Why Not Home In New Zealand?
“Why not Home?:The surprising birth choices for doctors and nurses” is a new and beautifully produced US documentary exploring the experiences of several family nurse practitioners, obstetrically trained doctors and midwives who choose to deliver (as they call birth) their babies at home, rather than in a hospital. This film reviews the history of birth moving from home to hospital in the USA, the rising and internationally high US caesarean section rates and 2 sets of research about the safety of home birth compared to hospital delivery; all of which are some of the reasons behind these US health professionals asking “Why Not Home”.
The interviews in this film; of the health professionals, their caregivers and partners reveals practical and emotional reasons why they chose to birth at home rather than in a hospital, but none mention the negative impacts of the external and, or internal environment of labour, on the production of the birthing hormones; Oxytocin, Endorphins, Adrenaline/Noradrenaline and Prolactin. Nor do any of the additional maternity experts even suggest that the flow of vital substances like Oxytocin,“the shy hormone”, can be helped or hindered by environmental factors such as bright lights, noise and activities including care-giver practices or a labouring woman’s fears and behaviours. All these factors can block a labouring woman’s ability to make the essential birthing hormone cocktail and thus labour stalls in all sorts of environments but especially in unfamiliar hospitals where bright lights and noises are common along with the all hours monitoring and treatment of their ‘patients’.
The labours and births shown in this film are very similar to those which result in hospital vaginal deliveries in New Zealand, with the women mostly in positions that permit a midwife or doctor to ‘deliver’ the baby and immediately lift the baby onto their mother’s chest. This hands-on, directive style contrasts that of homebirth midwives I work with, who encourage women to birth their babies in the way that facilitates the mother’s “Fetus Ejection Reflex” and the efforts of their baby to be born. This can happen when labour is disturbed as little as possible and the woman is confident, connected and works with her baby and body birthing instinctively as nature intends. For labour and birth to be an involuntary, instinctive process, the environment and all present during labour and birth need to protect, support and encourage the flow of birth hormones which orchestrate the ‘dance’ between mother and baby. Such natural or physiological birth is most often achieved when women, like other creatures nest, hence the better outcomes and greater satisfaction of women who birth at home compared to those who have more disturbed or managed labours and deliveries in hospital.
Not shown or discussed in this film is the natural option of gentle, spontaneous birth of the baby’s placenta, which usually results within half to an hour after the baby’s birth when this transition period is undisturbed, so the hormones flow optimally to complete the birth process. However I suspect that the women in this film had active management of this ‘stage’ including an injection of synthetic oxytocin followed by clamping and cutting of the cord before it had ceased its pulsations. Active management or placental delivery is done “to reduce bleeding” however statistics and experiences of hands-off midwives is showing that when nature is supported and protected mothers bleed less and babies retain most of their (uterine) circulation making them optimally healthy for life outside the womb.
New Zealand women, unlike those in the USA have access to continuity of care by a midwife, and this is one of many countries in the world who have better infant and maternal mortality rates than the US. However, New Zealand birth outcomes do not support the expressed belief of Prof Eugene DeClerq “that wider use of midwifery” is the single change needed to address rising rates of caesarean section. Here in New Zealand over 90% of women have continuity of a care by midwife through pregnancy, birth and afterwards, yet from 2009 to 2014, as in previous years, there has been an increase in the rates of Caesarean section, and other interventions with no correlation with increased clinical need. For example healthy first-time mothers, with no obstetric indications, aged 20–34 years old, in labour at term (37–41 weeks) with a single baby, presenting head first, have had a decrease in spontaneous vaginal births from 2009 to 2014. In addition, the latest and previous annual MOH report shows that the vast majority (87%) of women gave birth with their midwife at a secondary or tertiary maternity facility, whilst only 3% birthed at home. Also, half of all New Zealand women who birthed in 2014, mostly in the care of a midwife and in a hospital, had at least one form of intervention during their labour and, or birth (24% – induction, 26% – augmented labour, 27% – epidural, 15% – episiotomy).
The national caesarean section rate in 2014 was 27.4%, but 17.8% in 1999 when New Zealand women were first able to choose government funded maternity by the midwife of their choice. This rate was highest amongst women from the more affluent neighbourhoods who again would have a lower clinical need. Also, outcomes for women and babies varied between district health boards (DHBs) and between individual hospitals, all of which is consistent with the explanation in the “Why Not Home” film that; what practitioners experience influences their ‘world view” and what they professionally do and believe!
The women and community of New Zealand are generally unaware that local research indicates “that for women having a second or subsequent baby, home births and midwifery unit births appear to be safe for the baby and offer benefits for the mother”. as reported by the UK Birthplace study, UK media, and supported by the Royal College of Obstetricians.
The Ministry of Health, Royal Australian and New Zealand College of Obstetricians, Midwifery Council and College of Midwives need to explore and act on last year’s research by New Zealand born and now ex-pat Dr Sarah Buckley about the evidence on innate hormonally-mediated physiologic processes in women and foetuses or newborns during childbearing, and possible impacts of common maternity care practices and interventions on these processes, focusing on four birth hormones.
Finally the world would benefit from a Kiwi centred documentary which examines all the options, knowledge and issues of “Why Not Home In New Zealand?”