Doctor: "Having a home birth is like not putting your child's seat belt on"

It has been called a ‘silent tragedy’.

A ‘silent tragedy’ as parents risk the possibility of their baby having a long-term disability by choosing a home birth.

A ‘silent tragedy’ because the talked about risks of home birthing focus more often on the heartbreaking baby and maternal deaths.

A ‘silent tragedy’ because Australian parents are still often risking the futures of their unborn babies by making birthing decisions based on parental needs rather than the needs of the baby.

And Doctors are now demanding that this ‘silent tragedy’ comes to the fore.

A leading Australian obstetrician has argued that the risk of future long-term disability to newborns should “weigh heavily” in decisions about whether to give birth at home or in hospital.

Writing in the Journal of Medical Ethics, Associate Professor Lachlan de Crespigny of the University of Melbourne says that most arguments have focused on the risk of death, but he and Oxford University’s Professor Julian Savulescu believe the possibility of long-term disability deserves as much attention.

“Having a home birth may be like not putting your child’s car seat belt on,” they write. “The risk of being injured in a single trip by not wearing a seat belt is extremely low. Still, we expect people to wear a seatbelt to make the risks as low as possible, despite some inconvenience and diminution of driving pleasure.”

Professor de Crespigny feels that women and their partners may be poorly informed of all the potential risks they could be taking by choosing a homebirth.

“Obstetric care is a specialty where things go wrong very quickly,” Professor de Crespigny told AAP.

“Something that scares all people involved in delivery is shoulder dystocia, where the head is delivered but not the shoulders. The baby asphyxiates very quickly.

“To deal with that you need excellent training and hospital-level resuscitation facilities.”

They cited a study from the Netherlands which found that when travel time from home to hospital is more than 20 minutes, there is an increased risk of the baby dying or suffering a long-term condition, and other studies which showed that delays in accessing emergency care increased risks of brain damage.

Even a minor complication could lead to long-term educational and other developmental issues, he said.

Speaking to the ABC he singled out two main issues – of learning disabilities and cerebral palsy.

He told the ABC of the duplicity there is with women so concerned for the long-term effects of smoking or drinking, and yet no consideration is given to the potential long-term effects of home-birthing.

He said:

During pregnancy women are very, very focused on things that might cause problems to the baby after birth and they avoid alcohol and cigarettes and illicit drugs and are very careful with diet. They go to all sorts of lengths to try to produce the healthiest baby. But when it comes to home birth, it’s not always the focus that it should be.

Previously Professor de Crespigny has written for the SMH on the issue arguing that there is never a justification for taking a risk with a baby’s future.

To take an extreme example, home birth might result in quadriplegia. Now what risk could/should a couple take to have ”a really lovely spontaneous birth at home” that justifies quadriplegia? One in 1000? One in 1 million? Anything?

We contend that the choice to have ”a really, lovely spontaneous birth at home” is only justified if it exposes the future child to the lowest possible risk of avoidable disability. And this is just never the case at home.

A blogging site Hurt by Homebirth tells the story of Sam Comstive who was born in 2011.

His parents had planned a homebirth, but things went tragically wrong. The midwife involved failed to transfer Sam’s mother immediately to hospital, his brain was affected by the lack of oxygen he received and he suffered severe developmental delays, just like those described by Professor de Crespigny.

Sam died at the age of three.

The autopsy said his death was directly related to his labor and birth injuries. His mother wrote on the blogging site:

“Sam never talked, sat up, crawled, stood, walked, used arms/hands purposefully. He was completely dependent on us for his care. He was orally fed but it was always a challenge and he never had enough caloric intake….Sam was still on a bottle.”

Charges were brought before the midwife who failed to call an ambulance. She was given six months probated suspension.

In the article in the Journal of Medical Ethics, which came out yesterday, Professor de Crespigny and Professor Julian Savulescu call for hospitals to do more to make their environments acceptable for women.

“The more we can cater to all women’s needs the better it will be for everybody,” said Prof de Crespigny.

The article does not call for women to be forced into a hospital birth; in fact they acknowledge that hospital births are not without their own risks.

“We are not calling for home births to be banned, but we believe they should be actively discouraged.”

Home birth is a highly emotional topic for many to discuss, yet it is something we need to continue a discourse about to stop it being a ‘silent tragedy’.  Does this latest paper into the practise concern you? Would it put you off choosing this method of birthing?