Valerie Gommon Midwife’s Blog

Archive for the ‘Dutch Homebirth’ Category

Homebirth

Posted on: July 17, 2010

There are many benefits to be gained by giving birth at home.  The woman is in familiar surroundings and is therefore more relaxed allowing the birthing hormones to work properly.  Labour is usually shorter, less painful and the mother is more likely to have a normal birth (so less need for ventouse, forceps or caesareans), she is more likely to breastfeed and less likely to suffer postnatal depression and she is more likely to report that she is satisfied with her experience.  These claims are backed up by research and evidence can be found at www.nct.org.uk/about-us/what-we-do/research/roepregnancy-birth

The British Government policy is to encourage homebirth www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_073312) and in the Netherlands 30% of babies are born at home – would they really be supportive of homebirth if it were so dangerous?  A large retrospective cohort study from the Netherlands in 2009 http://www.welbornbaby.com/images/Home%20Birth%20Netherlands.pdf confirmed that the planned place of birth was not the main factor in contributing to perinatal morbidity and Low-risk women should be encouraged to “plan their birth at the place of their preference, provided the maternity care system is well equipped to underpin women’s choice”.  Furthermore, also published in 2009 was another study, from Canada http://www.sciencedaily.com/releases/2009/08/090831130043.htm which showed that planned home birth in low risk women were comparable to hospital births.  Both these studies concur with the latest US study http://www.sciencedaily.com/releases/2010/07/100701072730.htm demonstrating that women who plan home births experienced significantly fewer medical interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative vaginal and caesarean deliveries. Likewise, women intending home deliveries had fewer infections, perineal and vaginal lacerations, haemorrhages, and retained placentas. Data also showed that planned home births are characterized by less frequent premature and low birth weight infants.

This same American study is often quoted by obstetric practitioners because a conclusion read that infant mortality was trebled by planning a home birth, but suggested “it was because of an increased need for resuscitation among home births and therefore, the personnel, training, and equipment available for neonatal resuscitation represent other possible contributors to the excessive neonatal mortality rate among planned home births.”  The methodology of this study has also been severely criticised www.nct.org.uk/about-us/what-we-do/policy/choiceofplaceofbirth.

In conclusion, planned home births are very safe.  It is the presence of trained midwives with correct and necessary equipment that is most important factor, rather than location, in regards to safety of mother and baby.

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Well what a surprise, new research “Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births” http://www.rcog.org.uk/news/bjog-release-new-figures-safety-home-births has found that homebirth is safe for low-risk women.  These findings echo the work of Marjorie Tew way back in 1986 British Journal Obstet Gynaecol 1986 Jul;93(7):659-74

This large scale research from the Netherlands – which has a high rate of home births – found no difference in death rates of either mothers or babies in 530,000 births.

Low-risk women in the study were defined as those who had no known complications – such as a baby in breech or one with a congenital abnormality, or a previous caesarean section; additionally the researchers noted the importance of both highly-trained midwives who knew when to refer a home birth to hospital as well as rapid transportation.

I wholeheartedly support the initiative of the Dutch midwives, and also that of the Albany midwives (based in Peckham, South London) http://www.albanymidwives.org.uk – midwives attend a woman at home in labour and together they decide whether to stay at home or transfer to hospital.  If all is well many mothers opt to labour and give birth at home, but if she prefers to transfer her midwife will accompany her into hospital.

In my Independent Midwifery Practice www.3shiresmidwife.co.uk this is pretty much what happens.  Mothers often plan a homebirth, but know that they can transfer at any point if they wish, conversely if they plan a hospital birth and change their mind I will care for them at home.  Indeed many of my clients would not be considered “low-risk” but these women believe that by staying at home they are more likely to give birth without interference.

The number of mothers giving birth at home in the UK has been rising since it reached a low in 1988; currently only 2.7% of births occur at home in England and Wales.  Our government has pledged to give all women the option of a home birth by the end of this year. At present just 2.7% of births in England and Wales take place at home, but there are considerable regional variations – so we have a huge way to go in achieving this.

Louise Silverton, deputy general secretary of the Royal College of Midwives, said, the study was “a major step forward in showing that home is as safe as hospital, for low risk women giving birth when support services are in place, but she also acknowledged that ” the NHS is simply not set up to meet the potential demand for home births”, she went on to say that there needs to be a major increase in the number of midwives.  My experience fully supports this fact, sadly I am regularly hearing of women being denied a homebirth on the grounds of inadequate staffing – this is outrageous and women need to be campaigning and lobbying for better maternity services (www.aims.org.uk; www.onemotheronemidwife.org.uk; www.kentmidwiferypractice.net)

Further reading

www.nhs.uk/news/2009/04April/Pages/HomeBirthSafe.aspx
http://news.bbc.co.uk/go/pr/fr/-/1/hi/health/7998417.stm
www.independent.co.uk/opinion/commentators/annalisa-barbieri-i-gave-birth-at-home-ndash-and-heres-why-1669309.html


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