The sudden rise in the popularity of homebirths, especially in the West, has raised the pertinent question of whether this latest trend is really a safe alternative to the hospital suite.
Something has been going on lately that has surprised much of the general public and left obstetricians and gynaecologists a little stunned. Women are once again giving birth at home, but this time it is by choice rather than necessity. Although the number of homebirths is still relatively small – only 3 per cent of all births in 2008, that figure represents a drastic increase over previous years.
The official Middle Eastern figures are few and far between, but from what little information could be attained from various health ministries it seemed that the country with the highest hospital attendance was the UAE, Lebanon had a homebirth rate of around 5 per cent of the population, and in Yemen a whopping 84 per cent of all births take place at home. Of course the problem with the developing world is that many women have no choice but to give birth at home.
What we aim to investigate is why mothers who have the choice of giving birth in the maternity ward, perhaps even with a little mummy-tuck thrown in afterwards, would choose to return to practises deemed by most doctors as outmoded.
One of the most famous proponents of the homebirth movement is American talk-show host Ricki Lake. The 40-year-old celebrity has had two babies, the first was born in a hospital, the second at home. So moved was she by the homebirth experience that she released a documentary in 2008 entitled The Business of Being Born, which contrasts her vastly differing experiences while extolling the virtues of spurning the hospital. Lake hopes the film will educate and empower women to really know their choices in childbirth.
“During the hospital birth of my first son, Milo, now 11, I felt like stuff went on that was out of my hands,” she says. “The second time, I found a midwife who was comfortable with me giving birth in water at home. Everyone told me I was crazy – in America, less than 1 per cent give birth outside hospital – but my first birth took 36 hours and second took nine hours from start to finish. It was hard, and I was in a lot of pain, but it was an amazing and empowering experience.”
When questioned by Bespoke, the Assistant Professor of Obstetrics and Gynaecology at the American University Hospital in Beirut, Dr. Labib Ghulmiyyah, stated that even though he acknowledges a woman’s right to make informed decisions regarding her delivery, he could not condone giving birth at home. “At the end of the day maternal mortality rates dropped because of the hospital so the medical community can never support programs or individuals that advocate giving birth without the monitoring of both the woman and the foetus during labour and delivery. That means giving birth in either a hospital or accredited birthing centre. Remember that complications can arise with little or no warning even among women with low-risk pregnancies.”
In most of the world, homebirths are legal, provided you have at least one certified midwife present. The slightly worrying fact of the matter is that lay or other midwives attending homebirths are unable to perform life-saving emergency caesarean deliveries as well as other surgical and medical procedures that would best safeguard the mother and child. As Dr. Ghulmiyyah explains, “The decision to incision should take no longer than 20 minutes so any birth taking place far from a hospital is utter lunacy.”
Why then would mothers take such a risk? The answer lies in the fact that there is still a danger with giving birth in a hospital. For one there is the ever-present danger of infection by a superbug. There is also the fear of problems inadvertently caused by a physician (iatrogenic complications) that include puerperal fever. Furthermore statistics show that homebirths may even be safer. For example, the British Journal of Obstetrics and Gynaecology found that planned homebirth babies are 39 per cent less likely to die than hospital-born babies if – and it is a big if - nothing goes wrong. In actual fact one in seven mothers had to be transferred to hospital and in those cases the chances of the baby dying rose by almost eight times to about 1 per cent.
One of the commonalities amongst women who elect to give birth at home is that they do so without interventions such as oxytocin (to speed up contractions), forceps or ventouse, instead they choose to labour at their own pace. Dr. Ghulmiyyah revealed that doctors would only intervene if the labour were not progressing properly. Midwives on the other hand believe that every natural technique must be utilised before surgery is allowed so they often try to reposition the mother rather than allowing a doctor to start opening up.
“Women should choose their OB/GYN doctor carefully,” says Dr. Ghulmiyyah, “because many will offer the mother full control over the birth plan, with patients deciding every part of their experience whether it be the sex of the doctor delivering, if they wish for their water to break alone and even if they want the baby to placed on their chest straight after delivery. As for pain, epidural or other pain management tools are not imposed on the expecting mothers and you can always choose to have a natural birth whether for personal or cultural reasons. Not only that but women are most often allowed to labour at their own pace. Unfortunately there have been some cases where the rules have been abused and this lead to iatrogenic complications. Nevertheless an operative delivery could be life saving to the mother and baby if used by an appropriately trained professional.”
The crux of the matter is that women need to be better informed. In the old days when birthing would naturally take place in the community it had the positive effect of normalising the act. Nowadays women go into labour with no idea of what is going on. Therefore the best counsel is to enrol in programs that teach and prepare both parents for labour and birth. (The two most popular are Lamaze and Bradley, named after their developers.)
Clearly doctors are not the enemy and undoubtedly some births should only take place in a hospital but if this latest homebirth movement has been constructive in one way it has been in helping women to once again believe in their own bodies and that cannot be a bad thing.
