transferring from the desired situation to another. The nature of these transfers is obviously “up” a level or two, from less to more medically managed. Whether before or during labour, this can lead to much disappointment and anxiety. This indicates several possibilities: either childbirth is just not as simple as we are all led to believe; or that childbirth carries a large unforeseen element which manifests very frequently; or that many women have false confidence in their ability to give birth without medical management; or that medical manage-ment creates problems in birth for many women. My ideas on all of possibilities are elaborated in the following sections on birthing.
Most women usually know very clearly from the outset where they want to give birth, and 95% take the mainstream path their doctors recommend towards the hospital labour ward. Others may have looked at the options of a Birth Centre or homebirth and decided definitely which of them suits their desires and their situation. If you are already clear about where you want to have your baby this time round, then the discussions in this section are not of much use to you at present. However, if you are not yet clear about where you will be having your baby, or in the future you might feel like exploring the alternatives, the following comments may assist you in making a satisfying choice.
Whilst some people regard homebirthing as a selfish and dangerous choice, there are others who regard hospital birthing in exactly the same way! The bottom line in any such discussion, rather than which is a better place to be born, comes down to what is most appropriate according to the concerns of the mother for her own and the baby’s well being. After all, that is the call of our biology, to reproduce a healthy baby, easily and safely. That should also be the call of our maternal conscience, whilst securing equity in choice of venue should also be a part of our social conscience.
These days, few women in Western societies are having more than 2 children. The current Australian average is about 1.7. This means that most women will have only one or two chances to discover their potential for natural childbirth. Nearly all will take the mainstream path straight into the labour wards. A few will be allowed to take the left fork into the Birth Centre whilst a few second timers and a very few first timers will choose the homebirth option.
However, it needn’t be that way. Many first time mothers are safely fit enough for midwife-assisted homebirth and certainly there are many more second time mothers with good track records. I believe
the best way to increase the natural birthing skills of women in our culture, rather than to preach “homebirth for all”, is to teach all women, regardless of planned birthing venue, the most appropriate ways of birthing naturally, at the same time as encouraging those who could easily birth at home to do so following the same concepts and methods. And perhaps as this movement towards greater choice and greater freedom in childbirth grows, there will come a gradual migration of safe and supervised birthing back into the homes of women and their babies. Let us now look more closely at what each of the available choices actually offers.
Myths and Facts
• Hospitals are the safest (and therefore “best”) place to have a baby: This is just not true. Numerous international, published medical studies have consistently shown two things: (i) Hospital births for healthy, low risk women are no more or less safe than for those same women at homebirths. (ii) Intervention and peri-natal infant and maternal morbidity (difficulties and dissatisfaction) is greater in hospitals than at homebirths(18)(22).
• Doctor and nurses are there to look after you: The reality is that hospitals are very busy places, and whilst many of the staff may want to offer quality care, they are frequently unable to do so due to limited resources, bureaucratic red tape, efficiency timetables, and the politics of hierarchy demarcation.
• Doctors and nurses always know best: Not always. Everyone can make a bad judgement from time to time, and whilst they may think they know what is best for women in your situation, it is ultimately up to you to know what is best for you and your child.
• Hospital equipment and expertise can guarantee a 100% successful birthing outcome: Not true. Even with every available safeguard of modern medical science, accidents, errors, the unknown and the unexpected can each still contribute to maternal or infant death or disability.
• You’ll be in and out in no time: Not necessarily. On one hand, these days there are political and economic reasons for encouraging earlier discharge for birthing mothers. On the other hand, due to increasing legal caution, if there are any confirmed or suspected complica-tions arising from the birth, you will be advised to stay there until such time as