The extreme polarity in positions on home birth makes discourse on risk difficult. More than half the women reported avoiding talking to others about the risks of home birth. Women particularly avoided health care professionals, citing or anticipating judgmental responses. On the other hand, home birth midwives and other natural birth enthusiasts may echo the bumper-sticker refrain “birth is as safe as life gets” to discourage women from considering possible negative consequences of a choice to give birth remote from surgical facilities. These conflicting narratives undoubtedly contribute to women’s avoidance behavior, as exemplified by one respondent’s experience: “The attitudes and information we got from midwives and obstetricians were so inconsistent and I realized that I had to make my own decision”

The authors of the Swedish study suggest that some of the avoidance behavior exhibited by home birthing women was maladaptive “escape avoidance,” a response to stress. The stressors in this case would mostly be demeaning and judgmental attitudes of physicians toward home birth and the conflict between the desire to think positively and maintain confidence and the need to make contingency plans and establish whether proper safeguards are in place. Unfortunately, these obstacles to discussing risk with the very health care providers responsible for minimizing it interfere with achieving that goal.

Passage from chapter 21, The Place of Birth: Home Births
photo credit: Vicki Beauchamp, The Memory Box, Chicago, IL

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