I had another clinical observation day today, for my breastfeeding course. This was with a community based lactation consultant, which was very cool. It was great to see an L.C. in action (I wish i could do an observation day with my MOM--how cool would that be??!), and I know this L.C. from before, as I went to see her when I had my first bout of yeast last year, and we have kept in touch since then. She's very supportive of midwifery also, which is nice, and which makes logical sense, since there is so much overlap between natural childbirth and breastfeeding. But today she threw me a comment that surprised me [I'm beginning to get the impression that this shouldn't surprise me, ever, from anyone], about how she just can't bring herself to support home birth, 'because it is SO much safer to be in the hospital, where everything is there if you need it.'
I'm cautious in moments like these. You don't want to plow over people with your opinions, but I feel strongly about the safety and appropriateness of homebirths for low risk women, and support a woman's right to choose where to give birth with all my heart. So I just can't keep quiet. But how to approach in such a way that doesn't shut people down? Close their minds?
I pointed out the fact that in hospitals, the golden standard timeline from recognition of an emergency to in the operating room, performing surgery, is thirty minutes [I didn't point out that it is not uncommon for this to actually become 40 to 45 minutes]. Many midwives will stipulate that a woman's home, should she choose to give birth at home, be within a half hour of a hospital. This is comparable to hospital OR time, since in an emergency a midwife can phone ahead to the hospital, get the operating room ball rolling, and call an ambulance or get in the car and drive, and have a woman in the operating room within the same or similar time frame.
All of this is true. Some midwives will deliver a particularly low risk woman at home when she lives further from the hospital. But often people seem confounded by the idea of home birth because of its geographical distance from the operating room. That geographical distance isn't quite as far as we like to think. Operating rooms don't stand filled with staff and equipment at all times, ready to cut in four or five minutes. Even in hospital, even in an emergency, a cesarean takes time to prepare for. And even in a home birth, a cesarean is accessible.
I could also have pointed out that in Norway, 70% if women give birth at home, attended by midwives, and Norway has one of the lowest infant and maternal mortality rates in the world.
I could also point out that home birth statistics in Canada show that home birth is actually safer. Intervention rates are lower. Complications are lower. Surgical rates are lower. Infection rates are lower. Death rates are lower.
Women are screened for risk factors before being accepted as candidates for home birth. There is always a second medically trained person at a home birth in case of the need for resuscitation. But the statistics are inarguably in favor of home births for low risk women. Perhaps hospital based infection rates cause enough deaths to counter balance any home birth deaths in which a geographically proximal operating room or a larger resuscitation team would have made a difference.
The thing is, women should be free to choose. Birth is not dangerous. It is a vulnerable time in a woman and an infant's life, but it is not inherently dangerous. Nature is very good at directing birth, which is not a medical event until [unless] it becomes a medical event. Healthy women with adequate nutrition and access to clean water, good medical care, some degree of prenatal care, and access to accurate information regarding birth, can and do give birth with very little danger. Some women feel safer in proximity to a greater number of health care professionals. Wonderful! Give birth in hospital. Some women feel safer in their own homes, with their own family and bed and bathtub around them, exposed to the microflora that their bodies are accustomed to living with. Wonderful. They should be free to choose this, without judgement.
Such a long journey. So solitary sometimes.