FROM BEING the norm in the early part of the 20th century, home births are now the exception. Giving birth has become a markedly medicalised process involving a hospital stay; proponents point to how maternal mortality has become extremely rare as a result, while perinatal mortality rates have also dropped significantly.
However women who wish to exercise their choice to have home birth in the Republic face considerable obstacles. While there are independent community midwives who can be retained by expectant mothers to attend a home delivery, these professionals can appear marginalised by the mainstream hospital-based maternity complex. So there was considerable interest when Minister for Health James Reilly told this newspaper recently that he would like to see more women having their babies at home. He qualified his statement by saying, “I would like to ensure that women expecting their baby have a choice, but that choice has to be always predicated on safety.”
Home birth proponents point to a study in the Netherlands of more than 500,000 low-risk births which showed no increase in perinatal mortality or morbidity for home births provided there was sufficient availability of well-trained midwives along with a robust transportation and referral system. However the establishment view, in particular that of obstetricians, is that all births should take place either in, or close to a maternity unit. Complications such as severe bleeding or the need to carry out an emergency Caesarean section require rapid high-tech intervention. Many obstetricians would be comfortable with the home-from-home concept of birth within hospitals, where mothers would receive low intervention, midwife-led care.
Safety is the key to any expansion of community maternity services. A task force set up by the Health Service Executive and chaired by Dr Chris Fitzpatrick, Master of the Coombe Women and Infants University Hospital in Dublin, is currently examining the appropriate settings for maternity services as well as staffing and safety issues. With maternity hospitals experiencing severe capacity issues and a growing cohort of women who wish to explore more independent birthing options, the Minister for Health is right to advocate a policy of greater choice for mothers. Whether that includes a wider availability of home birth options will very much depend on a thorough assessment of the safety issues involved.