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Column: Home births, midwives, hospitals and the battle over being born | PBS NewsHour

A study released last month highlighting the risk associated with home births has reignited an increasingly polarizing debate among obstetricians, midwives and opinionated mothers everywhere.

Source: Column: Home births, midwives, hospitals and the battle over being born | PBS NewsHour

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“Trust your body, you are designed to give birth!”

Milli Hill hears how directing a new BBC documentary completely changed one woman’s perception of childbirth

Milli Hill on BBC Childbirth show

© Landmark Films

Childbirth on TV – it’s most often a drama, right? We know why they do it – a sense of panic, a terrified woman on her back, midwives running down corridors looking worried, and…cut to the ad break – we’re hooked.

But whilst this sort of telly might be entertaining, it unfortunately gives a false impression of birth, and this has the very real and damaging effect of rendering most women completely terrified.

One such woman was Rebecca Arnold, the Producer and Director of Childbirth: All or Nothing, a new documentary to be aired on BBC 1 this week.

“I’m 34 and yet to have children”, she told me. “I wondered if making this documentary actually might end up putting me off for life! Like lots of other people, I imagined birth was painful, messy, and probably pretty grim, just from what I’d heard and read about. I can imagine if I was pregnant then it would have scared me and I would have gone into the whole nine months not looking forward to the end result.”

Childbirth: All or Nothing, follows four women, three of whom give birth at home and one who chooses elective caesarean. Rebecca was inspired to make the film because she was curious about the way women often report feeling a failure if their birth does not go according to plan, and was keen to explore how women’s choices in birth are so often the subject of judgment and opinion:

“I hope this film will mean people become a bit more accepting of the choices women make. Live and let live. Birth should be a totally personal choice and what suits one woman will not necessarily suit another. People might not agree with all the decisions the women in the film make but that’s fine, it’s not their birth!”

When Rebecca began work on the film, she says she would personally have chosen a hospital birth because, “I’d never considered there to be any other way.” But her experiences have changed all that. The words of a midwife she met during filming have stayed with her: “The safest place to give birth is the place where you feel the safest. So, if that’s in a hospital with all the medical staff around you then that will probably suit you best, if you think being at home will keep you calmer, then that’s more for you.”

Like many women, Rebecca was unaware that how birth unfolds is not simply in the hands of fate: it can be influenced, for the better or for the worse, by a number of important factors, including how you feel, and where you are:

“I think I’ve learnt that being scared and being worried that birth is going to be a huge, horrible challenge won’t help your body relax when the time comes for the baby to arrive, however you decide you want to give birth. I hadn’t really considered how the environment you give birth in can have such a huge impact on how you birth.”

But it was one birth in particular that Rebecca describes as a pivotal moment. Having been ‘on call’ for a woman called Kati, Rebecca dropped everything to travel three hours by train for her home water birth. Having never seen anyone give birth before, Rebecca was surprised to arrive and find Kati, ‘calm, smiley, chatty and totally in control.”

Milli Hill on BBC Childbirth show

© Landmark Films

Kati with her baby

“As the contractions ramped up she got into the pool and was so focused I sensed she was totally in her own world. When the time came for the baby to arrive, she literally breathed it out. There was no screaming, no desperate need for any sort of drugs, just total focus. I’ll carry that memory with me forever and I feel lucky to have that very strong image in my mind because it’d be the thing I’d want to recall if I was going through it.”

Having started out, like so many women, with a very negative expectation of childbirth, Rebecca feels that, thorough filming, she has learnt that, whilst birth can be unpredictable, “…you can increase your chances of a ‘better’ birth if you prepare, keep active, learn breathing techniques, write a birth plan.”

Talking to Rebecca and knowing that her film will be shown on prime time UK television this week, I can’t help but feel excited, not just that her personal views of childbirth have experienced such a shift, but that this seems to represent a wider cultural shift that is happening.

Milli Hill on BBC Childbirth show

© Landmark Films

Lisa is another of the women who features in the show

By coincidence, Childbirth: All or Nothing is aired in the same week that a new book is published: “The Roar Behind the Silence: Why kindness, compassion and respect matter in maternity care”.

This little book will make a big impact – it calls for an end to the culture of fear that is driving up rates of intervention and creating labour wards that are governed by risk management and paperwork, to the detriment of the human experience of both women and maternity workers.

Change is happening. “Women are beginning to question things a bit more”, says Rebecca. “I’d like women to feel confident enough to trust in their bodies. It’s a very natural process, we are designed to give birth. Some women do experience complications and they will need medical support, but if women could start off trusting in themselves then that can only be a good thing.”

However, there is a way to go yet – as Rebecca puts it, “I think you have a be a particularly strong woman to do what you want and have your baby how you want. There is so much advice given to a pregnant woman that I think it’s incredibly difficult to weed out what is relevant and helpful to you and what’s not. There is freedom of choice, but whether you stick to your guns and go ahead with your plans slightly depends on who’s supporting you, in terms of both friends and family, and medical professionals.”

In the meantime, having begun making Childbirth: All or Nothing, believing a hospital birth would be for her, what would Rebecca choose now?

“I would have a home water birth with an Independent Midwife”, she replies confidently. “I really don’t think there could be a happier, more relaxed and empowering way to be.”

Childbirth: All or Nothing will be aired tonight on BBC1 at 10:45pm. (BBC N.Ireland and Wales 11:10pm and BBC Scotland Wednesday 25th February 10:40pm)

The Roar Behind the Silence is published on Friday 27th February and available from Amazon.

BestDaily columnist Milli Hill is the founder of The Positive Birth Movement. Her latest book is available on Amazon.

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British Regulator Urges Home Births Over Hospitals for Uncomplicated Pregnancies

LONDON — Reversing a generation of guidance on childbirth, Britain’s national health service on Wednesday advised healthy women that it was safer to have their babies at home, or in a birth center, than in a hospital.

Women with uncomplicated pregnancies — about 45 percent 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, the regulator said.

Hospital births were more likely to end in cesarean sections or involve episiotomies, a government financed 2011 study carried out by researchers at Oxford University showed. Women were more likely to be given epidurals, which numb the pain of labor but also increase the risk of a protracted birth that required forceps and damaged the perineum.

The risk of death or serious complications for babies was the same in all three settings, with one exception: In the case of first-time mothers, home birth slightly increased that risk. Nine in 1,000 cases would experience serious complications, compared with five in 1,000 for babies born in a hospital.

The findings could affect how hundreds of thousands of British women think about one of the biggest questions facing them. Nine in 10 of the roughly 700,000 babies born every year in England and Wales were delivered in a hospital.

As recently as 2007, the guidelines had advised women to be “cautious” about home birth in the absence of conclusive risk assessments.

Mark Baker, clinical practice director for the health institute, said first-time mothers with low birth risks would now be advised that a midwife-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.

Not everyone was at ease with the new guidelines. “Things can go wrong very easily and we do feel this advice could be dangerous,” Lucy Jolin of the Birth Trauma Association told the BBC.

So far doctors have not expressed any outrage over the decision. “If we had done this 20 years ago there would have been a revolution,” Dr. Baker said. “The penny has dropped. We’ve won the argument.”

With the exception of the Netherlands, where home births have long been popular and relatively widespread, few developed countries have significant numbers of women opting for nonhospital deliveries. In the United States, where a culture of litigation adds a layer of complication, only 1.36 percent of births took place outside a hospital in 2012. Two-thirds of those nonhospital births took place at home and 29 percent at free-standing birthing centers, according to the National Center for Health Statistics.

“We believe that hospitals and birthing centers are the safest places for birth, safer than home,” said Dr. Jeffrey L. Ecker, the chairman of the committee on obstetrics practice for American College of Obstetricians and Gynecologists. Under Britain’s integrated health system, if there is a complication, “they have a process and protocol for appropriately and quickly getting you somewhere else,” said Dr. Ecker, who added that he did not believe the British-style guidelines would come to America anytime soon. If such a recommendation were made in the United States, doctors might worry about losing patients to midwives.

That concern is absent in Britain’s taxpayer-funded system. “There are no financial incentives in the U.K. for doctors to deliver in a particular setting because there is no personal gain,” said Dr. Baker of the health institute. Childbirth is “effectively an N.H.S. monopoly,” he said, referring to the National Health Service, Britain’s public health system.

Holly Powell Kennedy, the immediate past president of the American College of Nurse-Midwives, an organization in the United States, praised the guidelines, saying, “This is how the practice should be happening.” In a hospital, “you are less able to labor without interventions,” Dr. Kennedy said.

Reducing the number of hospital births would save the health service money, but British officials said budgets had not factored into the new guidelines. A traditional hospital birth costs the country’s health system about $2,500, with a home birth roughly $1,500 and a birth center about $2,200.

“Yes, it’s a very expensive way to deliver healthy babies to healthy women,” Dr. Baker said about hospital births. “Saving money is not a crime.”