Home birth home

More than a thousand New Zealand women each year shun the hospital system and instead give birth in their own lounges, bedrooms and bathrooms. Is homebirth a fringe lunatic choice? JOANNA DAVIS reports.

Melanie Patterson describes the scene at her place at first-light last Boxing Day as cosy - she and husband Darren, three-year-old Jake, a friend and the midwife were sitting around eating pancakes with bananas and syrup and chatting about the travel photos on the living-room walls.

Every now and then Melanie had a contraction; she was, after all, in labour with baby No 2.

When things became more intense, the friend took Jake to the park, and 45 minutes later his little brother was born into his father's hands as Patterson leant into the sofa and pushed with all her might.

"Darren just reached out and Juliet [the midwife] told him what to do and he caught Lee," Patterson says. "That was pretty special. Then we all snuggled up. Jake arrived home and he had a baby brother."

She says the experience was much less harrowing than her first birth, which included a panicked trip to the hospital after a fast labour and the fear the baby would be born in the car.

"[This time] it was peaceful. It was cosy. I was curled up on the sofa quite a bit, with people around me, getting done whatever I wanted. We had relaxing music and then, later, silence. I was quite open in saying where I wanted the hot towels placed. All my needs were met so I felt really comfortable."

The Pattersons choice is not a mainstream one. Health Ministry figures put the percentage of New Zealand women having homebirths at 2.5 per cent - about 1500 a year - although a large group of midwife LMCs (lead maternity carers) report three times that rate.

Despite its low prevalence, homebirth is generally supported by midwives because, according to New Zealand College of Midwives adviser Lesley Dixon, it has good outcomes for women who are well and healthy.

"As midwives we want to support women to have a positive birth experience wherever they give birth."

Evidence suggests when women give birth at home or in a primary birthing unit they are less likely to have intervention in the normal physiology of labour and are therefore more likely to have a normal birth.

Dixon says midwives believe home, along with primary units such as Lincoln and Burwood, is actually the best place for well women to give birth.

Those with complex pregnancies or medical conditions should go to a secondary or tertiary hospital, such as Christchurch Womens', instead.

Dixon points to two Canadian research papers published last month and a Dutch study of more than 500,000 low-risk women published earlier this year, which show no increased risk to mother or baby from planned homebirth and fewer interventions such as forceps and caesarean, even taking into account the women who have to transfer to hospital.

If the research supports it, why do so few women choose it?

Julie Richards, who has been a homebirth midwife in Christchurch for 20 years, puts it down to the culture of fear of birth and the way we have so thoroughly embraced technology as a society.

"It's that fear of the unknown and the issue of risk and safety," she says. "It doesn't seem to be understood that there's risk wherever you are, and home actually has less risk because you're not exposing yourself to the technology.

"In hospital, women are more likely to use things such as epidurals and continuous foetal monitoring simply because they are available, and those medical interventions can in themselves make the labour more complicated."

North New Brighton businesswoman Tash Page, who gave birth to baby Matilda at home four months ago, says she encountered plenty of shocked reactions when she mentioned she was planning a homebirth. She says that, despite not being particularly alternative herself, she attributes choosing homebirth to having a different outlook to most.

"I just think we have a culture of people expecting labour to be medically managed, but I didn't want to be treated like I was ill," she says. "My mindset is more that birth is natural; everybody has a baby."

Of course, having a baby does not always go smoothly and naturally.

Jacqui Anderson, who works with Richards and is also co- head of midwifery education at Christchurch Polytechnic, has collated the statistics from her midwifery practice and says 12 per cent of women overall (during first and subsequent births) need to transfer to hospital in labour.

The main reason, she says, is for delay - for some reason the labour is not progressing as it should.

She says transfer for pain relief is exceedingly unusual and a red-light emergency for foetal distress (concern about the baby's heart-rate) is almost unheard of.

Surely then, the mess must be a remaining downside?

Patterson, who gave birth on a homemade birth mat, insists there was no blood on the carpet.

"We had towels for Africa," she says. "We threw the sheet away that was on the birth-mat but everything else just soaked out in cold water."

What do the doctors think?

In New Zealand, some individual obstetricians are supportive of homebirth, but their Australasian professional body (Royal Australian and New Zealand College of Obstetricians and Gynaecologists) does not endorse it as it considers it to be associated with an unacceptably high rate of adverse outcomes. Nonetheless, recognising that some will still choose homebirth, the college recommends women should have both a doctor and midwife caring for them with immediate transfer to hospital available in case of emergency.

This stance reflects that of the obstetrics- dominated United States, while in Canada obstetricians take no stand either way. British obstetricians are supportive of homebirth as a viable choice for those with uncomplicated pregnancies.

- © Fairfax NZ News