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Why home birth is crazy and why a hospital is the only place to have a baby: Discussing Alissa Warren's article.

by Lisa Morgan

I read a Daily Telegraph opinion piece this morning by Alissa Warren and agreed with it. I also disagreed with it. In the end, it all comes down to perspective - how different people will assess the same situation differently.

Alissa's first sentence really highlights her perspective -"After giving birth in hospital, I cannot imagine why anyone wants to have a "freebirth" at home", and helped to offset the inflammatory headline typical of the media. Instead of taking that comment personally considering the article title, I saw it as the position she was in.

I can't imagine why I would want to hospital birth for that matter (of course apart from an emergency, or a complication requiring hospital birth), but I can easily see why some people would prefer hospital birth, or even midwife attended homebirth.

Obviously Alissa was one of those preferring hospital birth, so out of curiosity I read on...

  • "You don't need to be a mother, let alone a woman, to know that things can go horribly wrong during childbirth. And you're crazy to think otherwise."

Of course things can go horribly wrong. Both mothers and babies can get injured. Sometimes babies die, and sometimes mothers die too. I'm not sure which is more tragic, a baby that has died during a birth, or a baby that has been saved only with severe permanent injury.

  • "The death of a baby during childbirth would be unimaginably heartbreaking. And surely, any mother would go to any lengths to make sure this didn't happen."

That is so true. But death is not an unavoidable aspect of life, it is a part of it. Sometimes no matter what people do, women and babies end up dying anyway regardless of what assistance or technology is available. And, tragically, sometimes because of that very assistance or technology.

  • So why do these homebirthers open their child - and their hearts - to the slightest chance of misfortune?

Perspective again. As with any medical procedure, there are risks. For some, the risks outweight the benefits, but for others, the risks don't. It would be too black-and-white to assume that the rule of thumb is whether a woman or baby lives or dies. However if you want to go there, lets put this very real statistic out there. In 2009, 0.23% of homebirthed babies died in Australia. Shockingly, in the same year, 0.78% hospital born babies died (AIHW). Why do women birth in hospitals? Does this increase their chances of their baby surviving? Is less than a 1% death risk considered substantial enough in this day and age where people constantly take bigger risks than 1%?

  • "I understand that having a baby at home is about experience, empowerment and choice."
    "To have simply considered it shows a level of confidence most of us don't have. Including me."
    "I don't trust my body enough to give birth without some sort of assistance at the ready."
    "Just knowing I had all the right people with all the right gear ready to spring into action was the best possible "birth plan" for me."

This is an example of Alissa's personal assessment - a woman who made the best possible decision for herself and her baby with her given set of circumstances. I agree that giving birth at home indicates a level of confidence. That confidence could be based in faith as seen with religions, it could be based in knowledge of the current evidence and the conclusions drawn from that body of evidence, it could even be based in lifestyle, or previous experiences. Whatever its base, for the individual it is perfectly legitimate and has truth to it. As for experience, empowerment and choice - they all factor in how the birth process can go and women who homebirth have usually determined these things can aid rather than hinder their births.

  • "And imagine the millions of women around the world who wish for the same access to medical care. They should be so lucky. It's an insult to these women to deny it. And it's a tragedy for the babies who would've made it, but don't."

I wholeheartedly agree. Women who want, and need the medical care we have available to us in Australian society, should be so lucky to have it. If these women did have that care available to them but it was denied to them, it is certainly insulting. In some countries, our level of medical care is available but denied to people because of money, insurance, distance to services, etc. It is always tragic when babies and their mothers are the ones who suffer. However (and without further clarification from Alissa), to me this comment appears to be an emotive argument that Australian homebirthers and freebirthers somehow are insulting women who can't access medical care, by not using that care for themselves. A bit like that argument parents use to get their kids to eat the crust off bread (think of all the starving kids in other countries!!).

Lets look a bit closer to home first. In Australia, it is insulting that women are denied medical assistance in the form of homebirth midwifery thanks to politics and powerful lobby groups pushing their perspective into legitimate authority. Isn't that insulting? Take for instance a recent news report (Turnbull & Frazier, 2012) that talks up homebirth being a supported choice by hospitals by offering TWO women a month access to homebirth. Wow! How generous and supportive that is (I guess homebirthing isn't as dangerous as they'd like us to think)! I guess thats not insulting for the other women who want a homebirth but lucked out. Of concern to me is the denial of respectful medical care offered to women who assess their homebirth situation and decide to transfer to hospital to use medical resources. In doing the responsible and right thing, these women are abused for it. Worse, the midwives supporting them at their homebirth, are also harassed, abused, prosecuted, and villified in all the ways legally and socially possible. Isn't that insulting?

  • "But mothers need to have confidence in the system and they need to have the chance to use it."

I agree. The maternity system in Australia is shit. Its not the reason I freebirth, or homebirth, but from my perspective, women should be supported to have the births they need without having to fight for them or miss out.

  • "If this forces more women to have their babies in public hospitals leading to overcrowding, no wonder desperate mothers are thinking twice about giving birth at home. It's this fear that makes women rethink homebirthing. A fear in the system. But is the fear justified?"
    "It's very easy to panic about the entire childbirth process. Let's be honest, it's no picnic. But fear of childbirth and fear of hospitals are two totally separate things."
    "Many homebirthers believe if mothers let go of the fear, it would be easier to say "yes" to a homebirth."
    "But when you're there, when you're doing it - and trust me, the memory is still clear enough for me to keep 10 feet away from my husband - you want that fear harnessed. No better way to have it reined in then by a team of professionals in a place where there are fewer questions and lots of answers."

Without further clarification, it seems Alissa is saying that women are rethinking homebirth because they are scared of the system. This ignores the multidimensional aspects people factor in when making decisions. She goes on to say homebirthers think more women would homebirth if they let go of their fear of childbirth, and that this fear can be harnessed by hospitals "where there are fewer questions and lots of answers". I had to chuckle at that one as it is a rather subjective observation of the capacity of medical professionals. There are many cases where there are next to no answers and lots of questions! Medical science also still has a long way to go to understanding the full impact of human and neonatal physiology. There are many cases where practice or policy are not evidence based as well.

  • "There's no doubt I was frightened about having my baby. I remembered all those rom-com movie moments in the '90s, a la, Nine Months, Father Of The Bride 2. Yikes. But I turned that fear into confidence. Confidence in me, my husband and my hospital."

I found this paragraph really interesting as for me it highlights the social and cultural aspects of childbirth. How people view birth, and give birth is very much so influenced by culture. Ours is a culture which on a whole, relies on a select group of people owning authoritative and technocratic knowledge (Davis-Floyd & Sargent,1997). Throw in the social conditioning of birth as an emergency, a medical event, a painful event, a complex event requiring medical / technocratic assistance, and society's dependence on technology to inform, and here you have a picture of childbirth that is thought to be quite alarming for the majority of women and babies.

  • "Stiff way to get a holiday, huh?"

This comment was in reference to Alissa enjoying her hospital experience as a relaxing break from being at home - not having to tell the visitors where the teabags are, not having to do the washing, being served tea and food etc. Some homebirthers get this experience at home, others sadly don't. However, this comment made me realise just how much women's work in the home is devalued, and how difficult it is for women to truly "get a holiday". Hospitals provide that break from home life for some women where it would not otherwise be possible to do so. This is important in the newborn period for the mother to establish breastfeeding, bonding, and the transition into parenting.

  • "No matter what, a mother makes choices from the moment she knows she's pregnant: Will I keep this baby? Will I make healthier eating choices? Will I do yoga? Will I book them into childcare? And that's the beautiful thing about motherhood - choice."
    "But it's a no-brainer when it comes to safety during childbirth. And that's something that shouldn't be up for debate. The health of a mother and her baby should be the No.1 priority during childbirth."

Bit contradictory don't you think? Choice is a beautiful thing, yet choice shouldn't be an option when it comes to safety. This logic reeks of the for-your-own-good logic which was prevalent in times of women not being able to vote and is still prevalent today (look at all those court ordered caesareans in America!). Those comments also assume that homebirthers do not have their own health and their baby at No. 1 priority.

  • "Regardless of any homebirthing or freebirthing success stories, no one will convince me otherwise. Because having a baby isn't just about a mother in labour."

I agree. Having a baby is more than the labour process of course! However this implies that the decision to homebirth or freebirth is purely about the labour process and conveniently ignores the impact labour can have on babies, mothers, families, parenting, and the rest of their lives. This comment is designed to focus on labour as the salient issue, obscuring other issues such as womens agency, the right of women to determine what happens to their bodies, human rights issues, evidence based medicine and the lack therof in practice, PTSD, mothers who committ infanticide, babies who end up permanently damaged from intervention leading to parents caring for 40 year old disabled children, the power of the state over peoples personal lives, the impact of birthing choice on breastfeeding, the impact of birth environment on the immune system of babies, and so on.

Given all the issues to consider, I always come back down to this - The right of individuals to decide based on their own assessment of how all these factors relate to them.

References

AIHW 2011. Australia's mothers and babies 2009. Perinatal statistics series no. 25. Cat. no. PER 52. Canberra: AIHW. <http://www.aihw.gov.au/publication-detail/?id=10737420870>. Source

Davis-Floyd, R., & Sargent, C.F. (1997). Childbirth and authoritative knowledge. Los Angeles, CA: University of California Press

Warren, A. (2012, April 22). Why home birth is crazy and why a hospital is the only place to have a baby. The Sunday Telegraph. Retrieved from http://www.dailytelegraph.com.au/news/opinion/why-home-birth-is-crazy-and-why-a-hospital-is-the-only-place-to-have-a-baby/story-e6frezz0-1226335144670 Source

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