By the time she arrived at the Emergency Room she had already lost a lot of blood. She was rapidly transferred from the ambulance to an ER bed and within a matter of minutes the life-saving transfusion was started. Had she waited just minutes longer to call for help she may not have survived. Her new baby would have been motherless.
For the doctors in the emergency room the treatment was common, a matter of routine. The reason for her brush with death was not. Post-partum hemorrhages are usually handled on the maternity floor, not in the emergency room. If her baby had been delivered in the maternity floor the bleeding would have been handled faster and the transfusion averted. Unfortunately she had chosen to avoid the maternity floor and have her baby at home. Her decision almost cost her life.
It was a decision that I had repeatedly and strongly argued against. I was her doctor for the first 4 months of her pregnancy. She had made it clear that she wanted a “natural” experience and I had promised her that this could be done in the hospital. I understood that many women preferred a natural delivery and had extensive experience managing natural childbirth. I was confident that her wishes could be honored and promised her they would. When she made the decision to deliver at home I had to resist and released her from my care. From my perspective as a doctor and as a father choosing home birth was and is one of the most selfish choices a woman can make.
Home birth goes against the two values that define obstetrical practice- Protect the health of the mom. Protect the health of the baby. These values guide all obstetrical care. The maternity unit is the only place in the hospital where the health care team begins with healthy patients and then works to keep them that way, so bad outcomes are especially tragic. Everything done by the nurses and doctors is directed at early identification of problems and preventing complications. The only acceptable outcome is a healthy mom and a healthy baby and no action or decision that makes that outcome less likely is tolerated.
While the goal of healthy mom and healthy baby is non-negotiable there is plenty of room for maternal choice during the course of labor and delivery. Birth positions (sitting, squatting, lying down), analgesia choices (epidural, narcotic or none at all), eating during labor, avoidance of IV lines and episiotomies, early nursing and skin to skin contact were all a part of births I attended. I often bent over backwards to meet the mother’s needs even if it meant spending extra hours in the hospital. My willingness to honor maternal wishes had one limit- I would not do anything that put the baby at risk. This is why I opposed home delivery.
In spite of opposition from the medical profession home birth seems to be making a comeback. While there are many possible explanations for the trend the facts support the conclusion that the choice to deliver at home is less about love and health and more about personal feelings and selfishness.
The patient who nearly died of a hemorrhage gave reasons for desiring a home delivery that were typical. She wanted a natural delivery and the experience of delivering at home in a supportive and comfortable environment. These desires seem worthy but they are not, for both place the feelings of the mother ahead of the health of the baby. Babies have no recollection of the room in which they are born, do not grow up feeling more loved and desired because the lights were low and the bed was soft. The baby does not care. Home deliveries are all about what the mother wants and not about what is best for the child. Is this not the very definition of selfishness?
The argument against home delivery is simple. It needlessly places the baby’s life at risk. While the risk is not massive (life threatening complications are rare in most pregnancies) the risk is always present. The American College of Ob-Gyn estimates that newborn mortality in home births is triple that of babies born in a hospital. Why would a loving mother make a choice that needlessly increased the chance that harm would come to her child? What warm feeling or joyous experience can justify that risk?
Current research suggests that as many of one in three women attempting home delivery will need urgent transport to a hospital due to a complication in labor. The transfer rate is lower for women who have previously delivered vaginally but it is still significant. Like every physician who has practiced obstetrics for any length of time I can share a number of stories where being in a hospital delivery room saved the life of a mom or baby.
Consider this analogy- If a young mom announced that she was foregoing the use of an infant car seat because she wanted the child to be in her lap while she drove she would be reported to the authorities. Her arguments that it made her feel close to her child, that bonding was important and that the risk of accident was low would fall on deaf ears. It would not matter that she was a safe driver and that because of cell phones medical help was never more than a few minutes away. Everyone would agree that it was irresponsible and selfish to risk the life of her child in such a way. How is this different than choosing to deliver a baby at home?
I have heard that home birth is gaining in popularity, part of the recycled fad of interest in all things “natural.” I doubt this post will change the minds of those who do not trust the knowledge or intentions of the medical profession but there is one thing of which I am certain. When it comes to the place of birth the baby does not care about the experience. No one remembers their birth experience.
Everyone remembers when a baby dies.
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