Home Birth Obstetrics

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About that time I had a home birth.

 

Eighteen years ago, against the advice of an obstetric college to which I belonged, I gave birth to my second daughter at home.  Back then, the governing body of obstetricians, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, had put out a statement advising women against attempting a home birth.  They reasoned that all women should have immediate access to an obstetrician during labour and birth.  I felt I’d met the criteria at a stretch, since I am myself a member of their college.  I did have access to myself at the time.

As it turned out, I did need myself.  I did have something of a complication.  My baby had practically fallen out on the floor, but my placenta had other ideas.   After an hour or so of waiting, it met the criteria for “retained”, and that usually buys one a consultation with a doctor and potentially a trip to the operating room for removal.

The complications of childbirth are a matter of degree, and not one hundred percent predictable.  As far as the placental situation goes,   I’d encountered the full spectrum of scenarios several times over in my line of work.   Most fearfully, some placentas just aren’t coming out without the uterus they are attached to hitching up for the ride, and in that case a great deal of blood products are usually required.   Wouldn’t you want to have your baby in a hospital just in case you are that rare case?  Who takes that sort of chance anyway?

The American College of Obstetricians knew who takes that sort of chance.  In a 2014 statement about home birth, they said that women who choose to birth at home are putting their own experiences ahead of the safety of their babies.  An article published in their journal in 2013 by Frank Cherney and others threatened any member of their group with professional sanctions if they supported it.  And my own college reaffirmed its anti-home birth vows in an updated guideline warning mothers against it.

The midwives tried the tricks they knew to coax out my selfish placenta.  Watchful waiting, gentle cord traction, instructions to cough, to push, to feed the baby, all to no avail.  They sent me to the bathroom where, they said, gravity and privacy might help.   As suggested, away from their prying eyes, I discovered that the entire thing was pretty much just sitting in the lowermost reaches of my uterus, merely pretending to be still attached higher up.  It just needed someone with a little nerve, small hands, and long fingers to reach in give it a grasp and pull.   Sometimes though, the comforting back op of an operating room, blood bank, and the lifesaving personal that come with those things are needed instead.    With my fellow obstetricians as my witness, this we know to be true.

Most obstetricians have seen terrible things that other people don’t see:  that horrible case where a mother or baby has a bad outcome, even death, which they know would have been prevented if only action had been taken sooner. If only that mother had been induced a day earlier, if only that labour was monitored more closely, if only someone had thought to give antibiotics.  Most importantly, we have all seen cases where mothers transfer in to hospital too late for us to help them.  If only they hadn’t been at home in the first place.

 

What’s less intuitive is the whole series of problems that might have been prevented if only actions hadn’t been taken. The antibiotics you gave that mother caused an anaphylaxis.  The close monitoring you thought that baby needed caused an unnecessary induction, and that induction caused a catastrophic uterine rupture.     Maybe that woman, your good friend, the one who never asked you for your professional opinion, whose damaged baby will require a lifetime of complex medical care, maybe she should have stayed at home in the first place.

The truth is that birth harms take place in between two extremes, the paradox of too many interventions and not enough.   We obstetricians strive to hit the sweet spot, to apply the medical model precisely and only when it is needed.   But we miss, all the time, and then we call your unnecessary procedure the numbers needed to treat.

As a resident, I remember a particular retained placenta which matched the situation of my own.   Except hers was removed in the operating room under a wholly unnecessary general anaesthetic.  My boss at the time instructed me to always make a great show of saving the day.  To him, what was the harm?   In his view, the operating room staff wouldn’t really want to know that their time was wasted.  The woman was happy feeling her life had been saved rather than marginally endangered by an unneeded exposure to anaesthetic drugs.   “Just in time” this guy used to smirk at the theatre team when he’d finished a particularly needless procedure.

 

It is the definition of duplicity to believe that women should not be allowed to birth at home out of what you think is their best interests, which, by an unexamined coincidence, align perfectly with your own. The point is that we are grown women, and we shouldn’t have our rights and freedoms limited by others’ good intentions.

And what of bad intentions?   When you have to achieve their compliance by threat.  When you imply that women are selfish, or misguided or stupid.    When you dismiss their experiences —-ones you will never be privileged to have, as having no value.   This is misogyny.  Worst of all is the lying.   You played the hero when you knew you were not.

 

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We bury my daughter’s placenta under a tree in our yard.    It grows into a fine young sapling.  There is a curious thing about time.  In tree years, eighteen years is nothing.  In mother years, it is shorter still.  Yet, it is a long time not to speak your truth to power.  For that the years move slowly, during which, we all know, a woman can bleed out.

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