Home birth

Four years ago when I was 42 I gave birth to my first child. At home. On a farm 1.5 hours from the nearest hospital, which is reached by crossing the river and traversing 20kms of dirt roads before reaching the bitumen highway.

I had engaged the services of a home birth midwife I felt safe with when I reached the 4 month milestone. She was a strong lady and I knew I could trust her completely. I believed, and still do, that home is a safe and viable birth place for many mothers and that birth rights are human rights – ie the parents get to choose.

The vitriol I encountered when I announced my decision was quite incredible. I am amazed to this day that I have forgiven some of the emails I received from my family. I educated myself, I read books and so did my husband. We both felt completely comfortable with our decision. While I might be accused of being a lentil muncher, neither of us are hippies and hubby is a red blooded Aussie tradie, farmer and crack shot (who loves lentils as much as steak). I read hundreds of birth stories, watched DVD's and worked through many of my fears or blocks which might prevent me from relaxing into a primitive birthing process.

I don't like hospitals. Never have. They stress me out. Maybe it is because I am a control freak, maybe because I am a rebel and I don't like people telling me what to do, or maybe it is because we are somehow rendered powerless and abandon responsibility for our own lives in the hallowed hospital halls. My very low blood pressure rose significantly on the two occasions I visited ante natal. On the second visit I was examined by an obstetrician who barked that I was too small even as I walked in the room and immediately started lecturing me. When he finally examined me he admitted that I was the perfect size for my dates but 'most of the mums here are so fat they can't see their pubis before they become pregnant, let alone after'. Then he harangued me about my iron levels and refusal to take prescription iron tablets because they would constipate me. 'I've never heard of it' he spat, when I mentioned the over the counter alternative supplement I was taking with success.

Needless to say I didn't bother telling him I was planning a home birth, nor did I go back to satisfy his need to berate and belittle mums to be.

The debate rages fast and furious wherever there are women and babies. Home birthers are dismissed as hippy hooligans who care only about themselves and disregard the safety of their baby. While Home Birthers protest the increasing interventionist approach to birth.

The UK has a strong culture of natural birthing in homes, birth centres and hospitals and The National Childbirth Trust is a respected charity promoting healthy birthing based on evidence based research. The UK's National Health Service actively encourages and instructs midwives to 'focus on normal birth and reduce the caesarean rate'  and prenatal and postnatal care is midwifery led, with obstetricians only called in at the discretion of the attending midwives.

The recent 'Birthplace' scientific study which was published in the British Medical Journal concludes that birth is as safe at home as in hospital. 

The Netherlands has the highest home birth rate in the western world at around 30 per cent. It also has the highest infant mortality rate in Western Europe which Home birth detractors cite as argument enough, but a closer look at the facts indicates that the vast majority of those deaths occur after hospital births so we can argue that the stats are being skewed to suit.

A detailed study by the Department of Obstetrics and Gynaecology at Erasmus Medical centre in Rotterdam in November 2011 concluded 'Home birth, under routine conditions, is generally not associated with increased intrapartum and early neonatal death, yet in subgroups, additional risk cannot be excluded.'

Home Birth rates are extremely low in the USA and Australia, where Home Birth is becoming almost impossible as Midwives are unable to source insurance for labour itself, only ante and post natal care. Recent Federal Government reforms stipulate that home birthing midwives must work in collaboration with a Doctor and therefore under their medical insurance cover. However, few medicos will collaborate with midwives and few midwives want to be constrained by the medical model of birth.

Birth is not a disease, it is a very natural function of the female body. Healthy women can birth their babies. Perhaps the problem is that women are too fat or not fit and strong enough for the rigours of birth. That's one of the things that a continuity of care midwifery model teaches mums to be – that they must be emotionally and physically fit for labour. It's not called labour for nothing – it is seriously hard work!

Just as no one in their right mind would run a marathon or climb a mountain without training beforehand, so the months of pregnancy are the time to train for impending birth. Building strength in both internal and external muscles, preparing the mind by reading birth stories, researching different positions and theories around labour etc. But the medical model doesn't advocate any of that and many mums have the 'I don't want to think about that til it happens' mentality which then means that labour pains are a rude shock.

The medical model starts with the precept that a woman cannot be more than 10 days overdue from their calculated due date. And this is interesting – I knew the date of my conception, as do many women, yet the medical profession still insisted on calculating my due date from the date of my last period. Since the last date of a period normally occurs about 10 – 14 days before ovulation, which is the most fertile time of the woman's cycle, this calculatory model is immediately and obviously flawed, yet it is the norm.

Then the medical model states that labour must progress at one cm dilation per hour from the commencement of labour – regardless of the mind or body set of the individual involved. We are all different and for some it is fast, for others slow.

On presentation at a hospital most women are offered syntocinon which is a synthetic chemical mimicking the body's own oxytocin which is the hormone which drives labour. At much the same time labouring women are also offered nitrous oxide as an anaesthetic to alleviate labour pain and stress. 'Gas and Air' sounds harmless but its use is unknown in birth in Europe and the USA where it is used mainly in dentistry. There is a huge body of research from all over the world about the ill effects of drugs on developing embryos and babies in utero which we are all well versed in (whether alcohol, nicotine or so called recreational drugs) but the definitive 1987 study by six Swedish doctors, led by Dr Bertil Jacobson, discovered distressing correlations between birth trauma and narcotic use in labour to later suicide and/or drug use/abuse. In both Mother and child.

It does seem very strange that we are so concerned with protecting the developing fetus from the ill effects of pollution and chemical concoctions, and then happy to dope them up for their initial foray into the world.

In hospitals across Australia Mums struggling with the pain of labour are offered morphine or epidural at around 5cm dilation. Medicos argue that this relaxes them, and removes the adrenalin 'fight' or 'flight' response which pain and stress triggers. Adrenalin heightens tension but slows dilation and dilation is the aim of the game in labour.

Morphine is a highly addictive opiate and like all drugs crosses the placenta immediately. Epidurals also contain opioids and often the level of relaxation and the methods of application inhibit movement in the Mum to be. Movement is the key to labour and gravity is the Mum's best and dearest friend!

As the opiates slow down dilation, so then more syntocinon is often encouraged and the spiral of ever increasing intervention continues.

Drugged babies are slower to respond, attach to the mother for breastfeeding and spend their first 62 hours coming down off the drug cocktails. So do their Mums. Not a good recipe for healthy bonding and breastfeeding.

(It is worth noting that Dr Virginia Apgar, who invented the score from 1 to 10 on which newborns are rated, worldwide, for colour, tone, breathing etc had never seen a baby born to an unmedicated Mother. Midwife Beverley Lawrence beech asked this very important question in 2004: 'If we scored the behaviour of babies born after normal births at home, what would a REAL top score baby be like? . . . No such standard exists.')

Home Birth midwifes assert that naturally born babies are brighter, more alert, often more intelligent and better at processing life's inevitable ups and downs. Of course their parents do too, but actually it is a problem. These children are very different from 'the norm' which makes integration harder but what should we do –medicate just to fit in with the masses?

In animal husbandry we talk about 'imprinting' – what the animal experiences during and just after birth it will assume as normal forever after. If we are imprinting our human babies that at the first sign of struggle, striving or pressure, what is normal is to mask those feelings with drugs, then surely we are creating our future addicts?

Yes, there are times when intervention is essential. Yes, birth sometimes goes wrong. Yes, medical science has come up with some fantastic methods to improve infant and maternal mortality. Yes, hospitals are fantastic places to go to when you are sick. But we are a pill popping culture who cannot handle pain and we have medicalised maternity too much. We must give our women more credit – they can birth brilliantly without all the drugs. We must empower them, train them, show them just how strong and invincible they can be. Nothing empowers women like surviving labour and birthing a baby on their own terms. Maybe that is the problem?