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Beyond the “homebirth horror” headlines: some wider questions for the health system (and media)

Karol Petrovska and Caroline Homer write:

Yet another ‘homebirth horror’ story has hit the headlines of late, most notably on the Mamamia website. 

A woman in Victoria, who had had two previous caesarean sections, researched her birthing options online when she next became pregnant and chose to have a homebirth based largely, the article states, on information found online that supported this option. Tragically, her baby died.

The article on Mamamia states its intention is to warn of the dangers of gathering information online that is not evidence-based.

While there is a disclaimer at the end of the story stating that the article was not intended to incite harsh judgments, the piece predictably unleashed a torrent of anti-homebirth commentary from the website’s readers.

‘Selfish!’, ‘putting the birth before the baby’ and ‘we live in a country with a great health system, why have the baby at home?’ captures the themes.

The piece was unhelpful at best, and at worst, a witch hunt. Ultimately, it airs even more non evidence-based information that will add to the complexity and confusion of the community.

Mamamia should be commended for accomplishing worthy achievements on other important issues. The website was quick to seek evidence based information on vaccination and called in an expert to lay out the facts for readers.

Disappointingly, a genuine attempt to do the same for homebirth is lacking, and the website continues to take an angle which is anti-homebirth despite evidence to the contrary.

The website has failed on other occasions to provide a balanced view of homebirth. It has also published other articles with skewed views that are poorly supported by evidence such as this story on breastfeedingTara Moss thankfully corrected that imbalance.

The failure to reference the large body of evidence citing homebirth as a safe practice when conducted under optimal conditions is irresponsible and misrepresents a genuine, safe option for many pregnant women.

It also shows the limited understanding many have when it comes to homebirth. The facts are almost always distorted and crucial information that would give a true picture of the situation is absent.

A number of states and territories support homebirth in Australia. In NSW Health there is a Public Homebirth Policy Directive highlighting homebirth as a choice offered by the public health system. A number of appropriately networked public programs exist across NSW with more than 14 across the country.

In addition, there are many private practising midwives across the country providing safe homebirth services to women who are at low risk of complications in labour.

The ‘homebirth horror’ stories usually include women who have risks associated with their pregnancies. Usually these women feel that they have no option but to give birth at home.

Women who choose a homebirth in less than optimal circumstances arrive at that decision for a reason. Often it is a result of trauma, fear and previous negative birthing experiences in our hospitals – both public and private. These women’s experiences are sometimes doubted and dismissed.

Women often choose homebirth because they want services that the hospital system will or cannot provide. They might want services such as a birthing pool for labour and birth, continuity of midwifery carer and vaginal birth after a caesarean section.

Some women choose homebirth because the hospital system would not let them have a vaginal breech birth or give birth naturally to twins. Instead of accommodating these women in a safe environment, we leave them little option but to choose a homebirth, but then we vilify them if things go wrong.

A more helpful approach would be to take the time to examine the reasons behind women’s fears or their requests and try to better accommodate them in a calm, supportive space.

Rather than create a frenzy around each ‘homebirth-goes-wrong’ case that surfaces in the media, it would be more useful to explore why these traumatic experiences originally occurred and how could our health system better accommodate their needs and the needs of other similar women and families.

Where is the compassion for these women and how can women be supported in the future to avoid these events from reoccurring? Shaking heads and pointing fingers is a futile exercise in shaming grieving women who have lost their babies.

It’s also a missed opportunity to shine a light on ways we can make a good maternity care system into a great one where women feel supported to make safe choices, rather than leaving them to navigate their birthing options alone.

We acknowledge the principle of freedom of speech and an ability to publish as you see fit, as done by the Mamamia site, however if you purport to provide evidence based information on a range of topics, please include homebirth in the future.

• Karol Petrovska  is a Masters of Health Services student, UTS, and Caroline Homer is Professor of Midwifery at UTS.

***

Useful resources

• National Maternity Services Plan – This is the national plan signed off by all the health ministers and includes homebirth

Towards Normal Birth NSW Policy Directive – the NSW Ministry of Health’s policy document supporting normal birth

Australian College of Midwives Position Statement on Homebirth

Birthplace in England study – the largest and most recent study about place of birth

Royal College of Obstetricians and Gynaecologists (UK) statement on the Birthplace in England study

Homebirth study from The Netherlands

Homebirth study from Canada.

 

 

 

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  • 1
    john2066
    Posted June 13, 2013 at 11:40 am | Permalink

    Yep all this reporting is driven by the creatures at the AMA. They’ll do anything to keep their outrageous monopoly incomes high, it was recently reported the average income of an obstetrician was 3m a year, after all outgoings. Simply outrageous.

  • 2
    Beth T
    Posted June 13, 2013 at 2:28 pm | Permalink

    A truly balanced and honest discussion of homebirth is much needed in Australia. This article is correct in stating that “the facts are almost always distorted and crucial information that would give a true picture of the situation is absent”. While this article takes an important step in correcting some skewed media reporting, it also leaves out some crucial information that is vital to ensuring that home birth is a genuinely safe choice for women.

    It may well be the case that there is a “large body of evidence citing homebirth as a safe practice when conducted under optimal conditions” but we need to be realistic that this is not how home birth is being practiced in Australia at the present time. Yes it is certainly the case for the publicly funded programs and some privately practicing midwives. But what about the others? Many midwives are offering homebirth services to women with risk factors – not reluctantly but very willingly.

    It is very important to consider the “push” factors for why women choose homebirth as this article does. Our maternity system absolutely needs to work better to engage “high risk” women and address the very real concerns they have about birthing in the system. However the article is silent on the “pull” factors. These include midwives who are telling women that homebirth is not just a safe choice for them but the safest choice, midwives who give skewed and incomplete risk information and a homebirth community that glorifies risk (when those births go well) and sweeps them under the carpet when they do not. When a baby dies at or shortly after a homebirth the mythical “woman determined to homebirth at any cost” is constructed in the midwife’s defence. It astounds me how often this construction is accepted by the homebirth community and how we ignore that in many cases women made these decisions with the full support and encouragement of their midwives. The homebirth community shames grieving homebirth women almost as effectively as Mamamia. Who within it is has not heard the rumours that abound after a homebirth death – “she refused to transfer”, “the midwife had to attend otherwise she would have freebirthed” or “she knew it was high risk and accepted that”. It is always the mother’s responsibility.

    The Coroner’s findings in Victoria are well worth a read. They don’t support the overblown rantings of the Mamamia set but they should give homebirth advocates and practitioners pause for serious reflection. This was not a homebirth conducted under optimal conditions. The mother had multiple risk factors, the midwives involved did not adequately identify the risks for the mother or actively encourage her to birth in hospital with their support. One of the midwives actually gave evidence that she thought the birth should happen in hospital but didn’t tell her client. The care provided during labour was also problematic with multiple red flags being overlooked. This family lived only 3 minutes away from the hospital but the advice to transfer was left so late that this safety net was rendered useless. Most importantly the midwives involved were not “rogue” or radical midwives but highly experienced and respected midwives. I would suggest the case is not an outlier but a rare glimpse into how blasé we have become about risk in everyday homebirth midwifery practice.

    The “birth is safe, interference is risky” dogma has made the homebirth community blind to risk. We seem to have situations where midwives are so focused on seeing birth as normal that they cannot identify when things are turning seriously abnormal. At the same time though the obsession with risk of many hospital-based providers leaves women squarely in the middle without options that are safe and respectful.

    Both sides need to stop pointing the finger at women and ask serious questions about why women with risk factors are leaving the hospital AND how they are actively encouraged to do so by midwives and birth advocates. We can then truly consider how these tragedies might be avoided in future.

  • 3
    J Green
    Posted June 14, 2013 at 6:40 am | Permalink

    Pardon my scepticism, but I have lived (and experienced maternity care) in several different countries, both developed and developing. I can’t help but notice that the only women who appear to be traumatised by the medical system into choosing homebirth live in wealthy, first world countries with healthcare systems that are worlds apart from pretty much everywhere else in terms of humanity, kindness and respect for patient autonomy. I lived in a country where going to hospital really DID mean you were likely to be treated with little respect or autonomy. In contrast with privileged white women in first world countries who complain about being offered pain relief, women in this country (as in many other countries) were denied any pain relief at all–a potent sign, I believe, of the value that women’s dignity and needs was given in this place. As in many other countries, women were not even allowed to have their husbands present while in labour. Yet, as unpleasant at the hospital system is, women recognise that it is the safest place in which to give birth and go there for that reason.

    The real reason why high-risk women in countries like Australia choose homebirth is because the homebirth movement is not honest about its risks. Attempts to challenge misinformation about its safety risks are censored out and denied. And frankly, if women really are choosing to put their babies at substantially greater risk because they want a waterbirth, or to retain the same carer, or to avoid a C-section, then the fact is that their are privileging their own personal experience over the safety of their child. To many–perhaps most–this is unthinkable. Women all over the world are prepared to put up with far, far worse to ensure the safety of their child.

    This is not to say that improving the experience for women giving birth in hospital is not a perfectly laudable or important goal. However, I see precious few homebirth advocates doing much to improve hospital care. Most of them seem to be grossly ignorant about what normal hospital care even is. For this reason, it’s hard to take these claims of women being driven into homebirth by the cruelty of the hospital system very seriously. It seems to me more like an attempt to justify a choice that most people would see as unjustifiable.

  • 4
    Doctor Whom
    Posted June 18, 2013 at 2:18 am | Permalink

    In my experience there is a high correlation between emphatic home birthers and holders of anti-vaccination beliefs, faith in homeopathic remedies and other similar faith based “treatments”.

    Has there been any research on the link between vitalistic thinking and midwives and those who see home birth as a mystical and empowering experience?

  • 5
    Dani Stone
    Posted July 11, 2013 at 1:18 am | Permalink

    I’m sorry but people get so carried away when it comes to home birth. If you fell like you can great. But I always suggest a professional with a medical degree!
    you take a doula it’s like flipping a coin with your baby!

    http://www.laboraide.com/article/1332-the-benefits-of-natural-homebirth

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