Monday, June 29, 2009

What about the baby's rights?

"Homebirth is about to become illegal in July 2010, as private midwives do not have access to professional indemnity insurance and therefore will not be able to register on the new national register. Even if you don't believe in homebirth, this is an infringement of women's rights."

This statement elicited the response from one person of, "What about the baby's rights?"

It's a frequently heard point brought up whenever homebirth and women's rights to choice for the mode of care is brought up recently it seems. It always strikes me as such a curious question. What about the rights of the baby?

First, it supposes that homebirth is more risky to the life of mother and child than hospital birth. Evidence based, empirical, large scale, peer reviewed research flatly proves that incorrect. Further to that, countries across the world (and no, not third world 'backward' ones) where homebirth is a fully supported option contradict it through experience - infant mortality is LOWER in these countries.

If and when medical care is necessary, the midwife(s) are able to both treat (the same as a midwife would in attending a hospital birth) or advise and attend transfer to a facility where more advanced care is available. (As would be the case if something happened in a hospital based check-up or were in the L&D ward and saw something that warranted further investigation or had an emergency necessitating transfer to theater.) These are all things that are prearranged and in place well ahead of the EDD should a non-emergent transfer become advisable or an emergency crop up.

Second, it's curious the question never comes up in terms to what are the babies rights in regards to a woman choosing to go to a hospital to birth. Women have the right to have elective
c-sections - a procedure which has multiple risks including higher incidence of neonatal death, persistent pulmonary hypertension etc. A recent large-scale 4 year US study of 12,000 neonatal deaths examining rates for babies born by Cesarean among low-risk women who chose for non medical reasons is 1.77 to 0.62 vaginal deaths.

Ignoring the big tickets like caesars - how about the other procedures women who choose hospitals choose for their babies - such as pain management (gas, pethidine, epidurals etc) all of which carry many risks for the neonate as well as risks for the mother. Rare, as are complications in homebirths one might argue, but risks still - ranging from increasing risk of infection, risk of respiratory distress, decreased success and duration in breastfeeding, including and up to the risk of death. The common 'generally harmless' epidurals have a relatively common side effect for example of cause the mothers BP to drop, which compromises the fetus oxygen supply through the placenta causing distress and further intervention. Failure of labor to progress, 4x the rate of requiring forceps, 2-3x more likely to have c-sections are only a few others.
Look at the rate of unintervened births in hospitals or the average c-section rate either Australia wide or especially within the private hospitals. We fall woefully short of the World Health Organizations recommendations.

Even further up the chart of 'safe', 'normal' procedures in hospitals such things as routine vitamin K for their newborns or cord clamping before the cord has fully stopped pulsating carry risks. The vitamin K used is a synthetic variety and there are a number of risks linked to it. Halting the cord flow prematurely has got to be one of the least sensible things around and risks many issues including brain damage and more than doubles the risk of hematocrit levels remaining dangerously low for MONTHS. I might also mention Hep B vaccinations. Again, all these things are well documented in peer reviewed studies, papers and the major professional journals - but no one EVER brings up the issue of the babies rights vs the mothers choice when the mother chooses to have a hospital birth or chooses hospital procedures on behalf of herself and her child.

It astonishes me that there is a common perception that while those who choose hospital births and/or management/interventions go completely without questioning simply because it is the broader cultural norm in Australia while homebirth seems to assume the woman does so because they are ignorant of how risky it must be or else selfishly choose to risk their children because of their own personal preferences and suddenly all the rights of the baby come into question.

There is an awful lot of 'behind the scenes' stuff that goes into a homebirth to ensure safety of both mother and child that most people are simply not aware of when they make suppositions about safety of homebirths or what one entails. No one is more motivated to protect a baby than it's own mother.

Let me also be perfectly clear here: I am NOT anti-hospital. Where it is necessary and warranted it is absolutely a lifesaving miracle. Had I need of it, I would be there in a heartbeat. I am against the removal of our rights to choose, poor arguments and misinformation however.
Likewise I am flatly against the lack of balanced and full information disclosed to the patients in the widely available 'mainstream' education programs/resources. It's impossible to make an informed decision when the information is withheld or skewed to suit any agenda instead of being allowed to speak for itself and be weighed individually on a case by case basis - even if it's withheld with good intentions or ostensibly good reasons. (IE "Don't want to confuse them with too many choices/information they don't wouldn't understand/don't need to know..." type stuff)

It also occurs to me that safety of the baby isn't the only important thing. No one is suggesting it's not important or suggesting risking baby for the sake of mother but it doesn't bear up that any outcome is acceptable so long as the baby comes out healthy either. Maternal physical and mental well-being are very valid issues. Neither is it an exclusive issue - maternal experience certainly impacts on the child, it's likelihood to thrive and their relationship potentially for years to come.

So... what about the rights of the baby?


katef - said...

I am totally with you on this... I have not had a home birth, though I love and support many who have chosen to birth at home and might choose the same in the future.... this is not about home birth or hospital birth, this is about choice. A choice that a mother makes for herself AND her child.... just like so many other choices she will make for her children as they grow.

phoeberae said...

I looked into the possibility of experiencing a homebirth for my second child. Having scooted around a stack of websites and YouTube, I was encouraged to hear some more positive stats on homebirth.

All I can say is that I am delighted to have experienced a natural delivery VBAC although in hospital I felt safe and cared for throughout and like you am still buzzing 6 months later when I mentally relive the experience.

My first was an emergency c-sec and although far from what I wanted, my naiivity going into the birth meant I had now knowledge to challenge the advice of my caregivers. I think knowing your body and what is happening and understanding every aspect of what can and may happen could prevent what I experienced (which by the way wasn't at all a nightmare, just different than I expected).