Unicorn Birth

Andre Picard is the health reporter for the Globe and Mail. This weekend, he wrote an opinion piece about how childbirth has been "over-medicalized" with 97% of births taking place in hospitals. He feels that, since birth is a natural process, and can be done at home with minimal medication or intervention, that women should be strongly considering this as their first option, with hospital birth second.

I have a few thoughts on this.

My first, visceral, reaction is this; kidney stones can be managed at home. Why don't you try that and get back to me?

Mr Picard states that "pain relief can be offered in the home" and this is true. However, your options for pain relief in a non-monitored, non-medical situation are extremely limited. There can be no IV or epidural. Your medication must be delivered orally, or if you're lucky, with a shot to the muscle (if you deign to allow a nurse/midwife into your home). This analgesia is less reliable; if it's in your muscle, it gets a prolonged release time, meaning you can be doped up and woozy for much longer than the duration of the labour. Epidurals are great because you control when the quick-on, quick-off pain relief kicks in and WHEN IT STOPS.

I would like Mr Picard to endure passing a kidney stone, at home, with only the limited options of analgesia available to him. It meets all the conditions of his argument; it's natural, has been done at home since the dawn of man, and would vastly decrease hospital/health-care costs.

My second reaction is that this man is comfortable assuming risk for people who are not him. I have only attended about 40 births. The majority of them went smoothly. However, the few that did not go well had almost no warning.

The child who came out with the cord wrapped three times around it's neck? Normal birth/labour until the head appeared. Required immediate suctioning (not available at home) and pediatrician-led resuscitation, then time in the NICU. The change from happy-delivery to terrifying ordeal happened in 10 seconds. That's not enough time to call an ambulance, get mum and baby to hospital, get the team assembled and so on. Mr Picard would be comfortable with this child's potential cerebral palsy/oxygen deprivation/death, as it would cost the medical system less in the short-term.

The other terrifying situation I was involved in included a post-partum haemorrhage. Again, normal labour, normal delivery, but this woman's uterus couldn't clamp down fast enough after the placenta was delivered, so she started dumping blood. She lost about a litre in the first 30 seconds. It took us another minute to get large IV's into her and a third minute to get fluids running. If she had been at home for this situation, she would be dead. There is no home "rapidly replace blood loss" protocol. Again, an ambulance would have been required.

During this bleed, I remember trying to wrap the baby in a swaddle (I was a medical student at the time) and handing it to her new father. He pushed the baby away, unable to take his eyes of his potentially dying wife. If we hadn't been in a hospital, with trained OB staff, I might not have been able to congratulate them the next day (as Mother received a third transfusion) and visit the baby.

Mr Picard states that we are over-medicalising a natural process to attempt to get rid of risk. Statistically, he says, that's impossible and home births should be just as safe.

The problem with statistics is that if you're the one in one hundred who has a bad outcome, you get 100% of the bad outcome. 100% of the dead baby. 100% of the brain-damaged child. 100% of the dead mother. Yes, you're the exception, but your life is all you have. As such, you should not be pushed to try a "natural, beautiful" option that puts you at higher risk.

My third and final reaction is that this is a man with limited medical experience trying to tell women what's best for them. There are some women who absolutely prefer to give birth at home. They are aware of the risks and feel that the benefits outweigh them. There are women like me, who are paralyzed by the potential risk of popping a sprog, and want to be in the most controlled setting possible to minimize the chance of death for myself and my bub. Mr Picard would like us to put the home birth option first. I don't want to take the "natural" 50% fetal-maternal risk of dying in childbirth. I would like to keep my freedom of reproductive choice.

The reaction on Twitter and around the internet has been varied, but ultimately, it has to come down to choice. If you are the one giving birth, you can't let an old white guy tell you that the birth should be "natural", "magical", "messy" or "beautiful". Ultimately, it's one more man telling you what to do with your body, regardless of your own desires and experience. And that's unacceptable.