Homebirth – is it really that dangerous in 2015?

Posted by: on May 11, 2015 | No Comments

There’s a gameshow here in the UK called QI (which stands for Quite Interesting). When a contestant says a wrong answer, gigantic screens behind the contestant flash on and off whilst very loud alarm bells scream around the studio and the contestant is mocked for being such a dilly and saying the wrong thing. Sound familiar? Has that happened to you when you told people you wanted a homebirth? Of course I’m not suggesting ACTUAL alarm bells have gone off (That would be a bit weird) but…. when you encounter that attitude, you’ll know it’s there. It might be a veiled comment at the school gate, an exclamation of disbelief over dinner with friends, or an outright NO WAY! when suggesting the idea to your partner. What? You want a homebirth? You do know that women and babies used to die during birth at home, right? Are you mad? What if something goes wrong?

It’s a true enough fact. Women used to die in childbirth far more frequently. And so did babies. But is it really the act of being in hospital that has brought these incidents down to such a very tiny number? Can hospitals and modern machinery and advances really scoop up ALL the credit for birth being safer in 2015? Those entrenched in the system will tell you hell yeah! But I think not. And here’s why.

Giving birth at home in 2015 is not even remotely like giving birth in 1215, 1615 or even as recently as 1915. And here are 10 reasons that prove it.

1) Germs

We now understand that germs can cause infections. But, for hundreds of years, no one realised that inserting dirty hands or instruments into the birth canal could be fatal for the mother. It is estimated that over a million women died from ‘childbed fever’ in Europe alone in the years before the link was made. Ordinary household germs are fine when they are just knocking around in the home and it is actually beneficial for baby to be born in their own home where they will be immune to those normal germs – providing of course you don’t live in actually squalid conditions. But things like MRSA and other superbugs in a hospital environment are alien to a woman’s immunity. And the very act of being in hospital increases the likelihood of the use of instruments like forceps for example, or use of needles, or Caesarean surgery which could cause infections to happen. Staying away from hospital in the first place means these kinds of things are less likely to be needed. Giving birth in a modern day not-too-dirty but not-too-bleachy home which is clean and warm is a safer environment germ-wise than most hospitals. 

2) Water

….. Clean, fresh, running water. In the home. Coming out of a tap. Not only do most modern homes have their own bathroom with flushing toilet but they also have access to heated water, (Not just that but central heating – big trump card for homebirthers in 2015) and washing machines for instant cleaning of linens, bedding and clothes, which has greatly improved overall sanitation in the home – making modern day homebirth a much safer option than in earlier centuries. We take it for granted that water comes out of a tap on demand but getting clean water used to take up a lot of time and effort. Even better than just having water on tap – we can now have birth pools in our very own living room, offering drug-free pain relief and a more ‘active-birth friendly’ environment to replace the bed and to lying in the stranded turtle position. What’s not to love?

3) Diet

Women overall are well nourished in 2015. Ok some like myself are a tad erm too well nourished and we do have issues in the west with obesity. But overall? Women in 2015 have access to a wider variety of grains, meats, fish, fruits, vegetables, minerals and supplements than any other generation of women before them. There is greater understanding of women’s dietary needs, and even such conditions as diabetes or anaemia can be managed and improved with proper care, treatment and planning – by conventional means and also by a wide range of complementary medicines/practitioners. Both of these conditions can be extremely dangerous when unchecked and untreated, but we are better at addressing this today than ever before, and can even rule out homebirth if medically necessary – not an option in 1615. Dr. Amali Lokugamage talks in her book ‘The Heart in the Womb’ about the ways in which she reversed her gestational diabetes and was able to safely give birth at home, partly through modifying her diet. It is possible.

Malnourishment was once a frequent cause of death for mothers, whose bodies were depleted and not strong enough to support them through a long or difficult labour. We now have better access to foods to fortify mothers and most women here in the UK can afford to feed themselves quite well. A very different story to the poorest Victorian working class mother, perhaps having her eighth child on an empty stomach in cold and maybe even squalid, conditions. This particularly grinding poverty is not likely to be the case for most home birthing mothers in 2015.

4) Improved gynaecological health

Speaking of women having many children…. since the introduction of contraception, women are no longer having so many children as they once did. Gone are the days when it was entirely normal for a woman to have a brood of ten, and for the placenta to keep having to implant itself in a new spot each time that gets harder and harder when we are getting into such high numbers – causing increased risk of fatal post-partum haemmorrage. Women (or indeed very young girls) may also have had no choice but to give birth to a child following rape. Or incest. Such things were not discussed or written about and there were no self help groups or counselling services from folks trained in how to cope with such enormously emotionally damaging scenarios.Women giving birth to a disabled child could not know with certainty if the child would be well received by her husband and family and some may have been reported as having died during the birth but were in fact sent away. Having a baby out of wedlock was considered to be an absolute disgrace, so women were forced to give birth in secret, sometimes far away from home, where no one could find out. It must’ve been very difficult for some women (or young girls, let’s be honest) to bond with their unborn babies and lovingly carry them to full term. There was also the problem of dodgy abortions which were very dangerous for women and if performed badly, could leave their wombs scarred and damaged for any subsequent pregnancies. Let’s also remember that it was quite common for women to have STD’s in earlier centuries which sometimes went untreated. Syphilis in particular was rampant in earlier centuries and could have terrible consequences for mother and babe if left untreated.

5) Overall health

Women in earlier centuries would not have understood such underlying medical conditions as pre-eclampsia, or gestational diabetes or had any means of screening for them. Their bodies carried the scars of every illness that they ever had. Some illnesses could leave a woman weakened permanently. She may also have had treatments or operations that were dangerous or botched in some way. It stands to reason that women used to also give birth whilst suffering from cancers, tumours, rickets, poxes, viruses… all kinds of physical conditions that could make pregnancy and birth more difficult or even life threatening than it would be for today’s average woman. Nowadays women are cared for throughout pregnancy and can have their blood and urine tested, choose screening by ultrasound, receive effective, immediate, or ongoing treatment if needed for any underlying conditions and have an idea of how baby is doing. We now have so many ways to detect and identify if there are any obvious reasons why birth might be difficult or dangerous in advance of the event and anticipate how to manage those risks, and whether to absolutely avoid homebirth altogether. A woman in 1715 could not choose between the two -it was home or nothing.

6) No more corsets

In 2015 women are not contorting their bodies into corsets or other physique-altering clothing. Imagine what having such a pinched waist would do to a woman’s insides! It literally altered the shape of a woman’s womb and moved her internal organs into positions they were not meant to be in. Is it any wonder some women could not give birth to their children with such contorted bodies?

7) Women are more informed than ever

The age of information and the explosion of material on pregnancy and birth means that modern day women understand the mechanics and physiology of their own bodies and the birth process better than any other time in history. Information has gotten into the mainstream and women can read books, blogs and websites by midwives and other birth professionals,  attend courses, join support groups, compare graphic details, watch youtube videos of women giving birth, or talking about birth, and learn things like hypnobirthing to help them to feel informed and in control. Women in 1215, 1615, and let’s face it even as recently as 1915, might not have received any sex education at all, or at best be relying only on the bible, or a church person to tell them about birth. If they were lucky their mothers might tell them in advance but it’s not uncommon for women to literally be given no indication at all as to where their babies would even come out of them. Prudishness and modesty prevented some people (and some entire cmmunities in fact) from talking frankly and honestly about the female body and it’s functions. Any birth attendants might have chuckled knowingly amongst themselves or spoken in coded language that betrayed very little of what the woman in labour should expect. Imagine how terrifying birth must have seemed for women who didn’t have a clue what was happening to their bodies and if they would survive – how tense they would’ve been! This alone may have caused long difficult labours in the past.

8) Skilled equipped birth attendants are the norm

Those who attend homebirths nowadays tend to be trained midwives who have studied, witnessed, attended and analysed a variety of births and they attend with a whole kit of clean equipment (some life saving) – but not every woman was so lucky throughout the ages. Before the NHS and free midwifery care, not everyone could afford to pay a midwife to attend to them. They may have been particularly unlucky and lived at a time when a new breed of midwife came to the fore – cocky doctor men with instruments to wield – whether a woman needed them or not. Such doctors thought they knew best and became zealous advocates of forceps and told all their women patients to lie down to give birth. By inserting things into their vaginas so they could be seen to be doing things and justify their fee, many actually made childbirth more dangerous for women.

But by the same token, not every midwife had enough skill or knowledge to assist mothers well either. Some were living under very close watch and approval (or disapproval) of the church and had to be very, very careful about what they prescribed, did or suggested to mothers. There was a very real fear that midwives with their hooked nails ( for piercing the amniotic sac) and faith and knowledge in healing herbs might be at odds with the churches way of thinking and could end up on trial, or worse, on the scaffold. In the 1600′s in particular, witchcraft was something that terrified people and accusations of this were most often levelled at midwives. It stands to reason that a certain number of women and babies died because some midwives were actively prevented or at least, deterred, from performing some potentially life-saving action, or from prescribing a particular thing that would assist a mother or baby in difficulty. Women could be accused of witchcraft if they gave birth to a disabled child. Thank goodness we have a more compassionate outlook in 2015.

9) We no longer rely on horses for transport

Look at our infrastructures for transport in 2015. We have smooth roads, A-roads, motorways, cars, ambulances – heck we even have helicopers! Most midwives will tell you that any problems a woman has in labour tend to unfold slowly, and with proper observation and action can be managed at home, and even if transfer is needed, it might not always be a 999 drama. But even if, in the extremely rare circumstances that you DID need to get to hospital fairly quickly, this is not 1715 when you might be relying on a horse and cart to take you to the midwife woman in the next village (Who you would hope to god would be at home but you couldn’t be absolutely sure). No, in 2015, we have house phones, mobile smartphones to call for extra assistance and (and a team who will come in a flash), cars and fully equipped ambulances to help take you to one of perhaps several hospitals. All of which no woman ever had in earlier centuries.

10) We have our men by our sides

Women in 2015 have something many others did not have in the centuries before – the love and comforting support of their men in the birth room. Women supporting other women has always been the norm, and fine it is too. But there is some thing particularly reassuring for a woman to have the father of her child there to lean on, to rock with, to hold and kiss, and to love. Having that strong masculine presence and energy has made me feel bolder, more confident and more calm during my homebirths than I imagine I might have felt as a woman giving birth in 1615 with a group of gossipy old women surrounding me and making me feel like a silly little girl who doesn’t know diddly squat. Michel Odent says men in the birth room are a wimpy nuisance as they are too needy and nervous. I say pish to that. Sometimes, yes, men can be like this. But I have found in my own birthings the opposite to be true.
So there you have it. I’m sure I probably missed a whole bunch of reasons why homebirth is safer today than any other time in history. What I can tell you is this: electric foetal monitoring in hospital hasn’t been proven to save even one life. A quarter to a third of babies being born by caesarean is not normal. Women being routinely induced as frequently as they are (which often triggers what is known as the cascade of interventions) is also not normal. Women getting infections in hospital from c-section operations – not normal or desired.

Next time all those alarm bells seem to be going off when you tell someone you want to have your baby at home, and they tell you how dangerous homebirth is…. Take a step back. Remember hospital births with all their routine interventions are not always so very safe. Clinical yes. Sterile, perhaps. A little soulless. Possibly.

Is hospital birth necessary for some mothers who have very particular needs and risks?Absolutely. Should we have hospitals as a back up? Absolutely. But is it really necessary for 99% of women to have their baby in a hospital with all the increased risks of interventions and surgery and infections that that brings….. in these modern times when we’ve never had it so safe?

Well, I’ll leave that up to you to decide…..