Milli Hill: Hospitals hinder women from giving birth

Choices cannot be fully free if they are rooted in fear, not fact. Nowhere is this illustrated more vividly than in the 21st-century birth room. Here is a place where the power dynamic is weighted heavily in favour of the experts, where information is not always given in an unbiased way and where fully grown women still talk in terms of what they are “allowed” or “not allowed” to do.

When I was pregnant for the first time seven years ago, I had two friends who were midwives. Not only that, they were midwives of the subversive variety, who disagreed with many of the practices they saw in their day-to-day work on labour wards. Both of them told me to have a home birth, advising that I’d be safer and get better care.

I took their advice but, when my baby was not born on her due date, I came under increasing pressure to have a hospital induction. Ultimately, I was afraid: doctors talked of an increased risk of my baby dying as each day passed. Eventually the pressure became too much, I abandoned my home birth plan and my baby was born in a more conventional way – forceps, episiotomy, feet in stirrups.

I have gone on to have two more babies, both at home, in a birth pool, both under the care of an independent midwife. Both births went smoothly and have been the cosy, family-centred and joyful experience I dreamed of. Never did I have any concerns for safety, as I trusted my own body and my midwives to see if the birth was not unfolding as it should – and transfer me to hospital if needed.

I chose to give birth at home because I felt safer there. This was an intuitive choice. But the Birthplace study, upon which the new Nice guidelines are based, says quite clearly that this intuition is supported by evidence. The hospital environment hinders women from giving birth without unpleasant, traumatic and risky intervention.

Unfortunately these facts are almost impossible for many people to accept. Our cultural fear of childbirth is so great that even robust evidence cannot be heard over the din of panic. Today’s new guidelines are a rallying cry for evidence-based choice to replace fear-based choice – but will we listen?

Ellie Gibson: Why create a new stigma around going to hospital?

I have huge respect for those who choose a home birth. I believe it is every woman’s right to make her own decision when it comes to her body and her baby. However, that wasn’t the right choice for me. I feel safe in a hospital environment and I wanted the option of pain relief if things got really bad.

As it turned out, things got really quite bad indeed. But we got to hospital too late for an epidural, and then there were complications. I ended up having an episiotomy and a ventouse – procedures Nice is suggesting I could have avoided if I had stayed at home.

It’s not the first time I’ve heard this. I met a midwife at a dinner party who said it was “a shame” I “had” to go to hospital. I explained it was my choice, that I was grateful to have had that medical intervention close at hand. She said I should have hung on and pushed harder.

Maybe that’s true. I’ll never know. What I do know is that there were no long-term effects from these procedures. Three and a half years on, I am happy and healthy and so is my son. In fact, his head is less pointy than his father’s.

I’m aware that my choice isn’t for everyone. I understand home births are safe and that they are the best option for millions of women.

But I’m concerned about the amount of emphasis being placed on avoiding procedures that are sometimes necessary, even life-saving. I’m worried this could create a culture of fear and guilt. I know women who had their hearts set on staying at home, but were disappointed when pre-existing medical conditions or last-minute complications meant they couldn’t have the “natural” labour they planned – as if there’s anything unnatural about the birth of a baby.

Every mother should have the right to decide where she gives birth, without feeling pressured one way or the other. It’s taken years to begin shifting the stigma around home births – why create a new one around going to hospital?

Joseph Harker: Thank god the paramedics walked in

I’m all for hospital births – in today’s highly medicalised western world it’s all to easy to underestimate just how risky the start of life can be, for mother and baby. Our first two children were born in hospital, where the care provided by our midwives was excellent, and both births passed without incident.

By our third child we’d moved away from family, though, and partly because we didn’t know who could look after our three and one-year-old when the time came, we chose a home birth. We were assigned a team of midwives, who my wife Helen and I got to know over the nine months. On the big day, though, Helen went into labour at around 7am, just as the team’s shifts were changing. It didn’t seem to be a problem – we assumed the incoming midwife would have plenty of time to get to our house. But shortly afterwards Helen felt a sudden urge to push and we realised the birth was imminent. I frantically called the ambulance but within minutes the baby’s head had emerged. Thank god, at that point the doorbell rang and the paramedics walked in to collect the baby as she shot out on to the floor.

Once I’d got over the shock, though, I started thinking this birth thing was quite straightforward. Catch the baby. Cut the cord. Simples.

Baby four showed me how wrong I was. We chose home again – for the same childcare reasons – but his was a longer birth, complicated by the fact that the umbilical cord was wrapped around his neck, potentially choking him. Had the midwife not been there, I don’t know what would have happened.

Due to the risk of complications, we were not offered a home birth for our fifth child, so we had our final baby in hospital, which went as smoothly as our first two had.

Having the choice worked for us – and home births do relieve pressure on maternity wards and can help to save the NHS money. But the decisions always have to be medically led: if the mother and child are at low risk, it’s fine. But it may not be right for everyone and I’d hate to have a system in which pushy parents demanded home births, overriding the professionals’ advice.

It remains the case that for most people the most dangerous part of our life is the moment it begins.