I think it's important to recognize that when Robin Lim talks about the 981 mothers that die daily in childbirth she doesn't distinguish between the ones in developed countries and the ones outside. Mothers are mothers and if they're dying in childbirth, something needs to change. It is inaccurate to picture the women dying in childbirth as living in squalor without medical care because out of those 981 there are plenty of women who are dying in high-tech hospitals. Over-medicalization of birth can kill and maim women and children just as total lack of medical care does the same. There must be a balance.
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I subscribe to the Pulitzer Center on Crisis Reporting YouTube channel and just watched this story (which is horrific, in my opinion...especially since I experienced the exact same situation as this woman did but I had proper prenatal care and a midwife who anticipated this problem and acted quickly and correctly to save my life). It makes me think that people may think that a homebirth with a midwife in a developed country would be like this. Thankfully that's far from the truth (for any trained, registered nurse midwife in good standing professionally).
I also get the opposite sense. That advocates of home births in developed countries think all home births are like the ones they are familiar with. I wish they would qualify that they are only referring to home births with good medical support systems in developed countries. So that people from developing countries who read the same articles would also have a clear picture of exactly what scenarios home birth advocates in developed countries are talking about.
I think it's pretty easy (if you have access to a computer as both of us obviously do) to research what midwifery in "the west" vs. midwifery elsewhere entails. The audience I'm addressing is pretty obvious by the fact that I'm posting to a forum that is frequented by mostly expatriate women in Hong Kong.
Just like we know that there is a general standard for medical practice in "the west" so when we say, "I went to see my doctor in the States..." it doesn't seem necessary to point out that, "and he isn't the shaman-type that burns incense and sacrifices animals to heal people." In most places in "the west", midwives are licensed nurses who have had years of practice before they become a midwife. In some cases they are apprenticed but still have years of experience and practice--often employing more variety of techniques with better success than most doctors are trained to do.
And women in the developing world can gain a lot from are properly trained midwives handling home births--especially where medical facilities (or in Mae's case, roads) are scarce.
I think that the people who are advocates of home birth in "the west" are generally comparing hospitalized birth in those countries against home birth in those countries. They have no interest in comparing "first world" midwifery (built on sound medical/scientific practice) to "third world" traditional midwifery (possibly based on superstition and shamanism--as we see in Mae's case) .
In the case of Robin Lim, she is training midwives in "first world" practices (hygiene, medical equipment, medical procedure etc.) not in "third world" practices (i.e. shamanism). It's the same way that in some countries in sub-Saharan Africa women are trained as medics and then serve dispatches to rural areas. Do they have a degree in medicine? No. But, they are trained and know how to help in many cases which in turn saves lives.
If we're just going to wait for the modernization of these countries (i.e. they have good infrastructure and abundant medical facilities) so that women can "properly birth in a hospital setting" (and "properly birth" is up for debate here) then we're just going to lose more lives. Why not properly train medics and midwives in sound medical practice?
"First world" sound medical practices can benefit "third world" world countries--whether it's in a clinic or with a midwife--it's a practical improvement on the system already in place.
So, in short, if the audience I was addressing was composed of women (and men) living in third-world conditions (similar to Mae's case) of course my explanations would be different. I just assume that women on this forum have the tools to educate themselves on the difference between third-world traditional midwifery practices and first-world midwifery practices. We have a lot of resources available to us, I think.
Thanka2, my comment was not simply about what you are saying and who you are addressing or about Robin Lim in particular. It is about articles I read about home births emanating from the West in general. In between "the west"/developed word/expatriate women in Hong Kong and poor women in some village in sub-Saharan Africa, there is a huge number of women in between in urban areas in developing/third world countries with access to good nutrition and medical care, including qualified mid-wives. These are the women with the tools to educate themselves and they go online and read about home births - most of what comes up is from the West, including the statistics. They probably identify more with women in the West because, as you say, they technically tick all the boxes you mention that make it 'safe' to have a home birth. And yet, I wonder if having a home birth is safe for them because the conditions, while superficially the same, are different.
Yes, I would like people writing about home births in the West - not necessarily posters on forums such as these where the audience is specific - to qualify the narrow circumstances (relative to the whole world, not just poor rural women) under which they are advocating home birth. Some of these articles will quote WHO statistics which are global, but then everything else they are saying pertains only to the specific conditions in their own country... why not say so so that in this globalised world, women everywhere who are reading what they post on the Internet, get that?
Yes, I would like people writing about home births in the West - not necessarily posters on forums such as these where the audience is specific - to qualify the narrow circumstances (relative to the whole world, not just poor rural women) under which they are advocating home birth. Some of these articles will quote WHO statistics which are global, but then everything else they are saying pertains only to the specific conditions in their own country... why not say so so that in this globalised world, women everywhere who are reading what they post on the Internet, get that?
But doesn't that come back to your original premise (was it yours?....correct me if I'm wrong) that women are responsible and capable of making their own choices and if they choose a home birth or a c-section or anything in between we can't assume that 1) it's necessarily unsafe for them 2) they are "uneducated" and not aware of what they're doing or being "tricked" or "forced" into it. Is it plausible that highly educated women, in their right state of mind may choose home birth and that it is a legitimate option (even a healthier option) for some some women? Isn't it also possibly true that it is that many educated and informed women are also choosing home birth for maybe similar reasons that drive some women to choose elective c-sections--in that they've looked at the facts for themselves and have chosen that path. There is a lot of information out there, afterall.
The percentage of women who choose home birth is still something low like 1% or under in the United States so my view is that most women who choose (not mentioning those who have no choice--unlikely that exists in the States) home birth are in a special group. Women who I know who choose home birth (I know a lot of them) don't just casually make that choice...like "Oh, yeah...whatever...that sounds good...sign me up." (Showing my own bias...seems to me that many more women sign up for interventions with this attitude, though). Of course, there may be those that choose it like that but I've never met anyone. I think it must be similar to my own choice to do a med-free birth after giving birth already. I had no delusions that it was going to be easy and I had to overcome a lot of things in order to sign up for that type of experience. I would say that home birth moms are some of the most educated women on the topic. There is a lot of care given before baby's arrival and they really have to be "on their game" at the time of birth as well. They have to be a very active participant in the planning and execution of a birth plan--in a hospital often women can be passive patients as the doctors call the big shots for them. Again, that's my opinion.
Again, the people advocating home birth in the States are advocating it for women living in the States--who have the choice of hospital birth or home birth. Most people in developed countries aren't speaking to women in the third world who live in drastically different circumstances (nutrition, sanitation, infrastructure, support, position of women in society etc.). Most of the people writing about home birth are writing from the viewpoint of a western developed nation--to people in those types of nations under those circumstances. Maybe there is not enough writing being addressed to women of other backgrounds--that might be an area you can fill?
But, if they're quoting WHO global statistics, my thoughts are that this would (considering the plight of some women in developing countries) actually make the statistics look less in favor of home birth (if you throw in all the births that were like Mae's--where the woman lost her life or the child died)--so if it's an issue of thinking that statistics are skewed to make home birth look safer than it is--it doesn't seem to me that that would be the case. I wSo,ould think that if you throw in all the world statistics for home birth (i.e. Mae's case coupled with cases like the ones my friends have experienced) it would look less and less in favor of home birth due to lumping traditional midwifery practices (shamanism) into the same category with modern midwifery practices (medically-based). So, except that maybe the statistics aren't as clear as they could be, I don't see what the contention is--as if women are being tricked into giving birth at home (in the developed world). But, you know what they say about statistics. "There are three types of lies. Lies, damn lies and statistics." So...
I'm just having a conversation here--it's only a small reflection of what goes on in real life for me.
I enjoy interesting conversations and this has been and continues to be one. It is very interesting for me to be exposed to the various mindsets that are out there when it comes to this and related topics. I'm from the "each one, reach one" camp. I think most people who share a similar mindset with me on this topic also advocate for it on a more individual level--for us it's an intimate topic that we're passionate about because it's close to our heart and we've experienced a lot of great benefits from it. It's easy to write off if you haven't been around it, experienced it or know others who have, I think.
So, as I said, this little forum here only gives a glimpse of my real life involvement.
If the only thing I do here is challenge womens' perceptions, that is already a great thing. I think the women I've met here mostly stick to one mindset and easily write off others without really examining all sides in-depth. Hopefully, I'm going against that trend myself and hope that others will as well. I think it's really important to engage deeply with this topic. The more people engage, the more they think and then the more likely they are to dig deeper and discover more for themselves. That's how I started on my personal journey and am really thankful for those people who challenged my thinking. But, I tend to be a fairly "fluid" thinker--meaning I don't compartmentalize things so easily--I see that all of life--all aspects of it are connected--so I'm not just a body divided from a mind divided from a spirit--I'm a whole person so that's how I see birth (and many other aspects of life)--it must be approached as a system. That's why I have a problem with the lack of bedside care in the medical system here in HK. Anyway....As far as what can be done? Depends on what your perspective and agenda are. If you think that the system as-is in the developed world is great for maternity care then there doesn't seem to be any reason to deviate from that. If you think that medicalized birth has gone too far (as I do) then there are women (mostly midwives) slowly but steadily working to give more women options. But...they are met with red tape as the medicalized system is the majority and holds the keys to the gate, so to speak.
sure am still not fully convinced about the topic but atleast i understand where you are coming from.
nb: birthing was a very neutral expereince for me. i dont remember much nor did i care about pregnancy / delivery. my single agenda the whole of those nine months was that my baby be safe and as healthy as God wills him to be. so we chose and still would whatever was the safest option presented to us and advised by a doctor we trusted. am not saying this is the ideal way to be. change comes because people question existing mindsets. am just putting accross another mindset to you on why women like me are not buying into birthing without interventions.
am still not fully convinced about the topic but atleast i understand where you are coming from. nb: birthing was a very neutral expereince for me. i dont remember much nor did i care about pregnancy / delivery. my single agenda the whole of those nine months was that my baby be safe and as healthy as God wills him to be. so we chose and still would whatever was the safest option presented to us and advised by a doctor we trusted. am not saying this is the ideal way to be. change comes because people question existing mindsets. am just putting accross another mindset to you on why women like me are not buying into birthing without interventions.