for madamez
text of guardian article ........
While women in the developing world are dying in childbirth, why are we fetishising doing it at home?
Catherine Bennett
Thursday April 5, 2007
The Guardian
Even if earthly arrangements were, in every other respect, irreproachable, human parturition would be fatal to the theory of intelligent design. Unless, as someone has recently speculated, God is a psychopath as well as a top designer, who chose to punish women for original sin by tearing up an earlier scheme for pain-free birth. Whatever the reason - divine malice, or the evolutionary conflict between big brains and pelvises tilted for walking upright - the consequences for at least 529,000 women a year are fatal. The World Health Organisation has estimated that this may be only half the true number.
As you'd expect, the deaths are unevenly spread. "In some developing regions", the WHO reported recently, "a woman has a one in 16 chance of dying in pregnancy and childbirth. This compares with a one in 2,800 risk for a woman from a developed region." A risk so low as to seem, to many women in those developed regions, completely negligible. Natural childbirth campaigners routinely challenge what they perceive to be the pathologising of childbirth with their mantra, "pregnancy is not a medical condition". Such is the hostility to medicine among some natural-birth enthusiasts that doctors are presented as a greater risk to a mother's health than childbirth.
The organisers of Aims (Association for Improvements in the Maternity Services), for instance, provide for women whose GPs have identified them as high risk (and thus ineligible for home birth) this template letter to the local director of midwifery services: "I have carefully considered the risks of home birth and compared them with the risks of hospital birth and I am not prepared to risk my, or my baby's health, by being delivered in hospital." Other mothers are so opposed to intervention that they aim for "freebirth", or unassisted childbirth. Aims informs them that this very traditional choice (last popular when our ancestors were still crawling) is perfectly legal: "The woman herself cannot be prosecuted for birthing her own baby."
If freebirth remains a minority interest, the principle that - for western women - satisfactory childbirth involves far more than a safe delivery has long been mainstream. It underpinned the Department of Health's Changing Childbirth in 1993, and was repeated this week, with Patricia Hewitt's offer of home births for all: "We want it to be as safe and satisfying for every woman in every part of the country as it can be."
An insincere promise, obviously, given that many maternity units are still appallingly understaffed (as well as dirty and ill-equipped). And a rash one, perhaps, given that "satisfying", to certain mothers, now means an episode of ecstasy. "Labour can be pleasurable, not painful, and it sometimes builds up to a crescendo at birth," an independent midwife explained recently. The least ambitious alumni of natural childbirth classes are likely to plan, if not an actual crescendo, a combination of a pool, dimmed lights, whale music, and a drug-defying triumph over pain that will transform the humdrum business of childbirth into something heroic and meaningful.
So long as their babies are safe, there is, of course, no reason why Britain's birth fetishists should not attempt, and then advertise on dedicated websites, their prodigious feats of home-dilation, and skill in outwitting anxious midwives: "My hubby got the waterproof shower curtains out at this point." There seems no reason, however, why this peculiarly middle-class form of self-absorption should be indulged by the rationing, supposedly rational NHS. Merciless when denying life-prolonging drugs to cancer patients, indifferent to pensioners who are still being humiliated on mixed wards, Hewitt has instead prioritised the demands of that limited group of women who believe that state-funded childbirth should be tailored around their own lifestyle choices, as set out in bossy, novella-length birth plans: "Please keep the room as quiet as possible during the second stage," goes a suggested plan by home-birth advocate Angela Horn. "I would like to minimise distractions at this time. If you need to discuss matters with the second midwife, please could you do so very quietly and preferably out of earshot!" There is little evidence on the websites of this kind of demand emanating from pregnant women who live in cramped or uncomfortable conditions, for whom a stay in hospital might even be welcome.
With the end of home visits by GPs, is there another condition to which the NHS will respond by sending out one, or two, sometimes three specialists to spend hours in the patient's home? While terminally sick and elderly patients are dispatched to die among strangers in medic-free wards, Hewitt has accepted that our sturdiest, most articulate primigravidae should be encouraged to summon medical staff to their sitting rooms, for reasons which, when they are not to do with the sacred, or personal self-esteem, seem largely to relate to convenience: "It was perfect, being able to relax and recover at home, instantly, knowing everything was at hand ..."
Including the emergency services. Even with high-risk patients (resentfully) excluded, home birth is risky. When complications do arise, the outcome "is likely to be less favourable" than in hospital (The National Institute for Health and Clinical Excellence regrets the poor quality of evidence on relative safety). And sometimes, even the most fanatical home-birthers have to accept that natural isn't synonymous with safe. "Our own birth story was as far from perfect as we could have envisaged," posts a mother whose home birth was replaced by a caesarean, following a diagnosis of pre-eclampsia. "My overwhelming feelings in the 48 hours after the birth were of failure." The baby, you gather, was completely fine.