Is it safe?

One of the first questions a pregnant mother who is planning a home birth is asked is “is it safe?” This question is rarely asked of the pregnant mother attending the local maternity hospital. Why? As a society we have now become conditioned by popular culture to believe that the safest place to have a baby is in a hospital. Historically, in the late 1800s, and early 1900s births at home were associated with poverty and possibly a lack of any professional care. Remember, The Rotunda Lying-in hospital came into being to provide the poor of Dublin with a sanitary place to give birth and recover. Having a baby in hospital became a sign of wealth and status in society. Middle class society still abounds with discussions of “oh and who is your obstetrician?” as if announcing your obstetrician´s name was the equivalent to revealing a new season Prada creation.

In addition, during the last century, many observers drew crude statistical inferences between decreasing maternal and perinatal mortality rates (numbers of mothers and babies dying in childbirth) and increasing hospital births. However, it is an established fact that the improvements in living standards, nutrition, general health and antenatal care have had a much greater effect on these rates than the trend to deliver in hospital. Finally, most people have absolutely no idea of what having a home birth is about. The average person in the street tends to imagine that having a baby at home is about a woman doing it on her own without any professional care at all. Nothing could be further from the truth. On average a SECM will spend around 52 hours with her client, whilst an obstetrician will rarely manage two hours in total. Home birth mothers and babies get very individualized one to one care, all the way through the pregnancy and labour and also after the baby is born. The midwife attending the home birth mother is a highly qualified professional trained to deal with all aspects of maternity care including neonatal resuscitation.

It is generally accepted by even the most arch opponents of home birth that the peer reviewed  international research published in the most reputable international journals shows that for low risk women, home birth is as safe as, or in some cases safer than hospital birth. This is borne out by studies in the U.K., Holland and Australia where there have been enough home births to make meaningful comparisons in maternal, perinatal and infant mortality rates. Unfortunately no such peer reviewed research is available in Ireland as the home birth numbers are simply too small to make any statistical inferences valid and unbiased. There was a paper published in the Irish Journal of Obstetrics that attempted to show home birth in Ireland was not as safe as hospital births, but this was subsequently discredited in a peer reviewed international journal as being statistically biased against home births and therefore the results meaningless. For more details see our research page.

However, one of the findings of Report of the National Domiciliary Births group in 2004, Ireland, (which contained independent assessments of four different models of homebirth services), was that in Ireland, homebirth is as safe as hospital birth for women with normal pregnancies. Other findings of the report were that “low-risk women should be offered choices in maternity care, including homebirth where feasible”. (This report was accepted by the HSE as a “dynamic, working document” and has been acted upon by a National Implementation Committee in 2008.)

How can expectant parents evaluate safety and risk? In the majority of the research available safety is equated with the risk to perinatal and maternal mortality. That is the chances of babies or mother’s dying during pregnancy, labour and within a short time afterwards. These are statistically speaking relatively rare occurrences, although due to the large numbers of women giving birth in hospitals in Ireland, babies do die every day in hospital settings mainly due to unavoidable circumstances. Maternal deaths should be and are very rare occurrences in Irish hospital settings and unheard of at home. One of the most recent cases being that of Sergeant Tania Corchoran in 2007 following a Caesarean birth at Our Lady of Lourdes Hospital Drogheda with the previous case being three years back in 2004.

However, what the research does not address in the broad catch phrase of “safety” are issues associated with infant and maternal morbidity (injury to mother and baby), either physical or emotional, yet careful scrutiny of the high court reports in the national press reveals many cases taken against obstetricians and hospitals for permanent damage to babies and mothers as a result of negligent or inappropriate clinical practice. These occurrences it would appear are much more prevalent than mortality and infinitely under reported.

So maybe it’s worth considering the safety issue this question from another vantage point. Is it safe to have your baby in hospital? Two years ago in the Irish Times, the Master of the Coombe stated that overcrowded conditions and lack of resources were making it unsafe to have your baby in the large Dublin Maternity Units.

Here are some other safety considerations:
1. Getting to the hospital. If you live in the greater Dublin area this is probably not a problem. However, if you live in a more rural or remote area of the country, chances are you will have a long journey to make whilst in labour. This means that you will have to decide exactly how in labour you are and whether it’s worth making that journey. If you are not in established labour – you may well get sent back home and will have spent a substantial amount of time dealing with contractions in the car. For second time plus mothers making this call is even harder as second and subsequent labours can go from very little to full on very fast. This means that you will have to have arrangements for your other children and make the hospital in time, bearing in mind you may be sent home or may deliver by the roadside. These births are called Birth Before Arrivals (BBAs) They are by no means safe, as there is no professional in attendance. Given these risks, some women choose induction in order to avoid either of these scenarios. However, induction itself is not without risk, the primary one being a distressed baby and a subsequent Caesarean birth. Opting for a home birth means not having to consider this issue as your carer cones to you and is in close contact from the minute you get the first contraction..
2. Progressing too slowly in labour. If you are not making good time in your labour (according to the time a unit of production (you) is allowed to occupy hospital resources) – usually delivery in about12 hours, your body and therefore your baby will be forced to do it faster. How? By artificially making your uterus contract faster (via synthetic hormones given intravenously) or by artificially breaking the protective bag or waters that surround the baby keeping it free of infection. Babies are designed to be deprived of oxygen with each natural contraction, but they are not designed to be deprived of oxygen at the faster continuous rates forced upon the uterus by synthetic oxytocin for long periods. As a result, many babies who are speeded up get distressed. Distressed babies need to be delivered quickly either by Caesearan or if the birth is imminent by assisting the mother with forced pushing, episiotomies, forceps or venteuse. All of these procedures have effects on the mother or baby including breathing difficulties (baby),  nerve, and tissue damage (baby) loss of bladder and rectal control (mother), pain (mother) infection (mother and baby) breastfeeding (mother and baby) PND (mother). More serious consequences include permanent disabilities. Home births are never speeded up in this manner.
3. Being in over-crowded postnatal wards. The chances of infection are much greater in a hospital setting. Many mothers and babies have contracted MRSA. Yet the condition is unheard of at home. The chances of breastfeeding successfully are more limited in hospital, yet home birthers have a rate of over 95%.