In another twist in maternal care standards, Britain’s National Health Service is recommending to healthy women that birthing at home or at a birth center is safer than having babies in a hospital. As reported by the NY Times on Dec 4, 2014,
Women with uncomplicated pregnancies – about 45% of the total – were better off in the hands of midwives than hospital doctors during birth, according to new guidelines by the National Institute for Health and Care Excellence. For these low risk mothers-to-be, giving birth in a traditional maternity ward increased the chances of surgical intervention and therefore infection. Hospital births were more likely to end in cesarean section or involve episiotomies…
This is an innovative and unconventional recommendation, considering that the overwhelming majority of women who give birth in developed countries do so in a hospital.
For most of human history, babies were born at home. Laboring women were attended by midwives and female family members. With the advent of the scientific revolution, a slow transition occurred from the 1800’s to the 1900’s bringing laboring women into hospitals under the care of physicians. At first, because of physicians’ lack of understanding of the spread of infection, and their enthusiasm for “heroic” measures of unproven efficacy, hospital birth was a more dangerous proposition than home birth.
However, as medical training improved and the number of women giving birth in hospitals increased, a corresponding improvement in the maternal and infant mortality rates was seen. In the U.S., from 1900 to 1990, the maternal mortality rate decreased from 850 to 7.7 deaths per 100,000 births, and infant mortality greatly decreased from 100 to 7.2 deaths per 1000.
In the last century, the sensibilities applied to childbirth have gone through several permutations:
Only poor women birth at home (1930’s)
The more technology the better (1950’s)
Go natural with no meds and no tech (1970’s)
Schedule your c-section (1980’s)
Decrease c-sections (the advent of the vbac) (1990s)
Everyone can have a c-section (2000s)
One aspect of opinions on childbirth methods that has been consistent is judgment. Whatever the trend, it has commonly been presented with great superiority and dogma. Women who don’t give birth in the way they thought they should, no matter what the standard, can experience a sense of failure and disappointment. How tragic is that! Birthing is hard enough without having to think about whether you’re doing it right, according to the ever-changing standards of the day.
What’s great about the recommendations of the British National Health Service is that women are being given accurate information with which they can make a choice that’s right for them. As recounted in the NY Times,
Mark Baker, clinical practice director for the health institute, said first-time mothers with low birth risks would now be advised that a mid-wife-led unit would be particularly suitable for them, while mothers who already have given birth would be told that a home birth would be equally safe for the baby and safer for the mother than a hospital. But women are still free to choose the option they are most comfortable with, Dr. Baker said. “This is all about women having a choice,” he said.
Childbirth has different meanings for different women. Some see it as an opportunity for an emotional life-altering experience. Others see it simply as the means to getting their baby into the world. When women are given options that respect their preferences and their health, everybody wins.