Soul Midwifery

The risks of planning a hospital birth 🏥

Controversial, I know.

Home birth is often heavily scrutinised for its risks, but has anyone stopped to ask the opposite question?

What are the risks and benefits of planning a hospital birth?

For well and healthy women, planning birth in hospital is associated with a significantly higher chance of intervention, including caesarean section, forceps, vacuum birth and episiotomy, compared with planning birth at home with a midwife.

And these interventions are not always without consequence.

A primary caesarean can change the risk profile of future pregnancies and births. Instrumental births can cause significant pelvic floor and perineal trauma. Induction and birth before 39 weeks without a clear medical indication can also carry risks for mothers and babies.

Then there is the experience of birth itself.

We know far too many women walk away from birth describing trauma, loss of autonomy, coercion or feeling like things were done to them rather than with them.

Of course, for a woman experiencing medical or obstetric complications, the risks and benefits can look very different and hospital may absolutely be the safest place to birth.

But for well women with healthy pregnancies, I think it is worth asking the question we rarely seem to ask:

Do we adequately consider the risks of planning a hospital birth?

All choices respected here. Just a counter cultural thought I felt was worth sharing.

🎧 Great discussion on this in episode 111 of The Great Birth Rebellion, Is Hospital Birth Dangerous for Women?

We just witnessed the most phenomenal thing.
A passionate educated woman, a supportive epic team and a safe and physiological birth of twin babies coming bum first!
🍑 🍑

Women are powerful. And vaginal breech birth is a safe and reasonable option in skilled hands!
So much love and oxytocin flowing 💜

Doula Lou

A study I keep coming back to.

I can hardly believe the Johnson & Daviss study was published back in 2005.

5,418 planned home births attended by Certified Professional Midwives across the US and Canada. And the outcomes?

🤍 0 maternal deaths
🏡 3.7% caesarean rate
🤍 4.7% epidural rate
✨ 12.1% transferred to hospital

And importantly, women who transferred to hospital were still included in the planned home birth group, so the results weren’t simply based on those who stayed home.

As a midwife, I find it incredible that we still have to defend the safety of planned home birth with a qualified midwife.

How much research do we need?

Home birth isn’t about avoiding hospital care at all costs.

It’s about having the right care, the right support and the right transfer pathways when they’re needed.

The evidence has been there for a long time. 🤍

Johnson & Daviss, BMJ, 2005 — “Outcomes of planned home births with certified professional midwives: large prospective study in North America.”

Doula Lou

A new learning from The Convergence of Rebellious Midwives 🤍

Out of 6,000 women who gave birth at Fremo Birth Centre in Kenya, a birth centre co-created by Vickie Chan:

✨ 0% maternal mortality
✨ 96% vaginal birth rate
✨ Including twin and breech births

This is in a country where caesarean birth carries significant risk. Access to surgery is limited, complications can be difficult to manage, and the consequences of an unnecessary caesarean can be life changing or even life threatening.

Of course, Kenya and Australia are very different settings, and we can’t directly compare outcomes.

But I think there is still so much we can learn from places where physiology remains at the centre of maternity care, and where intervention is reserved for when it is truly needed.

🤍 Physiology at the centre. Women at the centre.

Things I love about continuity of midwifery care.

Continuity doesn’t mean you’re guaranteed a home birth.
It doesn’t mean you’ll have a physiological birth without any interventions, or that your pregnancy will be completely free of complications.

It means having a consistent midwife beside you through all the waves and changes that can come with maternity care.
For most women, continuity can look like very little from the outside.

But sometimes things change.

👉 Babies turn breech.
👉 Mums develop pre-eclampsia.
👉 You unexpectedly find out you’re having twins.

All of these have been part of our experience this year. And these are the moments when continuity really matters. The plan might change, but the support doesn’t.

Additional care providers may need to join the team. Your place of birth might change. Your care might become more complex.

But having a midwife who already knows you, understands what matters to you and can continue supporting you through those changes is incredibly valuable.

We can work alongside obstetricians and other care providers when needed, while continuing to support physiology, and most importantly, keeping you at the centre of your decision making.

Because continuity isn’t about promising you a particular birth.
It’s about staying with you, whatever your birth journey looks like.

You’re not hiring a home birth.
You’re hiring a midwife. 💕

There are things that cannot be broadcasted on social media.

I felt it then and I feel it now.

But one message is really important to share.

Women are being robbed of experiencing a positive and physiological birth. They can be presented with minimal options, with alternatives treated as being unsafe. They can be scrutinised for their “poor choices”, being robbed of control, power and autonomy.

Midwifery and the midwives’ role of supporting birth is under attack. It is presented as a ‘nice to have’ but not essential. But what would a maternity world look like if all women had continuity?

If midwives were respected to work within their role? If obstetricians/doctors came alongside to support the women in their choices when things deviate from normal?

Working harmoniously together for the women and babies’ benefit? That’s what I’m fighting for. 💪

And some maternity services and health care providers are making huge strides towards this new future. Some are acting in ways that are resulting in increased birth trauma, rising caesarean rates and unnecessary interventions.

It’s not one person.
It’s a huge cultural shift that changes one person at a time.

While we continue to fight for a better maternity world, I truly believe all power lies with the women.
To make choices that give them the best possible outcomes based on research and their values.
To choose their support team.
To invest in continuity.
To choose a health service that aligns with them.
To stand up for yourself.
To educate yourself and others.
To demand the care you deserve.

We have a long way to go.
But I ultimately believe in women, and my only goal in this work is to truly be ‘with women’. 🤍

The great birth rebellion podcast

The most common times for babies to arrive or labour to ramp up is around sunrise or sunset. 👶⏰

Isn’t it amazing how our bodies follow the natural rhythms of the day?

As midwives, we see time and time again how birth is influenced by our hormones and our environment. Melatonin naturally increases overnight and into the early morning hours. Most people know melatonin as the hormone that helps us sleep, but it also works beautifully alongside oxytocin, the hormone responsible for labour and contractions.

This is one of the reasons labour often starts or becomes more active during the night, with many babies making their arrival as the sun rises.

Birth is a physiological process, and our bodies are designed to work in harmony with these natural rhythms. Darkness, privacy, safety, and rest all help support the hormonal dance that unfolds during labour.

Perhaps it’s no coincidence that so many babies choose to arrive at these transition points of the day around sunrise, sunset or overnight!

Our bodies are deeply connected to nature, rhythm, and the incredible physiology of birth. 🌸

spotto - can you see the old icecream container? It’s basically our go to for placental births 🙈

photo credit Doula Lou