What do you think of when you hear the words ‘home birth'? Do you envision a sudden emergency and a panic-stricken dash to the hospital, or do you imagine a calm, candlelit arrival into the world? Do you think of home birth as the province of reckless hippies, or is it an event in which you can imagine yourself taking part? Do you think of risk, or do you think of safety? Whatever your response to those two words, there's no doubt that that response is an emotional, instinctive one. People's attitudes towards birth - and particularly that controversial arena of home birth - are formed by many different kinds of information, and not all of it is factual and based on good quality evidence. This leads us to the idea of risk.
Let us consider some of the evidence that the general population may use. Personal experience, stories from friends and families, and images in the media all play a part. Some of this information is taken on consciously, but much of it is absorbed unconsciously as we process society's biases and archetypes. Opinions are strong, but are they based on fact, or fiction? Intuition, or information - or both? This is a question I sought to answer when I began to write my book, The Father's Home Birth Handbook.
Making decisions based on emotion, not facts
For the last five years, I have worked in the greater Glasgow area as a doula - someone who provides emotional and practical support for women and their partners during the childbearing year. Although the majority of my clients during this time gave birth in local hospitals, this was not always their intention. On the contrary: most of the women I worked with told me when we first met that they would ideally prefer to give birth at home. For some of these women, that wish became a reality, but for most of them, the wish never came to fruition. Why? ‘I really would like a home birth,' my clients would say, ‘but my partner says no.'
As I heard this statement over and over again, at first I was saddened by these apparently thwarted dreams, but then I became perplexed. It seemed strange to me that so many women were being denied their birth wishes by the very people who had pledged to support them. I already knew that there was good quality evidence available that for healthy women and their babies, birth at home is at least as safe, if not safer, than birth at hospital. This provides a good basis for making informed decisions about home births. Could it be that there was a gap in the information flow to the people who really needed it?
It became quite evident that the key issue was around using and accessing information, and in particular using the correct information to make informed decisions by the people who really needed it. Who were these men who stood so fiercely opposed to their partners' wishes? Were they obstructive ogres, dominating dads-to-be?
Hardly. These men were often kind, intelligent, and otherwise supportive partners. They were willing to sit through hours of antenatal classes, trawl through department stores for the perfect pram, and assemble flat-pack nursery furniture ad nauseam, but committing to home birth was a step too far.
These men's attitudes towards home birth had been irrevocably coloured by tales of doom and disaster, whether real or imagined. Asked why they were so opposed to home birth, the men would simply say, ‘I just don't think it's safe. What if something happens?' However, most of these men were hard pressed to substantiate that idea with any solid factual basis. Very few of them, if any, had ever heard of a friend, colleague, or relative who had witnessed a normal, straightforward birth in the hospital, let alone at home. The correct information, although available and of high quality, was not easily usable and digestible to the expectant public and their partners.
Combining qualitative and quantitative research
In healthcare we are all on a ‘patient journey' and this requires us to have information, in the form of good evidence, and use it accordingly. There was very little information available for that demographic, yet clear, balanced information appeared to be the very thing that was needed if opinions were to change and women's wishes were to be respected. I decided to write a book that would help on this ‘birthing journey' and serve as the ultimate resource for men and their partners who were thinking about home birth.
As I began to research the topic, I realised that when it comes to birth, ‘information' actually takes two very distinctive forms: ‘information' in the form of statistics and clinical research (quantitative), and ‘information' that provokes an intuitive response (slightly more qualitative), i.e., anecdotal evidence and stories from real parents. Any book that could speak genuinely and effectively to prospective parents would have to include a fine balance of these two forms of information, and thus, my work began. I would like to think that the finished product does a good job of balancing the need for hard facts with their interest in the experiences of other men. For those reluctant readers who only pick up the book on the insistence of their partners, the first chapter sets the scene with evidence from clinical studies (and importantly many of them large-scale and long-term) which support the safety of home birth for healthy women. I hope that those skeptical readers will be intrigued enough to plough on with the rest of the book, which guides the prospective father through various stages of home birth preparation, explores the birth itself, and addresses potential complications and challenges.
Interspersed throughout these chapters are dozens of anecdotes and birth stories (qualitative evidence) from men around the world who have themselves experienced at least one home birth. This ranges from a US Marine to an English investment banker and a Scottish artist. These diverse voices speak of home births which are sometimes straightforward, sometimes frustratingly complex, but always joyous and inspiring. This kind of real-life, first-hand information will sway some readers even more than the clinical kind will, but that's just the nature of birth - it's a subject which provokes (and deserves) both the head and the heart.
Reaching the intended audience
Perhaps my biggest challenge after writing the book was making sure that it reached its target audience. Information - no matter how well analysed or collated - has little meaning until it is used, and this is particularly true in the area of birth. With a marketing budget of precisely zero pounds, I decided that a grassroots advertising campaign was the way forward. I sent e-mails to every independent midwife I could find in the UK, Canada, the US, Australia, and New Zealand, in the hope that these practitioners would appreciate the ideas behind the book and appraise and use the evidence I was presenting. I'm pleased to say that this technique has paid off, as there are now several midwives in locations from Auckland to Arkansas who have recommended the book to their clients.
Finding the main users of this type of information was not difficult as many pregnant women and their partners find birth-related information on specialised websites and online forums, so 'cyberspace' was the next frontier for my shoestring marketing efforts. Because home-birthing parents often encounter opposition to their plans from their mainstream healthcare providers, these parents are often particularly keen to learn and share information on dedicated home birth websites. Recently, I had the pleasure of answering users' questions in the ‘Meet the Expert' section of holistic parenting website http://iwantmymum.com. This opportunity to share information while promoting the book was as valuable as any full-page ad - and a lot less expensive!
Globally there is a lot of enthusiasm and expanding demographic for home births and with the findings I present in my book I hope that I have bridged the gap for information flows (quantitative and qualitative) for all kinds of evidence and how to use this effectively. The book serves as a conduit to the public to make informed choices about their and their baby's journey before, during and after childbirth. As with all good research and evidence, it is about joining the dots and with contacts and information flows already started it would be good to continue this journey.
Leah Hazard grew up in the United States and graduated from Harvard University before moving to the United Kingdom to pursue a career in journalism and the arts. The birth of her first daughter in 2003 inspired Leah to retrain as a doula, providing birth support to families in homes and hospitals across Central Scotland. In 2006, Leah experienced the joyful birth of her second daughter at home. Since then, she has written articles on birth and parenting for a number of national and international publications, including Midwifery Today, Midwifery Matters, Birth and Beyond, and The Mother magazine. Next year, Leah will pursue a degree in midwifery at Glasgow Caledonian University. Leah can be contacted at leah_hazard@hotmail.com and her book The Father's Home Birth Handbook is available to order online for £8.99 plus postage and packaging from www.homebirthbook.com.
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What do you think of when you hear the words ‘home birth'? Do you envision a sudden emergency and a panic-stricken dash to the hospital, or do you imagine a calm, candlelit arrival into the world? Do you think of home birth as the province of reckless hippies, or is it an event in which you can imagine yourself taking part? Do you think of risk, or do you think of safety? Whatever your response to those two words, there's no doubt that that response is an emotional, instinctive one. People's attitudes towards birth - and particularly that controversial arena of home birth - are formed by many different kinds of information, and not all of it is factual and based on good quality evidence. This leads us to the idea of risk.
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