Are women who give birth at home selfish?

Milli Hill has written a thoughtful piece on home birth. The piece is in response to comments by the president of the Australian Medical Association Western Australia, Michael Gannon, that women who choose to give birth at home when they are considered “high risk” are “selfish”. He was commenting in response to an inquest into the deaths of two babies who had died after home births.

Leaving aside the questionable tact of labelling two grieving mothers “selfish”, there are some bigger issues here. One is: why pick on mothers? The investigation into the deaths of babies at University Hospitals Morecambe Bay NHS Trust found that the babies died as a result of negligence by doctors and midwives.

There are many reasons why babies die, some of which are down to bad luck, but baby deaths that result from the “selfishness” of the mother are much fewer in number than those resulting from mistakes by health professionals. Yet I don’t see Gannon criticising his medical colleagues, even though Australia’s stillbirth rate is six times as high as that of Finland. Gannon isn’t alone, of course – if you don’t believe me, try googling “home birth selfish”.

Another question is: why do women choose to give birth at home? Wanting to have a positive experience, in the familiarity of your own home, isn’t selfish. Wanting a good experience as a mother also means wanting a good experience for your baby. As Hill writes: “I had experienced home birth with my second baby and knew how delicious and comforting it is to be in your own surroundings as you birth and get to know your newborn.” Women who choose a home birth want their baby to be born in a relaxed, warm, gentle atmosphere. This doesn’t make them bad people.

Of course safety is important. But as Hill argues, some women feel safer at home. And the reason for that is very often that they have had a bad experience of giving birth in hospital – an experience that has been traumatic for both them and their baby. At their worst, hospital maternity units can be places where women feel bullied, where poor decisions are made about their care, where their needs are neglected and, yes, as in Morecambe Bay, where babies die as a result.

Anecdotal evidence suggests that women who have had a very traumatic birth often opt, next time round, either for a home birth or a planned caesarean, because both allow a woman to regain some control over the experience. They are both choices that give the mother an active say in her baby’s birth, rather than being expected to passively wait while decisions are forced upon her.

One way to make this happen is to improve the quality of care offered to women in hospital so that they can give birth in comfortable, quiet, private surroundings, looked after by a midwife who isn’t overstretched or exhausted, while knowing that interventions such as caesareans or Ventouse delivery are available if they become necessary. It will be expensive, though, as Morecambe Bay found out when it paid £12.5m to bereaved parents, perhaps not as expensive as the cost when maternity care goes badly wrong.

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