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In a press release today, The Royal College of Midwives has warned of a “calculated and concerted backlash” against home births, saying some doctors are too prone to refer women automatically for a hospital delivery. In particular, RCM general secretary Cathy Warwick expressed concern that global studies gave a misleading impression of the relative safety of home and hospital births. Furthermore, Frances Day Stirk, ex-community midwife and now RCM’s Director of Learning Research, says that childbirth is now seen as largely a medical process.
Certainly, the statistics showing the trend towards hospital birth is undeniable. In the 1960s, 1 in 3 births in the UK took place in the home, whereas today the figure is close to 1 in 40.
But are there other factors at work here – social, cultural and economic influences that also drive how an ‘ideal outcome’ for birth is defined?
Some clues can be found in other countries.
In the US, where individuals without medical insurance pick up the bill themselves, the average cost to a couple of having a baby in hospital is in the range $5,000-$10,000. This compares to a typical $4000 price tag for home births. Perhaps for this reason, when set alongside a near doubling of unemployment to 9.8% in the last decade and 15% of people without insurance, home births are beginning to rise in some states http://www.kimatv.com/news/local/85006092.html
In Holland, which has a long tradition of home birth but where rates of home birth have declined recently, factors such as a full range of pain relief and quicker deliveries, often by C-section, are cited as being the reasons why mothers prefer to have their delivery in hospital.
In Australia, state-funded trials in Victoria are underway to expand the availability of home-births to women with low-risk pregnancies, which includes upskilling of state midwives and hospital backup if required. Reasons for conducting the trial included both a demand from local communities, and potential cost-savings.
Closer to home in Bridgend, South Wales, where one in four babies are born at home, a central reason for why the home-birth rate is higher than the UK is the target of 10 per cent, set by the Welsh Assembly in 2002. Anecdotal evidence from the region suggest that the return to greater involvement of midwives in the home had revived a community culture amongst young mums, with mothers sharing their experience of home birth with pre-natal groups.
Looking across these trends, it seems that simply using maximum safety and risk-aversion as the only yardstick for successful birth outcome is becoming out-dated.
Both national governments and its citizens are exploring a wider balance of success measures, including how a birth environment should ‘feel’, what support a birth community should provide, and the accompanying cost implications for both low-risk and higher-risk mothers.
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