A home birth tragedy

Exact statistics on the number of home births in New Zealand each year are hard to find. Photo / Bay of Plenty Times

At the end of March, the baby daughter of one of Australia's most ferocious homebirth advocates died after her mother endured a five-day labour at home, with only her partner and a friend by her side.

Janet Fraser is the national convener of Joyous Birth, a particularly extreme group of homebirth proponents who believe a doctor's interventions in childbirth are "birth rape". Many attempt "free births", which, unlike home births, are not attended by anyone with any medical expertise.

Fraser's plight has become fodder for columnists and bloggers across the ditch, many of whom are quick to dismiss not just Fraser and her extreme feminist ilk as a bunch of quacks but indeed the whole home birthing scenario.

Strangely, as she was labouring, Janet Fraser was interviewed by the Age to defend accusations she was reckless in advocating home births.

The paper reported the labour's tragic end several days later.

One who seems to have a real bee in her bonnet about home births (because she's written on the subject before) is the Sydney Morning Herald's Miranda Devine. She writes here pouring scorn on home-birthers. In the comments page after this article are many references to the fact that in New Zealand homebirths are "government supported" in comparison to Australia, where the health system and insurers appear to actively discourage the practice.

It is difficult to estimate the number of local home births - a figure of about 7 per cent of all births is bandied about, but it includes births that happen accidentally at home, as well as those in which women have ended up being rushed to hospital to avoid disaster.

Certainly in New Zealand midwives are paid to attend home births. And from time to time the practice has been encouraged by politicians suggesting it would lessen costs on the health system.

But how safe is home birth?

Clear and concise statistics are again hard to find.

Proponents of home births point to several studies (one in particular from NZ looking at the 20 years between 1973 and 1993) that show little difference in infant mortality between low-risk women who birth at home and the same type of women who birthed in a hospital. Iit also showed, as you'd imagine, lower rates of "interventions" - epidurals, c-sections etc - and higher rates of satisfaction with the birthing experience.

International studies have found very acceptable rates of risk in some European countries, where up to a third of all women give birth at home in some Scandanavian countries, for example.

But the problem with this comparison is that whether a woman is low-risk or not is often not realised until the birth is underway.

Complications can be unseen, or even develop during labour.

Where the home birthing system is the safest, midwives come armed with a full arsenal of drugs and other "interventionist" equipment, and are very connected into the hospital system which they are quick to utilise at the first sign of trouble.

One hopes New Zealand midwives attending home births do the same.

Certainly there is a very strident branch of men, women, and midwives who actively discourage any pain relief, vaginal examinations, electrical monitoring, episiotomies and anything else vaguely surgical in birth, reasoning that our foremothers did it naturally, and so can we.

It would be interesting to know if Janet Fraser will be able to maintain her defence of home births and. in particular, free births after she's emerged a little from her current catastrophe...

- Dita De Boni

Pictured above: Exact statistics on the number of home births in New Zealand each year are hard to find. Photo / Bay of Plenty Times