Are home births 'unethical' ?

Controversial opinion piece

nhs.uk/news/2014/01January/...

In which the authors argue that home birth may be considered ethically unsound, akin to driving your child around without making them wear a seatbelt.

That is you are exposing them to a small but avoidable risks

Are home birthers just spoilt middle-class women putting their kids long-term future at risk for their own short-term comfort? Or should they be praised for standing up for their reproductive rights?

9 Replies

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  • Interesting use of words.

    I would agree that home births are potentially "problematical" but I would hardly call them unethical.

    Giving birth is about far more than the mechanics or the health risks, it is primarily about things like relationships, comfort, security, life-changes and so on. Sometimes you create better foundations for such things in familiar and friendly surroundings. Is it "unethical" to ignore those considerations too?

    Sometimes I think researchers should stick to facts that allow people to make educated judgement calls and stay out of the realms of ethics and morality unless that is specifically what the research is about. Research by way of guilt does not sound productive.

  • I'd say most of them are neither of those things.

    The whole area of pregnancy and birth is drowning in misinformation and psuedoscience. A lot of women will have been told by websites and antenatal classes that homebirth is actually safer than hospital becuase there is less "risk" of needing interventions (as mentioned in the NHS choices piece linked to). This though can be misleading as it seems to give equal weighting to two very different outcomes. You are far more likley to need an instrumental delivery in a hospital birth than to have a baby die in a home birth - but surely those two outcomes aren't equally bad?

    Additionally many women, especially those who have had difficult experiences of giving birth in hospital, feel that home birth is the ONLY way for them to get better care. Not only do you avoid the unpleasentness of being in a desperatly over stretched hospital service, but choosing homebirth often means you get a dedicated small team of midwives through pregnancy, birth and the postnatal period, rather than seeing someone different at every appointment and giving birth with a total stranger.

    The NHS choices piece ends by saying that we should offer more support to homebirth Mums to make it safer. I would add that work should also be done to make hospital birth less traumatic and to offer proper treatment and support to those who have had previous bad experiences. Then perhaps fewer women would choose home birth anyway.

    We also need to do more to dispel some of the many myths about the benefits and ease of natural birth so that women making thses decisions do so with an accurate understanding of the risks of every option.

  • Agree. And beyond that there is something about Obstetrics in the NHS that seems to evade all the codes of balance and reason in the way that medical information is communicated to patients. I'd be interested in evidence anyone can find around the communication of pain relief and anaesthesia information to perinatal women (probably hard to find). In my (very limited) anecdotal experience women are often made to feel guilty the less pain they opt to have.

  • Making birth in hospitals a more "homely" experience is not exactly difficult. I remember a GP Maternity unit that my son was born in some 30 years ago.

    It was on the top floor of an ancient old hospital with a big open ward. It was sunny, friendly, full of sofas and comfy chairs, pot plants, coffee and tea and bossy matrons. (Despite being a GP unity, the nurses kept them at arms length, and good thing too!)

    It was full of gossiping mothers who, to be honest, were pretty reluctant to go home.

    The floor immediately below was far more clinical and dealt with any births that were problematical. But most were not, of course and the mothers had a warm welcoming atmosphere in which to welcome their child for a couple of days before trundling off home to face the next scary eighteen years!

    It still wan't like giving birth at home, I would think, but it was running a pretty close second.

  • There are some "midwife led" units that are similar, at least they aim to be. St Thomas' in London for example has a "home from home birthing centre" which is staffed entirely by midwives, so the most medical thing you can get is a couple of paracetamol and some gas and air. It is right next to the main Obstetric unit if anything goes wrong or a woman decides she wants an epidural. Comfy chairs and gossiping for a couple of days is out though, you get turfed out in a matter or hours to home (if you're lucky) or the ward if not *shudders at memory of the ward*

    It's a shame that isn't an option in more places, a sort of middle ground between home birth and full on hospital unit.

  • Its one of those odd things where there is probably a "market for it" but since the NHS is not a private company being in the position to exploit markets, there is no financial incentive.

    Not that I would want to see the NHS change, but it is difficult to cover all variations for all people while on a fixed budget. Well. impossible, actually.

    Not sure why you would be limited to Pracetamol and gas and air, don't midwives do Nurse Prescribing courses? Matrons do.

  • I was there 5 years ago so it could have changed, but at the time the only pharmaceutical pain relief you could get at St T's was paracetamol, entonox or epidural, the latter was only available on the main birth unit as it requires an anaesthetist and monitoring . Options vary enormously between hospitals though.

    The NHS certainly can't offer everything for everyone but I would rather see more units like those at St T's than hospitals encouraging more home births instead (as seems to be the case where my second child was born)

  • There does seem to be some sort of weird Puritan mindset about natural birth. Not sure why choosing to take painkillers is seen as unnatural.

    People aren't queuing to get natural appendectomies, for example.

  • Just in case I haven't become a total bore on this subject yet - I've also blogged about it: southwarkbelle.blogspot.co....

    I hope it's ok to post that here? I assume someone will remove it if not!

    I've had a Mummy blog for years but now trying to concentrate more on looking into the world of pregnancy and parenting woo/ dodgy media reports, etc. It's a huge area but one few people seem to be very concerned about. All tips very welcome, I'm very much a novice.

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