Tuesday, 21 April 2015
H is for Hospital, Home and Genuine Choice
This is another #MatExp ABC post. Today we have reached H and when I went on twitter this morning the first suggestion I saw was H is for Homebirth. That got me thinking and, as usual, 140 characters wasn't really enough. So my H is for Hospital birth, Home birth and genuine choice.
To be clear I am not at all against home birth. I support the idea of making it available to more women and of giving them accurate information about how safe and beneficial it can be. But, especially online and in social media, I hear a great many voices, mothers, midwives, doula's etc. all championing that cause. I stand with them, but I also have some concerns.
I'll be honest, when I read stories of high risk mothers having home births it does worry me, ultimately I support the ideal that it's her body her choice, but as a mum who saw her straightforward natural birth become anything but, I can't help but worry about what might happen. That however isn't what troubles me most about the current advocacy for homebirth. I have two main concerns:
1-Avoiding the problems
The birthplace study led to many calls for all low risk women to be encouraged to give birth at home. It found that those who did were less likely to end up with interventions such as c sections and and epidurals. But what few commentators seemed to ask was - why are there so many more interventions in hospital and if they are unnecessary - how can we stop them? The consensus seemed to be that it was better just to convince women to have home births so they could avoid the problem. But where does that leave those who want to be in hospital? A lot of mums actively choose to have an epidural and you can't get that at home. What about the mums who would have loved a straightforward home birth but who's pregnancies have become too complex for them to feel safe at home? What about those whose home environment isn't safe and comforting?
1- Equality of care
My NCT teacher was a staunch advocate of homebirth. At our first class she advised us all to have one or to at least pretend we wanted one (then fake chickening out at the last minute). It might seem a bit bizarre to pretend to want a homebirth if you don't, but (on this at least), she had a point. In our area, planning a homebirth means you have a named midwife working with a small caseload team. That small team will all get to know you and care for you before, during and after the birth. Each midwife has a carefully limited number of women to ensure she has enough time for all of them. In a cash strapped NHS it's an amazing service. But it's only available to those choosing a homebirth.
I worry that these two aspects could combine to create a two tier maternity service within the NHS. Excellent, consistent care, a nice environment, time to discuss options and fears, no unnecessary interventions - but only if you are willing and able to have a homebirth.
Clearly the losers here are those many women who need to be in hospital. Who, in many cases will be those most in need of kind and consistent care. It effectively says you can either have modern medicine or compassion, but not both. Fall from that narrow pedestal of "low risk" and you may have to accept that the demon doctors will be waiting for you.
That said, I don't think this dichotomy is good for anyone. I am all for women making informed choices about where and how they give birth, but that choice should be between giving birth at home, in their own, familiar environment or giving birth in a modern hospital with every possible form of medical assistance and pain relief close at hand. If we simply wash our hands of the problems in hospitals and instead tell people to go home to avoid them, then that is not the choice that's being made. Instead we are asking women who think they will want an epidural to chose between between good care or pain relief. It means women who develop complications in pregnancy will have to decide between compassion or safety. That's not making the best choice for yourself, it's going with the least worst option.
Women should be able to chose hospital birth because it's what they want, not because they have over inflated fears of homebirth. But they should also be able to chose homebirth because it's what they want, not because the alternative is terrifying and those whose choices are limited by their medical or social situation should never be forced to accept sub standard care because no one was shouting loudly enough for them.