Angry Doctor

Tuesday, September 11, 2007

Death and Other Inconveniences 4

There is an old joke that runs thus:

In a campaign to discourage home births some years back doctors put up a poster in the antenatal clinic that proclaimed: 'the first three minutes of life are the most dangerous'.

Underneath the poster, someone wrote: 'the last three minutes are pretty dodgy to'.

angry doc wonders if that story was what inspired this letter to the ST Forum today:

Ministry should also study merits of enabling S'poreans to give birth at home

I REFER to the article, 'Dying at home: Ministry to look into changing rules' (ST, Sept 8).

I am heartened to know that the Health Ministry is looking into giving Singaporeans a say in how they want to live their last days and where they want to draw their last breath.

As a maturing society, Singapore is now looking into various ways to address the needs and concerns of an ageing population. Ageism is being confronted head-on and its assumptions are being challenged. Legislation is also being changed to allow older workers to be treated more fairly by employers.

In giving older Singaporeans the option of dying at home, I am prompted to ask the question: 'How about birthing at home? Isn't life and death but two sides of the same coin?' If people are allowed to die in the privacy of their homes among their loved ones and in familiar surroundings, we should also consider giving women the legitimate option of birthing at home.

Allowing for home birth does not at all indicate that we are moving backwards or that we are ignoring the advances which medical science has made in the area of gynaecology and obstetrics. Rather, similar to the option of dying at home, it simply means adding another option to birthing which complements current birthing options in hospital settings.

Young healthy women who have been assessed by their gynaecologists to have no likely complications in pregnancy will be able to consider this option if they so desire. However, that is only if the Health Ministry takes the lead and identifies the barriers to such an option, some of which are the reluctance of gynaecologists in certifying a home birth and the absence of trained and registered midwives who are able to work with gynaecologists in ensuring that the woman is able to safely birth her child at home.

Many women will still choose to give birth in a hospital but I am convinced that a growing minority will appreciate the opportunity to give birth at home.

In reviewing the option for people to die at home, I hope that, in the near future, the Health Ministry will also embark on studying the merits of enabling Singaporeans to give birth at home.

Low Poh Lyn (Mdm)

Dying at home and delivering at home are two completely different things except for this: if you screw up, someone dies.

So is home birth safe? Well, that's like asking: is the water safe to drink?

A woman in a developed country with access to comprehensive antenatal care, trained home birth personnel, and easy access to a maternity hospital in the event of any mishap will probably think home birth is safe and be more likely to want to deliver at home, and she would be right.

A woman in a developing country with little or no antenatal care, poor home birth support, and no easy access to a maternity hospital will probably think birth in hospital is a safer choice for her and her baby, and she too would be right.

What about Singapore?

Singapore has the lowest perinatal mortality and early neonatal mortality rates, and one of the lowest maternal mortality rates in the world. That doesn't tell us that home births carry a higher risk to mother and baby in the local context, but it does tell us that the existing situation where most deliveries take place in hospitals is a safe and sound one.

Will home births be as safe as hospital births? The number of home births we have these days are probably too small to tell us one way or the other.

So why are people calling for a return to home birth?

angry doc suspects that the answer is that the modern hospital system is 'a victim of its own success'. We have so removed the dangers and difficulties of a home birth and 'home death' from laymen, and made them so much 'easier', that they have the luxury to romanticise these life events.

Certainly the choice to give birth and/or die at home is always available, but let us not promote that choice without presenting all the facts.



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