“I don’t agree with home birth”

July 18, 2010 at 9:15 pm

I’ve encountered several statements similar to this one over the last week:

“While I do not agree with home birth…”

A few things come to mind when I hear this statement.

1) How can you “disagree” that home birth was right for me or anyone else?  Do you know my medical history?  Do you know my midwives’ level of experience and the quality of their outcomes?  Do you know your own care provider’s?  How many home birth studies have you examined? 

2) I’ve never heard a home birth advocate suggest that home birth is right for everyone.  On the contrary, I always hear home birth advocates clarify repeatedly that it isn’t right for everyone, and there are some women and babies who absolutely need to be in the hospital.  So if it’s not right for you, that doesn’t mean you “disagree with home birth.” It just means it’s not right for you.

3) I don’t even know if home birth will be right for me in the future.  Each pregnancy and birth is different, so I intend to be open to my care providers’ judgment as well as inspiration and intuition to guide me where my babies and I need to be. 

4) Can you really disagree with the facts?  I mean… I know people do all the time, but I’m inclined to believe they disagree because they simply don’t know the facts.  And “my doctor told me…” doesn’t fly with me as the sole reference point for forming an educated opinion.  You’ll only have to spend a few minutes on this site to become convinced that not everything maternity care providers think or say is true.

5) I’d wager that most of the people who utter the words, “I don’t agree with home birth,” really mean “Home birth feels scary to me” or “I don’t feel comfortable choosing home birth.” And those sentiments can change with time and research… I’m living proof of that (as are many of my blog readers, family members, and friends).

I’ll end with a lengthy excerpt from Marsden Wagner, M.D.’s “Fish can’t see water” (emphasis mine):

Many clinicians and their organizations continue to believe in the dangers of planned out-of-hospital birth, either in a center birth or at home, rejecting the overwhelming evidence that planned out-of-hospital birth for low risk women is safe. The clinician’s response to this evidence is “But what if there is an out-of-hospital birth and something happens?” Since most clinicians have never attended an out-of-hospital birth, their ‘what if’ question contains several false assumptions. The first assumption is that in birth things happen fast. In fact, with very few exceptions, things happen slowly during labour and birth and a true emergency when seconds count is extremely rare and, as we will see below, often in these cases the midwife in the birth center or home can take care of the emergency.

The second false assumption, that when trouble develops there is nothing an out-of-hospital midwife can do, can only be made by someone who has never observed midwives at out-of-hospital births. A trained midwife can anticipate trouble and usually prevent it from happening in the first place as she is providing constant one-on-one care to the birthing woman, unlike in the hospital where usually nurses or midwives can only look in occasionally on the several women in labour for which they are responsible. If trouble does develop, with few exceptions the out-of-hospital midwife can do everything which can be done in the hospital including giving oxygen, etc. For example, when a baby’s head comes out but the shoulders get stuck, there is nothing which can be done in the hospital except certain maneuvers of the woman and baby, all of which can be done just as well by the out-of-hospital midwife. The most recent successful maneuver for such shoulder dystocia reported in the medical literature is named after the home birth midwife who first described it (Gaskin maneuver).
 
The third false assumption is there can be faster action in the hospital. The truth is that in private care the woman’s doctor often is not even in the hospital most of the time during her labour and must be called in by the nurse when trouble develops. The doctor ‘transport time’ is as much as the ‘transport time’ of a woman having a birth center or home birth. Even when a caesarian section is indicated, it takes on average 20 minutes for the hospital to set up for surgery, locate the anesthesiologist, etc. and during this 20 minutes either the doctor or the birth center or home birthing woman are in transit to the hospital. This is why it is important for a good collaborative relationship between the out-of-hospital midwife and the hospital so when the midwife calls the hospital to inform them of the transport, the hospital will waste no time in making arrangements for the incoming birthing woman. These are the reasons there are no data whatsoever to support the single case, anecdotal ‘what if’ scenario used by some doctors to scare the public and politicians about out-of-hospital birth.

Recently there is a desirable movement towards basing medical practice on evidence but still today many doctors are not familiar with recent evidence nor with the means to obtain it. In a 1998 British study 76% of practicing physicians surveyed were aware of the concept of evidence based practice, but only 40 % believe that evidence is very applicable to their practice, only 27% were familiar with methods of critical literature review and, faced with a difficult clinical problem, the majority would first consult another doctor rather than the evidence. This helps explain the continuing gap between clinical practices and the evidence. . . .

Another reason for the gap between evidence and practice is the excuses often given by physicians for why they reject evidence in their medical practice. These excuses include: the evidence is out of date; collecting evidence is too slow and prevents progress; I use clinical judgment and my experience; using anecdotal ‘horror stories’ to try to prove the need for an intervention which the evidence has found unnecessary; quoting evidence which is of poor and/or inadequate quality; ‘trust me, I am a doctor’; ‘stop doctor-bashing'; evidence erodes physician autonomy. In addition to these excuses, in maternity care common excuses include: our women have smaller pelvises (no evidence), our babies are getting bigger (no evidence), our population is not as homogenous (no evidence).

Obstetricians, as members of society, tend to blind faith in technology and the mantra: technology = progress = modern. The other side of the coin is the lack of faith in nature, best expressed by a Canadian obstetrician: ‘Nature is a bad obstetrician.’ So the idea is to conquer nature and results in the widespread application of attempts to improve on nature before scientific evaluation. This has led to a series of failed attempts in the twentieth century to improve on biological and social evolution. Doctors replaced midwives for low risk births, then science proved midwives safer. Hospital replaced home for low risk birth, then science proved home as safe with far less unnecessary intervention. Hospital staff replaced family as birth support, then science proved birth safer if family present. Lithotomy replaced vertical birth positions, then science proved vertical positions safer. Newborn examinations away from mothers in the first 20 minutes replaced leaving babies with mothers, then science proved the necessity for maternal attachment during this time. Man-made milk replaced woman-made milk, then science proved breast milk superior. The central nursery replaced the mother, then science proved rooming-in superior. The incubator replaced the mother’s body for care of low-weight newborns, then science proved the kangaroo method better in many cases.