Place of birth and postnatal depression

[JCF]

http://www.midwiferytoday.com/enews/enews0113.asp

Homebirth Offsets Depression
Women who give birth in a hospital are much more likely to experience postpartum depression or even post traumatic stress disorder. British childbirth expert Sheila Kitzinger states that the more interventions a woman experiences, the more likely she is to be depressed, with cesarean sections obviously carrying the greatest risk of depression.

Aidan McFarlane, a British physician, notes that while 68 percent of hospital mothers experience postpartum depression, only 16 percent of homebirth mothers do. On The Farm, a self contained, alternative lifestyle community in Tennessee, the rate of postpartum depression was 0.03 percent. Almost all mothers on The Farm had both a homebirth and a supportive, loving community of women to assist them postpartum. Avoiding depression, in itself, would be a major reason for mothers to consider giving birth in their own homes, if that is where they are most comfortable, especially if they had previously experienced postpartum depression and thus were at high risk for a repeat episode.

Aspects of hospital birth that may strongly contribute to the incidence of postpartum depression in our country are the way the moment of birth is handled and routine separation of baby and mother. In a study published in the New England Journal of Medicine in 1972, Marshall Klaus found that holding the baby close released "dormant intelligences" in the mother and caused "precise shifts of brain functioning and permanent behavior changes." Bonding therefore is not just an emotional thing that only mothers think happens; it is a biochemical process that forever changes the mother so that she knows more instinctively how to relate to her baby. Routine separation of mom and infant makes baby frightened and mom depressed. This may be why postpartum depression and difficult adjustments are so common in the hospital system.

Jennifer L.Griebenow, excerpted from "Home Birth vs. Hospital Birth: How Safe?," Birthing magazine, Summer 1998

[Jamie]

Interesting. I wonder how many homebirthing mums prepare themselves for the birth experience and prepare for support after the birth compared with hospital birthing mums and how much impact this has.

[Claudette]

Avoiding depression, in itself, would be a major reason for mothers to consider giving birth in their own homes, if that is where they are most comfortable

Unfortunately, the belief in their own body to safely birth a baby has been so badly diminished over the past century, that many women do not feel safest at home. Much can be done to create a homely environment in the hospital which would alleviate a lot of the stress that is felt there and that contributes to PND. This is especially important these days as many women are not convinced they are safer at home, or do not have family support for a homebirth (an important ingredient in staving of the effects of PND even after a homebirth)... Homebirth in and of itself does not prevent PND, but rather the support of the woman during the labour and birth process. Many women who choose to birth at home have, at a minimum, the support of their partner and a midwife, without this support, their risk of PND would increase significantly.

[JCF]

Support is definitely a contributing factor to avoiding PND and hospitals just don't provide much of it. But as a community we need to provide parents with more support across the board which would help in some ways.

More importantly, the natural protection afforded by spontaneous, undrugged labour rarely happens in hospitals and always happens in home births - unless they choose to transfer, of course. The normalising of pregnancy and birth is just not possible in a medicalised situation which views every pregnant woman as a ticking timebomb of potential risk factors. That, in itself, can't be a great way to kick off parenting.

It's not so much "place of birth" that matters but "model of care" and since the obstetric model of care is demonstrably dangerous to mothers and babies and the midwifery model rarely available in the hospital system, home is clearly the safest place to birth in Australia and around in the world. The fact that obstetricians and hospital have such a stranglehold on birth does increase women's fear but it's amazing what a little information can do. If people can read the studies on home birth it's pretty obvious why it's safer. Most critics of home birth, say one's family or one's bus driver, have never read the studies but are relying on hearsay and the word of surgeons who not surprisingly, are promoting surgical birth. And the fact that so many women are pushed into hospital birth by family attitudes says a great deal about how little women are respected in our society.

[hanabi]

It's not so much "place of birth" that matters but "model of care"

I think the study is flawed in terms of only simplistically accounting for location of birth and not model of care, childbirth education, support systems, prior expectations and relationship stability, etc. Not to mention that fact that only a statistically insignificant minority of women actually get to/choose to access homebirth as a childbirth choice. We are comparing less than 1% of the population with the other 99% here. It simply can't offer any useful information.

I could mention that birth centre research offers the same outcomes - but is also statistically flawed for the same reasons.