It's time to stop the home birth stigma

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Recently, discussion about childbirth was reignited when health authorities in the UK stated that for many women with a healthy pregnancy, giving birth in hospital is no safer than giving birth at home.

While midwives and birth advocates welcomed the news, Australian obstetric authorities hastily intoned the status quo, with the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) stating, "For the woman whose highest priority is the welfare of the baby, a hospital birth may be preferred".

In other words, according to RANZCOG, good mothers birth only in hospital.

And yet, according to the Australian College of Midwives, "[P]lanned home birth is a safe option for women who are at low risk of complications ... There is no evidence that shows an increase of risk … in relation to homebirth."

While RANZCOG suggested a threefold increase in the risk of foetal death at home, the latest data from the Australian Institute of Health and Welfare for 2012 demonstrates a 99.4 per cent live birth rate at home, and 99.2 per cent live birth rate in hospital.

Meanwhile, the single Australian maternal death following homebirth in over a decade is splashed across headlines - yet the 39 women who died in hospital as a direct result of childbirth in 2006-10 hae gone virtually unacknowledged.

Why?

Let's clarify that greater access to homebirth does not - and should not - threaten a woman's right to choose birth in hospital. Obviously homebirth is not a safe option for the woman who feels safest in hospital. Yet the opposite is also true: some women feel safer birthing at home.

And while Australia's maternity options flounder in politics and overcrowded hospitals run out of resources, other countries with better birth outcomes also have more acceptance of homebirth.

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Public discourse about childbirth inevitably reduces to polarised rhetoric; caricatures are drawn of 'too posh to push' or 'whale-music hippies'. Private tragedies are tossed in as evidence.

Women seeking a natural birth, or women who admit birth trauma, are particularly singled out for criticism, accused of not prioritising their baby's welfare, cited as selfish, ungrateful, of whining about 'first world problems' or even labelled reckless.

In a world that considers it unremarkable to police women's bodies, pregnant women especially invite public dissection of what they do within their own skin.

"Not surprisingly, women are cultured to be the most passive in circumstances that innately signify our greatest power," writes Kathi Valeii of Birth Anarchy. "[Pregnant women are] lectured about ... how much weight she may gain, which tests she's obligated to take, how long she will be 'allowed' to remain pregnant, and which items on her birth plan are frivolous fantasies. Challenging women on reproduction is the foundational space to keep women in their place."

Historically, frailty and sacrifice were considered essential qualities of morally successful women. Devoted housewife and mother was an image idealised to maintain the patriarchal standing. We still operate today within a paradigm that absolute deference to a seemingly higher, seemingly better-informed authority is therefore the ultimate demonstration of Good Mothering. We have been conditioned over centuries to not only believe that women are passive, flawed gestational vessels in need of salvation, but that motherhood and women's individual agency are incompatible.

While the majority of pregnant women want the absolute best for their baby, human experience dictates that not all assessment of risk will be the same. So while one birthing woman feels safest surrounded by white coats, another may feel safest in her lounge room. While one woman may feel unaffected by whatever happened to result in a live mother and baby, another women will be so traumatised by birth that she may commit suicide.

Our obsession with safety in childbirth is well intentioned: it is a desire for healthy mothers and healthy babies. But our social dialogue desperately needs to change focus. While we deliberate over the 'best' manner of birth, we overlook that we still consider it acceptable to monitor (and allow authorities to dictate) personal bodily actions.

In a society where reproduction remains subject to scrutiny and legislation, discussion about childbirth is both necessary and valid. But the demonisation of women who make what we believe are unconventional choices must stop. Regular criticism of or disdain for any woman's reproductive decisions is not only unhelpful, it is, more insidiously, a symptom of society's systemic aversion to women's bodily autonomy.

The single greatest factor that inspires meaningful discussion is empathy. Each women's choice is based on what she knows, what support is available to her, and what life circumstances have led her to feel safe (or unsafe) in any given situation.

Genuine social progress is made when pregnant women are unconditionally supported to make their own informed decisions. When a woman is free to decide when, where, how and with whom she will give birth we are stepping away from reproductive restriction, and towards equality.

Because while her informed choice may be different to what you or I choose, only the woman herself is the ultimate authority on what is right for her - and for her baby.

Kim Lock is a mother of two and the author of Peace, Love and Khaki Socks. This artcle first appeared on Daily Life.