03 October 2008

where to birth

I was just speaking with a new client and she said that she really wants a homebirth, but feels her family would flip out if she did that since this is her first baby and is the first grandchild on both sides. Her husband isn't 100% comfortable yet either. Next time she says she wants to birth at home. This time she is doing everyting she can to have as low-intervention a hospital birth as possible. OK.

Yesterday there was a wonderful post on Vancouver Doula about just this subject. Some of it is specific to Canada, but there is lots of good information, so check out the whole post. Lots of it is universal:

-When you are presented with two equally effective treatments, then "best practice" requires that you take into account the patients' preferences (that means HER).

- A 1986 World Health Organisation report concluded that “home is the most appropriate birth setting for most childbearing women. Women (and their attendants) choosing this option must be provided with necessary diagnostic, consultative, emergency and other services as required, regardless of place of birth.” See College of Midwives of British Columbia.

- In 2002, the "Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia" was published in the Canadian Medical Association Journal. The results showed that "women who gave birth at home attended by a midwife had fewer procedures during labour compared with women who gave birth in hospital attended by a physician." "Comparison of home births with hospital births attended by a midwife showed very similar and equally significant differences." The final interpretation of the study was that "there was no increased maternal or neonatal risk associated with planned home birth under the care of a regulated midwife."

--. In September 2007, the UK National Institute for Health and Clinical Excellence issued clinical guidelines (The NICE Intrapartum Care Guidelines) on intrapartum care of healthy women and their babies during childbirth. Under ‘‘key priorities’’ it stated: ‘‘Women should be offered the choice of planning birth at home.’’ Information suggests that for ‘‘women who plan to give birth at home or in a midwife-led unit there is a higher likelihood of a normal birth, with less intervention’’.

Where to give birth, assuming you are healthy, is a personal decision that A LOT of people will give you their opinion on...often times that opinion will be based on *misinformation and speculation when it comes to homebirth or any type of birth really. Unfortunately that's our culture - we mostly have been raised to fear or dread birth and that is a shame. Add to this the fact that the organization comprised of obstetricians (ACOG) in the US has decided to perpetrate a campaign of *disinformation and scare tactics about homebirth and you can see that it gets even trickier to navigate the process of choosing.

What to do? Educate yourself. Perhaps, rather than automatically doing what everyone else expects and wants, get the facts and then mentally try on all your options and see what feels right for you. It may still be hospital birth and that's fine. I would just challenge you to understand that you have an actual choice and then make it consciously.

Of course, the idea of choosing can feel overwhelming. And choosing something that is less common means that you will not only have to overcome outside fears and concerns but perhaps also your own. Wherever feels best and most right to you, in your gut and heart and bones, is where you should give birth. But explore your options based on fact. As the saying goes, "If you don't know what your options are, you don't have any".

In real estate it's all about "location, location, location"; apply that to birth and it's options, options, options.
Or as The Clash sang, "Know Your Rights".

* misinformation generally is given by mistake, while disinformation is given to purposely mislead.


Jacquie Munro said...

Thanks for adding your own take on the home birth decision!


kristen cook tyler said...

i think people need to be really honest with themselves if they want something, cuz sometimes they make it happen anyway and things maybe aren't in place for that. I think Doulamomma knows what i'm talkin' about!