Monday, June 13, 2011

Why I chose homebirth

This guest post was written by Miranda Davies.




Almost 3 weeks ago, I gave birth to my second child at home, a gorgeous little boy, in the bath at home, with my husband and two midwives present. It was an amazing experience that I will cherish forever.

I cannot describe how wonderful it is to be able to give birth in the comfort of your own home, at your own pace without people trying to interfere or tell you what to do. I came to understand what it meant for ‘me’ to be in charge of giving birth, no one would do it for me, which is so far removed from the concept of the Dr. or midwife ‘delivering’ the baby. Yet I was also well aware that I was in good hands if something was so come up, which meant I felt very safe.

When I first became pregnant I could not have imagined ending up having my baby at home. Homebirth sounded like an ideal situation, but we don’t have much exposure to it in our society. It is assumed that you see a Doctor and have your baby in hospital. Towards the end of my first pregnancy I watched ‘The business of being born’. It immediately clicked with me. My husband and I both thought that having a homebirth just made sense, not this time around, but in the future. The birth of my first child went reasonably smoothly with only a relatively small amount of intervention.

When we got pregnant again for the second time, we once again discussed the idea of homebirth, but were not 100% sure. We knew that we wanted midwife care; I firmly believe that for healthy pregnancies an obstetrician is overkill, pregnancy is not an illness. I also knew that the rates of intervention are significantly lower with a midwife. In 2008 a Cochrane review was published examining the outcomes of midwife compared to other models of care http://www2.cochrane.org/reviews/en/ab004667.html if you are interested.

It was only because a friend also became pregnant at the same time and was certain she would have a homebirth that it suddenly did not seem such a far-fetched idea. Given my job (as an epidemiologist) I became very interested in looking up original research papers that looked at the outcomes of planned homebirths, reasons for complications and risk factors etc. The more I read the more confident I felt about the safety side of having a homebirth.

It also became very apparent to me that many of the things that are ‘standard care’ in hospital were not things I necessarily wanted or had good evidence for doing them. I became aware that I would most likely have a battle on my hands, which really isn’t conducive to good birthing!

It was suggested that I read ‘Ina May's guide to childbirth’. I finished the birth stories section and realised I wanted my birth to be like those in the book! And if I wanted that I really needed to have a homebirth with a midwife that believed that 95% of the time pregnancy and childbirth are totally natural processes.

But how to pick a midwife? Given my background/job my main concern was a midwife who was a bit too ‘hippy’. I wanted to know that if I really did need to go to hospital the call would be made and early on. It was probably a bit of a silly concern as no midwife would put a mother or baby in harms way to maintain ‘natural childbirth’. I now attribute this thought to the media portrayal of homebirth midwives. The deal sealer for me was a connection with a girl I went to school with. Joy had been present at the birth of her daughter and also her sister’s child at home. I emailed Joy that same day and arranged to meet. As soon as we started chatting I was certain this was perfect for us, lucky for me my husband agreed!

I had my first antenatal appointment at 24weeks. It was in stark contrast to any appointment I had had in hospital. Firstly it was about an hour long and in the comfort of Joy’s home. I didn’t wait for an hour with 30 other pregnant women just to be rushed through with a quick ‘how are you feeling?’, blood pressure check, measure and heart rate check. My appointments weren’t filled with comments about me being either ‘too big’ or ‘too small’. They were a time where Joy and I got to know each other, we chatted about all manner of things, feelings, fears, statistics, certain protocols and philosophies. These are the things that are important, yet are things that are now lost. Busy Obstetricians and midwives don’t have the time to sit and really get to know you and what you want, there is only time to tick all the necessary questions and tests off the list.

Choosing an independent midwife and homebirth really are no brainers. You get the continuity of care through your pregnancy, labour and post-natal period. Having experienced both sides of it, I can tell you the level of care is far superior. You have someone who comes to your house when you are in labour, brings all the medical gear for if something crops up and more importantly has the experience and knowledge to let you know its all going fine and that you can stay at home or that maybe something isn’t going as expected and it is time to go to the hospital. There are no strangers and no shift changes. There is no pressure to ‘deliver’ a certain way, to get out of the pool, to have your waters broken or that IV put in. No one is telling you ‘your baby is not in an optimal position’ or you are ‘ONLY 3 cm’ neither of which are helpful. A wonderful thing that Joy said to me was ‘if you make it an issue it will become one’ very wise words that in many ways can bear weight to the high intervention outcomes of childbirth we see today.

I am not a crazy hippy, I did not have a terrible first birth, and I’m not anti the medical establishment. I went to university and have a PhD epidemiology and biostatistics. I like to research the choices I make in life and like things to be backed up with strong evidence. I feel like I am one of the few that know a secret. Being able to give birth your way, at your pace, free of inhibitions so you can get into your ‘labour song’ (as Janie called it), in a location you feel safe in, with people you already know and trust, is probably the most amazing and empowering thing a woman (and her partner) can ever do.

If even a small part of you thinks you might like care from an independent midwife and/or a homebirth, I say go for it, you wont be disappointed.



Thankyou for your comments

Tuesday, June 7, 2011

Action on maternal mortality in developing countries

Talk point: Maternal health - can MDG5 be achieved by 2015?

A global shortage of midwives is reducing the chances of countries hitting millennium development goal 5 to reduce by three-quarters the maternal mortality rate. Tell us what you think about maternal and child health, and the progress of the MDGs

Click on this link to guardian.co.uk for an insightful series of videos addressing maternal death rates and maternity care in Africa and Nepal.


A midwife from Melbourne, who is working with MSF in the African country of South Sudan, wrote recently:

"In the short time I had been in Aweil, I had seen more miscarriages, more stillbirths, more premature births resulting in death than in my 8 years as a midwife in Australia. I was faced with doing things that caused me so much distress and heartache. To balance this somewhat, I have seen more twin births (nearly all of them vaginal) here than in Melbourne – it seems to be a norm in Africa, maybe to balance all the other babies who die. It is difficult here – for all who live here – and part of the work is to try to get women to the hospital sooner so that their bodies, which are already so depleted in so many ways, are not left recovering with no baby, as they have stayed away too long. This is all too familiar a story. They are in labour for 3-4 days at home, they come to us with a baby that’s already dead. There are also many who come with their babies still alive but then they seem to give up right at the end and we can’t resuscitate them. It is normal for there to be meconium stained liquor. Too many dead babies…The women have many pregnancies, and their bodies don’t often have time to recover before they’re expected to be pregnant again. So, we are also looking to do education in antenatal clinics, trying to encourage women to come earlier to the hospital."

Thankyou for your comments