Home, Hospital and Decision-making about Birth

-By Joanna Roughton-

Speaking generally, the Home Renaissance Foundation inclines to the idea that the home should play a bigger role in the lives of people. If something – an event, a process – can take place in-house; then this is to be encouraged.

What then should we think of headlines this month proclaiming a big shift in the medical view of home births?

The rights and wrongs of giving birth at home have been one of the touchy subjects of ‘parenting’ in recent years; right up there with breast feeding and parental leave.

On one side of the debate have sat the clinicians – obstetricians mainly – who’ve argued that the safest place to bring a baby into the world is a maternity unit inside a well-equipped hospital. The risk of complications trump all other considerations, they say.

But their opponents – often midwives – maintain that a home-birth reduces stress and, therefore, the likelihood of complications.

Well, now the National Institute for Health and Care Excellence (NICE) has come down in favour of home births. In a finding which grabbed headlines, it said a home-birth could often be safer than a dash to the hospital, especially for low-risk mothers who had already experienced pregnancy before.

As an expectant mother, the idea of having a baby at home – in my own bed – always had tremendous appeal. But my husband, a true believer in the efficacy of western medicine if ever there was, was vehemently opposed to the idea.

When the birth of each of our six children approached, we had the same debate. I suppose I could have told him to take a running jump, that I was going to do what I wanted to do. But an atmosphere of parental warfare hardly seems like a congenial backdrop for the arrival of a new life.

And so I never forced the issue. Each of our children was born in hospital, not all of them in the UK, but all of them safe and well. After each birth, I said that if there was to be another, then it would be at home. But when the time came, I caved-in to spousal lobbying,  always slightly resentful.

Then came the birth of our youngest child, John. This time my arguments almost carried the day. In the eyes of NICE, I was the kind of mother who should have been having a baby at home. I had a string of successful, complication-free, births behind me. And my pregnancy with John had gone swimmingly. Not a cloud on the horizon.

But when it came to it, my husband and I decided that John would be born in hospital. What if something did go wrong? How could I look my husband in the face, if I had allowed my preference for a home birth to introduce unnecessary peril?

And, as it turned out, he was right. Because, although my pregnancy with John had not brought any complications, not all such complications can be predicted. And this is the bit which advocates of home births tend to gloss over. Not everything which can lead to problems in childbirth shows up in an ante-natal scan. Sometimes, things just go wrong in the final moments.

So it was for John. After nine months of drama-free life in the womb, his exit down the birth canal proved fraught with danger. He became trapped. The condition – shoulder dystocia – is particularly loathed by midwives because there are no indications in advance that it will happen.

When John finally appeared, he was immediately given an ‘Apgar’ score. This is a scale from 1-10, with ten healthy and zero, well, dead. His Apgar score was one.

Thankfully, and because we were in a well-equipped hospital with access to a ‘crash team’ of doctors, John made a full recovery. Had he been born at home, it seems unlikely he would have survived.

Does this mean that all home births are an act of folly? Of course not. Women have been giving birth in the home for millennia. But then, child and maternal mortality were things which were simply accepted as part of the risk of creating life.

My husband does not glory in his vindication. But he does point out that, what he calls the ‘cult of midwifery’ brooks no opposition from men. Fathers, he says, are increasingly airbrushed from the debate about where a birth should happen.

Giving birth is often now referred to in terms of it being an ‘experience’, where a woman – and only a woman – should exercise ‘choice’.

There are two men in my life, my husband and my son, who are there to remind me that choices are often best made with regards to the concerns of others.

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