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Lightly Born

Lightly Born - Just how risky is it to have your baby at home? by Sarah Lonsdale, Daily Telegraph, 8 July 2000

This article is subtitled:

Just how risky is it to have your baby at home? Sarah Lonsdale investigates

... except that she doesn't investigate. Instead, she writes about using independent midwives for home births, and implies that few home birth occur on the NHS.

Published Responses

A reasoned response from Maria Morgan was published in the paper's online edition. Maria wrote:

SIR - Sarah Lonsdale's article about home birth is a fine advertisement for independent midwives, but let's remember that that majority of women who opt for home birth are very ably supported by NHS community midwives [Lightly born, 8 July 2000].

Whilst I have no doubt that "most obstetricians agree that hospital is the safest place" to give birth, there is in fact no research-based evidence to back up their view. And since obstetricians have limited knowledge of normal birth, their opinions add very little to the debate either.

If we look at facts rather than opinions, we find that virtually all research (and certainly all recent studies in the UK) looking at planned home birth finds that mothers and babies are as healthy or healthier than in comparable groups where birth has been planned in hospital.

Provided that a woman has had no complications during her pregnancy there is no reason why she should not consider a home birth - and no reason why she should not have the care she wants from the NHS. If a woman finds that she has an obstructive GP, she should contact the Head of Midwifery at her local Trust, who will be happy to arrange alternative care.

Women should not be bullied into accepting the sub-optimal care that exists in the majority of this country's large consultant-led maternity units by badly informed GPs.


My initial comments:

The author means well, but she clearly hasn't researched the subject beyond talking to an independent midwife and a doctor. Mainly it reads like an advert for independent midwives. Misleading bits include:

"Women who want a home birth usually have to go privately, paying between 2,000 and 2,500 for the privilege of ruining their sitting-room carpets."

News to me - I would be interested to find out what proportion of home births are attended by independent midwives, but it is nonsense to suggest that you 'usually' have to hire them.

"..during the past two years, four independent midwives have been investigated for alleged malpractice, although none was struck off. The most high-profile investigation was into the practice of Caroline Flint, a home-birth "guru" and ex-president of the Royal College of Midwives, after a breech baby died within minutes of the birth. Although Flint was not struck off the Midwives Register, she was found guilty of professional misconduct for not writing satisfactory notes and not taking the mother's temperature, pulse and blood pressure after the birth."

No mention of the fact that this tragedy occurred at a hospital birth - so what has it to do with home birth?

"No one knows for sure what exactly the risk is of having a baby at home, although obstetricians agree that in the case of an unforeseen medical emergency, such as the mother haemorrhaging or the baby having breathing difficulties, then hospital is the safest place, where expert back-up is only seconds away."

"It is difficult to assess the relative danger of home versus hospital birth. Most studies conclude that home births are riskier, but this is because many that end in disaster are either unplanned births or concealed pregnancies, with the attendant greater risk. Anecdotally, midwives and obstetricians do agree that where the birth is planned for home and where the mother and baby are both healthy prior to labour then the increased risk is small."

The article does mention that some studies with poor outcomes for home birth lump together unplanned & planned home birth. But if the author had done even a miniscule quantity of research, ie contacting AIMS, the NCT, looking at a few original studies, flicking through the BMJ, searching the Net, she would surely have found that virtually all studies looking at planned home birth found comparable or better outcomes than hospital birth for the same risk level.

The only reference given at the end of the article is the Independent Midwives' Association. Is this the only source the author used?

My response...

....alas, unpublished.

Sir,

'Lightly Born' by Sarah Lonsdale (8 July 2000) left the question of how 'risky' it is to have your baby at home largely unexplored.

The article claimed that "Most studies conclude that home births are riskier" than hospital births. This is incorrect. All the evidence suggests that planned home birth is at least as safe as hospital birth for women with normal pregnancies. On my Home Birth Reference Website (www.homebirth.org.uk) I discuss thirty-two papers in this area. The National Birthday Trust survey of 6,044 planned home births in the UK found that planned home births were significantly less likely to end up as assisted or caesarean deliveries, and that the babies were less likely to need resuscitation, or to be in poor condition at birth. Women giving birth at home are at less risk of infection, and one could guess that other outcomes improve because women labour best where they feel most comfortable. The need for interventions (and side-effects) is thus reduced.

It is not the case that, as Sarah Lonsdale writes, "Women who want a home birth usually have to go privately". The fact that some GPs do not support home birth is largely irrelevant, as GPs do not usually attend home births and midwives, whether private or public sector, are the experts in normal pregnancy and birth. Women are entitled to make a booking directly with their local NHS community midwives if their GP is unsupportive, and anyone experiencing difficulty in booking a home birth should contact the Association for Improvements in the Maternity Services (AIMS) at 21 Iver Lane, Iver, Bucks SL0 9LH, telephone 01753 652781, website www.aims.org.uk.

The investigation of midwife Caroline Flint after the death of a breech baby was mentioned. The article omitted the crucial fact that this baby was born in hospital, at Ms Flint's recommendation, because of the breech position.

Finally, it is a nonsense that home birth ruins carpets; the mess is nothing that a plastic sheet cannot contain!

Sincerely,
Angela Horn
Homebirth Reference Site
www.homebirth.org.uk

This page updated 29 October 2000

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