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A home birth is not a safe birth

Reports this week of the death during childbirth of the baby of a leading home birth advocate at her inner-western Sydney home come just as the Government is considering a review of maternity services.

The review, while advocating an increased role for midwives in co-operative settings with doctors, rejected Government funding for home births when it was released in February. This was despite the fact that more than half its submissions came from a minority of home birth advocates, who have besieged the Health Minister, Nicola Roxon, ever since.

The most ardent of lobby groups is Joyous Birth, whose convener, Janet Fraser, 40, tragically lost her baby after several days of labour at her Croydon Park home, which ended on March 27, when an ambulance was called. The NSW Coroner's Office yesterday confirmed it had received a report of the baby's death.

The last thing anyone wants to do is compound the grief of Fraser and her family, so we will spare readers further details. But as one of the most extreme proponents of home births, Joyous Birth has been influential in persuading pregnant women to shun medical intervention in childbirth. It describes as "birth rape" doctor intervention that saves the lives of mothers and babies, and has made Australia one of the safest countries in the world for childbirth.

Its website is popular, boasting 30,000 visitors each month and claiming to have doubled its membership to 1000 last year. So it is important to dispel the myth it promotes: that home birth is safe, medical intervention dangerous and obstetricians evil incarnate.

As a Wodonga obstetrician, Dr Pieter Mourik, says, the natural birth lobby "has been advocating dangerous practices and I believe the media has a responsibility to publish these cases when a totally avoidable baby death occurs … so gullible, pregnant women are not persuaded to follow these risky practices".

Dr Andrew Pesce, Westmead Hospital's clinical director of women's health, says he knows of four home births in the past eight months in western Sydney in which the baby has died, along with a further four home births in which the baby has suffered possible brain damage from oxygen deprivation; preventable tragedies if prompt medical care had been available.

Despite the disasters, Joyous Birth continues to promote 2009 as "Birth Trauma Awareness" year, urging members to write graffiti on hospital walls: "Birth rape on demand, a surgeon's right to choose"; "Did your rapist wear a mask and gown? Mine did"; "Episiotomy is genital mutilation"; "Fingers, forceps, hands, ventouse, baby - which one belongs in a vagina?"; "My body, my birth, my choice".

The website features a fantastic account of an emergency caesarean by a woman calling herself Sungaikecil:

"There is a man at the end of my bed. He is big. He is overbearing. He has soft hands. His eyes are strange … He tells me to lay [sic] back … He tells me to open my legs. I don't want to … He uses his arm to spread them. I fight him. He fights back. I am scared … He enters me. With his hand. With his fist … Where's my mum …

"There are sharp things inside me. There are people's hands inside me … My stomach is cut. One swift cut. The man is cutting me. He is scarring me. He laughs. He does not look at me. He admires his cut. The slit he made. He has wounded me."

Honestly. At the end of this deathless prose, she says she is "handed a baby". Hello? wasn't that the point?

Even if few women (2.5 per cent) are convinced by such propaganda to opt for a home birth, the anti-hospital message is pervasive, making women fear and reject basic medical help, as Ellen discovered, when she gave birth last year to her first child at Orange Base Hospital

"I'm still traumatised by the experience, and not just because it was horribly painful. Mostly, I'm furious," she wrote to me last month.

"It was virtually impossible to find anything written which was not informed by the ideologies of the powerful, anti-medical intervention natural birth lobby … [They] made my first experience of birth more painful than it needed to be …

"Two good things happened during the 18 ½ hours of trying to give birth to my son. The first was the male anaesthetist giving me an epidural, the second was the male obstetrician delivering my son with a vacuum …

"It did not take me an inordinately long time to recover because I had medical interventions. I just felt great about having a healthy baby. The only thing that was hard to recover from was that nobody had just told me the truth about birth - that it's agonising, that it's not that important in the great scheme of being a mother."

Women seduced by the "empowering" idea that only a woman knows how to deliver her child forget, as Pesce said yesterday, that "100 years ago one in 10 women died from complications of childbirth, and [one in 10] babies".

Pesce, also the president of the National Association of Specialist Obstetricians and Gynaecologists, was at pains yesterday to point out he knew about Fraser's tragedy two weeks ago but did not mention it. It was only when the story became public that he revealed seven other home birth disasters he has encountered since July.

The cases are mainly from the Blue Mountains area, and two stillbirths occurred at the hands of "doulas" - women paid to help women give birth, often former midwives. In one case last September, Pesce says the woman had been warned of the risk of a previous caesarean scar rupturing but had been offered a trial labour at Nepean Hospital. She delivered a stillborn boy at home three days later.

"The trouble is we take safety for granted now and are arguing about quality issues, like maternal satisfaction, which is important. But I'm sorry, as a clinician, survival is the most important thing." Amen to that.

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Source: Sydney Morning Herald

Are home births safe? What do you think?

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Australia should look at the UK model. Homebirths are optional and they done through the local hospital. If you or your baby are at risk, then you are taken to hospital otherwise you can stay at home and give birth. These radical groups who hate medical intervention for any reason need to be stopped, not homebirths. We can't write one off because of a bunch of nuts who think they know best. To be so naive in ones approach as they are is what is dangerous to mothers.
Posted by Mrs W, 10/04/2009 12:59:14 PM
I think it is disgusting that you are taking the personal, and very painful experience of a woman and making fun of it. It's like telling a rape victim "at least you're alive".... well, yes, but that doesn't mean that the trauma of the rape isn't going to cause her emotional and physical pain for the rest of her life. I can't believe this got past the editors, to be honest. These women deserve a FORMAL and WRITTEN appology. Whether you think home birth is safe or not, it is still the right of a woman to choose - it's a feminist issue, people.
Posted by Jo, 10/04/2009 1:41:15 PM
Many European countries have very high homebirth rates and they have better safety records than Australia. Even the UK has mainstream homebirth programs and a much higher homebirth rate than here, with good outcomes. In fact, here in Australia, some hospitals run homebirth programs. If it was so dangerous, would hospitals really run those programs? I don't think people should be pressured either way, but homebirth is a perfectly reasonable choice, and I think people who say "it's not safe" really shouldn't be so easily led.
Posted by PJ, 10/04/2009 1:49:31 PM
"The last thing anyone wants to do is compound the grief of Fraser and her family, so we will spare readers further details. " This was written in extremely poor taste as was the riducule of another womans birth trauma. Is it really ok to do anything to a woman for the purpose of getting the baby out?? Perhaps if the perpetrators of this abuse realised how women and their partners are left feeling after an experience like this they will modify their impersonal approach to emergency situations. I am a midwife and have sen doctors insert their entire hands without any discussion with the woman about the necessity of it and without seeking consent. These things are DONE TO women, without any discussion about risks and benefits or alternatives. Little wonder they are reluctant to go back to the very place where they were 'abused' albeit apparently, for their own good??? Homebirth has been shown to be a safe alternative to hospital birth in a large North American study that has figures large enough to be statistically significant and with a strong methodology, unlike the two Australian studies that are being quoted by the doctors on the negative side of this debate. The Bastian study, which is quite old...actually concludes with the confirmation that LOW RISK women birthing at home are as safe as in hospital, unfortunately this study included births that were not attended by qualified midwives, and high risk births, which also has been demonstrated in the recent sensationalist headlines and this blog. The four recent deaths were in my understanding not attended by qualified midwives nor low risk. The WA perinatal report that identified 6 deaths over several years concluded that in 5 of those cases, place of birth was not likely to have affected the outcome, additionally many of these babies , although planned homebirths, were born in hospital or had died for no apparent reason prior to labour starting. It is a sad fact that this does sometimes happen, no matter who i delivering the care.
Posted by Di, 10/04/2009 2:08:36 PM
Homebirth carries risk. Hospital birth carries risk. LIFE carries risk. It is up to each individual to decide which set of risks they are most comfortable with. It is not the place of "journalists", the general public or governments to decide which risks to impose on everyone. Homebirth parents generally choose homebirth as they feel it is the safest way to bring their child into the world, and best for the long-term health of the child too. Miranda, while you are "honeymoon fresh" (your words) from your caesarian sections, your children will suffer from the increased risks of long-term health problems such as asthma, diabetes, imbalanced bowel flora etc. How dare you call selfish those who wish to bring their child into the world free of narcotics and other chemicals? How date you also mock the heartfelt trauma of another human being, whose experience of having things done to her which she hadn't consented to, including things put inside of her, felt similar to rape? Have you walked in her shoes? Obviously not, or maybe you would not be so callous, shallow and nasty and you would be able to show a little human empathy. Shame on you.
Posted by Maree, 10/04/2009 2:46:07 PM
I am sick to death of the media, health professionals and the public with clearly NO IDEA or NO EXPERIENCE of homebirth commenting on the safety & lack of responsibility of women choosing this option. Do they honestly think that other countries (and some hospitals in Australia) would publicly fund this as an option for women if it were so irresponsible & dangerous??? You will not force or convince all women to give birth in a hospital. It is not about choosing a 'wonderful experience' over safety for these women - it is about protecting their babies & their bodies / mental health. Of course a live mother & baby are important! But so are healthy ones... Private registered midwives who attend homebirths work safely & try to work in collaboration with the medical profession. They recommend ambulance subscription, a back up booking with a hospital & refer to medical colleagues as needed. Emergency equipment is also taken to the birth. Unfortunately this collaboration is often one sided. Many doctors refuse to order important tests, prescriptions & back up bookings into the hospital. They tell the women they are being foolish & that they or their baby will die. Is it any wonder then that if a problem occurs the women are reluctant to transfer despite their midwife's advice??? Yes things can ‘go wrong’ in childbirth. This is less likely to happen though if your uterus is not hyper stimulated, your membranes not artificially ruptured & drugs in your spine are not masking the pain. Why is pumping a woman full of synthetic oxytocin & narcotic drugs, or caesarean sections for no medical reason, considered safe & responsible childbirth? Because it's the 'modern' thing to do??? Dr Pesce, I saw ‘hospital birth disasters’ every day when I worked in hospital. "Thank God I was in hospital and the doctor was there to save my baby's life!" No mention of the inappropriate care that caused the problem in the first place. Is a woman publicly demonised in the media for choosing an induction or epidural in hospital, which causes her baby to get distressed, who subsequently dies despite continuous monitoring and access to immediate surgery??? Midwives know of ‘hospital tragedies’ too but don't report these to the media! By the way, STOP talking about freebirth and homebirth as if they were the same. Freebirth is NOT the same as planned homebirth with a registered midwife in attendance and the outcomes are VERY different. Deregistering private midwives who are unable to obtain insurance will unfortunately see a rise in freebirths.
Posted by Homebirth Midwife, 10/04/2009 2:57:59 PM
I would like to see this article written about the outcomes of hospital birth - no mention is made of the number of babies and mothers that die or are injured in hospital births, and so it seems that we are comparing apples to oranges... comparing homebirths, with risks, to hospital births, with the impression that there are never any bad outcomes.
Posted by Emma Someone, 10/04/2009 3:06:27 PM
Mrs M, what hospitals have you been to where there is little or no intervention by medical staff? I've been through the system twice (and a birth centre the third time), and have spoken to many others, and little intervention in hospital is very rare (really only if you birth too quickly for them to do anything). By the way, how do you know that "too many babies have died or are left traumatised" by homebirth?Where are you getting your numbers from? There are no accurate statistics. You're just relying on the rhetoric replayed over and over in the media. We also aren't told how many babies are dead or traumatised as a result of hospital mistakes/procedures and medical interventions, not to mention the long-term health implications of these interventions. We need to stop looking at health as merely a matter of "alive" or "dead" and look at what delivers the best outcomes for long-term health as well as mere survival.
Posted by Maree, 10/04/2009 3:15:42 PM
How sad that so many people are blinded by sensational journalism. If they looked beyond the hype they would see that the issue here is one of free will and choice. Women deserve to choose where they will have their babies and with whom. No one has a greater vested interest in the health and well-being of her baby than a mother. Hospitals are not the safe and secure places people imagine them to be. The main reason that many birth horror stories are not told is that staff are bound by confidentiality agreements. The safety of homebirth for healthy women attended by a midwife (who is a trained health professional) has been well established. We don't force Jehovah Witnesses to be administered blood products if they don't consent to it and the law upholds their right as a human being to make that choice. Women deserve choices and as one that has worked now for 10 years in hospital systems..... the care is substandard for the majority of women. Furthermore, the birth IS important to how a woman feels about herself, and her ability to bond and mother her baby. Wherever they birth, women who are in partnership with their care provider, treated with respect and dignity will have a better birth experience to the woman who is treated like a child and subject to high rates of intervention. The excessive rates of intervention in other 1st world countries has now resulted in an increase in maternal deaths. Let women make their own choices, they are the ones that have to live with them.
Posted by Shelley, 10/04/2009 3:22:59 PM
Why?Why?Why? Would anyone risk their babies and their own life with a home birth??? If anything goes wrong it is usually too late by the time intervention is applied. It should be illegal to have a home birth. If women are so hell bent on home delivery why not choose a birthing centre where women can labour as they wish with their doula but with medical assistance very close by if needed. I have had 3 deliveries. 2 very "normal" but 1 in which I would have lost my son had it not been for the fact that I was in a hospital and had intensive care on hand immediately for my son. Until you experience the urgent NEED for intervention and how these wonderful Drs save lives you may not understand the dangerous position that "activists" of "home births" place you in. OUTLAW HOME BIRTHS....MAKE THEM ILLEGAL
Posted by Ruth, 10/04/2009 3:41:40 PM
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