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call-the-midwifeWhen you look at childbirth historically and logically, it becomes apparent that many of the reasons women and babies used to get into difficulty or even die in childbirth are simply not the issue they would have been in bygone days, and in some cases those problems have actually been eradicated altogether.

In many ways, modern childbirth has never been safer. But can hospitals really take all the credit for this? Is it accurate to suppose that women at home in 2016 face quite the same risks as your average Call the Midwife birth-gone-wrong drama? (And let’s remember it IS a drama so the most salacious storylines are chosen to boost ratings and keep everyone interested). These types of storylines and tragedies of course did occur, and some were more common than others.

Whether a woman chooses hospital or home is her own personal business, and it is every woman’s right to choose for herself where she feels safest. I would never try to persuade any mother to have a homebirth as this is a deeply personal choice only she (and her partner) can make.

But if you are already considering homebirth or have already made the decision that this choice is for you, here are 10 reasons why homebirth in 2016 has never been safer.

1. Germs

During one of the darkest times in maternal history, doctors and midwives had yet to make the connection that inserting dirty hands or instruments into the birth canal was the reason women developed puerperal fever, a fatal infection which caused the mother to die of sepsis just hours or days after giving birth.

Some even attended births straight after performing autopsies – making both their hands and tools lethal. The realisation only happened in the mid 1800’s. Hungarian doctor Ignaz Semmelweiss was so perplexed by the maternal mortality rate at his hospital in Vienna, that he dedicated himself to studying what was causing these deaths. When he suspected it was something to do with the doctors themselves, with their hands and instruments, at first nobody wanted to believe him, and they resisted and laughed at his germ theory, (even after he introduced handwashing in his hospital) angry with the insinuation that they were to blame. It became clear though that he was right. Look at the data below.

Vienna General Hospital Puerperal Fever Mortality Data

  • October 1842 (no handwashing in place) 29.3% mortality rate
  • October 1847 (handwashing is now enforced) 4% mortality rate
  • October 1848 (strictly enforced handwashing) 2.3%

It is a shame that Ignaz Semmelweiss was not listened to sooner. If they had, he might not have died alone in a mental institution, and women would have been saved from this tragic fate much earlier. We owe him a great debt.

You would think that sanitizing alone would have eradicated infection but giving birth in a modern day not-too-dirty but not-too-bleachy home which is clean and warm is actually a safer environment germ-wise than most modern hospitals. If you stop and think about it, hospitals are full of sick people, and the sources of infection increase there because of the sheer number of different people and surfaces the mother is exposed to. Immunologically speaking, home, with all its domestic germs, is in many ways actually a safer place to have a baby, and the chances of an MRSA-type infection are dramatically lower at home.

2. Clean, fresh, running water

We take it for granted that we have really clean, even hot, water coming out of a tap, directly in our homes, upstairs and down! Those Call the Midwife days are over now. Not only do most modern homes have their own bathroom with flushing toilet but we also have washing machines for instant, effective and hands-free cleaning of linens, bedding and clothes, which has greatly improved overall sanitation in the home.

These simple things make modern day homebirth significantly safer than in earlier centuries. Getting clean hot water into the home for personal and domestic washing used to take up a lot of time and effort, might involve leaving the house to go and fetch it, and was of course, harder in winter. Modern day birth attendants aren’t having to check on mum in-between boiling pans of water fetched from the communal well in the street on a cold November night.

But even better than simply having water on tap, many women are now able to take advantage of pain-killing and gravity reducing water by labouring and giving birth in it too – birth pools offer women the ability to manoeuvre themselves into upright positions that help open up their sacrum, making birth easier than on dry land, with less tears, and less need for pain-relief.

Water birth isn’t a hippy fad but a total game-changer for women. Being able to move around in water rather than be stuck flat on their backs means their pelvis can open up much wider than before, reducing the risk of baby getting ‘stuck’.

3. Diet

Women in 2016 have access to a wider variety of grains, meats, fish, fruits, vegetables, vitamins, minerals and supplements than any other generation of women before them. Thankfully in 2016, we are not using ration books anymore either – gone are the days of having to make two eggs last a whole week!

large-vegbox
We live in an era where there is greater understanding of women’s dietary needs than ever before, and conditions like diabetes or anaemia can be managed and improved with proper care, treatment and planning – by conventional means and also by a wide range of complementary medicines/practices. Both of these conditions could be extremely dangerous when unchecked and untreated in earlier times, but in 2016 we are better at understanding, addressing, treating and supporting women with such conditions antenatally, and can even rule out homebirth if medically necessary – which was not an option in the Dark Ages.

Although women can of course choose to eat very unhealthily in 2016, at least for many, that really is a matter of choice and not so much a lack of affordable nutritious foods to choose from. We now have better access to foods to fortify mothers before pregnancy, during pregnancy, during birth and in the days and weeks afterwards. A very different story to the poorest working class 1950’s mother, perhaps having her eighth child on an empty stomach in cold and maybe even squalid, conditions. This particularly grinding poverty is not likely to be the case for most home birthing mothers in 2016.

4. Improved gynaecological health

Since the introduction of contraception, women are no longer having so many children as they once did. Gone are the days when it was entirely normal for a woman to have a brood of twelve (not counting the miscarriages that might occur in-between) where a woman’s placenta would have to keep having to implant itself in a new spot each time causing increased risk of fatal post-partum haemorrhage.

In the Call the Midwife era, women (or indeed very young girls) may also have had no choice but to give birth to a child following rape. Or incest. Such things were not discussed or written about and there were no self-help groups or counselling services from folks trained in how to cope with such enormously emotionally damaging scenarios. These births often went underground – and here lay the real danger. These were not the internet-savvy freebirthers of today but women who were alone and scared and who didn’t have access to a wide range of educational material at their fingertips. Women giving birth to a disabled child could not know with certainty if the child would be well received by her husband and family and some may have been reported as having died during the birth but were in fact sent away.

The fact that having a baby out of wedlock used to be considered a disgrace meant that women were forced to give birth in secret, sometimes far away from home, where no one could find out – often in grim, basic conditions. It must’ve been very difficult for some women (or young girls, let’s be honest) to bond with their unborn babies and lovingly carry them to full term, let alone give birth to them without the optimal hormonal conditions for birth where the mother feels safe, protected and cared for.

In the call the Midwife era, abortion was still illegal so there was the problem of DIY or backstreet abortions which were very dangerous for women and if performed badly, could leave their wombs scarred and damaged for any subsequent pregnancies. Going even further back historically, let’s also remember that it was common for women to have STD’s which might go untreated for years or even decades. Syphilis in particular was rampant even up until the late Victorian age and could have terrible consequences for mother and babe if left untreated.

5. Overall health

Doctors and midwives in earlier centuries did not fully understand how to manage or treat dangerous conditions such as pre-eclampsia or gestational diabetes for example, and had only a limited grasp of how to screen for them. Women’s bodies carried the scars of every illness that they ever had. Some illnesses could leave a woman weakened permanently. At any time in her life antenatally, and quite unrelated to giving birth to this particular baby, she may have had treatments or operations that were dangerous or botched in some way. Women used to also give birth whilst suffering from undiagnosed cancers, tumours, after rickets, riddled with poxes, carrying viruses… all kinds of physical conditions that could make pregnancy and birth more difficult or even life threatening compared to a healthy home birthing hopeful in 2016.

Nowadays women are cared for throughout pregnancy and can have their blood and urine tested, choose screening by ultrasound, receive effective, immediate, or ongoing treatment if needed for any underlying conditions and have an idea of how baby is doing. In 2016 we have so many ways to detect and identify if there are any obvious reasons why birth might be difficult or dangerous in advance of the event and can anticipate how to manage those risks, and make a decision whether to absolutely avoid homebirth altogether. A woman in earlier centuries could not choose between the two – it was home or nothing – and that could mean certain death.

6. No more corsets

In 2016 women are not contorting their wombs and stomachs into corsets or other physique-altering clothing. Imagine what having such a pinched waist would do to a woman’s insides! It literally altered the shape of a woman’s womb and moved her internal organs into positions they were not meant to be in. Is it any wonder some women could not give birth to their children without getting into difficulty? Fashions of 2016 are generally much kinder to pregnant and birthing women and allow them greater freedom of movement than during other eras. Hurrah for soft-waisted jogging bottoms!

7. Women are more informed than ever

The age of information and the explosion of material on pregnancy and birth means that modern day women can actually understand the mechanics and physiology of their own bodies and the birth process better than at any other time in history. Information previously only in textbooks for an elite group of medical professionals is now out there in the public domain and women can read books, blogs and websites by all kinds of birth professionals, as well as attend courses, join support groups, compare graphic details, watch videos of women giving birth/ talking about birth, and learn things like hypnobirthing to help them to feel informed and in control.

Women in 1216, 1616, and let’s face it even as recently as 1916, might not have received any useful sex education at all, at best, relying only on the bible, or a church person to tell them about birth. If they were lucky their mothers might tell them in advance but it’s not uncommon for women to literally be given no indication at all as to where their babies would even come out of them. Prudishness and modesty prevented some people (and some entire communities in fact) from talking frankly and honestly about the female body and its functions. Birth attendants might have chuckled knowingly amongst themselves or spoken in coded language that betrayed very little of what the woman in labour should expect. Imagine how terrifying birth must have seemed for women who didn’t have a clue what was happening to their bodies and if they would survive – how tense they would’ve been! This alone may have caused long difficult labours in the past, leaving the mother dangerously exhausted.

8. Skilled equipped birth attendants are the norm

Those who attend homebirths in the UK nowadays are midwives who have studied, witnessed, attended and analysed a variety of births. They may have practiced at home and abroad, attended many study days and conferences looking at birth from many different perspectives, across cultures and with the benefit of learning from many teachers and from the lessons of history. Midwives also come with a kit which includes sterile equipment and effective pain relief – but not every woman was so lucky throughout the ages.

Before the NHS and free midwifery care, not everyone could know for sure that a skilled midwife would attend to them. Wealthier women were often even more at risk – we have already talked about the dreaded Puerperal fever, which was more of a risk with the advent of forceps and other experimental and primitive instruments used by expensive male doctors. Such doctors thought they knew best but many actually made childbirth more dangerous for women because they were sometimes rather eager to be seen to ‘help’ the birth along (perhaps to justify their large fees?).

The mistrust in midwives in the domestic setting, away from the watchful gaze of others is nothing new. We only have to look at the mass witch burnings of the 1600’s for example to see how midwives have always been blamed for difficulties in childbirth. These women with their hooked nails (for piercing the amniotic sac) and their faith and knowledge in healing herbs had to be careful they did not meet a grisly end on the scaffold. Midwives and mothers could be accused of witchcraft by their community if the mother gave birth to a disabled child, if she got into difficulty at all, or if the baby died. It stands to reason that many of the reasons such things happened were in fact nothing to do with the midwive’s skill and more likely to do with the woman’s poverty, nutritional health, or her likelihood to have an ongoing undiagnosed condition of some kind, something which she could have been screened for antenatally in modern Britain. Scans, screens and blood tests just weren’t available in earlier times, and a midwife would not have had sophisticated backup like she has at the end of her mobile phone today.

9. We no longer rely on horses for transport

Look at our infrastructures for transport in 2016. Midwives no longer arrive rosy cheeked on bicycles a la Call The Midwife era (cue 1950’s shmaltzy background tune) so there’s another reason to forget that comparison. Nor is this the era of fetching the midwife from the next village by sending a lad out on horseback across the valleys to get help. It’s 2016! Instead of roman roads and dirt tracks we have smooth roads… A-roads, motorways, cars, ambulances – heck we even have helicopters! Most midwives will tell you that any problems a woman has in labour tend to unfold slowly, and with proper observation and action can be managed at home, and even if transfer is needed, it might not always be a 999 drama.

And in 2016, we have house phones, mobile smartphones to call for extra assistance and (and a team who will come in a flash), cars and fully equipped ambulances to help take you to one of perhaps several hospitals. All of which no woman ever had in earlier centuries.

10. We have our partners by our sides

Women in 2016 have something many others did not have in the centuries before – the love and comforting support of their spouses and partners in the birth room. Women supporting other women has always been the norm, and fine it is too. If I didn’t think so, I wouldn’t have trained as a doula.

doulaBut there is something particularly reassuring for a woman to have the person she is choosing to raise this baby with there to lean on, to rock with, to hold and kiss, and to love. For me, having my partner’s strong masculine presence and energy has made me feel bolder, more confident and calmer than I imagine I might have felt as a woman giving birth in 1616 with a group of gossipy old women surrounding me and making me feel like a silly little girl who doesn’t know diddly squat.

Since the 90’s we have seen a cultural shift in the role of partners at births and in the home in general. Gone are the days when they were nowhere near the birth room, considered to be unsuited to watching and supporting their women through the grisly and undignified work of birth. The days of smoking fags in the corridor or even drinking down the pub while she was shouted at to push by complete strangers in sterile rooms, are firmly in the past. Hospitals are still in many ways, rigged to marginalize partners however. You only have to watch One Born Every Minute to witness the culture in which midwives still undermine and even mock their efforts to be supportive in any meaningful way – pointing out their inadequacies and weaknesses because they aren’t going through the agonies the birthing woman is experiencing. It may be done in jest, but the message is clear: you have no idea, so leave it to us.

In some circles, this idea of male partners being useless is thankfully being reversed and a quiet revolution is happening particularly amongst home birthing partners. At home, the importance of their role becomes obvious – instead of sitting on a plastic chair at the side-lines being shouted at and having their hand squeezed blue, they are able to support and comfort their partners in meaningful ways. At home, their role is anything but useless – they do things which help create a calm environment for the mother – pottering around making tea or feeding her snacks, rubbing her back, filling the birthpool, making calls, lighting candles, look after the midwives and making them welcome, helping to settle and entertain other children, making the birthspace feel like a comfortable and safe space. They are more likely to read books about oxytocin, go to antenatal classes on hypnobirthing or read blogposts like this. From lawyers to deep sea divers to screen writers to mechanics – homebirth partners are no more likely to be sandal wearing hippies than homebirth mothers in 2016. And being integral at the birth sets both parents up to feel engaged and connected with their little one from the beginning – which can only be a good thing.

Women might be extra lucky and have the further help of a doula, in which case her needs can be met even further. No more the days of women being shaved, enema’d and plonked into stirrups with only a stern matriarch in the birth room – alongside the medical baby-catching role of the modern day homebirth midwife, doulas soften the atmosphere, give mum a cuddle, remind her she is beautiful, and don’t shout mean things at her. And if things do go awry, keeping the mother calm while getting extra help is easier at home with loving supporters all around her.

A new era

Women have always been mammalian in essence, but it is only now we really understand the effects of adrenaline and oxytocin and how ignoring these hormones can seriously send births ‘off course’.

We understand now that relaxing encourages the body to behave and birth babies without lower likelihood of obstruction and complication. Midwives also know that women being flat on their back strapped to monitors can also make things harder since this in itself restricts movement and blood, oxygen and hormonal flow to baby and makes babies exit harder than if the mother is in active, instinctive birth positions. Although hospitals are catching up with this knowledge, some are still a bit slow to genuinely and meaningfully facilitate women to give birth in more upright positions. When women give birth in their own territory however, their freedom to move around and do things that help ease the pain and help baby descend into the birth canal increases.

In 2016, complications can of course still happen at home births. Even with screening, unforeseen problems can occur. But midwives are often the first to point out that when problems do arise, things tend to unfold slowly. A midwife at home is more likely to be able to spot worrying changes in the mother very quickly because she is continuously present with her, rather than popping in intermittently, changing shift, relying on medical notes only, or having to manage another lady at the same time. Without wishing to sound in any way cavalier, what may happen in a spirit of total panic at hospital might actually be resolved calmly and without nearly the same level of drama at home. In the event of more serious problems, midwives have sophisticated back up on the end of a mobile phone available including the option for transfer at speed to hospital if necessary. In this respect, home birthing in 2016 really doesn’t bear any resemblance to those Call the Midwife bygone days. Life-saving technologies and equipment that was not available in bygone eras are quicker and easier to access even for home birthing families.

Having a real life woman and other birth partners up close who are watching your breathing, appearance, and blood pressure who can assess you with the most important instruments of all – the eyes, the hands, and the heart is as old as the hills. In 2016, for all the reason listed in this article, homebirth has never been so safe. Thankfully, those Call the Midwife days are something that exists only on our TV screens, and home birthing mothers in 2016 can benefit from how far we have all come since then – wouldn’t you agree?

Paula Cleary is a mother of five, doula, homebirth activist and writer. She gave birth to four of her children at home and is the founder of Birthplace Matters. You can contact Paula through her website ‘Go with The Flow Doula‘.