June 23, 2004

Homebirth transfers

I am back in Spain, presenting another program at the Acuario Birth Centre. This small private clinic is about an hour’s drive south of Valencia and as I was driven down by Rachel Macleod, the program facilitator, we got talking about women’s motivation for home births. Rachel works at Acuario and also offers a home birth service, using the Centre as a back up in case of transfer.

One recent transfer involved a woman who was following a strict macrobiotic diet during her pregnancy. She was of slight build and in good general health, although her baby was not growing as well as Rachel anticipated. She had booked for a home birth, and when labour began, it was clear it would be a long, drawn out event, as the baby was in a posterior position. The mother was well supported by her family and everything seemed to be on track. After a day of regular contractions, the membranes finally broke about 9.30 p.m., hopefully signalling the start of a more active phase of labour. Rachel visited her and found her to be 3 cms dilated with contractions every 3 minutes. Six hours later she was still 3 cms and making no progress at all. The decision was made to transfer to Acuario as the woman was exhausted and wanted help. An epidural was organised and a syntocinon drip, but the baby didn’t react well to the stronger contractions and a caesarean was the eventual outcome at 9.00 a.m.

In discussing this case, Rachel noted that this was not a strong, robust woman, with good reserves that she could draw on in the event of a long labour. When the baby is positioned like this, movement, walking, rocking etc will be important to get the baby to position itself and to move down. This woman was unable to keep this up, and it was clear she didn’t have the required stamina. The size of the baby was of concern as well. The question was whether the macrobiotic labour was a factor - this diet can be low in protein unless care is taken and whilst the woman was apparently well, the effect of such a diet on her baby was less clear. The baby was 2.8 kilos, small, but otherwise healthy, but one wonders if it too was unable to find the reserves it needed to weather a long slow labour. Of course, the longer labour may have been protective of such a tiny infant, and it may have done well if the epidural and syntocinon had not become necessary.

There was also the question of her motivation for a homebirth. Many women see a home birth as a “good idea”, without any real understanding of the benefits of labouring at home or any real commitment to the basic principles. It can also be seen as “appropriate” for a particular lifestyle”. In the event, sometimes these labours just don’t proceed until a transfer to hospital is made and the woman is at last able to let go and get on with the necessary work. The emotional and psychological state of a woman is a key factor in any birth, perhaps especially for those planning birth at home.

Much of this is speculation, but talking these events over and observing labours closely is how we learn more about birth and its many variations. There are always so many strories to tell!

Posted by andrea at June 23, 2004 06:02 PM