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Time to Reconsider Whether the NHS Should be Encouraging Home Births

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An Oxford University study out today reported that first-time mothers that go for a home birth are almost three times more likely to have complications than if they had their baby at the hospital. Plus half of them end up having to be transferred to the hospital during labour.

These findings alone should re-open the debate about the safety of home births, and make the government reconsider whether NHS professionals should be actively promoting it to new parents, like so many midwives do.

Before I get an angry crowd of home birth advocates beating down my door, let me just say this: Congratulations if you had a home birth and it was the most wonderful experience of your life. Great news if it made you feel empowered. Well done if your baby was born perfectly healthy in the blissful environment of your candle-lit bedroom and the two of you snuggled down happily for the rest of the night.

I remember vividly those first few months of my first pregnancy when the information about childbirth started flowing in. Midwives, doctors, NHS professionals, clinicians, friends and books all talked eagerly about "birthing options", telling you to think about "what's best for you" and "the kind of birth you want to have", including whether you want to consider having the baby at home.

The fact remains that a home birth is not as safe as having the baby in the hospital. And not one professional I've ever encountered through two births on the NHS was ever willing to say that.

Why not?

For one, it costs the NHS more money and resources for women to have their babies in the hospital. Maybe they've beent told to do everything they can to keep costs down.

Secondly, maternity care in this country is lead by midwives who on the whole are heavily biased toward "natural" birth. Propaganda against pain relief during labour is prevalent, as is an underlying suggestion that any form of assistance or intervention somehow presents an inferior type of birth.

Not only that, but there have been a number of smaller scale studies claiming that home births in developed countries are generally just as safe as hospital births. This study, however, is the largest and most comprehensive of its kind, involving over 65,000 women.

So much can go wrong during labour. A baby could suffer permanent brain damage if it loses oxygen for just a few minutes. Sure, midwives are skilled at dealing with foetal distress, but I certainly wouldn't want to take even the tiniest risk that those minutes were lost while we scrambled for an ambulance.

Or say the labour gets to stage two and an unplanned intervention is needed, such as forceps, ventouse, or even a caesarean. What about a postpartum haemorrhage? For any of these, you need to get to the hospital, and sometimes, albeit in a minority of cases, minutes could be the difference between life and death or permanent damage to the baby. These points aren't actively discussed with pregnant mothers.

The statistics even from this study say that home births are generally safe for "low risk" pregnancies. Then again, the thing about statistics is that no one knows whether they will be the outlier, the unlucky one. Even the healthiest pregnancies often end up with unpredicted complications during labour. At the hospital, the midwife need only press the call bell at the first sign of trouble and more professionals can pour in within minutes. Not at home.

Certainly women should continue to have a choice about having a baby at home and the NHS has a proud tradition of supporting that choice by deploying midwives to assist. But perhaps it's time that parents are told that it's not without potential serious risks, instead of carrying on as though it's just as safe as having baby at the hospital. The findings from this study would certainly support that.

Around the Web

What if your doctor is against home birth?

Home Births | Royal College of Obstetricians and Gynaecologists

Birthplace in England Research ... - NPEU - University of Oxford

Study will help guide women's choices in where to give birth ...

Choosing a home birth or birth in a midwife led unit

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