A response to Barbara Ellen’s “Meghan Markle’s home birth should not blind us to the risks for most women” published on The Guardian, 13th April 2019.
I am deeply disappointed in The Guardian for publishing Barbara Ellen’s ill-informed, fear-mongering article on the dangers of Meghan Markle’s decision for a home birth in influencing us, common plebeian women, who couldn’t possibly have a safe home birth without the royal treatment she will receive.
Based on research and reliable medical evidence, the World Health Organization (WHO) states “It has never been scientifically proven that the hospital is a safer place than the home for a woman who has had an uncomplicated pregnancy to have her baby.” No evidence that the hospital is safer for uncomplicated, low-risk pregnancies. You can also find, on the NHS website, information regarding revised guidelines issued by NICE (National Institute for Health and Care Excellence) which “recommended that women with low risk of complications in childbirth should be encouraged to either give birth at home or at a midwife-led unit.” The HSE, here in Ireland, also states that “research shows that a planned home birth is an acceptable and safe alternative to a planned hospital birth,” again, for healthy women with uncomplicated pregnancies. The HSE itself offers a homebirth scheme as one of its maternity care options, as does the NHS.
I could stop here. But I won’t.
I’m offended personally by the assumption that we, common women, wouldn’t carefully plan a home birth, or any kind of birth for that matter, as we have learned to do so from horrific hospital experiences. Anyone who has been listening to Joe Duffy lately would know all about that.
Among the inaccurate information contained in the article, I’d like to clarify a few:
Homebirths are not attended by one midwife, but two. That’s how it works under HSE guidelines. Besides, with a midwife, at home, you get continuity of care, which hospitals fail to provide due to the way they are structured. This continuous care, provided by one person who you have come to know and trust, is associated with shorter labors and lower rates of intervention; hence the ever-growing popularity of birth doulas (in all birth settings; hospital, birth center, home, etc).
When women who are giving birth at home need to transfer to the hospital, they don’t get there by “any means possible”; they use an ambulance service which has already been notified of the start of their labor and has coordinates to their home.
The article mentions the “risks to most women”, which is also untrue as high-risk complications occur in less than 15% of all pregnancies, as stated by UC San Francisco Health.
Furthermore, if Barbara knew anything about the physiology of childbirth (because yes, newsflash: it’s a physiological process, not necessarily a “serious, bloody business”, as she hauntingly states), she would understand that in fact “splashing about in a birthing pool […] surrounded by Jo Malone candles […] and Enya on Spotify” makes an enormous difference to the progress of labor and can be the crucial difference between a straight-forward, uncomplicated delivery and a cesarean.
That is because the physiology of childbirth is dependent on intricate, sophisticated hormonal dynamics. The driver’s seat is taken by oxytocin. They give you a synthetic version of said hormone in the hospital to start or augment labor. They also give it to you to facilitate the delivery of the placenta and to prevent hemorrhage. Oxytocin also aids in bonding with baby and the start of breastfeeding, both of which the synthetic version can’t do, by the way. But how is oxytocin brought about naturally then? Well, it’s the hormone of love and intimacy. So it’s raised through touch, massage, kissing, being in a safe, quiet, intimate place, with dimmed lights and privacy, with freedom to move around, have some water, eat something if you so wish; with no strangers walking in and out, asking a million questions, poking and probing at you. And for some people that might very well be a warm tub of water or shower, surrounded by candles, with Enya on Spotify. Delivering a baby is much more like making a baby than we seem to want to recognize. So, the answer is: whatever floats your boat, as long as it’s a safe option for you. Feel safer in a hospital? Then by all means, have a hospital birth! Have a complication that may require medical attention? Again, the hospital is probably a safer option for you. But this commonplace, ignorant discourse demonizing something you obviously know very little about is unacceptable. As a woman, I find that adding even more fear to this process, which can be a beautifully empowering one, is unacceptable. It’s like bullying women, more than they already are in this “serious, bloody business”.
There are various, researched techniques, or methods, that can attest to the efficacy of supporting this hormonal interplay, as they usually translate into calmer, quicker labors, with less unnecessary intervention (which means less risks for mother and baby), and better memories to cherish forever, because you will. forever. remember. that day. They are the likes of Lamaze, HypnoBirthing, and Ireland’s very own GentleBirth techniques, devising an informed birth plan, or hiring a birth companion, such as a doula, all of which work to empower and support the laboring woman and her baby, her feelings and desires, and in turn, this miraculous hormonal process.
You might wonder how you may benefit from having a doula, a hired birth companion, at a home birth, like Meghan is said to be doing. Doula support might indeed look a bit differently at home, because they can focus on you and your partner completely, and not have to deal with the hospital environment. They arrive before your midwife and are by your side the entire time. It gets to a point sometimes where midwives actually need to rest, to make sure they are well able to identify your medical needs, while a doula, in quite a different mindset, will still stand by you. Additionally, should you transfer to the hospital, they will accompany you and provide invaluable continuity of care.
General areas in which doulas focus their support include: emotional and psychological preparation, guidance, and ease; physical comfort, positioning, and nurturing touch; supporting you in your confidence, decision-making, learning, gathering information and understanding your preferences. Although doulas and midwives both value those components as part of a satisfying birth, doulas get to focus on them entirely, while midwives are tending to clinical tasks. So together, at home, they are a wonderfully powerful team.
Of all the fashionable trends out there, I think this would be an absolutely lovely one to get informed about—and yes, if it’s a suitable option for you and your specific circumstances, maybe even follow.
Birth and Postpartum Doula with DoulaCare Ireland
Member of the Doula Association of Ireland
Originally from Brazil, Anita now lives in Dublin with her husband David.