I am pro-choice and not afraid to
explain why, Before we go any further I should probably explain that I am not referring to anything to do with abortion, what I am talking
about is the recent case in Ireland of Aja Teehan Vs HSE. Quick
background is this woman wanted a home-birth was was refused because
she is attempting a VBAC (vaginal birth after caesarian section).
Even though she lost her case, she emerged triumphant from the
courtroom and made the following statement:
"It
is a very difficult system we are working with here. It is a very
difficult system that seeks to control a woman during her birth
period in a way that anybody else is not controlled for any other
reason. It is deeply, deeply ingrained in our society, it is very
hard to overthrow it".
Outside
the courthouse Aja made her point perfectly when she said:
"It
is not that I am determined to have a home birth regardless of
consequences – if I thought there was anything going wrong with my
labour I would be the first one calling the ambulance. I just want
the option of a trial of labour in my home".
Homebirth is largely misunderstood not just in Ireland but in most of
the developed world. Any discussion usually gets quiet heated with
people forming alliances to two camps; either hospital or home. Now
before I came here I was very much in the “hospital” team and had
the same reason as most – is it not better to be in the hospital
just in case anything went wrong. This is a thought and fear that has
been ingrained in us over generations, that birth is “scary” and
“dangerous” and is best handled in a medical environment. Since
coming here to the Philippines I have been present at almost 100
births in what is known as an “out-of-hospital” setting, and
participated in probably 5 times that amount of prenatal examinations
and I am slowly but surely developing my knowledge, understanding and
experience of unmedicated birth.
The first thing I learned here was that the midwifery model of care
and the medical model of care are totally different and each serve
different purposes. I could explain for hours my thoughts on this
topic but here is a quick explanation The basic difference is that the midwifery model of care sees pregnancy and birth as normal and puts emphasis on trusting the woman's body in it's natural ability to give birth.The basic midwifery approach to birth and the pregnant woman tends to be more holistic, all factors which may contribute to the health and safety of the woman and her birth are considered; emotions, living situations, nutrition, and education should all be addressed. At the time of birth, this care provider will be aware of and trained to spot things that may go wrong, but will, overall, consider childbirth a natural process that frequently proceeds normally and safely. A practitioner using the medical model of care tends to approach the patient from a problem solving approach, searching for the defect or dysfunction and trying to fix it. Unlike the midwifery model of care that seeks to understand the whole person and prevent unnecessary intervention or surgery, things are viewed from a pathological model searching for the problem and a solution. In a normal pregnancy that has
no complications where both mother and baby are healthy, the mother
can very safely give birth in an out-of-hospital setting. And yes I
am including VBAC in this also. The best way I can think to explain
this is it is like going to the dentist for a check-up, them finding
a small cavity and choosing to do root canal “just in case”
instead of a simple filling.
Let me explain this point further. The amount of unnecessary
interventions that go on in hospitals are astounding. I think that alot of people don't understand the long slippery slope they can end up on if they start to interfere unnecessarily in what is essentially a natural process. Marsden Wagner explains this perfectly in his book "Born In The USA";
"This fear of imminent trouble leads obstetricians to jump in and intervene too early with procedures that create complications, necessitating more procedures. one example of such a cascade is an induction of labour with powerful drugs, which leads to increased labour pain, which leads to an epidural block to relieve the pain, which leads to a slowing of labour, which becomes 'failure to progress', the number one diagnosis used to justify pulling the baby out with forceps or a vacuum extractor of performing a C-section".
There was a recent study done in the US where
expectant mothers were given the warning leaflet that is supplied
with the epidural medication, listing all the complications and warnings that come with an epidural, not one of them opted for an epidural during their birth.
Of course there are times when medical intervention is necessary and
it does save lives of mothers and babies in medical emergencies. But
the point I want to make is these emergencies don't happen all of a
sudden, midwives are trained extensively in how to recognise any
changes from the normal during labour, how to intemperate the degree
of seriousness and there are very strict guidelines in place
regarding when to transfer the care of the woman over to a hospital.
Any reputable out-of-hospital birth setting or home-birth midwife
will have explained to the woman prenatally the danger signs in
pregnancy and made a plan that if necessary they will go to the
nearest hospital. Here at Abundant,we monitor the health of the woman throughout her entire pregnancy and if there are any serious warning signs we refer for a doctor check and if necessary recommend a hospital birth. We also explain to every woman on
admission in labour the plan of care for medical emergencies – we
transport them immediately to our nearest hospital. I would also like to point out things can go wrong in hospital – forceps
being misused, over-perscription of medication, babies being delivered
too soon, unnecessary caesarian, don't even get me started on MRSA!
The thought it is “safer” to give birth in hospital in my humble
opinion is absurd.
One
thing that I have found refreshingly brilliant is that the HSE is
actively encouraging home births in Ireland by providing a grant to
help cover the costs of having a self employed community midwife
attend the birth. Families who choose to have a home birth do so because they understand the midwifery model of care and they want their child to be born into this environment. It makes my blood boil when I see comments such as a woman choosing a home birth is "crazy" or she is putting the life of her baby in danger or she is "selfish". It makes me wonder what kind of faith do some people have in skilled midwives? Do they just think we throw our hands up in the air and freak out when something out of the ordinary happens? Midwives are experts when it comes to birth, it's what they do! A woman having her baby at home with a midwife is getting professional one-to-one care throughout her entire labour and birth. And for all those people terrified of something "suddenly" going wrong, I assure you that complications are noticed sooner and treated quicker in a situation such as at home because the midwife has only one woman she can completely focus on, as opposed to an overcrowded understaffed hospital labour ward. This type of care just cannot be provided in a hospital due to lack of staff. I just hope that the requirements for being eligible for a homebirth don't become so limiting that they only exist on paper and nobody is actually allowed.
I personally think that women should be applauded for taking control over their own birth experience, be it in a hospital, in a birth centre or at home. It is not the location that is important, it is that they feel they are able to make decisions on how they are cared for. Of course I am all in favour of unmedicated homebirths for low-risk pregnancies and I think that the women who choose this should be supported and encouraged, not challenged and made climb over barriers.
