It’s time for women to take back the experience of birthing. Modern medicine has medicalized it, falsely claiming that it’s evidence-based. It is not, and a new Cochrane Collaboration Review clearly documents that fact. The medicalization of birth is doing untold harm to mothers and babies, intervening where none is needed and devastating this most significant of life’s events.
by Heidi Stevenson
In the face of mass medicalization of childbirth, the highly respected Cochrane Collaboration has produced a review that shows no benefit in routine hospital deliveries over midwife-assisted home deliveries.[1] Home births lead to fewer interventions and rarely involve the now-common practice of inducing labor.
Authors Ole Olsen and Jette A. Clausen go so far as to imply that outcomes may be worse when birth is treated as a medical event requiring modern equipment and oversight:
Increasingly better observational studies suggest that planned hospital birth is not any safer than planned home birthassisted by an experienced midwife with collaborative medical back up, but may lead to more interventions and more complications.
“… more interventions and more complications.” Yet, women are not only being discouraged from natural home births, they are now often treated as criminals, with some countries going so far as to outright ban home deliveries. The UK has just effectively made home deliveries illegal without actually passing a law against them. In October, assisting a home delivery will become illegal unless the midwife has indemnity insurance—but no insurance providers will cover them![2] In Hungary, Agnés Geréb, a midwife and gynecologist, is now serving a two-year sentence for the “crime” of attending a home delivery.[3]
The Study
The study is a review of several existing studies and looked for certain outcomes:
- Maternal mortality
- Perinatal mortality (non malformed)
- Birth trauma (e.g. cerebral haemorrhage, fracture of clavicle, long bones or skull, fascial nerve injury or nerve injuryeffecting movement of a child’s shoulder, arm, and hand)
- Apgar < 7 at 5 min
- Resuscitation
- Early cord clamping
- Jaundice
- Other neonatal morbidity
- Transfer to neonatal intensive care unit
- Baby not breast fed
- Assisted vaginal birth
- Caesarean section
- Haemorrhage
- Perineal trauma
- Other maternal morbidity
- Epidural
- Other (non-epidural) medical pain relief
- Non-medical pain relief
- Medical augmentation
- Episiotomy
- Maternal satisfaction
They were able to find adequate data on only four of these items: baby not breast fed, assisted vaginal birth, caesarian section, and other (non-epidural) medical pain relief. They also found adequate information for three other outcomes, which they reported: perineal sutures, mother disappointed about allocation, and father did not state that he was relieved.
Only one of the six studies that matched the initial requirements was found to be adequate. They required that the births involved be determined as low risk by an obstetrician and likely to have suitable home support and conditions, which includes a qualified midwife. The trial took place in the UK, and though all UK midwives are trained for home births, it’s believed that none in this trial had prior experience with home deliveries. Midwives are used in UK hospitals, including this trial, but not necessarily on a one-to-one basis and never continuously, as in home births.
The study was a randomized trial, so the women were assigned to either hospital or home births. Out of 71 pregnant women judged to be low risk, only 11 agreed to take part in the randomization of the trial.
The study found no differences between the two groups in terms of outcomes, with one dramatic difference. The majority of mothers in the hospital group were disappointed in their experiences, but none of the women who had home births was disappointed.
Evidence Based Medicine?
The results are based on fairly scanty evidence, but the fact is that this is the first serious look at the evidence that’s available—and this review found the five other potential studies to be inadequate. It is, therefore, a good start … and it doesn’t bode well for routine hospital deliveries.
The medicalization of birth has been accomplished without any evidence base, in spite of modern medicine’s constant claim of being evidence based. The move to routinely hospitalized births has been accomplished through fear mongering, by scaring new parents into believing that birth is inherently dangerous for both mother and baby, even going so far as to suggest that any new mother who would consider having her child outside a hospital is guilty of child abuse.
The reality is that, in most cases, the opposite is true. As reviewers Olsen and Clausen found, there simply is no evidence for the claims. But of course, birth has become a highly profitable business for doctors and hospitals. Consider, though, the utter lack of evidence in support of hospital-doctor directed births, which has led to an assorted array of high-tech devices resulting in:
- Routine surgical deliveries, disadvantaging both mothers and infants.
- Early cord clamping, denying virtually every newborn’s inherent right to his own blood. Sadly, this tends to be done by midwives, too, though they do appear to be the frontrunners in ending the practice.
- Routine use of invasive, harmful, and generally useless techniques, including:
- Episiotomies.
- Birth scheduling by labor inducement.
- Introduction of unnecessary monitors.
- Pressure for, and often insistence on, caesarian deliveries when doctors arbitrarily decide labor is taking too long. In Brazil, up to 82% of births are done surgically!
- Depersonalization of the entire process.
The bottom line is that there is no conclusive evidence in support of hospital over home births. If the experience of the women in this study is any indication, giving birth in a hospital was a bad experience, while home deliveries were satisfactory.
There is no evidence of better outcomes in hospital deliveries for normal births, and there is good reason to believe that there may be a significant amount of iatrogenic (doctor-induced) injuries to both babies and mothers. After all. when caesarian deliveries are routine, the added risks of major surgery cannot possibly lead to better outcomes in any instances beyond those where normal delivery is impossible.
As many midwives can attest, many of the caesarians that doctors treat as necessary, such as labors that are longer than they like, are not legitimate excuses. Certainly, scheduling deliveries can never best serve the infants. The routine uses of drugs and epidural injections, which can result in permanent disability from the painful neurological disorder arachnoiditis, are avoided in home births.
Modern medicine’s claim to being evidence based is simply untrue in terms of childbirth. Such evidence has never existed, as this Cochrane Review clearly documents.
Finally, the dehumanization of hospitals cannot possibly be to the benefit of the newest entries into the world. Surely, unless good evidence is produced demonstrating that hospital births truly are safe, the headlong rush to medicalize birth needs to be ended. Women need to reclaim their bodies and take control of this most central of life’s experiences. Leaving it to the whims and profits of modern medicine has benefitted only the medical practioners’ and hospital corporations’ bottom lines.
Source:
- Planned hospital birth versus planned home birth (Review); The Cochrane Collaboration; Olsen O, Clausen JA; DOI: 10.1002/14651858.CD000352.pub2
- Independent midwives – and home births – are under threat
- Hungary: Midwife Agnes Gereb taken to court for championing home births
- Agnes Gereb