|
Why
a Midwife
Homebirth: What Are the Issues?
by Sara Wickham, RM, BA (Hons)
© 1999 Midwifery Today, Inc. All rights reserved
There is no shortage of evidence to support the
fact that homebirth is safe, satisfying and empowering
for women and their families. It is also a much-neglected
option for childbearing women in Western society
today. This article seeks to discuss modern-day
attitudes about birth and present the arguments
for midwifery care and homebirth in an accessible
format.
It must be stressed that different caregivers
have different philosophies in relation to birth.
These philosophies are generally referred to as
the "midwifery" and "medical"
models, although it is not accurate to say that
all doctors believe in the medical model and all
midwives in the midwifery model. The medical model
sees childbirth as inherently dangerous and suggests
that all women should undergo routine interventions
to ensure safety and give birth in hospital, and
the midwifery model uses a more holistic approach
and assesses women on an individual basis—a process
which often enables women to give birth in their
own homes. Although the medical model has been
the dominant model of birth in our society for
a number of years, researchers in all fields are
now showing the midwifery model to be more accurate
in the way it sees birth.
Many women approach a "medical model"
practitioner for care during their pregnancy,
although this is not necessarily the best option.
While obstetricians and hospitals have a part
to play in the care of women with serious medical
conditions or who develop a problem during pregnancy
or labour, research shows that the vast majority
of women would be better served by choosing a
midwife for their care. Equally, this majority
of women would also be well advised to consider
homebirth as an option because of its many advantages
over hospital care. Some of the advantages of
homebirth with a midwife are cited below.
Women Experience Less Pain at Home
It is well understood that sensations of pain
in labour are regulated by hormones released by
the woman’s body. During labour, oxytocin—the
hormone which causes contractions and helps the
baby be born—works in harmony with endorphins—the
body’s own pain relieving hormone. During a homebirth,
the woman’s body will release these hormones according
to her needs and she will usually cope well with
the sensations of labour.
When a woman attempts to give birth in another
environment such as a hospital, however, this
process may not work as well. Even if a woman
feels rationally that hospitals are "safer"
places in which to give birth, her subconscious
mind knows that this is not the case, and she
feels insecure. This causes her body to secrete
the hormone adrenaline, which causes the levels
of both oxytocin and endorphins to drop. She experiences
far more pain than she would in her own home,
and this has several other effects on her labour
which are described below.
Women Experience Lower Levels of Intervention
at Home
There are two main reasons that women experience
lower levels of intervention at home. The first
concerns the hormones described above. In a hospital
environment, women often produce the hormone adrenaline
in response to subconscious or conscious fear.
This inhibits the release of the hormone oxytocin,
and labour may well slow down. Although this slowing
of labour is a natural safety mechanism designed
to let the woman know she needs to find another
environment, it is interpreted by many medical
professionals as "failure (of her body) to
progress." Rather than suggesting that the
woman talk about her fears or find a different
environment, they will turn instead to drugs to
"speed up" the labour. This drug (usually
Pitocin or Syntocinon) can cause distress in the
baby, among other effects, and often itself leads
to a "cascade of intervention" which
may result in an instrumental delivery or a cesarean.
The second reason is that hospitals are systems
which need to run efficiently. They need to have
procedures in place for workers to follow so that
chaos does not ensue! Unfortunately, this often
means that hospitals have policies where a certain
number of interventions are carried out on all
women who choose to give birth there. Often there
is no evidence to support these interventions,
and many of them (e.g. electronic fetal monitoring)
are known to be harmful when used on a routine
basis. Every intervention is useful to a small
number of women when used appropriately, but when
applied to all women, they often cause far more
harm than good. Women's choices are not sought
and it is often difficult for staff to offer individualized
care, because they feel restricted by the "hospital
policy."
Women Have More Autonomy at Home
Another major difference between giving birth
in your own environment or in someone else’s is
this: in your own home you are "in charge."
You would not feel you needed to ask permission
to make a drink in your own home or visit the
bathroom, yet that is exactly the way many women
feel in hospital. And the effects of feeling as
if they need to ask permission to do everyday
things can lead to women feeling they are not
in control. This may then have an impact on a
woman’s labour, because labour is a time when
women need to feel very strong and powerful within
their own bodies, not as if they were small children
who needed to ask mommy to take them to pee!
Eating and drinking is another important aspect
of this. In your own home, you are free to eat
and drink whatever you feel like. Although women
often do not feel like eating in strong labour,
the choice is there. Many hospitals still refuse
women food and drink in labour, even though all
the research evidence shows that this restriction
is harmful rather than beneficial. Consequently,
women become dehydrated and have low energy levels
at a time when they need lots of energy. Hospital
staff may provide an IV drip to replace fluids
but this is not ideal—it limits a woman’s movement
and adds to the feeling that she is "sick"
rather than experiencing a perfectly normal event.
|
Breast
feeding