House of birth

Less than one per cent of Scottish women give birth at home, but fear of unnecessary Caesarean delivery in hospital could see that figure increase

KONRAD was born while his mother Claudia Bolling was watching Charlie's Angels on the TV. Margaret pushed into the outside world to the rhythm of Massive Attack, playing on her mother Anna Ashmole's stereo, and Kirstie Graham's son Alexander was born just in time for his sister Morven to kiss him goodnight.

Just a few generations ago giving birth at home was often a fatal experience, but these days, with qualified, well-equipped midwives and medical help just a short drive away, some women argue it is the best and most natural option. "It's lovely being in your own home. It's so calm," recalls Kirstie Graham. "People think that just because it's in a building called hospital it is safer but actually it is the quality of care that's important, not where you receive that care. When you give birth at home you have two experienced midwives just for you. In hospital you are lucky if you have one."

At home an expectant mother can move around the house while in labour, light candles, burn aromatherapy oils, watch TV or listen to music. Other children can remain in the home and midwives will keep a discreet distance from the mother and her partner, until their assistance is required.

It is a far cry from the hectic, impersonal atmosphere of a hospital ward. "It's quite difficult to maintain a sense of focus with other people going through this major experience next door to you," notes Anna Ashmole, who was taken to hospital to deliver her baby, when after a few hours of labour it became clear she would not be able to give birth at home. Ashmole believes that her late arrival to hospital meant she avoided intervention such as a Caesarean section or forceps delivery.

Claudia Bolling was not so fortunate. After two normal births at home she delivered one of her children in hospital because it was overdue and community midwives could no longer be on call for her to give birth at home. Her baby was born by Caesarean section after an induction went wrong. For her last child she hired a private midwife to avoid a similar scenario.

For many women home births are a way to take control over their own bodies, rather than become a victim of what they see as the hospital machine. The sophisticated hi-tech equipment and powerful drugs available to medical staff mean that today's hospital birth is a long way from normal. Births are routinely induced and some would say that Caesareans or forceps delivery are unnecessarily common. "If you're in a hospital and under a doctor's care you will have more intervention statistically, there's no doubt about that," admits Dr Laura Cassidy, consultant obstetrician at Inverclyde Royal Hospital.

Despite that, less than one per cent of Scottish women give birth at home, compared to 35 per cent in Holland. British doctors tend to discourage home births, stressing the frightening complications that can arise during delivery - haemorrhage or inability for the baby's shoulders to pass through the vagina, are common concerns. "Unfortunately doctors and midwives are not very good predictors of who is to be normal and a small proportion of women who are pregnant will not be normal and will have some complications. Sometimes that complication is very rapid and very unpredictable and that tends to happen around the time of the delivery," stresses Cassidy.

At such times, every minute counts. That was the case for Anne Marie Lyall, whose baby Callum entered the world with the umbilical cord wrapped around his neck, meaning immediate resuscitation and other, related care was essential. "I would far prefer a home birth - I didn't enjoy the hospital - but personally I feel it would be irresponsible to have a home birth for the next baby," says Lyall.

Despite doctors' fears, midwives say that home births for those women who are not in high-risk categories are statistically no more dangerous than those in hospital. Resuscitation is possible from a mobile oxygen unit and, provided the hospital is nearby, the ten per cent of home births where problems occur can be quickly transferred - traffic permitting.

In reality, a large increase in home births would be a logistical nightmare in the current system, and is unlikely without major expansion and reorganisation of maternity services. "If you get a request for a home birth in a remote rural area then you need professionals attending that birth to make it safe," says Patricia Purton, director of the Royal College of Midwives. "What you're actually doing is taking two practitioners away from a workforce that isn't large, diminishing resources that can be provided for women coming in to give birth. That's a safety issue."

For more information on birth choices contact the Royal College of Midwives (0131 225 1633) or the National Childbirth Trust (0131 260 9201)

Copyright 2000
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