Home Birth and Doctors

Home Birth and Doctors

Remember that you do not have to consult a doctor at all about having your baby at home. In fact not consulting one might be a wise precaution; GPs’ reactions can be surprisingly fierce, even when such doctors are normally mild-mannered and considerate.

However, it is worth analysing the reasons for such reactions. In most cases it will not be a result of sheer bloody-mindedness, although it can seem like it. It can be due to apprehension and a genuine belief that you are proposing something that will endanger you and the baby and of course the doctors reputation, notwithstanding the current evidence.

Part or all of this apprehension will stem from the doctors previous experience of childbirth during his or her training, and may even go back further than that — to the type of person that he or she was before being selected for a place at medical school. In choosing science subjects a potential medical student is expressing a preference for subjects in which they study precise information and definite knowledge, rather than topics which are a matter of debate or interpretation. In a study in Toronto, medical students were compared with their contemporaries studying arts subjects. They scored more highly in intellect, achievement and endurance but substantially lower than the others in their ability to tolerate change, uncertainty and lack of structure. Clearly childbirth, with its unpredictable start, uncertain duration and emotional, uncontrolled nature, is unlikely to appeal to the average doctor.

Moreover, even those students starting medical school with a sensitive appreciation of peoples needs find it difficult to maintain their sympathy in the rigidly conformist hospital atmosphere. They learn that it is more important not to make a mistake than to deal with peoples emotional needs. They may be judged solely on results, and in childbirth the desired result is a healthy child, no matter what the cost in physical and psychological terms. In hospital the instruments are available for controlling the naturally untidy process of birth. Labor can be started at a convenient time, Syntocinon can limit its length and, should it fail to produce the desired result in the specified amount of time, ventouse, forceps or Caesarean section can bring the matter to a close. Although the doctor considers he is responsible for the outcome, there are others around with whom he can share the burden.

Interestingly, a study of the perceptions of pregnancy by obstetricians and midwives and pregnant women showed a difference in the degree of risk that each group thought it involved. Obstetricians, particularly males who had been practising longest, viewed pregnancy as being more risky than midwives, the longest-serving of whom regarded it as a normal event. Pregnant women saw it as being less risky than the obstetricians, although more risky than the midwives.

Consider then the doctors feelings if a woman comes to him rejecting this whole package and suggesting that she and her family are the ones responsible for the baby (whom he sees as his patient) and threatening him by asking him to deliver the baby without any of the support around him that he knows to be indispensable for safe delivery.

In any case his experience of any birth may be severely limited. He can qualify as a doctor having spent as little as seven days on the labor ward. He is most unlikely to have been with a pregnant woman from the time she is admitted to hospital until her baby is born. His experience of normal birth is likely to be limited to a brief dash into the room minutes before the birth; he is far more likely to have experience of the complicated delivery where mid-wives have been replaced by doctors. If he spent any time on the labor ward after qualifying he will have spent most of it making decisions about lack of progress, and acting on them, and performing ventouse, forceps and Caesarean section deliveries. He is most unlikely to have attended any home births except in alarming or unhappy circumstances such as a late miscarriage or secondary postpartum haemorrhage when the baby is a few days old, and again his impression will be of disaster attending home birth.

No wonder, then, that a request for a doctor to attend a home birth can alarm and frighten, to the extent that reason can fly out of the window. Such ingrained beliefs are unlikely to be altered by statistical evidence. The conclusion, then, is that you are better off without a doctor who agrees reluctantly and who is actually hoping for something to go wrong so that you have to go into hospital.

Women report frightening reactions from their doctors. They have been known to shout, to use emotional blackmail, to use threats that would be actionable if related to any other health area, and generally to make women feel very wretched and miserable at a time when they are feeling vulnerable anyway. They can also be deliberately misleading and say that women are not allowed to have their babies at home, e.g. if it is their first baby. It is true that there appears to be a greater acceptance of home birth as GP involvement decreases. It is also clear that GPs have a financial interest in providing maternity services — many women prefer to have all their care from midwives as it provides an opportunity to get to know them.

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