In defence of home birth

I’ve been meaning to write for a while about the recent media stories about the safety of home birth for babies and mothers.  There was much media coverage and discussion at the time (1, 2) much of it not as measured as the original Lancet story

My gut instinct is that it makes little sense to compare data on home birth from a range of different countries, especially not the US and UK. The healthcare system in the US is so different to here I imagine it’s almost impossible to meaningfully collate statistics across the two countries.

In the UK women can opt for home or hospital birth without thought of the financial cost. We are fortunate enough not to have to worry about hospital bills running into the thousands when we make our decision.  When I chose to have a home birth it was following full NHS antenatal support and advice. I was safe in the knowledge that my (two!) midwives would be NHS trained and that the system would be seamless should I choose or need to go into hospital at any point. I can imagine that many women choosing home birth in America are not so fortunate, perhaps having had no access to any medical care during their pregnancy and without such a straightforward option to ‘go medical’ if required during labour. In fact I’ve just seen that in some of the US you are restricted from having your home birth attended at all – this must massively increase the risk to mother and baby should they go ahead with birth at home. More evidence of how meaningless it is to compare the UK and US position on home births.

However, fortunately I don’t have to delve into the murky world of statistics and counter-statistics as someone else has written a great article in defence of home birth instead. Sali Hughes in the Guardian writes that:

In fact, the safety statistics for planned home births are very good. Official government guidelines state that planned home birth is “at least as safe as hospital delivery”. The key word here is “planned”, because all too often home births are lumped together. This is one of the Royal College of Midwives‘ chief complaints about recent reports by doctors in the US (where midwives as we know them don’t exist) in The Lancet, claiming that “home birth” is more likely to result in infant mortality. This is simply not true of “planned home birth”. For example, a woman who goes into spontaneous labour at 34 weeks while standing in her kitchen is better off in hospital. Ditto teenage girls, who either don’t realise or ignore that they’re pregnant and end up giving birth in their bedrooms, women who have very fast labours, where transfer is out of the question, or those who choose to birth without any medical assistance (an entirely different practice known as freebirthing). These cases are often placed under the same umbrella as my methodically planned home births, to misleading and damaging effect. For clarity’s sake, planned home birth is organised in conjunction with your GP and local midwife team, and ultimately signed off by a consultant obstetrician if there are any irregularities.

I really like this article. I like that she isn’t judgemental about the choice between home or hospital – it’s  just what was right for her. And I like that she emphasises how integrated British home birth is with the established medical system. And I really like her defense of NHS funding and support for home birth as an option for all women.

If you’re interested in home birth I’d recommend reading Sali’s article (and the comments too if you want to be both elated and depressed in quick succession!) You might also enjoy reading our home birth story.


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One Response to “In defence of home birth”

  1. erinmidwife Says:

    “it makes little sense to compare data on home birth from a range of different countries, especially not the US and UK”

    YES and it makes even less sense to draw conclusions about the safety of homebirth based on flawed data and really shoddy, politically motivated meta-analysis, which has been the primary criticism of the Wax study.

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