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Safe and sound

MagazineSeptember 1992 (Vol. 3 Issue 6)Safe and sound

Everywhere in the world, whenever a pregnant woman mentions home birth in front of her doctor, the most common reaction is, "It is a return to the past

Everywhere in the world, whenever a pregnant woman mentions home birth in front of her doctor, the most common reaction is, "It is a return to the past. What will you do if. . ."

Many doctors do not hesitate to reinforce the fear of childbirth without taking any account of fear being the main obstacle to an easy birth.

The current medical attitude is deeply entrenched. Most of the medical students I have met could never imagine that the environment might influence the physiological processes in the perinatal period and that therefore environment ought to be taken into account. Very few doctors around the world mention that birth in a familiar place and in privacy might be a way to avoid complications, and very few doctors have looked into the statistics from the Netherlands, the only Western country where home birth with the backup of a hospital is commonplace.

Very few doctors mention that a newborn has been sharing its mother's antibodies and is therefore specifically adapted to the domestic microorganisms.

In 1975 while teaching epidemiology to medical students in Nottingham, Marjorie Tew inadvertently discovered that no statistics could support the widely accepted hypothesis that the increased hospitalization of birth had caused the decline by then achieved in the perinatal and maternal mortality rates.

A report about neonatal mortality in Missouri home births, including 3,067 planned home births, provided evidence that nearly all the mortality excess for planned home births occurred in association with less experienced attendants. This is the main conclusion shared by all the home birth practitioners who follow up their own outcomes: the statistics improve according to their experience.

The most common mistake is to continue with a home birth after a long and difficult first stage. In other words, the first stage of labour should be considered the best time to select women who can give birth at home. From my discussions with hundreds of birth attendants it appears that most complications (newborn baby in need of resuscitation, post partum haemorrhage, etc) are preceded by a long and difficult first stage.

Furthermore, a transfer during labour is not associated with special risks. This has been demonstrated in the Netherlands in the "Wormerver Study", where the perinatal mortality rate after transfer during labour was the same as the overall national rate during the same period. On the other hand, if the first stage of labour is considered to be the elective time for screening, fewer pregnant women have to carry the label "high risk" for several months of pregnancy which is, itself, a cause of dangerous anxiety. In the Wormerver Study, referral by the midwife to an obstetrician during pregnancy was associated with a very high perinatal mortality rate (51 per 1000).

A second common mistake among home birth attendants is to underestimate the importance of privacy during labour. It is commonplace in the home birth movements to emphasize the mother's need for support, emotional help, assistance, etc. The word "privacy" comes far down the list. Friends are invited to share a home birth. This attitude is at odds with the concept of "natural childbirth". Among all the mammals "natural childbirth" is birth in privacy.

A third common mistake is to introduce the rules established by professionals who have no experience of home birth, such as repeated vaginal exams and recording of the progress of the dilation of the cervix on a graph. In fact, midwives who have good experience of home birth in complete privacy do not need to disturb the labouring woman with many vaginal examinations. They can easily assess the progress of labour by the noise the woman is making, the way she is breathing, her position, etc.

Since the main obstacle to our modern society adapting to home birth is in the realm of beliefs the priority must be to challenge the universal propaganda that home birth is dangerous. The best means by which to do so are the statistics from the Netherlands (1986 Monthly Bulletin Population of Health Statistics). The Netherlands is the only industrialized country where one third of all births happen at home and where they can reconcile a perinatal mortality rate lower than 10 per 1000, a maternal mortality rate lower than 1 per 10,000 and a rate of caesarean section of around 6 per cent.

The effect of environmental factors on human parturition and other physiological processes in the perinatal period should also be a topic introduced into the curriculum of medical students.

This article is an extract of a report prepared by Dr Odent, a pioneer in the active birth movement, for the World Health Organization about planned home birth.

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