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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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Date: Newest first | Oldest first
Of her six children, my older sister has birthed five at home, happily and safely. The last few hundred years in which doctors have taken what is a family experience are finally drawing to a close. I don't say that lightly- I am married to a doctor- but there is a normal way to give birth, and on your back under lights is not it.
Posted by Chris, 16/04/2009 1:06:09 PM
I am a mother of one child at this stage. I chose to have him in a Hospital under the care of my chosen Obstetrician who was undoubtedly brilliant when he needed to intervene on behalf of my baby and me during the process. I am quite sure a home-birth would not have suited my delivery as the large size of my baby and the complications that came from that factor would have created an ambulance emergency. I was not expecting a complicated birth but 10lb 9oz is a difficult delivery for most of us. My Obstetrician was fully aware of my preferred choices for delivery regarding interventions etc. and he knew my exact position on all issues going in, barring unforseen complications. I do however believe women must have the right to birth at home if that is their preference. This must only be done in the presence of qualified midwives with appropriate certification and regularly updated training. It must only be available with an emergency back up plan if things don't go according to plan as they didn't in my case. Mothers must have regular check ups with their midwife and must be referred to a General Practitioner if any pre-birth issues arise that require follow up and additional care. Don't become reactionary and stop all home-births but make them a properly regulated and controlled option for those who prefer that method.
Posted by Lemonhead, 17/04/2009 10:08:04 PM
I am also a midwife and a mother and I practice in the UK. I have read many of these posts and am very sorry to hear about some peoples negative experiences. Homebirth is as safe as giving birth in a hospital only if the woman giving birth is at low risk of complications. That is she has not previously had a c-section, she has no hypertensive disorders, diabetes or other obstetric complications. http://news.bbc.co.uk/1/hi/health /7998417.stm It is also true that women do better in labour and post natally if they know and have a good relationship with their primary carer. Everyone has the right to choose where they give birth and midwives are obliged to attend women no matter how bizarre the location...I have heard of a woman giving birth on a boat. Judgement in not required when someone is making an informed decision.
Posted by Bethstar, 18/04/2009 2:15:17 AM
For too long we have been brainwashed by the male dominated medical profession. Fearing losing control of what has always been their domain, they send out messages aimed at scaring us to the point we are too afraid to be different. I have seen both sides of the story, I am a midwife and a mum. From my experiences I have found that those women who choose to birth at a birth centre or at home, do so after a long process involving lots of research and discussion. I admit there are always going to be women who will shun ALL medical advice and involvement....as there are women who willingly give their body and unborn baby to an obstetrician and let him decide how and when the baby will be born. I don't beleive either party involved here is 100% right or wrong. I would like to see women given all the information, on both sides of the argument....and then allow them to make their own decision. Women need to be accountable then for that decision, whichever way it goes. Why not consider a compromise....a hospital birth by an exeprienced midwife.....where the Dr is only called in should a complication arise??? Sounds good to me!
Posted by Jillidee, 20/04/2009 10:41:12 AM
My mother was in a NSW hospital when she gave birth to a still born baby who died 3 days before he was delivered... He died whilst my Mum was in hospital... this was her 11th child mind you.... Me i have had 3 births... the first child was a planned c-section as they thought my son wouldnt turn in the uterus(breech birth basically) they would not let me go full term... Cause of that system i had trouble adapting to mother hood as the hospital was pushing me to do this and that.. thankfully the 2nd child i had was VBAC but i was told early in the peice i would die if i didnt have her at the hospital(fair point to them it was only 53 weeks after my 1st child) but it scared me to peices and my partner.... nothing happened to any of us... the 3rd child it was a traumatic experience in hospital again!! i needed help and they were always too busy again it was a VBAC... this next child i WILL be home birthing as i believe if you have the right support and the Doula knows what they are doing then everything should be right... I SAY GO HOMEBIRTHING... cause hospitals can get it wrong too... look at the news lately...
Posted by AJC, 22/04/2009 1:39:38 AM
Please do not follow the NZ example of having only one midwife at a birth. There have been frequent tragic outcomes from this policy. Whether the birth is at home, in a birthing centre or in a maternity unit at a hospital, there needs to be 2 qualified staff present because there are 2 people to deal with - the mother and the baby. Last year I watched a lone midwife (as per usual practice in NZ) struggle to deliver my grandchild and deal with an exhausted mother and a tired baby. This is common prcatice in NZ and is to be avoided.
Posted by Rosie, 24/04/2009 11:56:18 AM
What is irresponsible in some of these posts, it is the selfish number of children some mothers are producing. Have you not heard of World Population targets. Act local-think Global
Posted by neighbour, 28/04/2009 12:45:21 AM
The story Kate tells of losing her baby is tragic and to not have support counselling later is devastating. I am a midwifery student and a supporter of home birth as an option for women. Women who have previouly lost a child at or soon after birth would never be classed as low risk and encouraged to birth at home. Most midwives have respect for obstetricians...in the words of one of my lecturers "highly skilled individuals who save womens lives"...what a pity that many obstetricians don't repay that respect and continue to belittle midwives, who are also highly trained and skilled.
Posted by mid student, 28/04/2009 7:24:10 AM
The death of a baby is always a tragedy, but there's a difference between 'homebirth' (at home with a trained professional caregiver) and 'freebirth' (birthing without qualified assistance). Dr Pesce is being inflammatory when he conflates the two. A new study from the US has unequivocally proved that homebirth is safe. No evidence to the contrary has been included in the recent Maternity Services Review. I advise Dr Pesce to check his data. Women should be able to choose the venue of their birth, and feel confident that with a trained professional midwife, their birth can be both safe and satisfying.
Posted by Ellie, 3/05/2009 9:38:57 PM
I work in a great hospital (as a midwife) where we have many beautiful empowering, women-centered births, thanks to the respectful midwives and some of our excellent doctors. Unfortunately I also witness some very awful, medicalized, revolting procedures being done (by midwives as well as doctors) during labour and births. If the people attending hospital births were more mindful of the beautiful nature of birth and the natural ability of a woman to give birth under her own steam, women would not be driven to give birth at home. Some of the responsibility for unnecessary cesareans also lies with the woman who go in unprepared for the pain of labour and opt for epidurals for pain relief, with the medicalized birth being the end result.
Posted by Midwife /mother, 14/05/2009 10:00:31 PM
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