Homebirth Debate

Birth in nature, the fantasy vs. the reality

Homebirth advocacy is based in large part on mistruths, half truths and outright deceptions. One of the most egregious is the fantasy of what birth was like among indigenous peoples. Supposedly women "know" how to give birth. They "trust" their bodies. Birth is a deeply spiritual experience. Mortality is restricted to "rare" cases because birth is inherently safe. Anyone who knows even the most basic facts about childbirth knows that these claims are absurd.

Consider this article, in the Chicago Tribune, about the birth practices among traditional women in the mountains of Nepal:

In the mountains of tradition-bound Nepal, women give birth the way they always have: in the cow shed.

When labor begins, they are sent out of the house, because bleeding associated with childbirth is seen as polluting. Most give birth on dirty rags or simply on the shed's cow-dung floor, sometimes with a local midwife helping. After the birth, the midwife routinely pummels or steps on the new mother's abdomen "to get the bad blood out."

In Nepal, as in many other traditional societies, childbirth is not viewed as a "spiritual" experience, it is viewed as "dirty". Women are not even allowed to give birth in the meager comfort of their own homes; they are forced out into cowsheds or other outbuildings so the they won't "pollute" their homes.

Complications of childbirth, including the death of baby and mother, are not rare. They are common. Nepal has been trying to reduce the astronomical death rate of "natural" childbirth.

... [O]ver the past decade, as pregnancy-related deaths have fallen worldwide at a frustratingly slow rate of 1 percent a year, according to the World Health Organization, Nepal has managed to cut its losses by almost 50 percent.

Nepal is an exception in South Asia, which, along with sub-Saharan Africa, has the highest rates of maternal mortality in the world, according to a report released in October by the World Bank, World Health Organization and several UN agencies. Together sub-Saharan Africa and South Asia account for 85 percent of the world's maternal deaths.

Afghanistan is tied with Sierra Leone as the most dangerous place to become pregnant -- with 1 in 6 women dying as a result of pregnancies -- and death rates are high in Pakistan, India and Bangladesh as well.

Today, 281 women die per 100,000 live births in Nepal, down from 540 women a decade ago, according to the UN...

A key to lowering rates of neonatal death is increasing the rate of hospital birth.

Through education campaigns and expanded clinic networks, Nepal also has managed to boost births at hospitals from 10 percent to 20 percent of the total, and increase the number of postnatal visits to clinics by more than 30 percent...

The country is still struggling to get help to the 5 percent of Nepali women who need a Caesarean section to deliver their babies. Many live in remote rural areas and a long walk from the nearest clinic...

Even that is not always enough.

Worse, because a Caesarean can cost $140, a fortune in rural Nepal, some husbands prefer to save the money and let their wives die, health workers say.

"If a woman has to have a Caesarean, husbands say it's cheaper to marry another wife," Pokharel said.

This is the reality of birth in nature. It is not a deeply spiritual experience; it is terrifying and viewed as "dirty". Women do not "know" how to give birth; they either give birth or die, or worse yet, they give birth AND die. Childbirth complications are not rare; they are amazingly common.

If all that were not enough, there is this: the new lifesaving drug in Nepal is Cytotec!

More help is on the horizon for Nepal's rural women, however. A new study in a few districts indicates that delivering a few oral drops of an easy-to-use drug called mistoprostol, which doesn't need refrigeration, appears to have reduced likely deaths of women from postpartum hemorrhage by 85 percent, Locatelli-Rossi said.

With more than half of the country's deaths now attributed to such bleeding, the drug "is extremely promising," she said.

It is difficult to imagine how homebirth advocates' most basic assumptions about childbirth could be any farther from reality than they are. If the fundamental assumptions of homebirth advocacy are so wrong, it is hardly suprising that their conclusions about homebirth safety are wrong, too.

Labels: maternal mortality

posted by Amy Tuteur, MD @ 7:03 AM