Is hospital the safest place to give birth? (Part 1)

Mythbusting!

Hospital is the safest place to give birth.

NOT TRUE!

It's true for SOME people, sure. But in general? Not necessarily.

Here comes my Morpheus impression again:

What if I told you... that moving birth out of the community and into hospital was never about safety in the firts place?

It was about:

1. Efficiency. Not to put too fine a point on it: money. Two midwives for each birth, or two midwives for a ward of 20 birthing dyads? 🤔🤔🤔

2. Access to pain relief. At the time when the shift occurred, pain relief for labour was relatively new. Lots of women wanted to try it.

Of course, we don't use chloroform for that anymore. The most common options for pain relief offered to birthing women these days are: gas and air, pethidine and epidural. Gas and air is usually available at home, and pethidine often is as well. 🎶 Two out of three ain't bad...

What if I told you... that the death rate initially went UP when birth was moved into hospital? This was because doctors did not yet understand the importance of handwashing. I don't know whether midwives did at that point, but if not, at least the birthing women were surrounded by their own bacteria (this is actually good for the baby's microbiome!) The midwives probably hadn't been handling dead bodies just before attending a labouring woman, so that's a plus.

When people look back at the terrible numbers of women who died in childbirth, and how that number has been brought down by the wonders of modern medicine... They often assume this is due to immense technological or pharmacological advances, which I affectionately call "The Machine That Goes Ping". They forget that quite a large factor is doctors finally learning to wash their hands 🤷‍♀️

Our standard of living has shot up in the last century or so. It is standard for homes to have running water. It is relatively unusual for children to develop rickets. The level of hygiene and nutrition available to the average family is much better than it was back when women were first encouraged to leave their nest and give birth in a more clinical setting. Reduction in poverty is surely a huge factor in reducing poor outcomes in maternity services.

The rise of obstetrics saw midwives' contribution to women's reproductive health dismissed. Male doctors positioned themselves as heroes. Learned men who saved women from themselves, their babies, and other women. Midwifery wasn't good enough. It was archaic, unscientific. This attitude was pervasive, and contributed to the shift towards birthing in hospital being the norm.

...was safely delivered of a son...

(This phenomenon of seeing doctors as the saviours of women, and midwifery not being as important... that still occurs. Speak to service users. Speak to midwives. Listen to women. Midwives to this day report being scapegoated, overworked, under-appreciated, and, frankly, bullied in the workplace. But I digress.)

OF COURSE we benefit from medicine and doctors. I would be dead twice over without the existence of skilled doctors and strong antibiotics, respectively.

BUT. Are doctors needed for every birth? No.

Does every woman need to give birth in hospital? No.

Have women and babies suffered as a result of giving too much credence and responsibility to doctors? I think so, yes.

Would women and babies benefit from a shift back to birth occurring in the community as the default? I think so.

(Would women and babies benefit from midwives receiving proper credit, and recognition as experts in their own right? Yes, but I digress again. That is a post for another day.)

SOME mothers and babies do have special circumstances that require a doctor. Absolutely! But for many, maybe even most, hospital is not necessarily safer. We have the research to prove this, which I'll share tomorrow 😁

The short version is that many complications are less likely to occur at home. Which raises the question: how often are they iatragenic? In other words, caused by the very people who resolve them? And who are probably telling us that those complications are the very reason we mustn't stay at home to give birth?

Other questions raised by this topic include:

But what if something goes wrong?

Can I have my baby at home if...?

What would maternity care look like if we trusted women a whole lot more?

If home birth were more normal... what ripple effects might we see in hospital birth?

I'm looking forward to digging into these over coming weeks.

What questions do you have that you'd like to see me explore?

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