For many women, the thought of giving birth - particularly the first time - is terrifying. Hospital bags are packed weeks before your due date, plans are made for every eventuality, and antenatal classes are attended more religiously than work, as every possible scenario runs through your mind. For the majority of women, these scenarios will most likely involve a hospital bed and a doctor. But imagine for a second that they don't. Imagine what it would be like to give birth at home.
Just 50 years ago, over 30 per cent of babies were born at home, usually with the assistance of midwives and district nurses. Today, in the UK the home birth figure stands at a little over two per cent; in the US it stands at a little over one, although some states do not allow the practice. But home births are becoming increasingly fashionable once more and, if media reports are to be believed, then the Duchess of Cambridge is planning a home birth with her third child next year. Although we can only imagine that Kate's will feature a lot more space and support than your everyday home birth, this news has still led to a 44 per cent increase in enquiries about home births.
But one question remains controversial - how safe is a home birth? The subject of medical, scientific and lunchroom debates for years, it’s a difficult question to answer. Without fail, everyone has some kind of answer to the would you/wouldn’t you debate, each informed by their own anecdotes and experiences.
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Credit: Pexels[/caption]
At the forefront of most expectant mother's mind when deciding whether or not to opt for a home birth is the idea of what might happen if something were to go wrong for her. Quite understandably, the presence of a whole team of doctors, midwives and a specialist kit is infinitely reassuring for many women - pregnancy is, after all, an inherently risky process and it's nice to know you're giving yourself, and your child, the best chance of survival, should the worst happen. This is a position that many doctors agree with, occasionally leading to accusations that they too often push women towards hospital births unnecessarily.
But despite the criticism, the figures suggest that, in some cases, they may be right; during a large-scale study, published in 2011, it was found that for first-time mothers, the risk of an “adverse outcome” was higher during home birth than for those who delivered their baby in a hospital. For those having subsequent children, there was no difference, but it must be considered that this may be, in part, because mothers who have had a difficult first birth are advised against a home birth the second time around.
However, there are some that believe that the atmosphere of a hospital can actually increase the risks associated with giving birth. Annie Francis, who was model Lily Cole’s midwife during the home birth of her daughter, is among them, arguing that bright, loud labour wards are the opposite of a “natural” birthing environment: “As mammals, we birth well when our hormones flow normally, and for that to happen we need quiet, dark spaces supported by people we know," she told The Telegraph. The absence of this, she says, may cause "anxiety levels go through the roof and you have a dysfunctional labour."
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Credit: Pexels[/caption]
Mihal-Greener, an Australian woman living in the Netherlands, which has the highest home birth rate in the developed world, explained the ways in which giving birth in the comfort of her own flat gave her more control over her labour: "Avoiding the car ride to the hospital. Not sharing a room with three other moms and their crying babies. Not worrying if I forgot something in my hospital bag. Not having a nurse wake me with a flashlight on her midnight rounds. Sleeping in my own bed. Not being subjected to hospital food. Being allowed outside to get some fresh air."
Yet, home birth rates in the Netherlands are in decline, something that has been put down to an increasing demand for pain relief, which is not available to women who choose to give birth at home as only doctors can administer anaesthetics, including epidurals.
The risks - or lack thereof - to mother and child also seems to vary by country. In the USA, where the shift from home birth to hospital birth has been credited with a 90 per cent decrease in neonatal mortality over the 20th century, it seems to carry a higher risk than in other developed nations; the perinatal death rate in the country is three times higher in cases of home birth than in hospitals. In some states, it is up to seven times higher. The American College of Obstetricians and Gynaecologists have even gone so far as to declare that "choosing to deliver a baby at home… is to show a preference for the process of giving birth over the goal of having a healthy baby".
Yet in Canada, a 2015 study by McMaster University indicated that women with low-risk pregnancies who gave birth at home were at no greater risk than those who gave birth in hospital, and the UK's National Institute for Health and Clinical Excellence (NICE) even went so far as to say that in certain cases, it may even be lower risk. While mortality rates are higher in the developing world, where the practice is still commonplace, research has shown that wherever you are in the world, home birth is safer for women from more affluent socio-economic backgrounds than those from lower-income groups.
[caption id="attachment_42075" align="aligncenter" width="1125"]
Credit: Pexels[/caption]
Another common thread is that, wherever you are in the world, the pre-existing health of the mother also plays a large role in the safety of any home birth. Women with certain health concerns, including more common medical conditions such as epilepsy, high blood pressure and diabetes, will normally be advised to give birth in a hospital, as they are at higher risk of something going wrong. The same is true for women who have previously experienced a difficult labour.
Mother nature is notoriously unpredictable and for some women, the decision between a home or hospital birth is a difficult one to make. Like with most things in life, there are pros, cons and influencing factors at every turn. More than anything, it only serves to show how individualised the process of giving birth is, no matter how strategised a birth plan may make it seem. All we can ask for is clear, honest and accurate information, un-muddled by personal opinion. Whatever happens though, one thing must always be remembered: that the final decision about where a woman gives birth, whether that be at home, in a midwife-led unit or a hospital ward, is hers and hers alone.
Credit: Pexels[/caption]
At the forefront of most expectant mother's mind when deciding whether or not to opt for a home birth is the idea of what might happen if something were to go wrong for her. Quite understandably, the presence of a whole team of doctors, midwives and a specialist kit is infinitely reassuring for many women - pregnancy is, after all, an inherently risky process and it's nice to know you're giving yourself, and your child, the best chance of survival, should the worst happen. This is a position that many doctors agree with, occasionally leading to accusations that they too often push women towards hospital births unnecessarily.
But despite the criticism, the figures suggest that, in some cases, they may be right; during a large-scale study, published in 2011, it was found that for first-time mothers, the risk of an “adverse outcome” was higher during home birth than for those who delivered their baby in a hospital. For those having subsequent children, there was no difference, but it must be considered that this may be, in part, because mothers who have had a difficult first birth are advised against a home birth the second time around.
However, there are some that believe that the atmosphere of a hospital can actually increase the risks associated with giving birth. Annie Francis, who was model Lily Cole’s midwife during the home birth of her daughter, is among them, arguing that bright, loud labour wards are the opposite of a “natural” birthing environment: “As mammals, we birth well when our hormones flow normally, and for that to happen we need quiet, dark spaces supported by people we know," she told The Telegraph. The absence of this, she says, may cause "anxiety levels go through the roof and you have a dysfunctional labour."
[caption id="attachment_42076" align="aligncenter" width="4878"] Credit: Pexels[/caption]
Mihal-Greener, an Australian woman living in the Netherlands, which has the highest home birth rate in the developed world, explained the ways in which giving birth in the comfort of her own flat gave her more control over her labour: "Avoiding the car ride to the hospital. Not sharing a room with three other moms and their crying babies. Not worrying if I forgot something in my hospital bag. Not having a nurse wake me with a flashlight on her midnight rounds. Sleeping in my own bed. Not being subjected to hospital food. Being allowed outside to get some fresh air."
Yet, home birth rates in the Netherlands are in decline, something that has been put down to an increasing demand for pain relief, which is not available to women who choose to give birth at home as only doctors can administer anaesthetics, including epidurals.
The risks - or lack thereof - to mother and child also seems to vary by country. In the USA, where the shift from home birth to hospital birth has been credited with a 90 per cent decrease in neonatal mortality over the 20th century, it seems to carry a higher risk than in other developed nations; the perinatal death rate in the country is three times higher in cases of home birth than in hospitals. In some states, it is up to seven times higher. The American College of Obstetricians and Gynaecologists have even gone so far as to declare that "choosing to deliver a baby at home… is to show a preference for the process of giving birth over the goal of having a healthy baby".
Yet in Canada, a 2015 study by McMaster University indicated that women with low-risk pregnancies who gave birth at home were at no greater risk than those who gave birth in hospital, and the UK's National Institute for Health and Clinical Excellence (NICE) even went so far as to say that in certain cases, it may even be lower risk. While mortality rates are higher in the developing world, where the practice is still commonplace, research has shown that wherever you are in the world, home birth is safer for women from more affluent socio-economic backgrounds than those from lower-income groups.
[caption id="attachment_42075" align="aligncenter" width="1125"] Credit: Pexels[/caption]
Another common thread is that, wherever you are in the world, the pre-existing health of the mother also plays a large role in the safety of any home birth. Women with certain health concerns, including more common medical conditions such as epilepsy, high blood pressure and diabetes, will normally be advised to give birth in a hospital, as they are at higher risk of something going wrong. The same is true for women who have previously experienced a difficult labour.
Mother nature is notoriously unpredictable and for some women, the decision between a home or hospital birth is a difficult one to make. Like with most things in life, there are pros, cons and influencing factors at every turn. More than anything, it only serves to show how individualised the process of giving birth is, no matter how strategised a birth plan may make it seem. All we can ask for is clear, honest and accurate information, un-muddled by personal opinion. Whatever happens though, one thing must always be remembered: that the final decision about where a woman gives birth, whether that be at home, in a midwife-led unit or a hospital ward, is hers and hers alone.