More on Homebirth and the New Meta-Analysis

There is still quite a bit of discussion online and in the media about the new meta-analysis I mentioned in my previous post.  It seems that birth had become political in many ways.  It has been categorized as either feminist/anti-feminist, liberal/conservative, selish/self-less, male dominated/female postured.  Ultimately, it is none of those things.  Birth is a natural occurance.  Live birth has occurred in mammals since our existence on this planet.  It is a physical function of the female body.  Let’s take a moment and look at it from the viewpoint of evolution and natural selection.  Nature does have a vested interest in our survival as a species.  Our bodies, whether you believe they are created by Divine Intelligence, or have evolved by scientific chance, are existing as we are today because of an inborn trait of survival.  We have instincts, traits, and mechanisms that are developed to work in our favor more times than not to ensure that we as a species solidify our existence.  The definition of natural selection is ” the process by which certain heritable traits—those that make it more likely for an organism to survive and successfully reproduce —become more common in a population over successive generations.”  How long has homo sapien been giving birth vaginally?

The phrase “trust birth” comes up much in the conversations of natural birth and the safety of the places where women give birth being it home or hospital.  Should we trust the process of birth to be a safe one?  Is it a process that ensures our survival?  The answer is a complicated one.  Anyone who has given birth and experienced complications, trauma, or child loss, knows that in their case birth wasn’t trustworthy.  Nature is fallible.  I am one of those mothers.  My second birth would not have occurred safely without cesarean surgery.  I am fortunate to live in the time of modern medicine.  In some cases, it isn’t going to matter where the mother is – home or hospital, the outcome of her birth would be no different.  In other cases, mothers would clearly have benefitted from less intervention and homebirth.  And in my case, my care had to be transferred from home to hospital to create a positive outcome in a situation where intervention was necessary.  In the natural world there are anaomalies.  It is inevitable.  Does that mean that many of those are less devastating?  Absolutely not.  It should be acknowledged that for some birth is and will be a tragic experience.

However, the question is how often do the anaomalies occur, and what have we done as a human species to protect ourselves against these occurances?  Our intelligence and ability to intervene in nature sets us somewhat apart from other species of mammals.  Our approach to birth has changed drastically over the years in an attempt to make life better for ourselves.

What is normal birth?

We define normal birth as: spontaneous in onset, low-risk at the start of labour

and remaining so throughout labour and delivery. The infant is born spontaneously in

the vertex position between 37 and 42 completed weeks of pregnancy. After birth

mother and infant are in good condition.

The World Health Organization, Care in Normal Birth

How often can we consider women to be normal at the onset of labor?

Generally, between 70 and 80% of all pregnant women may be considered as low-risk at the start of labour.

-WHO

What is the role of the caregiver in normal birth?

He or she should have a proper training and a range of midwifery skills appropriate to

the level of service. At the least, these should permit the caregiver to assess risk factors,

recognise the onset of complications, perform observations of the mother and monitor the

condition of the fetus and the infant after birth. The birth attendant must be able to perform

essential basic interventions and to take care of the infant after birth. He or she should be able to

refer the woman or the baby to a higher level of care if complications arise which require

interventions which are beyond the caregiver’s competence. Last but not least, the birth

attendant should have the patience and empathetic attitude needed to support the woman and her

family.

-WHO

In the aims of the caregiver is where we are seeing the breakdown of our current system.  In a country that in general isn’t supportive of homebirth and midwifery care, situations that are out of the ordinary are made more complicated by this lack of support of homebirth attendants.  Are we trusting too much in ourselves and less in birth to show us when there is a problem whether it be through physical signs or mother intuition?  In hospitals, we are seeing caregivers intervene in normal birth creating problems for mothers and babies.  In homebirths, is there sometimes a delay in seeking help when it is needed because of the lack of support from hospitals, doctors, and government?  The meta-analysis has, and in my estimate does not show that homebirth is not safe.  Is birth safe?  Generally, yes.  Does that mean it is without risks?  No, as with any major life event there are serious risks involved whether birth occurs at home or in the hospital.  Period.  It is imperative in our society that we move our maternity care practices toward more holistic approaches.  That we make access to trained caregivers simple whether the mother chooses to give birth at home or in the hospital.  We need to support these caregivers so that they are free to give to mothers and babies the level of care we deserve.  That is what will make homebirth an even safer choice for mothers than it already is.  It ultimately comes down to our choice of caregiver at this point in time.  Thoroughly interview doctors and midwives.  Ask the hard questions.  Do trust in the ability of your body to give birth safely most of the time, but also make sure that you can trust your caregiver to have your and your baby’s best interest in mind at all times should something go wrong despite what that might mean for them.

Birth Sense offers a dissection that is complete of the meta-analysis.

Since the study is not due to be published until September, I requested and received an advance copy of the article, to be printed in the American Journal of Obstetrics and Gynecology.  As I read through the methodology and the studies that were included in the metaanalysis, I became increasingly surprised at the huge leaps the investigators took to draw their conclusions.  They freely admit that planned home birth with a certified birth attendant did not have any greater risks than planned hospital birth.  They admit that studies comparing midwifery care versus physician care within the hospital have indicated the superiority of midwifery care, with equivalent perinatal death rates, and low levels of interventions in the midwife group.  How do they then leap to the conclusion that low levels of intervention = increased risk of neonatal death?

Please take the time to look at the complete article.  It isn’t very long and is very helpful in showing how these studies can often take a twist to arrive at their conclusions.

 

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About Kelli

I am Kelli B. Haywood, LCCE, a childbirth educator certified through Lamaze, a birth doula, and prenatal yoga instructor. My two little girls light my life. I am the wife of artist, musician, and teacher - John Haywood.
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