Thursday, April 26, 2007

Home Births

Evening Standard 5 April 2007

Delivering the truth on "risky" home births

Any woman with a low risk pregnancy in London would be mad not to consider a home birth, especially if she has had a baby before.
In the capital, a transfer to hospital only takes a few minutes by ambulance. If things look dangerous, a midwife will advise a transfer long before those few minutes become critical.
Last weekend I found myself wondering yet again why humans are the only mammals who respond to birth pangs by running away from home to a huge, unfamiliar building. I am a doula, a professional birth companion. My client and I were trapped for hours in a Victorian pile with bloodstained communal toilets and broken plumbing – a Ghormenghast of a place. Not the cosy nest other mammals prepare, but the labour ward of St Mary’s Hospital, Paddington.
The hospital website boasts of “a caring and pleasant environment, excellent labour facilities with individual birthing rooms and a birthing pool”. We are wedged into a tiny room that is nearly all bed and machinery. One of the rooms opens directly onto Reception, and none have curtains screening the doors. Staff barge in frequently and interrogate my client in mid-contraction. Builder’s rubble fills the one shower stall: the ceiling has fallen in.
A labouring woman needs to be mobile to help her baby to move down – no hope of this in the few inches of space between the bed and door. Someone, somewhere, is playing pop music ceaselessly through the night. The whole building is shouting at us: “Give up! Have a C-section!”
Birth is the work of the instinctive part of our brain, which needs a familiar, private environment to function well. It is not good at accepting strange situations – and it can be very stubborn. So while the thinking part of the brain “knows” that hospital is “safe”, the primal brain is saying, “I don’t know this place or these people, I’m going into emergency mode and slowing down labour right NOW!” Fear increases tension, which increases pain.
A third of Dutch women give birth at home. Dutch women are not known for being masochists: they are known for being sensible. Doctors who gleefully recount the risks of home birth (based on statistics from rural districts in other countries) less often mention the problems of hospital interventions even in wards far more pleasant than Paddington’s Ghormenghast.
Few people realise that a midwife’s homebirth pack includes entonox and other pain relieving drugs, and resuscitation equipment. Few know that home birth in the UK died out only because Sir John Peel , the Queen’s Surgeon-gynaecologist, believed that birth would be safer in hospital than in 1960s working class homes with outside toilets.
Things are different now. We no longer live in slums, we have MRSA in hospitals. It is time to put aside Peel’s patrician scruples, and bring birth home.
Sarah Johnson