Sir , – As a practising obstetrician, I strongly support the woman’s right to choose her birth place ( “Hospital or home; the politics of birth”, Health + Family, August 13th). However, this needs to be done by an appropriate caregiver. If low-risk, this caregiver should be the woman’s midwife.
As you correctly identified, there are many benefits to homebirth. There is less intervention, the caesarean section rate and instrumental rate is lower and maternal satisfaction is higher. This in turn has a positive effect on cash-strapped hospitals. (However, the Dutch study quoted superseded a large UK study, which suggested that babies born at home to first-time mothers were three times more likely to require resuscitation or medical support than those born in hospital, although this figure is still below 1 per cent).
The list of contraindications to homebirth that the HSE has published, exists for a reason. Women with medical conditions need joint midwifery-obstetric support in labour. Those first-time mothers who are over 40 have only a 25 per cent chance of delivering without medical intervention, so it would be advisable to deliver in a hospital where such intervention can be offered.
Although the medical community is in favour of the right women having a trial of vaginal delivery after caesarean (VBAC), it must be stressed that these births can go terribly wrong with the risk of uterine rupture quoted as high as one in 200 births. If a woman chooses to birth outside medical/midwifery guidance then the woman needs to accept responsibility for all potential outcomes – including the adverse ones. This can only occur with appropriate multi-disciplinary counselling.
We need to stop this “us and them” mentality between the homebirth and hospital birth camps. If we support those low-risk women to birth where they want to, and give those women at higher risk of complications a better hospital birth experience (including offering psychological support to deal with previous bad experiences) then can we ensure childbirth is as safe as it possibly can be. – Yours, etc,
Dr EAMONN BRESLIN,
University Hospitals of
Leicester,
NHS Trust,
Leicester,
England.