Giving birth: home can be better than hospital
BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7505.0-a (Published 16 June 2005) Cite this as: BMJ 2005;330:0-aAll rapid responses
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With the progress of science, we are becoming negative thinkers and
fearful with everything. We are becoming so over dependent on doctors and
hospitals. We take medicines for every small problem though our own body
has inbuilt mechanisms to solve such a problem without taking any
medicine. Urination, defecation and parturition are natural ways of
expelling the normal things when they become unmanageable inside the body.
Actually we are well equipped to expel them out of the body and are
expelling those things without the intervention of doctors for centuries.
The birth of the child is a natural event and it can happen at home or
anywhere without any difficulty. Only a very few cases of complications
are found. Now a days, as people have become knowledgeable about the
fertilization and conception, they start running to the hospital for urine
test to confirm pregnancy, then for scanning, and then for delivery.
Cesarean sections have become a fashion. Educated women are scared if
anything will go wrong during pregnancy and childbirth. So they go to
doctors for every small thing. They expect the unexpected to happen and
take extra precautions. If you compare the percentage of complicated child
birth and percentage of cesarean sections 50 years back and now, you can
understand how fearful people have become about the natural process of
childbirth.
We hear about deliveries taking place in the cars, trains and flights, on
the way to the hospital etc. What does it mean? It means that it is a
simple process. Who assists all other animals when they deliver? Won’t
they survive? Complications increase in all the processes where there is
human intervention. No wonder if doctor’s help is taken for urination and
defecation in the future. A day will come when; people will get admitted
for such simple processes like defecation and micturition also.
Competing interests:
None declared
Competing interests: No competing interests
In countries like India, where home deliveries are a norm for
centuries, suddenly the policy makers and plannersd are pushing for
institutional deliveries in the Reproductive and Child Health program for
the country. Till recently,Government of India used to conduct training
programs supported by WHO for Traditional Birth Attendants (TBAs)in the
art of delivery and care of newborn at birth. In India, where 25 million
births are taking place every year,out of which about 66% are occuring at
home, it is a herculian task to arrange logistics for institutional
deliveries of all the babies. This study form US may help to change minds
of funding agencies, policy makers and planners who always site lack of
evidence about effectiveness of TBAs to assist home deliveries.
Competing interests:
None declared
Competing interests: No competing interests
Dear Sir
I have read the very interesting study on the outcome of pregnancies at
home.
The Dutch women have this experience for a very lon time with the
excellent health indicators we are all aware of.
Also, some "movements" of "back to the ecological and natural" Have
insisted in the return to home births, namely through the report og nice
experiences by mothers in general public magazines.
Notwithstanding, I think that we have to be very cautious. Not only to
avoid fashions that spread more rapidly and universally than scientific
sound knowledge, but also because this issues are reported in newspapers
and pass to the general public as being "very easy". Portugal had a
tremendous perinatal and infant mortality rate thirty years ago (close to
90 and 65 per thousand, respectively). Only 20% of births took palce in
hospital environment. Now, figures are 5.0 and 4,6. Obviously there are
multiple causes for that, bu the fact that 99,8 births are in hospitals
definetely contributed to that. Any movement in the opposite direction has
to be extremely careful and backed up by human and technical resources -
with the present budget "crysis", I am sure we wouldn´t be able to support
it, with the immediate undesirable consequences as far as mother and
children´s health.
Yours sincerely
Mário Cordeiro, MD, PhD, Professor of Paediatrics and Public Health
Competing interests:
None declared
Competing interests: No competing interests
I was delighted to read the recent research findings that once again
reiterate that home births are as safe if not safer than hospital births
for low risk mothers.
In my line of work as a natal Hypnotherapist and Doula, I deal with
many women who have substantial fears around birth, which, more often than
not, result from a fear of the "medical environment" of giving birth.
Women now days are bombarded with negative stories surrounding birth, the
majority of which are connected with the fear of intervention, feeling out
of control, fear of excessive pain etc. So many women have lost the
intuitive trust in their own bodies to give birth naturally and so go into
labour feeling scared and tense, which in turn leaves them far more open
to intervention.
And yet for those of us who are privileged enough to work with women
birthing in their own environment, where they feel safe, private,
unobserved, their births can be calm, beautiful and fulfilling
experiences. If more women are encouraged to opt for a home birth, so
much of the fear and tension will go and more women will experience the
joy and empowerment of a normal birth outcome.
Competing interests:
None declared
Competing interests: No competing interests
Scientific support for previously recognised phenomenon
This study, coming from North America (of all places), highlights
what was accepted by us many years ago. Copying the "modern" practices of
the metropolitan countries has been a failing of most underdeveloped and
developing countries. Not the least has been the hospital delivery for
women with low risk pregnancies. It became fashionable for women, even of
moderate means, to have a delivery in private hospitals by "their
gynaecologist", and their babies to be seen at birth and thereafter by
"their paediatrician". This in spite of the fact that over 96% of
pregnancies are said to be normal.
There was a time when the District Health Visitor/Midwife saw the mothers
throughout their pregnancy, and proceeded to deliver them at home. The
District Medical Officer (DMO) reviewed each mother on admission, at 3
months and near term. The local midwife ("Middie"), usually with a great
deal of practical experience, successfully conducted most of the
deliveries, the DHV visiting soon after. As a young District Medical
Officer, I was at first appalled at the practice, until my brother, a
consultant with WHO, convinced me that I should, instead, take advantage
of the services of these women (already well-accepted in their
communities) by helping them to upgrade their skills.
The first oil boom did not help. Government Health planners preferred to
build more hospitals (poorly staffed, poorly equipped and poorly
maintanied, than to train more district midwives. With this came a
proliferation of Ob & G "specialists" who performed ALL private
hospital deliveries, and Paediatric "specialists" who would oversee the
infant from birth, including the administration of protective vaccines!
There is only an impression, but from patient records it would appear that
there are significantly more Caesarean deliveries now than ever before, a
claim denied but not disproven.
Competing interests:
None declared
Competing interests: No competing interests