal death following childbirth up to three years after the birth, but the statistics are only gathered up to one year; and, of course, Irish statistics are barely worth the paper upon which they are written. We believe that many more deaths would be recorded were the enquiry period extended. From our records postnatal depression and post traumatic stress features in far too many of the appeals to our help line.
While I acknowledge that a hospital is the place to be if a woman has a problem pregnancy or birth but for low-risk women a large centralised hospital is the last place she should be. The Birthplace Study revealed that, and now a recent study from Australia has shown that one-to-one midwifery care produces the best outcomes with fewer caesareans, 30% fewer inductions, less severe blood loss and the women were more likely to breastfeed their babies.
It is time that articles in the press drew women’s attention to the risks they are taking booking into a hospital for the birth.
Yours, Beverley Lawrence Beech
Hon Chair Association for Improvements in the Maternity Services
Birthplace in England Collaborative Group (2011) Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study, British Medical Journal, 343:d7400 doi: 10.1136/bmj.d7400
Tracy Prof SK et al. Caseload midwifery care versus standard maternity care for women of any risk: M@NGO, a randomised controlled trial, The Lancet, 17 Sept 2013, doi:10.1016/S0140-6736(13)61406-3